Design and Operation of the

National Survey of Children

with Special Health Care

Needs, 2009–2010

Series 1, Number 57 November 2014
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reproduced or copied without permission; citation as to source, however, is

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Suggested citation

Bramlett MD, Blumberg SJ, Ormson AE, et al. Design and operation of the

National Survey of Children with Special Health Care Needs, 2009–2010.

National Center for Health Statistics. Vital Health Stat 1(57). 2014.

Library of Congress Cataloging-in-Publication Data

Design and operation of the National Survey of Children with Special Health

Care Needs, 2009–2010.

p. ; cm.— (DHHS publication ; no. 2015–1333) (Vital and health statistics,

series 1, program and collection procedures ; number 57)

Includes bibliographical references.

ISBN 978–0-8406–0668-6 (alk. paper)—ISBN 0–8406-0668–0 (alk. paper)

I. National Center for Health Statistics (U.S.), issuing body. II. Series:

DHHS publication ; no. 2015–1333. 0276–4733 III. Series: Vital and health

statistics. Ser. 1, Programs and collection procedures ; no. 57.

[DNLM: 1. National Survey of Children with Special Health Care Needs

(U.S.) 2. Child Health Services—United States. 3. Disabled Children—

United States. 4. Data Collection—methods—United States. 5. Health Care

Surveys—United States. 6. Statistics as Topic—methods—United States.

W2 A N148va no.57]

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Printed on acid-free paper.
Series 1, Number 57

Design and Operation of the

National Survey of Children with

Special Health Care Needs,

2009–2010

Programs and Collection Procedures

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

Hyattsville, Maryland

November 2014

DHHS Publication No. 2015–1333
National Center for Health Statistics

Charles J. Rothwell, M.S., M.B.A., Director

Jennifer H. Madans, Ph.D., Associate Director for Science

Division of Health Interview Statistics

Jane F. Gentleman, Ph.D., Director
Contents
 

Acknowledgments ........................................................................................ vii 
 

Abstract ................................................................................................ 1 
 

Introduction ............................................................................................. 1 
 

State and Local Area Integrated Telephone Survey Program .................................................... 1 
 

History of the SLAITS Program........................................................................... 2 
 

Background ............................................................................................. 2 
 

The 2009–2010 NS-CSHCN.............................................................................. 3 
 

The Survey of Pathways to Diagnosis and Services ........................................................... 3 
 

Sample Design........................................................................................... 4 
 

NIS and SLAITS Sampling Plan .......................................................................... 4 
 

The NS-CSHCN Sampling Plan ........................................................................... 5 
 

Drawing the Samples ................................................................................... 5 
 

Conducting the NS-CSHCN Interviews ..................................................................... 6 
 

Questionnaire ............................................................................................ 7 
 

Content............................................................................................... 7 
 

Computer-assisted Telephone Interviewing .................................................................. 8 
 

NS-CSHCN Augmentation Questionnaire ................................................................... 9 
 

Interviewer Training ...................................................................................... 9 
 

Training Sessions....................................................................................... 9 
 

Data Collection .......................................................................................... 10 
 

Pretest of the CATI Instrument............................................................................ 10 
 

Advance Letter ........................................................................................ 12 
 

Toll-free Telephone Numbers ............................................................................. 12 
 

Selection of Respondent ................................................................................. 12 
 

Informed Consent ...................................................................................... 12 
 

Assurance of Confidentiality.............................................................................. 13 
 

Selection of Sampled Child .............................................................................. 13 
 

Finding NIS-eligible Children in NS-CSHCN Rostering ....................................................... 13 
 

Interviews in Spanish ................................................................................... 13 
 

Interviews in Languages Other Than English or Spanish ...................................................... 14 
 

United States Virgin Islands Sample ....................................................................... 14 
 

Cell-phone Sample ..................................................................................... 15 
 

Interview Length ....................................................................................... 15 
 

Interview Breakoffs..................................................................................... 15 
 

Cases Pending at Close of Data Collection .................................................................. 16 
 

Response Rates ........................................................................................ 17 
 

Realization Rates....................................................................................... 22 
 

Efforts to Improve Response Rates ........................................................................ 24 
 

Nonresponse Bias ...................................................................................... 24 
 

Quality Control of Interviewing ........................................................................... 24 
 

iii
Data Files............................................................................................... 25 
 

Screener File .......................................................................................... 25 
 

Household File......................................................................................... 25 
 

CSHCN Interview File .................................................................................. 25 
 

Linking Files .......................................................................................... 25 
 

Editing ............................................................................................... 26 
 

Missing Data .......................................................................................... 26 
 

Coding of Verbatim Answers Into Question Responses ........................................................ 26 
 

Edits to Protect Confidentiality............................................................................ 27 
 

Geography ............................................................................................ 27 
 

Race ................................................................................................. 27 
 

Language ............................................................................................. 28 
 

Family Structure ....................................................................................... 28 
 

Number of Children in Household ......................................................................... 28 
 

Age.................................................................................................. 29 
 

Other Edits to Protect Confidentiality ...................................................................... 29 
 

Data Perturbations ...................................................................................... 29 
 

Derived Variables on Screener File ........................................................................ 29 
 

Derived Variables on Household File....................................................................... 30 
 

Derived Variables on CSHCN Interview File ................................................................ 30 
 

Dummy Variables ...................................................................................... 31 
 

Additional Data Notes................................................................................... 32 
 

Procedures for Developing Sampling Weights.................................................................. 32 
 

Household-screener Weight............................................................................... 32 
 

Base Sampling Weights.................................................................................. 32 
 

Adjustment for Unknown Household Status ................................................................. 32 
 

