Children with Special Health Care Needs Who Receive Care that Meets Federal Minimum Quality Standards, by Complexity of Need (California Only)
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- Definition: Percentage of children ages 0-17 with special health care needs, by complexity of need, whose care met all age-relevant federal minimum quality standards: 1) shared decision making between families and providers; 2) care within a medical home; 3) consistent and adequate insurance coverage; 4) annual screening through preventive medical/dental visits; 5) access to community-based services; and 6) transition planning for adulthood for ages 12-17. "More complex needs” refer to those requiring more than just prescription medication to manage the conditions, while “less complex needs” refer to those primarily managed by prescription medications.
- Data Source: Child and Adolescent Health Measurement Initiative, Data Resource Center for Child and Adolescent Health, National Survey of Children with Special Health Care Needs (Dec. 2012).
- Footnote: Children with special health care needs are defined as those who have or are at increased risk for a chronic physical, developmental, behavioral, or emotional condition and who also require health and related services of a type or amount beyond that required by children generally. For information about statistical significance, see the report in the Data Source above.
Learn More About Quality of Care for Children with Special Health Care Needs
- Measures of Quality of Care for Children with Special Health Care Needs on Kidsdata.org
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Children with special health care needs (CSHCN) are defined as those who have or are at increased risk for a chronic physical, developmental, behavioral, or emotional condition and who also require health and related services of a type or amount beyond that required by children generally. On kidsdata.org, indicators related to quality of health care for CSHCN include:
- Children who receive care that meets federal minimum quality standards, overall, by race/ethnicity, by type of insurance, and by complexity of health care needs
- Receipt of effective care coordination, overall, and by complexity of need
- Receipt of family-centered care, overall, by income level, by race/ethnicity, by type of insurance, and by complexity of need
- Children whose families feel engaged in shared decision-making with providers, overall, by type of insurance, and by complexity of need
- Receipt of care within a medical home, overall, by age, by income level, by race/ethnicity, by type of insurance, and by complexity of need
These data come from the National Survey of Children with Special Health Care Needs and the National Survey of Children's Health, which are conducted through telephone interviews with parents. Depending on the indicator, data are available for California, the U.S., all states other than California (including the District of Columbia), and/or geographies with at least 70,000 residents (as local area synthetic estimates based on American Community Survey data from the U.S. Census Bureau). -
- Quality of Care for Children with Special Health Care Needs
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- Children with Special Health Care Needs Who Receive Care that Meets Federal Minimum Quality Standards (California & U.S. Only)
- Receipt of Effective Care Coordination for Children with Special Health Care Needs (California & Other States Only)
- Receipt of Family-Centered Health Care for Children with Special Health Care Needs (California & U.S. Only)
- Children with Special Health Care Needs Whose Families Feel Engaged in Shared Decision-Making with Providers (California & U.S. Only)
- Receipt of Care Within a Medical Home for Children with Special Health Care Needs (California & U.S. Only)
- Receipt of Care Within a Medical Home for Children with Special Health Care Needs (Regions of 70,000 Residents or More)
- Bullying and Harassment at School
- Characteristics of Children with Special Needs
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- Children with Special Health Care Needs
- Children with and without Special Health Care Needs Who Are Overweight or Obese (California & U.S. Only)
- Children with Special Health Care Needs with One or More Adverse Experiences
- Children with Special Health Care Needs Who Are Usually/Always Resilient
- Prevalence of Special Health Care Needs Among Children, by Type of Health Insurance (California & U.S. Only)
- Four or More Functional Difficulties Among Children with Special Health Care Needs, by Type of Health Insurance (California & U.S. Only)
- Emotional or Behavioral Difficulties Among Children with Special Health Care Needs (California & U.S. Only)
- Poverty Among Children with Special Health Care Needs, by Race/Ethnicity (California & U.S. Only)
- Children with Major Disabilities
- Children with and without Major Disabilities, by Health Insurance Coverage Status
- Active California Children's Services (CCS) Enrollees, by Age Group
- Student Demographics
- Access to Services for Children with Special Needs
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- Children with Special Health Care Needs Who Need Five or More Services (California & U.S. Only)
- Children with Special Health Care Needs Who Had a Preventive Medical Visit in the Last Year (California & U.S. Only)
- Difficulty Accessing Community-Based Services for Children with Special Health Care Needs (California & U.S. Only)
- Early Intervention for Children with Special Health Care Needs (California & U.S. Only)
