Susan L. Parish

Economic implications of caregiving at midlife: comparing parents with and without children who have developmental disabilities.

We compared the economic well-being and maternal employment of parents whose children did or did not have developmental disabilities. This prospective study is a secondary analysis of data from the Wisconsin Longitudinal Study, collected when respondents were aged 18, 36, and 53, on average. Although the two groups were similar at age 18, income and savings differed markedly by age 53, but statistically significant differences were not found on other measures. Mothers of children with disabilities were less likely to have job spells lasting more than 5 years and had lower earnings when they were 36 years old. Further, there was a trend for them to be less likely to have full-time jobs as their children grew older.

Material Hardship in U.S. Families Raising Children with Disabilities

Researchers analyzed the 2002 wave of the National Survey of Americas Families, conducted by the Urban Institute and Child Trends, and examined material hardship in families raising children with disabilities. Measures of hardship included food insecurity, housing instability, health care access, and telephone disconnection. The research indicated that families of children with disabilities experienced significantly greater hardship than did other families. As family income rose above the federal poverty level, hardship declined sharply for families of children without disabilities but not for families raising children with disabilities. Thus, the U.S. federal poverty level was found to be a particularly poor predictor of hardship for families raising children with disabilities. Finally, among families of children with disabilities, single-mother and cohabiting-partner families particularly were at risk for experiencing severe hardship. This article also discusses policy and advocacy implications.

Care Integration in the Patient Protection and Affordable Care Act: Implications for Behavioral Health

Individuals with co-occurring serious mental illness and substance use disorders experience a highly fragmented system of care, contributing to poor health outcomes and elevated levels of unmet treatment needs. Several elements in the health care reform law may address these issues by enhancing the integration of physical and behavioral health care systems. The purpose of this paper is to analyze these elements, which fall into three domains: increasing access, restructuring financing and reimbursement mechanisms, and enhancing infrastructure. We conclude with a consideration of the implementation challenges that lie ahead.

Racial and ethnic disparities in quality of health care among children with autism and other developmental disabilities.

We examined racial and ethnic disparities in quality of care for children with autism and other developmental disabilities and whether disparities varied for children with autism compared to children with other developmental disabilities. Analyzing data from the National Survey of Children with Special Health Care Needs (N  =  4,414), we compared Black and Latino children to White children. We found racial and ethnic disparities on 5 of 6 quality outcomes. The interaction between race and disability status indicated that disparities in quality indicators were exacerbated among families of children with autism. These analyses suggest that children with autism, particularly those who are Latino and Black, face greater challenges in receiving high-quality health care.

Women with cognitive limitations living in the community: evidence of disability-based disparities in health care.

Using data from the Medical Expenditure Panel Survey for 2000 and 2002, we compared potential and realized use of health care for a national sample of working-age women with cognitive disabilities. Despite having similar likelihoods of potential access to health care as compared to nondisabled women, they had markedly worse rates of receiving cervical cancer and breast cancer screenings, similar rates of routine check-ups, and yet had better rates of receipt of influenza shots. They were also less likely to be satisfied with their medical care than were nondisabled women. Policy recommendations are suggested to address the disability-based disparities in reproductive health care for women with cognitive limitations.

Domestic Violence and Sexual Assault Services Historical Concerns and Contemporary Challenges

More than 20 years ago, concerns were raised about whether domestic violence and sexual assault agencies need for stable funding would conflict with the values that initiated these respective movements. Since then, the movements have evolved considerably. Therefore, it is timely to investigate the challenges domestic violence and sexual assault agencies face today. This exploratory study used focus groups and interviews to identify the challenges facing North Carolina domestic violence and sexual assault movements from the perspectives of agency directors and funding staff. Using an open-coding approach, seven challenges were identified including funding, sustainability, community norms, tension between grassroots versus professional service providers, lack of attention to sexual assault, the need for welcoming services for all survivors, and the need for comprehensive services to help survivors with co-occurring mental illnesses and substance abuse problems. The findings also pointed to recommendations for ways to address these challenges.

Financial Burden in Families of Children With Special Health Care Needs: Variability Among States

OBJECTIVE. The main objective of this study was to examine variability among states for 3 indicators of the family financial burden related to caring for children with special health care needs. METHODS. Data were from a 2001 national survey of households with children (<18 years of age) with special health care needs, with a representative sample from each state. The outcomes examined included whether a family had any out-of-pocket expenditures during the previous 12 months related to the childs special health care needs, the amount of expenditure (absolute burden), and the amount of expenditure per

Family Support in the United States: Financing Trends and Emerging Initiatives

1000 of family income (relative burden). We used multilevel regression to examine state-level variability in financial burden, controlling for individual-level factors. We also examined the association between state median family income and state mean financial burden. RESULTS. Overall, 82.5% of families reported expenditures of more than

INCOME POVERTY AND MATERIAL HARDSHIP AMONG U.S. WOMEN WITH DISABILITIES

0. Among these families, the mean unadjusted absolute burden was

Perspectives on Health Care of Adults With Developmental Disabilities

752 and the relative burden was