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The Medical Home Clinic for Special Needs Children (MHCL) at Arkansas Children's Hospital provides comprehensive care oversight for children with medical complexity (CMC). The objective of this study is to [...]

Introduction Attention-deficit disorder and Attention-Deficit Hyperactivity Disorder (ADHD) are among the most commonly diagnosed neurobehavioral disorders in childhood [1]. Approximately 9.5% of children ages 4-17 have been diagnosed with ADHD [...], Providing a medical home to children with Attention-Deficit Hyperactivity Disorder (ADHD) is challenging. Little is known about the factors associated with having a medical home for these children, or how comorbidities affect having a medical home. Our study aims are: (1) identify factors associated with having a medical home and five sub-components of a medical home and (2) determine the effect of medical home on several outcomes for children with ADHD. The sample included 5,495 children with ADHD from the 2007 National Survey of Children&apos;s Health. Descriptive and multivariate analyses were conducted. Children with ADHD alone and children with ADHD plus a physical diagnosis had greater frequencies of having a medical home, or meeting the five sub-components, than children with ADHD plus a mental diagnosis. Multivariate results show that children with ADHD plus a physical and/or mental comorbidity were 24-63% more likely to be without a medical home compared to children with only ADHD. Having a medical home also had a bearing on several child health outcomes. Having a medical home was significantly associated with being less likely to have an unmet health need and having fewer missed school days; but also being less likely to have received needed mental health care (P < .05). Our results suggest that there are differences in parent&apos;s perceptions of receiving care among children with ADHD. Pediatric medical home projects and policies should acknowledge that children with ADHD often have comorbidities making their care more complex. These complexities should be addressed during practice transformation and setting reimbursement policies. Keywords ADHD * Medical home * Child health outcomes * Comorbidities * Survey

Introduction Injuries are under-recognized causes of death and disability for children worldwide [1, 2]. In the US, child injury deaths are usually the result of traffic-related accidents, highest for males, [...], 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. Keywords Child welfare * Child protective services * Child injuries * Child maltreatment * Child abuse and neglect

Introduction For children in the United States (US), stable health insurance coverage guarantees better 'financial access' to care; [1-4] even short coverage gaps are associated with unmet needs [5]. Recent [...], We employed a mixed-methods study of primary data from a statewide household survey and in-person interviews with parents to examine--quantitatively and qualitatively--whether low-income children experienced differences between public and private insurance coverage types. We carried out 24 in-depth interviews with a sub-sample of respondents to Oregon&apos;s 2005 Children&apos;s Access to Healthcare Study (CAHS), analyzed using a standard iterative process and immersion/crystallization cycles. Qualitative findings guided quantitative analyses of CAHS data that assessed associations between insurance type and parental-reported unmet children&apos;s health care needs. Interviewees uniformly reported that stable health insurance was important, but there was no consensus regarding which type was superior. Quantitatively, there were only a few significant differences. Cross-sectionally, compared with private coverage, public coverage was associated with higher odds of unmet specialty care needs (odds ratio [OR] 3.54; 95% confidence interval [CI] 1.52-8.24). Comparing full-year coverage patterns, those with public coverage had lower odds of unmet prescription needs (OR 0.60, 95% CI 0.36-0.99) and unmet mental health counseling needs (OR 0.24, 95% CI 0.10-0.63), compared with privately covered children. Low-income Oregon parents reported few differences in their child&apos;s experience with private versus public coverage. Keywords Child health insurance * Child access to care * Medicaid * CHIP * Health services research * Health policy * Health care disparities

Introduction The recent debates over the reauthorizations of the State Children's Health Insurance Program (SCHIP) have refocused the national spotlight on children without health insurance coverage [1-4]. Of the estimated [...], Millions of US children have unstable health insurance coverage. Some of these uninsured children have parents with stable coverage. We examined whether household income was associated with longer coverage gaps among US children with at least one insured parent. A secondary data analysis of the nationally-representative 2004 Medical Expenditure Panel Survey, this study uses logistic regression models to examine the association between income and children&apos;s insurance gaps. We focused on children with at least one parent insured all year (n = 6,151; estimated weighted N = 53.5 million). In multivariate models, children from families earning between 125 and 400% of the federal poverty level (FPL) had twice the odds of experiencing coverage gaps > 6 months, as compared to those from high income families. Children in the poorest income groups (< 125% FPL) did not have significantly greater odds of a gap > 6 months. However, the odds of a gap [less than or equal to] 6 months were significantly greater for all income groups below 400% FPL, when compared to the highest income group. Among children with continuously insured parents, those from lower middle income families were most vulnerable to experiencing coverage gaps > 6 months, as compared to those from the lowest and highest income families. These findings are likely due to middle class earnings being too high to qualify for public insurance but not high enough to afford private coverage. This study highlights the need for new US health care financing models that give everyone in the family the best chance to obtain stable coverage. It also provides valuable information to other countries with employer-sponsored insurance models or those considering privatization of insurance payment systems and how this might disproportionately impact the middle class. Keywords Child health * Health insurance * Discontinuous health insurance coverage * Access to healthcare * Medicaid * SCHIP * Health policy

Introduction Our nation's children with special health care needs (CSHCN)--hose children with chronic conditions requiring an inordinate amount of health care and health-related services--ace a number of barriers to receiving [...], Objectives To assess the effectiveness of the Maternal and Child Health Bureau&apos;s (MCHB) Six Core Outcomes for children with special health care needs (CSHCN) as indicators in measuring the degree to which mental health care needs are met. Methods This study analyzes data from the 2001 National Survey of Children with Special Health Care Needs for 9,748 CSHCN who needed mental health care. Bivariate and logistic analyses were employed to investigate the impact of the MCHB&apos;s Six Core Outcomes on the probability of having an unmet need for mental health services. Results Of the 2.3 million CSHCN in the U.S. who needed mental health care in 2001, almost one-fifth did not receive all of the mental health services that they needed. Ultimately, eight Outcomes and sub-categories of Outcomes were considered. Sixty-one percent of CSHCN with a need for mental health care had care that fulfills six of the eight considered Outcomes. Logistic analysis indicates that individual fulfillment of each of the Core Outcomes and fulfillment of additional Outcomes have a significant association with reducing the probability of having an unmet mental health care need for CSHCN. Conclusions This study is the first attempt to apply the Six Core Outcomes to meeting the needs for mental health care among CSHCN. Estimates of unmet need for mental health care suggest that efforts can be made to improve access for CSHCN. The initial estimates generated by this study indicate that the MCHB Outcomes are important in meeting children&apos;s mental health needs and are important indicators for informing MCHB policy. Keywords Children with special health care needs * Children * Access * Medical home * Mental health * Maternal and Child Health Bureau

Abstract Recent research indicates that the statistical properties of the input have an impact on the prosodic shape of young children's word production. However, it is still not clear whether [...]