Advertisement

The Medical Home: Relationships With Family Functioning for Children With and Without Special Health Care Needs

Published:August 13, 2012DOI:https://doi.org/10.1016/j.acap.2012.06.001

      Abstract

      Objective

      In this study we tested the association of the medical home with family functioning for children without and with special health care needs (CSHCN).

      Methods

      We used data from the 2007 National Survey of Children’s Health to run multivariate logistic regressions to test the association between having a medical home and family functioning (difficulty with parental coping, parental aggravation, childcare/work issues, and missed school days). We further assessed interactions of CSHCN status with having a medical home.

      Results

      In adjusted analysis, parents of children with a medical home were less likely to report difficulty with parental coping (odds ratio [OR] 0.26 [0.19–0.36]), parental aggravation (OR 0.54 [0.45–0.65]), childcare/work issues (OR 0.72 [0.61–0.84]), and missed school days (OR 0.87[0.78–0.97]) for their children than those without a medical home. Using interaction terms, we found that for most outcomes, the medical home had a greater association for CSHCN compared with healthy peers, with odds ratios ranging 0.40 (CI 0.22–0.56) for parental aggravation to 0.67 (CI0.52–0.86) for missed school days.

      Conclusions

      We show that the medical home is associated with better family functioning. All children may benefit from receiving care in a medical home, but CSHCN, who have greater needs, may particularly benefit from this enhanced model of care.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Academic Pediatrics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Repetti R.L.
        • Taylor S.E.
        • Seeman T.E.
        Risky families: family social environments and the mental and physical health of offspring.
        Psychol Bull. 2002; 128: 330-366
        • Wyman P.A.
        • Moynihan J.
        • Eberly S.
        • et al.
        Association of family stress with natural killer cell activity and the frequency of illnesses in children.
        Arch Pediatr Adolesc Med. 2007; 161: 228-234
        • Frank S.J.
        • Olmsted C.L.
        • Wagner A.E.
        • et al.
        Child illness, the parenting alliance and parental stress.
        J Pediatr Psychol. 1991; 16: 361-371
        • Kuhlthau K.
        • Kahn R.
        • Hill K.S.
        • et al.
        The well-being of parental caregivers of children with activity limitations.
        Matern Child Health J. 2010; 14: 155-163
        • Schor E.L.
        Family pediatrics: report of the Task Force on the Family.
        Pediatrics. 2003; 111: 1541-1571
        • Feeney J.A.
        Implications of attachment style for patterns of health and illness.
        Child Care Health Dev. 2000; 26: 277-288
        • Kim H.K.
        • Viner-Brown S.I.
        • Garcia J.
        Children’s mental health and family functioning in Rhode Island.
        Pediatrics. 2007; 119: s22-s28
        • Raphael J.L.
        • Zhan Y.
        • Liu H.
        • et al.
        Parenting stress in US families: implication for pediatric healthcare utilization.
        Child Care Health Dev. 2009; 36: 216-224
        • Carbone P.L.
        • Behl D.D.
        • Azor V.
        • et al.
        The medical home for children with autism spectrum disorders: parent and pediatrician perspectives.
        J Autism Dev Disord. 2010; 40: 317-324
        • American Academy of Pediatrics, Medical Home Initiatives for Children with Special Needs Project Advisory Committee
        Policy statement: Organizational principles to guide and define the child health care system and/or improve the health of all children.
        Pediatrics. 2002; 110: 184-186
        • Cooley W.C.
        • McAllister J.W.
        • Sherrieb K.
        • et al.
        Improved outcomes associated with medical home implementation in pediatric primary care.
        Pediatrics. 2009; 124: 358-364
        • Homer C.J.
        • Klatka K.
        • Romm D.
        • et al.
        A review of the evidence for the medical home for children with special health care needs.
        Pediatrics. 2008; 122: e922-e937
        • Palfrey J.S.
        • Sofis L.A.
        • Davidson E.J.
        • et al.
        The pediatric alliance for coordinated care: evaluation of a medical home model.
        Pediatrics. 2004; 113: 1507-1516
        • Okumura M.J.
        • Van Cleave J.
        • Gnanasekaran S.
        • et al.
        Understanding factors associated with work loss for families caring for CSHCN.
        Pediatrics. 2009; 124: S392
        • DeRigne L.
        • Porterfield S.
        Employment change and the role of the medical home for married and single-mother families with children with special health care needs.
        Soc Sci Med. 2010; 70: 631-641
        • Ghandour R.M.
        • Perry D.F.
        • Kogan M.D.
        • et al.
        The medical home as a mediator of the relation between mental health symptoms and family burden among children with special health care needs.
        Acad Pediatr. 2011; 11: 161-169
        • Knapp C.A.
        • Madden V.L.
        • Marcu M.I.
        Factors that affect parent perceptions of provider–family partnership for children with special health care needs.
        Matern Child Health J. 2010; 14: 742-750
        • Farmer J.E.
        • Clark M.J.
        • Sherman A.
        • et al.
        Comprehensive primary care for children with special health care needs in rural areas.
        Pediatrics. 2005; 116: 649-656
        • Long W.E.
        • Bauchner H.
        • Sege R.D.
        • et al.
        The value of the medical home for children without special health care needs.
        Pediatrics. 2012; 129: 87-98
        • U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau
        The National Survey of Children’s Health 2007.
        DHHS, Rockville, Md2009
        • Bethell C.D.
        • Read D.
        • Stein R.E.
        • et al.
        Identifying children with special health care needs: development and evaluation of a short screening tool.
        Ambul Pediatr. 2002; 2: 38-48
      1. Blumberg SJ, Foster EB, Frasier AM, et al. Design and Operation of the National Survey of Children’s Health, 2007. National Center for Health Statistics. Vital Health Stat 1. 2009.

