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class="vector-toc-link" href="#Population"> <div class="vector-toc-text"> <span class="vector-toc-numb">2</span> <span>Population</span> </div> </a> <button aria-controls="toc-Population-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle Population subsection</span> </button> <ul id="toc-Population-sublist" class="vector-toc-list"> <li id="toc-Epidemiology" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Epidemiology"> <div class="vector-toc-text"> <span class="vector-toc-numb">2.1</span> <span>Epidemiology</span> </div> </a> <ul id="toc-Epidemiology-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Challenges" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Challenges"> <div class="vector-toc-text"> <span class="vector-toc-numb">2.2</span> <span>Challenges</span> </div> </a> <ul id="toc-Challenges-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Challenges_for_CSHCN_with_emotional_and_behavioral_disorders" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Challenges_for_CSHCN_with_emotional_and_behavioral_disorders"> <div class="vector-toc-text"> <span class="vector-toc-numb">2.3</span> <span>Challenges for CSHCN with emotional and behavioral disorders</span> </div> </a> <ul id="toc-Challenges_for_CSHCN_with_emotional_and_behavioral_disorders-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Effective_Support_for_Families" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Effective_Support_for_Families"> <div class="vector-toc-text"> <span class="vector-toc-numb">2.4</span> <span>Effective Support for Families</span> </div> </a> <ul id="toc-Effective_Support_for_Families-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-United_states_government_involvement" 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class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Children's_health_insurance_program"> <div class="vector-toc-text"> <span class="vector-toc-numb">3.2</span> <span>Children's health insurance program</span> </div> </a> <ul id="toc-Children's_health_insurance_program-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Title_V" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Title_V"> <div class="vector-toc-text"> <span class="vector-toc-numb">3.3</span> <span>Title V</span> </div> </a> <ul id="toc-Title_V-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Childhood_Care" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Childhood_Care"> <div class="vector-toc-text"> <span class="vector-toc-numb">4</span> <span>Childhood Care</span> </div> </a> <button aria-controls="toc-Childhood_Care-sublist" class="cdx-button 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.mbox-empty-cell{border:none;padding:0;width:1px}.mw-parser-output .ambox .mbox-image-div{width:52px}@media(min-width:720px){.mw-parser-output .ambox{margin:0 10%}}@media print{body.ns-0 .mw-parser-output .ambox{display:none!important}}</style><table class="box-Lead_rewrite plainlinks metadata ambox ambox-style ambox-lead_rewrite" role="presentation"><tbody><tr><td class="mbox-image"><div class="mbox-image-div"><span typeof="mw:File"><span><img alt="" src="//upload.wikimedia.org/wikipedia/en/thumb/f/f2/Edit-clear.svg/40px-Edit-clear.svg.png" decoding="async" width="40" height="40" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/en/thumb/f/f2/Edit-clear.svg/60px-Edit-clear.svg.png 1.5x, //upload.wikimedia.org/wikipedia/en/thumb/f/f2/Edit-clear.svg/80px-Edit-clear.svg.png 2x" data-file-width="48" data-file-height="48" /></span></span></div></td><td class="mbox-text"><div class="mbox-text-span">The article's <a href="/wiki/Wikipedia:Manual_of_Style/Lead_section" title="Wikipedia:Manual of Style/Lead section">lead section</a> <b>may need to be rewritten</b>.<span class="hide-when-compact"> Please help <a class="external text" href="https://en.wikipedia.org/w/index.php?title=Children_with_Special_Healthcare_Needs_in_the_United_States&action=edit">improve the lead</a> and read the <a href="/wiki/Wikipedia:Manual_of_Style/Lead_section" title="Wikipedia:Manual of Style/Lead section">lead layout guide</a>.</span> <span class="date-container"><i>(<span class="date">October 2024</span>)</i></span><span class="hide-when-compact"><i> (<small><a href="/wiki/Help:Maintenance_template_removal" title="Help:Maintenance template removal">Learn how and when to remove this message</a></small>)</i></span></div></td></tr></tbody></table> <p> <b>Children with Special Healthcare Needs</b> (CSHCN) are defined by the <a href="/wiki/Maternal_and_Child_Health_Bureau" title="Maternal and Child Health Bureau">Maternal and Child Health Bureau</a> as: </p> <dl><dd>"Those who have one or more chronic physical, developmental, behavioral, or emotional conditions and who also require health and related services of a type or amount beyond that required by children generally"<sup id="cite_ref-McPherson_1-0" class="reference"><a href="#cite_note-McPherson-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup></dd></dl> <meta property="mw:PageProp/toc" /> <div class="mw-heading mw-heading2"><h2 id="Types_of_special_healthcare_needs">Types of special healthcare needs</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Children_with_Special_Healthcare_Needs_in_the_United_States&action=edit&section=1" title="Edit section: Types of special healthcare needs"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>There are a wide variety of physical, mental, and psychological health conditions considered to be special healthcare needs in the United States. They range from relatively mild to chronic and severe. The functional impairments of CSHCN include problems with one or more of the following criteria: breathing, swallowing/digestion/metabolism, blood circulation, chronic pain, hearing even with corrective devices, seeing even with corrective devices, taking care of self, coordination/moving around, learning/understanding/paying attention, speaking/communicating, making/keeping friends, and behavior.