Internal Psychometric Properties of the Children with Special Health Care Needs Screener

doi:10.1016/j.acap.2009.11.006

Academic Pediatrics

Volume 11, Issue 2, March–April 2011, Pages 128-135

https://doi.org/10.1016/j.acap.2009.11.006 Get rights and content

Abstract

Objective

Insufficient research has established the measurement properties of the Children with Special Health Care Needs (CSHCN) Screener. This leaves unclear whether CSHCN Screener–based estimates reliably identify CSHCN. We used classical and modern test theory to establish the CSHCN Screener’s internal psychometric properties.

Methods

Data came from the 2005-2006 National Survey of Children with Special Health Care Needs (NS-CSHCN), a nationally representative survey of US children (N = 359 154).

Results

Cronbach’s α, a measure of internal reliability, equaled .76. Confirmatory factor analysis for ordered-categorical measures indicated that a single underlying trait that we label health-condition-complexity underlies CSHCN Screener responses. Item response theory showed that responses provide particularly precise measurement among children experiencing elevated health-condition-complexity trait levels.

Conclusions

Findings demonstrate that responses to the CSHCN Screener as used in the NS-CSHCN have good internal psychometric properties and include minimal random measurement error. Epidemiologists, clinicians and others can rely on CSHCN Screener responses to reliably identify CSHCN experiencing 1 or more of the 5 consequences included on the CSHCN Screener.

Section snippets

Data Source

The National Survey of CSHCN provides national and state level data on the prevalence of special health care needs and their impact on children and their families.¹⁷ The National Center for Health Statistics, with funding and direction from MCHB, has conducted this random-digit-dial telephone survey every 4 years since 2001. In 2005 to 2006, survey interviewers contacted 192 083 households with children and screened 364 841 children <18 years of age. A parent or guardian knowledgeable about the

Classical Test Theory

Using the first-question approach, overall standardized α = .716. For all but the “medications” item, deleting items decreased reliability. Removing the services item created the largest negative change (Δα ≈ −.1). These findings indicated acceptable reliability for the questions that provided the basis for skip patterns related to CSHCN Screener follow-up questions. Poor reliability (ie, random measurement error) did not lead some parents to incorrectly fail to receive follow-up questions and

Discussion

In this study, we examined the internal psychometric properties of responses to the CSHCN Screener in the 2005–2006 NS-CSHCN. Classical test theory, CFA-OCM, and IRT supported the hypothesis that CSHCN Screener responses reliably describe whether children experience 1 of the 5 health-related consequences included on the CSHCN Screener and whether the consequences result from a medical, behavioral, or other health condition lasting at least 12 months. IRT demonstrated that CSHCN Screener

Acknowledgments

We thank the U.S. Health Resources and Services Administration, Maternal and Child Health Bureau, and the U.S. Centers for Disease Control and Prevention, National Center for Health Statistics, for making the data publicly available, and Ruth Stein, Christina Bethell, Michael Seid, and Lisa Opipari-Arrigan for their collegial support and insightful comments on our work. Adam Carle thanks Tara J. Carle and Margaret Carle, whose unending support and thoughtful comments make his work possible.

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Cited by (26)

