Special Health Care Research Articles

Collaborative practices for children with medical complexities and their families: A scoping review

Objective This scoping review aimed to provide an overview of collaborative practices for children with medical complexities and their families by life stage.Methods This scoping review was conducted based on the JBI scoping review manual using the PubMed, CINAHL, and Medical Journal databases. Search terms included "collaboration," "intersectoral collaboration," "children with medical complexity," and "children with special healthcare needs," whereas control words included "children with special healthcare needs," "children with medical care," "children with severe mental and physical disabilities," and "children with severe mental and physical disabilities." The inclusion criteria were articles in Japan that reported on practices for children (aged 0-18 years) with medical care needs and collaboration among other multiple professions, research articles, excluding review and protocol articles, and English or Japanese articles. For the analysis, collaboration-related practices were extracted from selected papers, categorized based on similarities in content, and further summarized according to the life stage. Three researchers discussed the selection of papers, data extraction, and analysis until a consensus was reached.Results The analysis included 30 papers (27 Japanese and three English papers). Regarding publication year, 14 papers were published within the last 3 years. Additionally, 19 case and 26 practice reports and 11 studies (quantitative research; one, qualitative research; 10) were published by professionals. Regarding collaborative practices, 160 cases were extracted and classified into nine. In "discharge support," practices in all subcategories were reported for preschoolers, whereas only two of the five subcategories were reported for school-aged children. Contrastingly, in the "maintenance phase in preschool, daycare, and school," preschoolers reported practices in two of the seven subcategories. Additionally, various professionals from the fields of medicine, welfare, education, and administration were involved in the collaboration.Conclusion There were differences in the reporting of collaborative practices at each life stage. Although numerous professionals were involved, reports of collaborative practices among them were unevenly distributed. Eventually, it will be necessary to investigate the nature of collaborative practices among various professionals, focusing on children and their families.

From ECG to Imaging: Challenges in the Diagnosis of Adult Congenital Heart Diseases.

Congenital heart diseases (CHD) are one of the most common birth defects and the main leading cause of death in children. Many patients with CHD are reaching adulthood due to the success of improved contemporary surgical procedures. Understanding the etiology of CHD remains important for patient clinical management. Both genetic and environmental factors are involved in the development and progression of CHD. Variations in many different genes and chromosomal anomalies can be associated with CHD, by expression of different mechanisms. Sporadic cases are the most frequently encountered in these patients. Atrial septal defect is a common congenital heart disease that refers to direct communication between atrial chambers, found isolated or associated with other syndromes. Imaging techniques, especially transthoracic and transesophageal echocardiography (TOE) represent the key for diagnosis and management of ASD. The disease has a major incidence in adulthood, due to late symptomatology, but assessment and treatment are important to avoid time-related complications. Ebstein's anomaly is a rare congenital disease, with a dominant genetic participation, characterized by an abnormal displacement of the tricuspid valve and right ventricular myopathy, often requiring surgical intervention. Alongside echocardiography, cardiac magnetic resonance (CMR) imaging is the gold standard tool for the assessment of ventricular volumes. Early diagnosis and adequate treatment are mandatory to avoid possible complications of CHD, and thus, ECG, as well as imaging techniques, are important diagnostic tools. However, patients with CHD need a special healthcare team for the entire monitorization in various life stages.

Utilization of special services among children and youth with special healthcare needs: A time-to-event analysis of the national survey of children's health data, 2016–2022