<sup id="cite_ref-Data_2-0" class="reference"><a href="#cite_note-Data-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> The list below states health conditions considered to be special healthcare needs. </p> <ul><li><a href="/wiki/Attention_deficit_disorder" class="mw-redirect" title="Attention deficit disorder">Attention deficit disorder</a> (ADD)</li> <li>Attention deficit hyperactivity disorder (ADHD)</li> <li><a href="/wiki/Depression_(mood)" title="Depression (mood)">Depression</a></li> <li>Anxiety problems</li> <li>Behavioral problems</li> <li><a href="/wiki/Autism_spectrum_disorders" class="mw-redirect" title="Autism spectrum disorders">Autism spectrum disorders</a> (ASD)</li> <li><a href="/wiki/Diabetes" title="Diabetes">Diabetes</a></li> <li><a href="/wiki/Developmental_disability" title="Developmental disability">Developmental disability</a></li> <li><a href="/wiki/Intellectual_disability" title="Intellectual disability">Intellectual disability</a> (ID)</li> <li><a href="/wiki/Epilepsy" title="Epilepsy">Epilepsy</a></li> <li><a href="/wiki/Migraines" class="mw-redirect" title="Migraines">Migraines</a></li> <li><a href="/wiki/Traumatic_brain_injury" title="Traumatic brain injury">Traumatic brain injury</a> (TBI)</li> <li>Heart problems</li> <li>Blood problems</li> <li><a href="/wiki/Cystic_fibrosis" title="Cystic fibrosis">Cystic fibrosis</a></li> <li><a href="/wiki/Cerebral_palsy" title="Cerebral palsy">Cerebral palsy</a></li> <li><a href="/wiki/Muscular_dystrophy" title="Muscular dystrophy">Muscular dystrophy</a></li> <li><a href="/wiki/Down_syndrome" title="Down syndrome">Down syndrome</a></li> <li><a href="/wiki/Arthritis" title="Arthritis">Arthritis</a></li> <li>Joint problems</li> <li>Allergies</li></ul> <div class="mw-heading mw-heading2"><h2 id="Population">Population</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Children_with_Special_Healthcare_Needs_in_the_United_States&action=edit&section=2" title="Edit section: Population"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>As of 2009, 15.1% of all children in the US are considered to have special healthcare needs,<sup id="cite_ref-Data_2-1" class="reference"><a href="#cite_note-Data-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Context_3-0" class="reference"><a href="#cite_note-Context-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Epidemiology">Epidemiology</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Children_with_Special_Healthcare_Needs_in_the_United_States&action=edit&section=3" title="Edit section: Epidemiology"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The prevalence of children with special healthcare needs in the population depends on several factors, including gender, age, socioeconomic level and family household education.<sup id="cite_ref-Epidemiologic_4-0" class="reference"><a href="#cite_note-Epidemiologic-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> In the National Survey of Children's Health Data in 2007, gender is the strongest predictor of special health care needs—about 60% of children with special health care needs are boys and 30% are girls.<sup id="cite_ref-Data_2-2" class="reference"><a href="#cite_note-Data-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> A study by Newacheck et al. found that age is also a strong predictor, as school-age children are found to be twice as likely as toddlers to require special needs care, and this prevalence continues to increase as children grow older.<sup id="cite_ref-Epidemiologic_4-1" class="reference"><a href="#cite_note-Epidemiologic-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> Families with income below the <a href="/wiki/Poverty_in_the_United_States" title="Poverty in the United States">federal poverty level</a> are 1/3 more likely to have children with special health care needs, and families with 12 or fewer years of education have increased prevalence of a child with SHCN as well.<sup id="cite_ref-Epidemiologic_4-2" class="reference"><a href="#cite_note-Epidemiologic-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> Family structure also correlates with this prevalence—for <a href="/wiki/Single_parent" title="Single parent">single-mother</a> families are 40% more likely to have a CSHCN than two-parent households.<sup id="cite_ref-Epidemiologic_4-3" class="reference"><a href="#cite_note-Epidemiologic-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Challenges">Challenges</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Children_with_Special_Healthcare_Needs_in_the_United_States&action=edit&section=4" title="Edit section: Challenges"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>In a comprehensive study by the U.S. <a href="/wiki/Health_Resources_and_Services_Administration" title="Health Resources and Services Administration">Health Resources and Services Administration</a> (HRSA), using the 2007 National Survey of Children's Health data, it was found that children with SHCN when compared to those children without SHCN, face more inadequacies in healthcare, education, health of family, and maintaining a healthy lifestyle.<sup id="cite_ref-Context_3-1" class="reference"><a href="#cite_note-Context-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> CSHCN face more difficulties with accessing mental health care <sup id="cite_ref-Context_3-2" class="reference"><a href="#cite_note-Context-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> as well as having a <a href="/wiki/Medical_home" title="Medical home">medical home</a>. A medical home is one of the standards of administering healthcare recommended by the Maternal and Child Health Bureau.<sup id="cite_ref-AAP_5-0" class="reference"><a href="#cite_note-AAP-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> In school, these children have an increased risk of missing class, being disengaged in the classroom, and repeating a grade.<sup id="cite_ref-Context_3-3" class="reference"><a href="#cite_note-Context-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> They also have more cases of inadequate sleep every night in comparison to their peers.<sup id="cite_ref-Context_3-4" class="reference"><a href="#cite_note-Context-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> CSHCN are more likely to not exercise the recommended four times a week, and they have higher chance of being overweight/obese.<sup id="cite_ref-Context_3-5" class="reference"><a href="#cite_note-Context-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> They also face increased challenges in making friends.<sup id="cite_ref-Context_3-6" class="reference"><a href="#cite_note-Context-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> The parents of CSHCN have challenges as well. The study by HRSA, found that the parents of special needs children experience more stress, decreased health, and more questioning of their parenting skills.