Adjustments for Unknown Household Eligibility ............................................................. 33 
 

Adjustment for Households With Multiple Telephone Lines .................................................... 33 
 

Adjustments for Combined Landline and Cell-phone Samples and for Noncovered Populations ....................... 33 
 

Raking Adjustment of Household Weight ................................................................... 34 
 

Child-screener Weight ................................................................................... 34 
 

Raking Adjustment of Child-screener Weight ................................................................ 34 
 

Child-interview Weight .................................................................................. 34 
 

Adjustment for Multiple-CSHCN Households................................................................ 34 
 

Adjustment for Nonresponse to the NS-CSHCN Interview ..................................................... 34 
 

Optimized Combined Landline and Cell-phone Sample ........................................................ 35 
 

Raking Adjustment of Child-interview Weight ............................................................... 35 
 

Quality Control ........................................................................................ 35 
 

Estimation and Hypothesis Testing........................................................................... 35 
 

Interpretation of Weighted Estimates ....................................................................... 35 
 

Variables Used for Variance Estimation ..................................................................... 36 
 

Variance Estimation Using SUDAAN or Stata ............................................................... 37 
 

Variance Estimation for Subsets of Data .................................................................... 37 
 

Weighted Frequencies, Prevalence Estimates, and Standard Errors ............................................... 37 
 

Guidelines for Data Use ................................................................................... 38 
 

Further Information ....................................................................................... 38 
 

References .............................................................................................. 38 
 

Appendix I. Sampling and Weighting Technical Summary........................................................ 40 
 

Appendix II. 2009–2010 National Survey of Children with Special Health Care Needs Questionnaire .................... 55 
 

Appendix III. Summary of Key Differences Between the 2005–2006 and 2009–2010 Questionnaires ..................... 180 
 

Appendix IV. Computer-assisted Telephone Interview Pretest ..................................................... 183 
 

Appendix V. Summary of Questionnaire Changes During Data Collection ........................................... 186 
 

Appendix VI. Procedures for Assigning Household Poverty Status................................................. 188 
 

iv
Appendix VII. Program Names Used for Medicaid and Children’s Health Insurance Program Questions .................. 198 
 

Appendix VIII. Program Names Used for Temporary Assistance for Needy Families Questions ......................... 202 
 

Appendix IX. Letters Sent to Sampled Households ............................................................. 203 
 

Appendix X. Disposition Code Frequencies and Response Rate Calculations......................................... 222 
 

Appendix XI. Alternative Response Rates..................................................................... 226 
 

Appendix XII. Incentive Effort.............................................................................. 237 
 

Appendix XIII. Nonresponse Bias Analysis.................................................................... 242 
 

Appendix XIV. Multiple Imputation of Income and Demographic Variables ......................................... 257 
 

Appendix XV. Key Prevalence Estimates and Weighted Frequencies ............................................... 270 
 

Text Tables

A.	 Children with special health care needs screener questions used in the 2009–2010 survey........................ 3 
 

B.	 Augmentation sample, by state and sample type ......................................................... 6 
 

C.	 External (nongovernment) technical expert panel members................................................. 7 
 

D.	 Number of interviewers trained, by month and telephone center location ..................................... 10 
 

E.	 Number of completed interviews, by state and telephone sample type ....................................... 11 
 

F.	 2009–2010 NS-CSHCN pretest special-needs screener completes............................................ 12 
 

G.	 Number and percentage of respondents, by relationship to sampled child ..................................... 13 
 

H.	 Mean and median length of CSHCN interview in minutes and seconds, by interview type, section, and NIS
 

eligibility: Landline sample .......................................................................... 15 
 

J.	 Mean and median length of CSHCN interview in minutes and seconds, by interview type, section, and NIS
 

eligibility: Cell-phone sample ........................................................................ 16 
 

K.	 Final disposition of age-eligible households where the interview was not completed ............................ 17 
 

M.	 Final dispositions of the 2009–2010 NS-CSHCN sample .................................................. 18 
 

N.	 Weighted NS-CSHCN completion rates, nationally and by state: Landline sample .............................. 19 
 

O.	 Weighted NS-CSHCN completion rates, nationally and by state: Cell-phone sample ............................ 20 
 

P.	 Weighted NS-CSHCN completion rates, overall, nationally, and by state...................................... 21 
 

Q.	 NS-CSHCN realization rates, landline and cell-only/mainly, nationally, and by state ............................ 23 
 

Appendix Figures

1.	 Incentive Group 5B eligibility ........................................................................ 239 
 

2.	 Incentive Group 3A eligibility ........................................................................ 240 
 

3.	 Survey stages and types of nonrespondents ............................................................. 242 
 

Appendix Tables

I.	 Covariates used to create nonresolution adjustment cells within sampling area, by census region and
 

directory-listed status: Landline sample ............................................................. 43 
 

II.	 Covariates used to create nonresponse adjustment cells for age-eligibility screener within state, by census region
 

and directory-listed status: Landline sample .......................................................... 45 
 

III.	 Covariates used to create nonresponse adjustment cells for CSHCN Screener within state, by census region and
 

directory-listed status: Landline sample ............................................................. 46 
 

IV.	 Summary statistics for household weights, by state .................................................... 50 
 

V.	 Summary statistics for child-level screener weights, by state ............................................ 52 
 

VI.	 Summary statistics for child-level interview weights, by state ........................................... 54 
 

VII.	 Year 2008 household poverty guidelines for families in the 48 contiguous states and the District of Columbia.... 188 
 

