Addressing Maternal Health Disparities: Building a Novel Two-Generation Approach to Comprehensive Postpartum Care.

The United States is facing a maternal health crisis with increasing rates of severe maternal morbidity and mortality. To improve maternal health and promote health equity, the authors developed a novel 2-generation model of postpartum and pediatric care. This article describes the Two-Generation Clinic (Two-Gen) and model of care. The model combines a dyadic strategy for simultaneous maternal and pediatric care with the collaborative care model in which seamless primary and behavioral health care are delivered to address the physical health, behavioral health, and social service needs of families. The transdisciplinary team includes primary care physicians, nurse practitioners, psychiatrists, obstetrician-gynecologists, social workers, care navigators, and lactation specialists. Dyad clinic visits are coscheduled (at the same time) and colocated (in the same examination room) with the same primary care provider. In the Two-Gen, the majority (89%) of the mothers self-identify as racial and ethnic minorities. More than 40% have a mental health diagnosis. Almost all mothers (97.8%) completed mental health screenings, >50.0% have received counseling from a social worker, 17.2% had a visit with a psychiatrist, and 50.0% received lactation counseling. Over 80% of the children were up to date with their well-child visits and immunizations. The Two-Gen is a promising model of care that has the potential to inform the design of postpartum care models and promote health equity in communities with the highest maternal health disparities.

Screening fathers for postpartum depression in a maternal-child health clinic: a program evaluation in a midwest urban academic medical center.

BACKGROUND: Postpartum depression (PPD) impacts fathers as well as mothers, and is estimated to affect between 8 and 13% of fathers. Paternal PPD is a risk factor for worsened quality of life, poor physical and mental health, and developmental and relational harms in the father-mother-child triad. There are no current recommendations for PPD screening among fathers. Paternal PPD screening was piloted in an intergenerational postpartum primary care clinic. METHODS: The pilot was carried out in an intergenerational postpartum primary care clinic located at a Midwest urban academic safety net health system from October 2021 to July 2022. Fathers actively involved in relationships with mothers or infants receiving primary care in the clinic were approached with mothers' permission. A novel survey instrument was used to collect demographic/social data, as well as mental health history and current stress levels; an Edinburgh Postnatal Depression Scale (EPDS) was also administered. Screenings were completed by social workers; data were collected in REDCap and descriptive statistics were calculated in SAS. RESULTS: 29 fathers were contacted and 24 completed screening (83%). Mean age was 31 years (range 19-48). Most (87%) identified as belonging to a racial or ethnic minority group. Fathers self-reported low rates of stress and preexisting mental health conditions, but 30% screened positive for PPD on EPDS (score of ≥ 8, or suicidal ideation). Gaps in health care were found, as one-quarter (26%) of fathers were uninsured and half (54%) did not have a primary care provider. After screening, two requested mental health services, and three established new primary care with a physician. CONCLUSIONS: Participation was high in a PPD screening pilot for fathers in a primary care setting. This small sample of fathers demonstrated significant peripartum mental health challenges unlikely to have been identified otherwise. For some participants, engaging in PPD screening was an effective tool to prompt their subsequent engagement with general health care. This pilot is a step toward incorporating the health of fathers into models for supporting the health of families. Expanding screening for paternal PPD into routine primary care is necessary to reach more affected fathers.

Elevating Women's Voices: The Illinois Maternal Health Digital Storytelling Project.

Numerous initiatives at the national, state, and local levels are focused on addressing the U.S. maternal health crisis. However, most efforts fail to center women's voices and personal perspectives about pregnancy experiences and complications. This article describes the Illinois Maternal Health Digital Storytelling Project conducted by the University of Illinois at Chicago, in partnership with StoryCenter, a storytelling nonprofit organization based in Berkeley, California. The project aimed to elevate voices (stories) to complement other sources of data on maternal outcomes. We relied on partners to help recruit storytellers with a self-identified perinatal-related challenge. We screened interested individuals using a trauma-informed approach and a social worker provided storytellers with support during the project. Two groups participated in this project, one in 2021 and another in 2022, culminating with 10 digital stories. Both instances were conducted virtually and included group and individual skills-based sessions where storytellers learned to create and edit their digital stories. The storytellers own their digital stories and provided consent to include them in ongoing dissemination efforts. In September 2021, a webpage was launched to house the stories, and this resource is being shared widely. Evaluation efforts of the webpage are ongoing to understand how these digital stories are being used to inform maternal health efforts. Digital stories add richness to ongoing maternal health prevention work and may serve as a powerful tool to elicit understanding among providers, practitioners, and constituents.

