Maternal Psychotic Disorders and Pediatric Well-Child Care: Medicaid-Insured Families In Pennsylvania

Background and Purpose: More than two-thirds of women who meet the criteria for a psychiatric disorder are parents. While studies have found that women with serious mental illness typically utilize less preventive and prenatal health services for themselves – often a precursor of inadequate preventive pediatric health care use in the general population – the existing research on the association between maternal mental health and pediatric health care use is limited and inconsistent. Well-child visits are particularly important during infancy and early childhood development as they include developmental and family psychosocial assessments and preventive care (e.g. immunizations, nutrition, and injury/violence prevention). Using the Andersen Behavioral Model of Health Services Use as a conceptual framework, we examined the extent to which mothers with and without a psychotic disorder (e.g. schizophrenia, bipolar disorder with psychotic features) differed on compliance with pediatric well-child care.

Methods: This study was retrospective analysis of Medicaid claims data for the Commonwealth of Pennsylvania, using a robust set of independent variables corresponding to predisposing (e.g. race), enabling (e.g. poverty level), and need factors (e.g. complex chronic conditions) along with dependent variables based on rigorously defined quality of care standards for pediatric care, comparing age-specific cohorts of children whose low-income mothers had been treated for a psychotic disorder with children whose mothers had not been treated for a mental illness. Using five years of Medicaid data, multivariate regression analysis examined compliance with well-child care guidelines by maternal mental health status, controlling for predisposing, enabling, and need factors.

Results: Our multivariate analysis found few significant differences between the groups, with the exception of compliance with well-child care for children ages 1-2; in this age group, mothers with a psychotic disorder were significantly more likely (1.27, AOR 1.10-1.47, p<.001) to be compliant than mothers without a mental illness. However, compliance rates were quite low – ranging from 21.7%-36.0% across the ages – for both groups of mothers.

Conclusions and Implications: Results indicate that mothers with a psychotic disorder display patterns of preventive pediatric health care that are similar, if not better, than mothers without a mental illness, suggesting a real strength in this area of parenting. Still, regardless of maternal mental health, Medicaid-insured families in Pennsylvania have suboptimal rates of well-child compliance despite having health insurance coverage. Given that early childhood is a crucial developmental period when children have more recommended preventive visits than in later childhood; and are less likely to be in school or childcare, limiting their exposure to guidance or intervention outside of their immediate family, the social work field needs to identify non-traditional opportunities to intervene with these families. Macro and micro social work strategies to promote greater adherence to recommended levels of preventive pediatric health care for all Medicaid-eligible families have the potential to improve the health and well-being of these families.