Patterns of medical, educational, and mental health service use in a national sample of US children.
BACKGROUND
Special services are provided to children by the medical, educational, and mental health service systems, but it is unknown whether the same group of children receives different types of services or whether discrete subgroups predominantly receive these services.


OBJECTIVE
To determine the proportions of children who receive special medical, educational, and mental health services, individually and in combination.


METHODS
Using data from the 1994 National Health Interview Survey (NHIS) and its concurrent Disability Supplement (NHIS-D), we determined the proportions of children under age 18 (N = 30 032) who received each of 3 types of special services (medical, educational, mental health). We also examined the proportions of children who used combinations of these services. Finally, we determined whether the patterns of service use differed across age, sex, socioeconomic, or racial/ethnic groups.


RESULTS
Overall, 9.6% of children used some type of special services. Somewhat greater proportions of children used specialized health services (5.5%) or educational services (5%) than mental health services (1.5%). About one third of children receiving services in each of the special medical and educational sectors are users of another type of services as well, but among children receiving mental health services, the majority also are recipients of another type of services. Highest rates of overall service use and of use in all 3 sectors were found among subgroups of children who were elementary school-aged or adolescents, male, of white non-Hispanic race/ethnicity, and living below the federal poverty level. This pattern is consistent with the literature on service utilization within the 3 systems of care and with the greater prevalence of children with chronic conditions in these same subgroups.


CONCLUSIONS
These findings underscore the importance of communication in the planning of services for children across the medical, educational, and mental health sectors. Further research is needed to assess the actual degree of overlap among the various systems providing this care and the degree to which children and their families would benefit from more integrated systems.
Stein
Ruth E K
RE
Department of Pediatrics, Albert Einstein College of Medicine/Children's Hospital at Montefiore, Bronx, NY 10467, USA. Rstein@aecom.yu.edu
Silver
Ellen Johnson
EJ
D000293:Adolescent; D002648:Child; D002662:Child Health Services / Q000706:statistics & numerical data*; D004519:Education, Special / Q000458:organization & administration* / Q000706:statistics & numerical data; D015981:Epidemiologic Factors; D005006:Ethnicity; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data*; D044469:Racial Groups; D012959:Socioeconomic Factors; D014481:United States