P3.051: Care Coordination, Referral Barriers, and Unmet Medical Care Among Children With Special Health Care Needs and Adverse Childhood Experiences

Background: Children with special health care needs (CSHCN) have chronic or complex conditions requiring more frequent health services than typically needed. These children are more likely to experience adverse childhood experiences (ACEs), which increase their risks for unmet healthcare needs. Care coordination can address these challenges by helping families navigate referrals, including medical subspecialists, mental health providers, and supportive services (e.g., speech therapy, educational resources). Understanding how care coordination interacts with referrals among CSHCN with ACEs may inform targeted interventions to reduce unmet medical care needs. To assess the association between care coordination and unmet medical care needs, with attention to referral status and other key covariates, among CSHCN who have at least one ACE.

Methods: We analyzed pooled 2018–2022 National Survey of Children’s Health data for CSHCN who had at least one ACE. Primary outcome: Parent‐reported unmet medical care needs. Main exposure: Care coordination status (not needed, needed and received, or needed but not received) with an interaction between care coordination and referral status (no referral needed, referred and no problems accessing, or referred and problems accessing). Covariates: ACE severity (1–3 vs. ≥4), family‐centered care, insurance type, CSHCN functional limitations, parental education, race/ethnicity, household language, federal poverty level, and child’s sex. The 9‐item ACE measure encompassed economic hardship, parental divorce/separation, parental death, parental incarceration, witnessing or experiencing violence, household mental illness, household substance use, and both race‐ and health‐based discrimination. Survey‐weighted multivariable logistic regression estimated adjusted odds ratios (aOR) and 95% confidence intervals (CI).

Results: Among 26,251 CSHCN with at least one ACE, 52.49% of families overall needed but did not receive care coordination. In logistic regression, children whose parents reported referral problems had nearly six times the odds of having unmet care needs (aOR = 5.90, 95% CI: 2.99–11.65). However, receiving care coordination substantially attenuated that excess risk in families who faced referral problems (interaction aOR = 0.33, 95% CI: 0.14-0.76). Having 4+ rather than 1–3 ACEs (aOR = 1.93, p< 0.001), lacking rather than having family-centered care (aOR = 2.20, p< 0.001), and having rather than not having functional limitations (aOR = 1.56, p< 0.001) were associated with higher odds of having unmet medical care needs. Having rather than lacking public (aOR = 0.45, p< 0.001) or private (aOR = 0.50, p< 0.001) health coverage was associated with lower odds of unmet medical care needs.

Conclusion: In this high‐risk population of CSHCN with ACEs, referral problems are associated with greater risk of unmet care needs. However, receiving care coordination is associated with less excess risk in those experiencing referral problems. These findings underscore the importance of providing effective care coordination for families facing referral barriers to improve healthcare delivery for children with special healthcare needs and adverse childhood experiences.