UNMET HEALTH NEEDS & DISPARITIES IN CALIFORNIA'S SCHOOL CHILDREN

Lisa Chamberlain, MD, MPH

Outline

¨  Unmet health needs ¤  General population ¤  Children with Special Needs

¨  Disparities that weave throughout both

¨  Role of the child health community in solutions

The Great Divide

The Unmet Health Needs of America’s Children Recent Clinical Case

Latina young girl Recently seen for headaches

Now wearing glasses! Yippee!

When I asked her if she liked having glasses she said “Life is so much easier.”

Children with Special Health Care Needs (CSHCN)

¨  Definition: Children with special health care needs are those who have chronic physical, developmental, behavioral, or emotional conditions, and require health and related services of a type or amount beyond that required by children generally.

There are one million such children in California.

Common and Increasing Conditions

Children's Defense Fund. Disparities in Children'sHealth and Health Coverage. Fact Sheet; 2009. Available at: http://www.childrensdefense.org/child-research-datapublications/data/childrens-health-disparities-

factsheet.pdf. Accessed August 5, 2011

¨  Asthma – inhalers for maintenance & exacerbations ¨  Mental health conditions - ADHD – stimulants ¨  Allergies/Anaphylaxis - Epipen ¨  Type 1 DM – Insulin and blood glucose monitoring ¨  Medically fragile children and technologically

dependent children

Asthma ER Visits on the Rise 2001-2012, California school aged children 5-17 yo

Hospitalizations for Mental Health Issues, by Age Group: 2002 to 2013 (Age Group: 15-19 years)

Definition: Number of hospitalizations for mental health issues per 1,000 children and youth ages 5-19, by age group.

Data Source: As cited on kidsdata.org, Special Tabulation by the State of California, Office of Statewide Health Planning and Development (Oct. 2014); California Department of Finance, 2000-2010 Estimates of Population by Race/Ethnicity with Age and Gender Detail and State and County Population Projections by Race/Ethnicity and 5-year Age Groups, 2010-2060 (by year). Accessed at: P-3: Detailed Population Projections - Demographic Research - California Department of Finance (Jan. 2013).

Mental health challenges include:

Anxiety disorders, Depression, Behavior disorders, ADHD. These can become chronic, continuing across the life span,

and undermine school success. Mental health conditions negatively impact development.

CDC, http://www.cdc.gov/ncbddd/childdevelopment/mentalhealth.html

Mental Health Statistics

¨  One in ten children has a mental illness serious enough to impair how they function at home, at school, and with peers.1

¨  In 2007, more than 1 in 4 high school students reported feelings of depression that were severe enough to impair their daily activities.

¨  Despite high rates of mental illness in children, 4 out of 5 children ages 6 to 17 who have mental health problems do not receive any help.

Department of Health and Human Services (U.S.). Mental health: a report of the Surgeon General. Washington: DHHS; 1999. http://www.surgeongeneral.gov/library/mentalhealth/home.html.

Inequity in receiving mental health services

“Over 12 month period 80% of kids who needed mental health services did not receive them. Adjusting for other factors unmet need associated

with being Latino and uninsured.”

Strategies to improve health services to CSHCN in schools: •  Increased funding •  Monitoring of school health services, particularly for

children not receiving Individual Education Program (IEP) services

•  Integration of services •  Interagency collaboration

Stanford Pediatrics & Ravenswood Schools

•  Asthma •  Wellness Policy •  Epi pen protocols •  H1N1 response •  Flu shot education

Summary

¨  Wide range of unmet health needs – ranging from kids who need eyeglasses to those who need medications monitored throughout the day.

¨  Across nearly all of them children from low income groups suffer health disparities with worse outcomes

¨  Innovative partnerships may help ease the burden