Leading Health Indicator 3
Children with Special
Health Care Needs (CSHCN)
Florida 2010 Goal for Children and Youth
Provide access to a family-centered, coordinated managed system of care for
children with special health care needs. Empower families and children to
participate in their health care decisions
HP 2010 Goal for Disability and Secondary Conditions
Promote the health of people with disabilities, prevent secondary conditions
and eliminate disparities between people with and without disabilities in the
Florida's goal to ensure every child with special health care needs access to
quality health services requires establishing statewide systems that can identify
children with CSHCN from birth to adulthood and monitoring the system that cares
for CSHCN. Newborns are screened at birth for high risk conditions that require
special health care. Children who have access to health care through a medical
home are more likely to be screened throughout their childhood and adolescence.
Another major effort in Florida occurs through the KidCare child health insurance
application process, where families are asked to identify a child with special
health care needs.
With so much at stake for children, there is a need to evaluate the progress in
identifying CSHCN. Nationally and in Florida, efforts have been made to standardize
definitions and measures. While there is no definitive number, prevalence measures
range between 5 percent and 30 percent depending on definitions and whether only
severely affected children are included or whether children with ongoing conditions
that are under control but need monitoring are included. In Figure 25, the
results of a survey by Shenkman and Bono (2002) are
Approximately 2,770 Florida families in all 67 counties with children below age 18
were interviewed by telephone using the Children with Special Health Care Needs
(CSHCN) Screener — a five-part, 15-item screening tool approved by the National
Commission on Quality Assurance (NCQA) to identify CSHCN.
Families were asked five questions on any special health conditions for which
they (1) used medicine prescribed by a doctor, (2) received medical care, (3)
received special therapy, (4) had limited function, (5) had a behavioral problem.
If families said yes to any of the questions, they were also asked if the condition
was expected to last over 12 months. The researcher, Shenkman (2002),
(1) commented that while nearly 30 percent of
Florida families with children were found to have a condition lasting over 12
months, while similar U.S. surveys yielded an 18 percent prevalence. Further
analyses are being conducted to understand the large differences between U.S. rates
and Florida rates. With a voluntary insurance program (like SCHIP), families who
believe their children have special health care needs may be more likely to enroll
their children in the program.
Figure 25: Prevalence of Florida and U.S. with a
or Chronic Condition Using the CSHCN Screener
Source: E. Shenkman, and C. Bono (2002) Results From The
Statewide Children's Health
Insurance Survey - Phase 1: A report prepared for the Healthy Kids Board of
Institute for Child Health Policy.
Identifying children with special health care
needs is important to maximize development and avoid the development of secondary
Note: Five questions are asked to determine a child's dependency in three
domains: medication, services used and functional limitations.
Back to Top