The influence of health insurance on the unmet mental health needs of children with special health care needs

Using data (N=10,675) collected as part of the National Survey of Children with Special Health Care Needs (NSCSHCN)(USDHHS, 2004), this study examined (1) the prevalence of unmet mental health needs in children with special health care needs manifested as emotional/developmental/behavioral problems, (2) the characteristics of these children, (3) bivariate and multivariate associations between predisposing (demographic), enabling (income), and need (severity of condition) factors associated with unmet mental health needs, (4) the bivariate and multivariate associations between health insurance status and type of health insurance (private vs. public) on the prevalence of unmet mental health needs and (5) the bivariate and multivariate associations between insurance status and type of health insurance and the parent reported reasons for unmet need. The data were collected across the nation from October 2000 to April 2002 as a module of the State and Local Area Integrated Telephone Survey which tracks and monitors the health and well-being of children and adults. Interviews were conducted with parents of 750 special health care needs children from every state across the nation. Frequency analysis, bivariate analysis, and logistic regression were used to analyze the data. Findings indicate that of the nearly 67% of children who needed mental health care or counseling in the previous 12 months, 20% did not receive it. Findings indicate that children covered by public health insurance programs (Medicaid, State Children's Health Insurance Program, Title V, Military, Native American) have fewer unmet mental health needs than children covered by private health insurance plans with uninsured children the most likely to have unmet mental health needs. Findings also indicate that being uninsured increases the likelihood of reporting "costs too much" as the reason for having unmet mental health needs while being insured by public health insurance decreases the likelihood of reporting "costs too much" as the reason. An extensive review of the literature on unmet mental health needs in children and the factors that influence the prevalence of unmet need are included. Policy and clinical implications are included as well as recommendations for future research.