title: Social Work Services Utilization by Children with Medical Complexity.
abstract: OBJECTIVE
  Children with medical complexity (CMC) are a growing population in pediatric primary care practices, and families caring for these children face increased medical, developmental, education and social needs. The objective of this study was to quantify hospital-wide social work services utilization by CMC compared to non-medically-complex children (non-CMC) to inform the development of family-centered care models that support these vulnerable patients and families.
  
  
  METHODS
  Social work department records from a tertiary children's hospital were used to compare CMC aged 0-17 (n = 564) with age- and sex-matched non-CMC (n = 1128) over a 16-month retrospective period. The main outcomes measures were the proportion of patients who used social work services and mean number of hours of services provided per patient, both by social work providers in the primary care setting and throughout the hospital.
  
  
  RESULTS
  A greater percentage of CMC used social work services than non-CMC (60.3 vs. 18.9%), and CMC used more hours per child (5.50 h/child vs. 0.69). In multivariate analysis, medical complexity was associated with 6.23-fold greater odds of using social work services (95% CI 4.94-7.85) and with 8.07 times more hours of services per child (95% CI 6.30-10.34), independent of primary health insurance, age, or sex.
  
  
  CONCLUSIONS
  This study confirms that CMC use significantly more social work services in the medical setting. This must be considered when designing proactive medical home models to provide high quality family-centered care for this population, and further research is needed to elucidate the factors that drive this utilization.
authors.affiliation: Division of General Pediatrics, Department of Medicine, Children's Hospital Primary Care Center, Boston Children's Hospital, 300 Longwood Avenue, Hunnewell Ground Floor, Boston, MA, 02115, USA. madeline.coquillette@childrens.harvard.edu.
authors.forename: Madeline
authors.initials: M
authors.lastname: Coquillette
authors.affiliation: Division of General Pediatrics, Department of Medicine, Children's Hospital Primary Care Center, Boston Children's Hospital, 300 Longwood Avenue, Hunnewell Ground Floor, Boston, MA, 02115, USA. joanne.cox@childrens.harvard.edu.
authors.forename: Joanne E
authors.initials: JE
authors.lastname: Cox
authors.affiliation: Division of General Pediatrics, Department of Medicine, Children's Hospital Primary Care Center, Boston Children's Hospital, 300 Longwood Avenue, Hunnewell Ground Floor, Boston, MA, 02115, USA. sara.cheek@childrens.harvard.edu.
authors.forename: Sara
authors.initials: S
authors.lastname: Cheek
authors.affiliation: Division of General Pediatrics, Department of Medicine, Children's Hospital Primary Care Center, Boston Children's Hospital, 300 Longwood Avenue, Hunnewell Ground Floor, Boston, MA, 02115, USA. romiwebster@gmail.com.
authors.forename: Romi A
authors.initials: RA
authors.lastname: Webster
mesh_terms: D000293:Adolescent; D002648:Child; D002662:Child Health Services / Q000706:statistics & numerical data*; D002675:Child, Preschool; D019988:Children with Disabilities / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012947:Social Work
keywords: Children with special health care needs; Medical complexity; Medical home; Primary care; Social work