Table 1

Social Complexity Risk Factors Having Demonstrated or Hypothesized Association With Suboptimal Health Care Use Among Children

Risk Factor	Definition of Risk Factor in Administrative Data
Parent domestic violence^13,14	Any arrest for which a charge recorded is in a domestic violence crime category
Parent death^a	State health department death certificates for biologic parents
Parent mental illness^15–18	Mental health diagnosis, service encounters, procedures, or prescribed psychotropic medications recorded in medical claims or publicly funded mental health records for either biologic parent^b
Parent criminal justice involvement^a	Any arrest or conviction recorded by state patrol or court filings, including adjudication in state court database, for any crime category for either biologic parent
Child abuse/neglect¹⁷	Any family involvement (child or either biologic parent) in child welfare or child protective services system in Washington State
Homelessness^a	Indicates at least 1 period of homelessness, including shelter stays, recorded by a financial eligibility worker during eligibility (re)determination for public assistance for child or either biologic parent
Poverty^12,19–21	TANF benefit recorded for child^c
Parent has limited English proficiency or speaks a language other than English at home^12,22	Primary language other than English and indicated need for interpreter for biologic parent and/or child
Child mental illness^a	Mental health diagnosis, service encounters, procedures, or prescribed psychotropic medications recorded in medical claims or publicly funded mental health records for child aged ≥5 y^b
Child substance abuse^a	Substance-related diagnosis, service or encounters recorded in medical claims or publicly funded mental health records; any arrest for which a charge recorded is in a substance-related crime category (eg, driving under the influence, possession of controlled substance) for child aged ≥12 y^b
Child juvenile or criminal justice involvement^a	Any arrest or conviction recorded by state patrol or court filings, including adjudication in state court database, for any crime category for child aged ≥12 y

TANF = Temporary Assistance for Needy Families.
Note: Based on Washington State administrative data. Four risk factors could not be identified using the available administrative data: (1) low parent educational attainment, (2) single parent in household, (3) adolescent exposure to intimate partner violence, and (4) discontinuous insurance coverage.
↵a Risk factor hypothesized to have an association with suboptimal health care use.
↵b Full list of codes used to identify parent/child mental illness and child substance abuse is given in the Supplemental Appendix, available at http://www.annfammed.org/content/16/1/62/suppl/DC1/.
↵c The income of a TANF family of 3 in Washington State with any housing expenses was approximately 38% of the 2008 Department of Health and Human Services Poverty Guidelines.