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Children with Special Healthcare Needs

Identification Tools


Elizabeth Shenkman, Ph.D., Director of Health Services Research, and Associate Professor, Institute for Child Health Policy.

One important consideration when trying to design appropriate services and provide high-quality care for children with special health care needs (CSHCN) is ensuring adequate identification of these children within the system.

Betsy Shenkman, Ph.D., of the Institute for Child Health Policy, presented the findings of her study that compare the results of alternative approaches to identify CSHCN. Her results indicate that when using administrative databases for identification, 4 percent of those children meeting diagnostic codes and characterized as CSHCN are identified as high-end users. However, administrative data analysis disproportionately identifies children with injuries and tends to miss children with chronic, well-controlled conditions.

Dr. Shenkman then compared the findings of the administrative data analysis with data collected using the population-based Questionnaire for Identifying Children with Chronic Conditions (QuICCC) and a shorter, population-based questionnaire called the Three Item Screener. The findings indicate that:

  • Healthcare use of those meeting the QuICCC screener is almost twice that of those who do not meet the QuICCC screener.
  • No diagnostic pattern is apparent for those meeting the QuICCC screener.
  • A high proportion of those meeting the diagnostic criteria for the QuICCC also met the criteria for the shorter, population-based screener.

Dr. Shenkman emphasized that, although administrative databases are often the most cost-effective to use for identification purposes, they do not always provide the most useful information. She suggested that shorter, population-based screeners might be a viable option for identification of CSHCN within most populations.


Newacheck PW, Strickland B, Shonkoff JP, et al. An Epidemiologic Profile of Children With Special Health Care Needs. Pediatrics 1998;102(1):117-21.

Stein REK, Westbrook LE, Bauman LJ. The Questionnaire for Identifying Children with Chronic Conditions: A Measure Based on a Noncategorical Approach. Pediatrics 1997;99(4):513-21.

Stein REK, Westbrook LE, Silver EJ. Comparison of Adjustment of School-Age Children with and Without Chronic Conditions: Results from Community-Based Samples. J Dev Behav Pediatr 1998;19(4):267-72.

Westbrook LE, Silver EJ, Stein REK. Implications for Estimates of Disability in Children: A Comparison of Definitional Components. Pediatrics 1998;101(6):1025-30.

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