The Effect of Neighborhood Disorganization on Care Engagement Among Children With Chronic Conditions Living in a Large Urban City.

Neighborhood context plays an important role in producing and reproducing current patterns of health disparity. In particular, neighborhood disorganization affects how people engage in health care. We examined the effect of living in highly disorganized neighborhoods on care engagement, using data from the Coordinated Healthcare for Complex Kids (CHECK) program, which is a care delivery model for children with chronic conditions on Medicaid in Chicago. We retrieved demographic data from the US Census Bureau and crime data from the Chicago Police Department to estimate neighborhood-level social disorganization for the CHECK enrollees. A total of 6458 children enrolled in the CHECK between 2014 and 2017 were included in the analysis. Families living in the most disorganized neighborhoods, compared with areas with lower levels of disorganization, were less likely to engage in CHECK. Black families were less likely than Hispanic families to be engaged in the CHECK program. We discuss potential mechanisms through which disorganization affects care engagement. Understanding neighborhood context, including social disorganization, is key to developing more effective comprehensive care models.

Rates of diagnoses of sleep disorders in children with chronic medical conditions.

STUDY OBJECTIVES: This investigation examines sleep disorder (SD) diagnoses in a large population of children and adolescents with chronic medical conditions (CMCs). Little is known about SD diagnoses in this population. The large population used in this study allowed examination of SD rates by CMC type and demographics. METHODS: Data were from the Coordinated Health Care for Complex Kids (CHECK) project designed for Medicaid-funded children and adolescents with at least 1 CMC from a large metropolitan area. The study population (n = 16,609) was limited to children and adolescents, 0 to 18 years of age. SD and CMC diagnoses were obtained from Medicaid claims data. RESULTS: Fourteen percent of the population (mean age of 9.1 years [standard deviation = 5.2]; 35.8% African American; 56.4% male; 77 with more than 1 CMC) received a sleep disorder diagnosis. The most frequent diagnosis was sleep-disordered breathing (11.2%), followed by nocturnal enuresis (1.2%) and insomnia (1%). SDs were diagnosed more frequently in those with multiple CMCs than in those with 1 CMC (19.7% vs 5.8%; P < .001). Insomnia rates in Hispanic/Latinx (1.2%) and African American (0.8%) children and adolescents were significantly lower (both P < .001) than in Caucasians (3.5%). Odds of receiving a sleep diagnosis varied among CMCs. CONCLUSIONS: Our analysis of Medicaid claims data of a large urban cohort offers detailed information about the rates of sleep diagnoses and suggests underdiagnosis of SDs in this vulnerable, high-risk, primarily ethnic minority population. Underrecognition of sleep disorders has short- and long-term health and economic consequences. Study results may help clinicians implement appropriate SD screening and management for children and adolescents with CMCs. CITATION: Adavadkar PA, Pappalardo AA, Glassgow AE, et al. Rates of diagnoses of sleep disorders in children with chronic medical conditions. J Clin Sleep Med. 2022;18(8):2001-2007.

Trends in School Attendance for Low-Income Children with Chronic Health Conditions: Results from a Randomized Controlled Trial.

BACKGROUND: In this study, we aimed to determine how school attendance changed over time for children on Medicaid with chronic health conditions enrolled in a comprehensive care coordination program called Coordinated HEalthcare for Complex Kids (CHECK). METHODS: Medicaid beneficiaries from one managed care organization were randomized into 2 arms: CHECK program services or usual care. The final sample was 1322. RESULTS: The mean age was 10.9 (SD = 3.7) years old and children were mostly non-Hispanic Black (62.6%) or Hispanic (34.9%). The median school attendance at baseline was 94.9% (IQR 88.9, 97.9); over one-fourth of children (28.4%) were chronically absent. School attendance was not associated with race/ethnicity, risk level, and health condition. In a model including a significant time/grade interaction, school attendance increased over time for children in pre-kindergarten (OR = 1.52, 95% CI: 1.38, 1.68; p < .001) and kindergarten to 5th grade (OR = 1.21, 95% CI: 1.17, 1.26; p < .001), and decreased for children in 6th to 8th grade (OR = 0.80, 95% CI: 0.77, 0.83; p < .001). No differences were seen in school attendance or chronic absenteeism associated with enrollment in the CHECK program. CONCLUSIONS: School attendance improved for most of the low-income children with chronic health conditions in our cohort, except for children in middle school.