BackgroundSpecial services including physical, occupational, speech, or behavioral therapies are associated with enhanced long-term functioning and well-being of children and youth with special healthcare needs (CYSHCN). Yet, there is a lack of recent evidence on the utilization of these services, and the age at which CYSHCN first receive them. ObjectiveThis study assessed the distribution, timing, and determinants of special services utilization across different types of special healthcare needs. MethodsData from 63,734 caregivers of CYSHCN aged 0–17 years from the 2016–2022 National Survey of Children's Health were analyzed using Rao-Scott Chi-Square, Log-rank, and Cox proportional hazard tests. ResultsOverall, 41.9 % of CYSHCN ever received special services, including 91.4 %, 90.3 %, 88.0, and 34.1 % of children and youth with Down syndrome, cerebral palsy, autism, and other special healthcare needs (OSHCN), respectively. Children with Down syndrome and cerebral palsy received special services earlier than those with autism or OSHCN. Utilization of special services was higher among male children and youth (aHR 1.41; 95 % CI: 1.33–1.49), aged 0–5 years (aHR: 4.70; 95 % CI: 4.32–5.11), second or later born children (aHR: 1.18; 95 % CI: 1.10–1.26), from families with low-income (aHR: 1.14; 95 % CI: 1.04–1.24), living with married parents (aHR: 1.11; 95 % CI: 1.04–1.19), consistently insured (aHR: 1.24; 95 % CI: 1.08–1.42), and with a more complex health condition (aHR: 3.40; 95 % CI: 3.13–3.70) compared to their counterparts. ConclusionsThese findings highlight the necessity of adopting tailored approaches for children with different special healthcare needs to optimize and sustain the utilization of special services.

Examining outpatient occupational therapy utilization among children and youth with special health care needs in South Carolina: A structural equation model of individual- and community-level factors

BackgroundChildren and youth with special health care needs (CYSHCN) comprise 23 % of the pediatric population in South Carolina (SC), compared to state prevalences of 13.6 %–24 % nationwide. While occupational therapy (OT) is critical to maximizing CYSHCN's participation in daily activities, there are significant disparities in rehabilitation access in the Southeast region. ObjectiveThis study examines associations between patient-and community-level factors and outpatient OT utilization. MethodsThis study analyzes OT utilization data among CYSHCN (N = 1913) in a health system in SC from 07/01/2022-06/31/2023, merged with Child Opportunity Index 2.0 zip-code level social drivers of health (SDOH) data. SDOH are non-medical factors that affect individual's long-term health, with estimates ranging from “very low” to “very high” opportunity. Structural equation modeling was conducted to understand complex associations between observed and latent variables in a real-world context. ResultsCYSHCN were diagnosed with congenital (40.77 %), developmental (37.87 %), and neurological/neuromuscular conditions (21.36 %). CYSHCN who were non-Hispanic Black or Hispanic and were hospitalized were associated with living in lower opportunity areas. CYSHCN with private or military/other insurance/self-pay were associated with living in higher opportunity areas than Medicaid-insured CYSHCN. CYSHCN who were female and ≥12 years demonstrated lower OT utilization. CYSHCN who participated in speech and/or physical therapy demonstrated higher OT utilization. OT utilization increased with each increase in SDOH. ConclusionWith these findings, healthcare providers may consider accessibility barriers, including transportation, when referring CYSHCN to OT services. Further research is needed to examine the impact of household-level SDOH on OT access across SC.

Countering the Identified Barriers to Delivered Oral Care for Children With Special Healthcare Needs: A Narrative Review.

Children with Special Health Care Needs (SHCNs) have poor oral health as a result of structural and systemic barriers. These children frequently have limited access to dental treatment, a higher prevalence and incidence of dental problems, and worse oral hygiene than the rest of the population.This review aims to offer an understanding of the existing oral care barriers of children with SHCNs. We reviewed the literature on children with SHCNs and their caregivers to identify the implications of the barriers faced by these individuals. Some of the perceived barriers to appropriate oral healthcare faced by these children include obstacles to adequate oral care and hygiene in the home, challenging behaviours, and limited preventive care and accessibility. We focussed on interventions and different management approaches to support the stakeholders responsible for these children. There is a need for strong communication as well as care coordination between caregivers, dentists, and other providers to achieve positive outcomes. The current dental healthcare system appears to desert the needed demands of this demographic.

