Fiscal Year 2002
Research on Children's Health: New Starts
In building on its research on child health, the Agency for Healthcare Research and Quality (AHRQ) funded grants starting in Fiscal Year 2002 that focus on outcomes; quality; and cost, use, and access, AHRQ's three strategic goals.
This fact sheet summarizes AHRQ-funded child and adolescent health care studies focusing on AHRQ's three strategic goals: outcomes; quality and patient safety; and cost, use and access. It also summarizes AHRQ's support for capacity building in research, education, and dissemination.
In Fiscal Year 2002, AHRQ announced support for $16 million over the life of all new intramural and extramural research grants, contracts, and inter-agency agreements.
Barriers to Care for Chronically Ill Vulnerable Children
Principal Investigator: Michael Seid, Children's Hospital Research Center, San Diego, CA
Grant No.: R03 HS13058 (03/01/02-02/28/03)
Description: This project will develop and test a Barriers to Care questionnaire in English and Spanish. The questionnaire will be used to identify and measure modifiable barriers to care that affect the link between vulnerability factors and health care structures, processes, and outcomes for children with special health care needs.
Parenting Effects of Healthy Steps: Health Care Utilization and Expectations for Pediatric Care
Principal Investigator: Cynthia Minkovitz, Johns Hopkins University, Baltimore, MD
Grant No.: R01 HS13086 (05/05/02-04/30/05)
Description: This project will assess whether enhanced delivery of behavioral and developmental services in the first 3 years of life changes parental attitudes and practices when their children reach 5 years of age.
Medical Management of Children with Chronic Conditions
Principal Investigator: Frederick Connell, University of Washington, Seattle, WA
Grant No.: R03 HS13230 (10/01/02-09/30/03)
Description: The aims of this study are to (1) develop an operational definition that can be used with Medicaid claims data to identify a child's medical home, and (2) examine the relationships between demographic factors and disease severity associated with having a medical home. The four chronic conditions to be investigated are asthma, diabetes, cerebral palsy and low-birth weight.
Maternal Depressive Symptoms and Children's Health Care
Principal Investigator: Cynthia Minkovitz, Johns Hopkins University, Baltimore, MD
Grant No.: R03 HS13053 (09/30/02-09/29/03)
Description: The aims of this project are to determine (1) whether maternal depressive symptoms are associated with children's receipt of pediatrics visits, hospitalizations, emergency departments visits, referrals for behavior/developmental concerns and immunizations; (2) whether associations between maternal depressive symptoms and children's receipt of services vary depending on the timing of symptoms; and (3) whether associations between maternal depressive symptoms and children's receipt of services vary depending on participation in the Healthy Steps program.
*Health of Grandparents Raising Their Grandchildren
Principal Investigator: Jan Blustein, New York University, New York, NY
Grant No.: R03 HS11747 (06/01/02-05/31/03)
Description: This study will examine the following issues: (1) What is the impact of grandparents' care-giving on grandparent health status, health behaviors, and health care utilization patterns; (2) How do these impacts differ for grandparents heading households with different family configurations, i.e., split generation and three-generation households; and (3) To what extent can these impacts be mitigated by the availability of tangible and social resources?
*Long-Term Health Care Effects of Domestic Violence
Principal Investigator: Robert Thompson, Center for Health Studies, Seattle, WA
Grant No.: R01 HS10909 (07/09/02-04/30/06)
Description: This study will assess the longitudinal impact of domestic violence on the health care utilization, patterns, costs, and social functioning and health status of female and male victims and their children.
*Time Series Modeling of Trends in Medication Prescribing
Principal Investigator: Randall Stafford, Massachusetts General Hospital, Boston, MA
Grant No.: R01 HS13405 (04/19/02-12/31/04)
Description: The aim of this project is to develop and assess a novel economic model of influence of multiple determinants on trends in medication prescribing for asthma, depression, hypertension, and congestive heart failure.
*Violence and Spinal Cord Injury: Understanding the Rehabilitation Context
Principal Investigator: Thilo Kroll, Medstar Research Institute, Washington, DC.
Grant No.: R03 HS13039 (05/01/02-04/30/03)
Description: The purpose of this qualitative study is to develop an in-depth understanding of the context and consequences of violently-acquired spinal cord injury (VASCI) through an inductive process, and to develop an evaluation plan for VASCI rehabilitation programs that will serve as a template for future program evaluations targeting interventions for vulnerable populations.
