Uninsured children with psychosocial problems: Primary care management

Objective. Nearly 14% of children in the United States are uninsured. We co mpared the prevalence of psychosocial problems and mental health services r eceived by insured and uninsured children in primary care practices. Methods. The Child Behavior Study was a cohort study conducted by Pediatric Research in Office Settings and the Ambulatory Sentinel Practice Network. Four hundred one primary care clinicians enrolled an average sample of 55 c onsecutive children (4-15 years old) per clinician. Results. Of the 13 401 visits to clinicians with 3 or more uninsured patien ts, 12 518 were by insured children (93.4%) and 883 were by uninsured child ren (6.6%). A higher percentage of adolescents, Hispanic children, those wi th unmarried parents, and those with less educated parents were uninsured. According to clinicians, uninsured children and insured children had simila r rates of psychosocial problems (19%) and severe psychosocial problems (2% ). For children with a clinician-identified psychosocial problem, we found no differences in clinician-reported counseling, medication use, or referra l to mental health professionals. Conclusions. Among children served in primary care practices, uninsured chi ldren have similar prevalence of clinician-identified psychosocial and ment al health problems compared with insured children. Within their practices, clinicians managed uninsured children much the same way as insured children .