Presentation For MCHCOM'COM April, 2003

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Presentation For MCHCOM.COMApril, 2003

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• Health Resources And Services Administration
• Maternal And Child Health Bureau
• Peter C. van Dyck, M.D., M.P.H.

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CSHCN SURVEY
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• Partnership between HRSAs Maternal and Child
  Health Bureau (MCHB) and National Center for
  Health Statistics (NCHS)
• Using SLAITS, complete 750 CSHCN interviews per
  state
• Data available Winter 2002-2003

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• Establish uniform state, regional, and national
  prevalence estimates for CSHCN under 18 with
  existing special health care needs using the MCHB
  definition.
• Provide state, regional, and national data for
  CSHCN characteristics and systems impact as
  baseline estimates for federal and state
  performance measures, Title V needs assessment
  activities and HP 2010.

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• Screened 196,888 households with children
• Screened 373,055 children for special health care
  needs
• Completed 38,866 CSHCN interviews

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Outline of National Survey of Children With
Special Health Care Needs

• Introduction
• Prevalence of Special Health Care Needs
• Health and Functional Status of CSHCN
• Health Insurance Coverage
• Health Care Needs and Access to Care
• Care Coordination
• Family-Centered Care
• Impact on Families
• State by State Data
• Appendix

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Children with special health care needs (CSHCN)
are defined by the Department of Health and Human
Services as
those who have or are at increased risk for
chronic physical, developmental, behavioral, or
emotional conditions and who also require health
and related services of a type or amount beyond
that required by children generally.1
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To identify CHSCN, the survey asked whether the
child used more medical care, mental health, or
educational services than usual for most children
of the same age whether the child used
specialized therapies, mental health counseling,
or prescription medication or whether the child
was limited or prevented in any way in his or her
ability to do things most children of the same
age can do, due to a medical, behavioral, or
other health condition that is expected to last
at least one year.
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Prevalence of Special Health Care Needs
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Prevalence of Special Health Care Needs Persons
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Prevalence of Special Health Care Needs By Age
20
Percent
10
0-5 years
6-11 years
12-17 years
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Prevalence of Special Health Care Needs By Race
and Ethnicity
20
Percent
10
Native Hawaiian/ Pacific Islander
Hispanic
Non- Hispanic White
Non- Hispanic Black
Native American/ Alaska Native
Asian
Mixed Race
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Prevalence of Special Health Care Needs
Households
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Health and Functional Status Of CSHCN
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The population of children with special health
care needs is diverse, including children with a
wide range of conditions with varying levels of
impact. This section describes the types of
special needs these children have and
the impact of their conditions on both
children and their families.
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Proportion of CSHCN with Different Needs
80
60
Percent
40
20
Emotional/ Behavioral/ Developmental Services
Prescription Medicines
Elevated Service Use
Limitation in Activities
Specialized Therapies
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Health Insurance Coverage
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Health insurance, whether financed through the
private or the public sector, is an essential
ingredient for access to care for children with
special health care needs. Without health
insurance, children are more likely to forgo
necessary preventive health care, and acute
health care when children are sick can leave
their families with overwhelming medical
bills.   This section reviews the surveys
findings on insurance coverage among children
with special health care needs, the adequacy
of their coverage, and the other programs
and services they use to meet their medical and
educational needs.
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Health Insurance Coverage for CSHCN Over the Past
Year
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Percent of CSHCN Ever Uninsured in the Past
Year, By Race and Ethnicity
20
Percent
10
0
Non-Hispanic White
Non-Hispanic Black
Non-Hispanic Other
Hispanic
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Percent of CSHCN with Inadequate Insurance
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Percent of CSHCN with Inadequate Insurance By
Income Level
50
Percent
30
10
Federal Poverty Level One or more criteria are
not always or usually met adequate benefits,
access to needed providers, and reasonable
charges.
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Health Care Needs and Access to Care
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Children with special health care needs require a
broad range of services, from primary and
specialty medical care to
prescription medications, medical equipment and
therapies. In addition to the needs of
the child, families of CSHCN may need
additional services, such as
respite care, family counseling, or genetic
counseling.   This section
describes both the prevalence of need
for a variety of medical and support services
and the proportion of children who
have unmet needs for each service.
Other aspects of access to care,
such as access to referrals and the presence of a
usual source of care, are also
presented here.
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Percent of CSHCN with Unmet Health Service Needs
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Number of Unmet Health Service Needs By Insurance
Type
50
30
Percent
10
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Impact on Families
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Having a child with special health care needs can
affect a familys finances, employment status,
and mental health. The demands on families may
require that parents cut down their work hours or
give up a job, at the same time that they face
burdensome out-of-pocket health care costs. This
section describes the impact that children
with special health care needs have on
their families, including their
out-of-pocket expenditures, the time spent
caring for their children, and the impact of
childrens needs on parents
employment.
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Time Spent Providing, Arranging, or Coordinating
Care for CSHCN, Per Week
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Percent of CSHCN Whose Families Spend 11 or More
Hours Per Week Providing, Arranging, or
Coordinating Their Care by Income Level
30
25
20
26.7
15
20.7
Percent
10
10.3
5
6.0
0
0-99 FPL
100-199 FPL
200-399 FPL
400 FPL
Federal Poverty Level
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Percent of CSHCN whose Families Experience
Financial Problems Due to Childs Condition
Do Not Experience Financial Problems 79.2
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Percent of CSHCN Whose Families Experience
Financial Problems, By Insurance Type
50
40
30
Percent
20
10
0
Private Only
Public Only
Both
Uninsured
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Impact of Childs Condition on Parents
Employment
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Impact of Childs Condition on Parents
Employment by Income Level
50
40
30
Percent
20
10
0
0-99 FPL
100-199 FPL
200-399 FPL
400 FPL
Federal Poverty Level
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State-by-State Data
The second section of this chart book shows
selected indicators for each of the 50 States and
the District of Columbia. These indicators are
displayed for each state, except in cases where
the sample size would compromise
the respondents confidentiality.
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State-by-State Data pages
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Breastfeeding Promotion in Physicians Office
Practices

