Links between health-related social needs and mental health care disparities: Implications for clinical practice.

Abstract

Objective: There are known disparities in access to and utilization of pediatric health care and mental health care. Unmet health-related social needs, particularly food insecurity and housing instability, have previously been associated with poorer health and mental health outcomes as well as reduced utilization of preventive care. The relation between health-related social needs and pediatric mental health care utilization, however, has been largely unexplored. Method: Using a cross-sectional design with retrospective data extraction through a large, urban medical center's clinical data warehouse, this study investigated whether parent-reported unmet health-related social needs were associated with differences in the relationship between parent-reported child psychiatric symptoms and pediatric mental health care utilization. Additionally, the association between pediatric mental health care utilization and visiting an on-site food pantry, offered to address food insecurity, was assessed. Results: Consistent with the hypotheses, parent report of higher child psychiatric symptoms was associated with more pediatric mental health care utilization (rate ratio [RR] ϭ 1.17, p Ͻ .001), and as parents reported more unmet health-related social needs, this relationship weakened (B ϭ Ϫ.015, p Ͻ .001). Although the use of the on-site food pantry had no effect on the relationship between reported child symptoms and pediatric mental health care utilization, the use of the food pantry did independently correspond to an increased rate of mental health care visits (RR ϭ 2.25, p ϭ .002). Conclusions: These findings suggest that screening for and addressing unmet health-related social needs may be an important part of the effort to reduce pediatric mental health service disparities.

Relating multidimensional deprivation index to adherence outcomes in pediatric solid organ transplant.

“…This consideration of the overall level of deprivation in the environment in which families reside can be used as a tool to enable pediatric transplant psychologists to assess health disparities and social determinants of health that may not be readily apparent in a family-level assessment of deprivation and inform how a psychosocial team facilitates access to resources (Barnett et al, 2020). Interventions that address systemic and individual barriers in pediatric transplant have been shown to improve health and adherence (Kahana et al, 2008;Kuhn et al, 2020). Our findings point to the importance of including mental health and social work professionals in multidisciplinary teams as part of ongoing care to address psychosocial and neighborhood barriers to adherence and communicate these barriers to medical teams.…”

Introduction to the special issue: Clinical approaches to address health disparities in pediatric psychology.

“…Articles by Kuhn, Bair-Merritt, Xuan, and Kistin (2020); Oberoi et al (2020), and Rodríguez et al (2020) illustrate that there are many factors that influence how and when families, particularly those from diverse backgrounds or with unmet social needs, decide to access care and support for their children. Kuhn et al’s (2020) article raises the interesting question of whether a family’s unmet health-related social needs (e.g., food security, housing instability) are a factor in parent utilization of pediatric mental health care. Not surprisingly, in their study, parent report of child psychiatric symptoms was associated with utilization of mental health services; however, this association was attenuated by parental report of unmet, health-related social needs (Kuhn et al, 2020).…”

“…Kuhn et al’s (2020) article raises the interesting question of whether a family’s unmet health-related social needs (e.g., food security, housing instability) are a factor in parent utilization of pediatric mental health care. Not surprisingly, in their study, parent report of child psychiatric symptoms was associated with utilization of mental health services; however, this association was attenuated by parental report of unmet, health-related social needs (Kuhn et al, 2020). These findings suggest that families with unmet social needs may experience barriers to receiving behavioral health care because they must focus on addressing the most basic of family needs.…”

“…They suggest a series of clinical strategies to enhance a family’s level of coping, including low-literacy interventions, partnerships with schools and community organizations, and asthma management interventions supplemented with tools for enhanced coping, self-efficacy, and parenting skills. Taken together, the articles by Oberoi et al (2020); Kuhn et al (2020), and Rodríguez et al (2020) illustrate the importance of considering family culture, context, and social barriers in designing programs for maximum access and providing care with maximum impact.…”

“…Disparities in health services persist among racial/ethnic minorities and families of low income; the articles in this special issue highlight the impact that unmet social needs, SES-specific processes, and high levels of stress can have on service utilization and access (Christian-Brandt & Santacrose, 2020; Kuhn et al, 2020; Oberoi et al, 2020; Rodríguez et al, 2020). Yet the research included here also suggests solutions and promising new ways to minimize health disparities.…”