Quality and Patient Safety
Evidence-based Selective Referral in VLBW Infants
Principal Investigator: Jeannette Rogowski, Rand Corporation, Santa Monica, CA
Grant No.: R01 HS13371 (09/19/02-08/31/04)
Description: This study will investigate the validity of volume as an indirect quality indicator for neonatal intensive care by evaluating the association between volume and multiple outcomes for very low birth weight infants, including measures of respiratory, infectious, neurological, gastrointestinal and ophthalmological diseases.
Parent-initiated Prevention Program
Principal Investigator: Dimitri A. Christakis, University of Washington, Seattle, WA
Grant No.: R01 HS13302 (09/30/02-09/29/06)
Description: This randomized controlled trial will test a computer-driven, patient-centered expert system to improve the receipt of evidence-based prevention for pediatric patients. The study will assess the effectiveness of a real-time Parent-initiated Prevention Program in changing physicians' delivery of preventive care as well as parental preventive behaviors.
Automated Lab Test Follow-up to Reduce Medical Errors
Principal Investigator: David Greenes, Children's Hospital, Boston, MA
Grant No.: R03 HS11711 (09/30/02-09/29/03)
Description: This project will evaluate the effectiveness of a computerized system, Automated Late-Arriving Results Monitoring System (ALARMS), in an emergency department. ALARMS will gather and generate a list of all late-arriving abnormal laboratory results to improve the rates of follow-up for late-arriving abnormal laboratory results.
Testing a New Measure of Quality of Asthma Care
Principal Investigator: Yvonne Senturia, Jacobi Medical Center, Bronx, NY
Grant No.: R03 HS13081 (09/30/02-12/31/03)
Description: This study will test the feasibility and validity of a new measure of quality of asthma care for poor inner-city children with asthma. The project will also test the Asthma Visit Questionnaire to assess the quality of asthma care in primary care settings.
Quality of Life in Children After Liver Transplantation
Principal Investigator: Estella Alonso, Children's Memorial Hospital, Chicago, IL
Grant No.: R03 HS13270 (09/30/02-09/29/04)
Description: This cross-sectional study will (1) evaluate 150 children aged 12-18 at the 2-year anniversary of their transplant, (2) describe the health-related quality of life of children who survive liver transplantation, and (3) examine the impact of disease severity at transplant and the type of graft received on long-term health related quality of life.
Physician Networks and Children with Chronic Conditions
Principal Investigator: David Grembowski, University of Washington, Seattle, WA
Grant No.: R01 HS13147 (09/30/02-03/31/04)
Description: This study will examine whether out-of-network benefits and cost-sharing of managed health plans are associated with the likelihood of seeing an in-network vs. out-of-network physician, and whether health care quality and expenditures are similar or different for children seeing in- vs. out-of-network physicians.
Principal Investigator: Paul Cleary, Harvard University, Boston, MA
Grant No.: U18 HS09205 (09/30/02-05/31/07)
Principal Investigator: Ronald Hays, RAND, Santa Monica, CA
Grant No.: U18 HS09204 (09/30/02-04/30/07)
Principal Investigator: Steven Garfinkel, American Institute for Research, Washington, D.C
Grant No.: U18 HS13193 (06/24/02-05/31/07)
Description: This project includes development of the pediatric version of the CAHPS® instrument for assessing care at the group practice level and production of refined and tested instruments that will be suitable for a large-scale field test. These cooperative agreements fund a collaborative program of research, development, and evaluation that will advance the state of the field with respect to the design, collection, and use of consumers' assessments of health care for purposes of informing health care choices and improving health care quality.
*The Impact of HMOs on Disparities
Principal Investigator: Kevin Fiscella, University of Rochester, Rochester, NY
Grant No.: R01 HS10910 (09/30/02-09/29/05)
Description: This project will (1) assess the scope and magnitude of racial/ethnic and socioeconomic disparities in HMOs, and (2) develop age, sex, and case-mix adjusted utilization and quality measures. The measures will examine racial/ethnic disparities in preventive care, satisfaction, change in health status, use of expensive hospital-based procedures, and avoidable hospital complications and mortality.
