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Caregiver and Child Behavioral Health Service Utilization Following Pediatric Traumatic Brain Injury

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Abstract

Given sparse literature examining receipt of behavioral health service in children and caregivers following traumatic brain injury (TBI), we sought to identify predictors of unmet need. We performed an individual participant data meta-analysis using generalized linear mixed-effect models to examine predictors of behavioral health service use and unmet need. We included 572 children, ages 3 to 18, who were hospitalized overnight following complicated mild to severe TBI between 2002 and 2015. Caregivers completed ratings of depression and distress, child behavior problems, family functioning, and behavioral health service utilization. For children, unmet behavioral health service need was defined as an elevation on one or more child behavior problem scales without receipt of behavioral health services. For caregivers, unmet need was defined as an elevation on either a depression or distress scale without behavioral health service utilization. Among those with behavioral health needs, rates of unmet need were high for both children (77.8%) and caregivers (71.4%). Poorer family functioning was related to more unmet need in children (F(1, 497) = 6.57, p = 0.01; OR = 1.8) and caregivers (F(1, 492) = 17.54, p < 0.001; OR = 2.7). Children with unmarried caregivers also had more unmet behavioral health service need than those with married caregivers (F(1, 497) = 12.14, p < 0.001; OR = 2.2). In conclusion, unmet needs are common after pediatric TBI and relate to family factors. The findings underscore the importance of monitoring service needs following pediatric TBI and point to disparities in service use.

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Abbreviations

TBI:

Traumatic Brain Injury

RCTs :

Randomized controlled trials

ADHD :

Attention deficit/hyperactivity disorder

GCS :

Glasgow Coma Scale

FAD :

Family Assessment Device

BRIEF :

Behavior Rating Inventory of Executive Functions

CBCL :

Child Behavior Checklist

HCSBS :

Home and Community Social Behavior Scale

SCL-90-R :

Symptom Checklist 90-Revised

CES-D :

Center for Epidemiological Studies Depression Scale

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1R21HD089076-01

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Authors and Affiliations

  1. Division of Physical Medicine and Rehabilitation, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center and University of Cincinnati, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA

    Allison P. Fisher, Jessica M. Aguilar & Shari L. Wade

  2. Division of Biostatistics and Epidemiology, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, USA

    Nanhua Zhang

  3. Department of Psychology, Alberta Children’s Hospital Research Institute, and Hotchkiss Brain Institute, University of Calgary, Calgary, Canada

    Keith Owen Yeates

  4. Abigail Wexner Research Institute at Nationwide Children’s Hospital, and Department of Pediatrics, The Ohio State University, Columbus, USA

    H. Gerry Taylor

  5. Division of Pediatric Rehabilitation Medicine, Cincinnati Children’s Hospital Medical Center, Departments of Pediatrics and Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, OH, Cincinnati, USA

    Brad G. Kurowski

  6. Behavior Medicine and Clinical Psychology Department of Pediatrics College of Medicine, Cincinnati Children’s Hospital Medical Center University of Cincinnati, Cincinnati, OH, USA

    Megan E. Narad

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  1. Allison P. Fisher
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  2. Jessica M. Aguilar
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Fisher, A.P., Aguilar, J.M., Zhang, N. et al. Caregiver and Child Behavioral Health Service Utilization Following Pediatric Traumatic Brain Injury. Res Child Adolesc Psychopathol 49, 491–501 (2021). https://doi.org/10.1007/s10802-020-00737-1

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