VIII.	 Year 2008 household poverty guidelines for families in Hawaii.......................................... 189 
 

IX.	 Year 2008 household poverty guidelines for families in Alaska .......................................... 189 
 

X.	 Year 2009 household poverty guidelines for families in the 48 contiguous states and the District of Columbia.... 190 
 

XI.	 Year 2009 household poverty guidelines for families in Hawaii.......................................... 190 
 

XII.	 Year 2009 household poverty guidelines for families in Alaska .......................................... 191 
 

XIII.	 Year 2008 reference table for additional income cascade questions for families in the 48 contiguous states and
 

the District of Columbia ......................................................................... 192 
 

XIV.	 Year 2008 reference table for additional income cascade questions for families in Alaska..................... 193 
 

v
XV.	 Year 2008 reference table for additional income cascade questions for families in Hawaii .................... 194 
 

XVI.	 Year 2009 reference table for additional income cascade questions for families in the 48 contiguous states and
 

the District of Columbia ......................................................................... 195 
 

XVII.	 Year 2009 reference table for additional income cascade questions for families in Alaska..................... 196 
 

XVIII.	 Year 2009 reference table for additional income cascade questions for families in Hawaii .................... 197 
 

XIX.	 State-specific program names for Medicaid and CHIP ................................................. 199 
 

XX.	 State-specific program names for Temporary Assistance for Needy Families ............................... 202 
 

XXI.	 Unweighted response rate calculations for 2009–2010 National Survey of Children with Special Health Care
 

Needs: All sample .............................................................................. 222 
 

XXII.	 Unweighted response rate calculations for 2009–2010 National Survey of Children with Special Health Care
 

Needs: Landline sample .......................................................................... 223 
 

XXIII.	 Unweighted response rate calculations for 2009–2010 National Survey of Children with Special Health Care
 

Needs: Landline sample for U.S. Virgin Islands only .................................................. 224 
 

XXIV.	 Unweighted response rate calculations for 2009–2010 National Survey of Children with Special Health Care
 

Needs: Cell-phone sample ........................................................................ 225 
 

XXV.	 Weighted NS-CSHCN household-level special-needs screener response rates, nationally and by state: Landline
 

sample ........................................................................................ 228 
 

XXVI.	 Weighted NS-CSHCN household-level special-needs screener response rates, nationally and by state: Cell-phone
 

sample ........................................................................................ 229 
 

XXVII.	 Weighted NS-CSHCN household-level special-needs screener response rates, overall, nationally, and by state .... 230 
 

XXVIII.	 Weighted NS-CSHCN child-level special-needs screener response rates, nationally and by state: Landline
 

sample ........................................................................................ 231 
 

XXIX.	 Weighted NS-CSHCN child-level special-needs screener response rates, nationally and by state: Cell-phone
 

sample ........................................................................................ 232 
 

XXX.	 Weighted NS-CSHCN child-level special-needs screener response rates, overall, nationally, and by state ........ 233 
 

XXXI.	 Weighted NS-CSHCN interview response rates, nationally and by state: Landline sample..................... 234 
 

XXXII.	 Weighted NS-CSHCN interview response rates, nationally and by state: Cell-phone sample ................... 235 
 

XXXIII.	 Weighted NS-CSHCN interview response rates, overall, nationally, and by state ............................ 236 
 

XXXIV.	 Incentive experiment groups ...................................................................... 238 
 

XXXV.	 Response rates, by incentive group ................................................................. 238 
 

XXXVI.	 Overall response rates, by incentive group ........................................................... 239 
 

XXXVII.	 Number and percentage of active and passive incentive cases, by final case disposition: All quarters ........... 240 
 

XXXVIII.	 Completion rates, by incentive group: Quarters 3 and 4, 2010 ........................................... 241 
 

XXXIX.	 Information available for both respondents and nonrespondents.......................................... 243 
 

XL.	 Weight variables used in the nonresponse analysis .................................................... 244 
 

XLI.	 Special-needs screener and interview response rates, by subgroup: Landline sample ......................... 245 
 

XLII.	 Comparing respondents and nonrespondents at each stage using frame information: Landline sample ........... 246 
 

XLIII.	 Observed and expected means of frame variables for respondents: Landline sample ......................... 248 
 

XLIV.	 Estimates of nonresponse biases in the key survey estimates attributable to biases in the frame information:
 

Landline sample ................................................................................ 249 
 

XLV.	 Comparing non-HUDIs with converted HUDIs, by sample type ......................................... 250 
 

XLVI.	 Comparing non-HUDIs with converted HUDIs: Dual-frame sample ...................................... 251 
 

XLVII.	 Comparing nonrefusals with converted refusals, by sample type ......................................... 252 
 

XLVIII.	 Comparing nonrefusals with converted refusals: Dual-frame sample ...................................... 253 
 

XLIX.	 Comparing low-call-attempt respondents with high-call-attempt respondents, by sample type .................. 254 
 

L.	 Comparing low-call-attempt respondents with high-call-attempt respondents: Dual-frame sample............... 255 
 

LI.	 Estimates of nonresponse biases in the key survey estimates, based on the comparison of respondents with five
 

calls or more with all respondents: Dual-frame sample ................................................. 256 
 

LII.	 Estimates of survey bias in key survey variables, by method used to estimate the bias ....................... 256 
 

LIII.	 Independent variables used in multiple-imputation model............................................... 261 
 

LIV.	 Parameter estimates for the multiple-imputation model................................................. 264 
 

LV.	 Unweighted and weighted estimates of the frequency and prevalence of households with children with special
 

health care needs ............................................................................... 270 
 

vi
Acknowledgments
 

The National Survey of Children

with Special Health Care Needs

(NS-CSHCN) was sponsored and funded

by the Maternal and Child Health

Bureau of the Health Resources and

Services Administration.