<sup id="cite_ref-Context_3-7" class="reference"><a href="#cite_note-Context-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> They also experience challenges with health information management and communication among their child's caregivers, where research on the design of digital health tools in this context recommends developing tools that reduce physical documentation needs, support timely access to information, can be customized for specific communication needs, and have shallow learning curves.<sup id="cite_ref-6" class="reference"><a href="#cite_note-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup> </p><p>Despite these challenges, children with SHCN fare better than non-affected children in preventative health care and preventative dental care.<sup id="cite_ref-Context_3-8" class="reference"><a href="#cite_note-Context-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> They have a higher rate of having health insurance than normal children.<sup id="cite_ref-Data_2-3" class="reference"><a href="#cite_note-Data-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> They more frequently complete the recommended annual primary care visit, and bi-annual dentist visit.<sup id="cite_ref-Data_2-4" class="reference"><a href="#cite_note-Data-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> They also have a tendency to use more Developmental Screening, especially those with public healthcare.<sup id="cite_ref-Context_3-9" class="reference"><a href="#cite_note-Context-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> Developmental screening is used by doctors to check and evaluate for proper child development over time on a physical and cognitive level. The American Academy of Pediatrics recommends visits for developmental screening at ages 9,18 and at 24–30 months.<sup id="cite_ref-Developmental_7-0" class="reference"><a href="#cite_note-Developmental-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Challenges_for_CSHCN_with_emotional_and_behavioral_disorders">Challenges for CSHCN with emotional and behavioral disorders</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Children_with_Special_Healthcare_Needs_in_the_United_States&action=edit&section=5" title="Edit section: Challenges for CSHCN with emotional and behavioral disorders"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p><a href="/wiki/Emotional_and_behavioral_disorders" title="Emotional and behavioral disorders">Emotional and behavioral disorders</a> (EBD) are disorders that include ADD/ADHD, anxiety, ASD, depression, OCD/conduct disorder, developmental delay and Tourette's Syndrome, and they increase the challenges CSHCN face.<sup id="cite_ref-Context_3-10" class="reference"><a href="#cite_note-Context-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> 40% of CSHCN have an EBD and 80% of these children also experience another health problem along with their EBD, according to the 2007 National Survey of Children's Health.<sup id="cite_ref-Data_2-5" class="reference"><a href="#cite_note-Data-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> The Health Resources and Services Administration found that these disorders are associated with an even greater decrease in quality of family-life, education and healthcare.<sup id="cite_ref-Context_3-11" class="reference"><a href="#cite_note-Context-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> Parent's health worsens and stress increases when they have children with an EBD.<sup id="cite_ref-Context_3-12" class="reference"><a href="#cite_note-Context-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> These EBD children miss more classes and are more disengaged in class than non-EBD CSHCN.<sup id="cite_ref-Context_3-13" class="reference"><a href="#cite_note-Context-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> EBD-CSHCN experience reduced family center-care and effective care-coordination.<sup id="cite_ref-Context_3-14" class="reference"><a href="#cite_note-Context-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> They also face greater difficulty in their ability to make friends than non-EBD CSHCN.<sup id="cite_ref-Context_3-15" class="reference"><a href="#cite_note-Context-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Effective_Support_for_Families">Effective Support for Families</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Children_with_Special_Healthcare_Needs_in_the_United_States&action=edit&section=6" title="Edit section: Effective Support for Families"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>A systematic review of randomized controlled trials found evidence that </p> <ul><li>Including parents in psychological therapies to help children manage painful conditions was effective;</li> <li><a href="/wiki/Cognitive_behavioral_therapy" title="Cognitive behavioral therapy">Cognitive behavioral therapy</a> that includes parents reduces primary symptoms;</li> <li>Problem solving therapy for parents improves their skills and mental health.<sup id="cite_ref-8" class="reference"><a href="#cite_note-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup></li></ul> <div class="mw-heading mw-heading2"><h2 id="United_states_government_involvement">United states government involvement</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Children_with_Special_Healthcare_Needs_in_the_United_States&action=edit&section=7" title="Edit section: United states government involvement"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The United States governments employs several different programs in order to provide insurance and care for CSHCN. These include Title V grants, Medicaid and Children's Health Insurance Program (CHIP). These three programs vary in their definition and eligibility of care for CSHCN.<sup id="cite_ref-McPherson_1-1" class="reference"><a href="#cite_note-McPherson-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Medicaid">Medicaid</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Children_with_Special_Healthcare_Needs_in_the_United_States&action=edit&section=8" title="Edit section: Medicaid"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p><a href="/wiki/Medicaid" title="Medicaid">Medicaid</a> is the program implemented under Title XIX of the Social Security Act.