Identifying Children with Special Health Needs

Identifying children with special health care needs (CSHN) is an important part and essential first step in a chronic condition management program in the primary care office. A systematic process for identifying CSHN will:

• identify a child with a chronic condition for all office staff (receptionist, nurses, MDs)
• enable staff to schedule appointments specific to a child's needs (time of day, length of appointment, need to avoid long waits in the office and other special issues)
• improve communication between the family and office staff.
• provide reminders to physicians and office staff on individual health issues/care needs to improve care management

In addition, information about the number of CSHN and their service needs may help to improve reimbursement (e.g., for care coordination and related services).

A number of tools are available to identify CSHN in the primary care office and to document the complexity of their conditions and related services. Tools that can be used to identify all children in the office that have a special health need or chronic condition include the FACCT Screener, the Questionnaire for Identifying Children With Chronic Conditions - Revised (QuICCC-R), Bob's CSHN Screener and the definition used by New England's Project SERVE. These screeners include general questions about functional limitations, ongoing need for certain types of services (health, behavioral, educational) and whether a child requires more than usual health care services for that age.

Some children with chronic conditions, however, may be functioning very well and require few or no special services. For this reason, tools that rate the complexity of a child's chronic condition and related service needs have been developed. These include the definition used by the Pediatric Alliance for Coordinated Care (PACC), the Complexity Index developed by Dr. David Hirsh, the HOMES (Exeter Pediatric, VT), Bob's Levels of Support Scale (BLSS), the Child Health Questionnaire (CHQ), and the Clinical Risk Group Classification System of the National Association of Children's Hospitals and Related Institutions (NACHRI).

In Oregon, an interagency working group convened by CDRC, OHSU (the agency responsible for the services for CSHN in Oregon) recommended the QuICCC-R² as the screener and the BLSS¹ as the complexity tool. Their report is available in the About Us section of this web site. Unfortunately, no data has been published on the use of any of these tools in a primary care office setting. Some providers have developed their own system to prioritize care for certain children and families in their office. One goal of the working group, however, was to recommend one tool so that data would be comparable across practices.

References

1. Nickel, R (2001). Bob's Levels of Support Scale, Child Development and Rehabilitation Center, Oregon Health & Sciences University, Portland, OR.
   
2. Stein, REK, Bauman, LT & Silver, ET Manual for Questionnaire for Identifying Children with Chronic Conditions, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY.