1. Family Financial Stress and Insurance Type Alexander Alvarez, OTS and Ruth Benedict, DrPH,OTR Occupational Therapy Program, Department of Kinesiology University of Wisconsin-Madison DESIGN & METHODS Purpose of Study The purpose of this study is to determine whether type of child health insurance is associated with family financial stress among families of children with special health care needs. A secondary aim is to determine whether family financial stress is associated with age of child, sex of child, race, household structure, and/or poverty level. Background Grace, Grembowski, & Watts (2009) reported that insurance type may have an impact on family finances. Extensive research has documented a link between families with children who have disabilities and poverty. Others have shown links between poverty and family stress (Wadsworth, Raviv, Santiago & Etter, 2011). No published studies using the data from the 2009/2010 National Survey of Children with Special Healthcare Needs have included analysis of family reported financial stress in relation to insurance type. Hypotheses It is hypothesized that families of CSHCN without insurance and those with public or other types of insurance will report having higher financial family stress compared to families of CSHCN with private insurance. RESULTS CONCLUSIONSINTRODUCTION ACKNOWLEDGEMENTS Insurance Type and Financial Stress Families of Uninsured (at time of interview) children were significantly more likely to report financial stress compared to those in the Private Insurance group. Families of children that had Other Insurance (public insurance, public + private insurance, & other comprehensive insurance) did not report a significantly higher financial family stress when compared to Private Insurance group. Covariates Race: African Americans were significantly less likely to report financial family stress compared to Whites (People of Hispanic descent are incorporated into either African- American, White, or Other category as per Census data.) Age: Families with older children were more likely to report financial stress when compared to the youngest age group Sex: There was a trend (p= 0.053) but no significant association between sex type and financial family stress Family Structure: Single parent mother households of CSHCN were significantly more likely to report financial family stress when compared to two-parent biological households. Poverty level: The moderately low income group, 130% - 300% FPL, reported significantly higher financial family stress when compared to the lowest income group, ≤129% FPL. Thank you to Dr. Benedict for her dedication in assisting and sharing her great knowledge and expertise throughout the course of this project. Thank you to my family, friends, and to all of my classmates whom provided a great energy throughout. Also thank you to all of the survey respondents for taking time to answer the NS-CSHCN survey questions and sharing parts of their life story. IMPLICATIONS FOR PRACTICE Occupational therapists must be aware of the potential for financial stress among the families of CSHCN because such stress can interfere with and strain interpersonal relationships including those in personal, family, friend, and work settings. An awareness of the risk factors for family financial stress can aid practitioners in providing appropriate individualized treatment plans to assist their clients. Practitioners should advocate for their clients and educate them on stress coping strategies especially if they fall into a family financial stress risk group. Quality of life needs to be preserved in all aspects of a client’s life including mental health and interpersonal relationships. As such practitioners should provide their clients with education and available and attainable resources that may reduce their family’s financial stress. Future research should look at underlying reasons why the significant covariate groups showed higher family financial stress. Data from the 2009/2010 National Survey of Children with Special Healthcare Needs (NS-CSHCN) Representative sample from all 50 states of approximately 750 children per state between the ages of 0-17 years (N= 35,814). Cross-sectional, random-digit-dial telephone survey using the State and Local Area Integrated Telephone Survey (SLAITS) developed by the National Center for Health Statistics at the Centers for Disease Control and Prevention. Dependent Variable Financial Family Stress as defined by the response to the survey question, “Have [S.C.]'s health conditions caused financial problems for your family?” Independent Variable A custom variable was created and includes the categories of: (1) private insurance only, (2) public, public and private, or other comprehensive insurance, (3) uninsured. A variety of factors appear to increase a family’s risk of reporting higher financial stress. It seems likely that the likelihood of family financial stress would increase if the CSHCN exhibits multiple risk characteristics. However, some categories may reduce the risk. It was unexpected to discover that the Other Insurance group did not significantly differ from the Private Insurance group when reporting family financial stress. Being very poor (<134% FPL) does not necessarily mean that the family will report financial stress attributed to the child’s condition. Qualifying for public family and financial services/assistance may explain why the families of CSHCN living in poverty did not report high family financial stress. Families of older CSHCN were found to report family financial stress more frequently when compared to the youngest age group. Families of older CSHCN may be less likely to receive available resources and education on adequate care and management of family stress.