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PEDIATRICS Vol. 112 No. 6 December 2003, pp. 1373-1378

Do Needs Drive Services Use in Young Children?

Sarah McCue Horwitz, PhD*,{ddagger}, Lisa C. Gary, MS, MPH*, Margaret J. Briggs-Gowan, PhD* and Alice S. Carter, PhD§

* Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Connecticut
{ddagger} Child Study Center, Yale University School of Medicine, New Haven, Connecticut
§ Department of Psychology, University of Massachusetts Boston, Boston, Massachusetts

Objective. To determine whether different factors predicted parental recognition of mental health problems in children and use of services for those problems and to determine whether mental health problems elicit service use in the same way as physical health or developmental problems.

Methods. Survey of the parents of an age- and sex-stratified random sample of children who were born in 1 Connecticut hospital selected from state birth records.

Results. Logistic regression results demonstrate that a number of child and family factors are related to problem recognition, defined as thinking about seeking services and/or talking to a professional about a problem. However, factors related to the third outcome of interest—service use—are more limited and include only physical health and developmental problems, parental worry about language, and family conflict. Furthermore, mental health problems were not discussed with professionals, and they were not associated with receipt of services at the same rates as physical health or developmental problems.

Conclusions. The correlates of problem recognition (defined as thinking about seeking services or actually speaking to a professional about a problem) differ from those of service use, and, whereas mental health, physical health, and developmental problems all affect problem recognition, mental health problems do not result in service use. Furthermore, rates of service use vary dramatically across the 3 categories. These results suggest that needs alone do not drive service use. Rather, other factors may influence which needs are met.

Key Words: pediatrics • mental health • health care

Abbreviations: ITSEA, Infant Toddler Social and Emotional Assessment • CES-D, Center for Epidemiologic Studies Depression Inventory • BAI, Beck Anxiety Inventory; LEI, Life Events Inventory

Received for publication Sep 12, 2002; Accepted Feb 12, 2003.


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