Projects Funded Under the RFA: Partnerships for Quality
This Request for Applications (RFA) sought projects that will collaborate among member organizations to translate research findings into practice and policy with the goal to improve health care services and security, safety, outcomes, quality, effectiveness, and cost-effectiveness. Anticipated funds will support multi-year projects that focus on improving the quality of the health care system's preparedness in the event of a bioterrorist event.
Partnership to Improve Children's Health Care Quality
Principal Investigator: Carole Lannon, National Initiative for Children's Healthcare Quality, Boston, MA
Grant No.: U18 HS13721 (09/30/02-09/29/06)
Description: This project will bring together pediatric organizations to coordinate efforts and resources to support large-scale activities that have been shown to be effective in improving care for children. These partners will engage State American Academy of Pediatrics chapters in evidence-based collaborative learning sessions as well as an interactive Web-based quality improvement tool with the goal of supporting practice changes leading to improved care for children with Attention-Deficit/Hyperactivity Disorder.
Implementing Pediatric Patient Safety Practices
Principal Investigator: Paul Sharek, Child Health Corporation of America, Shawnee Mission, KS
Grant No.: U18 HS 13698 (09/30/02-09/29/06)
Description: This project will plan and support the expansion of a medication error reduction program, identify and collaborate on best practices in pediatric pain management, and implement a pediatric patient-safety best-practices program.
AHRQ Evaluation of the Robert Wood Johnson Foundation/California HealthCare Foundation/National Health Care Purchasing Institute (NHCPI) Rewarding Results Program (RRP)
The NHCPI's RRP is a partnership of foundations, government, business and research communities. The program will seek and test ways to implement the Institute of Medicine's recommendations to reward quality of care.
*Evaluation of the Rewarding Results Program
Principal Investigator: Gary Young, Boston University, Boston, MA
Grant No.: U01 HS13591 (09/30/02-09/29/06)
Description: Under a grant administered by AHRQ, Dr. Young will conduct a comprehensive national evaluation of six projects. Four of the projects being evaluated will address issues relevant to children. They include pediatric access, service and HEDIS scores, and asthma.
Cost, Utilization, and Access
Child Mental Health and Mental Health Service Use
Principal Investigator: Michael Ganz, Harvard University, Boston, MA
Grant No.: R03 HS13047 (04/01/02-09/30/03)
Description: The aims of this project are to examine families' socio-economic status, clinical and insurance correlates of mental health conditions, and related services for children in the U.S.
Disparities in Child & Family Health Care Expenditures
Principal Investigator: Paul Newacheck, University of California, San Francisco, CA
Grant No.: R01 HS11662 (07/01/02-06/30/04)
Description: The aim of this project is to examine the extent to which disparities exist in out-of-pocket health care expenses for children and families, and the role that health insurance plays in reducing or eliminating disparities.
Costs of Care for VLBW Infants
Principal Investigator: Jeannette Rogowski, RAND Corporation, Santa Monica, CA
Grant No.: R03 HS13429 (09/30/02-09/29/03)
Description: This descriptive study will use data from 29 hospitals in the Vermont Oxford Network to examine the costs and cost-effectiveness of care for VLBW infants, and investigate how these costs of care vary with the degree of prematurity. The study will include 13,610 infants with birth weights under 1500 grams.
Dental Access and Costs for Chil dren in a SCHIP Program
Principal Investigator: Peter Damiano, University of Iowa, Iowa City, IA
Grant No.: R03 HS13410 (09/30/02-09/29/04)
Description: The purpose of this study is to determine (1) dental services utilization for children in the Iowa SCHIP and Medicaid programs; (2) factors related to unmet dental need for children; (3) factors related to self-reported unmet dental need for children; and (4) costs associated with providing dental care for children in both programs and whether there is pent-up demand for dental care.
Health Care Access for Children of the Working Poor
Principal Investigator: Sylvia Guendelman, The Regents of the University of California, Berkeley, CA
Grant No.: R03 HS13411 (09/30/02-09/29/03)
Description: This study will analyze data from the California Health Interview Survey to (1) compare access and utilization of health care among working poor children with children in other socioeconomic strata; (2) explore the differences in access and utilization of health care between immigrants and native born children of the working poor; and (3) assess the extent to which expansions in health coverage for working poor parents can improve access and use of health services for their children.