Differences in the Oral Health of Children With Medical Complexity

ObjectiveChildren with medical complexity (CMC), a subgroup of children with special health care needs (CSHCN) with the most serious medical conditions and disabilities, are at risk for negative effects from poor oral health. CSHCN have high rates of poor oral health, including cavities. This study aimed to compare oral health status between CMC and CSHCN. MethodsThis was a cross-sectional analysis of the 2016–17 National Survey of Child Health data. CMC and CSHCN were identified using validated algorithms. The primary outcome was oral health status; secondary outcomes included dental service use. Bivariate analyses compared the prevalence and service use by medical complexity status. Multivariable logistic regression assessed oral health outcomes by complexity, adjusting for influencing variables. ResultsOf 16,178 CSHCN ages 1 to 17 years, 6% were CMC and 94% were non-CMC CSHCN. Compared to CSHCN, CMC had a higher prevalence of fair/poor teeth conditions (19% vs 9%; P < 0.001) and higher odds for fair/poor teeth conditions after adjusting for socioeconomic factors (aOR: 1.54; 95% CI: 1.01–2.34). There was no statistically significant difference between groups when assessing cavities, toothache, or receipt of most preventive dental services. ConclusionsOne in 5 CMC are reported by caregivers as having poor oral health, including cavities, despite high rates of receiving preventive dental services. After adjusting for socioeconomic factors, medical complexity remained associated with fair or poor teeth conditions. Understanding potentially modifiable targets could further help families of CMC prioritize dental needs and potentially reduce negative effects on overall health.

Lessons Learned From a Retrospective Analysis of Medicolegal Risks for Physicians Treated Adolescents and Young Adults With Medical Complexity

PurposeAdolescent and young adult patients occupy a clinically transitional space between pediatric and adult care. Youth with chronic conditions and special healthcare needs may have trouble accessing and receiving appropriate care in this transition, which may lead to patient safety issues and medicolegal risks for physicians. The objectives of this article were to explore patient safety issues and identify medicolegal risks for physicians. MethodsA national repository was retrospectively searched for medicolegal cases (MLCs) involving complaints from youth. The study included MLCs closed at the Canadian Medical Protective Association between 2013 and 2022 involving youth. The study participants were adolescents and young adults aged ≥ 15 and ≤ 21 years with medical complexity. The frequencies and proportions of patient safety events and medicolegal risks for physicians were calculated by exploring factors that contributed to each incident using established frameworks. ResultsA total of 182 eligible MLCs were identified. Of 206 involved physicians, 55 were psychiatrists. The most common reasons for patient complaints were deficient assessment, diagnostic error, and communication breakdown with the patient and/or family. More than half of the cases were related to a harmful incident. Peer experts reviewed the cases and identified factors such as a deficient assessment, a failure to perform a test or intervention, failure to refer the patient, and insufficient provider knowledge/skill as contributing to the patient safety event. DiscussionThe impact of our findings is to identify gaps in care delivery to youth that can inform practitioners of ways to mitigate the gaps and improve patient care and health outcomes.

SPECIAL CARE DENTISTRY FOR DEVELOPMENTALLY DISABLED CHILD

Special Care Dentistry (SCD) is a discipline focused on enhancing oral health for individuals with diverse impairments, including physical, sensory, intellectual, and medical conditions. It highlights the significant prevalence of disabilities in India and globally, as well as the complex nature of disability according to the WHO International Classification of Functioning. It discusses the extended lifespan of Children with Special Healthcare Needs (CSHCN) due to medical advancements, which necessitates tailored dental care to manage associated oral health challenges. Despite global efforts to improve oral health, disadvantaged and disabled populations continue to face disparities. It concludes by outlining the scope of a forthcoming library dissertation, which aims to review prevalent oral conditions among individuals with special needs and propose general care recommendations to address their unique challenges in accessing dental treatment.

Oral Health-related Quality of Life of Children with Special Health Care Needs in Riyadh: A Cross-sectional Study.

