CSHCN with hearing difficulties: Disparities in access and quality of care

Factors that influence health service access in deaf and hard-of-hearing children: a narrative review

OBJECTIVES

Early diagnosis and intervention of deaf and hard-of-hearing (DHH) children leads to improved language and psychosocial outcomes. However, many child, parent and provider related factors can influence access to early intervention services, including hearing devices. This narrative review aims to explore factors that influence health service access in DHH children.

DESIGN

A systematic search was conducted to identify articles that explored factors that influenced health service access in DHH children in countries with Universal Newborn Hearing Screening, published between 2010 and 2022.

STUDY SAMPLES

Fifty-nine articles met the inclusion criteria for data extraction. This included 4 systematic reviews, 2 reviews, 39 quantitative and 5 mixed methods studies and 9 qualitative studies.

RESULTS

The identified factors were grouped into the following themes: (a) demographic factors, (b) family related factors, (c) child related factors, (d) factors specific to hearing devices, (e) service delivery, f) telehealth and (g) COVID-19.

CONCLUSION

This review provided a comprehensive summary of multiple factors that affect access to health services in DHH children. Psychosocial support, consistent clinical advice, allocation of resources to rural communities and use of telehealth are possible ways to address barriers and improve health service access.

Facilitators and Barriers to Care for Patients with Disabilities in Primary Pediatrics

Nearly 20% of children in the United States have special health care needs, and they often experience disparities in health outcomes. This article reviews barriers to and facilitators of primary pediatric care for children within four defined categories of disability: (1) physical disabilities, both temporary and permanent; (2) chronic conditions requiring accommodations, including mental health conditions; (3) sensory disabilities and conditions; and (4) cognitive, educational, neurodevelopmental, and social disabilities. Primary care facilitators include interventions for both providers and patients that focus on time as a valued resource, provide psychosocial support, coordinate interdisciplinary teams of care, and provide training for providers. Barriers include exclusion of patients with disabilities from research trials and gaps in educational reform regarding ableism and hidden disabilities. Identified facilitators should be implemented on a larger scale, and barriers need to be addressed further so we may better support children with disabilities. [Pediatr Ann. 2022;51(6):e243-e253.].

Health Disparities and Their Effects on Children and Their Caregivers During the Coronavirus Disease 2019 Pandemic

The coronavirus disease 2019 (COVID-19) pandemic has uncovered long-standing health disparities in marginalized communities, including racial and ethnic minorities and children with underlying medical and social problems. African Americans, Hispanics, and Native Americans have higher rates of COVID-19 infections and deaths than their population percentages in the United States. Unique populations of children, including children with developmental disabilities, children in the foster care system, children with chronic medical problems, and children who are homeless are particularly vulnerable to COVID-19 infection. This article explores how the COVID-19 pandemic superimposed on health disparities directly and indirectly affects children, adolescents, and their caregivers.

Integrating community health workers into a community hearing health collaborative to understand the social determinants of health in children with hearing loss

BACKGROUND

Children with hearing loss (HL) require coordination of care to navigate medical and social services. Strong evidence supports the role of community health workers (CHWs) to identify and address social barriers.

OBJECTIVE

The goal of this study was to evaluate the impact of integrating CHWs into the medical teams of children with HL and identify the social needs associated with their caregivers at a large urban hospital center.

METHODS

A retrospective chart review was conducted for 30 children with HL whose caregivers enrolled in a CHW program between August 1, 2017 and December 31, 2019. Baseline demographic data were collected, including social circumstances such as food and housing insecurity, status of social security supplemental income (SSI), and need for referral to early intervention (EI) or preschool/school services. Caregivers were assessed for confidence in self-management; baseline distress level was measured via a distress thermometer.

RESULTS

Of the 30 charts reviewed, 93% demonstrated social needs including food insecurity (24%) and educational service needs (45%). Eighty-seven percent of caregivers reported a sense of control over the child's condition, yet 73% reported a stress level of four or greater on the distress thermometer scale. At 3 months follow-up, 70% of patients completed referrals; a significant number of patients had obtained hearing aids and cochlear implants compared to baseline (p = 0.017).

CONCLUSIONS

Caregivers of children with HL face multiple social obstacles, including difficulties connecting to educational and financial resources. CHWs are instrumental in identifying social needs and connecting caregivers to services.

Social-Ecological Barriers to Access to Healthcare for Adolescents: A Scoping Review

Access to healthcare for adolescents is often overlooked in the United States due to federal and state-sponsored insurance programs such as Medicaid and the Children's Health Insurance Program. While these types of programs provide some relief, the issue of healthcare access goes beyond insurance coverage and includes an array of ecological factors that hinder youths from receiving services. The purpose of this scoping review was to identify social-ecological barriers to adolescents' healthcare access and utilization in the United States. We followed the PRISMA and scoping review methodological framework to conduct a comprehensive literature search in eight electronic databases for peer-reviewed articles published between 2010 and 2020. An inductive content analysis was performed to thematize the categories identified in the data extraction based on the Social-Ecological Model (SEM). Fifty studies were identified. Barriers across the five SEM levels emerged as primary themes within the literature, including intrapersonal-limited knowledge of and poor previous experiences with healthcare services, interpersonal-cultural and linguistic barriers, organizational-structural barriers in healthcare systems, community-social stigma, and policy-inadequate insurance coverage. Healthcare access for adolescents is a systems-level problem requiring a multifaceted approach that considers complex and adaptive behaviors.

Aleitamento materno na experiência de mães de crianças traqueostomizadas e o uso da válvula Passy-Muir®

Resumo Objetivo compreender a experiência de mães de crianças traqueostomizadas, entre 0 e 24 meses de idade, que retomaram o aleitamento materno com o uso de válvula de deglutição Passy-Muir®. Método pesquisa descritiva, de natureza qualitativa, com 11 mães de crianças traqueostomizadas que adaptaram a válvula de deglutição Passy-Muir®, acompanhadas em um centro de reabilitação e fonoaudiologia, mediante entrevistas semiestruturadas, nos meses de junho a agosto de 2017. A análise foi fundamentada nos pressupostos da análise de conteúdo temática. Resultados na experiência das mães, após a traqueostomia da criança, o uso da válvula de deglutição Passy-Muir® minimizou as dificuldades no aleitamento materno. Superado o processo de adaptação da válvula, foram percebidos seus benefícios. São descritos os sentimentos das mães nesse processo, suas expectativas quanto ao uso do dispositivo e o prazer e plenitude para a mulher no retorno do aleitamento materno. Conclusões e implicações para a prática observaram-se segurança ao aleitar, menor produção de secreção, reduções no número de aspirações de vias áreas, melhora no padrão respiratório, vocalizações (balbucios e choro), melhora na qualidade do sono da criança. Novas pesquisas que abordem o aleitamento materno de crianças traqueostomizadas são necessárias para aprofundar conhecimentos nesta área.