Comparing States on Outcomes for Children with Special Health Care Needs

Do unmet needs differ geographically for children with special health care needs?

The purpose of this study was to identify geographic differences in health indicators for children with special health care needs (CSHCN). It was hypothesized that geographic differences in unmet health care needs exist among CSHCN by region in the United States. Data were obtained from the National Survey of Children with Special Health Care Needs, 2005-2006. Nine variables representing unmet needs were analyzed by geographic region. The region with the highest percent of unmet needs was identified for each service. Logistic regression was utilized to determine differences by region after controlling for age, gender, ethnicity, race, federal poverty level, relationship of responder to child, insurance status, severity of condition, and size of household. A total of 40,723 CSHCN were represented. Crude analysis demonstrated that the greatest unmet need for routine preventive care, specialist care, prescription medications, physical/occupational/speech therapy, mental health care, and genetic counseling occurred in the West. The greatest unmet need for preventive dental care, respite care, and vision care occurred in the South. Significant differences between regions remained for six of the nine services after controlling for potential confounders. Geographic differences in unmet health care needs exist for CSHCN. Further delving into these differences provides valuable information for program and policy planning and development. Meeting the needs of CSHCN is important to reduce cost burden and improve quality of life for the affected child and care providers.

A statewide case management, surveillance, and outcome evaluation system for children with special health care needs

Objectives. To evaluate the feasibility of implementing a statewide children with special health care needs (CSHCN) program evaluation, case management, and surveillance system using a standardized instrument and protocol that operationalized the United States Health and Human Services CSHCN National Performance Measures. Methods. Public health nurses in local public health agencies in Washington State jointly developed and implemented the standardized system. The instrument was the Omaha System. Descriptive statistics were used for the analysis of standardized data. Results. From the sample of CSHCN visit reports (n = 127), 314 problems and 853 interventions were documented. The most common problem identified was growth and development followed by health care supervision, communication with community resources, caretaking/parenting, income, neglect, and abuse. The most common intervention category was surveillance (60%), followed by case management (24%) and teaching, guidance, and counseling (16%). On average, there were 2.7 interventions per problem and 6.7 interventions per visit. Conclusions. This study demonstrates the feasibility of an approach for statewide CSHCN program evaluation, case management, and surveillance system. Knowledge, behavior, and status ratings suggest that there are critical unmet needs in the Washington State CSHCN population for six major problems.

The well-being of the health care environment for CSHCN and their families: a latent variable approach

OBJECTIVE

Using structural equation modeling, we sought to assess the system of services for children with special health care needs (CSHCN) and their families by using 14 key indicators of functional abilities of CSHCN, health insurance coverage, access to care, and the impact of their conditions on their families.

METHODS

With data from the 2001 and 2005-2006 National Surveys of Children With Special Health Care Needs, we used confirmatory factor analysis for ordered-categorical measures to model the relationship between an indirectly observed (ie, latent) variable and the key indicators and evaluate changes in this relationship over time.

RESULTS

For both survey periods, a single-factor model fit well. The latent construct was defined as the well-being of the health care environment for CSHCN and their families. Family financial problems caused by the child's condition, unmet needs for family support services, and negative impact on employment were most strongly related to the latent well-being construct. The lowest levels of the well-being construct were associated with families that had unmet needs for support services, CSHCN who lacked a usual place for care, and families that spent > or = 11 hours/week providing or coordinating care. CSHCN and their families with family-centered care and with adequate health insurance were likely to have average or better levels of the well-being construct. Mean levels of the well-being construct were unchanged over time.

CONCLUSIONS

The 14 key indicators can be used to reliably assess a single latent construct. The relative ordering of the indicators' thresholds (a model parameter) may be useful for guiding pediatricians' evaluations of the health care environment for CSHCN and their families. Researchers may use the scores available from the latent-variable model to assess outcomes related to the health care environment and the system of services for CSHCN and their families.

Differences in risk factors for children with special health care needs (CSHCN) receiving needed specialty care by Socioeconomic Status

BACKGROUND

The purpose of this study is to identify factors affecting CSHCN's receiving needed specialty care among different socioeconomic levels. Previous literature has shown that Socioeconomic Status (SES) is a significant factor in CHSHCN receiving access to healthcare. Other literature has shown that factors of insurance, family size, race/ethnicity and sex also have effects on these children's receipt of care. However, this literature does not address whether other factors such as maternal education, geographic location, age, insurance type, severity of condition, or race/ethnicity have different effects on receiving needed specialty care for children in each SES level.

METHODS

Data were obtained from the National Survey of Children with Special Health Care Needs, 2000-2002. The study analyzed the survey which studies whether CHSCN who needed specialty care received it. The analysis included demographic characteristics, geographical location of household, severity of condition, and social factors. Multiple logistic regression models were constructed for SES levels defined by federal poverty level: < 199%; 200-299%; >or= 300%.

RESULTS

For the poorest children (,199% FPL) being uninsured had a strong negative effect on receiving all needed specialty care. Being Hispanic was a protective factor. Having more than one adult in the household had a positive impact on receipt of needed specialty care but a larger number of children in the family had a negative impact. For the middle income group of children (200-299% of FPL severity of condition had a strong negative association with receipt of needed specialty care. Children in highest income group (> 300% FPL) were positively impacted by living in the Midwest and were negatively impacted by the mother having only some college compared to a four-year degree.

CONCLUSION

Factors affecting CSHCN receiving all needed specialty care differed among socioeconomic groups. These differences should be addressed in policy and practice. Future research should explore the CSHCN population by income groups to better serve this population.

Accuracy in self-reported health insurance coverage among Medicaid enrollees

The largest portion of the Medicaid undercount is caused by survey reporting error--that is, Medicaid recipients misreport their enrollment in health insurance coverage surveys. In this study, we sampled known Medicaid enrollees to learn how they respond to health insurance questions and to document correlates of accurate and inaccurate reports. We found that Medicaid enrollees are fairly accurate reporters of insurance status and type of coverage, but some do report being uninsured. Multivariate analyses point to the prominent role of program-related factors in the accuracy of reports. Our findings suggest that the Medicaid undercount should not undermine confidence in survey-based estimates of uninsurance.

Financial and employment problems in families of children with special health care needs: implications for research and practice

INTRODUCTION

The purpose of this study was to identify factors related to financial burden among families of children with special needs and to identify specific provider-level activities associated with decreased risk for such burden.

METHOD

Data for secondary analysis are from the National Survey of Children with Special Health Care Needs (CSHCN). Logistic regression analysis of state-level data was conducted to identify significant predictors of financial and employment problems among families of children with SHCN in Minnesota.

RESULTS

Children with more severe conditions and whose family members provided health care at home were more likely to have parents report financial and employment problems due to the child's condition. On the other hand, families whose health care providers communicated well with other service providers and who helped them feel like partners in their child's care were significantly less likely to report financial and employment problems.

DISCUSSION

Pediatric nurses and nurse practitioners can use these findings as they work with families for optimal family outcomes. Advocacy and policy implications at state and federal levels also are discussed.