The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #60591

Roberta Scheinmann, MPH¹, Gerry Fairbrother, PhD¹, Melinda J. Dutton, JD², Beth Osthimer, JD², and Rachel Cooper, MA². (1) Division of Health and Science Policy, The New York Academy of Medicine, 1216 Fifth Avenue, New York, NY 10029, 212.822.7200, rscheinmann@nyam.org, (2) Children's Defense Fund, 420 Lexington Avenue Suite 655, New York, NY 10170

Objectives. To examine how Children with Special Health Care Needs (CSHCN) with mental health problems differ from other CSHCN in measures of their utilization of health services and unmet needs for health services.

Methods. A cross-sectional random-digit dial survey of parents of publicly insured or uninsured children was conducted in New York City in 2002/2003. Questions about access to and use of medical care were asked about a focal child.

Results. Of the 998 respondents, 22% (n=223) identified their child as a CSHCN using the standard tool developed by FACCT. Of the 223 CSHCN children, 30% had an emotional problem that was expected to last more than one year. Children with emotional or behavioral problems were less likely than other CSHCN [35% vs. 57%; p=.008] to have been to a doctor for acute care in the past 12 months and also less likely to have had a well-child checkup [68% vs. 81%; p=.06]. They were more likely to have seen a mental health professional in the past year [54% vs. 7%; p=.000] and were more likely to have delayed or gone without mental health care [19% vs. 2%; p=.000]. Among the problems these children and their families face in getting care compared to the other CSHCN were cost of care [19% vs. 9 %; p=.04] and not knowing where to go for care [23% vs. 11%; p=.05].

Conclusions. CSHCN with emotional problems, regardless of insurance status, experience greater health access difficulties than other CSHCN. Public insurance has gaps in coverage for key services, such as mental health care. Public coverage needs to be expanded in order to effectively pay for and link these CSHCN with care.

Learning Objectives:

At the end of the presentation, the audience will be able to: (
• describe differences in utilization of services by CSHCN with mental health problems compared to other CSHCN (
• understand how these differences relate to public insurance coverage.

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.