Disparities in Mental and Behavioral Health Treatment for Children and Youth in Immigrant Families

Background and ObjectiveChildren and youth in immigrant families (CIF)—children and youth with at least 1 foreign-born parent—face unique psychosocial stressors. Yet little is known about access to mental and behavioral health (MBH) services for CIF. Among US CIF and non-CIF with MBH problems, we assessed access to MBH treatment.MethodsWe used the National Survey of Children's Health-2016, a nationally representative survey of predominantly English- or Spanish-speaking US parents. The sample included 2- to 17-year-olds whose parent reported at least 1 MBH problem. The primary outcome was prior-year receipt of MBH treatment (counseling, medication, or both).ResultsOf 50,212 survey respondents, 7164 reported a current MBH problem (809 CIF and 6355 non-CIF). The majority of CIF were Hispanic/Latinx (56% CIF vs 13% non-CIF, P < .001). CIF were less likely than non-CIF to have an Attention Deficit Hyperactivity Disorder (ADHD) diagnosis (35% vs 59%, P < .001) and less likely to have received MBH medication and/or counseling (61% vs 71%, P = .02). This difference was pronounced for receiving medication (32% vs 50%, P < .001). When controlling for multiple covariates, differences in any MBH treatment were no longer statistically significant (adjusted odds ratios 0.76, 95% confidence interval 0.52–1.11), while the odds of receipt of medication remained significantly lower for CIF (adjusted odds ratios 0.61, 95% confidence interval 0.42–0.88).ConclusionsAmong children and youth with at least 1 parent-reported MBH problem, CIF, compared with non-CIF, were less likely to receive MBH treatment, specifically medication. This may be explained, in part, by differences in the proportion of CIF and non-CIF diagnosed with ADHD.     

Children in Immigrant Families in Switzerland: Family and Socioeconomic Environment

Switzerland is from the end of World War II an immigration country. After three decades of labour migration, in the early 1980s, family reunification progressively became the most important reason for immigration. At the time of the 2000 Census, there were 1.5 million documented foreigners living in Switzerland. This represented 20% of the resident population, one of the highest proportions of foreigners in any country in Europe. Approximately 39% of children in Switzerland were members of families of foreign origin with at least one foreign-born parent. This paper statistically describes the living conditions and socioeconomic environment of those children, by computing indicators according to the origin. It shows the huge diversity of situations regarding the socioeconomic position of parents and the social background. In particular, children from Western Europe and the United States live in highly skilled families whereas children from Portugal and the Balkans live in families with a very low level of qualification. Such results justify the formulation of integration and school policies that take into account the characteristics of each migration flow.     

A Portrait of Children in Immigrant Families in Italy

The number of foreign minors living in Italy in 2003 was 353,500. According to the latest estimates, for 2008, over 862,000 foreign minors are now residing in Italy. This means that, within 5 years, the number of foreign minors more than doubled, and, within last 10 years, it more than quadrupled. In 2008, more than 16% of births occurred to couples including at least one foreign parent and children now account for more than 22% of the foreign population. Despite the extraordinarily rapid growth in immigration and in the number of foreign children in the last decade, little research has been conducted on issues regarding children in immigrant families. In this study, in the framework of the Unicef comparative research project on ‘Children in Immigrant Families in Eight Affluent Countries: Their Family, National and International Context’ we analyse the household composition and wellbeing of children in immigrant families with 2001 Italian Census data. In particular, we analyse, by gender and country of origin, the time of arrival and citizenship of children aged up to 17 years; the educational attainment and job activity of their parents; family composition and housing conditions.     

Review of the Circumstances Among Children in Immigrant Families in Australia

Australia has always had a very high level of immigration. There were about 1.5 million children 0 to 17 years of age in immigrant families in Australia in 2001. This represented almost 33% of all children. More than a quarter of these children were in families from the most consistent countries of immigrant origin, Ireland and the United Kingdom. Another 17% were in families from other parts of Europe, while 10% were in families from New Zealand, and 3% were in families from other countries in Oceania. Compared with most other OECD countries, there is a dearth of research on children in immigrant families in Australia, and relatively limited administrative data that might allow us to compare immigrant families to other families in the general population. No recent studies track the educational, health, or employment trajectories of children in families in various immigrant groups. Research on children in immigrant families undertaken since the 1970s has been sporadic and fragmentary. None of the flagship studies on child well-being provides specific information about culturally and linguistically diverse children or children in immigrant families. There are no national studies on the involvement of these children with the child welfare, juvenile justice, or out-of-home care systems, and it is therefore not known if they are overrepresented or underrepresented. Studies tend to compare two or three ethnic or language groups, group all immigrants together, or classify immigrant children according to English-speaking or non-English speaking backgrounds. Australians pride themselves on the harmony and the relative lack of racial tension in their society, but hard data on indicators of racial harmony are scarce. We examine the limited evidence base below, and supplement an analysis of census data and data from the Longitudinal Study of Australian Children (LSAC). The findings are rather paradoxical. On the one hand the research confirms the serious disadvantages in well-being that children in certain immigrant groups face, relative to the overall population. The disadvantages include poorer educational outcomes, exposure to racism, the trauma of separation from the cultural and social networks of their countries of origin, challenges to adjusting to the Australian culture and life style, identity problems and less access to services and social support. These issues are heightened among immigrants who have come to Australia with fewer skills and fewer resources, as well as less knowledge of English. On the other hand the wellbeing of migrant children appears to be relatively good compared to the general Australian population and also compared to migrants in other OECD countries.     

