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Xie Y, Wu J, Li Y, Liu H, Peng Y, Zhou P, Sun Y, Kang L, Jiang C, Wu H. Requirements for and Barriers to Rehabilitation Services for Children With Disabilities in Middle- and High-Income Countries: Scoping Review. Interact J Med Res 2024; 13:e50047. [PMID: 39110502 PMCID: PMC11339577 DOI: 10.2196/50047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 02/08/2024] [Accepted: 05/29/2024] [Indexed: 08/24/2024] Open
Abstract
BACKGROUND The rehabilitation of children with disabilities has received considerable attention from the United Nations. However, the state of rehabilitation services for children with disabilities worldwide remains far from optimistic, even in economically affluent middle- and high-income countries. OBJECTIVE This scoping review aimed to identify the rehabilitation needs of children with disabilities and their barriers to rehabilitation services in middle- and high-income countries. METHODS A systematic search was conducted using MEDLINE and Web of Science for papers published from January 2013 to December 2023. Studies were included if they were peer-reviewed, full-text articles related to children with disabilities, reporting on their access to rehabilitation services, and conducted in countries classified by the World Bank 2023 as middle- and high-income economies. Exclusion criteria included duplicates, unavailable full texts, and studies without distinct outcomes. A total of 27 studies were selected following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, focusing on children, their families, or service providers. RESULTS The suitability, availability, and affordability of rehabilitation services were identified as the major needs and barriers for children with disabilities in middle- and high-income countries. This included communication barriers, a need for more personnel and facilities, and the stagnation and inadequacy of economic subsidies. CONCLUSIONS Middle- and high-income countries have relatively well-established rehabilitation infrastructure and support systems. They are nevertheless insufficient for meeting the needs of children with disabilities. More attention should be paid to these issues to improve the well-being of children with disabilities. The data provided by this review can help raise awareness of rehabilitation needs and barriers at the policy level.
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Affiliation(s)
- Yijun Xie
- Clinical Center for Intelligent Rehabilitation Research, Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
| | - Jing Wu
- Department of Fundamental Nursing, School of Nursing, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yao Li
- Clinical Center for Intelligent Rehabilitation Research, Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
| | - Hui Liu
- Clinical Center for Intelligent Rehabilitation Research, Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
| | - Yanyan Peng
- Office of Rehabilitation, Shanghai Disabled Persons' Federation, Shanghai, China
| | - Ping Zhou
- Office of Rehabilitation, Shanghai Disabled Persons' Federation, Shanghai, China
| | - Yizhou Sun
- Office of Rehabilitation, Shanghai Disabled Persons' Federation, Shanghai, China
| | - Luyan Kang
- Office of Rehabilitation, Shanghai Disabled Persons' Federation, Shanghai, China
| | - Chenghua Jiang
- Clinical Center for Intelligent Rehabilitation Research, Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
| | - Hengjing Wu
- Clinical Center for Intelligent Rehabilitation Research, Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
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Ault AK, Comer-HaGans D, Faubert SJ, Wallace BA, Weller BE. Reasons for Unmet Health Care Needs Among Black, Hispanic, and White Children in the United States With or at Risk for Physical and Mental Health Conditions. Clin Pediatr (Phila) 2024:99228241263042. [PMID: 38912591 DOI: 10.1177/00099228241263042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/25/2024]
Abstract
Children with special health care needs (CSHCN)-ie, children who are at increased risk for, or currently manage, persistent physical and mental health conditions-require more health care resources than children without special health care needs. Furthermore, CSHCN who identify as racial/ethnic minorities disproportionately encounter unmet needs, according to reports from their caregivers. However, the reasons for their unmet needs are relatively unknown. This study estimated and compared the US national prevalence of caregiver-reported reasons for unmet health care needs for Hispanic, non-Hispanic black, and non-Hispanic white CSHCN. The most common reasons were problems getting an appointment for black CSHCN and cost for Hispanic and white CSHCN. Issues related to transportation were significantly less likely for black than for white and Hispanic CSHCN. Cost-related issues were significantly less likely for black than Hispanic CSHCN. To address reasons for unmet needs for CSHCN, effective structural changes are needed.
