Improving Access to Mental Health Care among Children who Receive Subspecialist Care

• Published in: Maternal and child health journal Vol. 29; no. 7; pp. 879 - 886
• Main Authors: Gigli, Kristin Hittle, Graaf, Genevieve
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.07.2025; Springer Nature B.V
• Subjects: Adolescent; Brief Report; Caregivers; Child; Child, Preschool; Children; Children & youth; Children with Disabilities - psychology; Children with Disabilities - statistics & numerical data; Chronic illnesses; Cohort Studies; Female; Gynecology; Health care; Health care policy; Health insurance; Health Services Accessibility - standards; Health Services Accessibility - statistics & numerical data; Health Services Needs and Demand; Health services utilization; Humans; Male; Maternal and Child Health; Medicine; Medicine & Public Health; Mental disorders; Mental health care; Mental Health Services - standards; Mental Health Services - statistics & numerical data; Pediatrics; Physicians; Population Economics; Public Health; Retrospective Studies; Sociology; Specialization; United States > US; Access to care; Child mental health; Mental health access; Children and youth with special health care needs
• ISSN: 1092-7875; 1573-6628; 1573-6628
• DOI: 10.1007/s10995-025-04116-4

Objectives Children and Youth with Special Healthcare Needs (CYSHCN) have high rates of unmet health care need, particularly mental health. To increase access to mental health care, policymakers support pediatric subspecialists providing mental health care. Yet it is unclear how great the need for this role might be. This study described mental health care needs among CYSHCN who needed pediatric subspeciality care, and rates at which needs go unmet. Methods We conducted a retrospective cohort study of 20,335 CYSHCN who needed subspecialist care from 2016 to 2021 using pooled National Survey of Children’s Health data. Analysis described rates of mental health care need and unmet need. Results 40% ( N  = 8,538) of CYSHCN who needed subspecialist care had mental health care needs. CYSHCN receiving care from a specialist had a significantly lower unmet need for mental health care, compared to those who did not receive specialist care (12.5% vs. 43.5%). Receiving subspecialist care was associated with a 24-percentage point decrease in unmet mental health need. Conclusions for Practice CYSHCN who receive subspecialist care have high rates of mental health care need, most need is met. Future work should explore strategies to support subspecialists in the provision of holistic, physical, and mental, health care without assuming roles as mental health care providers. Significance What’s Known on this Subject Children and youth with special healthcare needs (CYSHCN) have high rates of unmet physical and mental health care need. However, many CYSHCN receive medical care from pediatric subspecialists and policymakers support increasing their role in providing mental health care. What this Study Adds CYSHCN who receive pediatric subspecialist care have high rates of mental health care need, but among those who see subspecialists, most of the need is met. This suggests pediatric subspecialists confer a benefit in addressing mental health needs of CYSHCN, while the extent of their role as providers of mental health care remains uncertain.