<sup id="cite_ref-Title_XIX_9-0" class="reference"><a href="#cite_note-Title_XIX-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> It is a public insurance program that provides mandatory services for patients such as: </p> <ul><li>Inpatient/outpatient hospital resources</li> <li>Transportation for non-emergency medical care</li> <li>Home health services</li> <li>Laboratory procedures</li> <li>Physician services</li> <li><a href="/wiki/Family_planning" title="Family planning">Family planning</a></li> <li>Nursing facilities</li> <li>Early Periodic Screening, Diagnosis, and Treatment (EPDST) program</li> <li>Tobacco cessation programs for pregnant women</li></ul> <p>Medicaid requires no co-payment or deductibles. To be eligible for the program one must be in one of four categories. The first is income level, the second is disability criteria, the third is eligibility for institutional level of care, and the fourth is out of home placement. Many CSHCN qualify for Medicaid based on low income level, but some children qualify independently of income level due to their disabilities. Medicaid has a more restrictive definition of disabilities and special healthcare needs than the Maternal and Children's Health Bureau (MCHB), and defines special needs as needs that must impede daily functioning. Medicaid accepts children who need to receive Supplemental Security Income program money, and children who are defined as medically needy.<sup id="cite_ref-Title_XIX_9-1" class="reference"><a href="#cite_note-Title_XIX-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Basic_10-0" class="reference"><a href="#cite_note-Basic-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup> Medically needy children are those whose families have above the maximum income to receive Medicaid, but due to health expenditures their income is lowered to the level required. 40 states currently offer this program.<sup id="cite_ref-Medically_Needy_11-0" class="reference"><a href="#cite_note-Medically_Needy-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup> Medicaid programs in each state are administered differently, and federal dollars go to each state based on per capita income levels. As of 2010, the Medicaid program had 405 billion dollars for the entire program. With the new <a href="/wiki/Patient_Protection_and_Affordable_Care_Act" class="mw-redirect" title="Patient Protection and Affordable Care Act">Patient Protection and Affordable Care Act</a>, by 2014 state Medicaid levels will rise to 138% of the Federal Poverty Line, increasing the number of CSHCN receiving Medicaid.<sup id="cite_ref-Title_XIX_9-2" class="reference"><a href="#cite_note-Title_XIX-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Basic_10-1" class="reference"><a href="#cite_note-Basic-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Children's_health_insurance_program"><span id="Children.27s_health_insurance_program"></span>Children's health insurance program</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Children_with_Special_Healthcare_Needs_in_the_United_States&action=edit&section=9" title="Edit section: Children's health insurance program"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>This program, the <a href="/wiki/Children%27s_Health_Insurance_Program" title="Children's Health Insurance Program">Children's Health Insurance Program</a> (CHIP), was created with Title XXI of the Social Security Act,<sup id="cite_ref-Title_XXI_12-0" class="reference"><a href="#cite_note-Title_XXI-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup> and is meant to cover the gap between children who qualify for Medicaid and those who can afford private insurance.<sup id="cite_ref-Basic_10-2" class="reference"><a href="#cite_note-Basic-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup> It covers children up to nineteen years of age and many states also choose to help insure pregnant women. 46 of the states and the District of Columbia insure up to 200% of the Federal Poverty Line. CHIP receives its funding from the federal government but it is capped, unlike Medicaid. CSHCN who use CHIP receive all of the same federally mandated programs that Medicaid must offer. The program also requires that mental health services be offered as equally as physical health services.<sup id="cite_ref-Basic_10-3" class="reference"><a href="#cite_note-Basic-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Title_XXI_12-1" class="reference"><a href="#cite_note-Title_XXI-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Title_V">Title V</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Children_with_Special_Healthcare_Needs_in_the_United_States&action=edit&section=10" title="Edit section: Title V"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>This <a href="/wiki/Social_Security_(United_States)" title="Social Security (United States)">Social Security</a> Act, Title V, states that $850,000,000 in grant money is to be allotted starting in 2001 and every year after to the states in order to accomplish health goals of the Public Health Service Act as well as the goals of Title V. The Title V grant money is set out to specifically affect CSHCN in several ways. First, it requires states to provide rehabilitation services for blind or disabled individuals under the age of 16. It also allocates money to projects of both national and state importance that help maternal and child health as well as children with special healthcare needs. The act requires that there are community-based programs such as daycare that help provide for CSHCN. Another requirement is the creation of family-to-family health information centers that assist families with CSHCN to make informed decisions regarding healthcare and resources.<sup id="cite_ref-Title_V_13-0" class="reference"><a href="#cite_note-Title_V-13"><span class="cite-bracket">[</span>13<span class="cite-bracket">]</span></a></sup> </p><p>This program works with the <a href="/wiki/Maternal_and_Child_Health_Bureau" title="Maternal and Child Health Bureau">Maternal and Child Health Bureau</a>, and employs their definition of CSHCN as stated earlier. Title V does not provide as much money as CHIP or Medicaid, but is used to fill the gaps where these programs do not cover. The Title V money is used to help with the Early Periodic Screening Diagnosis and Treatment Program (EPSDT) that is employed by Medicaid to test children. Title V shares the data collection responsibility of these three programs as well as develops educational materials. The Title V programs also have the goal to promote community-based services for all children as well as to promote coordinated care for families.