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Rennane S, Sobol D, Stein BD, Dick A. Insurance coverage during transitions: Evidence from Medicaid automatic enrollment for children receiving supplemental security income. Health Serv Res 2024; 59:e14261. [PMID: 37985435 PMCID: PMC11063087 DOI: 10.1111/1475-6773.14261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2023] Open
Abstract
OBJECTIVES To analyze relationships between Medicaid automatic enrollment for child Supplemental Security Income (SSI) recipients and health insurance coverage during transitions. DATA SOURCES AND STUDY SETTING Medical Expenditure Panel Study, 2000-2020 and National Survey for Children with Special Health Care Needs, 2001-2010. STUDY DESIGN Leveraging variation in SSI-Medicaid automatic enrollment status across regions and over time, we estimate a regression model to quantify associations between automatic enrollment and insurance coverage. We validate our findings in the NS-CSHCN. DATA COLLECTION Our sample includes children receiving SSI for a disability. We also analyze a subsample of children newly enrolled in SSI. PRINCIPAL FINDINGS Automatic enrollment is associated with a statistically significant increase in insurance coverage. Expanding automatic enrollment to all states is associated with increases in Medicaid enrollment of 3% (CI 0.9%-6.7%) among all SSI children and 7% (CI 1.1%-13.9%) among children newly enrolled in SSI. We find similar decreases in uninsurance. Analysis in the NS-CSHCN replicates these findings. CONCLUSIONS Medicaid automatic enrollment policies are associated with increased insurance coverage for SSI children, particularly those transitioning into the program. Medicaid policy defaults could play an important role in reducing administrative burdens to improve children's coverage and access to care.
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Anderson KA, Roux AM, Rast JE, Garfield T, Shea L. Low-Income Households of Children With Autism and the Economic Safety Net. Acad Pediatr 2024; 24:258-266. [PMID: 37931804 DOI: 10.1016/j.acap.2023.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 10/13/2023] [Accepted: 11/01/2023] [Indexed: 11/08/2023]
Abstract
OBJECTIVE This paper examines the distribution, parameters, and determinants of safety net program use among a nationally representative sample of low-income children with autism spectrum disorder (ASD). METHODS We used data from the 2021 National Survey of Children's Health to produce population estimates of material hardship and safety net program use among 554 low-income households of children with ASD, ages 3 to 17 years, relative to 2831 children with other special health care needs (SHCN) and 8758 children with no SHCN of the same age. Design-adjusted multivariate logistic regression models identified predictors of cash assistance, Supplemental Nutrition Assistance Program, and disconnection from both. RESULTS There were few significant differences in material hardship between children with ASD and those with other SHCN, although children with ASD experienced significantly higher levels of hardships compared to children with no SHCN. Having a child with ASD did not significantly increase the odds of safety net use. Health insurance and household income were stronger predictors of use than disability. Nine percent of disconnected children lived in households under 100% federal poverty level and experienced some type of material hardship. CONCLUSIONS Future research about the economic security of children with ASD and their families could focus on the following 3 areas of inquiry: assess how race, ethnicity, or socioeconomic position interact with disability to influence safety net program use; examine the intersection between Medicaid and safety net programs at the state and national levels; and identify specific subgroups of children at risk for disconnection and understand why they are not accessing benefits.
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Affiliation(s)
- Kristy A Anderson
- College of Social Work (KA Anderson), Florida State University, Tallahassee, FL.
| | - Anne M Roux
- A.J. Drexel ASD Institute (AM Roux, JE Rast, T Garfield, and L Shea), Drexel University, Philadelphia, Pa.
| | - Jessica E Rast
- A.J. Drexel ASD Institute (AM Roux, JE Rast, T Garfield, and L Shea), Drexel University, Philadelphia, Pa.
| | - Tamara Garfield
- A.J. Drexel ASD Institute (AM Roux, JE Rast, T Garfield, and L Shea), Drexel University, Philadelphia, Pa.
| | - Lindsay Shea
- A.J. Drexel ASD Institute (AM Roux, JE Rast, T Garfield, and L Shea), Drexel University, Philadelphia, Pa.
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Phillips B. Caring for a Child With an Acquired Disability: Unveiling Light From Darkness. ANS Adv Nurs Sci 2024; 47:89-103. [PMID: 36745159 DOI: 10.1097/ans.0000000000000488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This study explored how parents of children with acquired disabilities transform loss into meaning when faced with traumatic experiences. This type of loss is ambiguous and different from that of the bereaved. Directed content analysis was guided by the predetermined categories of unveiling, darkness, and light. Stories from 8 parents revealed the ability to decide how they perceived their experiences, discovering meaning in caring for their child despite the suffering associated with loss. These findings offer direction for nursing research, practice, and policy on how to assist parents in overcoming these challenges and shed light on the dynamic perspectives of loss.
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Affiliation(s)
- Brad Phillips
- West Virginia University School of Nursing, Morgantown
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Rennane S, Dick A. Effects of Medicaid Automatic Enrollment on Disparities in Insurance Coverage and Caregiver Burden for Children with Special Health Care Needs. Med Care Res Rev 2023; 80:65-78. [PMID: 35788159 DOI: 10.1177/10775587221106116] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We analyze how Medicaid automatic enrollment policies for children with special health care needs (CSHCN) who are enrolled in Supplemental Security Income (SSI) reduce disparities in health insurance coverage and caregiving burden. Using the 2009-2010 National Survey of Children with Special Health Care Needs, we implement a difference-in-differences regression model comparing insurance enrollment rates between CSHCN receiving SSI and CSHCN not receiving SSI, in states with and without automatic enrollment policies. We find that Medicaid automatic enrollment has a meaningful impact on insurance enrollment for low-income CSHCN who participate in SSI and can be an effective method for mitigating disparities in insurance coverage (reducing uninsurance by 38%). Medicaid automatic enrollment also reduces caregiver burden among socioeconomically disadvantaged families with CSHCN. The effects of these policies are largest families who might be on the margin of eligibility or who face high administrative burden.