The survey was conducted by the

Centers for Disease Control and

Prevention’s (CDC) National Center for

Health Statistics (NCHS) asa module of

the State and Local Area Integrated

Telephone Survey (SLAITS). The

SLAITS project director is Marcie

Cynamon. Design, production, and

analytic assistance for this project were

provided by Rosa Avila, Julian Luke,

and Kathleen O’Connor. CDC’s

National Center for Immunization and

Respiratory Diseases graciously

permitted the use of the National

Immunization Survey sampling frame

for this survey.

NORC at the University of Chicago

conducted all interviews for this project.

Technical assistance was contributed by

Nadarajasundaram Ganesh, Ph.D.; Wei

Zeng, M.S.; Erin B. Foster, M.S.T.; Erin

S. Raasch; and Anthony Curry. Kirk M.

Wolter, Ph.D.; Kennon R. Copeland,

Ph.D.; and Tiffani A. Balok provided

management support.

This report was edited and produced

by NCHS Office of Information

Services, Information Design and

Publishing Staff: Danielle Woods edited

the report; typesetting was done by

Zung Le, Jacqueline Davis, and

Annette Holman; and graphics were

produced by Chic James and Mike

Jones (contractors).

The report’s outline and some text

were borrowed with permission from an

earlier Vital and Health Statistics series

report (‘‘Design and Operation of the

National Survey of Children with

Special Health Care Needs, 2005–

2006’’).

Finally, the authors extend their

appreciation to the thousands of parents

and other family members who were

willing to share their stories. Their

efforts made this projecta reality.

vii
Objectives

This report presents the

development, plan, and operation of the

2009–2010 National Survey of Children

with Special Health Care Needs, a

module of the State and Local Area

Integrated Telephone Survey. The

survey is conducted by the Centers for

Disease Control and Prevention’s

National Center for Health Statistics.

This survey was designed to produce

national and state-specific prevalence

estimates of children with special health

care needs (CSHCN), to describe the

types of services that they need and

use, and to assess aspects of the

system of care for CSHCN.

Methods

A random-digit-dial sample of

households with children under age 18

years was constructed for each of the

50 states and the District of Columbia.

The sampling frame consisted of

landline phone numbers and cellular­

(cell) phone numbers of households

that reported a cell-phone-only or

cell-phone-mainly status. Children in

identified households were screened for

special health care needs. If CSHCN

were identified in the household, a

detailed interview was conducted for

one randomly selected child with

special health care needs.

Respondents were parents or

guardians who knew about the

children’s health and health care.

Results

A total of 196,159 household

screening interviews were completed

from July 2009 through March 2011,

resulting in 40,242 completed

special-needs interviews, including

2,991 from cell-phone interviews. The

weighted overall response rate was

43.7% for the landline sample, 15.2%

for the cell-phone sample, and 25.5%

overall.

Keywords: children with disabilities • 

chronic disease • needs assessment • 

pediatrics

Design and Operation of the

National Survey of Children

with Special Health Care Needs,

2009–2010

by Matthew D. Bramlett, Ph.D., and Stephen J. Blumberg, Ph.D.,

National Center for Health Statistics; A. Elizabeth Ormson, M.A.,

Jacquelyn M. George, Kim L. Williams, M.S., Alicia M. Frasier, M.P.H.,

Benjamin J. Skalland, M.S., Kathleen B. Santos, M.S., Danielle M.

Vsetecka, M.A., Heather M. Morrison, M.A., Steven Pedlow, M.S., and

Fang Wang, M.S., NORC at the University of Chicago

Introduction
 

To help states develop and provide

coordinated systems of care for children

with special health care needs

(CSHCN), Title V of the Social Security

Act establishes a block grant system that

provides funds and creates federal and

state partnerships. State-level data

regarding the need for, use of, and

barriers to care are necessary for

accurate program evaluation. First

conducted in 2001, the National

Survey of Children with Special

Health Care Needs (NS-CSHCN) was

designed to produce prevalence

estimates of CSHCN using a standard

battery of screening questions, in order

to describe the types of services that

these children need and use, and to

assess possible areas of improvement

in the system of care for CSHCN

(1,2). This information was made

available at the state level and was

collected in a manner that enables

comparison across states and

nationally.

NS-CSHCN was conducted for a

second time in 2005–2006 and for a

third time in 2009–2010. This

methodology report documents the

2009–2010 NS-CSHCN design and

procedures.

State and Local Area

Integrated Telephone

Survey Program

All three rounds of NS-CSHCN,

conducted in 2001, 2005–2006, and

2009–2010, were modules of the State

and Local Area Integrated Telephone

Survey (SLAITS) Program. SLAITS,

sponsored by the Centers for Disease

Control and Prevention’s (CDC)

National Center for Health Statistics

(NCHS), is a broad-based, ongoing

surveillance system available at national,

state, and local levels for tracking and

monitoring the health and well being of

children and adults. SLAITS modules

use the same sampling frame as CDC’s

National Immunization Survey (NIS)

and immediately follow NIS in selected

households, using its sample for

efficiency and economy. In the course of

identifying households with age-eligible

children, NIS uses a random-digit-dial

(RDD) sample and computer-assisted

telephone interview (CATI) technology

to screen approximately 1 million

households each year. The process of

identifying this large number of

households—most of which are

ultimately age-ineligible for NIS—offers

an opportunity to administer other

surveys on a range of health- and

welfare-related topics in an operationally

Page 1
Page 2 [ Series 1, No. 57

seamless, cost-effective, and statistically

sound manner.

SLAITS modules vary in content,

duration, and sample size based on the

research needs of their sponsors.

