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Cited by 6Mental Health Treatment and AccessChild and Adolescent HealthChild and Adolescent Psychosocial and Emotional Development

State Differences in Children’s Mental Health Care

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Graaf, Genevieve, Hughes, Phillip M., Gigli, Kristin H., deJong, Neal A., McGrath, Robert E., Thomas, Kathleen C.·2025·Academic Pediatrics
DOI 10.1016/j.acap.2024.09.009PMC PMC11897828
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Abstract

Objective This study estimates and compares variation in the probability of child unmet need for mental health care and difficulties accessing care for each state in the United States. Estimates are also generated and compared for three socioeconomic and demographic subgroups nationwide: racial and ethnic group, household income, and insurance type. Methods Using a retrospective, cross-sectional design, this study pooled 2016-2019 National Survey of Children's Health data. National, state, and subgroup adjusted probabilities of caregiver-reported child unmet need for mental health care and ease of access to mental health care were generated from logistic regression models with marginal post-estimation. Results Adjusted national probabilities of caregiver-reported child unmet mental health need and difficulty in accessing care were 0.21 and 0.46, respectively. State probabilities of unmet need ranged from 0.08 to 0.32. One state was significantly above the national estimate; nine states were below it. State probabilities of difficulty accessing mental health care ranged from 0.28 to 0.57; nine states' probabilities were significantly below the national estimate and two states were significantly above it. Estimates of unmet mental health need and difficulty accessing care varied more widely across states than across racial or ethnic groups, income groups, insurance groups. Conclusions Geographic inequities in children's mental health care access persist; in some cases, they are larger than sociodemographic inequities.

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  • Variation in geographic availability of care coordination and Wraparound is an on-going concern.

    “Variation in geographic availability is also an on-going concern (Graaf et al., 2025).”

    From Adequate Care Coordination is Associated with Reduced Unmet Mental Health Needs for Children (2026) · cites this paper as Graaf et al., 2025

    The Discussion says state-based inequities in children’s mental health access merit further attention, supporting the cited sentence’s general concern about geographic variation. The passage does not address the geographic availability of care coordination or Wraparound specifically, so it does not support that narrower claim. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • Over 20% of all children with caregiver-reported mental health problems and need for mental health care report unmet mental health need.

    “Over 20% of all children with caregiver-reported mental health problems and need for mental health care report unmet mental health need”

    From Adequate Care Coordination is Associated with Reduced Unmet Mental Health Needs for Children (2026) · cites this paper as Graaf et al., 2025

  • 46% of families of children with caregiver-reported mental health problems and need for mental health care reported some level of difficulty in accessing mental health care.

    “46% of these families reported some level of difficulty in accessing mental health care”

    From Adequate Care Coordination is Associated with Reduced Unmet Mental Health Needs for Children (2026) · cites this paper as Graaf et al., 2025

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Cited by

Sorted by citations

Authors
Graaf, G., Hughes, P. M., Gigli, K. H., deJong, N. A., McGrath, R. E., & Thomas, K. C.
Affiliations
  • The University of Texas at Arlington (US)
  • University of North Carolina at Chapel Hill (US)
  • Fairleigh Dickinson University (US)
Corresponding author
Graaf, Genevieve
ORCID
Venue
Academic Pediatrics
Publisher
Elsevier BV
Published
2025-03
Volume
25
Issue
2
Pages
102585
ISSN
1876-2859 (ISSN-L)
DOI
10.1016/j.acap.2024.09.009
PMC
PMC11897828
OpenAlex
W4403016532
Cited by
6
References
2
Citations by year
2026: 3 · 2025: 3
FWCI
2.85
Type
journal article
Language
en
Open access
Licence
Locations
  • Academic Pediatrics (acceptedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • Carolina Digital Repository (University of North Carolina at Chapel Hill) (submittedVersion)
Funders
  • Agency for Healthcare Research and Quality (T32-HS000032)
  • National Institute of Mental Health (1K01MH129991)
  • University of North Carolina at Chapel Hill
  • National Institutes of Health
  • Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill
Topics
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Health Sciences › Health Professions › General Health Professions › Child and Adolescent Health
  • Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
Keywords
child mental health services, unmet mental health needs, access to mental health care, state-level variation, geographic inequity, racial and ethnic disparities, household income, health insurance, National Survey of Children's Health, caregiver-reported outcomes
MeSH terms
Adolescent, Child, Child Health Services, Child, Preschool, Cross-Sectional Studies, Ethnicity, Female, Health Services Accessibility, Health Services Needs and Demand, Humans, Infant, Insurance, Health, Male, Mental Health Services, Retrospective Studies, Socioeconomic Factors, United States, Logistic Models, Racial Groups, Healthcare Disparities

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