The Uneven Distribution of Medically Underserved Areas in Chicago.

Purpose: Safety net health services, such as federally funded health clinics, are interventions that aim to mitigate inequality in resource distribution, thus primarily clustered in poor areas with lack of access to health care. However, not all neighborhoods with the most needs benefit from safety net health services. In this article, we explore the distribution of a federally funded health service intervention designed to serve impoverished areas, the medically underserved areas (MUAs), and the relationship between MUA designation and neighborhood sociodemographic characteristics. Methods: We explore the spatial distribution of MUAs. The 2010 U.S. census data including 868 census tracts in Chicago were used for the analysis. We then examined the likelihood of being designated as an MUA using census tract level neighborhood demographic variables. Results: We found that the likelihood of obtaining MUA designation increases for neighborhoods with higher levels of poverty, the likelihood of being designated as an MUA begins to decline beyond the tipping point, whereas the proportion of black residents continues to increase. In census tracts that were eligible but not designated, there was a greater proportion of black residents compared with white residents (p<0.01). The census tracks also had higher mean disadvantage scores (p<0.01) and lower social capital (p<0.01). Furthermore, MUA eligible areas that were not designated as MUAs were predominantly black neighborhoods in poverty. Conclusion: Studies have documented that receiving MUA designation substantially reduces disparities in access to health care, and yet, our study finding indicates that the most racially segregated poor neighborhoods are excluded from the benefits of having such federal health safety net program. Seemingly race-neutral safety net health services may still be distributed in a way that perpetuates racial inequality in health.

Mental Health Diagnoses among Children and Adolescents with Chronic Medical Conditions in a Large Urban Cohort.

We analyzed data for 6,458 children with chronic conditions. The most prevalent diagnoses were mood disorders (8.6%), attention deficit hyperactivity disorder (ADHD; 7.4%), conduct disorders (6.1%), and anxiety disorders (4.8%). Adjusted odds of having a mental health diagnosis increased with age for mood disorders and anxiety disorders and decreased with age for ADHD and conduct disorders. When compared with females, males had lower odds of being diagnosed with mood and anxiety disorders and higher odds of being diagnosed with ADHD and conduct disorders. Blacks had lower odds of being diagnosed with anxiety, mood disorders, and ADHD than children in the other racial category. Hispanics had lower odds of being diagnosed with ADHD than children in the other racial category. Racial/ethnic minorities were less likely to have a mental health diagnosis than children in the other race/ethnicity category, which suggests under identification of mental health needs particularly in minority children.

Exploring Racial Disparities in Mental Health Diagnoses and Neighborhood Disorganization Among an Urban Cohort of Children and Adolescents with Chronic Medical Conditions.

Objective: This article describes the demographic distribution of, and association between, neighborhood disorganization and mental health diagnosis by race in a large cohort of urban children with chronic medical conditions. Methods: Data for this study were from Coordinated Healthcare for Complex Kids (CHECK), a health care demonstration project funded by the Center for Medicare and Medicaid Innovation. We conducted regression analyses to examine the relationship between neighborhood disorganization and mental health diagnosis among 6,458 children enrolled in CHECK. Results: The most common mental health diagnoses were mood disorders (8.6%), Attention-Deficit/Hyperactivity Disorder (7.4%), conduct disorders (6.1%), and anxiety disorders (4.8%). Black children had the highest neighborhood disorganization scores compared with other racial/ethnic categories. However, Black children had the lowest proportion of mental health diagnoses. Lower neighborhood disorganization was associated with having a mental health diagnosis; however, when adding race/ethnicity to the model, neighborhood disorganization no longer was significant. Conclusions: Level of neighborhood disorganization was highly correlated with racial/ethnic composition of the neighborhoods, and Black children disproportionately resided in highly disorganized neighborhoods compared with other groups. Neighborhood disorganization may not have sufficient variability within the racial/ethnic categories, which may explain the absence of an interaction between race/ethnicity and mental health diagnosis.

A Two-Way Interactive Text Messaging Application for Low-Income Patients with Chronic Medical Conditions: Design-Thinking Development Approach.

