title: Disparities in Access to Easy-to-Use Services for Children with Special Health Care Needs.
abstract: OBJECTIVE
  Families, clinicians and policymakers desire improved delivery of health and related services for children with special health care needs (CSHCN). We analyzed factors associated with ease of use in obtaining such services. We also explored what were specific difficulties or delays in receiving services. By examining data from the National Survey of Children with Special Health Care Needs (NS-CSHCN 2009-2010) and using the revised criteria for "ease of use," we were able to assess the percentage of parents who reported that their experiences seeking services for their children met those criteria.
  
  
  METHODS
  We performed Chi square tests to examine associations between the independent variables and their relationship to the difficulties or delays assessed in the survey; including: eligibility, availability of services, waiting lists, cost, and access to information. We used logistic regression to determine the association of meeting the "ease of use" criteria with socio-demographic, complexity of need, and access variables.
  
  
  RESULTS
  Overall, a third of families of CSHCN (35.3 %) encounter difficulties, delays, or frustrations in obtaining health and related services. The lack of access to health and community services in this study fell most heavily on children from racial/ethnic minority backgrounds, those in poverty, and those with complex emotional/behavioral or developmental needs and functional limitations.
  
  
  CONCLUSIONS
  for Practice CSHCN require services from a broad array of providers across multiple systems. Unfortunately, there are certain difficulties that hamper the accessibility of these systems. These findings underscore the need for both practice-level response and systems-level reform to ensure equitable distribution of health and community resources.
authors.affiliation: Institute for Community Inclusion, University of Massachusetts, Boston, 100 Morrissey Blvd., Boston, MA, 02125, USA. myra.rosenreynoso@umb.edu.
authors.forename: Myra
authors.initials: M
authors.lastname: Rosen-Reynoso
authors.affiliation: School of Education, Boston University, Two Silber Way, Boston, MA, 02215, USA.
authors.forename: Michelle V
authors.initials: MV
authors.lastname: Porche
authors.affiliation: Institute for Community Inclusion, University of Massachusetts, Boston, 100 Morrissey Blvd., Boston, MA, 02125, USA.
authors.forename: Ngai
authors.initials: N
authors.lastname: Kwan
authors.affiliation: Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Christina
authors.initials: C
authors.lastname: Bethell
authors.affiliation: Institute for Community Inclusion, University of Massachusetts, Boston, 100 Morrissey Blvd., Boston, MA, 02125, USA.
authors.forename: Veronica
authors.initials: V
authors.lastname: Thomas
authors.affiliation: Oregon Health and Science University, Portland, OR, USA.
authors.forename: Julie
authors.initials: J
authors.lastname: Robertson
authors.affiliation: Oregon Health and Science University, Portland, OR, USA.
authors.forename: Eva
authors.initials: E
authors.lastname: Hawes
authors.affiliation: Institute for Community Inclusion, University of Massachusetts, Boston, 100 Morrissey Blvd., Boston, MA, 02125, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Foley
authors.affiliation: Children's Hospital Boston, 300 Longwood Avenue, Boston, MA, 02115, USA.
authors.forename: Judith
authors.initials: J
authors.lastname: Palfrey
mesh_terms: D000293:Adolescent; D002648:Child; D002662:Child Health Services / Q000706:statistics & numerical data*; D002675:Child, Preschool; D019988:Children with Disabilities / Q000523:psychology / Q000706:statistics & numerical data*; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D054625:Healthcare Disparities / Q000208:ethnology*; D006801:Humans; D007223:Infant; D008297:Male; D008913:Minority Groups / Q000706:statistics & numerical data; D010290:Parents; D018802:Patient-Centered Care; D012959:Socioeconomic Factors
keywords: Disparities; Medical home; Special-needs children; Survey