Community-Based Services: The Gateway to Coordinated Care for Children with Special Healthcare Needs (CHSCN)

Background: Care coordination (CC) is important because Children with Special Healthcare Needs (CSHCN) often have complex needs that require services from a variety providers. Access to these services within the community may be a major factor in CC for CSHCN. Therefore, we examined the relationship between access to community-based services and CC while accounting for potential covariates. Method: The latest version of the NS-CSHCN included questions that addressed insurance coverage, access to services, and CC. Maternal Child Health Bureau (MCHB) Core Outcomes, National Chartbook Indicators, and Stratifiers were used to model the likelihood of CSHCN receiving CC (N=29,845). Results: Odds ratios indicated that access to community-based service systems had the greatest influence on the receiving CC (Exp(B) = 2.92). Those who had adequate insurance (Exp(B) = 1.45) and who were white (as opposed to Hispanic) were also more likely to receive CC(Exp(B) = 1.18). Those who participated in shared decision-making were slightly less likely to receive CC (Exp(B) = .338). Higher out-of-pocket expenses, family financial burden, more hours per week providing care, and greater impact on family work life further decreased the likelihood of CC. Increasing age, nontraditional family structures, public insurance, higher education levels, and residences within metropolitan statistical areas also had negative influences on CC. Conclusion: The results support the need for accessible community-based services for CHSCN in order for care to be coordinated. All stakeholders must address issues related to eligibility, availability, cost, and lack of information which can all limit access to community-based services.

This presentation was given at the American Public Health Association.