Sponsors work with NCHS to establish

parameters—including questionnaire

design, sample size, and other survey

requirements. Since 2005, NORC at the

University of Chicago has administered

all aspects of the survey operations,

including development and testing of the

CATI instrument; recruiting and training

interviewers; completing the targeted

number of interviews; and preparing

data files and final documentation.

History of the SLAITS

Program

SLAITS began in 1997 with a pilot

test in two states: Iowa and Washington.

This pilot survey included a series of

questions on health, such as access to

care, health status, and insurance. In

1998, a SLAITS module concerning

child well being and welfare issues was

implemented using three samples: a

general RDD sample of children in

Texas, known Medicaid program

participants in Texas, and known

Medicaid or MinnesotaCare participants

in Minnesota. In 2000, SLAITS fielded

the National Survey of Early Childhood

Health, which collected data regarding

parents’ perceptions of their young

children’s pediatric care and examined

relationships between the promotion of

health in the pediatric office and

promotion of health in the home (3).

In 2001, SLAITS conducted

the first NS-CSHCN, which was

designed to collect data on the special

health care needs of children, children’s

health insurance coverage, and

uninsured children from low-income

households (1,2). With a target of 750

interviews per state, the 2001

NS-CSHCN was the first SLAITS study

to take full advantage of the NIS

sampling frame to produce state-level

estimates. In 2003, SLAITS fielded the

National Survey of Children’s Health

(NSCH), which examined the physical

and emotional health of children aged

0–17 years (4). In 2003, SLAITS also

facilitated the National Asthma Survey,

which examined the predictors of better

asthma control, such as factors related to

health, socioeconomics, behavior, and

environment.

In 2005–2006, SLAITS fielded

the second administration of

NS-CSHCN (5). Three SLAITS modules

were conducted in 2007: the second

round of NSCH (6); the National Survey

of Adoptive Parents (7), a concurrent

follow-back survey to the 2007 NSCH;

and the Survey of Adult Transition and

Health (8), a follow-back to the 2001

NS-CSHCN. In 2008, SLAITS fielded

the National Survey of Adoptive Parents

of Children with Special Health Care

Needs (9), a follow-back to the

2005–2006 NS-CSHCN.

The 2009–2010 NS-CSHCN,

documented in this report, marks the

third time that the SLAITS mechanism

has been used to conduct this survey.

Background

NS-CSHCN was funded by the

Maternal and Child Health Bureau

(MCHB) of the Health Resources and

Services Administration (HRSA).

MCHB, established in 1935 as part of

Title V of the Social Security Act, is

responsible for protecting the health of

mothers and children through the

development of programs and systems

of care for those populations.

The 1989 Omnibus Budget

Reconciliation Act enhanced the

Maternal and Child Services Programs’

mission with specific provisions for

CSHCN, including improved access to

care to be monitored by state

agencies (10). Today, Title V is

administered by MCHB using block

grants to create federal-state partnerships

to provide family-centered, communitybased coordinated systems of care for

CSHCN (11). A minimum of 30% of

block grant funds must be used to

support programs for CSHCN, and

specific steps must be taken to improve

service delivery for these children and

their families. States have considerable

flexibility in determining the services to

provide and the manner in which they

are provided.

To guide the development of

appropriate services for children with

special needs, MCHB established a

work group whose mission was to create

a broad and inclusive definition of what

constitutes special health care needs.

After considering condition-list and

functional status-based approaches, the

work group decided to adopt a

definition based on increased service

needs and to include at-risk children to

facilitate program planning (12,13). The

resulting definition was, ‘‘Children with

special health care needs are those who

have or are at increased risk for a

chronic physical, developmental,

behavioral, or emotional condition and

who also require health and related

services of a type or amount beyond that

required by children generally’’ (12).

Using data from the 1994 National

Health Interview Survey on Disability,

researchers established an initial special

health care needs prevalence rate among

children of 15%–20% (14). The at-risk

population was not included in this

estimate, as there is no accepted

approach to identifying these children.

In fact, there was no one accepted

method of identifying CSHCN. To

augment ongoing research on this

subject, the pretest phase of the first

NS-CSHCN (2001) used two different

batteries of questions to screen

households to identify CSHCN (15,16).

Ultimately, the CSHCN Screener was

adopted for use in the National Survey

of CSHCN.

The CSHCN Screener was

developed as part of the Child and

Adolescent Health Measurement

Initiative, which was originally a part of

the Foundation for Accountability, and is

now housed at the Oregon Health and

Science University. The CSHCN

Screener includes five stem questions on

general health needs that could be the

consequence of chronic health

conditions (e.g., need for special

therapies or need for prescription

medication). If a child currently

experiences one of these consequences,

follow-up questions determine whether

this health care need is the result of a

medical, behavioral, or other health

condition, and whether the condition has
 

Series 1, No. 57 [ Page 3

lasted or is expected to last for 12

months or longer. Those with

affirmative answers to the stem and both

follow-up questions (Table A) are

considered to have a special health care

need.

Using CSHCN Screener data from

the 2001 NS-CSHCN, researchers

estimated that 12.8% of children had

special health care needs. Other surveys

using the CSHCN Screener at that time

or shortly afterward found prevalence

rates as high as 19.3% (17). Using the

2005–2006 NS-CSHCN, researchers

estimated that the special-needs

prevalence rate among children was

21.8%. Despite these differences in

prevalence estimates, the characteristics

and health needs of CSHCN remained

relatively stable across surveys and data

collection years (17,18).

