Children with Special Physical Health Care Needs: Restraint Use and Injury Risk in Motor Vehicle Crashes

Physical disabilities may affect a child passenger’s fit within a conventional motor vehicle restraint. The aim of this study is to describe and compare injury risk in motor vehicle crashes (MVC) among children with and without special physical health care needs (SPHCN). This analysis, conducted in 2007–2008, utilizes data collected between December 1998 and November 2002 in a cross-sectional study of children ≤15 years old involved in crashes of State-Farm insured vehicles in 15 states and the District of Columbia. Parent reports via telephone survey were used to define pre-crash SPHCN, restraint status, and occurrence of significant injuries using a validated survey. Complete data were collected for 18,852 children aged 0–15 years; 159 children were reported to have a SPHCN (0.8% and 0.7% of children aged 0–8 and 9–15 years, respectively). A greater proportion of children with SPHCN aged 0–8 years were appropriately restrained (P < 0.001), but there was no significant difference in restraint use among children with and without SPHCN aged 9–15 years. There was no significant association between the presence of a SPHCN and injury risk in either age group, after adjustment for child/driver characteristics (children aged 0–8 years: OR 1.27, 95% CI: 0.48–3.33; children aged 9–15 years: OR 1.51, 95% CI: 0.38–6.11). Children with and without SPHCN have similar injury risk in MVC, despite increased age-appropriate restraint usage among children aged 0–8 years. When counseling families about vehicle safety, practitioners should consider the fit of a child with SPHCN in a restraint system.     

Children Who Are Medically Fragile in North Carolina: Using Medicaid Data to Estimate Prevalence and Medical Care Costs in 2004

Objectives: The purpose of this paper is to demonstrate a method of using medical insurance paid claims and enrollment data to estimate the prevalence of selected health conditions in a population and to profile associated medical care costs. The examples presented here use North Carolina Medicaid data to produce estimates for children ages 0–19 who are medically fragile. These children with serious health conditions are a small subset of all children with special health care needs. Methods: The children who are medically fragile were identified through selected procedure and durable medical equipment codes. We profiled the expenditures for all medical services provided to these children during 2004. Results: 1,914 children ages 0–19 enrolled in Medicaid were identified as medically fragile (0.22 percent). The amount paid by Medicaid for these children during 2004 for all medical services was $133.8 million, or $69,906 per child. By comparison, the average expenditure by Medicaid during 2004 for a randomly selected group of children receiving well-child care visits was $3,181 per child. The $133.8 million of Medicaid expenditures for the children who are medically fragile represents 6.8 percent of the nearly $2 billion spent by Medicaid in 2004 for all medical services for all children ages 0–19. Conclusions: This study presents a standard methodology to identify children with specific health conditions and describe their medical care costs. Our example uses Medicaid claims and enrollment data to measure prevalence and costs among children who are medically fragile. This approach could be replicated for other health care payer data bases and also in other geographic areas.     

Gradients in the Health Status and Developmental Risks of Young Children: The Combined Influences of Multiple Social Risk Factors

Objectives: To analyze child vulnerability as a profile of multiple risk factors for poorer health based on race/ethnicity, social class (maternal education and family poverty status), child health insurance coverage, and maternal mental health. Profiles are examined in relation to disparities in the health status and developmental risks of young children. Data Sources: Cross-sectional data on 2,068 children ages 4–35 months from the 2000 National Survey of Early Childhood Health. Study Design: Multiple logistic regression models are used to examine risk profiles in relation to child health status and developmental risk (based on parent concerns about development). The profiles are also examined in relation to three measures of basic access to health care: telephone contact with a physician, well-child visit in the past year, and missed or delayed needed care. Principal Findings: About one-third of (or 3.1 million) young children in the United States have two or more risk factors (RF) for poor health. Controlling for other family factors, having more RFs is associated with poorer health status (i.e., percent reported “good/fair/poor” vs. “excellent/very good”) and being higher risk for developmental delays. For example, the likelihood of having either poorer health or higher developmental risk increases with each RF (vs. zero): 1 RF (OR = 1.70, CI: 1.20–2.38), 2 RFs (OR = 3.28, CI: 2.27–4.73), 3 RFs (OR = 4.69, CI: 2.84–7.73), 4 RFs (OR = 14.58, CI: 4.98–42.64). Higher RFs were also associated with poorer health care access. Conclusions: This study demonstrates a dose–response relationship of higher risk profiles with poorer child health status and higher developmental risk. Because children with higher profiles of risk are also more likely to lack access to care, this suggests that children who most need care have the greatest difficulty obtaining it. Addressing health gradients for vulnerable children will require explicit attention to these multiple, overlapping risk factors.     

