Family-centered care for US children with special health care needs: who gets it and why? 2010

Tumaini R Coker, and Michael A Rodriguez, and Glenn Flores
Department of Pediatrics, Mattel Children's Hospital, University of California, Los Angeles, CA, USA. tcoker@mednet.ucla.edu

OBJECTIVE The goal was to examine racial/ethnic and language disparities in family-centered care (FCC) and in FCC components for children with special health care needs (CSHCN). METHODS Bivariate and multivariate logistic regression analyses of data from the 2005-2006 National Survey of CSHCN were performed. RESULTS A total of 66% of CSHCN with a health visit in the past year received FCC. In adjusted analyses, we found lower odds of FCC for Latino (odds ratio: 0.53 [95% confidence interval: 0.45-0.63]), African-American (odds ratio: 0.60 [95% confidence interval: 0.52-0.69]), and other (odds ratio: 0.58 [95% confidence interval: 0.43-0.78]) children, compared with white children, and for children in households with a non-English primary language (odds ratio: 0.48 [95% confidence interval: 0.36-0.64]), compared with those in households with English as the primary language. These disparities persisted after adjustment for child health (condition severity and emotional, behavioral, and developmental needs), socioeconomic (poverty level, parental education, household composition, and residing in a metropolitan statistical area), and access (insurance type, usual source of care, and having a personal physician) factors. Of these factors, only condition severity was significantly associated with the racial/ethnic disparities; none was significantly associated with the language disparities. Disparities were found for Latino and African-American children and children in households with a non-English primary language for the FCC components of time spent with the provider and sensitivity to the family's values and customs. CONCLUSIONS Robust FCC racial/ethnic and language disparities exist for CSHCN; initial efforts to address these disparities should focus on increasing provider time and cultural sensitivity.

UI MeSH Term Description Entries
D007223 Infant A child between 1 and 23 months of age. Infants
D008297 Male Males
D008913 Minority Groups A subgroup having special characteristics within a larger group, often bound together by special ties which distinguish it from the larger group. Group, Minority,Groups, Minority,Minority Group
D002648 Child A person 6 to 12 years of age. An individual 2 to 5 years old is CHILD, PRESCHOOL. Children
D002669 Child Welfare Organized efforts by communities or organizations to improve the health and well-being of the child. Adolescent Welfare,Welfare, Adolescent,Welfare, Child
D002675 Child, Preschool A child between the ages of 2 and 5. Children, Preschool,Preschool Child,Preschool Children
D005006 Ethnicity A group of people with a common cultural heritage that sets them apart from others in a variety of social relationships. Ethnic Groups,Nationality,Ethnic Group,Nationalities
D005192 Family Health The health status of the family as a unit including the impact of the health of one member of the family on the family as a unit and on individual family members; also, the impact of family organization or disorganization on the health status of its members. Health, Family
D005260 Female Females
D006301 Health Services Needs and Demand Health services required by a population or community as well as the health services that the population or community is able and willing to pay for. Health Services Needs,Needs,Needs and Demand, Health Services,Target Population,Health Services Need,Need, Health Services,Needs, Health Services,Population, Target,Populations, Target,Target Populations

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