Practical Needs in the Home Care of Latino Children With Medical Complexity.

Latino children face barriers to high-quality healthcare. Because children with medical complexity (CMC) have higher healthcare needs, Latino CMC are likely to experience greater effects of these barriers. These vulnerabilities are exacerbated when Latino CMC endure adverse social conditions, such as food insecurity and housing instability. The study objective was to describe the challenges faced by caregivers of Latino CMC in meeting the practical needs of their children when caring for them at home. In this qualitative study, 70 Latino CMC enrolled in a complex care program of a tertiary care children's hospital were followed for a median duration of 45 months. We collected care coordination notes from encounter logs and interviewed bilingual care coordinators regarding their experiences with each child. Using thematic content analysis and an iterative process, we identified recurrent themes related to practical needs. Four themes emerged. Caregivers: 1) faced financial challenges due to many reasons that were exacerbated by children's medical conditions; 2) had challenges meeting basic needs of their families, including food and shelter; 3) experienced difficulties obtaining necessary medical supplies for their children; and 4) relied on care coordinators to navigate the system. We conclude that Latino caregivers of CMC experience many challenges meeting their families' basic needs and obtaining necessary medical supplies to care for their CMC at home. Care coordinators play a major role in addressing the practical needs of Latino CMC. Future studies should determine whether addressing the practical needs of Latino CMC would improve their health outcomes.

Challenges Faced by Latino Caregivers in Transportation of Children with Medical Complexity.

BACKGROUND Transportation challenges affect access to health care. Our objective was to describe transportation challenges faced by Latino children with medical complexity and identify strategies that could address these challenges.METHODS This is a qualitative study. Seventy Latino children with medical complexity who were enrolled in a complex care program of a tertiary care children's hospital were followed for a median duration of 18 months. Qualitative data were care coordination notes for each child obtained from care coordinators' encounter logs and reported experiences. Using thematic content analysis and an iterative process, we identified recurrent themes related to transportation challenges.RESULTS Caregivers of Latino children with medical complexity face many challenges transporting their children to medical appointments. These include lack of vehicle, inability to drive, lack of driver's license due to immigration status, and lack of resources to maintain a vehicle. As a result, Latino children with medical complexity often need non-emergency medical transportation, but caregivers find these systems difficult to use, in part because of language difficulties. Thus, they rely on care coordinators to access non-emergency medical transportation. Transportation problems can lead to missed medical appointments for the child and lost work for the caregiver. We identified interrelated factors that contributed to transportation issues for Latino children with medical complexity and potential strategies to address them.LIMITATIONS The extent of transportation challenges cannot be discerned because this is a qualitative study.CONCLUSIONS Transportation is difficult for Latino children with medical complexity, who rely on non-emergency medical transportation to access medical services. Care coordinators play a major role in addressing transportation problems for Latino children with medical complexity and their caregivers.