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Behavioral Health Service Utilization and Unmet Need After Traumatic Brain Injury in Childhood

Narad, Megan E. PhD*,†; Moscato, Emily BS‡,§; Yeates, Keith Owen PhD; Taylor, H. Gerry PhD¶,**; Stancin, Terry PhD††; Wade, Shari L. PhD†,‡

Journal of Developmental & Behavioral Pediatrics: May 16, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/DBP.0000000000000681
Original Article: PDF Only

Objective: The need for behavioral health services, service utilization, and predictors of utilization was examined in children with moderate-to-severe traumatic brain injury (TBI) relative to a comparison group of children with orthopedic injury (OI) 6.8 years after injury.

Methods: A total of 130 children hospitalized for moderate-to-severe TBI (16 severe and 42 moderate) or OI (72) between the ages of 3 and 7 years, who were enrolled at the time of injury at 3 tertiary care children's hospital and one general hospital in Ohio, and completed a long-term follow-up 6.8 years after injury were included in analyses.

Results: Adolescents with TBI (moderate [38%] and severe [69%]) had significantly greater rates of need than those with OI (17%). Behavioral health services were utilized by 10% of the sample with no injury group differences (OI: 6%; moderate: 17%; severe: 13%). Early treatment and white race were associated with less service utilization; 77% had an unmet need, with no injury group differences (OI: 75%; moderate: 75%; severe: 82%). Rate of unmet need was greater among white than non-white children.

Conclusion: Children who sustain a TBI in early childhood experience persistent and clinically significant impairments even years after injury. Rates of unmet need were high for all injury groups. Findings underscore the importance of long-term monitoring to identify developing needs and prevent significant complications/deficits.

*Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH;

Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH;

Division of Physical Medicine and Rehabilitation, Cincinnati Children's Hospital Medical Center, Cincinnati, OH;

§Department of Psychology, University of Cincinnati, Cincinnati, OH;

Department of Psychology, Alberta Children's Hospital Research Institute and Hotchkiss Brain Institute, University of Calgary, Alberta, Canada;

Biobehavioral Health Center, Nationwide Children's Hospital Research Institute, Nationwide Children's Hospital, Columbus, OH;

**Department of Pediatrics, The Ohio State University, Columbus, OH;

††Division of Child Psychiatry and Psychology, Department of Psychiatry, MetroHealth Medical Center and Case Western Reserve University, Cleveland, OH.

Address for reprints: Megan E. Narad, PhD, Division of Physical Medicine and Rehabilitation, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 3015, Cincinnati, OH 45229; e-mail:

This project was supported by the National Institute of Child Health and Human Development (R01 HD42729, K02 HD44099, 1F32HD088011-1), United States Public Health Service National Institutes of Health (M01 RR 08084), State of Ohio Emergency Medical Services trauma research grants, National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health (8 UL1 TR000077-04). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Disclosure: The authors declare no conflict of interest.

Received August 30, 2018

Accepted March 22, 2019

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