1. Center for Children with Special Needs 1 What can the Behavior Risk Factor Surveillance System do for Children with Special Health Care Needs? Jacquie Stock, MPH Shervin Churchill, MPH Stacey DeFries, MSW

2. Center for Children with Special Needs 2 Maternal Child Health Bureau Defines CSHCN as “… have or are at increased risk for a chronic –physical –developmental –behavioral –emotional condition… … also require health and related services of a type or amount beyond that required by children generally.”

3. Center for Children with Special Needs 3 Strengthen with Structure Social need to improve health of children –For 68 years (1935) states have received funds as a result of Title V, Soc Sec Act States facilitate development of…systems of care for CSHCN. States need to know epidemiology of CSHCN (and a lot more).

4. Center for Children with Special Needs 4 How Can States Learn about CSHCN? 1994-Nat’l Health Interview Survey on Disability –18% of children were CSHCN 2003-Nat’l CSHCN Survey –13% of children were CSHCN 2000-Washington State Department of Health CSHCN Program included questions about CSHCN in Behavioral Risk Factor Surveillance System (BRFSS)

5. Center for Children with Special Needs 5 Methods Center for Children with Special Needs, via funding from Washington State Department of Health CSHCN Program, analyzed data from 2000 WA BRFSS. BRFSS- “…largest, continuously conducted telephone survey in the world…” (www.doh.wa.gov)www.doh.wa.gov

6. Center for Children with Special Needs 6 Methods: Who’s a CSHCN? Respondents familiar with health care of children in their household were asked questions adapted from the CSHCN Screener. (Foundation for Accountability, www.facct.org ) www.facct.org Respondents with a CSHCN=respondents who said they had a child with a chronic condition that had lasted or was expected to last 12 months.

7. Center for Children with Special Needs 7 Sample 95% (No.=1,245) of respondents with children were familiar with health care of children in household. 12% of those (No.=150) reported having a child with a chronic condition in their household.

8. Center for Children with Special Needs 8

9. 9 Mean age in years –Respondents with CSHCN=39 yrs –Respondents without=37 Mean number in household –Respondents with CSHCN=4.5 –Respondents without=4.1 p=.01 Sample Similarities and Differences

10. Center for Children with Special Needs 10 Sample Similarities and Differences

11. Center for Children with Special Needs 11 Results: CSHCN Were… Mean Age=9.44 Yrs SD=4.6

12. Center for Children with Special Needs 12 Type of Special Need

13. Center for Children with Special Needs 13 Access To Health Care Child Indicator CSHCNNoCSHCNOR95% CI Has health insurance 91%90%1.08.55,2.11 Has usual source of care 97%.97.31,2.99 Has primary care provider 92%88%1.53.79,2.93

14. Center for Children with Special Needs 14 Characteristics Associated with Having a CSHCN in Household CharacteristicCSHCNNo CSHCN Adj OR 95% CI General health good or excellent vs. fair or poor 82%92%.58.32,1.03 Mental health not good for 8 more more days in last 30 days 24%12%1.781.09,2.88 Current smoker33%21%1.591.02,2.46 Adjusted for respondent age, gender, marital status, education, income, employment, ethnicity

15. Center for Children with Special Needs 15 Benefits of Using BRFSS to Learn More about CSHCN Offers prevalence of CSHCN by household –Comparison to other surveys when same definition used Epidemiological information about households in which CSHCN live Environmental factors pertinent to child and adult health

16. Center for Children with Special Needs 16 Contact Information: Jacquie Stock, MPH Research Associate Center for Children with Special Needs Children’s Hospital and Regional Medical Center (206) 987-5327 jacquie.stock@seattlechildrens.org Stacey DeFries, MSW Assessment Coordinator Children with Special Health Care Needs Program Washington State Department of Health (360) 236-3559 stacey.de_fries@doh.wa.gov