title: The medical home as a mediator of the relation between mental health symptoms and family burden among children with special health care needs.
abstract: OBJECTIVE
  This study explores the role of medical home as a mediator of the relationship between emotional and behavioral difficulties among CSHCN and financial- and employment-related burden experienced by their families.
  
  
  METHODS
  Data were obtained from the 2005-2006 NS-CSHCN, a nationally representative cross-sectional survey of 40 465 CSHCN. Family burden was measured using parent-reported financial problems and changes in family member employment resulting from the child's needs. Emotional and behavioral symptoms were reported by parents using 3 binary items capturing difficulty with depression, anxiety, disordered eating, and emotional or behavior problems. Medical home was measured according to the framework of the American Academy of Pediatrics. Bivariate and multivariate analyses were used to explore the role of medical home in the relation between mental health symptoms and family burden.
  
  
  RESULTS
  A smaller proportion of CSHCN with emotional or behavioral difficulties had a medical home or related components compared to CSHCN generally, and a greater proportion of their families experienced burdens. Multivariate analyses showed that the mediated effect of care coordination on the relation between emotional or behavioral symptoms and family burden explained 18% to 35% of the total effect of these symptoms on financial problems and employment changes. Overall medical home access explained 16% to 28% of the total effect of symptoms on burden.
  
  
  CONCLUSIONS
  Medical home access, and care coordination in particular, may partially mediate the relation between emotional and behavioral symptoms and financial hardship. Future efforts to implement the medical home model may benefit from an increased focus on care coordination as a means of reducing these burdens.
authors.affiliation: Office of Epidemiology, Policy and Evaluation, Maternal and Child Health Bureau, Health Resources and Services Administration, Rockville, Maryland 20857, USA. rghandour@hrsa.gov
authors.forename: Reem M
authors.initials: RM
authors.lastname: Ghandour
authors.forename: Deborah F
authors.initials: DF
authors.lastname: Perry
authors.forename: Michael D
authors.initials: MD
authors.lastname: Kogan
authors.forename: Bonnie B
authors.initials: BB
authors.lastname: Strickland
mesh_terms: D000293:Adolescent; D016009:Chi-Square Distribution; D002675:Child, Preschool; D003266:Continuity of Patient Care / Q000458:organization & administration*; D003430:Cross-Sectional Studies; D019988:Children with Disabilities; D004651:Employment / Q000706:statistics & numerical data; D005192:Family Health; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data; D006301:Health Services Needs and Demand; D006306:Health Surveys; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology*; D012307:Risk Factors; D014481:United States / Q000453:epidemiology