More than two-thirds of women with serious mental illness (SMI) are parents. These mothers face significant stressors beyond the usual difficulties of parenting including high rates of poverty, unemployment, single parenthood, low educational attainment, and the stigma and threat of custody loss that accompany parenting with a mental illness. Given that women with SMI use less physical health services, particularly preventive and primary care, it is possible that mothers with SMI, particularly women with psychotic disorders, use less preventive pediatric health care for their children. Preventive pediatric care is essential for the healthy development of infants and young children. Lack of health service utilization and routine physician visits for children can result in missed opportunities for developmental family psychosocial assessment;and adequate preventive care (e.g. immunizations, dental care, nutrition, and injury/violence prevention), which may put children at risk for developmental, medical and psychiatric problems. Using the Andersen model as a conceptual framework, the proposed research will determine the extent to which low income mothers with and without a psychotic disorder differ with respect to their use of preventive pediatric health care. We will then examine whether predisposing, enabling, and need factors are differentially experienced by these mothers and whether maternal mental illness moderates the relationship between these factors and use of pediatric health care. The proposed research will use Medicaid data from the state of Pennsylvania to compare age-cohorts of children whose low-income mothers have been treated for a psychotic disorder with matched age-cohorts of children whose mothers have not been treated for a mental illness to identify whether the groups differ significantly on: following recommended preventive pediatric health care and immunization guidelines;and the degree of reliance on emergency care during infancy and early childhood. The study will also examine the extent to which maternal mental health service use and type of service is associated with pediatric health care use for their children. We will elaborate and expand upon these quantitative findings by conducting a qualitative investigation to examine the complete range of predisposing, enabling and need factors associated with pediatric health care use for mothers with and without psychosis. This will allow for the identification of strategies to enhance pediatric health care use among mothers with SMI in order to promote the overall health and wellbeing of their children.
