Description

For sample children age 17 and under, CHNEEDRX reports parents' responses to the question, "Does [sample child] currently need or use medicine prescribed by a doctor (other than vitamins)?"

CHNEEDRX was part of the Children with Special Health Care Needs (CSHCN) Supplement included in the Sample Child Health Care Access and Utilization section of the NHIS. Before beginning this part of the survey, interviewers read the following statement:

The question for CHNEEDRX was the first item in the section of the CSHCN dealing with prescription medicine. Respondents who answered "yes" to CHNEEDRX received the follow-up question, "Is this because of any medical, behavioral or other health condition?" (CHNEEDRXHC). Persons with a "yes" response in CHNEEDRXHC received an additional follow-up question, "Is this a condition that has lasted or is expected to last for at least 12 months?" (CHNEEDRXYR).

The 2002 Field Representative's Manual provides the following information regarding the purpose of the CSHCN Supplement:

• Behavior

• Learning

• Growth or physical development

• Abilities and activities at school or play

• The kind or amount of services needed or used

According to the 2002 Survey Description, the CSHCN Supplement was included in the NHIS "to compare the results of a face-to-face in-home interview as conducted by the NHIS with a random digit dial telephone interview as conducted by NCHS's State and Local Area Integrated Telephone Survey (SLAITS)." The Survey Description also noted that the special needs questions included in the 2001 SLAITS and 2002 NHIS were taken from a standardized screener developed by the Foundation for Accountability (FACCT). The Child and Adolescent Health Measurement Initiative (CAHMI), in collaboration with FACCT, provides further information on this screener on their website at http://www.cahmi.org, including scoring procedures used to identify children with special health care needs. This information is discussed in further detail below.

According to the CAHMI website, "The CAHMI uses the definition developed by the Maternal and Child Health Bureau (MCHB) to define CSHCN [Children with Special Health Care Needs]: those who have a chronic physical, development, behavioral, or emotional condition and who also require health and related services of a type or amount beyond that required by children generally."

Children with Special Health Care Needs (CSHCN) Supplement Questions

The Children with Special Health Care Needs Supplement consists of fourteen questions falling into five categories that cover different areas of health care needs:

• Prescription Medicine

• Medical Care, Mental Health, and Educational Services

• Functional Limitations

• Special Therapy

• Treatment/Counseling

For all of the five question categories, only respondents who answered "yes" to the first category item received at least one follow-up question in that category.

In the "Treatment/Counseling" category, respondents who answered "yes" to the first item received only one follow-up question, asking if the problem that required treatment had lasted or was expected to last 12 months. In the other four categories, respondents received up to two additional questions following a "yes" response to the initial category item. For these four categories, the first follow-up question inquired whether the special need stemmed from any medical, behavioral, or other health condition. Respondents who answered "yes" to this item received a second follow-up question asking if the condition had lasted or was expected to last at least 12 months.

The questions included in the five categories are:

• Does [sample child] currently need or use medicine prescribed by a doctor (other than vitamins)? (CHNEEDRX)

• Is this because of any medical, behavioral or other health condition? (CHNEEDRXHC)

• Is this a condition that has lasted or is expected to last for at least 12 months? (CHNEEDRXYR)

• Does [sample child] need or use more medical care, mental health, or educational services than is usual for most children of the same age? (CHMOCARE)

• Is this because of any medical, behavioral or other health condition? (CHMOCAREHC)

• Is this a condition that has lasted or is expected to last for at least 12 months? (CHMOCAREYR)

• Is [sample child] limited or prevented in any way in [his/her] ability to do the things most children of the same age can do? (CHLIMIT)

• Is this because of any medical, behavioral or other health condition? (CHLIMITHC)

• Is this a condition that has lasted or is expected to last for at least 12 months? (CHLIMITYR)

• Does [sample child] need or get special therapy, such as physical, occupational or speech therapy? (CHSPTHER)

• Is this because of any medical, behavioral or other health condition? (CHSPTHERHC)

• Is this a condition that has lasted or is expected to last for at least 12 months? (CHSPTHERYR)

• Does [sample child] have any kind of emotional, developmental or behavioral problem for which [he/she] needs or gets treatment or counseling? (CHEMOTRET)

• Has this problem lasted or is expected to last for at least 12 months? (CHEMOTRETYR)

As mentioned above, the questions included in the CSHCN Supplement were taken from a screener developed by the Child and Adolescent Health Measurement Initiative (CAHMI) in collaboration with the Foundation for Accountability (FACCT). The CAHMI website (http://www.cahmi.org) provides instructions for calculating CSHCN screener scores, which in turn can be used to identify children with special health care needs.

A child meets the criteria for having a special health care need if all questions within at least one of the five categories listed above has an affirmative response. Differently stated, to qualify as a child with a special health care need, all three category questions relating to Prescription Medicine, to Medical Care, Mental Health, and Educational Services, to Functional Limitations, or to Special Therapy must be answered "yes," or both questions in the Treatment/Counseling category must be answered "yes."

IPUMS NHIS has created the variable SPNEEDKID as a summary measure indicating whether these criteria were met and thus whether a particular sample child qualified as a child with a special health care need, according to the CAHMI scoring procedures. A "yes" value in SPNEEDKID (IHIS code 2) indicates that the child met the criteria for having a special health care need.

The CAHMI scoring procedures also outline three "definitional domains" that include:

• (1) Dependency on prescription medications

• (2) Service use above that considered usual or routine

• (3) Functional limitations

The first definition (Dependency on prescription medications) is met if all items in the "Prescription Medicine" category are answered "yes." The second definition (Service use above that considered usual or routine) is met if all the items in either the "Medical Care, Mental Health, and Educational Services" category, in the "Special Therapy" category, or in the "Treatment/Counseling" category are answered "yes." Finally, the third definition (Functional limitations) is met if all items in the "Functional Limitations" category are answered "yes."

According to the CAHMI scoring procedures, "[t]he definitional domains are not mutually exclusive categories" and "[a] child identified by the CSHCN Screener can qualify on one or more definitional domains . . .."

IHIS has created the variable SPNEEDRX to indicate whether a child with a special need for health care met the definitional criteria for domain (1) Dependency on prescription medications. The IHIS-created variable SPNEEDSERV indicates whether a child with a special need for health care met the definitional criteria for domain (2) Service use above that considered usual or routine. The IHIS-created variable SPNEEDLIM indicates whether a child with a special need for health care met the definitional criteria for domain (3) Functional limitations.

As noted above, these domains are not mutually exclusive. A child with a special need for health care (here operationally defined as a sample child with a "yes" value [IHIS code 2] in SPNEEDKID) must have a value of "yes" in at least one of the IHIS-created variables SPNEEDRX, SPNEEDSERV, and SPNEEDLIM, but may have a value of "yes" in more than one of these variables.

Comparability

CHNEEDRX only occurs in 2002.

Universe

Availability

• 2002

Weights

• 2002 : SAMPWEIGHT