241286 Taking stock of the CSHCN Screener: Key findings, applications and methods issues

Sunday, October 30, 2011

Christina Bethell, PhD, MBA, MPH , Department of Pediatrics, School of Medicine, The Child and Adolescent Health Measurement Initiative, Oregon Health & Science University, Portland, OR
Stephen J. Blumberg, PhD , National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD
Paul Newacheck, DrPH , Institute of Health Policy Studies, University of California, San Francisco, San Francisco, CA
Ruth EK Stein, MD , Pediatrics, Albert Einstein College of Medicine/Yeshiva University, Bronx, NY
Bonnie B. Strickland, PhD , Maternal and Child Health Bureau/Division of Services for Children with Special Health Care Needs, Health Resources and Services Administration, Rockville, MD
Background: The CSHCN Screener has been used since 1999 as an efficient way to identify populations of children with ongoing physical, mental, behavioral or other conditions who also require above normal health care and related services.

Objectives: Revisit the construct, internal and external validity of the CSHCN Screener. Evaluate variations in prevalence observed across applications and validity of stratifying subgroups of CSHCN according to how they met screener criteria.

Methods: Three large national datasets were used. Potential discrepant cases were identified based on child's health conditions, functional difficulties, services use and needs to estimate potential magnitude of over or under-identification of CSHCN, identify patterns indicating possible revisions to the instrument and further assess stratifying CSHCN by screening criteria met.

Results: Some children not meeting screening criteria have parents who report presence of chronic conditions, functional difficulties or need/use of special health services. However, presence of conditions and service needs are not generally reported simultaneously and are due to acute rather than chronic conditions. While stratifying CSHCN according to quantity of screening criteria met is useful for identifying more versus less complex subgroups of CSHCN, follow up needs assessments are required to more specifically understand the range of health and service need consequences CSHCN experience.

Conclusions: The CSHCN Screener continues to provide an efficient, highly discriminating method for identifying children. Sampling, administration methods and cultural perspectives on child's health impact identification in ways not specific to the screening instrument. Individual items are not intended for use as stand-alone screening methods.

Learning Areas:
Advocacy for health and health education
Chronic disease management and prevention

Learning Objectives:
Define and describe the population of children with special health care needs (CSHCN) in the United States. Identify CSHCN by use of a population-based screening instrument. Evaluate use of Screener and assess prevalence rates of CSHCN in the US. Analyze whether new items are warranted based on what we have learned from the Screener's use after 10 years.

Keywords: Child/Adolescent, Children With Special Needs

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have over 20 years of experience in health services research, including being the principal investigator of several large grants and studies. Here is a partial list of publications: 1. Bethell C, Read D, Goodman E, et al. Consistently inconsistent: a snapshot of across- and within-state disparities in the prevalence of childhood overweight and obesity. Pediatrics. 2009;123 Suppl 5:S277-86. 2. Bethell C, Reuland CH, Halfon N, Schor EL. Measuring the quality of preventive and developmental services for young children: national estimates and patterns of clinicians' performance. Pediatrics. 2004;113(6 Suppl):1973-1983. 3. Bethell C, Simpson L, Stumbo S, Carle AC, Gombojav N. National, state, and local disparities in childhood obesity. Health Aff (Millwood). 2010;29(3):347-356. 4. Bethell CD, Read D, Blumberg SJ, Newacheck PW. What is the prevalence of children with special health care needs? toward an understanding of variations in findings and methods across three national surveys. Maternal and Child Health Journal. 2008;12(1):1-14. 5. Bethell CD, Read D, Brockwood K, American Academy of Pediatrics. Using existing population-based data sets to measure the American Academy of Pediatrics definition of medical home for all children and children with special health care needs. Pediatrics. 2004;113(5 Suppl):1529-1537. 6. Bethell CD, Read D, Neff J, et al. Comparison of the children with special health care needs screener to the questionnaire for identifying children with chronic conditions--revised. Ambul Pediatr. 2002;2(1):49-57. 7. Bethell CD, Read D, Stein RE, Blumberg SJ, Wells N, Newacheck PW. Identifying children with special health care needs: development and evaluation of a short screening instrument. Ambul Pediatr. 2002;2(1):38-48. 8. Blumberg SJ, Read D, Avila RM, Bethell CD. Hispanic children with special health care needs from Spanish-language households. Pediatrics. 2010;126 Suppl 3:S120-8. 9. Bramlett MD, Read D, Bethell C, Blumberg SJ. Differentiating subgroups of children with special health care needs by health status and complexity of health care needs. Matern Child Health J. 2009;13(2):151-163. 10. Read D, Bethell C, Blumberg SJ, Abreu M, Molina C. An evaluation of the linguistic and cultural validity of the Spanish language version of the children with special health care needs screener. Matern Child Health J. 2007;11(6):568-585.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.