Methodologic
Overview of
Two National Data Sets
Methodologic
Overview of
Two National Data Sets
Issues in Comparing Findings Across
and Within Data Sets for CSHCN
Presenter:
Collaborators:
Centers for Disease Control and Prevention
National Center for Health Statistics
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National Survey of Children with Special
Health Care Needs
National Survey of Children’s Health
Both conducted as part of CDC’s State and
Local Area Integrated Telephone Survey
Both sponsored by the Maternal and Child
Health Bureau at HRSA
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National Survey of CSHCN
Interview Process in 2001
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Screened 2.6 million telephone lines to
identify households with children under age
18
Screened all children to identify CSHCN
Asked detailed questionnaire for 38,866
CSHCN (~ 750 per state)
Asked about health insurance coverage for an
additional 176,296 children without special
health care needs
Christina Bethell
Debra Read
Paul Newacheck
National Survey of Children with
Special Health Care Needs, 2001
Two National Data Sets
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Stephen Blumberg
Produced national and statestate-based estimates
on the prevalence and impact of children with
special health care needs (CSHCN)
Is being repeated in 2005 – 2006
National Survey of CSHCN
Detailed Questionnaire
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Health and functional status
Access to care, utilization, unmet need
Health insurance and adequacy
Care coordination
Satisfaction with care
Impact on the family
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National Survey of
Children’s Health, 2003
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Produced national and statestate-based estimates
on the health and wellwell-being of children, their
families, and their communities
Will be repeated in 2007
National Survey of Children’s Health
Interview Process in 2003
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National Survey of Children’s Health
Detailed Questionnaire
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Health and functional status
Health insurance coverage
Health care access and utilization
Medical home characteristics
AgeAge-specific wellwell-being questions
Family functioning
Parental health
Neighborhood characteristics
Demographics
Both Surveys Identify CSHCN
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CSHCN Screener
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Does your child need or get special therapy, such
a physical, occupational, or speech therapy?
Does your child have any kind of emotional,
developmental, or behavioral problem for which
he/she needs treatment or counseling?
CSHCN Screener
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Both Surveys Identify CSHCN
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Screened 1.9 million telephone lines to
identify households with children < 18 years
Randomly selected one child to be the target
of an interview on health and wellwell-being
Asked detailed questionnaire for 102,353
children (~ 2,000 per state)
Cash incentives were offered to known
households with children who had not
completed the interview
Does your child currently need or use medicine
prescribed by a doctor, other than vitamins?
Does your child need or use more medical care,
mental health, or educational services than is
usual for most children of the same age?
Is your child limited or prevented in any way in
his/her ability to do the things most children on
the same age can do?
Both Surveys Identify CSHCN
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National Survey of CSHCN, 2001
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National Survey of Children’s Health, 2003
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Prevalence = 12.8%
Prevalence = 17.6%
FollowFollow-up questions
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Is this because of any medical, behavioral, or
other health condition?
Is this a condition that has lasted or is expected to
last 12 months or longer?
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Why Might Prevalence Rates Differ
from One Survey to the Next?
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Dates of data
collection
Method of data
collection and
estimation
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Mode
Sampling frame
Interviewers
Weighting methods
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Sample size and
sampling error
Method of
identification
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Respondent
Recall period
Question wording
Question ordering
Question context and
introduction
Mode and Sampling Frame
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National Survey of CSHCN
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All interviews conducted by Abt Associates Inc.
National Survey of CSHCN
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All interviews conducted by Abt Associates Inc.
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Sample Size and Sampling Error
National Survey of CSHCN
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102,353 children aged 00-17
Response rate = 55.3%
Incentives offered to families that initially refused
to participate
All weights calculated by Abt Associates Inc.
Adjusted for nonresponse and noncoverage of
nontelephone households
Poststratified by age, sex, race/ethnicity, highest
education in household, and household size
Method of Identifying CSHCN
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373,055 children aged 00-17
Response rate = 63.4%
No incentives
National Survey of Children’s Health
All weights calculated by Abt Associates Inc.
