Research Objective: Too little research has established the psychometric (measurement) properties of the Children with Special Health Care Needs (CSHCN) Screener. This leaves unclear whether Screener-based estimates reliably identify CSHCN. To address this, we sought to establish the CSHCN Screener's psychometric properties.
Study Design: The CSHCN Screener asks parents a series of questions to determine whether children experience one of five health related consequences and whether the consequence(s) result from a medical, behavioral, or other health condition lasting at least 12 months. Any child who meets criteria for at least one of the five consequence receives classification as a CSHCN. We used classical and modern test theory, including confirmatory factor analysis for ordered-categorical measures (CFA-OCM) and item response theory (IRT), to establish the CSHCN Screener's psychometric properties in a large, nationally representative survey of US children.
Population Studied: Data came from the 2005-2006 National Survey of Children with Special Health Care Needs (NS-CSHCN). The National Survey of CSHCN provides state- and national-level data on the prevalence of special health care needs and their impact on children and their families. Children (n = 359,154) ranged in age from 0 to 18 years. Design weights make the data representative of children nationally and within states.
Principal Findings: Cronbach's alpha equaled 0.76. Confirmatory factor analysis for ordered-categorical measures (CFA-OCM) indicated that a single underlying health-condition-complexity trait underlies Screener responses. Item response theory (IRT) showed that responses provide particularly precise measurement among children experiencing elevated health-condition-complexity levels.
Conclusions: Findings demonstrate that responses to the CSHCN Screener as used in the NS-CSHCN have good internal psychometric properties and include minimal random measurement error. CFA-OCM results support the suggestion that a health-condition-complexity continuum describes CSHCN's health conditions. IRT analyses show that Screener responses provide excellent discrimination among children experiencing above average health-condition-complexity levels in concordance with the CSHCN definition.
Implications for Policy, Delivery or Practice: Health service providers, epidemiologists, clinicians and others can rely on CSHCN Screener responses to reliably identify CSHCN experiencing the consequences included on the CSHCN Screener. Additionally, results show that children who need specialized physical, occupational, or speech therapies likely experience the greatest levels of health-condition-complexity. Programs designed to improve systems of care for CSHCN with the greatest health-condition-complexity levels may find that this question proves particularly useful for identifying CSHCN with the highest health-condition-complexity levels.