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Children with Special Health Care Needs (CSHCN) Screener

The Children with Special Health Care Needs (CSHCN) Screener is a 5-item screening tool to identify children with special health needs based on the definition provided by the federal Maternal and Child Health Bureau (MCHB). The MCHB defines CSHCN 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.” The CSHCN Screener operationalizes the MCHB definition of CSHCN by focusing on the health consequences a child experiences as a result of having an on-going health condition rather than on the presence of a specific diagnosis or type of disability.

The screener can either be self-administered or given in a telephone interview as part of a parent/caretaker survey. It takes about 1 minute to complete. The CSHCN Screener is currently used in the many national surveys. It is available in English and Spanish.

The CAHMI and the CAHPS© project team co-developed a 31 question supplement to be integrated, along with the CSHCN screener, into the CAHPS® 2.0H Child Questionnaire or other core general patient experience survey. Four domains of care of particular importance for children with chronic or special health care needs are assessed:

  • Access to prescription medications
  • Access to specialized services
  • Family-centered care
  • Coordination of care

The Need for the Screener

The screener responds to the need for an efficient, standardized and non-condition specific method for identifying CSHCN in populations and for quality assessment purposes. Unlike the adult population, the relatively low prevalence of any single childhood chronic condition and the large number of applicable diagnoses, many of which are rare, makes disease-specific checklists and/or diagnosis-based case-finding inadequate for capturing the full range of chronic childhood diseases. In addition, diagnosis-based approaches are known to miss many children with chronic conditions due to coding errors, misdiagnoses, lack of access to care, and the global or developmental nature of some childhood problems. In field testing, the CSHCN Screener efficiently and effectively identified a robust, valid denominator of children with special heath care needs for quality measurement.

The CSHCN Screener when incorporated into other health and health care quality measurements allows for the comparison of the health and health care quality of children with and without special health care needs. Since children with special health care needs require greater exposure to health services, their experiences of health care may more accurately depict the existing gaps in health care quality.

Implementation Materials

  • Please fill out this form and return to info@cahmi.org to receive additional materials and tell the CAHMI how you are using the screener.
  • Using the Screener
  • Screener Items and Scoring Instructions
  • Screener Items in Spanish
  • A manual for State Medicaid Agencies and managed care organizations (MCOs) on identifying children and/or adults with special health care needs.
  • CAHPS® Health Plan Survey and Reporting Kit 2007. This toolkit provides preliminary information on gathering, analyzing and reporting data from the CSHCN Screener and 31 supplemental questions.

Applications in the Field

The CSHCN Screener can be found in:

  • Promoting Healthy Development Survey (PHDS)
  • National Survey of Children with Special Health Care Needs (NS-CSHCN)
  • National Survey of Children’s Health (NSCH)
  • Medical Expenditure Panel Survey (MEPS)
  • Consumer Assessment of Healthcare Providers (CAHPS©) Children with Chronic Conditions survey.

In Partnership With: The David and Lucile Packard Foundation / The Robert Wood Johnson Foundation / Stephen Blumberg, Julie Brown, Treeby Brown, Paul Cleary, Christine Crofton, Susan Epstein, Jack Fowler, Shirley Girouard, Maxine Hayes, John Hochheimer, Charles Homer, Alice Lind, Margaret McManus, Merle McPherson, John Neff, Paul Newacheck, Debra Read, Donald Steinwachs, Ruth Stein, Joe Thompson, Deborah Klein Walker, and Nora Wells.