摘要：Objectives. We examined the perceived effects of leave from work among employed parents of children with special health care needs. Methods. Telephone interviews were conducted from November 2003 to January 2004 with 585 parents who had missed 1 or more workdays for their child's illness in the previous year. Results. Most parents reported positive effects of leave on their child's physical (81%) and emotional (85%) health; 57% reported a positive effect on their own emotional health, although 24% reported a negative effect. Most parents reported no effect (44%) or a negative effect (42%) on job performance; 73% reported leave-related financial problems. In multivariate analyses, parents receiving full pay during leave were more likely than were parents receiving no pay to report positive effects on child physical (odds ratio [OR] = 1.85) and emotional (OR = 1.68) health and parent emotional health (OR = 1.70), and were less likely to report financial problems (OR = 0.20). Conclusions. Employed parents believed that leave-taking benefited the health of their children with special health care needs and their own emotional health, but compromised their job performance and finances. Parents who received full pay reported better consequences across the board. Access to paid leave, particularly with full pay, may improve parent and child outcomes. Children with special health care needs are defined as children “who have or are at increased risk for a chronic physical, developmental, behavioral or emotional condition and who also require health and related services of a type or amount beyond that required by children generally.” 1 These children make up 13% to 17% of US children 2 – 6 and account for a vastly disproportionate number of hospital days, 7 medical encounters, 3 , 7 and school absences. 8 Parents of children with special health care needs must often choose between being with their child when he or she is ill and going to work. 9 The 1993 federal Family and Medical Leave Act (FMLA) guarantees eligible workers up to 12 weeks of unpaid leave annually to care for themselves or ill family members without risk of being fired. 10 Only half of employees, however, are eligible for FMLA leave, 11 and many choose not to use it because the leave is unpaid. 10 Although some can use vacation or sick leave, others have no access to employer-provided leave. 12 To address these gaps, several states have begun to implement or are considering establishing paid family-leave programs, 13 – 16 and Congress is exploring similar policies as well. 17 – 21 Access to FMLA and employer-provided leave has been associated with more leave-taking and less unmet need for leave among parents of children with special health care needs. 22 , 23 Effects of leave-taking, however, are unknown. Although leave-taking may improve child health, it may also require employment-related and financial sacrifices that might harm parents and families, creating a complex picture of benefits and costs. Parents' perceptions of effects are particularly important to understand. Studies have shown that parental perceptions of child health are a primary determinant of health care utilization. 24 – 26 Similarly, perceptions of leave's effects will likely shape parents' decisions about childcare and employment, responses to future child illnesses, and reactions to new employer or government initiatives. Moreover, differences in the perceived effects of paid and unpaid leave may influence how employers and policymakers weigh costs and benefits of paid leave programs. We report on employed parents of children with special health care needs who took leave in the past year to care for their child and their perceptions of leave's effects in 5 domains: their child's physical health, their child's emotional health, their own emotional health, their job performance, and their finances. We also examined associations with factors that might influence these perceptions and that might have relevance for policy discussions regarding paid leave options, including receipt of full or partial pay during leave.