Parental Nativity Affects Children’s Health and Access to Care

Objective To examine the effect of parental nativity on child health and access to health care. Data Source The 2002 National Survey of America’s Families. Results Among US children, 14% have foreign-born parents; 5% have one foreign- and one native-born parent (“mixed-nativity”). In multivariate logistic regression analyses, children with foreign-born parents were less likely than children with US-born parents to be perceived in “very good” or “excellent health” [OR = 0.68; 95% CI (0.56–0.82)] and to have a usual health care site [OR = 0.52 (0.38–0.69)]; having mixed-nativity parents is associated with better perceived child health. These effects persisted for minority, but not white, children. Regardless of race and ethnicity, non-citizen children have worse access to care. Conclusion Efforts to improve children of immigrants’ health and access to care should focus on families in which both parents are immigrants, particularly those who are ethnic or racial minorities. Efforts to increase use of health services should focus on non-citizen children.     

Health Insurance and Access to Care for Families with Young Children in California, 2001–2005: Differences by Immigration Status

Objectives To examine differences and trends in health insurance coverage and access to care for California families by immigration status. Methods Cross-sectional data on 37,236 families with young children <18 years of age from the 2001, 2003 and 2005 California Health Interview Survey are used to assess trends in health insurance and access to care for children and their parents by four immigration dyads: (1) both are Citizens; (2) child is a legal resident/citizen, and parent is legal resident (Documented); (3) child is a citizen, and parent is undocumented (Mixed); and (4) both are Undocumented. Results Before and after adjustment for covariates, only children in Undocumented dyads were less likely than Citizen dyads to have insurance (OR = 0.20, CI: 0.16–0.26) and all three measures of access: physician visits (OR = 0.69, CI: 0.52–0.91), dental visits (OR = 0.47, CI: 0.35–0.63), and a regular source of care (OR = 0.51, CI: 0.37–0.69). Parents in all non-Citizen dyads had poorer access than Citizen dyads across all measures, with the exception of dental visits and a regular source for parents in Documented dyads. Children of all dyads except Citizens were more likely to be insured in 2005 vs. 2001. The largest gain was for undocumented dyad children with 2.77 times higher odds (CI: 1.62–4.75) of being insured in 2005 vs. 2001. All children dyads except Mixed were also more likely to have a physician visit. For parents, there was only a decrease in insurance coverage for Citizen dyads (OR = 0.79, CI: 0.67–0.93) and few changes in access. Conclusions While there were relatively few disparities and some improvements in insurance coverage and access for children in California (except for undocumented children), concomitant changes for parents were not observed. Without attention to the family in health care reforms, disparities may not fully resolve for children and may continue or even increase for parents.     

Caregiver Reports of Serious Injuries in Children Who Remain at Home After a Child Protective Services Investigation

