Objectives: To study factors contributing to difficulty using community-based services by families of children with special health care needs (CSHCN) in Hawai’i. Methods: Data source was the 2001 National Survey of Children With Special Health Care Needs. The study population included the 449 respondents who were surveyed after additional items were added to the original questionnaire. Outcome of interest was “% of CSHCN whose families report community-based service systems are organized so they can use them easily.” Explanatory variables included child health conditions (functional limitation, degree of severity, types of service needs), child and family characteristics (child age, maternal education, poverty level), and health services characteristics (partnership of family in decision making, family-centered coordinated care, adequate health insurance). Results: Children with special health care needs comprised 11.0% of < 18 years old children. Overall, 69% of respondents reported that community-based services could be used easily. Logistic regression analysis showed that the odds of reporting difficulties in using community-based services were almost 5 times higher for families who did not partner in decision making, 2.9 times higher for families who did not receive family-centered coordinated care, and 2.7 times higher for families who did not have adequate health insurance compared with families who were satisfied with the care received. Need for services contributed independently to reporting difficulties in community-based service use. Contrary to the hypothesized associations, severe health conditions or limited functionality did not contribute significantly to reporting difficulties in service use. Conclusions: Families who reported difficulties in using community-based services were those who have children who need extensive and varied services. Lack of involvement in decision making, lack of coordinated care in a medical home, and insufficient health insurance were the main obstacles to their ability to use community-based services easily.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Price includes VAT (USA)
Tax calculation will be finalised during checkout.
McPherson M, Weissman G, Strickland BB, van Dyck PC, Blumberg SJ, Newacheck PW. Implementing community-based systems of services for children and youth with special health care needs: How well are we doing? Pediatrics 2004;113:1538–44.
Brewer EJ Jr, McPherson M, Magrab PR, Hutchins VL. Family-centered, community-based coordinated care for children with special health care needs. Pediatrics 1989;83:1055–60.
McPherson M, Arango P, Fox H, Lauver C, Mc Manus M, Newacheck PW, Perrin JM, Shonkoff JP, Strickland B. A new definition of children with special health care needs. Pediatrics 1998;102:137–40.
Palfrey JS, Levy JC, Gilbert KL. Use of primary care facilities by patients attending specialty clinics. Pediatrics 1980;65:567–72.
Stein RE, Jessop DJ, Riessman CK. Health care services received by children with chronic illness. Am J Dis Child 1983;137:225–30.
Palfrey JS, Walker DK, Butler JA, Singer JD. Patterns of response in families of chronically disabled children: An assessment in five metropolitan school district. Am J Orthopsychiatry 1989;59:94–104.
Singer JD, Butler JA, Palfrey JS. Health care access and use among handicapped students in five public schools systems. Med Care 1986;24:1–13.
Sabbeth B, Stein RE. Mental health referral: A weak link in comprehensive care of children with chronic physical illness. J Dev Behav Pediatr 1990;11:73–8.
Newacheck PW, Hughes DC, Hung Y-Y, Wong S, Stoddard JJ. The unmet health needs of America’s children. Pediatrics 2000;105:989–97.
Newacheck PW, McManus M, Fox HB, Hung YY, Alfon N. Access to health care for children with special health care needs. Pediatrics 2000;105:760–6.
Perrin JM, Kuhlthau KA, Gortmaker SL, Beal AC, Ferris TG. Generalist and subspecialist care for children with chronic conditions. Ambul Pediatr 2002;2:462–9.
Stein REK, Silver EJ. Patterns of medical, educational, and mental health service use in a national sample of US children. Ambul Pediatr 2003;3:87–92.
Newacheck PW, Hung YY, Wright KK. Racial and ethnic disparities in access to care for children with special health care needs. Ambul Pediatr 2002;2:247–54.
Mayer ML, Skinner AC, Slifkin RT. Unmet need for routine and specialty care: Data from the National Survey of Children with Special Health Care Needs. Pediatrics 2004;113:e109–15.
