Behavioral Health Service Utilization and Unmet Need After Traumatic Brain Injury in Childhood.
Megan E Narad, Emily Moscato, Keith Owen Yeates and 3 others
PMID 31107769WHAT IT FOUND
Years after injury, children with traumatic brain injury had higher rates of behavioral health need than those with other injuries, but service use did not differ.
Across all groups, 77% of those needing care were not receiving it. Race predicted access, with white children having higher unmet need.
Key findings
01Severe TBI was associated with the highest rate of potential need for behavioral health services (69%), compared to moderate TBI (38%) and other injuries (17%).
02Despite higher need in the TBI group, there was no significant difference in behavioral health service utilization between injury groups at the 6.8-year follow-up.
03Unmet need was high for all groups, with 77% of children identified as needing services not receiving them.
STILL TO COME
How it was doneWhat they foundWhat it means for OTsWhat it means for SLPs
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What it does not show
The sample size, particularly for the severe TBI group, was relatively small, which may have limited the power to detect differences in service utilization. Clinical need was determined solely by parent report on the CBCL, which may be less sensitive to internalizing problems like anxiety and depression. Service utilization data was based on parent report, with no verification of the type, quality, or duration of services received. The study did not account for pre-injury behavioral functioning or current level of disability. Attrition bias may be present, as families who completed the 6.8-year follow-up may have had more stable living situations or ongoing engagement with services.
Declared interests
The authors have no conflicts of interest to disclose.
The easy way to misread this
Do not assume that early intervention leads to better long-term outcomes based on this study. The finding that children who received services in the first year were less likely to receive them at 6.8 years is descriptive and does not prove that early services reduced the need for later care. It may reflect that these children recovered sufficiently or that services were successfully tapered, but the study design cannot confirm this causal link.