Predictors and Costs of Adolescent Risky Behavior
Principal Investigator: Lise Youngblade, University of Florida, Gainesville, FL
Grant No.: R03 HS13261 (09/30/02-09/29/03)
Description: The aims of this study are to (1) examine the prevalence of risky behaviors and their associated health care utilization and cost patterns in a pool of adolescents enrolled in Title XXI State Children's Health Insurance Program; (2) examine the odds of engaging in risky behavior based on a psycho-social model that specifies predictive domains; and (3) examine the health care use and costs associated with risky behaviors and how these patterns are explained by social-demographic, health, psycho-social and community conditions.
*Impact of Three Tier Prescription Drug Copay on Use and Spending
Principal Investigator: Dominic Hodgkin, Heller School for Social Policy and Management, Waltham, MA
Grant No.: R01 HS013092 (09/16/02-08/31/04)
Description: This study will examine the impact of a three-tier prescription drug copayment program on drug and medical services utilization, expenditures, and therapeutic continuity of care, using enrolled patient cohorts in the Tufts Health Plan, a large HMO in Massachusetts. Part of this study will focus on five specific drug classes. The study of use of asthma and allergy medications and possibly antidepressants will include children.
Methodological Issues in Child-relevant Evidence Syntheses
Principal Investigator: Terry Klassen, University of Alberta, Alberta, Canada
Contract No.: 02R000233 (09/30/02-09/30/03)
Description: The purpose of this project is to develop a report on methodological issues in child-relevant systematic reviews. Questions include whether it is necessary to examine child data in broad, adult-dominant, evidence reviews.
Integrated Delivery System Research Network (IDSRN)
The IDSRN creates, supports, and disseminates scientific evidence about what works and what does not work in terms of data and measurement systems and organizational best practices related to care, delivery, and research diffusion.
Prevalence and Strategies for Appropriate Prescription Medication Dosing in Children
Principal Investigator: Robert Davis, Kaiser Foundation Research Institute, MA and OR
Contract No.: 290-00-0015 (11/01/02-11/30/03)
Description: This project will assess the prevalence of inappropriate prescribing of medication in the ambulatory pediatric setting and the scope and breadth of current strategies to avoid inappropriate prescribing. This project will include an assessment of appropriate medication safety monitoring by recommended laboratory tests (e.g. liver function tests for carbamazepine). The project will also evaluate strategies and make recommendations to minimize outpatient prescription medication errors in children.
Evidence-based Practice Centers (EPCs) Program
The EPCs develop evidence reports and technology assessments on clinical topics that are common, expensive, and/or are significant for the Medicare and Medicaid populations. The following 2002 topics/studies are relevant to children and adolescents:
*Efficacy of Behavioral Interventions to Modify Physical Activity
Principal Investigator: University of Minnesota.
*Economic Incentives: Impact on Use/Outcomes of Preventive Health Services
Principal Investigator: University of Minnesota.
*Cross-Cutting Quality Measures for Cancer Control
Principal Investigator: University of Ottawa.
*Sexuality and Reproductive Health Following Spinal Cord Injury-Phase I Feasibility Study
Principal Investigator: University of Ottawa.
AHRQ supports research for infrastructure development in the field of health services research.
Projects Funded Under RFA: Primary Care Practice-Based Research Networks (PBRNs) III
This RFA sought projects in two categories: (1) development or enhancement of network infrastructure, and (2) exploratory or pilot research projects.
Translating National Pediatric PBRN Research into Practice
Principal Investigator: Eric Slora, American Academy of Pediatrics, El Grove Village, IL
Grant No.: R21 HS13512 (09/30/02-09/29/04)
Description: Pediatric Research in Office Settings (PROS), a national network of over 500 pediatric practices, will (1) develop a Web-based information system for posting of confidential practice-specific feedback reports and enhance minority representation in patient populations served by pediatricians in PROS, and (2) test two different methods for translating research into practice on optimizing rates of pediatric immunizations.
A Pediatric PBRN (Pediatric PitNet) and a Pilot Project
Principal Investigator: Ellen Wald, Children's Hospital of Pittsburgh, Pittsburgh, PA
Grant No.: R21 HS13523 (09/30/02-09/29/04)
Description: This new network of community and university-based pediatricians (Pediatric PitNet) will further develop its network infrastructure and conduct a pilot project to study methods of increasing adherence to recommendations for prevention of unintentional injuries, the most common cause of death and disability in young children.
