TY - JOUR
KW - Adolescent
KW - Chi-Square Distribution
KW - Child, Preschool
KW - Continuity of Patient Care/organization & administration
KW - Cross-Sectional Studies
KW - Disabled Children
KW - Employment/statistics & numerical data
KW - Family Health
KW - Female
KW - Health Expenditures/statistics & numerical data
KW - Health Services Needs and Demand
KW - Health Surveys
KW - Humans
KW - Infant
KW - Logistic Models
KW - Male
KW - Mental Disorders/epidemiology
KW - Risk Factors
KW - United States/epidemiology
AU - R. M. Ghandour
AU - D. F. Perry
AU - M. D. Kogan
AU - B. B. Strickland
A1 - 
AB - OBJECTIVE: This study explores the role of medical home as a mediator of the relationship between emotional and behavioral difficulties among CSHCN and financial- and employment-related burden experienced by their families. METHODS: Data were obtained from the 2005-2006 NS-CSHCN, a nationally representative cross-sectional survey of 40 465 CSHCN. Family burden was measured using parent-reported financial problems and changes in family member employment resulting from the child's needs. Emotional and behavioral symptoms were reported by parents using 3 binary items capturing difficulty with depression, anxiety, disordered eating, and emotional or behavior problems. Medical home was measured according to the framework of the American Academy of Pediatrics. Bivariate and multivariate analyses were used to explore the role of medical home in the relation between mental health symptoms and family burden. RESULTS: A smaller proportion of CSHCN with emotional or behavioral difficulties had a medical home or related components compared to CSHCN generally, and a greater proportion of their families experienced burdens. Multivariate analyses showed that the mediated effect of care coordination on the relation between emotional or behavioral symptoms and family burden explained 18% to 35% of the total effect of these symptoms on financial problems and employment changes. Overall medical home access explained 16% to 28% of the total effect of symptoms on burden. CONCLUSIONS: Medical home access, and care coordination in particular, may partially mediate the relation between emotional and behavioral symptoms and financial hardship. Future efforts to implement the medical home model may benefit from an increased focus on care coordination as a means of reducing these burdens.
BT - Academic pediatrics
C5 - Financing & Sustainability; Medical Home
CP - 2
CY - United States
DO - 10.1016/j.acap.2010.12.015
IS - 2
JF - Academic pediatrics
N2 - OBJECTIVE: This study explores the role of medical home as a mediator of the relationship between emotional and behavioral difficulties among CSHCN and financial- and employment-related burden experienced by their families. METHODS: Data were obtained from the 2005-2006 NS-CSHCN, a nationally representative cross-sectional survey of 40 465 CSHCN. Family burden was measured using parent-reported financial problems and changes in family member employment resulting from the child's needs. Emotional and behavioral symptoms were reported by parents using 3 binary items capturing difficulty with depression, anxiety, disordered eating, and emotional or behavior problems. Medical home was measured according to the framework of the American Academy of Pediatrics. Bivariate and multivariate analyses were used to explore the role of medical home in the relation between mental health symptoms and family burden. RESULTS: A smaller proportion of CSHCN with emotional or behavioral difficulties had a medical home or related components compared to CSHCN generally, and a greater proportion of their families experienced burdens. Multivariate analyses showed that the mediated effect of care coordination on the relation between emotional or behavioral symptoms and family burden explained 18% to 35% of the total effect of these symptoms on financial problems and employment changes. Overall medical home access explained 16% to 28% of the total effect of symptoms on burden. CONCLUSIONS: Medical home access, and care coordination in particular, may partially mediate the relation between emotional and behavioral symptoms and financial hardship. Future efforts to implement the medical home model may benefit from an increased focus on care coordination as a means of reducing these burdens.
PP - United States
PY - 2011
SN - 1876-2867
SP - 161
EP - 169
EP - 
T1 - The medical home as a mediator of the relation between mental health symptoms and family burden among children with special health care needs
T2 - Academic pediatrics
TI - The medical home as a mediator of the relation between mental health symptoms and family burden among children with special health care needs
U1 - Financing & Sustainability; Medical Home
U2 - 21306969
U3 - 10.1016/j.acap.2010.12.015
VL - 11
VO - 1876-2867
Y1 - 2011
ER -