- Receipt of Mental Health Services Among Children with Special Health Care Needs Who Need Treatment or Counseling (California & U.S. Only)
- Referrals to Specialty Care for Children with Special Health Care Needs (California & U.S. Only)
- Special Education Participation by Children with Special Health Care Needs (California & U.S. Only)
- Unmet Needs for Health Services Among Children with Special Health Care Needs (California & U.S. Only)
- Unmet Needs for Preventive Dental Services Among Children with Special Health Care Needs (California & U.S. Only)
- Usual Source of Health Care Among Children with Special Health Care Needs (California & U.S. Only)
- Youth with Special Health Care Needs Who Receive Needed Services for the Transition to Adulthood (California & U.S. Only)
- Insurance Coverage for Children with Special Health Care Needs
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- Insurance Coverage for Children with Special Health Care Needs, by Insurance Status (California & Other States Only)
- Insurance Coverage for Children with Special Health Care Needs (Regions of 70,000 Residents or More)
- Consistency of Insurance Coverage, by Special Needs Status (California & U.S. Only)
- Adequacy of Insurance Coverage Among Insured Children, by Special Needs Status (California & U.S. Only)
- Adequacy of Insurance Coverage Among Children with Special Health Care Needs (Regions of 70,000 Residents or More)
- Pupil Support Services
- Impact of Special Health Care Needs on Children & Families
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- Children with Special Health Care Needs Whose Conditions Caused Family Financial Problems (California & Other States Only)
- Children with Special Health Care Needs Whose Conditions Consistently and/or Greatly Affect Their Daily Activities (California & U.S. Only)
- Children with Special Health Care Needs Whose Families Spend 11 Hours or More a Week on the Child’s Health Care (California & U.S. Only)
- Children with Special Health Care Needs Whose Family Member(s) Avoided Changing Jobs Due to Health Insurance (California & U.S. Only)
- Children Whose Parents Experienced Stress Due to Parenting, by Child's Special Needs Status (California & U.S. Only)
- Impact of Child's Special Health Care Needs on Parental Employment (California & U.S. Only)
- Out-of-Pocket Expenses for Children with Special Health Care Needs, by Adequacy of Insurance (California & U.S. Only)
- Overnight Hospital Stays Among Children with Special Health Care Needs (California Only)
- Repeating a Grade in School, by Special Needs Status (California & U.S. Only)
- School Days Missed Among Children with Special Health Care Needs (California & U.S. Only)
- Why This Topic Is Important
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More than 1 million California children and youth have a need for health care services of a type or amount beyond that required by children generally. Their ongoing health problems—physical, behavioral, or developmental—can affect their ability to function and participate in important educational and social activities. In some cases their health problems can shorten their lives (1). Medical care for children with special health care needs (CSHCN) is often complicated by the co-occurrence of social, emotional, and academic problems (1, 2). Because of the higher caregiving burdens, families of CSHCN tend to experience more stress and difficulties with employment and finances than other families (1, 2).
CSHCN account for more than 40% of all health care costs among children nationwide, despite making up only about 16% of the U.S. child population (1). Though advances in medical care have extended and improved the lives of millions of children, obtaining timely, appropriate, and affordable care remains a problem for many families. More than four in five CSHCN do not receive one or more basic aspects of quality health care, in California and nationally (1). Increasing access to quality care is critical to improving the health and well being of CSHCN. As these children depend more on the health care system than children without special needs, the quality of health services has a greater impact on their lives and their families’ experiences (1, 2).For more information, see kidsdata.org’s Research & Links section and our Program for Children with Special Health Care Needs site.
Sources for this narrative:
1. Child and Adolescent Health Measurement Initiative. (2013). Children with special health care needs in California: A profile of key issues. Lucile Packard Foundation for Children’s Health. Retrieved from: http://www.lpfch.org/publication/children-special-health-care-needs-california-profile-key-issues
2. Hughes, D. (2015). In their own words: Improving the care experience of families with children with special health care needs. Lucile Packard Foundation for Children’s Health & University of California, San Francisco. Retrieved from: http://www.lpfch.org/publication/their-own-words-improving-care-experience-families-children-special-health-care-needs - How Children Are Faring
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In 2009-2010, 84% of children with special health care needs (CSHCN) in California did not receive care that met federal minimum quality standards. Also nearly half (47%) of the state's CSHCN did not receive effective care coordination. CSHCN with more complex health needs, who may need more help coordinating services, were less likely to get help with care coordination than CSHCN with less complex needs (46% vs. 70%, respectively).
