University of Denver, Graduate School of Social Work, 2148 S. High St. Denver, CO 80208, United States.
Child Abuse Negl. 2017 Mar;65:212-225. doi: 10.1016/j.chiabu.2017.01.021. Epub 2017 Feb 10.
Children referred to child welfare have higher-than-average rates of physical, mental, and developmental health conditions, yet coordinating medical care to address their complex needs is challenging. This study investigates complex health characteristics of child welfare-involved children to inform evolving patient-centered medical homes that incorporate multidisciplinary care and social health determinants. Study questions include: (1) To what degree do child welfare-involved children present with complex physical, behavioral, and developmental conditions? (2) How does the clustering of complex health concerns vary according to developmental stage? (3) What demographic factors relate to complex health concerns? Data are from 5873 children (birth to 18) who participated in the National Survey of Child and Adolescent Well-being II. Latent class analyses were conducted for children in four developmental groups (infants, preschool-age, elementary school-age, and adolescents), including up to 11 indicators from standardized health measures. For all developmental groups, the best fitting model indicated a complex health concern class and a class with fewer health concerns. Multivariate logistic regressions revealed that membership in the complex health concerns class was associated with: increased age, poverty, poor caregiver health, out-of-home placement, gender, and race/ethnicity; although some developmental differences in predictors were observed. Results suggest that for younger children, preventive approaches and integration of developmental specialists in primary care is needed, while school-age children and adolescents demonstrate greater need for integrated behavioral health. All developmental groups would benefit from multidisciplinary teams that address complex health issues related to environmental risks common among children involved in child welfare.
被转介到儿童福利机构的儿童存在较高比例的身体、心理和发育健康问题，但协调医疗服务以满足他们复杂的需求具有挑战性。本研究旨在调查儿童福利机构中儿童的复杂健康特征，为不断发展的以患者为中心的医疗之家提供信息，这些医疗之家整合了多学科护理和社会健康决定因素。研究问题包括：（1）有多少儿童福利机构涉及的儿童存在复杂的身体、行为和发育问题？（2）根据发育阶段的不同，复杂健康问题的聚类程度如何？（3）哪些人口统计学因素与复杂健康问题有关？本研究的数据来自于参加国家儿童和青少年福利调查 II 的 5873 名儿童（从出生到 18 岁）。对四个发育组（婴儿、学龄前、小学和青少年）中的儿童进行潜在类别分析，包括来自标准化健康测量的多达 11 个指标。对于所有发育组，最佳拟合模型表明存在一个复杂健康问题类别和一个健康问题较少的类别。多变量逻辑回归显示，复杂健康问题类别的成员与：年龄增长、贫困、照顾者健康状况不佳、离家安置、性别和种族/族裔有关；尽管在预测因素方面存在一些发育差异。结果表明，对于年幼的儿童，需要采取预防措施，并在初级保健中整合发育专家，而学龄儿童和青少年则更需要综合行为健康。所有发育组都将受益于多学科团队，这些团队可以解决与儿童福利机构中常见的环境风险相关的复杂健康问题。