The study objectives were to examine serious injuries requiring medical attention among children who remain at home after a child welfare/child protective services (CPS) maltreatment investigation in the US and to determine whether child/caregiver characteristics and ongoing CPS involvement are related to injuries requiring medical attention. Using the National Survey of Child and Adolescent Well-being, we analyzed data on the subsample of children who remained at home (N = 3,440). A multivariate logistic regression model included child characteristics, chronic illness and disability in the child, level of CPS involvement, subsequent foster care placement, caregiver characteristics, and caregiver/family psychological variables. Injuries requiring medical attention were identified in 10.6% of the in-home population over a15-month period, with no differences in rates by age. Children with a chronic medical condition (OR = 2.07; 95% CI, 1.20–3.58) and children with depressed caregivers (OR = 2.28; 95% CI, 1.45–3.58) were more likely to have an injury that required medical care. Older caregivers (>54 years) were less likely (OR = 0.15; 95% CI, 0.03–0.69) to have a child with an injury requiring care. Injuries were not related to further involvement with CPS after the initial maltreatment investigation. Children with chronic medical conditions who remained in their biological homes or whose caregivers were depressed were likely to experience an injury requiring medical attention. Older caregivers were less likely to report a child injury. Extending existing health policies for foster children to children who remain at home following referral to CPS may encourage more comprehensive injury prevention for this population.     

National Disparities in the Quality of a Medical Home for Children

Objectives To examine socio-demographic disparities associated with a quality medical home. Methods A nationally representative sample of children ages 0–17 years (n = 102,353) from the 2003 National Survey of Children’s Health. Risk factors including non-white race/ethnicity, income <200% of the federal poverty level (FPL), uninsured, parent education lesser than high school, and non-English primary household language, were examined in relation to a quality medical home separately and together as a “profile” of risk. Fourteen questions were used to measure five medical home features: access, continuity, comprehensiveness, family-centered care, and coordination. Quality was defined as a value greater than median for each feature and for an overall score. Results Before and after adjustment for child demographics and health status, all studied risk factors were associated with poorer quality medical home features. Uninsured [odds ratio (OR) = 0.43, 95% confidence interval (CI): 0.40–0.47] and low-income children (OR = 0.65, CI: 0.62–0.69) had among the lowest odds of a quality medical home overall and across most features, except coordination that showed an opposite trend. Summarized through risk profiles, children experiencing all five risk factors had 93% lower odds of a quality medical home overall (OR = 0.07, CI: 0.04–0.25) compared to zero risk children. Conclusion This study demonstrates large national disparities in the quality of a medical home for children. That disparities were most prevalent for the uninsured and those in or near poverty, both modifiable risk factors, suggests that reforms to increase coverage and to lift families out of poverty are essential to assuring that children have access to the full complement of appropriate health care services including a quality medical home.     

Child care choices: Low income mothers in bridgeport,connecticut

This study was undertaken in 1994 in Bridgeport, Connecticut, to determine what child care systems are being utilized by low-income parents. Only twenty-four percent of Bridgeport’s children are enrolled in formal, licensed child care programs. Although prohibitive expense was predicted by providers and administrators of child care and child welfare programs to be the greatest hindrance to obtaining formal, licensed child care by low income parents, results of the study showed that it was parents’ lack of trust of providers that was the main reason for underutilization of child care. However, even though lacking in trust, many mothers informally stated that they would use the publicly-funded Head Start program if it were available to them. The author wishes to particularly thank Michie Hesselbrock of the University of Connecticut School of Social Work and Robert Kocienda of Save the Children/USA.     

Norm values for the Generic Children's Quality of Life Measure (GCQ) from a large school-based sample

This study aimed to assess the quality of life of a population sample of schoolchildren. The Generic Children's Quality of Life Measure (GCQ) has been developed to allow comparison between chronically ill children and the general child population. The measure assesses how the child views his or her life and also how they would like it to be. Quality of life is measured as the discrepancy between the two viewpoints. This large community-based survey aimed to establish GCQ norm values for children aged 6–14 years. The children were from a sample of schools stratified by geographical location and social need: rural affluent, rural low affluence, urban affluent and urban low affluence. 720 completed questionnaires were analysed. The scores were normally distributed with a wide range. The GCQ showed an acceptable reliability with a Cronbach's α of 0.75. The quality of life score was not correlated with age (r = −0.02, p = 0.64) nor with the deprivation score of the area in which the children lived (r = −0.026, p = 0.49). There were no significant differences between the scores by gender (p = 0.22) nor by rural/urban location (p = 0.60). Normative values were established. The GCQ is suitable for using with children over a large age range (6–14 years) without the scores being confounded by the age, gender, affluence or geographical location. This revised version was published online in June 2006 with corrections to the Cover Date.     

