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Children's Health

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Some low-income parents do not recognize mental health problems and service needs of children with special health care needs

Over one-third of children with special health care needs (CSHCN) have a mental health problem, but only one-quarter of caregivers recognize the need for mental health services, according to a recent study supported in part by the Child Health Insurance Research Initiative (CHIRI™). CSHCN comprise approximately 13 to 17 percent of all children in the United States.

CSHCN who are from low-income families and those who are members of a racial/ethnic minority group have higher rates of mental health problems, yet they are less likely than their counterparts to receive mental health services. Ensuring that these children receive early diagnosis and treatment for mental health problems depends, in part, on the parents recognizing that their child has a mental health need and identifying, accessing, and accepting services.

Researchers surveyed caregivers who were seeking primary health care services for their Medicaid-enrolled children in six urban Midwestern community health centers, to determine the prevalence of mental health problems among CSHCN and caregiver perceptions. The study found that among the caregivers seeking health care services, 30 percent had a child with a special health care need, a significantly higher prevalence than among the general population. Using the Child Behavior Checklist (CBCL), 38 percent of the CSHCN were determined to have a mental health problem. In contrast, only 26 percent of caregivers reported that their child had a need for mental health services.

The authors conclude that mental health screenings and assessments should be incorporated as a routine part of primary health care practice.

Additional findings can be found in, "Behavioral and mental health problems in low-income children with special health care needs (CSHCN)" by Janie Canty-Mitchell, Joan K. Austin, Kim Jaffee, and others in the June 2004 Archives of Psychiatric Nursing 18(3), pp. 79-87.

Editor's Note: CHIRI™ is cosponsored by the Agency for Healthcare Research and Quality, The David and Lucile Packard Foundation, and the Health Resources and Services Administration. CHIRI™ provides policymakers with information to help them improve health care access and quality for low-income children. Select to access additional CHIRI™ findings.

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