CUBS: Preventive Services for At Risk Infants
Principal Investigator: Robert Pace, Louisiana State University, New Orleans, LA
Grant No.: R21 HS13562 (09/30/02-09/29/04)
Description: This is a new network created from pediatric practices that have worked together to study the health and development of vulnerable children who previously received care in the Louisiana State University's neonatal intensive care unit. The network will use infrastructure funding to standardize methods of information management and develop a common database adequate to support research.
Continuity Research Network (CORNET)
Principal Investigator: Janet Serwint, Ambulatory Pediatric Association, McLean, VA
Grant No.: R21 HS13582 (09/30/02-09/29/04)
Description: This newly developed national network composed of pediatric practices will assess the health status and quality of care delivered to children belonging to minority and underserved populations, including an examination of health care disparities.
Washington University Pediatric Research Consortium
Principal Investigator: Jane Garbutt, Washington University, St. Louis, MO
Grant No.: R21 HS13530 (09/30/02-09/29/04)
Description: This newly established network of community pediatricians affiliated with Washington University will establish a Web-based communication network to coordinate activities, enhance a computer interviewing system, and implement a faculty development plan to increase expertise among network members.
Enhancement of the Technology Interface for the Cincinnati Pediatric Research Group
Principal Investigator: Thomas DeWitt, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
Grant No.: R21 HS13506 (09/30/02-09/29/04)
Description: This regional network of pediatric providers will develop a system to allow electronic solicitation of data using handheld devices and wireless communications. Since the system will allow a real-time transmission of clinical impressions and symptoms, one of its intended uses is bioterrorism surveillance.
Creating a Primary Care Practice-based Research Network
Principal Investigator: Louis Bell, Children's Hospital of Philadelphia, Philadelphia, PA
Grant No.: R21 HS13492 (09/30/02-09/29/04)
Description: The Children's Hospital of Philadelphia network will develop an information system linking its pediatric practices and create a project committee to assess potential research questions aimed at improving the delivery of primary care to children and families.
Preventive Asthma Care Utilization Among Black Children
Principal Investigator: Andrea Ireland, University of North Carolina-Chapel Hill, Chapel Hill, NC
Grant No.: F31 HS11929 (04/01/02-03/31/06)
Description: The aim of this Predoctoral Award is to explore factors such as health insurance coverage, access to preventive health care, financial resources, and health beliefs that contribute to the disparity in preventive asthma care utilization among African-American children.
Adherence in Children with Cystic Fibrosis and Asthma
Principal Investigator: Avani Modi, University of Florida, Gainesville, FL
Grant No.: F31 HS11768 (03/01/02-11/30/04)
Description: The aims of this Predoctoral Award are to assess the extent of adherence problems in children with cystic fibrosis and asthma, compare patterns of adherence in two pediatric pulmonary populations, and identify key barriers associated with poor adherence.
Doctor-Parent Communication and Antibiotic Over-Prescribing
Principal Investigator: Rita Mangione-Smith, University of California, LA, Los Angeles, CA
Grant No.: K02 HS13299 (09/30/02-09/29/07)
Description: The aim of this Independent Scientist Award is to examine the doctor-parent communication as a determinant of both inappropriate antibiotic prescribing and parent satisfaction with care, and then develop a communication-based intervention to decrease antibiotic over-prescribing in pediatric outpatient settings to improve the quality of patient care.
Shared Decision-Making and Inappropriate Antibiotic Use
Principal Investigator: Elizabeth Cox, University of Wisconsin, Madison, WI
Grant No.: K08 HS13183 (07/01/02-06/30/07)
Description: The aim of this Mentored Clinical Scientist Development Award is to develop and validate an instrument to measure shared decision-making in pediatric primary care, and to improve the quality of care and outcomes for children with upper respiratory infections.
Telemedicine For Children in Rural Emergency Departments
Principal Investigator: James Marcin, University of California, Davis, Davis, CA
Grant No.: K08 HS13179 (07/19/02-06/30/07)
Description: The aim of this Mentored Clinical Scientist Development Award is to determine what impact telemedicine consultations have on the quality and satisfaction of care that critically ill and injured children receive in rural emergency departments.