Is Health Insurance Enough? A Usual Source of Care may be More Important to Ensure a Child Receives Preventive Health Counseling

Despite the promise of expanded health insurance coverage for children in the United States, a usual source of care (USC) may have a bigger impact on a child’s receipt of preventive health counseling. We examined the effects of insurance versus USC on receipt of education and counseling regarding prevention of childhood injuries and disease. We conducted secondary analyses of 2002–2006 data from a nationally-representative sample of child participants (≤17 years) in the Medical Expenditure Panel Survey (n = 49,947). Children with both insurance and a USC had the lowest rates of missed counseling, and children with neither one had the highest rates. Children with only insurance were more likely than those with only a USC to have never received preventive health counseling from a health care provider regarding healthy eating (aRR 1.21, 95% CI 1.12–1.31); regular exercise (aRR 1.06, 95% CI 1.01–1.12), use of car safety devices (aRR 1.10, 95% CI 1.03–1.17), use of bicycle helmets (aRR 1.11, 95% CI 1.05–1.18), and risks of second hand smoke exposure (aRR 1.12, 95% CI 1.04–1.20). A USC may play an equally or more important role than insurance in improving access to health education and counseling for children. To better meet preventive counseling needs of children, a robust primary care workforce and improved delivery of care in medical homes must accompany expansions in insurance coverage.     

Missed Opportunities for Reproductive and Child Health Services of Clients in Urban NGO Clinics of Bangladesh

Objectives: The study was undertaken to identify the extent of missed opportunities of clients for selected reproductive and child health services, including the reasons and factors contributing to missed opportunities, in NGO clinics in Bangladesh. Methods: A cross-sectional survey of 6 NGO clinics from 6 randomly-selected municipality areas was conducted for one month during July-August 2000. In total, 1,478 clients were consecutively selected both from fixed and satellite clinics. A structured questionnaire was used for conducting exit-interviews. Results: Missed opportunities among female clients of reproductive age included tetanus toxoid (54%), family planning (26%), postnatal care (16%), reproductive tract infection (15%), and antenatal care (11%). The missed opportunities among children aged less than 5 years were the highest (42%) for acute respiratory infections, followed by diarrhoea (38%) and immunization (22%). Although the clients of clinics had specific health needs, over 50% did not perceive their importance, resulting in missed opportunities. Significantly higher missed opportunities for tetanus toxoid were observed among women aged 26 years and over and also among housewives. Missed opportunity for family-planning method was significantly lower (p < 0.01) among women aged 26 years and over compared to women aged 20–25 years. Missed opportunities for child immunization were significantly higher (p < 0.05) among the children living nearer ( <1 km) to the clinic compared to children who lived >1 km away from the clinic. Conclusions: The findings suggest that providing a broader range of services alone is not enough to ensure their use. A systematic screening mechanism should be in place for regular appraisal of clients for their missed opportunities. Behavioral change communication needs to be introduced to increase awareness among clients about the availability of additional services.     

Use of restraint devices to prevent collision injuries and deaths among welfare-supported children.

Evidence that death and injury rates for young children involved in automobile collisions could be reduced if children were restrained prompted the State of Tennessee to pass the nation's first child passenger law, a law that became effective in January 1978. Although similar laws have now been enacted throughout the United States, usually restraint devices are not provided to low-income groups who may have difficulty affording them. Few studies have examined the use of such devices by welfare recipients. A total of 56 black women, receiving Medicaid and residing in inner city Memphis, were interviewed about their use of passenger restraints during automobile travel for their children ages 0-3 years. About two-thirds of the mothers interviewed said they rarely or never used child passenger restraint devices when transporting their child. Children age 3 years were significantly less likely to be transported in child restraint devices than younger children. Women who had received welfare payments for 3 years or more or who made fewer than one automobile trip a week with their child were significantly less likely to use child passenger restraints. These results suggest that, in spite of child passenger laws, automobile restraint devices are not used for a high percentage of children ages 0-3 years receiving medical care under State and Federal Medicaid programs. Since treatment costs are paid under these programs when children are injured in collisions, program administrators may have strong incentives to increase the proportion of these children being restrained while traveling in motor vehicles.     

