Friday, March 11, 2016 From PTJ: Analysis Paints Dire Picture of Unmet Mobility and Therapy Needs Among Children When it comes to the mobility aid and therapy needs of children, as of 2010, the outlook was not good: nearly 1 in 10 children requiring mobility aids were not receiving them, and nearly 1 in 5 did not receive the therapy they needed. The rates were even more dismal for children with developmental disabilities or from low-income households. The statistics are part of an analysis that appeared in the February issue of Physical Therapy (PTJ), the research journal of APTA. Authors Beth M. McManus, PT, ScD, MPH, Laura A. Prosser, PT, PhD, and Mary E. Gannotti, PT, PhD, used the 2009–2010 National Survey of Children With Special Health Care Needs to address what they believe is a scarcity of information on how well children's needs for mobility aids and therapy are being met. Authors screened caregiver-reported survey results related to 372,698 children from 196,195 households. Of that total, 40,242 children were categorized as having a special health care need. In addition, "More than 70% of the children with a need for therapy or mobility aids had a diagnosis of developmental disability," the authors note. Overall, therapy needs were revealed to be more prevalent than the need for mobility aids. When authors took a closer look at the data, they uncovered some troubling details about the unmet needs for physical therapy, occupational therapy, and speech therapy services among children. Among them: Nearly 1 in 5 children (17.7%) reported unmet therapy needs. Children diagnosed with a developmental disability were almost 3 times more likely to have unmet therapy needs than children with medical conditions. Children with conditions "always" affecting their ability to function were nearly 3 times more likely to have an unmet therapy need than children whose condition affected them "very little" of the time. Children whose condition "usually" affected them were 2 times more likely to experience an unmet therapy need than those with conditions affecting them "very little of the time." Compared with the oldest group surveyed (ages 12–17), children ages 3 to 5 had much higher odds of encountering an unmet need for therapy. Black, non-Hispanic children experienced a 30% greater likelihood of having an unmet therapy need compared to white, non-Hispanic children. Being uninsured at any point during the previous 12 months made children twice as likely to have unmet needs as children benefiting from continuous health coverage. Children residing in households with incomes ranging between 200% and 399% of the federal poverty level (FPL) were nearly 50% more likely to have an unmet therapy need than households with incomes greater than 400% FPL. The authors identify the most common reasons for unmet therapy needs as "cost (23.1%), followed by lack of resources at school (17.3%), unavailability of services or transportation (15.0%), problems with health plan (14.3%), and appointments unavailable or not convenient (12.2%)." When it came to mobility aids, the needs were somewhat less dire, but still dramatic: Nearly 1 in 10 children (7.7%) requiring mobility aids reported having an unmet need. Children ages 3 to 5 had the highest percentage of unmet needs (12.1%). Children "always" affected by a condition were 6 times more likely to have an unmet need than those who were affected "very little of the time." Overall, authors write that the likelihood of unmet therapy increased with the "diagnosis of a developmental disability, having a condition that always affected function, and insurance discontinuity." Authors note that the expansion of the State Children's Health Insurance Program under the Affordable Care Act is likely to increase coverage, and they believe that baseline statistics such as the ones they uncovered will help build a foundational understanding of the issue—and help to serve as reminder of the needs of an underserved population. For more insights, listen to the podcast of PTJ Editor in Chief Alan Jette's interview with coauthor Beth McManus. The children's needs article appears in the final installment of PTJ's special series on health services research. Check out the entire series at the PTJ website.