Informative Technology: Linking Parents and Providers
Principal Investigator: Stephen Porter, Children's Hospital, Boston, MA
Grant No.: K08 HS11660 (07/01/02-06/30/05)
Description: The aims of this Mentored Clinical Scientist Development Award are to (1) develop and test an electronic interface on the basis of user-perceived quality and the capture of valid data for asthma-specific history, and (2) present parent-derived information to providers in the content of current evidence-based guidelines and assess the effects of this electronically-supported collaboration on parents' report of satisfaction and process measures of quality.
Modeling Health Utilization of Medicaid Children
Principal Investigator: David Rein, Georgia State University, Atlanta, GA
Grant No.: R03 HS13286 (09/30/02-02/28/03)
Description: The aim of this Dissertation Award is to predict the health care expenses for the full population of Georgia Medicaid children. Two leading forecasting models will focus on three goals (1) build a better predictive model of health service utilization, (2) address health policy relevant to children with special health care needs, and (3) build upon the theory of the behavioral model of who uses health services and why.
*Improving Health Care Outcomes Among the Homeless
Principal Investigator: Margot Kushel, Regents of the University of California, San Francisco, CA
Grant No.: K08 HS11415 (03/01/02-02/28/07)
Description: The aims of this Mentored Clinical Scientist Development Award are to: (1) examine the effects of different levels of community services (including housing, health care, overall services) for homeless people on hospitalization and emergency department rates of homeless adults and children; (2) examine the cost-effectiveness of case-management as a strategy for improving health outcomes among HIV infected homeless persons; and (3) examine the health care utilization and public costs of a cohort of homeless persons under different policy options: supportive housing and usual care.
*Emergency Department Crowding: Causes and Consequences
Principal Investigator: Brent Asplin, HealthPartners Research Foundation, Minneapolis, MN
Grant No.: K08 HS13007 (03/01/02-02/28/07)
Description: The aim of this Mentored Clinical Scientist Development Award is to determine the availability and time of outpatient appointments for medical and surgical conditions requiring urgent emergency department follow-up care according to insurance status. Project 1 of this study includes children, pregnant women, mentally disabled patients and elderly patients. The study population at ED sites will interact with investigators to complete survey instruments addressing ED crowding and patients' outcomes.
*Ethnography of the Social Ethics of Catholic Health Care
Principal Investigator: Simon Lee, University of California, San Francisco, CA
Grant No.: R03 HS13111 (09/30/02-06/25/02)
Description: This dissertation research project will investigate the role of Catholic religious values in the design of health care policy and service delivery intended for underserved and other vulnerable populations.
Project Funded Under PA for the Minority Research Infrastructure Support Program
The intent of this research infrastructure program is to strengthen the research environments of minority institutions through grant support to develop and/or expand existing capacities for conducting research in all areas of health services.
*Morehouse School of Medicine (MSM) Clinical Faculty Research Training Program
Principal Investigator: Robert Mayberry, Morehouse School of Medicine, Atlanta, GA
Grant No.: R24 HS11617 (09/03/02-09/29/05)
Description: The goal of this project is to strengthen the MSM infrastructure to enhance the capacity of individual faculty members to conduct health services research aimed at improving the quality of health services for African-Americans and vulnerable populations and eliminating racial/ethnic health care disparities. This program will include research on barriers to prenatal care for low socioeconomic women, improving immunization rates for low-income preschool children, and translating prevention research into primary practice.
Faculty Development for General Pediatrics Teaching in Community-Based Settings
AHRQ helps to support the Ambulatory Pediatric Association's (APA) Primary Care Pediatrics Research Awards. This special projects program helps build the field of child health services research. AHRQ supported the following awards:
Barriers to Mental Health Services for Adolescents
Principal Investigator: Cheryl Kodjo, University of Rochester, NY
Description: This project will describe: (1) the prevalence of self-reported depressive symptoms among adolescents; (2) the trends in utilization, perceived barriers to care, and insurance coverage for adolescents; and (3) the association between sociodemographics, severity of depressive symptoms, perceived barriers to health care, and access to psychological counseling.
Treatment of Maternal Depression and the Impact on Children's Use of and Expenditures for Health Care
Principal Investigator: Whitney P. Witt, Massachusetts General Hospital for Children, Boston, MA
Description: This study will determine whether maternal depression increases children's use of and payments for health care services, and if and how maternal mental health care treatment moderates the relationships among maternal depression, adverse child health outcomes, and children's higher health care use and expenditures.