Adjusted for nonresponse and noncoverage of
nontelephone households
Poststratified by age, sex, race/ethnicity, mother’s
education, and household income
National Survey of Children’s Health
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RandomRandom-digitdigit-dial telephone survey
Stratified by state
No oversampling
Weighting
National Survey of Children’s Health
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RandomRandom-digitdigit-dial telephone survey
Stratified by state
No oversampling
National Survey of Children’s Health
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Interviewers
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National Survey of CSHCN
National Survey of CSHCN
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CSHCN Screener asks about consequences
currently experienced
Respondent was generally the mother (78.9%) or
father (17.2%)
National Survey of Children’s Health
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CSHCN Screener asks about consequences
currently experienced
Respondent was generally the mother (78.6%) or
father (17.3%)
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Question Wording
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National Survey of CSHCN
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FamilyFamily-level (all children)
„ Do any of your children currently need or use
medicine prescribed by a doctor?
„ Who is that?
National Survey of Children’s Health
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Question Ordering
ChildChild-level (one randomly selected child)
„ Does (CHILD) currently need or use medicine
prescribed by a doctor?
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National Survey of CSHCN
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CSHCN Screener questions were the first health
questions asked
Immediately followed demographics
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CSHCN Screener questions were not the first
health questions asked
Immediately followed demographics, overall
health status, height, and weight
National Survey of CSHCN
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“The next questions are about any kind of health problems,
concerns, or conditions that may affect your children’s
behavior, learning, growth, or physical development.”
“Some of these health problems may affect your children’s
abilities and activities at school or at play. Some of these
problems affect the kind or amount of services your children
may need or use.”
National Survey of Children’s Health
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“The next questions are about any kind of health problems,
concerns, or conditions that may affect your children’s
behavior, learning, growth, or physical development.”
Nothing more
“…the survey will be about the health and health
care of (CHILD).”
“The survey will take about 25 minutes.”
Why Might Wording, Ordering,
Context, and Introduction Matter?
Question Introduction
National Survey of CSHCN
“…the survey asks about the health and health
care of the child or children under 18…”
“Depending on the health characteristics of your
children, these questions take between 5 and 25
minutes, but for most families, it’s around 10
minutes.”
National Survey of Children’s Health
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1) Does (CHILD) currently need or use medicine
prescribed by a doctor?
2) Does (CHILD) need or use more medical care,
mental health, or educational services than is
usual for most children of the same age?
Survey Introduction
National Survey of Children’s Health
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1) Do any of your children need or use more
medical care, mental health, or educational
services than is usual for most children of the
same age?
2) Do any of your children currently need or use
medicine prescribed by a doctor?
National Survey of Children’s Health
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Question Context
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National Survey of CSHCN
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CSHCN Screener includes difficult concepts
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Does your child currently need…?
need…?
Does your child need or use more...than is usual
for most children of the same age?
…limited…in
limited…in his/her ability to do the things most
children of the same age can do?
Is this because of any medical, behavioral, or
other health condition?
condition?
Is this a condition that has lasted or is expected to
last 12 months or longer?
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Final Thought
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Why do we identify CSHCN?
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For more information
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To monitor prevalence or trends in the population
To identify children and families who need
services or other assistance
To assess equalization of opportunity
Differences in prevalence may not matter for
researchers focusing on these last two
reasons
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Stephen J. Blumberg, Ph.D.
National Center for Health Statistics
3311 Toledo Road, Room 2112
Hyattsville, Maryland 20782
sblumberg@cdc.gov
Christina Bethell’s talk, Monday, 9:00 AM
“Comparing and interpreting findings on the prevalence and
health and health care service need characteristics of children
and youth with special health care needs (CYSHCN) across
three new national data sets”
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