In addition, according to 2011-2012 estimates, less than 36% of the state's CSHCN receive care within a medical home—a basic level of care that is ongoing, comprehensive, coordinated, and family-centered—with estimates for some counties as low as 30%. CSHCN with private health insurance were more likely to receive care within a medical home (47%) than those with public insurance (25%) in 2009-2010.
California CSHCN are less likely to have families who feel engaged in shared decision-making with health care providers than CSHCN in other states (62% vs. 71% in 2009-2010).*Access to family-centered care—a fundamental part of quality care—is a challenge for CSHCN who have more complex needs or who are low income, of color, or publicly insured. For example, 52% of African American/black CSHCN and 59% of Hispanic/Latino CSHCN received family-centered care in 2009-2010, compared to 70% of white CSHCN in California.
* Child and Adolescent Health Measurement Initiative. (2013). Children with special health care needs in California: A profile of key issues. Lucile Packard Foundation for Children’s Health. - Policy Implications
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Children and youth with special health care needs (CYSHCN), like all young people, need ready access to appropriate medical care, educational opportunities, and, sometimes, social services. CYSHCN, especially those with more complex conditions, may face challenges in obtaining timely access to pediatric subspecialty care and receiving comprehensive, coordinated, high quality health care (1, 2). They also may experience difficulties participating in school and recreational activities (1, 3). Their families, too, often have to manage economic, social, and personal burdens in excess of families without CYSHCN (1, 3).
Policies and programs to promote the health and well-being of CYSHCN and their families should address:- Comprehensive and consistent health care coverage: CYSHCN need comprehensive health insurance that provides adequate medical and mental health coverage, including access to specialty care providers (1, 4, 5). These children also need consistent coverage, without gaps that can cause delays or problems receiving critical services. Appropriate reimbursement is critical to maintaining an adequate provider network, as well (4, 5).
- High-quality, well-coordinated, and consistent services: CYSHCN benefit from evidence-based health care services provided in the context of a “medical home” that assures high quality, well-coordinated care (1, 2, 4).
- Family-centered care: Families are the most central and enduring influence in children’s lives, and most of children’s care depends on their families carrying out agreed-upon management plans. Families’ values, beliefs, goals, and priorities should help guide care plans, and families should be included as partners in all health care decision-making (1, 3, 4).
- Early and continuous screening: Systematic screenings for special health care needs beginning early in a child’s life have the potential to reduce long-term consequences of some chronic conditions. Such screenings help identify problems early and can provide an opportunity to assess the needs and strengths of families, as part of providing tailored and family-centered care (3, 4).
- Inclusion: Providing CYSHCN with opportunities for inclusion with other children in academic, social, and recreational settings is critical to their development and can maximize achievement and quality of life (6).
- Support for adulthood transition: As CYSHCN age, they need support from their health care, educational, and social service systems to successfully transition to adulthood. For example, they may need assistance to move from school to work or post-secondary education, from pediatric care to adult health care, and/or from family dependency to self-sufficiency (1, 4).
- Financing of care: Families of CYSHCN must navigate a complicated web of service systems with dueling eligibility criteria and confusing payment policies. This can result in delayed or denied services for children and financial hardship for families. State policy must work toward a unified, efficient, and comprehensive payment system for health care and developmental services, as well as ensuring adequate funding for public systems serving CYSHCN (1, 2, 4, 7).
For more information, see kidsdata.org’s Research & Links section and LPFCH's program for Children with Special Health Care Needs.