<sup id="cite_ref-Basic_10-4" class="reference"><a href="#cite_note-Basic-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Title_V_13-1" class="reference"><a href="#cite_note-Title_V-13"><span class="cite-bracket">[</span>13<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Childhood_Care">Childhood Care</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Children_with_Special_Healthcare_Needs_in_the_United_States&action=edit&section=11" title="Edit section: Childhood Care"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Children with special healthcare needs require more healthcare for their various health conditions as well as more types of therapies and treatments.<sup id="cite_ref-Data_2-6" class="reference"><a href="#cite_note-Data-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> Therapies include <a href="/wiki/Occupational_therapy" title="Occupational therapy">occupational therapy</a>, <a href="/wiki/Physical_therapy" title="Physical therapy">physical therapy</a>, and <a href="/wiki/Speech-language_pathology" class="mw-redirect" title="Speech-language pathology">speech-language pathology</a> among others. </p> <div class="mw-heading mw-heading3"><h3 id="Medical_home">Medical home</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Children_with_Special_Healthcare_Needs_in_the_United_States&action=edit&section=12" title="Edit section: Medical home"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The <a href="/wiki/American_Academy_of_Pediatrics" title="American Academy of Pediatrics">American Academy of Pediatrics</a> (AAP) medical home model is the suggested form of healthcare administration for children with special health care needs due to their increased healthcare needs.<sup id="cite_ref-AAP_5-1" class="reference"><a href="#cite_note-AAP-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> In a study by Judith Palfrey et al. it was found to indicate improved health and increase patient satisfaction.<sup id="cite_ref-Evaluation_14-0" class="reference"><a href="#cite_note-Evaluation-14"><span class="cite-bracket">[</span>14<span class="cite-bracket">]</span></a></sup> This model as defined by the AAP is a total coordination of care for infants, children and adolescents. It consists of a primary physician, preferably a pediatrician, that a child and their family know well and who is a medical advocate for the care of the child. All medical care in the medical home is accessible, continuous, comprehensive, family-centered, compassionate and coordinated.<sup id="cite_ref-AAP_5-2" class="reference"><a href="#cite_note-AAP-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> This model requires several elements: </p> <ul><li>Provision of preventative care</li> <li>Assurance of ambulatory/inpatient care at any time</li> <li>Provision of care over a long period of time</li> <li>Ability to identify need for sub-specialists and to make these referrals</li> <li>Interaction with the school and community programs of a child to work with a child's special needs</li> <li>Central record keeping data base</li></ul> <p>The pediatrician assumes the ultimate responsibility for all care that is provided for the child even though other medical professionals are involved.<sup id="cite_ref-AAP_5-3" class="reference"><a href="#cite_note-AAP-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> Currently, 48.9% of CSHCN have access to a medical home while 59.6% of non-affected children have access to a medical home.<sup id="cite_ref-Data_2-7" class="reference"><a href="#cite_note-Data-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Therapy_for_CSHCN">Therapy for CSHCN</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Children_with_Special_Healthcare_Needs_in_the_United_States&action=edit&section=13" title="Edit section: Therapy for CSHCN"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Therapies for children with special healthcare needs can be accessed via public schools or private therapists. The <a href="/wiki/Individuals_with_Disabilities_Education_Act" title="Individuals with Disabilities Education Act">Individuals with Disabilities Education Act</a> (IDEA) includes occupational and physical therapy as well as other therapies, as part of the <a href="/wiki/Special_education" title="Special education">special education</a> that should be offered in all public schools to CSHCN. This act states that all children with disabilities should have access to education that suits their SHCN, including needed therapies.<sup id="cite_ref-OTPT_15-0" class="reference"><a href="#cite_note-OTPT-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-IDEA_16-0" class="reference"><a href="#cite_note-IDEA-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup> Out of school therapies can also be used be employed by children with SHCN but only 3.2% of CSHCN qualify for uses of special therapy under their insurance programs.<sup id="cite_ref-Data_2-8" class="reference"><a href="#cite_note-Data-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> </p><p>One type of therapy for children with SHCN is occupational therapy. Occupational therapists work with CSHCN by supporting them and their families to learn how to participate in everyday routines and daily activities. They encourage children with physical, cognitive, communication and behavior challenges to develop ways to live, play, learn and make friends despite their special needs.<sup id="cite_ref-AOTA_17-0" class="reference"><a href="#cite_note-AOTA-17"><span class="cite-bracket">[</span>17<span class="cite-bracket">]</span></a></sup> Occupational therapists can work with these children and their schools to create more accommodating learning environments. Another skill these professionals teach to children with SHCN is how to use adaptive equipment such as wheelchairs, eating aids and braces in daily life. Some occupational therapists try to work with very young children at risk for SHCN in order to try and prevent future disability through occupational therapy.