Investigating the Impact of Caregiver Transportation Needs on Children’s Response to Behavioral and Mental Health Treatment: A Longitudinal Analysis

Despite a rich and developing research literature on the relationships between transportation and healthcare outcomes, the impact of unmet transportation needs on children, particularly on their general psychosocial functioning, is less well understood. We hypothesized that caregiver’s transportation needs may be a key point of intervention for child-level health outcomes, such that the resolution of caregiver transportation needs may have an important, downstream impact on other areas of the child’s functioning. We tested this hypothesis in a sample of children (n=4341) served in a large, statewide public behavioral healthcare system. We conducted a retrospective longitudinal analysis of children served in the system between March 2019 and March 2020, using a specialized assessment tool that captures a comprehensive range of psychosocial functioning: the Child and Adolescent Needs and Strengths (CANS; Lyons, 2009) assessment. Linear mixed-effects analyses demonstrated that, if caregivers’ transportation needs were resolved during the episode of care, those children demonstrated greater improvements on both need reduction and strength building across multiple domains than did their peers whose caregivers had unresolved transportation needs. By the end of the episode of care, children whose caregivers had resolved transportation needs were not significantly different than those children whose caregivers never had transportation needs. The resolution of transportation needs may be an important focus for providers working with children with a complex behavioral health, such that the resolution of these transportation needs seems to have a large, positive downstream impact on their overall functioning.