Finding the right healthcare for a child or loved one can leave you feeling like you need a visit to the doctor. A new study by Vanderbilt University researchers has found that the type of stress you experience may depend on the type of health care system with which you are dealing.

Vanderbilt researchers Craig Anne Heflinger, associate professor of human and organizational development, and Ana María Brannan, research associate, surveyed over 600 families in Tennessee and Mississippi to determine factors related to caregiver strain. The results were published in The Journal of Behavioral Health Sciences Research.

Caregiver strain is defined as the stress and problems that people experience when caring for a family member with health issues. In this study, the researchers focused on parents who were caring for children with emotional and behavioral disorders.

Heflinger and Brannan chose to study Tennessee and Mississippi because the two states operate different forms of Medicaid. In Tennessee, Medicaid participants enroll in TennCare, a managed care system that operates sort of like an HMO. Patients in these systems have fewer choices about their own medical care any services are reviewed for medical necessity before authorizing them. Mississippi operates a fee for service system where patients have more freedom about where, when, and from whom they will receive their healthcare.

The authors found that under both systems, the severity of a child's problem was the most significant stressor. But they also found notable differences between the two. Under managed care, caregiver strain was related to provider/payer related barriers to care. In the fee for service system, strain was linked to family perceptions about the care they were receiving and inconvenient appointment locations and times.

"We have learned that caregiver strain is related to system performance," Brannan explained. "Barriers to care and poor service coordination have been found to be associated with caregiver strain."

In a related study, they also found that children in the fee for service system had access to more mental health services, and that the factors that influenced which children got services and how much varied between the two systems.

This research could help healthcare organizations re-evaluate how they deliver health care.

"If you compare two children with similar levels of clinical need, the one whose parent is experiencing great caregiver strain is more likely to be treated in an expensive residential setting," Brannan said. "It would appear that by reducing caregiver strain, mental health systems could reduce costs of care." Heflinger added, "As our health care systems seek to reduce hospital and residential care and provide more community based services, attention to caregiver strain will be critical."

Heflinger and Brannan are funded by the National Institute of Mental Health and National Institute on Drug Abuse to continue this work, and plan to explore differences in how this issue affects urban and rural families. They work closely with key family advocacy organizations in both states, Tennessee Voices for Children and Mississippi Families as Allies.

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