Maternal and Child Health Journal

, Volume 18, Issue 2, pp 467–477 | Cite as

Optimizing Health and Health Care Systems for Children with Special Health Care Needs Using the Life Course Perspective

  • Christina D. BethellEmail author
  • Paul W. Newacheck
  • Amy Fine
  • Bonnie B. Strickland
  • Richard C. Antonelli
  • Cambria L. Wilhelm
  • Lynda E. Honberg
  • Nora Wells


To date, life course research in maternal and child health has largely focused on elucidating fetal and early life influences on adult health and less on promoting the health of children with special health care needs (CSHCN). Consideration of life course theory (LCT) for CSHCN is especially important given their increasing prevalence and comorbidity, their disproportionate vulnerability to weaknesses or instability in the health care system, and the growing evidence linking child and adult health and quality of life. In this commentary we seek to advance the consideration of LCT for CSHCN. We (1) briefly summarize key issues and the importance of a life course approach for CSHCN; (2) present illustrative findings from population-based cross-sectional data that serve to generate hypotheses that can be more rigorously examined when population-based longitudinal data become available; and (3) discuss the application of life course principles as a driving force in the continued implementation and improvement of integrated systems of care for CSHCN.


Life course Children Children with special health care needs Health care quality Medical home 



Life course theory


Children with special health care needs


National Survey of Children’s Health


National Survey of Children with Special Health Care Needs


Emotional, behavioral or development problems


Maternal and Child Health Bureau


Standardized developmental and behavioral screening


Developmental, behavioral and/or social


Individualized Family Services Plan


Individualized Education Plan


Conflict of interest

The authors have no conflicts of interest to disclose.


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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Christina D. Bethell
    • 1
    Email author
  • Paul W. Newacheck
    • 2
  • Amy Fine
    • 3
  • Bonnie B. Strickland
    • 4
  • Richard C. Antonelli
    • 5
  • Cambria L. Wilhelm
    • 1
  • Lynda E. Honberg
    • 4
  • Nora Wells
    • 6
  1. 1.The Child and Adolescent Health Measurement InitiativeOregon Health and Science UniversityPortlandUSA
  2. 2.Department of Pediatrics, Philip R Lee Institute for Health Policy StudiesUniversity of California, San FranciscoSan FranciscoUSA
  3. 3.Center for the Study of Social PolicyWashingtonUSA
  4. 4.Maternal and Child Health BureauHealth Resources and Services AdministrationRockvilleUSA
  5. 5.Division of General Pediatrics, Harvard Medical SchoolChildren’s Hospital BostonBostonUSA
  6. 6.Family VoicesLexingtonUSA

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