Understanding the Impact of Supplemental Security Income on Reducing Disparities in Caregiving Burden for Families of Children with Special Health Care Needs

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Approximately one in five children has a special health care need. While often discussed as one group, these children have a diverse set of physical and mental conditions such as asthma, attention disorders, autism, and other developmental or learning delays. Prior research finds a higher prevalence of special health needs among racial and ethnic minority children and children in families of low socioeconomic status (SES) compared with their nonminority and higher-SES counterparts. Low-SES and minority children have also been found more likely to receive inappropriate diagnoses, experience worse health outcomes, and receive inadequate or unsatisfactory treatment. To reduce disparities in the health of children with special health care needs (CSHN), families must be able to utilize services that support their children and reduce parental stress, financial risk, and burden of care. However, families caring for CSHN often face challenges in accessing and coordinating supportive services, and these challenges can be exacerbated for socially and economically vulnerable families. While many health and income policies target at-risk populations, little is known about the effectiveness of cash and in-kind transfer programs in minimizing racial, ethnic or SES-related disparities in the familial burden associated with caring for CSHN. This study will examine the role of Supplemental Security Income, a means-tested program providing income to families of CSHN, in minimizing racial, ethnic or SES-related disparities in the familial burden associated with caring for CSHN. The study will conduct quantitative analyses using the National Survey of Children with Special Health Care Needs to identify existing differences in caregiving burden and use of SSI across racial and ethnic minority families and low-SES families who are caring for CSHN; isolate child and family characteristics that drive the identified differences in caregiving burden and SSI receipt using a Oaxaca-Blinder Decomposition method; and employ an instrumental variables strategy to obtain an estimate of the causal impact of the extent to which SSI cash benefit mitigates disparities in caregiving burden. This research will provide decision makers with information to assess how well a cash transfer improves the health and well-being of low-SES and minority CSHN and their families, and will lay a theoretical and methodological foundation for future research analyzing the mechanisms through which policy can improve family and child health outcomes for this vulnerable population.