<sup id="cite_ref-Labor_18-0" class="reference"><a href="#cite_note-Labor-18"><span class="cite-bracket">[</span>18<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Insurance_for_CSHCN">Insurance for CSHCN</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Children_with_Special_Healthcare_Needs_in_the_United_States&action=edit&section=14" title="Edit section: Insurance for CSHCN"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The types of insurance vary for children with special healthcare needs, 9.3% of CSHCN have no insurance at all, 52.4% have private insurance, 35.9% have public insurance and 8.2% have some combination of both public and private.<sup id="cite_ref-Data_2-9" class="reference"><a href="#cite_note-Data-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> Insurance gaps and other health costs affect 21.6% of families with CSHCN, who state that they face financial problems due to their CSHCN. In total, 34.3% of these families believe that their current insurance is not adequate in providing for all of their additional healthcare costs.<sup id="cite_ref-Data_2-10" class="reference"><a href="#cite_note-Data-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Adult_care">Adult care</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Children_with_Special_Healthcare_Needs_in_the_United_States&action=edit&section=15" title="Edit section: Adult care"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The Maternal and Child Health Bureau requires services to be available that are necessary for CSHCN to transition to all aspects of adult life.<sup id="cite_ref-Evidence_19-0" class="reference"><a href="#cite_note-Evidence-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup> 90% of Adolescents with SHCN (ASHCN) are expected to live into adulthood, and access to healthcare decreases as ASHCN grow older according to the Maternal and Child Health Bureau.<sup id="cite_ref-Association_20-0" class="reference"><a href="#cite_note-Association-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup> Youth lose health coverage they received in the past from programs like CHIP as well as Supplemental Security Income once they reach the ages of 18–21. Adult healthcare providers are not as familiar with childhood onset conditions as pediatricians.<sup id="cite_ref-Association_20-1" class="reference"><a href="#cite_note-Association-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup> A study by Jane Park et al. found that mental health conditions increase in prevalence as children get older and age into adulthood, and ASHCN who have mental health conditions (with or without physical conditions) fare worse on their transition to adult healthcare.<sup id="cite_ref-Q_21-0" class="reference"><a href="#cite_note-Q-21"><span class="cite-bracket">[</span>21<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Young_22-0" class="reference"><a href="#cite_note-Young-22"><span class="cite-bracket">[</span>22<span class="cite-bracket">]</span></a></sup> The MCHB recommends that children should have their transition to adult healthcare be mediated and provided for by their doctors. The Bureau requires that doctors need to have discussed with the adolescents with SHCN and their families three points: how to transition to adult primary care doctors as opposed to pediatricians, how health needs will change as the youth become adults, and how to maintain health insurance as an adult. The doctor is also supposed to encourage youth to take responsibility for their own health needs.<sup id="cite_ref-Association_20-2" class="reference"><a href="#cite_note-Association-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup> Currently 60% of doctors of adolescents with SHCN do not meet these criteria.<sup id="cite_ref-Data_2-11" class="reference"><a href="#cite_note-Data-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Healthcare_transition_plan">Healthcare transition plan</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Children_with_Special_Healthcare_Needs_in_the_United_States&action=edit&section=16" title="Edit section: Healthcare transition plan"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Another recommendation for healthcare providers by the Maternal and Child Health Bureau is the creation of a written Healthcare Transition (HCT) plan.<sup id="cite_ref-Association_20-3" class="reference"><a href="#cite_note-Association-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup> According to a study by Peter Scal and Marjorie Ireland, 30.08% of ASHCN had discussed such a plan. It was also found that adolescents who were older and who had more complicated needs were more likely to have an HCT.<sup id="cite_ref-Transition_23-0" class="reference"><a href="#cite_note-Transition-23"><span class="cite-bracket">[</span>23<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Patient_protection_and_affordable_care_act">Patient protection and affordable care act</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Children_with_Special_Healthcare_Needs_in_the_United_States&action=edit&section=17" title="Edit section: Patient protection and affordable care act"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The Patient Protection and Affordable Care Act passed by the Obama administration in 2010 sets forth new requirements for ability of adolescents with SHCN to transition healthcare services from pediatric services. The Act also expands their ability to pay for and access these services.<sup id="cite_ref-ACA_24-0" class="reference"><a href="#cite_note-ACA-24"><span class="cite-bracket">[</span>24<span class="cite-bracket">]</span></a></sup> It states three criteria that must be met for adolescents. First, adolescents need to have access to a comprehensive healthcare system that they can find a way to pay for, as well as be able to navigate the system. Second, preventable health problems need to be successfully prevented. Third, chronic conditions need to be managed and the transition to adult healthcare needs to be assured. Skills that ASHCN are recommended to possess to accomplish these goals include the ability to describe their own illness, know their own medication and dosages, know how to contact a clinician, and the ability to schedule appointments and call in for refills.