Utilization of Behavioral Therapy Services Long-Term After Traumatic Brain Injury in Young Children

Abstract

Objective To examine associations of clinical need, defined by elevated parent ratings of child behavior problems, and utilization of behavioral health services in young children with TBI and in an orthopedic injury (OI) comparison group. Design Parents completed outcome measures 18 months after injury and at an extended follow-up conducted an average of 38 months post injury. Setting Recruitment was conducted at Level 1 Trauma Centers at three children’s hospitals and one general hospital. Participants Participants included parents of three groups of children injured between 3 and 7 years of age: 47 children with complicated mild to moderate TBI, 18 with severe TBI, and 74 with OI. Interventions Not applicable. Main outcome measures Parents completed ratings of child behavior, mental health symptomology, and family functioning at both visits; at the extended follow-up, they reported utilization of behavior therapy or counseling services since the 18-month visit. Results Children with TBI had more behavior problems than those with OI. Although clinical need at both follow-ups was associated with greater service utilization at the extended follow-up, all groups had unmet needs as defined by a clinical need in the absence of services. Lower socioeconomic status was associated with higher rates of unmet need across groups. Conclusions The results document unmet long-term behavioral health needs following both TBI and OI in children and underscore the importance of monitoring and treatment of post-injury behavior problems.

Rural‐urban disparities in health care costs and health service utilization following pediatric mild traumatic brain injury

“…Traumatic brain injury (TBI) is the leading cause of death and disability among children and adolescents in the United States . Adverse outcomes associated with TBI include reduced capacity for communication and self‐care, compromised health‐related quality of life, behavioral problems, and family burden . In addition, TBI is associated with considerable economic burden, including increased health care utilization and cost after injury …”

Behavioral Health Service Utilization and Unmet Need After Traumatic Brain Injury in Childhood

“…17,20,21 Prior research examining the utilization of health care services within the first few years post TBI reveals that children with poorer family functioning, lower SES, or who are non-white have the highest rates of unmet mental health/ behavioral health care needs. 13,22 However, little is known about the utilization of behavioral health care services beyond the first few years after injury. To better understand the risk and resilience factors that contribute to long-term outcomes following pediatric TBI, research is needed to characterize behavioral health needs several years post-injury and the factors associated with un-met long-term behavioral health needs.…”

Do Children Who Sustain Traumatic Brain Injury in Early Childhood Need and Receive Academic Services 7 Years After Injury?

“…Brain injury sustained during childhood can negatively impact a wide-array of functional domains, often resulting in impairments in memory 3–5 , intellectual functioning 4,6,7 , behavior 3,8–11 , executive functioning and attention 12–17 , social interaction 18–20 , and academic performance 7,9,21–23 .…”