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Yu JA, Bayer ND, Beach SR, Kuo DZ, Houtrow AJ. A National Profile of Families and Caregivers of Children With Disabilities and/or Medical Complexity. Acad Pediatr 2022; 22:1489-1498. [PMID: 36002069 DOI: 10.1016/j.acap.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 08/10/2022] [Accepted: 08/13/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Provide an up-to-date description of the well-being of families and caregivers of children with disability and medical complexity at the national level. METHODS We performed a secondary analysis of the 2016-2019 National Survey of Children's Health and divided the sample based on a child's disability and medical complexity status: children with no special health care needs (non-CSHCN), children with special health care needs (CSHCN), CSHCN with significant disabilities (CSHCN-SD), and children with medical complexity (CMC). Outcomes included survey items assessing 1) caregiver emotional well-being, 2) family functioning, and 3) economic adversity. We conducted multivariable logistic regression analyses to examine associations between child disability and medical complexity status with study outcomes. RESULTS Among 131,774 survey responses, CSHCN-SD (weighted n = 4.2 million) and CMC (n =1.1 million) disproportionately reported adverse outcomes for every measure of well-being. Notably, caregivers of CSHCN-SD and CMC were more likely to report frequently feeling bothered (aOR 5.0 and 6.3, respectively) and angry (aOR 3.0 and 3.1) with their child than non-CSHCN caregivers. Families of CSHCN-SD and CMC had 40% lower odds of endorsing all aspects of family resilience and more likely to report three or more adverse childhood experiences (aOR 3.3 and 3.7) than non-CSHCN families. CSHCN-SD and CMC families were also more likely to experience difficulty covering basics (aOR, 2.6 and 3.3) and report caregivers changing jobs due to their child's care (aOR, 3.1 and 5.0). CONCLUSIONS Development and testing of interventions specifically targeting the well-being of CSHCN-SD and CMC families and caregivers is needed.
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Affiliation(s)
- Justin A Yu
- Department of Pediatrics, Divisions of Palliative Care and Pediatric Hospital Medicine (JA Yu), University of Pittsburgh School of Medicine and UPMC Children's Hospital, Pittsburgh, Pa.
| | - Nathaniel D Bayer
- Department of Pediatrics, Division of Pediatric Hospital Medicine (ND Bayer), University of Rochester Medical Center and Golisano Children's Hospital, Rochester, NY
| | - Scott R Beach
- University Center for Social and Urban Research (SR Beach), University of Pittsburgh, Pittsburgh, Pa
| | - Dennis Z Kuo
- Department of Pediatrics, Division of Developmental and Behavioral Pediatrics (DZ Kuo), University of Rochester Medical Center and Golisano Children's Hospital, Rochester, NY
| | - Amy J Houtrow
- Division of Pediatric Rehabilitation Medicine, Department of Physical Medicine & Rehabilitation (AJ Houtrow), University of Pittsburgh School of Medicine, Pittsburgh, Pa
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Houtrow A, Harris D, Molinero A, Levin-Decanini T, Robichaud C. Children with disabilities in the United States and the COVID-19 pandemic. J Pediatr Rehabil Med 2020; 13:415-424. [PMID: 33185616 DOI: 10.3233/prm-200769] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Children with disabilities are disproportionately impacted by COVID-19 and the containment response. Their caregivers must now adapt to increased stressors such as lack of access to needed therapies, medical supplies, and nursing care. Prior to COVID-19 these families were already marginalized, and this has only worsened during the pandemic. As a vulnerable population, children with disabilities have not been the focus of much discussion during the pandemic, likely because the disease disproportionately impacts older individuals. Nonetheless, children with disabilities should be a focus of evaluation and intervention to mitigate the negative consequences of COVID-19 and the resulting containment strategies. Their needs should be included in future crisis planning, as well. In order to raise awareness of pediatric rehabilitation professionals, health care administrators, policy makers, and advocates, this manuscript provides a discussion of the following topics: the immediate and ongoing impacts on children with disabilities and their families, the ethical concerns and implications of triage protocols for scarce resources that consider disability in their scoring systems, and optimizing medical care and educational needs in the time of COVID.
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Affiliation(s)
- Amy Houtrow
- Departments of Physical Medicine and Rehabilitation and Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Debbi Harris
- Family Voices of Minnesota, Minneapolis, MN, USA
| | | | - Tal Levin-Decanini
- Complex Care Center, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
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