Association between having a medical home and mental health service utilization among u.s. children with a mental health condition, 2007

Background: Mental health problems of U.S. children are prevalent (11%) but often overlooked. Using data from 2007 National Survey of Children's Health, this study examined the association between having a medical home and mental health service utilization. Methods: Analyses were restricted to children ages 2-17 with one of seven mental health conditions (weighted N=9,479, representing 7,372,814 U.S. children). Seven mental health conditions were ADD or ADHD; depression; anxiety problems; behavior or conduct problems; Autism, Asperger's Disorder, pervasive developmental disorder, or other ASDs; any developmental delay that affects the ability to learn; and Tourette syndrome. Several demographic, child, parental, family, and community factors were considered for inclusion in the final logistic regression model. All analyses accounted for the complex design of the survey. Results: Overall, 40% of children had a medical home. Only 46% received mental health services in the past 12 months. Because there was significant interaction between medical home and having a diagnosis of ADD/ADHD (p<.05), the interaction term was included in the final model. Among children with ADD/ADHD, having a medical home was associated with lower odds of receiving mental health services: AOR 0.51 [95% CI 0.37-0.69]. On the other hand, among children without ADD/ADHD, having a medical home was not associated with mental health services use: AOR 0.99 [0.72-1.38]. Conclusions: Our results indicate that there may be a lack of integration between primary care and mental health services, and a lack of availability of mental health services beyond the primary care setting.