Social Work Services Utilization by Children with Medical Complexity
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Social Work Services Utilization by Children with Medical Complexity Madeline Coquillette1 • Joanne E. Cox1 • Sara Cheek1 • Romi A. Webster1
Ó Springer Science+Business Media New York 2015
Abstract Objectives Children with medical complexity (CMC) are a growing population in pediatric primary care practices, and families caring for these children face increased medical, developmental, education and social needs. The objective of this study was to quantify hospital-wide social work services utilization by CMC compared to non-medically-complex children (non-CMC) to inform the development of family-centered care models that support these vulnerable patients and families. Methods Social work department records from a tertiary children’s hospital were used to compare CMC aged 0–17 (n = 564) with age- and sex-matched non-CMC (n = 1128) over a 16-month retrospective period. The main outcomes measures were the proportion of patients who used social work services and mean number of hours of services provided per patient, both by social work providers in the primary care setting and throughout the hospital. Results A greater percentage of CMC used social work services than non-CMC (60.3 vs. 18.9 %), and CMC used more hours per child (5.50 h/child vs. 0.69). In multivariate analysis, medical complexity was associated with 6.23-fold greater odds & Madeline Coquillette [email protected] Joanne E. Cox [email protected] Sara Cheek [email protected]
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of using social work services (95 % CI 4.94–7.85) and with 8.07 times more hours of services per child (95 % CI 6.30–10.34), independent of primary health insurance, age, or sex. Conclusion This study confirms that CMC use significantly more social work services in the medical setting. This must be considered when designing proactive medical home models to provide high quality family-centered care for this population, and further research is needed to elucidate the factors that drive this utilization. Keywords Children with special health care needs Social work Medical complexity Primary care Medical home
Significance What is already known on this subject? Families caring for children with medical complexity face increased financial stresses and parenting demands. Little is known, however, about the association of these demands with the use of social work services in the medical setting and the implications for development of family-centered care models. What this study adds? Children with medical complexity are high users of social work services in the medical setting, and medical complexity is the strongest driver of this increased utilization. This increased utilization represents a vast set of psychosocial needs that are critical to supporting these families.
Romi A. Webster [email protected]
Introduction
Division of General Pediatrics, Department of Medicine, Children’s Hospital Primary Care Center, Boston Children’s Hospital, 300 Longwood Avenue, Hunnewell Ground Floor, Boston, MA 02115, USA
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