Abstract
Objectives
Children with medical complexity (CMC) are a growing population in pediatric primary care practices, and families caring for these children face increased medical, developmental, education and social needs. The objective of this study was to quantify hospital-wide social work services utilization by CMC compared to non-medically-complex children (non-CMC) to inform the development of family-centered care models that support these vulnerable patients and families.
Methods
Social work department records from a tertiary children’s hospital were used to compare CMC aged 0–17 (n = 564) with age- and sex-matched non-CMC (n = 1128) over a 16-month retrospective period. The main outcomes measures were the proportion of patients who used social work services and mean number of hours of services provided per patient, both by social work providers in the primary care setting and throughout the hospital.
Results
A greater percentage of CMC used social work services than non-CMC (60.3 vs. 18.9 %), and CMC used more hours per child (5.50 h/child vs. 0.69). In multivariate analysis, medical complexity was associated with 6.23-fold greater odds of using social work services (95 % CI 4.94–7.85) and with 8.07 times more hours of services per child (95 % CI 6.30–10.34), independent of primary health insurance, age, or sex.
Conclusion
This study confirms that CMC use significantly more social work services in the medical setting. This must be considered when designing proactive medical home models to provide high quality family-centered care for this population, and further research is needed to elucidate the factors that drive this utilization.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Cohen, E., Kuo, D. Z., Agrawal, R., et al. (2011). Children with medical complexity: An emerging population for clinical and research initiatives. Pediatrics, 127(3), 529–538.
Cohen, E., Berry, J. G., Camacho, X., Anderson, G., Wodchis, W., & Guttmann, A. (2012). Patterns and costs of health care use of children with medical complexity. Pediatrics, 130(6), 1463–1470.
Neff, J. M., Sharp, V. L., Muldoon, J., Graham, J., & Myers, K. (2004). Profile of medical charges for children by health status group and severity level in a Washington State Health Plan. Health Services Research, 39(1), 73–89.
Burke, R. T., & Alverson, B. (2010). Impact of children with medically complex conditions. Pediatrics, 126(4), 789–790.
Goudie, A., Narcisse, M. R., Hall, D. E., & Kuo, D. Z. (2014). Financial and psychological stressors associated with caring for children with disability. Families, Systems, and Health, 32(3), 280–290.
Bachman, S. S., & Comeau, M. (2010). A call to action for social work: Minimizing financial hardship for families of children with special health care needs. Health and Social Work, 35(3), 233–238.
Okumura, M. J., Van Cleave, J., Gnanasekaran, S., & Houtrow, A. (2009). Understanding factors associated with work loss for families caring for CSHCN. Pediatrics, 124(4 suppl), S392–S398.
Thyen, U., Kuhlthau, K., & Perrin, J. M. (1999). Employment, child care, and mental health of mothers caring for children assisted by technology. Pediatrics, 103(6), 1235–1242.
Chen, A. Y., & Newacheck, P. W. (2006). Insurance coverage and financial burden for families of children with special health care needs. Ambulatory Pediatrics, 6(4), 204–209.
Nageswaran, S., Silver, E. J., & Stein, R. E. K. (2008). Association of functional limitation with health care needs and experiences of children with special health care needs. Pediatrics, 121(5), 994–1001.
Kuo, D. Z., Cohen, E., Agrawal, R., Berry, J. G., & Casey, P. H. (2011). A national profile of caregiver challenges among more medically complex children with special health care needs. Archives of Pediatrics and Adolescent Medicine, 165(11), 1020–1026.
Ray, L. D. (2002). Parenting and Childhood Chronicity: Making visible the invisible work. Journal of Pediatric Nursing, 17(6), 424–438.
Macdonald, H., & Callery, P. (2008). Parenting children requiring complex care: A journey through time. Child: Care, Health and Development, 34(2), 207–213.
Brehaut, J. C., Kohen, D. E., Raina, P., et al. (2004). The health of primary caregivers of children with cerebral palsy: How does it compare with that of other Canadian caregivers? Pediatrics, 114(2), e182–e191.
Bauman, L. J., Silver, E. J., & Stein, R. E. K. (2006). Cumulative social disadvantage and child health. Pediatrics, 117(4), 1321–1328.
Palfrey, J. S., Sofis, L. A., Davidson, E. J., Liu, J., Freeman, L., & Ganz, M. L. (2004). Pediatric alliance for coordinated care: Evaluation of a medical home model. Pediatrics, 113(5 suppl), 1507–1516.
Harris, P. A., Taylor, R., Thielke, R., Payne, J., Gonzalez, N., & Conde, J. G. (2009). Research electronic data capture (REDCap)—A metadata-driven methodology and workflow process for providing translational research informatics support. Journal of Biomedical Informatics, 42(2), 377–381.
Acknowledgments
We acknowledge Sylvia Missal, LICSW, from the Department of Social Work at Children’s Hospital Boston for facilitating access to social work records and contributing to study design.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Coquillette, M., Cox, J.E., Cheek, S. et al. Social Work Services Utilization by Children with Medical Complexity. Matern Child Health J 19, 2707–2713 (2015). https://doi.org/10.1007/s10995-015-1795-x
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10995-015-1795-x