Individualized Education Plans: Associations with Care Coordination and Mental Health Service Use

Background: Children with special healthcare needs (CSHCN) often have disabilities that require additional supports to be successful in educational settings. Under United States (US) law, students in public schools whose disabilities interfere with their academic performance and success are eligible for specialized educational supports, organized under an Individualized Educational Plan (IEP). IEPs specify a student’s educational needs and goals, as well as the services, interventions, and accommodations that will be provided by the school to ensure the child meets their learning goals. IEPs can be particularly critical to ensuring school success for students with emotional, behavioral, or developmental disabilities (EBDDs), as they provide a structure for coordination, accountability, and accessibility of services. This study compares rates at which parents report their child having a current IEP for non-CSHCN, CSHCN with no EBDDs, and CSHCN with EBDDs. The association between a child having an IEP in place and their probability of having unmet need for mental health care and care coordination is also assessed.

Methods: Using a retrospective cross-sectional design, this study drew on the National Survey of Children’s Health, pooling data from years 2016-2022. Rates of parent-reported need and unmet need for mental health care, care coordination, and healthcare provider communication with schools or daycares were generated and compared among non-CSHCN, CSHCN with no EBDDs, and CSHCN with EBDDs. Logistic regression with marginal post-estimation, using complex survey weights to reflect state and national probabilities and controlling for sociodemographic characteristics, estimated the association of having an IEP and unmet need for mental health care, care coordination, and health care provider communication with school/childcare providers.

Findings: More than half of caregivers for CSHCN with EBDDs reported their child had a current IEP (55%), compared to 24% of caregivers for CSHCN with no EBDDs and 7% of caregivers for non-CSHCN. Having an IEP was not significantly associated with having adequate care coordination or having mental health needs met for any CSHCN. However, non-CSHCN with an IEP had significantly lower rates of unmet mental health needs (-0.04 percentage points). For all children, having an IEP was significantly associated with higher probability of reporting adequate provider-school communication, with values ranging from 13, 14 to 15 percentage points higher for non-CSHCN with IEPs, CSHCN with no EBDDs with IEPs, and CSHCN with EBDDs with IEPs, respectively.

Conclusion: Having an IEP is associated with significantly increased probability of caregivers reporting adequate healthcare provider-school communication. Because provider-school communication is a component of care coordination, the role of IEPs in successful care coordination outcomes should be studied further. Practice implications include the possibility of leveraging IEP meetings as touchpoints for care coordination across school and health systems that work with students and families. Special education teams may consider including care coordination activities in IEPs to clarify expectations for care coordination. Findings suggest that school staff may need to strengthen support for CSHCN with EDBDs in the IEP context, given that they are most likely to have an IEP but less likely to have reduced unmet mental health needs.