BACKGROUND: Two-way interactive text messaging between patient and community health workers (CHWs) through mobile phone SMS (short message service) text messaging is a form of digital health that can potentially enhance patient engagement in young adults and families that have a child with chronic medical conditions such as diabetes mellitus, sickle cell disease, and asthma. These patients have complex needs, and a user-centered way can be useful for designing a tool to address their needs. OBJECTIVE: The aim of this study was to utilize the user-centered approach of design thinking to develop a two-way interactive communication SMS text messaging tool for communication between patients or caregivers and CHWs. METHODS: We applied a design thinking methodology for development of the SMS text messaging tool. We collected qualitative data from 127 patients/caregivers and 13 CHWs, health care professionals, and experts. In total, 4 iterative phases were used to design the final prototype. RESULTS: The design thinking process led to the final SMS text messaging tool that was transformed from a one-dimensional, template-driven prototype (phases 1 and 2) into a dynamic, interactive, and individually tailored tool (phases 3 and 4). The individualized components consider social factors that influence patients' ability to engage such as transportation issues and appointment reminders. SMS text messaging components also include operational factors to support staff such as patient contact lists, SMS text messaging templates, and technology chat support. CONCLUSIONS: Design thinking can develop a tool to meet the engagement needs of patients with complex health care needs and be user-friendly for health care staff.

Development of a Community-Based Medical Neighborhood for Children with Chronic Conditions.

BACKGROUND: Children with chronic conditions have unmet health needs. Coordinated Healthcare for Complex Kids (CHECK) is a demonstration project with aims to improve health outcomes using an innovative approach to community-based health care. OBJECTIVE: We describe the development and implementation of a community-based medical neighborhood (CBMN). METHODS: The CHECK CBMN used several novel approaches to partner with clinical and community organizations, including care coordination software, advisory board participation, and an external social service referral database (SSRD). RESULTS: The CHECK CBMN executed 25 formal partnership agreements. We hosted 15 advisory board meetings, participated in 43 community events, and made 1,443 community-based social service referrals. We provided 43 trainings on pediatric chronic conditions and participated in four community in-service trainings. CONCLUSIONS: The CHECK CBMN contributes to the understanding of how innovative processes and collaboration can improve care coordination for children with chronic conditions through community and clinical partnerships.

A multivariable analysis of childhood psychosocial behaviour and household functionality.

BACKGROUND: Social determinants of health play a vital role in population health. Awareness of household social factors and their impact on health can help health professionals to provide effective strategies in health promotion, especially for children and adolescents showing signs of psychosocial dysfunction. The objective of this study was to explore the association between parents' perceptions of the psychosocial behaviour of their children and the functionality of their household. METHODS: This cohort study analysed data from the Coordinated Health Care for Complex Kids programme. The sample included 293 parents of children aged 4-17 years with chronic conditions, and from urban, low-income families. Psychosocial behaviour of the child was measured using the Pediatric Symptom Checklist (PSC-17), which included subscales for internal, external, and attention symptoms. Household functionality was measured using the Confusion, Hubbub, and Order Scale. Responses to both assessments were scored in a standard manner. RESULTS: There was a significant association between parents' perceptions of the psychosocial behaviour of their children and the functionality of the home environment. The mean Confusion, Hubbub, and Order Scale scores in the home environment improved from baseline to the first reassessment (the period between the two assessments ranged from 4 to 8 months). Additionally, positive PSC-17 screening results of the children decreased by 11% in the first reassessment. The odds of having a positive PSC-17 screening result also decreased in the first reassessment after receiving interventions. CONCLUSION: The association between psychosocial dysfunction and household functionality indicates the importance of family-centred care and taking the home environment into consideration when administering health services to low-income children with chronic conditions. This study brings attention to the more hidden factors that influence child mental health, which must be addressed to improve care delivery and child health outcomes.

A Real-World Community Health Worker Care Coordination Model for High-Risk Children.

Health care systems across the United States are considering community health worker (CHW) services for high-risk patients, despite limited data on how to build and sustain effective CHW programs. We describe the process of providing CHW services to 5,289 at-risk patients within a state-run health system. The program includes 30 CHWs, six care coordinators, the Director of Care Coordination, the Medical Director, a registered nurse, mental health specialists, and legal specialists. CHWs are organized into geographic and specialized teams. All CHWs receive basic training that includes oral and mental health; some receive additional disease-specific training. CHWs develop individualized care coordination plans with patients. The implementation of these plans involves delivery of a wide range of social service and coordination support. The number of CHW contacts is determined by patient risk. CHWs spend about 60% of their time in an office setting. To deliver the program optimally, we had to develop multiple CHW job categories that allow for CHW specialization. We created new technology systems to manage operations. Field issues resulted in program changes to improve service delivery and ensure safety. Our experience serves as a model for how to integrate CHWs into clinical and community systems.