National Perspective of Health Outcomes of 8- to 11-Year-Old Children Born Prematurely and Their Full-Term Peers
2016, Journal of Pediatric Nursing
Citation Excerpt :
The CSHCN Screener has been used in the National Survey of Children with Special Health Care Needs from 2001, 2005–2006 and 2009–2011, the Medical Expenditure Panel Survey since the year 2000, as well as the National Survey of Children's Health 2003, 2007 and 2011–2012 (Bethell et al., 2015). The CSHCN Screener identifies children who are at increased risk for or have a chronic physical, developmental, behavioral or emotional condition and who require health-related services beyond those required by children generally (Bethell et al., 2002; Carle et al., 2011; McPherson et al., 1998). These special health care services allow the children to improve their health, and access their environment or perform the activities of childhood.
The specific aim of this study was to evaluate the health sequelae of preterm birth on children 8 to 11 years of age as compared to same age children born at term; selected variables include special health care needs, chronic conditions, and caregiver perception of health.
A secondary data analysis was conducted to evaluate the health outcomes of children 8 to 11 years of age who were born prematurely compared to a sample of children born at term. The 2011/2012 National Survey of Children's Health (NSCH) is a nationally representative telephone interview survey of parents/caregivers of children 0 to 17 years of age. Preterm birth was determined by parent report of birth more than 3 weeks early.
Utilizing the Children with Special Health Care Needs (CSHCN) Screener, 35% of children born prematurely, compared to 24% of children born at term were identified as having a special health care need. The 5 most prevalent conditions were the same in both groups of 8 to 11 year old children and in the larger total sample of children 2 to 17 years of age. However 82% of children born prematurely were described by parents as having excellent or very good health.
Premature birth places children at increased risk for conditions that impede the crucial activities of childhood (education, psychosocial development and play). These conditions may require both medications and increased health care services.
Understanding the relationship between preterm birth and ongoing health risks has the potential to inform the health care providers' ability to provide care that maximizes the potential of children born prematurely. Health care providers need to be cognizant of this risk, utilizing early screening and encouraging intervention and family supports.
Taking stock of the CSHCN screener: A review of common questions and current reflections
2015, Academic Pediatrics
Citation Excerpt :
Although youth and adult self-reported versions of the screener have been developed and used in national samples, here we only report findings from the parent-reported version of the CS.29,30 dentification of children on the basis of the consequences they experience from a health problem was first promulgated by Pless and Pinkerton31 and rested on the observations that: 1) many service need and functional, psychological, and social consequences of childhood health problems are common across different diseases; 2) there is great variation in service needs and functioning (consequences) within diagnostic groups;16,32–34 and 3) eliciting valid information about the presence of specific chronic conditions by either parent report or medical records is impractical and highly prone to errors.11–13,35–37 Thus, use of a non-condition-specific method for the CS was selected in recognition of these factors and inherent limits of diagnostic-based methods, including limitations in the standardization, accessibility, and validity of clinical administrative data, especially where CSHCN rely on services from multiple systems whose data systems are not integrated.
Since 2000, the Children with Special Health Care Needs (CSHCN) Screener (CS) has been widely used nationally, by states, and locally as a standardized and brief survey-based method to identify populations of children who experience chronic physical, mental, behavioral, or other conditions and who also require types and amounts of health and related services beyond those routinely used by children. Common questions about the CS include those related to its development and uses; its conceptual framework and potential for under- or overidentification; its ability to stratify CSHCN by complexity of service needs and daily life impacts; and its potential application in clinical settings and comparisons with other identification approaches. This review recaps the development, design, and findings from the use of the CS and synthesizes findings from studies conducted over the past 13 years as well as updated findings on the CS to briefly address the 12 most common questions asked about this tool through technical assistance provided regarding the CS since 2001. Across a range of analyses, the CS consistently identifies a subset of children with chronic conditions who need or use more than a routine type or amount of medical- and health-related services and who share common needs for health care, including care coordination, access to specialized and community-based services, and enhanced family engagement. Scoring algorithms exist to stratify CSHCN by complexity of needs and higher costs of care. Combining CS data with clinical diagnostic code algorithms may enhance capacity to further identify meaningful subgroups. Clinical application is most suited for identifying and characterizing populations of patients and assessing quality and system improvement impacts for children with a broad range of chronic conditions. Other clinical applications require further implementation research. Use of the CS in clinical settings is limited because integration of standardized patient-reported health information is not yet common practice in most settings or in electronic health records. The CS continues to demonstrate validity as a non-condition-specific, population-based tool that addresses many of the limits of condition or diagnosis checklists, including the relatively low prevalence of many individual conditions and substantial within-diagnosis variations and across-diagnoses similarities in health service needs, functioning, and quality of care.
The effect of special health care needs and health status on school functioning
2013, Disability and Health Journal
Citation Excerpt :
This third group of CSHCN may include children regardless of whether they need or use prescription medication. This sub-classification of CSHCN was based on previous research.13,23,27 These studies suggest that CSHCN-RX have less complex health care needs than C-CSHCN.
Past studies have shown that specific child conditions are associated with poor school outcomes. A national health survey with noncategorical measures of health and indicators of school functioning offers the opportunity to examine this association.
To compare links between two health measures (children with special health care needs and general health status) and multiple school outcomes.
The analysis was based on 59,440 children aged 6–17 years from the 2007 National Survey of Children's Health. Child health was assessed using the Children with Special Health Care Needs (CSHCN) screener and a question on general health status. CSHCN were classified by the complexity of their health care needs. Indicators of school functioning included special education use, many problem reports, repeated a grade, lack of school engagement, and many missed school days.
Overall 22% of children were identified as CSHCN: 13% with more complex needs (C-CSHCN) and 9% with medication use only (CSHCN-RX). Approximately 17% of children were in less than optimal health. After controlling for a child's sociodemographic characteristics C-CSHCN had an increased risk of all of the negative school outcomes compared to children without SHCN, while CSHCN-RX had an increased risk of only one school outcome (many missed school days). Children in less than optimal health were at an increased risk of all negative school outcomes compared to children in optimal health.
The CSHCN screener and health status question identify related, but distinct, groups of children with worse outcomes on the indicators of school functioning.
Community health centers: Medical Homes for children?
2013, Academic Pediatrics
Citation Excerpt :
We included the number of parents a child lives with (0, 1, or 2) and the language of the interview. We categorized health status as poor/fair or good/very good/excellent and also noted whether the child had a special health care need, as determined by the CSHCN screener.18 We analyzed questions from MEPS that closely approximated medical home attributes of the primary care setting20 and compared these variables for children attending a CHC versus non-CHC.
To explore medical home attributes of community health centers (CHCs) that provide care to low-income children nationwide compared to other providers for the poor.
Cross-sectional study of children aged 0 to 17 years in the Medical Expenditure Panel Survey (MEPS; 2003 to 2009) who resided in families living at <200% of the federal poverty level (FPL) and had visits to a primary care setting. CHC visits were defined as a visit to a neighborhood/family health center, rural health clinic, or community health center. Independent measures included provider type, age, gender, race/ethnicity, insurance, FPL, number of parents at home, language, maternal education, health status, and special health care need. Dependent measures included 4 medical home attributes: accessibility, and family-centered, comprehensive, and compassionate care.
CHCs typically serve low-income children who are publicly insured or uninsured, come from racial/ethnic minority groups, and have poorer health status. Eighty percent to 90% of parents visiting both CHCs and other primary care providers rated high levels of family-centered, comprehensive, and compassionate care. However, CHCs had a 10% to 18% lower rating of accessibility (after-hours care, telephone access) even after controlling for sociodemographic characteristics. Racial/ethnic disparities existed at both settings, but these patterns did not differ between CHCs and other settings.
On the basis of parental reports, CHCs received similar ratings to other primary care providers for family-centered, comprehensive, and compassionate care, but lower ratings for accessibility. Further studies should examine strategies for practice transformation in CHCs to improve patient satisfaction and accessibility to optimize child health outcomes.
Multiple birth families with children with special needs: A qualitative investigation of mothers' experiences
2012, Twin Research and Human Genetics
A Mixed-Methods Study on Topical Fluoride Beliefs and Refusal Behaviors for Caregivers of Children with Special Health Care Needs
2024, Maternal and Child Health Journal

