19 Children Need Healthcare

This chapter is based on the Social Ecological Model.

The challenges faced by at-risk youth are magnified by barriers to healthcare, including growing up in poverty, missing out on strong educational resources early in life, and lacking access to important services like medical care or counseling (Woolfenden et al., 2014).

Limited access to healthcare services, such as hospitals or healthcare providers’ offices, poses a significant problem that negatively impacts the well-being and future of children at risk (Fletcher, 2004). A yearly routine health screening allows healthcare providers to monitor a child’s growth and development. These appointments help keep children and teens healthy both physically and emotionally, can help improve their learning abilities, and lead to better health in adult life (Borman, 2023). Children growing up in low-income or under-resourced neighborhoods often face additional barriers to accessing quality care (All For Kids, 2025). This lack of care “can negatively affect their physical and mental development, leading to long-term health issues such as heart disease, hypertension, and reduced life expectancy. Additionally, poverty is associated with higher rates of mental health problems, including depression and anxiety, which can impede academic success and social development” (All For Kids, 2025, para. 2).

Many barriers make it hard for at-risk children and their families to get the healthcare services they need (Borman, 2023). Without routine check-ups, children are more likely to get sick, fall behind in school due to developmental delays, and face financial struggles later in life. They can face a higher risk of long-term health problems and preventable diseases due to missed vaccines (Lewis, 2024). Understanding what blocks children from getting healthcare helps build practical solutions to make healthcare easier to reach and fair for every family.

Individual

Some problems that keep at-risk youth from getting healthcare come from individual experiences and knowledge. Many kids and families are unaware of available healthcare services or how to use them. Others may have had bad experiences with doctors in the past, leading to fear or mistrust and discouraging them from seeking care. Additionally, some children may not understand how to take medicine properly or why regular check-ups are important (Garney et al., 2021). These challenges highlight the need for individual strategies to promote health education and build trust.

One helpful approach is to increase awareness of available healthcare services through outreach programs and online resources. Health websites and mobile apps designed for young people can offer helpful health information, connect them with support groups, and help them learn about available services (Garney et al., 2021). For example, KidsHealth.org (2025) is a free, trusted website offering easy-to-read articles, videos, and activities made by medical experts focusing on growing up healthy and strong. Kids, teens, parents, and teachers can gain knowledge through simple and effective messaging. Health literacy can be enhanced when children and families are treated by healthcare providers in a supportive manner so that they continue using those services.

Relationship

How doctors and healthcare workers treat patients affects whether kids and their families get the care they need. Language barriers, discrimination, or a lack of trust in doctors sometimes make it hard for young people to get the proper care or feel safe asking for help (Garney et al., 2021). For example, if a doctor does not understand a child’s culture or background, they might give advice that does not make sense for that family or that the family does not feel comfortable following.

To fix this, doctors and healthcare staff should learn to understand and respect people from different cultures. Training doctors in cultural competence increases families’ trust and encourages them to return for care.  Patient-doctor relationships can be built with effort from both parties.. Clinics and hospitals can provide interpreter services so families who don’t speak English well can still understand their health information. Healthcare centers can also hire staff from different backgrounds who reflect the communities they serve. Medical training can include how doctors should ask respectful questions and listen carefully, especially when working with people who have faced unfair treatment (McCourt School of Public Policy, 2019). When kids and their families feel safe and respected, they are more likely to keep up with doctor visits, take medicine correctly, and talk openly about health problems. Creating supportive relationships between a doctor and patients helps them stay healthier in the long term (McCourt School of Public Policy, 2019). Even when doctors do their part to build trust, challenges in the community (i.e., fear, cost, and lack of access) can still make it hard for kids to get the care they need.