Financial and Employment Problems in Families of Children With Special Health Care Needs: Implications for Research and Practice

IntroductionThe purpose of this study was to identify factors related to financial burden among families of children with special needs and to identify specific provider-level activities associated with decreased risk for such burden.MethodData for secondary analysis are from the National Survey of Children with Special Health Care Needs (CSHCN). Logistic regression analysis of state-level data was conducted to identify significant predictors of financial and employment problems among families of children with SHCN in Minnesota.ResultsChildren with more severe conditions and whose family members provided health care at home were more likely to have parents report financial and employment problems due to the child's condition. On the other hand, families whose health care providers communicated well with other service providers and who helped them feel like partners in their child's care were significantly less likely to report financial and employment problems.DiscussionPediatric nurses and nurse practitioners can use these findings as they work with families for optimal family outcomes. Advocacy and policy implications at state and federal levels also are discussed.     

Disappearing Medicaid Enrollment Disparities for US Citizen Children in Immigrant Families: State-Level Trends from 2008 to 2015

Objective

Medicaid and the Children's Health Insurance Program (CHIP) provide health insurance to 38% of all children in the United States. Uninsured rates continued to fall over the past decade, and citizen children in immigrant families experienced the most dramatic gains. Our objective is to test whether states have managed to close Medicaid enrollment gaps between US citizen children in native and immigrant families.

The Employment and Financial Effects on Families Raising Children With Special Health Care Needs: An Examination of the Evidence

IntroductionOver 10 million children in the United States have special health care needs (U.S. Department of Health & Human Services, 2008). Parents struggle to afford needed health care and wrestle with the dual responsibilities of caregiving and employment. Researchers from a variety of disciplines, health care, and social science, in particular, are analyzing what variables affect a family’s ability to access needed health care while balancing work and caregiving.MethodsA systematic literature review was conducted on the past 11 years of research that examined insurance status, insurance type, family out-of-pocket expenses, employment outcomes (reductions in hours or stopping work all together), and the role of receiving care in a medical home.ResultsIt was found that private health insurance, more severe conditions, and specific diagnoses are related to increased expenses and employment changes. It was also found that receiving care in a medical home reduces both.DiscussionIt is vital that clinicians and policy makers move forward in expanding the concept of the medical home model as a means to improving the well-being of families raising children with special health care needs.     

Moving Beyond Ethnicity: The Socio-Economic Status and Living Conditions of Immigrant Children in the UK

This paper examines the situation of children in immigrant families living in the UK through an analysis of 2001 census data according to the country of birth of children and their parents. The foreign-born population in the United Kingdom reached 4.9 million in 2001, representing 8.3 per cent of the total population. Around 2.1 million children (16.3 per cent of all children in the UK) were living in immigrant families. A fifth of these children were born outside the UK with the remainder being born in the UK with at least one foreign-born parent. More than 40 per cent were in families from Asia, around 20 per cent from Africa and around 20 per cent from countries in Europe. Pakistan, India, the Republic of Ireland, Germany and Bangladesh were the main countries of origin. Although there is significant variation in the socio-economic status and living conditions of immigrant families from different regions and countries of origin, it is clear that immigrant children are faring less well overall than their native-born counterparts. Levels of employment are higher among the parents of native-born children despite the fact that parents in immigrant families generally exhibit higher educational attainment levels. Immigrant children are more likely to be living in overcrowded housing that is not owned. The analysis presented in this paper suggests that an ethnicity-focused approach alone is inadequate for addressing the present and future needs of immigrants and their children or in understanding the dynamics of immigrant inclusion and exclusion.     

The Impact of Technology Dependence on Children and Their Families

Advances in medical care and technologies have prolonged life for many children with medical complexity. These advances and their effects reinforce the need for further research to determine how children and their families are being affected by technology dependence and their quality of life. A review of the literature suggests that children, as well as their family members, are negatively affected by technology dependence in a variety of psychosocial domains. Implications for clinical care and future research of this population are discussed.