View all citing articles on Scopus

View full text

New Research on Children With Special Health Care NeedsInternal Psychometric Properties of the Children with Special Health Care Needs Screener

Abstract

Objective

Methods

Results

Conclusions

Section snippets

Data Source

Classical Test Theory

Discussion

Acknowledgments

Ambul Pediatr

Soc Sci Med

Ambul Pediatr

Ambul Pediatr

Ambul Pediatr

J Res Pers

A new definition of children with special health care needs

Pediatrics

Health Resources and Services Administration, Maternal and Child Health Bureau. The National Survey of Children with Special Health Care Needs Chartbook 2005–2006

Rockville, Md

Implementing community-based systems of services for children and youths with special health care needs: how well are we doing?

Pediatrics

An evaluation of the linguistic and cultural validity of the Spanish language version of the children with special health care needs screener [serial online]

Matern Child Health J

Is the prevalence of children and youth with special health care needs increasing? Toward an understanding of variations in findings across three national surveys

Matern Child Health J

Approaches to Identifying Children and Adults with Special Health Care Needs: A Resource Manual for State Medicaid Agencies and Managed Care Organizations

Questionnaire for identifying children with chronic conditions (QuICCC): a measure based on a noncategorical approach

Pediatrics

Implications for estimates of disability in children: a comparison of definitional components [serial online]

Pediatrics

Prevalence and impact of disabling chronic conditions in childhood [serial online]

Am J Public Health

Differentiating subgroups of children with special health care needs by health status and complexity of health care needs

Matern Child Health J

Design and operation of the National Survey of Children With Special Health Care Needs, 2005-2006

Vital Health Stat

Test Theory: A Unified Treatment

New Research on Children With Special Health Care Needs
Internal Psychometric Properties of the Children with Special Health Care Needs Screener