Pediatric poisonings and risk markers for hospital admission in a major emergency department in Romania

To identify the prevalence, characteristics, and risk markers for childhood poisonings treated in the emergency department of a large Romanian hospital. Trauma registry data using ICD-10 codes and case summaries were studied to identify poisonings among children aged 0–18. Multivariate logistic regression identified factors associated with hospital admission. Between 1999 and 2003, 1,173 pediatric trauma cases were seen in the emergency department; 437 (37.3%) were treated for poisoning, including medication (35%), alcohol (26%), chemical products (19%), and carbon monoxide (14%). Half of all poisonings were unintentional, primarily affecting children < 10 years. Half were intentional, mainly affecting children 10–18. Females were three times more likely than males to have documented suicidal intent (P < .0001). Over 30% of suicide attempts were among children ages 10–14 (P < .0001). We report significantly increased adjusted odds ratios (P < .05) of hospital admission for children 10–18, and for chemical substance poisoning, and suicidal intent. Pediatric poisoning is a serious public health issue in Romania, and we suggest these findings are relevant across other eastern European countries with limited resources. Poisonings result in morbidity and hospital admissions, yet there are few prevention resources available. Health education programs and consumer product safety policies are needed in Romania and eastern Europe.     

Child Food Insecurity and Iron Deficiency Anemia in Low-Income Infants and Toddlers in the United States

Objective: Examine the association between child-level food insecurity and iron status in young children utilizing community-based data from the Children's Sentinel Nutrition Assessment Program (C-SNAP). Methods: A cross-sectional sample of caregivers of children ≤36 months of age utilizing emergency department (ED) services were interviewed between 6/96–5/01. Caregiver interviews, which included questions on child-level food security, were linked to a primary clinic database containing hemoglobin, red blood cell distribution width, mean corpuscular volume, free erythrocyte protoporphyrin and lead values. Children a priori at-risk for anemia: birthweight ≤2500 g, with HIV/AIDS, sickle cell disease, or lead values ≥10.0 ug/dL, and children ≤6 months of age were excluded from the analysis. Only laboratory tests 365 days prior or 90 days after interview were examined. Iron status was classified in four mutually exclusive categories: 1) Iron Sufficient-No Anemia (ISNA), 2) Anemia (without iron deficiency), 3) Iron Deficient-No Anemia (IDNA), 4) Iron Deficient with Anemia (IDA). Results: 626 ED interviews linked to laboratory data met the inclusion criteria. Food insecure children were significantly more likely to have IDA compared to food secure children [Adjusted Odds Ratio = 2.4, 95% CI (1.1–5.2), p = 0.02]. There was no association between child food insecurity and anemia without iron deficiency or iron deficiency without anemia. Conclusion: These findings suggest an association between child level food insecurity and iron deficiency anemia, a clinically important health indicator with known negative cognitive, behavioral and health consequences. Cuts in spending on food assistance programs that address children's food insecurity may lead to adverse health consequences.Presented at the Pediatric Academic Soceity Meeting, Abstract No. 2668 held April 28, 2001 in Baltimore, MD.     