To assess children's OHRQoL and associated factors among a sample of children with special needs in Riyadh, Saudi Arabia. A sample of 6- to 12-year-old children was obtained using convenience sampling from rehabilitation centers. Data were collected through a questionnaire and dental examination. The questionnaire included items related to the children's and their families' characteristics, oral health-related quality of life scales (Parental-Caregivers Perceptions Questionnaire [P-CPQ] and Family Impact Scale [FIS]), perceived health status, and dental care utilisation. Clinical examination was performed by a trained and calibrated dentist. The data were analysed using SPSS; descriptive and inferential data analyses were also performed using SPSS. The mean P-CPQ was 1.10 ± 0.74, and the mean FIS was 1.39 ± 0.88. There was a statistically significant correlation between P-CPQ and caries (r = 0.36, p = 0.02). After controlling for confounders, caries was associated with poor P-CPQ (B = 0.06, p = 0.024). Compared to low-income families, higher-income families had better P-CPQ (4000-8000 SAR: B = -1.36, p = 0.001). Poor oral health-related quality of life in Saudi children is associated with caries and low income. Preventive measures addressing social determinants are vital to control caries and promote oral health in children with special health-care needs.

Sleepless nights, troubled futures: The association between insufficient sleep and child flourishing

ObjectiveTo examine associations between sleep and flourishing among children ages 0–5 years in the United States and whether these differ by age, developmental needs, and family resilience. Study design and methodsCross-sectional data from the 2020–2021 National Survey of Children's Health (N = 31,095) were used with survey-weighted logistic regression to explore associations between insufficient sleep (defined as not meeting age-recommended daily sleep guidelines: 12–16 h for 4- to 12-month-olds, 11–14 h for 1- to 2-year-olds, and 10–13 h for 3- to 5-year-olds) and flourishing (using four markers combined and categorized into two groups). Tests of effect measure modification (EMM) were performed on the multiplicative and additive scales. ResultsWeak but notable evidence was found that children with insufficient sleep had decreased odds of flourishing (aOR = 0.76; 95 % CI: 0.60, 1.00). No evidence of EMM by child age or family resilience was found. However, the sleep-flourishing association differed significantly by children's developmental needs, suggesting that the combined effect of sleep and developmental needs impact flourishing more than either factor alone. ConclusionsApproximately 38 % of children ages 0–5 years in the United States are estimated to have insufficient sleep. This study provides evidence that insufficient sleep is associated with decreased flourishing among children with special health care needs (CSHCN). Future implicationsIncreasing sleep interventions among children under five is warranted among children with special health care needs. The association between sleep and flourishing within specific CSHCN categories, including emotional, behavioral, or developmental (EBD) criteria, should be explored to optimize sleep policies.

Caregivers' Perspective on Successful Health Care Transition Outcomes for Adolescents and Young Adults With Special Health Care Needs

PurposeThere is limited caregiver-reported evidence determining health care transition (HCT) outcomes for their adolescents/young adults with special health care needs (AYA-SHCN). A subcommittee of the International and Interdisciplinary Healthcare Transition Research Consortium aimed to identify multidimensional outcomes of a successful HCT among AYA-SHCN based on parents/caregivers' perspectives. MethodsAfter literature review and expert interviews, a three-stage Delphi process identified HCT outcomes based on parents/caregivers' perspectives. Participants were parents/caregivers of patients attending the Victory Junction Therapeutic Camp and a nationally representative sample from Cint Healthcare Digital Solutions Platform. The cumulative 272 responses collected on a Health Insurance Portability and Accountability Act-compliant web-based engine (Qualtrics) rated potential HCT outcomes by level of importance on a Likert scale from 1 (not important) to 9 (very important) and narrowed in subsequent iterations. ResultsThe Delphi process included 127 (Stage 1), 82 (Stage 2), and 63 (Stage 3) parents/caregivers. The initial 25 HCT outcomes were narrowed to 13, across four major domains: coping/satisfaction, behavioral, structural, and HCT/healthcare-focused outcomes. The top outcome was “My child takes their medications as prescribed.” Several traditionally considered important outcomes for HCT were eliminated. DiscussionThirteen HCT outcomes for AYA-SHCN were identified in four major domains: coping/satisfaction, behavioral, structural, and HCT/healthcare focused. Future research in larger samples would allow stratification to represent diverse patients and caregiver populations. Identifying international consensus-derived outcomes among parents/caregivers is imperative for the evaluation of HCT preparation strategies that ensure appropriate support for diverse AYA-SHCN and their families during this process and enable implementation of the most effective interventions.

