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Students with disabilities with unmet health care needs are vulnerable to adverse educational outcomes, including exclusionary discipline. We examined the association between schools' spatial proximity to health care providers and their use of suspension to discipline students with disabilities. The study sample included the 398 public secondary schools in the Boston Metropolitan Statistical Area. We merged census-tract and school-level data from several sources, including the American Community Survey, the Health Resources and Services Administration, the Massachusetts Department of Public Health, and the U.S. Department of Education. Zero-inflated beta regression models were used to examine the association between schools' locations in medically underserved areas (MUAs) and the out-of-school suspension rates of students qualifying for special education services in the 2013–14 school year. Nested models and mediation analysis were used to parse the effects of medical underservice and neighborhood poverty on suspension rates. The suspension rate of students with disabilities was about 5 percentage points higher in schools located in medically underserved areas compared to schools that are not in MUAs, controlling for school- and neighborhood-level characteristics (z = 1.97, p <.05). Medical underservice significantly mediated the effect of neighborhood poverty on suspensions of students with disabilities (indirect effect, p <.05), accounting for 44% of the total effect of poverty. The findings indicate that schools with limited geographic access to health care services may more likely to use suspension as a tool to manage the behavior of students with disabilities. • The spatial distribution of health resources is unequal in the Boston area. • Local health contexts impact schools' inclusion of students with disabilities. • Schools in medically underserved areas suspend more students with disabilities. • Local health contexts impact suspension rates above and beyond neighborhood poverty. [ABSTRACT FROM AUTHOR]

There is increasing interest in the role of contextual factors in promoting well-being among parents of children with developmental disabilities. This study aimed to examine whether social network types moderate the impacts of having a child with a developmental disability on parents' health. Using cross-sectional data from the Midlife in the United States survey (MIDUS 2 and Refresher cohorts), we analyzed a sample of 363 parents of children with developmental disabilities and 4,919 parents of children without developmental disabilities. K-means cluster analysis was implemented to identify a social network typology. Modified Poisson and negative binomial regression models estimated the effect of having a child with a developmental disability and the typology on parents' physical health (self-rated health, number of chronic conditions) and mental health (self-rated mental health, major depression). The cluster analysis revealed two social network types. Parents of children with developmental disabilities were more likely to have "restricted/unsupported" networks, whereas parents in the comparison group were more likely to have "diverse/supported" networks. Social support was more important for differentiating the network types of parents of children with developmental disabilities, while social integration was more salient for the comparison group. Parents of children with developmental disabilities fared worse on all outcomes relative to parents of children without disabilities. However, the typology had a compensatory psychological effect; the diverse/supported network type conferred greater mental health benefits to parents of children with developmental disabilities than to those in the comparison group. The diverse/supported network type was also associated with better physical health, but the associations did not differ between the two parent groups. The results of this study emphasize the importance of social determinants of well-being for those with exceptional parenting responsibilities. Strengthening social networks may have a particularly positive impact on such parents' mental health. • Parents in midlife can be classified into two social network types. • Social support is paramount for parents of children with developmental disabilities. • Social integration matters more for other parents. • Diverse and supported network type is beneficial for parents' health. • Network type buffers the effects of having a child with developmental disabilities. [ABSTRACT FROM AUTHOR]