Effects of Welfare and Maternal Work on Recommended Preventive Care Utilization Among Low-Income Children

Objectives. We examined how maternal work and welfare receipt are associated with children receiving recommended pediatric preventive care services.Methods. We identified American Academy of Pediatrics–recommended preventive care visits from medical records of children in the 1999–2004 Illinois Families Study: Child Well-Being. We used Illinois administrative data to identify whether mothers received welfare or worked during the period the visit was recommended, and we analyzed the child visit data using random-intercept logistic regressions that adjusted for child, maternal, and visit-specific characteristics.Results. The 485 children (95%) meeting inclusion criteria made 41% of their recommended visits. Children were 60% more likely (adjusted odds ratios [AOR` = 1.60; 95% confidence interval [CI] = 1.27, 2.01) to make recommended visits when mothers received welfare but did not work compared with when mothers did not receive welfare and did not work. Children were 25% less likely (AOR = 0.75; 95% CI = 0.60, 0.94) to make preventive care visits during periods when mothers received welfare and worked compared with welfare only periods.Conclusion. The Temporary Assistance for Needy Families maternal work requirement may be a barrier to receiving recommended preventive pediatric health care.The Personal Responsibility and Work Opportunity Reconciliation Act was enacted in 1996, replacing Aid to Families With Dependent Children with a new program, Temporary Assistance for Needy Families (TANF). Sometimes called “welfare reform,” TANF is now in its 15th year, and another reauthorization is anticipated in 2013. Whereas Aid to Families With Dependent Children provided welfare cash assistance (“welfare”) for low-income mothers with young children and did not permit receipt of additional income through work, TANF requires most mothers receiving welfare to work or to participate in job-training programs.The impact of welfare reform on children’s health care access, utilization, and outcomes has been much debated. Several studies examined the consequences of welfare reform on children’s health and reported that TANF’s maternal employment requirements may negatively affect children’s health.1–5 In a previous study, we found that mothers working during periods when mothers were receiving welfare resulted in negative effects on the timely administration of childhood immunizations.6aWe sought to understand the association of welfare receipt and maternal work with recommended preventive pediatric health care visits. The American Academy of Pediatrics (AAP) provides recommendations for the ages at which a child should receive preventive care visits and, for each recommended visit, a “window,” or period of time, when the visit should be received.6b Preventive pediatric health care visits are critical during the vulnerable first years of a child’s life for monitoring growth and development and for providing timely immunizations.7–9 Also, previous research has shown that receipt of preventive pediatric health care is associated with reduced avoidable hospitalizations, reduced emergency department visits, and better health outcomes.10–12 Nevertheless, there is good evidence that many preventive care visits are delayed or missed entirely and, among low-income children, this is of particular concern because of their increased risks for poor growth and development.13–15 We hypothesized that maternal work required for welfare receipt was associated with reduced preventive health care visits.     

Adjusting Child Welfare to the Changing Portrait of Families in North America

Beginning in the 1950s changes began altering the social landscape in which the traditional approach to child welfare operated. Women began entering the workforce in record numbers. Divorce rates rose, as did the number of unwed mothers. The result was a dramatic increase in the number of impoverished lone-parent families. The traditional portrait of the family began to fracture. At the same time, child welfare policies and programs failed to respond to the needs created by these changes. Child welfare policies and programs that would address the problems these changes produced failed to materialize. Although public school education provides for the care of children between 6and18during the day, mothers with children under 6 were left to their own resources. The need for publicly supported child care was left unmet. The traditional approach to child welfare, using a casework method that focused on the parent#shchild relationship, was no longer able to cope with the problems produced by these changes.     

Equality in the early years∗

Beginning in the 1950s changes began altering the social landscape in which the traditional approach to child welfare operated. Women began entering the workforce in record numbers. Divorce rates rose, as did the number of unwed mothers. The result was a dramatic increase in the number of impoverished lone‐parent families. The traditional portrait of the family began to fracture. At the same time, child welfare policies and programs failed to respond to the needs created by these changes. Child welfare policies and programs that would address the problems these changes produced failed to materialize. Although public school education provides for the care of children between 6and18during the day, mothers with children under 6 were left to their own resources. The need for publicly supported child care was left unmet. The traditional approach to child welfare, using a casework method that focused on the parent#shchild relationship, was no longer able to cope with the problems produced by these changes.     

