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Risk factors for psychosocial dysfunction among enrollees in the State Children's Health Insurance Program
Andrew L Brickman1, Clelia P Garrity, Jon A Shaw
1Department of Psychiatry and Behavioral Sciences, University of Miami School of Medicine, Florida 33136, USA. abrickman@miami.edu
Insights
Parental mental health issues, chronic illness, and trauma are key risk factors for psychosocial dysfunction in children enrolled in the State Children's Health Insurance Program (SCHIP). Early screening is recommended for these vulnerable children.
Area of Science:
- Pediatric Health
- Mental Health
- Public Health Policy
Background:
- Children of the working poor often face unique challenges impacting their well-being.
- The State Children's Health Insurance Program (SCHIP) provides coverage for many such families.
- Defining behavioral health needs within this population is crucial for effective care.
Purpose of the Study:
- To identify risk factors for psychosocial dysfunction in children enrolled in SCHIP.
- To characterize the specific vulnerabilities of children from low-income working families.
Main Methods:
- A survey of 393 parents of SCHIP enrollees was conducted.
- Medical and psychosocial variables were assessed.
- Regression analysis was used to correlate variables with psychosocial dysfunction scores (Pediatric Symptom Checklist).
Main Results:
- Parental dysphoria, parental psychiatric/substance use history, chronic childhood medical illness, and trauma exposure were significant independent predictors.
- These factors explained 34% of the variance in psychosocial dysfunction.
- Identified risk factors are readily available in medical records or during primary care physician interviews.
Conclusions:
- Despite SCHIP's progress, the behavioral health needs of these children remain underdefined.
- Key risk factors for psychosocial dysfunction can be identified through routine clinical assessments.
- Screening for at-risk children within the SCHIP population is warranted.
Objective:
The authors studied enrollees in the State Children's Health Insurance Program (SCHIP) (Title XXI) to characterize risk factors for psychosocial dysfunction among children of the working poor.
Methods:
Medical and psychosocial variables were included in a survey completed by 393 parents of children enrolled in SCHIP. Regression analysis was used to examine the relationship between these variables and scores on the Pediatric Symptom Checklist, a measure of psychosocial dysfunction among children.
Results:
Stepwise multiple regression showed that parental dysphoria, parental history of psychiatric or substance use problems, childhood chronic medical illness, and exposure to traumatic events each contributed independently to variance in psychosocial dysfunction in this population, explaining 34 percent of total variance.
Conclusions:
Despite strong progress in implementing SCHIP at the state level, the behavioral health care needs of children of the working poor have not been well defined. This study identified risk factors that can be easily found in the patient's medical record or detected during an interview by the primary care physician. Thus screening to identify children at risk of psychosocial dysfunction is warranted among SCHIP enrollees.