A Comparison of Different Intensities of Patient Navigation After Abnormal Mammography.

Background. Patient navigation is a practice strategy to address barriers to timely diagnosis and treatment of cancer. The aim of this study was to examine the effectiveness of varying intensities of patient navigation and timely diagnostic resolution after abnormal mammography. Method. This is a secondary analysis of a subset of women with an abnormal screening or diagnostic mammogram who participated in the "patient navigation in medically underserved areas" 5-year randomized trial. We compared timely diagnostic resolution in women assigned to different intensities of patient navigation including, full navigation intervention, no contact with navigators, or limited contact with navigators. Results. The sample included 1,725 women with abnormal mammogram results. Women who interacted with patient navigators had significantly fewer days to diagnostic resolution after abnormal mammography compared with women who did not interact with patient navigators. Discussion. Results from our study suggest that even limited contact with navigators encourages women to seek more timely diagnostic resolution after an abnormal mammogram, which may offer a low-cost practice strategy to improve timely diagnosis for disadvantaged and underserved women.

Gendered and racialized social expectations, barriers, and delayed breast cancer diagnosis.

BACKGROUND: Black women are more likely to be diagnosed at a later stage of breast cancer in part due to barriers to timely screening mammography, resulting in poorer mortality and survival outcomes. Patient navigation that helps to overcome barriers to the early detection of breast cancer is an effective intervention for reducing breast cancer disparity. However, the ability to recognize and seek help to overcome barriers may be affected by gendered and racialized social expectations of women. METHODS: Data from a randomized controlled trial, the Patient Navigation in Medically Underserved Areas study, were used. The likelihood of obtaining a follow-up screening mammogram was compared between women who identified ≥1 barriers and those who did not. RESULTS: Of the 3754 women who received the Patient Navigation in Medically Underserved Areas navigation intervention, approximately 14% identified ≥ 1 barriers, which led to additional navigator contacts. Consequently, those women who reported barriers were more likely to obtain a subsequent screening mammogram. Black women, women living in poverty, and women with a higher level of distrust were less likely to report barriers. CONCLUSIONS: Minority women living in poverty have always been the source of social support for others. However, gendered and racialized social expectations may affect the ways in which women seek help for their own health needs. A way to improve the effectiveness of navigation would be to recognize how minority women's gender images and expectations could shape how they seek help and support. A report of no barriers does not always translate into no problems. Proactive approaches to identify potential barriers may be beneficial.

Substance-exposed newborn infants and public health law: Differences in addressing the legal mandate to report.

Prenatal exposure to illicit substances is a finding that typically requires reporting to a child protective services agency. We examine whether there is differential reporting to two public agencies, and whether it varies by race/ethnicity and region. We also study predictors of indicating a maltreatment report as credible. Data on positive neonatal toxicology reports were obtained from the Illinois Department of Public Health (IDPH) and the Illinois Department of Children and Family Services (DCFS). Variation in reporting rates by race/ethnicity and region were compared with Pearson chi-square analysis. Multivariate logistic regression examined factors related to the likelihood of DCFS indicating a report as credible for maltreatment. IDPH recorded 1838 reports of substance-exposed newborn infants while DCFS only recorded 459 reports. There was a greater percentage of whites than blacks reported to DCFS as compared to those reported to IDPH (p < 0.001). There was a greater percentage of whites than blacks found to be indicated by DCFS as compared to those reported to IDPH (p < 0.001). Infants reported in rural areas were indicated less often (OR:0.34, 95% CI:0.17-0.67, p = 0.002) than those from urban areas. In conclusion, there was variation in reporting patterns between the two agencies. To optimize health outcomes for substance-exposed newborn infants (SEIs), the law should be clarified to provide clear standards for reporting and managing SEIs. Clinicians should ensure they are acting within the confines of existing law, and should engage in an interprofessional process with a broad array of stakeholders to develop statewide drug testing and reporting protocols.

Oral Health Problems and Solutions in High-Risk Children and Young Adults.

