Moreover, the study found differences by age, race/ethnicity and insurance coverage that suggest inequalities nationwide in access to treatment, underidentification of need and substantial variability in the mental health treatment for children with disabilities.
According to Whitney P. Witt, assistant professor of medicine and researcher at the Center for Healthcare Studies at the Feinberg School of Medicine at Northwestern University, receipt of mental healthcare services was most strongly related to children's poor psychosocial adjustment; communication and social and learning-related functional impairments; public health insurance; and financial family burdens.
The study by Witt and co-investigators, published in a recent issue of the journal Health Services Research, also found that younger and disabled black children were even less likely to receive mental health services. However, all children were more likely to use care if a health professional was involved in coordinating care, in contrast to no one or family only.
Children with disabilities were more likely to receive outpatient mental health services if their care was jointly coordinated by a family member and a health professional, compared to a health professional working alone. In contrast to inpatient and outpatient care, race and family burden were not associated with the likelihood of mental health counseling in special education school settings.
Witt and colleagues noted that, as medical advances allow more children to survive birth defects or chronic diseases, concern has shifted from their survival to their quality of life. Previous research found that children with special health needs and their families are at increased risk for psychological disorders and therefore may have an elevated need for mental healthcare. But most of those studies were small and may not have been broadly representative of the U.S. population.
"Our study found, for the first time, that the involvement of a health professional in care coordination may play an important role in improving access to mental health care for this vulnerable group of children with disabilities," said Witt, who led the study.
"Ensuring that health professionals and families are engaged in the management of the child's care could make a significant difference in gaining access to specialized mental health services," Witt said.
The study analyzed information from the National Health Interview Survey, an annual survey of households across the country conducted by the National Center for Health Statistics (NCHS). Because the 1994 and 1995 surveys contained special sections addressing disability among household members, particularly children, information from both years was used for this study.
The researchers gathered information on more than 4,900 children aged 6 to 17 who, according to NCHS criteria, were identified as having a disability. About 11 percent of the disabled children were described as having psychosocial problems, such as anxiety or depression, hostility or poor interaction with their peers.
Witt's co-authors on the study were Judith D. Kasper and Anne Riley, Bloomberg School of Public Health, Johns Hopkins University, Baltimore.
The study was supported by grants from the U.S. Agency for Healthcare Research and Quality.
KEYWORDS: disabled children, psychosocial, mental healthcare, special needs
Journal
Health Services Research