Maternal and Child Health Journal

, Volume 16, Supplement 1, pp 35–43

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

  • Christina Bethell
  • Christopher B. Forrest
  • Scott Stumbo
  • Narangerel Gombojav
  • Adam Carle
  • Charles E. Irwin

DOI: 10.1007/s10995-012-0993-z

Cite this article as:
Bethell, C., Forrest, C.B., Stumbo, S. et al. Matern Child Health J (2012) 16: 35. doi:10.1007/s10995-012-0993-z


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 factorsChildren with special health care needsNational Survey of Children’s HealthSchool engagementMissed schoolRepeating a gradeEmotionalBehavioralDevelopmental problemsState variationsSchool case management



National Survey of Children’s Health


Children with special health care needs


Emotional, behavioral or developmental problem


Adjusted odds ratio

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Christina Bethell
    • 1
    • 2
  • Christopher B. Forrest
    • 3
    • 4
  • Scott Stumbo
    • 2
  • Narangerel Gombojav
    • 2
  • Adam Carle
    • 5
    • 6
  • Charles E. Irwin
    • 7
  1. 1.Department of Pediatrics, School of MedicineOregon Health and Science UniversityPortlandUSA
  2. 2.Child and Adolescent Health Measurement InitiativeOregon Health and Science UniversityPortlandUSA
  3. 3.Department of PediatricsThe Children’s Hospital of PennsylvaniaPhiladelphiaUSA
  4. 4.Leonard Davis Institute of Health EconomicsUniversity of PennsylvaniaPhiladelphiaUSA
  5. 5.Cinncinati Children’s Hospital Medical CenterCincinnatiUSA
  6. 6.James M. Anderson Center for Health Systems ExcellenceCincinnatiUSA
  7. 7.Phillip R. Lee Institute for Health Policy StudiesUniversity of California, San FranciscoSan FranciscoUSA