Purpose: The Coordinated Healthcare for Complex Kids (CHECK) project targets publically insured children and young adults with chronic diseases. The CHECK oral health program intervenes at individual, family, and community levels. This paper describes the baseline oral health status of CHECK patients. Methods: CHECK patients older than 18 years of age and caretakers of younger patients were asked about their oral health. Medicaid claims data were used to determine diagnoses and level of risk. Attendance data from the Chicago Public Schools was obtained to assess absenteeism. Results: Of the 5,509 CHECK patients, 1,122 (20.4%) reported some type of oral health problem in the last six months. The most common issue was a history of dental caries (N=753, 13.7%). The odds of oral health problems increased significantly in adolescents (odds ratio [OR]=1.20; 95% confidence interval [CI]=1.02 to 1.40) and young adults (OR=1.55; 95% CI=1.31 to 1.85) compared with children. Males were less likely than females to have oral health problems (OR=0.83, 95% CI=0.73 to 0.95). Worse general health was significantly associated with oral health problems. Conclusion: CHECK is implementing a multilevel comprehensive approach to address oral health problems.

Patient Navigation Improves Subsequent Breast Cancer Screening After a Noncancerous Result: Evidence from the Patient Navigation in Medically Underserved Areas Study.

BACKGROUND: Past efforts to assess patient navigation on cancer screening utilization have focused on one-time uptake, which may not be sufficient in the long term. This is partially due to limited resources for in-person, longitudinal patient navigation. We examine the effectiveness of a low-intensity phone- and mail-based navigation on multiple screening episodes with a focus on screening uptake after receiving noncancerous results during a previous screening episode. METHODS: The is a secondary analysis of patients who participated in a randomized controlled patient navigation trial in Chicago. Participants include women referred for a screening mammogram, aged 50-74 years, and with a history of benign/normal screening results. Navigation services focused on identification of barriers and intervention via shared decision-making processes. A multivariable logistic regression intent-to-treat model was used to examine differences in odds of obtaining a screening mammogram within 2 years of the initial mammogram (yes/no) between navigated and non-navigated women. Sensitivity analyses were conducted to explore patterns across subsets of participants (e.g., navigated women successfully contacted before the initial appointment; women receiving care at Hospital C). RESULTS: The final sample included 2,536 women (741 navigated, 1,795 non-navigated). Navigated women exhibited greater odds of obtaining subsequent screenings relative to women in the standard care group in adjusted models and analyses including women who received navigation before the initial appointment. CONCLUSIONS: Our findings suggest that low-intensity navigation services can improve follow-up screening among women who receive a noncancerous result. Further investigation is needed to confirm navigation's impacts on longitudinal screening.

An innovative health-care delivery model for children with medical complexity.

Children with medical complexity (CMC) account for a disproportionate share of pediatric health-care utilization and cost that is largely attributable to long hospitalizations, frequent hospital readmissions, and high use of emergency departments. In response, the Centers for Medicare and Medicaid Services Health Care Innovation Center supports the development and testing of innovative health-care payment and service delivery models. The purpose of this article is to describe the CMS-funded coordinated health care for complex kids (CHECK) program, an innovative system of health-care delivery that provides improved, comprehensive, and well-coordinated services to CMC. The CHECK program uses a combination of high-tech and low-tech interventions to connect patients, stakeholders, and providers. It is anticipated that the investment in additional support services to CMC will result in improved quality of care that leads to a reduction in unnecessary inpatient hospitalizations, readmissions, and emergency department visits and a total cost savings. The CHECK program has the potential to inform future cost-effective health-care models aimed at improving the quality of life and care for CMC and their families.

Behavioral Health Disparities Among Children and Youth with Special Health Care Needs.

The burden of mental health morbidity, disability, and mortality in children is not equally distributed across populations in the United States. The consequence is widespread differences in health status between certain groups of children that result in systematic behavioral health disparities. In the US, an estimated 12.8% of children (9.4 million) have a special health care need. Mental, emotional, and behavioral problems and disorders are widespread among children and youth with special health care needs (CYSHCN), but are often undetected and untreated despite the adverse consequences to children throughout the life course. CYSHCN experience behavioral health disparities in the prevalence of behavioral health problems and conditions, and in the access to needed services. Further investigation is required to fully identify behavioral health needs, the mechanisms contributing to the disparities, and effective strategies to prevent and provide interventions for CYSHCN. Investing in research and interventions is vital to reducing behavioral health disparities. [Pediatr Ann. 2017;46(10):e382-e386.].