Survey Results

Survey Items: Survey instrument item number for children 0-5 years: C9,C10, D1-4, D7-12; for children 6-11 years: C7,C8, D1-4, D7-12; for children 12-17 years: C8,C9, D1-4, D7-12
Variable name in public use data file: K4Q01; K4Q02_R; K4Q04_R; K5Q10; K5Q11; K5Q40; K5Q41; K5Q42; K5Q43; K5Q44; K5Q20_R; K5Q21; K5Q22; K5Q30; K5Q31_R; K5Q32

Denominator: Children with special health care needs age 0-17 years

Numerator: Children with special health care needs, ages 0 through 17, who meet the criteria for having a medical home (personal doctor or nurse, usual source for care, and family-centered care; referrals or care coordination if needed)

Revisions and Changes: In 2017, this measure did not change from the 2016 NSCH. The skip language in K5Q20_R’s response option “Did not see more than one health care provider” which skips children away from Care Coordination questions was removed in 2017.
Due to changes in the survey’s mode of data collection and sampling frame, as well as adjustments to item wording for the NSCH, results from surveys prior to 2016 are not directly comparable and should not be used to conduct trend analysis. In the 2016 NSCH, there are a few changes to the Medical Home composite measure compared to the 2011/12 NSCH: (1) Usual source for care subcomponent: Even though the 2016 and 2017 NSCH now ask about a usual source for preventive care, this subcomponent still only includes the usual source for sick care item. Additionally, in the 2016 and 2017 NSCH, the response options for the follow up item about the type of places child usually goes for sick care do not include "Friend/Relative", "Mexico/Other locations out of US", and "Does not go to one place most often". (2) Care coordination subcomponent: In the 2011/12 NSCH, the care coordination component was measured among all children who received more than one type of service: medical, dental, mental health care or received/needed a specialist care (NUMB_SERVICES>1). In the 2016 NSCH, the number of children who needed care coordination was defined based on the parent’s response to the question: "Does anyone help you to arrange or coordinate care among different doctors or services that this child uses?" If the parent responded, "Did not see more than one health care provider in past 12 months" to the question (K5Q20_R), it was assumed the child did not need care coordination. (3) In the 2011/12 NSCH, when any component of medical home was missing, the entire composite medical home measure was considered missing. In the NSCH 2016 and 2017, the composite medical home measure is only considered missing if all components are missing. Therefore, children with a valid, positive response to at least one component and the remainder of the components were missing or legitimately skipped are categorized as having a medical home. For more information on content changes, click here .

Additional Notes: The American Academy of Pediatrics specifies seven qualities essential to medical home care: accessible, family-centered, continuous, comprehensive, coordinated, compassionate and culturally effective care. Ideally, medical home care is delivered within the context of a trusting and collaborative relationship between the child’s family and a competent health professional who is familiar with the child and family and the child’s health history. In the 2016-2017 NSCH, the presence of a medical home was measured by a composite measure based on five components constructed from a total of 16 survey items. These components are:
- Personal doctor or nurse
- Usual source for sick care
- Family-centered care
- Problems getting needed referrals
- Effective Care Coordination when needed.
To qualify as having a Medical Home, children must meet the criteria for adequate care on the first three components: personal doctor or nurse, usual source for care, and family-centered care. Additionally, any children who needed referrals or care coordination must also meet criteria for those components in order to qualify as having a medical home. Children with a valid, positive response to at least one component and the remainder of the components were missing or legitimately skipped are categorized as having a medical home. Further information about the Medical Home concept and measurement is available on the Data Resource Center Medical Home portal. The medical home manual developed by the CAHMI is available on the DRC website.

Treatment of Unknown Values: Missing values due to non-response or a “don’t know” response are not included in the denominator when calculating prevalence estimates and weighted population counts displayed in the data query results table. In the majority of cases, the proportion of missing values is less than 2%. Exceptions are noted in the form of a Data Alert at the bottom of a results table. The exclusion of these values does not change the prevalence estimates (%) and only marginally affects the weighted population counts (Pop. Est.). If missing cases are handled in any other way, details can be found in the "Additional notes" section above.

History and Development:
Overview of the Title V Block Grant
The Title V Maternal and Child Health (MCH) Services Block Grant Program operates as a federal-state partnership in 59 states and jurisdictions to improve the health and well-being of MCH populations through the development of public health systems of care which are family-centered, community-based and culturally appropriate. To improve accountability and to more clearly demonstrate the impact of the Title V Block Grant Program, an updated national performance measure framework was introduced in 2015. This three-tiered framework includes National Outcome Measures (NOMs), National Performance Measures (NPM) and state-initiated Evidence-Based or –Informed Strategy Measures (ESMs). Updates to the Application/Annual Report Guidance released by HRSA in December 2017 retained the performance measure framework, but allowed greater flexibility for states in selecting national and state performance measures that align with their individual MCH priority needs. More information about the block grant can be obtained at the MCHB website.

About NSCH
The Health Resources and Services Administration’s (HRSA) Maternal and Child Health Bureau (MCHB) funds and directs the National Survey of Children’s Health (NSCH), and develops survey content in collaboration with the U.S. Census Bureau and a Technical Expert Panel. The Technical Expert Panel consists of experts in survey methodology and children’s health, federal and state stakeholders, clinicians and researchers. The U.S. Census Bureau conducts the survey, oversees the sampling, and produces a final data set of survey results. Respondents’ cognitive understanding of the survey questions was assessed during the pretest phase of the survey redesign and reassessed after the 2016 survey; subsequent revisions were made. Previously validated questions and scales are used when available. The manuscript “The Design and Implementation of the 2016 National Survey of Children’s Health”, provides detailed information about the redesign of the NSCH, administration of the first redesigned survey (2016), and the sampling and administration changes for the 2017 NSCH. Prior to 2016, the NSCH and the National Survey of Children with Special Health Care Needs were each conducted three times as interviewer-assisted telephone surveys using random digit dial sampling. In 2016, the two surveys were combined into a single annual self-administered questionnaire. Due to decline in the number of households with landline telephones, the NSCH now utilizes an address-based sampling method to select participating households, thus all invitations are sent by mail. Participants may choose to complete the survey either online using a secure website or a mailed paper version of the survey. All final data components are verified by the Census Bureau, HRSA/MCHB and CAHMI/DRC staff prior to public release. More information about the survey can be found in the “About the National Survey of Children’s Health” section of this website and HRSA’s MCHB website.