<sup id="cite_ref-Q_21-1" class="reference"><a href="#cite_note-Q-21"><span class="cite-bracket">[</span>21<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Young_22-1" class="reference"><a href="#cite_note-Young-22"><span class="cite-bracket">[</span>22<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-ACA_24-1" class="reference"><a href="#cite_note-ACA-24"><span class="cite-bracket">[</span>24<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="References">References</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Children_with_Special_Healthcare_Needs_in_the_United_States&action=edit&section=18" title="Edit section: References"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <style data-mw-deduplicate="TemplateStyles:r1239543626">.mw-parser-output .reflist{margin-bottom:0.5em;list-style-type:decimal}@media screen{.mw-parser-output .reflist{font-size:90%}}.mw-parser-output .reflist .references{font-size:100%;margin-bottom:0;list-style-type:inherit}.mw-parser-output .reflist-columns-2{column-width:30em}.mw-parser-output .reflist-columns-3{column-width:25em}.mw-parser-output .reflist-columns{margin-top:0.3em}.mw-parser-output .reflist-columns ol{margin-top:0}.mw-parser-output .reflist-columns li{page-break-inside:avoid;break-inside:avoid-column}.mw-parser-output .reflist-upper-alpha{list-style-type:upper-alpha}.mw-parser-output .reflist-upper-roman{list-style-type:upper-roman}.mw-parser-output .reflist-lower-alpha{list-style-type:lower-alpha}.mw-parser-output .reflist-lower-greek{list-style-type:lower-greek}.mw-parser-output .reflist-lower-roman{list-style-type:lower-roman}</style><div class="reflist"> <div class="mw-references-wrap mw-references-columns"><ol class="references"> <li id="cite_note-McPherson-1"><span class="mw-cite-backlink">^ <a href="#cite_ref-McPherson_1-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-McPherson_1-1"><sup><i><b>b</b></i></sup></a></span> <span class="reference-text"><style data-mw-deduplicate="TemplateStyles:r1238218222">.mw-parser-output cite.citation{font-style:inherit;word-wrap:break-word}.mw-parser-output .citation q{quotes:"\"""\"""'""'"}.mw-parser-output .citation:target{background-color:rgba(0,127,255,0.133)}.mw-parser-output .id-lock-free.id-lock-free a{background:url("//upload.wikimedia.org/wikipedia/commons/6/65/Lock-green.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-limited.id-lock-limited a,.mw-parser-output .id-lock-registration.id-lock-registration a{background:url("//upload.wikimedia.org/wikipedia/commons/d/d6/Lock-gray-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-subscription.id-lock-subscription a{background:url("//upload.wikimedia.org/wikipedia/commons/a/aa/Lock-red-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .cs1-ws-icon a{background:url("//upload.wikimedia.org/wikipedia/commons/4/4c/Wikisource-logo.svg")right 0.1em center/12px no-repeat}body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-free a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-limited a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-registration a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-subscription a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .cs1-ws-icon a{background-size:contain;padding:0 1em 0 0}.mw-parser-output .cs1-code{color:inherit;background:inherit;border:none;padding:inherit}.mw-parser-output .cs1-hidden-error{display:none;color:var(--color-error,#d33)}.mw-parser-output .cs1-visible-error{color:var(--color-error,#d33)}.mw-parser-output .cs1-maint{display:none;color:#085;margin-left:0.3em}.mw-parser-output .cs1-kern-left{padding-left:0.2em}.mw-parser-output .cs1-kern-right{padding-right:0.2em}.mw-parser-output .citation .mw-selflink{font-weight:inherit}@media screen{.mw-parser-output .cs1-format{font-size:95%}html.skin-theme-clientpref-night .mw-parser-output .cs1-maint{color:#18911f}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .cs1-maint{color:#18911f}}</style><cite id="CITEREFMcPhersonArangoFoxLauver1998" class="citation journal cs1">McPherson M, Arango P, Fox H, Lauver C, McManus M, Newacheck PW, Perrin JM, Shonkoff JP, Strickland B (1998). "A New Definition of Children With Special Health Care Needs". <i>Pediatrics</i>. <b>102</b> (1): 137–39. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1542%2Fpeds.102.1.137">10.1542/peds.102.1.137</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/9714637">9714637</a>. <a href="/wiki/S2CID_(identifier)" class="mw-redirect" title="S2CID (identifier)">S2CID</a> <a rel="nofollow" class="external text" href="https://api.semanticscholar.org/CorpusID:30160426">30160426</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Pediatrics&rft.atitle=A+New+Definition+of+Children+With+Special+Health+Care+Needs&rft.volume=102&rft.issue=1&rft.pages=137-39&rft.date=1998&rft_id=https%3A%2F%2Fapi.semanticscholar.org%2FCorpusID%3A30160426%23id-name%3DS2CID&rft_id=info%3Apmid%2F9714637&rft_id=info%3Adoi%2F10.1542%2Fpeds.102.1.137&rft.aulast=McPherson&rft.aufirst=M&rft.au=Arango%2C+P&rft.au=Fox%2C+H&rft.au=Lauver%2C+C&rft.au=McManus%2C+M&rft.au=Newacheck%2C+PW&rft.au=Perrin%2C+JM&rft.au=Shonkoff%2C+JP&rft.au=Strickland%2C+B&rfr_id=info%3Asid%2Fen.wikipedia.org%3AChildren+with+Special+Healthcare+Needs+in+the+United+States" class="Z3988"></span></span> </li> <li id="cite_note-Data-2"><span class="mw-cite-backlink">^ <a href="#cite_ref-Data_2-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-Data_2-1"><sup><i><b>b</b></i></sup></a> <a href="#cite_ref-Data_2-2"><sup><i><b>c</b></i></sup></a> <a href="#cite_ref-Data_2-3"><sup><i><b>d</b></i></sup></a> <a href="#cite_ref-Data_2-4"><sup><i><b>e</b></i></sup></a> <a href="#cite_ref-Data_2-5"><sup><i><b>f</b></i></sup></a> <a href="#cite_ref-Data_2-6"><sup><i><b>g</b></i></sup></a> <a href="#cite_ref-Data_2-7"><sup><i><b>h</b></i></sup></a> <a href="#cite_ref-Data_2-8"><sup><i><b>i</b></i></sup></a> <a href="#cite_ref-Data_2-9"><sup><i><b>j</b></i></sup></a> <a href="#cite_ref-Data_2-10"><sup><i><b>k</b></i></sup></a> <a href="#cite_ref-Data_2-11"><sup><i><b>l</b></i></sup></a></span> <span class="reference-text">National Survey of Children with Special Health Care Needs. NS-CSHCN 2009/10. Data query from the Child and Adolescent Health Measurement Initiative, Data Resource Center for Child and Adolescent Health website. Retrieved [10/25/12] from www.childhealthdata.org.