Validation of a German version of the caregiver strain questionnaire-short form 11 (CGSQ-SF11)

ObjectiveCaring for a child, particularly one with special healthcare needs, is a demanding task that can lead to the experience of caregiver strain. This in turn has an effect on the caregiver’s mental health, as well as on the child and his or her treatment. To enable the identification of afflicted parents, this study aims to provide a German version of the Caregiver Strain Questionnaire–Short Form 11 (CGSQ-SF11) and to examine its factor structure and psychometric properties.MethodsData from 698 caregivers were included in the analyses. Caregivers completed the CGSQ-SF11 along with measures of parenting stress (PSI-SF), stress (PSS-10), anxiety (GAD-7), depression (PHQ-8), family-related quality of life (FLQ), and social desirability (SES-17) as additional instruments for validation. A two-week follow-up questionnaire included only the CGSQ-SF11. Exploratory factor analysis followed by a confirmatory factor analysis was conducted for parents of children with and without special healthcare needs, separately. Further analyses examined the validity and reliability of the instrument.ResultsFor parents of children with special healthcare needs, a three-factor structure (objective, internalized subjective, externalized subjective strain) with a second-order factor (caregiver strain) was supported. For parents of children without special healthcare needs, a similar three-factor structure was found, although the second-order factor was not supported. Measurement invariance between the two groups was not confirmed. Internal consistency, test-retest reliability, and validity were largely supported in both groups.ConclusionsThe results indicate that the German version of the CGSQ SF-11 is a valid and reliable questionnaire for measuring caregiver strain.

The use of general anesthesia for dental treatment of children with special healthcare needs in Alberta, Canada.

Children with special healthcare needs (SHCN) often require specialized interventions due to their disabilities. Dental general anesthesia (DGA) is a treatment modality, which improves their access to care but concerns about repeated DGAs persist. This study investigated DGA utilization in children with SHCN and identified factors associated with multiple DGAs in Alberta, Canada (2010-2020). This retrospective population-based study used administrative data encompassing all children (<18 years) undergoing DGA in publicly funded facilities. Children were identified as SHCN based on their diagnosis codes and categorized into behavioral/psychiatric disorders, mental/intellectual disabilities, physical disabilities, systemic conditions, syndromes/congenital anomalies, physical-mental disabilities, and disabilities with medical conditions. This study analyzed 3884 DGA visits for children with SHCN, predominantly males aged 6-11 and from low-income families. Mental/intellectual disabilities were prevalent (31.8%), and autism was the leading disease. Caries was the primary dental diagnosis across all groups, whereas pulp problems were higher in psychiatric/behavioral disorders (23.6%), and periodontal problems were more common in physical-mental disabilities (13.2%). 28.7% had multiple DGAs, with younger age, disabilities with medical conditions, mental/intellectual disabilities, and initial pulp treatments, increasing the likelihood of multiple DGAs. This study highlights the importance of individualized prevention and less conservative treatments for younger children to reduce oral health disparities.

Focused Acceptance and Commitment Therapy Skills Training (FACT-ST) program for paraprofessionals serving families of children with special health care needs: A service evaluation study

