title: Health status and access to care for children with special health care needs.
abstract: BACKGROUND
  About 11-14% of children with special health care needs (CSHCN) have unmet needs during a given year. Little is known about the determinants of unmet health care needs for CSHCN.
  
  
  OBJECTIVE
  The objective of this study was to explore the association between access to care (unmet needs) among CSHCN and their caregivers' mental health status as well as children's mental health status.
  
  
  METHODS
  We surveyed a random sample of 1,088 caregivers of CSHCN who resided in the District of Columbia during the summer and fall of 2002. In the survey, we collected information on children's unmet needs mental health status (PARS) and their caregivers' mental health status (CES-D). We estimated the association between mental health status determinants of unmet needs adjusting for selection bias associated with plan choice (partially capitated managed care versus FFS) with an instrumental variables probit estimation technique. We used caregivers' preferences about physicians and hospitals networks, and whether the caregiver and child had the same last name to identify the plan choice equation.
  
  
  RESULTS
  We found that caregivers with symptoms of depression were 26.3% more likely to report any unmet need, 67.6% more likely to report unmet hospital and physician need, 66.1% more likely to report unmet mental health care need and 38.8% more likely to report unmet need for other health care services. Caregivers of children with poor psychological adjustment were 26.3% more likely to report their child had an unmet need and 92.3% more likely to report an unmet mental health care need.
  
  
  CONCLUSIONS
  Our analyses show that children whose caregivers experience symptoms of depression are significantly more likely to encounter difficulties obtaining needed medical and mental health care services. Furthermore, the findings reported here indicate that children with poor psychological adjustment are significantly more likely to experience unmet needs for medical and mental health care services. Our study has some limitations. First, most of the children in our sample are African-American, so these findings may differ for children of other races. Second, these findings may not be applicable to CSHCN who reside in rural areas. Third, we recognize the possibility that child and caregiver mental health is potentially endogenous.
  
  
  CONCLUSIONS
  The mental health status of CSHCN and their caregivers are barriers to care.
  
  
  CONCLUSIONS
  Policymakers should be concerned about the mental health status of children with special health care needs and their caregivers as such problems appear to be barriers to obtaining care. Therefore, to adequately address the access problems of children with special health care needs, policy must address the mental health problems of children and their caregivers. Providing mental health care for caregivers and children has the potential for improving overall access for CSHCN.
  
  
  CONCLUSIONS
  Future research should determine the causal relationship between mental health problems of CSHCN and their caregivers and the level unmet health care needs.
authors.affiliation: Center for Health Disparities Solutions, Department of Health Policy and Management, Johns Hopkins Bloomberg, School of Public Health, 624 North Broadway, Room 441, Baltimore, MD 21205, USA. dgaskin@jhsph.edu
authors.forename: Darrell J
authors.initials: DJ
authors.lastname: Gaskin
authors.forename: Jean M
authors.initials: JM
authors.lastname: Mitchell
mesh_terms: D000293:Adolescent; D002204:Capitation Fee; D017028:Caregivers / Q000706:statistics & numerical data*; D002648:Child; D002662:Child Health Services / Q000600:supply & distribution; D002675:Child, Preschool; D003866:Depressive Disorder / Q000175:diagnosis; D019988:Children with Disabilities / Q000523:psychology / Q000706:statistics & numerical data*; D004219:District of Columbia; D018588:Fee-for-Service Plans / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006304:Health Status; D006801:Humans; D008297:Male; D008329:Managed Care Programs / Q000706:statistics & numerical data; D008605:Mental Health Services / Q000600:supply & distribution