<sup class="noprint Inline-Template" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citing_sources#What_information_to_include" title="Wikipedia:Citing sources"><span title="A complete citation is needed. (July 2024)">full citation needed</span></a></i>]</sup></span> </li> <li id="cite_note-Context-3"><span class="mw-cite-backlink">^ <a href="#cite_ref-Context_3-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-Context_3-1"><sup><i><b>b</b></i></sup></a> <a href="#cite_ref-Context_3-2"><sup><i><b>c</b></i></sup></a> <a href="#cite_ref-Context_3-3"><sup><i><b>d</b></i></sup></a> <a href="#cite_ref-Context_3-4"><sup><i><b>e</b></i></sup></a> <a href="#cite_ref-Context_3-5"><sup><i><b>f</b></i></sup></a> <a href="#cite_ref-Context_3-6"><sup><i><b>g</b></i></sup></a> <a href="#cite_ref-Context_3-7"><sup><i><b>h</b></i></sup></a> <a href="#cite_ref-Context_3-8"><sup><i><b>i</b></i></sup></a> <a href="#cite_ref-Context_3-9"><sup><i><b>j</b></i></sup></a> <a href="#cite_ref-Context_3-10"><sup><i><b>k</b></i></sup></a> <a href="#cite_ref-Context_3-11"><sup><i><b>l</b></i></sup></a> <a href="#cite_ref-Context_3-12"><sup><i><b>m</b></i></sup></a> <a href="#cite_ref-Context_3-13"><sup><i><b>n</b></i></sup></a> <a href="#cite_ref-Context_3-14"><sup><i><b>o</b></i></sup></a> <a href="#cite_ref-Context_3-15"><sup><i><b>p</b></i></sup></a></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFHealth_Resources_and_Services_Administration,_Maternal_and_Child_Health_Bureau.2011" class="citation book cs1">Health Resources and Services Administration, Maternal and Child Health Bureau. (September 2011). <a rel="nofollow" class="external text" href="https://web.archive.org/web/20211219184234/https://mchb.hrsa.gov/sites/default/files/mchb/data-research/nsch-cshcn-context-09-2011.pdf"><i>Children with Special Health Care Needs in Context: A Portrait of States and the Nation 2007</i></a> <span class="cs1-format">(PDF)</span>. Rockville, MD: U.S. Department of Health and Human Services. Archived from <a rel="nofollow" class="external text" href="https://mchb.hrsa.gov/sites/default/files/mchb/data-research/nsch-cshcn-context-09-2011.pdf">the original</a> <span class="cs1-format">(PDF)</span> on 2021-12-19<span class="reference-accessdate">. Retrieved <span class="nowrap">2022-06-16</span></span>. <q>The NSCH provides a unique view of CSHCN in the context of where they live, play and go to school. 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Retrieved <span class="nowrap">2024-07-16</span></span> – via Congress.gov.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=124+Stat.+119&rft.atitle=Public+Law+111%E2%80%93148&rft.date=2010-03-23&rft_id=https%3A%2F%2Fwww.congress.gov%2F111%2Fplaws%2Fpubl148%2FPLAW-111publ148.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3AChildren+with+Special+Healthcare+Needs+in+the+United+States" class="Z3988"></span></span> </li> </ol></div></div>    </div><noscript><img src="https://login.wikimedia.org/wiki/Special:CentralAutoLogin/start?type=1x1" alt="" width="1" height="1" style="border: none; position: absolute;"></noscript> <div class="printfooter" data-nosnippet="">Retrieved from "<a dir="ltr" href="https://en.wikipedia.org/w/index.php?title=Children_with_Special_Healthcare_Needs_in_the_United_States&oldid=1250388518">https://en.wikipedia.org/w/index.php?title=Children_with_Special_Healthcare_Needs_in_the_United_States&oldid=1250388518</a>"</div></div> <div id="catlinks" class="catlinks" data-mw="interface"><div id="mw-normal-catlinks" class="mw-normal-catlinks"><a href="/wiki/Help:Category" title="Help:Category">Categories</a>: <ul><li><a href="/wiki/Category:Disability_in_the_United_States" title="Category:Disability in the United States">Disability in the United States</a></li><li><a href="/wiki/Category:Pediatrics_in_the_United_States" title="Category:Pediatrics in the United States">Pediatrics in the United States</a></li><li><a href="/wiki/Category:Special_education_in_the_United_States" title="Category:Special education in the United States">Special education in the United States</a></li><li><a href="/wiki/Category:Medical_terminology" title="Category:Medical terminology">Medical terminology</a></li></ul></div><div id="mw-hidden-catlinks" class="mw-hidden-catlinks mw-hidden-cats-hidden">Hidden categories: <ul><li><a href="/wiki/Category:All_articles_with_incomplete_citations" title="Category:All articles with incomplete citations">All articles with incomplete citations</a></li><li><a href="/wiki/Category:Articles_with_incomplete_citations_from_July_2024" title="Category:Articles with incomplete citations from July 2024">Articles with incomplete citations from July 2024</a></li><li><a href="/wiki/Category:Articles_with_short_description" title="Category:Articles with short description">Articles with short description</a></li><li><a href="/wiki/Category:Short_description_with_empty_Wikidata_description" title="Category:Short description with empty Wikidata description">Short description with empty Wikidata description</a></li><li><a href="/wiki/Category:Wikipedia_introduction_cleanup_from_October_2024" title="Category:Wikipedia introduction cleanup from October 2024">Wikipedia introduction cleanup from October 2024</a></li><li><a href="/wiki/Category:All_pages_needing_cleanup" title="Category:All pages needing cleanup">All pages needing cleanup</a></li><li><a href="/wiki/Category:Articles_covered_by_WikiProject_Wikify_from_October_2024" title="Category:Articles covered by WikiProject Wikify from October 2024">Articles covered by WikiProject Wikify from October 2024</a></li><li><a href="/wiki/Category:All_articles_covered_by_WikiProject_Wikify" title="Category:All articles covered by WikiProject Wikify">All articles covered by WikiProject Wikify</a></li><li><a href="/wiki/Category:Use_mdy_dates_from_July_2024" title="Category:Use mdy dates from July 2024">Use mdy dates from July 2024</a></li></ul></div></div> </div> </main> </div> <div class="mw-footer-container"> <footer id="footer" class="mw-footer" > <ul id="footer-info"> <li id="footer-info-lastmod"> This page was last edited on 10 October 2024, at 04:05<span class="anonymous-show"> (UTC)</span>.</li> <li id="footer-info-copyright">Text is available under the <a href="/wiki/Wikipedia:Text_of_the_Creative_Commons_Attribution-ShareAlike_4.0_International_License" title="Wikipedia:Text of the Creative Commons Attribution-ShareAlike 4.0 International License">Creative Commons Attribution-ShareAlike 4.0 License</a>; additional terms may apply. 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