Addressing mental health needs among parents of children with Special Health Care Needs (SHCN) requires improved access to effective interventions. This study assessed the satisfaction, skills implementation intention, and psychological flexibility of frontline paraprofessionals providing family and child rehabilitation services for families of children with SHCN in Hong Kong following participation in a Focused Acceptance and Commitment Therapy Skills Training (FACT-ST) program. The training program comprised two phases: an initial foundation training stage (i.e., the FT group), which provided theoretical instruction on ACT, and a subsequent supervised practice stage (i.e., the FT + SP group), during which participants were required to conduct at least three video-conferencing FACT sessions with parents of children with SHCN under supervision. A diverse sample of 317 paraprofessionals participated, with 246 completing the foundation training and an additional 71 completing both training phases. The FACT-ST program was positively received, as indicated by high average client satisfaction questionnaire scores. In the FT + SP group, paired sample t-test indicated that the mean total skills implementation intention score remained consistent at the 3-month follow-up (M = 36.65, SD = 7.56) when compared to the 2-week follow-up (M = 36.00, SD = 8.28, P = 0.063). Repeated measures analysis of covariance showed significant improvements in psychological flexibility from baseline to the 3-month follow-up in both the FT (F = 57.57, P = < 0.001, ηp2 = 0.20) and the FT + SP groups (F = 19.06, P = < 0.001, ηp2 = 0.24). Qualitative feedback highlighted the utility of live demonstrations, experiential exercises, and collaborative interactions during training. Our findings are one of the first affirming both the feasibility and acceptability of the FACT-ST program for paraprofessionals working with parents of children with SHCN. The findings underscore the potential of paraprofessionals to become crucial contributors to the mental health care system, addressing service gaps within the community.

Assessment of dental professionals' preparedness for treating patients with special health care needs in Lahore, Pakistan

Assessment of dental professionals' preparedness for treating patients with special health care needs in Lahore, Pakistan

Medical Complexity of Children with Special Healthcare Needs and Healthcare Experiences.

The rising prevalence of CSHCN has led to significant challenges for caregivers, particularly mothers, who face difficulties from caregiving demands and managing complex healthcare interactions. The objective of this study was to examine the association between the medical complexity of CSHCN and the healthcare experiences of their mothers while exploring the influence of sociodemographic factors on these associations. The study utilized data from the 2016-2020 National Survey of Children's Health (NSCH), involving 17,434 mothers of CSHCN. Mothers provided information on the medical complexity of CSHCN, healthcare experiences (care coordination, family-centered care, and shared decision-making), and sociodemographic information (race, community, insurance, child sex, age, and federal poverty level). Results from multiple regressions revealed that greater medical complexity was associated with more negative healthcare experiences. Minoritized mothers, those in rural areas, and families with lower income reported lower levels of family-centered care, indicating significant disparities. Additionally, the negative association between medical complexity and healthcare experiences was pronounced for White families and those with private insurance compared to minoritized families and those with public insurance. This study highlights the necessity for targeted interventions to improve care coordination, family-centered care, and shared decision-making, emphasizing the need for a comprehensive, family-centered approach to address healthcare disparities and promote health equity for CSHCN and their families.

Comparison of initial dental treatment decisions between in-person and asynchronous teledentistry examinations for people with special health care needs

BackgroundPeople with special health care needs in long-term care settings have difficulty accessing a traditional dental office. The goal of the authors was to assess initial treatment decision concordance between dentists conducting traditional in-person examinations using mobile equipment and additional dentists conducting examinations using asynchronous teledentistry technology. MethodsSix dentists from Access Dental Care, a North Carolina mobile dentistry nonprofit, saw new patients on-site at 12 participating facilities or asynchronously off-site with electronic dental records, radiographs, and intraoral images, all captured by an on-site dental hygienist. Off-site dentists were masked to other dentists’ treatment need decisions; 3 through 5 off-site examinations were conducted for each on-site examination. Demographic and binary treatment need category data were collected. For the 3 most prevalent treatment types needed (surgery, restorative, and new removable denture), the authors calculated the percentage agreement and κ statistics with bootstrapped CIs (1,000 replicates). ResultsThe 100 enrolled patients included 47 from nursing homes, 45 from Programs of All-Inclusive Care for the Elderly, and 8 from group homes for those with intellectual and developmental disabilities. Mean (SD) age was 73.9 (16.5) years. Among dentate participants, the percentage agreement and bootstrapped κ (95% CI) were 87% and 0.74 (0.70 to 0.78) for surgery and 78% and 0.54 (0.50 to 0.58) for restorative needs, respectively, and among dentate and edentulous participants, they were 94% and 0.78 (0.74 to 0.83), respectively, for new removable dentures. ConclusionsThe authors assessed the initial dental treatment decision concordance between on-site dentists conducting in-person examinations with a mobile oral health care delivery model and off-site dentists conducting examinations with asynchronous dentistry. Concordance was substantial for surgery and removable denture treatment decisions and moderate for restorative needs. Patient characteristics and facility type were not significant factors in the levels of examiner agreement. Practical ImplicationsThis evidence supports teledentistry use for patients with special health care needs and could help improve their access to oral health care.