Community

Many young people avoid seeking healthcare because they fear that people will judge them. This group includes youth with mental health conditions, those facing legal troubles, and those who identify as LGBTQ+ (Garney et al., 2021). The stigma around these identities can make youth feel embarrassed, isolated, or afraid to ask for help (Department of Mental Health & Substance Abuse Services, n.d.). Lack of transportation restricts access to healthcare, especially in low-income or rural areas where public transportation may be limited and healthcare providers are scarce. Families living in poverty or underserved areas often struggle to find transportation to medical facilities or cannot afford the time off work to attend appointments (Garney et al., 2021). Money challenges are among the biggest issues in accessing healthcare organizations. These problems include the high cost of care, not enough free or low-cost medical services, and families not being able to pay expensive copays (Garney et al., 2021). These challenges worsen health disparities and demand immediate action through support programs based in schools and communities.

Advocates, including teachers, can tell parents of uninsured children about the state’s health insurance programs, including those that have expanded Medicaid coverage for children (Healthy Schools Campaign, 2024). Many families do not know they qualify, and schools can serve as trusted messengers. Increasing awareness of available insurance programs can reduce healthcare costs that prevent families from getting care. Additionally, schools can make a difference by including more health education in the classroom. A quality health curriculum teaches uninsured children about key health topics in a safe and supportive environment (Fletcher, 2004). Talking openly about a variety of physical and mental health problems without judgment can help reduce stigma and encourage more kids to seek help when they need it (Department of Mental Health & Substance Abuse Services, n.d.). While schools and communities can help, lasting change will need a broader range of solutions, including improvements to problems with health insurance policies and healthcare costs. 

“Portland, OR, USA – Nov 29, 2021: Closeup of the homepage of Medicaid.gov seen on a smartphone. Medicaid provides free or low-cost health coverage to eligible needy persons.” by Tada Images is used with permission from Adobe Stock Images under an educational license.

Societal

A major barrier at the policy level is insurance coverage. In 2020, according to the National Center for Health Statistics, 3.7 million children were uninsured across the United States (University of Southern California, 2023). Without insurance, many families face unrealistic healthcare costs, preventing children from getting the care they need. Rising healthcare insurance costs make it hard for employers to offer insurance to parents and guardians in low-income communities, and private insurance is often too expensive. As a result, many youth and families in under-resourced communities go without affordable healthcare options and may be forced to delay or skip important care (University of Southern California, 2023). When children lack access to regular check-ups, early health problems may go unnoticed, leading to more serious and worsening conditions over time. Even those with insurance may struggle to access services if doctors do not accept Medicaid because of low payment rates (Healthy People 2030, 2020).

While more research is needed to make healthcare fair and available to everyone (Healthy People 2030, 2020), Medicaid expansion has helped increase coverage across the country. As of early 2020, 35 states and Washington, D.C., have expanded the program, resulting in more adults and their children having health insurance than in states that did not expand Medicaid (University of Southern California, 2023). Another promoising solution is to create continuous eligibility policies for Medicaid and the Children’s Health Insurance Program (CHIP). Children would be allowed to stay enrolled regardless of changes in family income, which would protect children’s health and reduce stress on low-income families (Schneider & Gibbs, 2022). For a clearer understanding of how public and private insurance differ (and how they affect care), see the attached resource, Health Insurance Definitions.

References

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Department of Mental Health & Substance Abuse Services. (n.d.). Reducing stigma. Tennessee State Government. https://www.tn.gov/behavioral-health/stigma.html

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Garney, W., Wilson, K., Ajayi, K. V., Panjwani, S., Love, S. M., Flores, S., Garcia, K., & Esquivel, C. (2021). Social-ecological barriers to access to healthcare for adolescents: A scoping review. International Journal of Environmental Research and Public Health, 18(8), 4138. https://doi.org/10.3390/ijerph18084138

Healthy Schools Campaign. (2024). Getting to know your state’s school Medicaid program: Overview for state education agencies and other partners. https://healthystudentspromisingfutures.org/wp-content/uploads/2024/05/Getting-to-Know-Your-States-School-Medicaid-Program.pdf

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