• Betty L. Crase, BA, IBCLC
• Project Director
• Administered by
• American Academy of Pediatrics
• in partnership with the
• Department of Health and Human Services
• Maternal and Child Health Bureau

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Goal 1

• Increase the number of pediatricians,
  obstetricians, family physicians, and other
  health care providers who effectively promote and
  manage breastfeeding in racially and ethnically
  diverse populations toward achievement of Healthy
  People 2010 goals and objectives.

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Objective 1A

• Enroll 300 pediatricians, obstetricians, family
  physicians, and other health care providers with
  racially and ethnically diverse backgrounds and
  those working with underserved populations in the
  program (Year 4).

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Total Enrollment

• 694 individual applications
• 350 applicants enrolled (50)
• 7 Voluntary Withdrawals
• 432 applicants AAP members (62)
• 259 AAP members enrolled (74)

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Objective 1B

• Determine and compare breastfeeding attitudes,
  knowledge, and management skills of the 300
  program participants through the baseline (Year
  5) and follow-up (Year 6) administration of the
  Physician Self-assessment Questionnaire, adapted
  to capture cultural competence and behavior
  changes.

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Objective 1C

• Distribute up to 15 technical and educational
  culturally appropriate publications and products
  to help program participants more effectively
  promote, support, and manage breastfeeding in
  their medical practices (Years 5 and 6).

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Objective 1D

• Provide technical assistance to all physicians
  and other health care providers in breastfeeding
  promotion, support, education, and effective
  management, including assisting them to utilize
  publications and products provided through the
  program (Years 4, 5, 6).

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Technical Assistance

• 623 requests for technical assistance since
  October 1, 2001
• Major categories
• Breastfeeding materials
• Breastfeeding recommendations
• Medication questions
• Policy statements
• BPPOP - Phase II program questions

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Objective 1E

• Through the use of the Parent Survey Tool,
  track changes in breastfeeding initiation and
  duration rates in participating medical practices
  before and after the educational and technical
  assistance interventions (Years 5, 6).

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Goal 2

• Develop strategies to bring health professional
  organizations and public health representatives
  together around breastfeeding promotion and
  support to increase the incidence and duration of
  breastfeeding and decrease racial and ethnic
  disparities as determined in the Healthy People
  2010 goals and objectives.

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Objective 2A

• Engage representatives from up to 10 health
  professional organizations and public health
  service providers in a collaborative network to
  meet the needs of racially and ethnically diverse
  populations via formation and utilization of a
  multidisciplinary project advisory committee
  (Years 4, 5, and 6).

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Project Advisory Committee

• ABM
• AAFP
• AAP
• ACOG
• IHS
• MCHB

• MCN
• NHMA
• NMA
• NWA
• USDA/FNS

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Objective 2B

• Facilitate the development (Year 4) and
  maintenance (Years 5 and 6) of regionally focused
  action groups geared toward breastfeeding
  initiatives in underserved populations in each of
  the 10 federal regions.

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Outcome Measures

• Administer Physician Self-assessment
  Questionnaire at program beginning end.
• Determine breastfeeding initiation duration
  rates in practices at program beginning end and
  compare with Healthy People 2010 goals with
  Parent Survey Tool.
• Track number of physicians participating in the
  program.

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Outcome Measures (continued)

• Track technical assistance provided.
• Assess effectiveness of overall program,
  including educational resources provided to
  program participants through the Program
  Evaluation Survey.

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Question and AnswerSession

• This presentation will probably involve audience
  discussion, which will create action items. Use
  PowerPoint to keep track of these action items
  during your presentation
• In Slide Show, click on the right mouse button
• Select Meeting Minder
• Select the Action Items tab
• Type in action items as they come up
• Click OK to dismiss this box
• This will automatically create an Action Item
  slide at the end of your presentation with your
  points entered.