Maternal and Child Health Journal

, Volume 17, Issue 9, pp 1658–1664 | Cite as

Factors Associated with a Patient-Centered Medical Home Among Children with Behavioral Health Conditions

  • Caprice Knapp
  • Lindsey Woodworth
  • Daniel Fernandez-Baca
  • Jacqueline Baron-Lee
  • Lindsay Thompson
  • Melanie Hinojosa


At some point in their lives, nearly one-half of all American children will have a behavioral health condition. Many will not receive the care they need from a fragmented health delivery system. The patient-centered medical home is a promising model to improve their care; however, little evidence exists. Our study aim was to examine the association between several behavioral health indicators and having a patient-centered medical home. 91,642 children’s parents or guardians completed the 2007 National Survey of Children’s Health. An indicator for patient-centered medical home was included in the dataset. Descriptive statistics, bivariate tests, and multivariate regression models were used in the analyses. Children in the sample were mostly Male (52 %), White (78 %), non-Hispanic (87 %), and did not have a special health care need (80 %). 6.2 % of the sample had at least one behavioral health condition. Conditions ranged from ADHD (6 %) to Autism Spectrum Disorder (ASD) (1 %). Frequency of having a patient-centered medical home also varied for children with a behavioral health condition (49 % of children with ADHD and 33 % of children with ASD). Frequency of having a patient-centered medical home decreased with multiple behavioral health conditions. Higher severity of depression, anxiety, and conduct disorder were associated with a decreased likelihood of a patient-centered medical home. Results from our study can be used to target patient-centered medical home interventions toward children with one or more behavioral health conditions and consider that children with depression, anxiety, and conduct disorder are more vulnerable to these disparities.


ADHD Autism Depression Medical home Child health outcomes Survey 


Conflict of interest

None of the authors have a conflict of interest.


  1. 1.
    Joint Principles of the Patient-Centered Medical Home. Patient-centered primary care collaborative website. Accessed May 29, 2012.
  2. 2.
    National Center for Medical Home Implementation. Mental health and medical home. Accessed March 1, 2012.
  3. 3.
    Any Disorder Among Children. Accessed March 26, 2012.
  4. 4.
    Faraone, S. V., Sergeant, J., Gillberg, C., & Biederman, J. (2003). The worldwide prevalence of ADHD: is it an American condition? World Psychiatry, 2(2), 104–113.PubMedGoogle Scholar
  5. 5.
    The Depressed Child. (2008). Accessed March 26, 2012.
  6. 6.
    Other Mental Disorders in Children and Adolescents. Mental health: A report of the surgeon general. Accessed March 26, 2012.
  7. 7.
    Merikangas, K. R., He, J. P., Brody, D., Fisher, P. W., Bourdon, K., & Koretz, D. S. (2010). Prevalence and treatment of mental disorders among US children in the 2001–2004 NHANES. Pediatrics, 125(1), 75–81.PubMedCrossRefGoogle Scholar
  8. 8.
    Data and Statistics. Autism spectrum disorders (ASDs). Accessed March 26, 2012.
  9. 9.
    Use of Mental Health Services and Treatment Among Children. Accessed March 26, 2012.
  10. 10.
    Chow, J. C., Jaffee, K., & Snowden, L. (2003). Racial/ethnic disparities in the use of mental health services in poverty areas. American Journal of Public Health, 93(5), 792–797.PubMedCrossRefGoogle Scholar
  11. 11.
    Wu, P., Hoven, C. W., Cohen, P., et al. (2001). Factors associated with use of mental health services for depression by children and adolescents. Psychiatric Service, 52(2), 189–195.CrossRefGoogle Scholar
  12. 12.
    Chen, A. Y., & Chang, R. K. (2002). Factors associated with prescription drug expenditures among children: an analysis of the Medical Expenditure Panel survey. Pediatrics, 109(5), 728–732.PubMedCrossRefGoogle Scholar
  13. 13.
    Kogan, M. D., Blumberg, S. J., Schieve, L. A., et al. (2009). Prevalence of parent-reported diagnosis of autism spectrum disorder among children in the US, 2007. Pediatrics, 124(5), 1395–1403.PubMedCrossRefGoogle Scholar
  14. 14.
    Toomey, S. L., Homer, C. J., & Finkelstein, J. A. (2010). Comparing medical homes for children with ADHD and asthma. Academic Pediatrics, 10(1), 56–63.PubMedCrossRefGoogle Scholar
  15. 15.
    National Survey of Children’s Health. (2007). Methodology report. Accessed May 29, 2012.
  16. 16.
    Statistical Analysis Software for Professionals, Release 9. Available at: Accessed July 15, 2010.
  17. 17.
    Child and Adolescent Health Measurement Initiative. NSCH 2007: met criteria for having a medical home. Accessed March 1, 2012.
  18. 18.
    United States Senate. Children’s Mental Health Parity Act. S-77. Accessed March 1, 2012.
  19. 19.
    National Technical Assistance Center for Children’s’ Mental Health. Accessed March 1, 2012.
  20. 20.
    American Academy of Pediatrics. Children’s Mental Health in Primary Care. Accessed March 15, 2012.
  21. 21.
    Center for Health Care Strategies. Care management entities: A primer. Accessed March 15, 2012.
  22. 22.
    Strickland, B. B., Jones, J. R., Ghandour, R. M., Kogan, M. D., & Newacheck, P. W. (2011). The medical home: health care access and impact for children and youth in the United States. Pediatrics, 127(4), 604–611.PubMedCrossRefGoogle Scholar
  23. 23.
    Flores, G., & Tomany-Korman, S. C. (2008). The language spoken at home and disparities in medical and dental health, access to care, and use of services in US children. Pediatrics, 121(6), e1703–e1714.PubMedCrossRefGoogle Scholar
  24. 24.
    Strickland, B. (2004). Access to the medical home: Results of the National Survey of Children With Special Health Care Needs. Pediatrics, 113(Supplement 4), 1485–1492.PubMedGoogle Scholar
  25. 25.
    Starfield, B. (2004). The medical home, access to care, and insurance: A review of evidence. Pediatrics, 113(Supplement 4), 1493–1498.PubMedGoogle Scholar
  26. 26.
    Olson, L. M., Tang, S. S., & Newacheck, P. W. (2005). Children in the United States with discontinuous health insurance coverage. New England Journal of Medicine, 353, 382–391.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  • Caprice Knapp
    • 1
  • Lindsey Woodworth
    • 1
  • Daniel Fernandez-Baca
    • 1
  • Jacqueline Baron-Lee
    • 1
  • Lindsay Thompson
    • 2
  • Melanie Hinojosa
    • 1
  1. 1.Department of Health Outcomes and PolicyUniversity of FloridaGainesvilleUSA
  2. 2.Department of PediatricsUniversity of FloridaGainesvilleUSA

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