Maternal and Child Health Journal

, Volume 16, Supplement 1, pp 35-43

First online:

Factors Promoting or Potentially Impeding School Success: Disparities and State Variations for Children with Special Health Care Needs

  • Christina BethellAffiliated withDepartment of Pediatrics, School of Medicine, Oregon Health and Science UniversityChild and Adolescent Health Measurement Initiative, Oregon Health and Science University Email author 
  • , Christopher B. ForrestAffiliated withDepartment of Pediatrics, The Children’s Hospital of PennsylvaniaLeonard Davis Institute of Health Economics, University of Pennsylvania
  • , Scott StumboAffiliated withChild and Adolescent Health Measurement Initiative, Oregon Health and Science University
  • , Narangerel GombojavAffiliated withChild and Adolescent Health Measurement Initiative, Oregon Health and Science University
  • , Adam CarleAffiliated withCinncinati Children’s Hospital Medical CenterJames M. Anderson Center for Health Systems Excellence
  • , Charles E. IrwinAffiliated withPhillip R. Lee Institute for Health Policy Studies, University of California, San Francisco

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School success predicts many pathways for health and well-being across the life span. Factors promoting or potentially impeding school success are critical to understand for all children and for children with special health care needs (CSHCN), whose life course trajectories are already impacted by their chronic health problems. The 2007 National Survey of Children’s Health was used (1) to estimate national and state prevalence and within and across states disparities in factors promoting school success (engagement, participation, safety) or potentially impeding success (missing school, grade repetition, school identified problems) for all children and CSHCN and (2) to evaluate associations with CSHCN service need complexity and presence of emotional, behavioral or developmental problems (EBD) as well as with school case management policies in states. Among school age children, 60 % experienced all three factors promoting school success (49.3–73.8 % across states), dropping to 51.3 % for CSHCN (39.4–64.7 % across states) and to 36.2 % for the 40 % of all CSHCN who have both more complex service needs and EBD. CSHCN were more likely to experience factors potentially impeding school success. After accounting for child factors, CSHCN living in states requiring case management in schools for children with disabilities were less likely to experience grade repetition (OR 0.65). Within-state disparities between non-CSHCN and CSHCN varied across states. Threats to school success for US children are pervasive and are especially pronounced for CSHCN with more complex needs and EBD. Findings support broad, non-condition specific efforts to promote school success for CSHCN and consideration of state school policies, such as case management.


School success factors Children with special health care needs National Survey of Children’s Health School engagement Missed school Repeating a grade Emotional Behavioral Developmental problems State variations School case management