Bridging Disciplinary Boundaries (January 11 - 14, 2007)

Obtaining appropriate and adequate health and mental health services for children can be a difficult if not an impossible task for many American families even those with health insurance. An unmet need for mental health services can be debilitating particularly for children with special health care needs. Nearly 13% of U.S. children, or 9.4 million children, have special health care needs. Twenty-five percent of children with special health care needs (CSHCN) were reported to need mental health care and nearly 5% of those did not receive the services. The only other service more commonly reported as needed but not obtained was dental care (U.S. Department of Health and Human Services, 2004).

Using data (N=38,866) collected as part of the National Survey of Children with Special Health Care Needs (NSCSHCN) this study examined 1) the bivariate and multivariate associations between insurance status and type of health insurance (private vs. public) on the prevalence of unmet mental health needs and 2) the bivariate and multivariate associations between insurance status and type of health insurance and the parent reported reasons for unmet need.

This study conducted secondary data analysis using the 2001 NSCSHCN on only those children identified as using or needing the use of treatment or counseling for an emotional, developmental, or behavioral problem that has lasted or is expected to last longer than 12 months (n=13,915). Binary and multinomial logistic regression was used to analyze the data.

Findings indicate that children covered by public health insurance programs (Medicaid, State Children's Health Insurance Program, Title V) have fewer unmet mental health needs than children covered by private health insurance plans with uninsured children the most vulnerable to unmet mental health needs. Older children, and minority children are more at risk for unmet mental health needs than younger white children. Findings indicate a relationship between type of health insurance and parent reported reasons for unmet mental health needs with parents of children covered by private health plans reporting problems with health plans as the primary reason for unmet mental health needs while parents of children covered by public health insurance programs report problems finding a provider, and getting a referral as the primary reasons for unmet need.

Policy implications include the importance of extending health insurance coverage to uninsured children and achieving parity of coverage for mental health benefits in private health insurance plans. Social workers could play an essential role in providing information about enrollment into public health insurance programs available to families in a variety of practice settings. Social workers may also assist in the coordination of care for children with special health care needs which is of vital importance since they often interact in frequent and complex ways with the health care system.

Reference: U.S. Department of Health and Human Services, H. R.S. A., Maternal and Child Health Bureau. (2004). The national survey of children with special health care needs chartbook 2001. Rockville, Maryland: U.S. Department of Health and Human Services.