# Presentation: 374486

## Monitoring MCHB’s Six Core Outcomes for CSHCN

- Paul Newacheck, DrPH
- MCH Policy Research Center

## Attributes of the MCHB Monitoring Approach

- Multilevel: national and state level measurement
- Multiple time points to measure progress: baseline, intermediate and endpoint measurement
- Sensitive to detecting bottlenecks
- Cost-effective to implement

## Measurement Approach

- Each core outcome disaggregated into components
- For each component, criteria were established that can be measured using the National Survey of CSHCN
- Successful attainment of a core outcome is based on a sample child meeting  the criteria for its components
- Results are summed across entire sample to produce national level estimates of how well we are doing with each core outcome

## Measurement Continued

- The same approach is used to produce state level estimates for the core outcomes
- Basic approach is to assume 100% success and then subtract children who do not meet one or more components
- The National Survey of CSHCN is used for 5 of the core outcomes
- The National Health Interview Survey is used for the core outcome on screening

## Goal #1

- Families of CSHCN will partner in decision making and will be satisfied with the services they receive
- Doctors make family feel like a partner
- Family is very satisfied with overall care experience

- Estimated Proportion of CSHCN Meeting Goal:  57.5%

## Goal #2

- All CSHCN will receive coordinated ongoing comprehensive care within a medical home
- Child has a usual source of care and a personal doctor or nurse
- The family experiences no problems in obtaining referrals for specialists
- Effective care coordination is available when needed
- Care provided is family centered
- • 	Spend enough time
- • 	Sensitive to culture
- • 	Listen carefully
- • 	Provide needed info
- Make family feel like a partner

- Estimated Proportion of CSHCN Meeting Goal:  52.6%

## Goal #3

- All CSHCN will have adequate public and/or private insurance to pay for the services they need
- Child has private or public health insurance at the time of the survey
- Child had no gaps in coverage during past 12 months
- Health insurance covers services that meet the child’s needs
- Costs not covered by insurance are reasonable
- Health insurance permits the child to see the providers he or she needs

- Estimated proportion of CSHCN Meeting Goal: 59.6%

## Goal #4

- Children will be screened early and continuously for special health care needs
- 1.  All children receive at least annual preventive medical visits
- 2.  All children receive at least annual preventive dental visits

- Estimated Proportion of Children Meeting Goal: 51.6%

## Goal #5

- Community-based services for CSHCN will be organized so families can use them easily
- Services are usually or always organized for easy use

- Estimated Proportion of CSHCN Meeting Goal:  74.3%

## Goal #6

- Youth with special needs will receive services necessary to support the transition to adulthood
- Teens receive guidance and support in the transition to adult health care
- Teens receive vocational and career training to prepare for adult job

- Estimated Proportions of Teen CSHCN Meeting Goal: 5.8%

## Summary: Where We Stand

- A strong national foundation exists for all goals except transition
- Children with more significant special needs are likely to do worse

## Strengths of Monitoring Approach

- Family based monitoring
- Nationally representative sample
- State level data
- Planned repetition

## Weaknesses of Monitoring Approach

- Family based monitoring
- Nationally representative sample
- State level data
- Planned repetition

## Next Steps

- Finalize and disseminate paper describing monitoring strategy and baseline results
- Begin planning process for 2005 National Survey of CSHCN
- Develop strategy for interim measurement of success in achieving the core outcomes