Yu SM, Nyman RM, Kogan MD, Huang ZJ, Schwalberg RH. Parent’s language of interview and access to care for children with special health care needs. Ambul Pediatr 2004;4:181–7.
Strickland B, McPherson M, Weissman G, van Dyck P, Huang ZJ, Newacheck P. Access to the medical home: Results of the National Survey of Children with Special Health Care Needs. Pediatrics 2004;113:1485–92.
Newacheck PW, Kim SE. A national profile of health care utilization and expenditures for children with special health care needs. Arch Pediatr Adolesc Med 2005;159:10–7.
Hawaii vs. US data from the National Survey of CSHCN. Hawaii Department of Health, Children with Special Health Needs Branch, 8/2003.
Van Dyck PC, McPherson M, Strickland BB, Nesseler K, Blumberg SJ, Cynamon ML, Newacheck PW. The national survey of children with special health care needs. Ambul Pediatr 2002;2:29–37.
Blumberg SJ, Olson L, Frankel M, et al. Design and operation of the National Survey of Children with Special Health Care Needs, 2001. National Center for Health Statistics. Vital Health Stat 2003;1(41):1–136.
US Department of Health and Human Services. Healthy People 2010. Conf ed. Washington, DC: US Department of Health and Human Services; 2000.
Andersen RM. Revisiting the behavioral model and access to medical care: does it matter? J Health Soc Behav 1995;36:1–10.
Goodwin R, Andersen RM. Use of the behavioral model of health care use to identify correlates of use of treatment for panic attacks in the community. Soc Psychiatry Psychiatr Epidemiol 2002;37:212–9.
Shah BV, Barnwell BG, Bieler GS. SUDAAN User’s Manual, Release 8.0. Research Triangle Park, NC: Research Triangle Institute; 2001.
Kleinbaum DG, Kupper LL, Morgenstern H. Epidemiologic Research Principles and Quantitative Methods. Belmont, CA: Lifetime Learning Publications, 1982.
Hosmer DW Jr, Lemeshow S. Applied Logistic Regression. New York: John Wiley & Sons, Inc., 1989.
Van Dyck PC, Kogan MD, McPherson MG, Weissman GR, Newacheck PW. Prevalence and characteristics of children with special health care needs. Arch Pediatr Adolesc Med 2004;158:884–90.
Dusing SC, Skinner AC, Mayer ML. Unmet need for therapy services, assistive devices and related services: Data from the National Survey of Children with Special Health Care Needs. Ambul Pediatr 2004;4:448–54.
Huang ZJ, Kogan MD, Yu SM, Strickland B. Delayed or forgone care among children with special health care needs: An analysis of the 2001 National Survey of Children with Special Health Care Needs. Ambul Pediatr 2005;5:60–7.
Prince CB, Reyes-Salvail F, Sappenfield W, Kuntz NL. Defining feto-infant mortality risk groups in Hawaii by ethnicity and military status. [Abstract] Paediatr Perinat Epidemiol 1999;13:A25.
Prince CB, Song L, Quadri N, Baker KK. The epidemiology of low birth weight and preterm delivery in Hawai’i, 2000–2001. Californian J Health Promotion 2003;1(Special Issue:Hawai’i):83–90.
Baruffi G, Hardy CJ, Waslien CI, Uyehara SJ, Krupitsky D. Ethnic differences in the prevalence of overweight among young children in Hawaii. J Am Diet Assoc 2004;104:1701–7.
Baruffi G, Fuddy LJ, Onaka AT, Alexander GR, Mor JM. Temporal trends in maternal characteristics and pregnancy outcomes: Their relevance to the provision of health services. Hawai’i, 1979–1994. Hawaii Med J 1997;56:149–53.
About this article
Cite this article
Baruffi, G., Miyashiro, L., Prince, C.B. et al. Factors Associated with Ease of Using Community-Based Systems of Care for CSHCN in Hawai’i. Matern Child Health J 9, S99–S108 (2005). https://doi.org/10.1007/s10995-005-3861-2
- community-based services
- medical home
- partnership in decision making
- health insurance