Children's Health

Children with special needs often don't receive the health care services and assistive devices they need

Only a small proportion of children with special health care needs (CSHCN) receive needed therapy, assistive devices such as wheelchairs, hearing aids, or glasses, and related services, according to a recent study by researchers at the University of North Carolina, Chapel Hill. In addition, children who are more severely impaired and impoverished are even less likely to receive the care or assistive devices they need. Uncorrected hearing, mobility, and communication deficits slow children's academic progress and development and may contribute to behavior problems, according to Stacey C. Dusing, P.T., M.S., and colleagues.

Using data from the National Survey of Children with Special Health Care Needs, the researchers calculated the first national estimate of the prevalence of unmet needs for therapy services, vision care or glasses, hearing care or hearing aids, mobility aids, and communication aids for CSHCN, as well as the demographic characteristics associated with these unmet needs. They found that 6 percent of CSHCN who needed vision care or glasses did not get them, and 25 percent of those who needed communication aids such as hearing aids did not receive them. CHSCN who were insured were substantially more likely than those who were uninsured to receive needed therapy, vision care, glasses, or mobility aids.

Impoverished children (at or below 100 percent of the Federal poverty level) were much less likely to have their needs met for vision care or glasses and hearing aids or hearing care than children living in households with incomes more than 200 percent of the poverty level. Eleven percent of children who needed physical, occupational, or speech therapy did not receive the needed service. For each of the services studied, more severely limited children were significantly less likely to receive what they needed. CSHCN insured by Medicaid had better access to vision care or glasses than other CSHCN. These findings demonstrate that Medicaid's comprehensive coverage of assistive devices increases access to these services, conclude the researchers.

See "Unmet need for therapy services, assistive devices, and related services: Data from the National Survey of Children with Special Health Care Needs," by Stacey C. Dusing, P.T., M.S., Asheley C. Skinner, B.A., and Michelle L. Mayer, PhD., M.P.H., R.N., in the September-October 2004 Ambulatory Pediatrics 4, pp. 448-454.

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