      2. Child and Adolescent Health Measurement Initiative (CAHMI). 2007 National Survey of Children’s Health SAS Code for Data Users, Data Resource Center for Child and Adolescent Health. Available at www.childhealthdata.org. Accessed April 28th, 2010.

        • McPherson M.
        • Weissman G.
        • Strickland B.
        • et al.
        Implementing community-based systems of services for children and youths with special health care needs: how well are we doing?.
        Pediatrics. 2004; 113: 1538-1544
        • Strickland B.
        • Jones J.R.
        • Ghandour R.M.
        • et al.
        The medical home: health care access and impact for children and youth in United States.
        Pediatrics. 2011; 127: 604-611
        • Raphael J.L.
        • Guadagnolo B.A.
        • Beal A.C.
        • et al.
        Racial and ethnic disparities in indicators of a primary care medical home for children.
        Acad Pediatr. 2009; 9: 221-227
        • Abidin R.R.
        Parenting Stress Index: A measure of the parent-child system.
        in: Zalaquett C.P. Wood R.J. Evaluating Stress: A Book of Resources. Scarecrow Press, Inc., Lanham, Md1997: 277-291
        • Easterbrooks M.A.
        • Goldberg W.A.
        Toddler development in the family: Impact of father involvement and parenting characteristics.
        Child Dev. 1984; 55: 740-752
        • Starfield B.
        • Shi L.
        The medical home, access to care, and insurance: a review of evidence.
        Pediatrics. 2004; 113: 1493-1498
        • Altman D.G.
        • Bland J.M.
        Interaction revisited: the difference between two estimates.
        BMJ. 2003; 326: 219
      3. SUDAAN: Software for the Statistical Analysis of Correlated Data [computer program]. Release 9.0.1. Research Triangle Park, NC: Research Triangle Institute; 2005.

        • Turchi R.M.
        • Berhane Z.
        • Bethell C.
        • et al.
        Care coordination for CSHCN: associations with family-provider relations and family/child outcomes.
        Pediatrics. 2009; 124: S428-S434
        • Markson S.
        • Fiese B.H.
        Family rituals as a protective factor for children with asthma.
        J Pediatr Psychol. 2000; 25: 471-480
        • Walsh F.
        Strengthening Family Resilience.
        The Guilford Press, New York, NY2006
        • Minuchin P.
        Families and individual development: provocations from the field of family therapy.
        Child Dev. 1985; 56: 289-302
        • Raphael J.L.
        • Zhang Y.
        • Liu H.
        • et al.
        Association of medical home care and disparities in emergency care utilization among children with special health care needs.
        Acad Pediatr. 2009; 9: 242-248