Maternal Wellbeing and Children with Special Healthcare Needs: Healthcare Coordination in Health Provider Shortage Areas

The National Survey of Children's Health (NSCH) indicates approximately 18.5% of children under 18 have a special healthcare need. Mothers of children with special healthcare needs (CSHCN) are disproportionately affected by the additional caregiving demands of providing at-home medical care and coordinating out-of-home services resulting in adverse consequences to their wellbeing. The American Academy of Pediatrics has proposed care coordination as an ideal response to cut across subspecialty divisions thereby increasing provider collaboration and access to healthcare specifically for children with complex medical needs. As part of the medical home model pediatric care coordination services have shown to improve the family's experience and treatment quality across the systems of care. Geographic factors such as national Health Professional Shortage Areas (HPSA) and rural communities are identified barriers to care that further contribute to health inequities.

Goals and objectives:

The overall goal of this proposal is to determine the multi-level influence of CSHCN healthcare coordination on maternal health and stress according to sociodemographic and geographic factors. Objectives are: 1) Evaluate the measurement properties of a comprehensive CSHCN severity assessment that includes the prevalence of co-occurring medical behavioral and developmental conditions. 2) Identify existing disparities in the access to care coordination among CSHCN according to child and maternal race/ethnicity and community rurality. 3) Determine the degree to which primary care HPSA and mental health HPSA explains the relationship between care coordination and maternal outcomes. 4) Delineate variation in the impact of care coordination on the relationship between CSHCN severity and maternal outcomes according to the sociodemographic factors child and mother race/ethnicity community rurality or primary care and mental health HPSA. PROPOSED DATA SETS & TARGET POPULATIONS: This study will focus on a target population of CSHCNs using a health equity framework to highlight important factors that contribute to growing health disparities. This will involve merging 2016-2020 NSCH and U.S. HPSA data.

Products:

We will create one of the largest nationally representative samples of child and maternal healthcare data providing a direct response to federal initiatives to standardize and evaluate child healthcare coordination resulting in proposals for care coordination that are community-informed by investigating the effect of care coordination of CSHCN living in rural areas primary care HPSAs and mental health HPSAs. Findings will be distributed widely via two peer-reviewed manuscripts (Families Systems and Health and Maternal and Child Health Journal) and to Maternal Child Health (MCH) professionals via conference presentations. A technical report fact sheet policy brief and press releases will be distributed to MCH policymakers Title V MCH Grantees programs serving CSHCN populations and families.

Evaluation:

A Continuous Quality Improvement framework will be employed to ensure program outcomes are being met according to the anticipated timeline and to maintain the effectiveness of the project. KEY TERMS: Coordination of Services Access to Health Care Health Disparities Medical Home Special Health Care Needs Persons who Live in Rural Areas Infancy (1-12 months) Toddlerhood (13-35 months) Early Childhood (3-5 years) Middle Childhood (6-11 years) Adolescence (12-18 years) Women's Health & Well-being (Parental