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. 2023 Jun;27(6):1097-1106.
doi: 10.1007/s10995-023-03652-1. Epub 2023 Mar 29.

The Medical Home and Mental Health Services in Children and Youth with Special Health Care Needs

Jessica E Rast  1 , Anne M Roux  2 , Gabrielle Connor  2   3 , Tobechukwu H Ezeh  2   3 , Lindsay Shea  2 , Renee M Turchi  3   4 , Paul T Shattuck  5
Affiliations

The Medical Home and Mental Health Services in Children and Youth with Special Health Care Needs

Jessica E Rast et al. Matern Child Health J. 2023 Jun.

Abstract
in English, German

Background and objectives: Children and youth with special health care needs (CYSHCN) commonly experience mental health concerns, but conditions are often not identified or treated within primary care. Mental health care is often not a primary focus of pediatric primary care, but the medical home model has potential to address these concerns more adequately. The purpose of this study is to examine the relationship between the medical home and use of mental health services in CYSHCN.

Methods: Data came from the Medical Expenditure Panel Survey years 2015-2017, a nationally representative survey of health and healthcare in US families. The study included CYSHCN ages 6-17. We compared the use of mental health services, expenditures, and psychotropic medications across CYSHCN with and without a medical home using multivariable regression.

Results: 45% of CYSHCN received care within a medical home. CYSHCN with and without a medical home reported similar frequency of office-based mental health visits (21.2% versus 25.2%), average expenditures for visits ($147 versus $128), and psychotropic medications (11.9% versus 15.1%). Medical home status was not associated with office-based mental health visits, use of psychotropic medications, or cost for either.

Conclusions: CYSHCN with mental health care needs face barriers to satisfactory care. Creating better connections between primary and mental health care could help to ameliorate this problem. Findings suggest the medical home, a more comprehensive primary care model, may not address mental health care needs of CYSHCN.

What is known on this topic? Mental health care is often fragmented from primary care, resulting in unaddressed symptoms and conditions. Comprehensive care approaches could address this gap, but it is unknown if these address mental health care in children and youth with special health care needs.What this study adds? There is no evidence of difference in mental health care for children with or without a medical home. To optimize care and improve mental health, medical home standards should address mental health care and connection with specialty providers.

Keywords: Integrated delivery of health care; Medical home; Mental health services; Pediatrics; Primary health care.

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