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Caregiver and Child Behavioral Health Service Utilization Following Pediatric Traumatic Brain Injury
Allison P Fisher1, Jessica M Aguilar2, Nanhua Zhang3
1Division of Physical Medicine and Rehabilitation, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA. allison.fisher@cchmc.org.
Insights
High rates of unmet behavioral health needs affect children and caregivers after traumatic brain injury (TBI). Poorer family functioning and caregiver marital status predict these unmet needs in pediatric TBI survivors.
Area of Science:
- Neuroscience
- Psychology
- Public Health
Background:
- Traumatic brain injury (TBI) in children can lead to significant behavioral health challenges.
- There is limited research on behavioral health service utilization and unmet needs in pediatric TBI survivors and their caregivers.
- Understanding predictors of unmet needs is crucial for improving care access.
Purpose of the Study:
- To identify predictors of unmet behavioral health service needs in children and caregivers following TBI.
- To analyze factors associated with service utilization in a pediatric TBI population.
Main Methods:
- An individual participant data meta-analysis was conducted.
- Generalized linear mixed-effect models were used to examine predictors of service use and unmet need.
- Data from 572 children (ages 3-18) hospitalized for complicated mild to severe TBI between 2002-2015 were analyzed.
Main Results:
- High rates of unmet behavioral health needs were observed: 77.8% for children and 71.4% for caregivers.
- Poorer family functioning was significantly associated with greater unmet needs for both children and caregivers.
- Children with unmarried caregivers experienced higher unmet needs compared to those with married caregivers.
Conclusions:
- Unmet behavioral health needs are prevalent following pediatric TBI.
- Family factors, including functioning and caregiver marital status, significantly predict unmet service needs.
- Findings highlight the need for systematic monitoring of service needs and addressing disparities in care access for pediatric TBI survivors.
Abstract:
Given sparse literature examining receipt of behavioral health service in children and caregivers following traumatic brain injury (TBI), we sought to identify predictors of unmet need. We performed an individual participant data meta-analysis using generalized linear mixed-effect models to examine predictors of behavioral health service use and unmet need. We included 572 children, ages 3 to 18, who were hospitalized overnight following complicated mild to severe TBI between 2002 and 2015. Caregivers completed ratings of depression and distress, child behavior problems, family functioning, and behavioral health service utilization. For children, unmet behavioral health service need was defined as an elevation on one or more child behavior problem scales without receipt of behavioral health services. For caregivers, unmet need was defined as an elevation on either a depression or distress scale without behavioral health service utilization. Among those with behavioral health needs, rates of unmet need were high for both children (77.8%) and caregivers (71.4%). Poorer family functioning was related to more unmet need in children (F(1, 497) = 6.57, p = 0.01; OR = 1.8) and caregivers (F(1, 492) = 17.54, p < 0.001; OR = 2.7). Children with unmarried caregivers also had more unmet behavioral health service need than those with married caregivers (F(1, 497) = 12.14, p < 0.001; OR = 2.2). In conclusion, unmet needs are common after pediatric TBI and relate to family factors. The findings underscore the importance of monitoring service needs following pediatric TBI and point to disparities in service use.