State Policy Environment and Delayed or Forgone Care Among Children with Special Health Care Needs

Objective To evaluate if children with special health care needs (CSHCN) residing in states with more generous public insurance programs were less likely to report delayed or forgone care. Methods We used multilevel modeling to evaluate state policy characteristics after controlling for individual characteristics. We used the 2001 National Survey of CSHCN for individual-level data (N = 33,317) merged with state-level data, which included measures of the state’s public insurance programs (Medicaid eligibility and enrollment, spending on Medicaid, SCHIP and Title V, and income eligibility levels), state poverty level and provider supply (including pediatric primary care and specialty providers). We also included a variable for state waivers for CSHCN requiring institutional level care. Results Delayed or forgone care significantly varied among CSHCN between states, net of individual characteristics. Of all the state characteristics studied, only the Medicaid income eligibility levels influenced the risk of experiencing delayed care. CSHCN living in states with higher income eligibility thresholds or more generous eligibility levels were less likely to experience delayed care (OR 0.89(0.80,0.99); P ≤ 0.05). Conclusions By analyzing child health policy in the context of individual characteristics that may place a child at risk for delayed care, we determined that improving Medicaid eligibility levels improved the process of care for CSHCN.     

Mother–Child Interactions and the Associations with Child Healthcare Utilization in Low-Income Urban Families

Studies have demonstrated that low-income families often have disproportionately high utilization of emergency department (ED) and hospital services, and low utilization of preventive visits. A possible contributing factor is that some mothers may not respond optimally to their infants’ health needs, either due to their own responsiveness or due to the child’s ability to send cues. These mother–child interactions are measurable and amenable to change. We examined the associations between mother–child interactions and child healthcare utilization among low-income families. We analyzed data from the Nurse-Family Partnership trial in Memphis, TN control group (n = 432). Data were collected from child medical records (birth to 24 months), mother interviews (12 and 24 months postpartum), and observations of mother–child interactions (12 months postpartum). We used logistic and ordered logistic regression to assess independent associations between mother–child interactions and child healthcare utilization measures: hospitalizations, ED visits, sick-child visits to primary care, and well-child visits. Better mother–child interactions, as measured by mother’s responsiveness to her child, were associated with decreased hospitalizations (OR: 0.51; 95% CI: 0.32, 0.81), decreased ambulatory-care-sensitive ED visits (OR: 0.65, 95% CI: 0.44, 0.96), and increased well-child visits (OR: 1.55, 95% CI: 1.06, 2.28). Mother’s responsiveness to her child was associated with child healthcare utilization. Interventions to improve mother–child interactions may be appropriate for mother–child dyads in which child healthcare utilization appears unbalanced with inadequate primary care and excess urgent care. Recognition of these interactions may also improve the care clinicians provide for families.     

Factors for Accessing a Medical Home Vary Among CSHCN from Different Levels of Socioeconomic Status

Purpose The purpose of this research study was to identify factors that are associated with receiving care in a medical home for children with special health care needs (CSHCN) and to identify how these factors vary among different socioeconomic levels. Methods Data were obtained from the National Survey of Children with Special Health Care Needs, 2000–2002. Access to a medical home was derived using an algorithm. This survey analysis also included demographic characteristics, geographical location of household, severity of condition, and social factors. Multiple logistic regression models were constructed for socioeconomic status (SES) levels defined by federal poverty level (FPL): <133%; 133–199%; 200–299%; ≥300%. Results Age group was significant in all but the 200–299% of FPL stratum. Severity of condition was significant in all strata. Race was significant in all but the ≥300% stratum. Maternal education was borderline significant in the lowest and highest strata. Insurance type/status was significant in all but the 133–199% of FPL stratum. Geographical location was significant in the lowest and highest strata. The language of the interview was only significant in the lowest stratum. The relationship of the respondent to the child was significant in the middle two strata. The total number of adults in the household was significant in the highest stratum, and the total number of children in the household was significant in the 200–299% of FPL stratum. Conclusions Factors affecting access to a medical home differed among socioeconomic groups. Future research should explore the CSHCN population by income groups to better serve this population.