Experiences of patients, parents, and healthcare professionals in the process of transitioning from hospital to community after inpatient pediatric rehabilitation among children with special health care needs

Purpose Children with Special Health Care Needs (CSHCN) may experience disruptions in education due to extended hospitalizations. The purpose of this study was to describe how CSHCN experience educational supports during inpatient rehabilitation and identify the ongoing challenges when planning to return to school. Materials and methods Semi-structured focus groups were conducted with parents (n = 12), former patients (n = 20), and rehabilitation professionals (n = 8). Results Through qualitative thematic analysis based on descriptive phenomenology, we developed three themes: 1) Inpatient educational support such as instruction and schoolwork helped reduce the learning loss during hospitalization. However, these supports were sometimes complicated by lags in school approvals and challenges in coordination between systems. 2) Transition planning involved establishing necessary services to support CSHCN’s educational and healthcare needs at school re-entry. However, families reported limited information and guidance as key barriers. 3) Dynamic courses of school re-entry required continued support after discharge. The participants recommended that reassessment and adjustment of transition plans were often necessary to account for evolving developmental and educational needs but were not always received. Conclusions There is an ongoing need to improve communication between clinicians and educators, information for families, and long-term follow-up on the changing educational needs for CSHCN after rehabilitation.

Reasons for Unmet Health Care Needs Among Black, Hispanic, and White Children in the United States With or at Risk for Physical and Mental Health Conditions.

Children with special health care needs (CSHCN)-ie, children who are at increased risk for, or currently manage, persistent physical and mental health conditions-require more health care resources than children without special health care needs. Furthermore, CSHCN who identify as racial/ethnic minorities disproportionately encounter unmet needs, according to reports from their caregivers. However, the reasons for their unmet needs are relatively unknown. This study estimated and compared the US national prevalence of caregiver-reported reasons for unmet health care needs for Hispanic, non-Hispanic black, and non-Hispanic white CSHCN. The most common reasons were problems getting an appointment for black CSHCN and cost for Hispanic and white CSHCN. Issues related to transportation were significantly less likely for black than for white and Hispanic CSHCN. Cost-related issues were significantly less likely for black than Hispanic CSHCN. To address reasons for unmet needs for CSHCN, effective structural changes are needed.

Implications of Childhood Autism Spectrum Disorder for Maternal Employment: United States vs. Norway

ObjectivesA country’s social welfare system may play an important role in maternal employment. This study compared the labor market participation of mothers of children within the United States (U.S.) and Norway to examine whether the child’s age and severity of the ASD affected mothers’ employment differently between the two countries.MethodsThe 2019 National Survey of Children’s Health was used for the U.S. analysis, and the 2019 administrative register data were used for the Norwegian analysis. A logit model was used to analyze the impact of a child’s age and ASD severity on maternal employment in the U.S. and Norway. We presented the results as average marginal effects obtained from the logistic regression analyses.ResultsAfter adjusting for mothers’ sociodemographic variables and the child’s age, U.S. mothers of children with mild ASD and moderate/severe ASD had respectively 12 and 25% points lower probability of being employed than U.S. mothers of children without special health care needs. In Norway, mothers of children with moderate/severe ASD had a 13% points lower probability of employment than mothers without special health care needs. The probability of being employed for mothers caring for a child with ASD was significantly greater as the child got older in both countries.Conclusions for PracticeThe employment gap was more substantial in the U.S. than in Norway. A general high employment participation rate among women and an elaborated welfare state and policy package seem to benefit employment among mothers of children with ASD in Norway.