Sources for this narrative:
1. Child and Adolescent Health Measurement Initiative. (2013). Children with special health care needs in California: A profile of key issues. Lucile Packard Foundation for Children’s Health. Retrieved from: http://www.lpfch.org/publication/children-special-health-care-needs-california-profile-key-issues
2. Bachman, S. S., et al. (2015). The care coordination conundrum and children and youth with special health care needs. Catalyst Center & Lucile Packard Foundation for Children’s Health. Retrieved from: http://www.lpfch.org/publication/care-coordination-conundrum
3. U.S. Department of Health and Human Services, Health Resources and Services Administration. (2013). The National Survey of Children with Special Health Care Needs Chartbook 2009-2010. Retrieved from: http://mchb.hrsa.gov/cshcn0910
4. Association of Maternal and Child Health Programs. (2014). Developing structure and process standards for systems of care serving children and youth with special health care needs. Lucile Packard Foundation for Children’s Health. Retrieved from: http://www.lpfch.org/publication/standards-systems-care-children-and-youth-special-health-care-needs
5. Gans, D., et al. (2013). Assuring children’s access to pediatric subspecialty care in California. UCLA Center for Health Policy Research & Lucile Packard Foundation for Children’s Health. Retrieved from: http://www.lpfch.org/publication/assuring-children's-access-pediatric-subspecialty-care-california
6. American Occupational Therapy Association. (2015). Occupational therapy’s role in mental health promotion, prevention, and intervention with children and youth: Inclusion of children with disabilities. Retrieved from: https://www.aota.org/~/media/Corporate/Files/Practice/Children/Inclusion-of-Children-With-Disabilities-20150128.PDF
7. Schumacher, K. (2015). Children’s health programs in California: Promoting a lifetime of health and well-being. California Budget and Policy Center & Lucile Packard Foundation for Children’s Health. Retrieved from: http://calbudgetcenter.org/resources/childrens-health-programs-in-california-promoting-a-lifetime-of-health-and-well-being - Research & Links
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- Websites with Related Information
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- Association of Maternal and Child Health Programs (AMCHP)
- California Dept. of Health Care Services: California Children's Services
- Catalyst Center. Boston University School of Social Work.
- Center for Parent Information and Resources. Statewide Parent Advocacy Network.
- Children's Regional Integrated Service System (CRISS)
- Disability Rights California
- Family Voices
- Got Transition: Resources and Research. National Alliance to Advance Adolescent Health.
- Health Affairs. Project HOPE.
- Lucile Packard Foundation for Children's Health: Program for Children with Special Health Care Needs
- Maternal and Child Health Bureau: Children with Special Health Care Needs. U.S. Dept. of Health and Human Services.
- Mathematica: Disability
- National Academy for State Health Policy (NASHP)
- Support for Families of Children with Disabilities
- Key Reports and Research
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- A State Multi-Sector Framework for Supporting Children and Youth with Special Health Care Needs. (2018). Lucile Packard Foundation for Children’s Health. Child Trends.
- Access to the Medical Home among Children with and without Special Health Care Needs. (2018). Pediatrics. Lichstein, J. C., et al.
- Building Systems That Work for Children with Complex Health Care Needs. (2018). Pediatrics. Agrawal, R., & Stille, C. (Eds.)
- Children with Special Health Care Needs Face Challenges Accessing Information, Support, and Services. (2020). Child Trends. Abdi, F. M., et al.
- Children with Special Health Care Needs: NSCH Data Brief. (2020). Health Resources and Services Administration, Maternal and Child Health Bureau.
- Fundamentals of Financing the System of Care for Children and Youth with Special Health Care Needs (CYSHCN) (2019). Catalyst Center. Comeau, M., et al.
- Hidden in Plain Sight: California Children Using Long-Term Care Services. (2015). Lucile Packard Foundation for Children's Health & Learning Partnerships. Brousseau, R., & MacDonald, S.
- Immigrant Families, Children with Special Health Care Needs, and the Medical Home. (2016). Pediatrics. Kan, K., et al.
- In Their Own Words: Improving the Care Experience of Families with Children with Special Health Care Needs. (2015). Lucile Packard Foundation for Children’s Health & University of California San Francisco. Hughes, D.
- Opportunities for Improving Programs and Services for Children with Disabilities. (2018). National Academies of Sciences, Engineering, and Medicine.
- Patient- and Family-Centered Care Coordination: A Framework for Integrating Care for Children and Youth Across Multiple Systems. (2018). Pediatrics. American Academy of Pediatrics, Council on Children with Disabilities & Medical Home Implementation Project Advisory Committee.
- Standards for Systems of Care for Children and Youth with Special Health Care Needs: Version 2.0. (2017). Lucile Packard Foundation for Children's Health. Association of Maternal and Child Health Programs, et al.
- The 2020 Federal Youth Transition Plan: A Federal Interagency Strategy. (2015). Federal Partners in Transition Workgroup.
- The Eye of the Beholder: A Discussion of Value and Quality from the Perspective of Families of Children and Youth with Special Health Care Needs. (2017). Pediatrics. Anderson, B., et al.
- More Data Sources For Quality of Care for Children with Special Health Care Needs
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- Data Resource Center for Child and Adolescent Health. Child and Adolescent Health Measurement Initiative.
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