Serving CSHCN requires a

broad-ranging system of health and

related types of care. These services

may include specialty physician care,

therapeutic services, family support

services and care coordination, durable

equipment and assistive devices, a

variety of education-related services, and

transportation services (12). Although

states vary greatly in the manner used to

provide these services, virtually all

provide them to some extent. Accurate

assessment of use and barriers to needed

care is critical to program planning and

evaluation. The 2001 NS-CSHCN was

the first survey to use comparable

methods in every state to provide the

information necessary to accurately

assess state activities and program

needs.

The 2009–2010 NS-CSHCN

The 2009–2010 NS-CSHCN had the

same goals as the 2001 and 2005–2006

administrations of NS-CSHCN: to

provide the information necessary to

accurately assess state activities and

program needs and to make comparisons

across states and nationally, as well as

over time. The major research questions

that the 2009–2010 NS-CSHCN was

designed to address were:

+	 What is the prevalence of special

health care needs among children

under age 18 years in each

state?

+	 Are their special health care needs

and the concerns of their families

being addressed?

+	 What is the quality of primary,

specialty, and ancillary care that

children receive?

+	 Are CSHCN receiving

comprehensive care in a medical

home?

+	 What factors are associated with the

receipt of better quality, more

comprehensive care?

+	 Do families of CSHCN have

adequate insurance to pay for the

services that CSHCN need?

+	 What is the effect of the child’s

health condition on the family?

+	 From whom are CSHCN receiving

needed care coordination services?

The Survey of Pathways to

Diagnosis and Services

The 2009–2010 NS-CSHCN also

provided the methodological foundation

for the Survey of Pathways to Diagnosis

and Services (Pathways), which was

administered as a follow-back survey in

2011. Sponsored by the National

Table A. Children with special health care needs screener questions used in the 2009–2010 survey

Introductory statements

The next questions are about any kind of health problems, concerns, or conditions that may affect your child’s physical health, behavior, learning, growth, or physical

development. Some of these health problems may affect your child’s abilities and activities at school or at play. Some of these problems affect the kind or amount of

services your child may need or use.

Stem question

Follow-up questions

1. Does your child currently need or use medicine prescribed by a doctor, other than vitamins?

(IF YES) Is your child’s need for prescription medicine because of ANY medical, behavioral, or other health condition?

(IF YES) Is this a condition that has lasted or is expected to last 12 months or longer?

(IF NO) Has your child’s need for prescription medication lasted or is it expected to last 12 months or longer?

2. Does your child need or use more medical care, mental health, or educational services than is usual for most children of the same age?

(IF YES) Is your child’s need for medical care, mental health, or educational services because of ANY medical, behavioral, or other health condition?

(IF YES) Is this a condition that has lasted or is expected to last 12 months or longer?

(IF NO) Has your child’s need for medical care, mental health, or educational services lasted or is it expected to last 12 months or longer?

3. Is your child limited or prevented in any way in (his/her/their) ability to do the things most children of the same age can do?

(IF YES) Is your child’s limitation in abilities because of ANY medical, behavioral, or other health condition?

(IF YES) Is this a condition that has lasted or is expected to last 12 months or longer?

(IF NO) Has your child’s limitation in abilities lasted or is it expected to last 12 months or longer?

4. Does your child need or get special therapy, such as physical, occupational, or speech therapy?

(IF YES) Is your child’s need for special therapy because of ANY medical, behavioral, or other health condition?

(IF YES) Is this a condition that has lasted or is expected to last 12 months or longer?

(IF NO) Has your child’s need for special therapy lasted or is it expected to last 12 months or longer?

5. Does your child have any kind of emotional, developmental, or behavioral problem for which he or she needs treatment or counseling?

(IF YES) Is your child’s need for medical care, mental health, or educational services because of ANY medical, behavioral, or other health condition?

(IF YES) Has your child’s emotional, developmental, or behavioral problem lasted or is it expected to last 12 months or longer?

NOTE: For households with more than one child, the phrase ‘‘does your child’’ was replaced with ‘‘do any of your children.’’ Affirmative answers were followed by a question asking for the names or

ages of the children with that particular health care consequence. The follow-up questions were then asked separately for each named child, filling either the child’s age or child’s name (as provided by

the respondent).
Page 4 [ Series 1, No. 57

Institutes of Health’s National Institute

of Mental Health, and funded by the

American Recovery and Reinvestment

Act of 2009 (Public Law 111–5),

Pathways was designed to collect data

on school-age CSHCN who currently

have or once had a diagnosis of autism

or autism spectrum disorder,

developmental delay, or intellectual

disability. The survey focused on the

history of the child’s mental health

condition, including the emergence of

symptoms; diagnosis; and treatments or

interventions used to address the

condition.

Data collection for Pathways began

in February 2011 and ended in June

2011, and involved both a telephone

interview and a mail questionnaire.

During data collection, 4,032 telephone

interviews were completed, and 2,998

mail questionnaires were completed

either via mail or telephone prompting.

For additional information on the

Pathways survey, see ‘‘Design and

Operation of the Survey of Pathways to

Diagnosis and Services’’ (19).

Sample Design

Like all SLAITS modules,

NS-CSHCN took advantage of the large

number of screening calls required for

NIS. This was the first time a cell-phone

sample had been fielded for a SLAITS

module, and that was done in response

to the potential coverage bias that could

occur from excluding the growing

wireless-only population. In 2010, 29%

of all children aged 0–17 years lived in

wireless-only households (20) and would

not be covered in a traditional landline

RDD sample. To address this potential

coverage bias, the 2009–2010

NS-CSHCN incorporated a cell-phone

sample in its design. The NS-CSHCN

cell sample was screened to retain just

those numbers that either did not have a

landline [cell phone only (CPO)], or

were unlikely to be reached through

their landline if they had one [cell

phone mainly (CPM)]. To accomplish

the goal of 750 completed special-needs

interviews (with 45 from cell-phone

interviews) in each state and the District

of Columbia (DC), telephone numbers

were initially selected from the

telephone numbers randomly generated

for the NIS screening effort. Therefore,

the procedures for drawing the NIS

sample were the first steps in the

procedures for drawing the NS-CSHCN

sample.

