262179 Prevalence of children with special healthcare needs and links to developmental risk in Chile

Wednesday, October 31, 2012

MaryCatherine Arbour, MD MPH , Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, MA
Hirokazu Yoshikawa, PhD , Academic Dean, Harvard Graduate School of Education, Cambridge
Clara Barata, EdD , School of Human and Social Sciences, ISCTE - Lisbon University Institute, Lisbon, Portugal
Andrea Rolla, EdD , Ministry of Education, Government of Chile, Santiago, Chile
Ernesto Trevino, PhD , Centro de Políticas Comparadas de Educación, Universidad Diego Portales, Santiago, Chile
Catherine Snow, PhD , NA, Harvard Graduate School of Education, Cambridge, MA
Judith S. Palfrey, MD , Division of General Pediatrics, Children's Hospital Boston, Boston, MA
Megan Murray, PhD , Epidemiology, Harvard School of Public Health, Boston, MA
Background. The prevalence of Children with Special Healthcare Needs (CSHCN) globally is mostly not known. Few studies validate the CSHCN Screener with concurrent child-level developmental measures to ascertain whether CSHCN outside the US experience early developmental risks predictive of lower educational attainment and adult productivity.

Objectives. Estimate prevalence of CSHCN among poor, urban young children in Chile. Assess CSHCN screener's ability to identify young children at risk for poor school readiness.

Methods. 1083 4-5 year-old children were assessed by parents using the CHSCN Screener, by teachers rating behavior and by professionals using Woodcock-Muñoz Achievement Tests and executive function tests (Dimensional Change Card Sort, Pencil Tapping, Walk-a-Line Slowly).

Results. CSHCN prevalence was 27%. The most commonly-reported qualifying criterion was elevated medical, mental health or educational service needs (14.3%), then needs for counseling or mental health (10.4%), prescription medications (10.3%), speech, occupational or physical therapy (8.9%) and functional limitations (4.8%). Most children met 1 or 2 criteria (48 and 32%, respectively); 3% met 4 or 5 criteria. CSHCN status was not associated with maternal education, employment status, or household size. CSHCN had lower vocabulary (p<.001, effect-size -0.34), poorer math skills (p<.001, ES -0.38), less cognitive control (p<0.005, ES -0.35), and more teacher-rated externalizing behaviors (p=.002, ES 0.20) than peers without SHCNs.

Conclusion. Prevalence of CSHCN is high among poor, urban 4-5 year-olds in Chile. The CSHCN screener is an efficient parent survey that could be used at school entry to identify children who could benefit from early intervention.

Learning Areas:
Advocacy for health and health education
Conduct evaluation related to programs, research, and other areas of practice
Public health or related public policy
Public health or related research

Learning Objectives:
Assess prevalence of children with special healthcare needs among poor, urban young children in Chile. Evaluate the CSHCN screener's ability to identify young children at risk for poor school readiness.

Keywords: Children With Special Needs, Risk Assessment

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have worked on child development, early risk & early intervention research for 5 years and in Chile for over 15 years. One of my central interests is the relationship between physical health and general healthy development, including cognition, language, behavior and executive function.
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.

Back to: 5024.0: MCH International Health and Children with Special Health Care Needs Poster Session