The Role of the Medical Home in Accessing Mental Health Care in Children with Special Health Care Needs

This project examines the connections between the mental health care of children with special health care needs (CSHCN) and their participation in a medical home. CSHCN often experience worse mental health and increased need for mental health care compared to children with no SHCN. Mental health concerns are often unrecognized within a primary care setting resulting in untreated conditions. Utilization of a medical home has the potential to increase recognition and treatment of mental health conditions as medical homes have previously been associated with increased access to health care. However the association between provision of care within a medical home and access to mental health services is largely unknown. We will assess the role of the medical home by examining mental health care use and out-of-pocket expenditures reported unmet need for mental health care and reported difficulty in accessing needed mental health care. Furthermore we will examine if the medical home plays a role in ameliorating racial and ethnic disparities in access to mental health care. This project directly responds to MCHB Strategic Research Issue III services and systems that assure quality of care for MCH populations. Under our conceptualization the medical home is the system of care that enables access to mental health services for CSHCN who are a MCH population of interest. This project responds to the call as it relates to MCH Block Grant National Performance Domains HRSA priorities and Healthy People 2020 objectives. Data will come from two national surveys the National Survey of Children's Health (NSCH) 2018 and the Medical Expenditures Panel Survey (MEPS) 2015-2017. Both surveys are nationally representative of non-institutionalized children in the US. Analyses will focus on CHSCN ages 6-17. We will perform multivariable logistic and linear regression to separately examine the association of medical home with four outcomes of interest related to mental healthcare use and access while controlling for confounding variables. Additionally we will examine the potential moderating effect of race and ethnicity on the relationship between medical home and unmet mental health care needs. This is important because CSHCN who are racial and ethnic minorities often receive less and lower quality mental health care. This project will result in three scientific publications documenting the relationship between the medical home and: 1) access to mental health care and out-of-pocket expenditures 2) unmet mental health care needs and access to mental health care and 3) the moderating effect of race and ethnicity on unmet mental health care needs.