However, because of the scope of

NS-CSHCN, additional sample was

necessary to augment the NIS sample in

certain states for the landline sample

and all states for the cell sample. In

these cases, an augmentation sample

was drawn for the purpose of

administering the NS-CSHCN interview

only (without going through NIS first).

While the landline sample started data

collection in Quarter 3, 2009 and lasted

6 full quarters, the cell-phone sample

data collection was only fielded during

Quarters 3 and Quarter 4, 2010, the last

2 quarters of data collection. Moreover,

the NS-CSHCN cell sample for Quarter

3, 2010 consisted of augmentation

cell-phone sample only, as the NIS

cell-phone sample was only fielded in

Quarter 4, 2010.

Additional landline sample was

fielded for the United States Virgin

Islands (USVI) during Quarters 3 and 4,

2010. The 2009–2010 iteration of

NS-CSHCN was the first SLAITS

module to include USVI sample.

Although this landline sample was not

large enough to attain 750 completed

surveys, all available NIS USVI sample

was flagged and fielded for NS-CSHCN.

Because a cell-phone sample frame for

USVI was not included in the NIS

sampling frame, a cell-phone sample for

NS-CSHCN was not fielded there.

The next two sections describe the

basic NIS sample design and serve as a

nontechnical description of the

NS-CSHCN sample design and

allocation procedures. Appendix I of this

report includes a more technical

description of the NS-CSHCN sample

design and weighting procedures.

Further information regarding NIS can

be found in ‘‘National Immunization

Survey: The Methodology of a

Vaccination Surveillance System’’ (21)

and online (http://www.cdc.gov/nchs/

nis.htm).

NIS and SLAITS Sampling

Plan

NIS was established to monitor

vaccination levels of very young

children within states and local areas.

These sampling areas are

nonoverlapping and cover the

United States and the U.S. Virgin

Islands. In effect, each quarter NIS

conducts a separate survey in each

sampling area using a common sample

design. The target number of completed

interviews in each sampling area reflects

the goal of obtaining equally precise

estimates in each estimation area. Thus,

the national target for the total number

of completed interviews is the sum of

the targeted number of completed

interviews in each sampling area. If

necessary, the target for a sampling area

in a quarter is adjusted to compensate

for its total shortfall or excess in the

previous quarters.

The target population for NIS is

children aged 19–35 months, the

primary targets of immunization

programs. Because less than 5% of

households in the United States contain

children in this age range, NIS screens

more than 1 million households per year

to identify households with eligible

children. SLAITS modules use this NIS

screening sample.

In addition to the main NIS survey

(NIS-Child), there is a second survey

fielded using the NIS sample—NISTeen, which monitors vaccination levels

for children aged 13–17 years. Because

the NIS-Teen age range is much larger

than the NIS-Child age range, fewer

households are screened in the landline

sample. Only a portion of the NIS

landline sample is necessary to meet the

NIS-Teen targets, and therefore, not all

the NIS landline sample is selected for

the NIS-Teen survey. SLAITS modules

also use this NIS screening sample, and

thus immediately follow either the

NIS-Child or NIS-Teen surveys. The

sample selection process minimizes the

amount of sample that is selected for

potential administration of both the

NIS-Teen and SLAITS surveys from the

NIS-Child sample, where possible.

The NIS-Child cell sample goes

through the same selection process,
Series 1, No. 57 [ Page 5

and here again, the selection process

minimizes the amount of sample

selected for both NIS-Teen and SLAITS

modules in a given sampling area.

However, the eligibility rate for

NIS-Teen is much lower in the cell

sample, and therefore, requires a higher

sample selection rate than seen in the

NIS-Child landline sample. This results

in a higher proportion of the available

NIS-Child cell-phone sample being

selected for both NIS-Teen and

NS-CSHCN, compared with the landline

sample.

NIS uses the list-assisted method of

RDD (22,23) for the landline sample.

This method selects a random sample of

telephone numbers from ‘‘banks’’ of 100

consecutive telephone numbers (e.g.,

773–256–0000 to 773–256–0099) that

contain at least one directory-listed

residential telephone number. The

sampling frame of telephone numbers is

updated each quarter to reflect new

telephone exchanges and area codes.

The landline-augmentation sample that

was needed for certain states used the

same process as NIS to select sample

lines, while ensuring no overlap with

what had been selected for NIS.

Unlike the landline component of

NIS, the Quarter 4, 2010 NIS-Child

national cell-phone sample was not

divided into estimation areas and was

limited to the 50 states and DC (i.e., did

not include USVI). The national

cell-phone sample was randomly drawn

based on the distribution of available

cell-phone exchanges across the

United States. For the cell-augmentation

sample, the data were randomly selected

at the state level, based on area code.

The sample line needs were estimated

using response rate information by state,

and take into account higher mobility

rates within the cell-phone frame,

compared with the landline frame (e.g.,

people are likely to keep the same

cell-phone number even if they have

moved to a different state).

The NS-CSHCN Sampling

Plan

The goal of the NS-CSHCN sample

design was to generate samples

representative of the state populations of

children with special health care needs

aged 0–17 years. An additional goal of

NS-CSHCN was to obtain state-specific

sample sizes that were sufficiently large,

to permit precise estimates of the

characteristics of CSHCN in each state.

To achieve these goals, state

samples were designed to obtain 750

completed interviews with parents or

guardians of CSHCN, with 45 of the

interviews obtained from the cell-phone

sample and the remaining 705

interviews from the landline sample. For

states with multiple landline sampling

areas for NIS, the number of CSHCN to

be selected in each sampling area was

determined by allocating the total of 705

children in the state to each sampling

area within the state in proportion to the

total projected number of households

with CSHCN in the sampling area. The

projected number of households with

CSHCN in each sampling area was

adjusted as needed based on the initial

data collected from the survey. Given

this allocation, the number of

households that needed to be screened

in each sampling area was calculated

using the expected proportion of

households with children under age 18

years in the sampling area. Then, the

number of telephone numbers that

needed to be called was computed using

the expected working residential

(household) number rate. The number of

telephone numbers drawn was increased

to compensate for the fact that not all

respondents would agree to participate

and, therefore, there would be some

degree of nonresponse.

For the cell sample, the sample was

selected at the state level. Based on the

target of 45 cell-phone interviews, the

number of cell lines that needed to be

screened in each state was calculated

using the expected proportion of

households with children under age 18

in the state. As with the landline sample,

the expected working active personal

cell number (APCN) rate was calculated

to determine the number of cell-phone

lines needed, and this was increased to

compensate for some nonresponse at

each stage.

The NS-CSHCN sample was a

state-level sample design, but the

NIS-Child Quarter 4, 2010 cell sample

was a national sample design. The

NS-CSHCN target was 45 CSHCN

completed interviews per state, which

could not be achieved using the

NIS-Child Quarter 4, 2010 national

cell-phone sample alone. In both

Quarters 3 and 4, 2010, augmentation

cell-phone sample was fielded in order

to attain the NS-CSHCN cell-phone

targets for each state. Some states had a

large portion of cell-completed

interviews through the NIS-Child cell

sample due to the large population

within those states (e.g., California and

Texas) and needed minimal amounts of

augmentation sample to attain the target

of 45 completed interviews through the

cell sample.

Drawing the Samples

After the number of landline and

cell-phone numbers necessary to achieve

the target number of interviews by

sample type (landline and cell phone) in

each area had been estimated, the

samples were drawn. The sample draw

proceeded in three steps. First, telephone

numbers were sampled in each area for

NIS-Child and NIS-Teen, as described

above. Next, a portion of these

telephone numbers in each area was

flagged to be part of the NS-CSHCN

sample. Thus, after these steps, every

landline and cell-phone number sampled

for NIS fell into one of four categories:

(1) NIS-Child; (2) NIS-Child and

NIS-Teen; (3) NIS-Child and

NS-CSHCN; or (4) NIS-Child,

NIS-Teen, and NS-CSHCN. Every effort

was made to minimize the flagging of

cases for both NIS-Teen and NSCSHCN, but it was necessary to have

some overlap between the two surveys

in certain sampling areas (‘‘overlap

sample’’). Overlap sample was required

for both the landline and cell samples of

NS-CSHCN that were fielded through

the NIS-Child sample frame.

For the landline sample, in 15 states

(Alaska, Arizona, Hawaii, Idaho, Iowa,

Kansas, Louisiana, Nebraska, New

Jersey, Nevada, North Carolina, North

Dakota, South Dakota, Vermont, and

Wyoming), there was insufficient NIS

sample available to obtain the desired

number of NS-CSHCN completed

interviews. Therefore, additional

telephone numbers were drawn in the
Table B. Augmentation sample, by state and sample type

Percent of Percent of

landline sample cellular-phone

called only sample called only

Area for NS-CSHCN for NS-CSHCN

Alaska ........................... 26.0 90.9

Alabama .......................... ... 42.7

Arkansas ......................... ... 55.4

Arizona........................... 3.0 41.6

California ......................... ... 3.2

Colorado.......................... ... 36.2

Connecticut ........................ ... 82.0

District of Columbia ................... ... 87.3

Delaware ......................... ... 90.8

Florida ........................... ... 13.8

Georgia .......................... ... 18.8

Hawaii ........................... 3.5 85.6

Iowa ............................ 0.9 56.2

Idaho ............................ 11.8 65.1

Illinois ........................... ... 13.7

Indiana ........................... ... 41.6

Kansas........................... 3.2 56.8

Kentucky.......................... ... 48.8

Louisiana ......................... 3.3 45.4

Massachusetts ...................... ... 43.7

Maryland.......................... ... 38.7

Maine............................ ... 78.5

Michigan .......................... ... 18.2

Minnesota ......................... ... 40.1

Missouri .......................... ... 26.3

Mississippi......................... ... 55.6

Montana .......................... ... 84.4

North Carolina ...................... 6.0 19.5

North Dakota ....................... 5.4 92.1

Nebraska ......................... 3.2 73.8

New Hampshire ..................... ... 89.0

New Jersey ........................ 1.2 55.1

New Mexico ....................... ... 75.6

Nevada .......................... 16.9 75.1

New York ......................... ... 13.5

Ohio ............................ ... 20.3

Oklahoma ......................... ... 56.8

Oregon........................... ... 56.0

Pennsylvania ....................... ... 18.4

Rhode Island ....................... ... 88.9

South Carolina ...................... ... 46.3

South Dakota ....................... 5.6 91.5

Tennessee......................... ... 32.3

Texas............................ ... 4.0

Utah ............................ ... 38.7

Virginia........................... ... 27.6

Vermont .......................... 1.4 93.2

Washington ........................ ... 28.2

Wisconsin ......................... ... 46.7

West Virginia ....................... ... 78.2

Wyoming ......................... 6.0 91.0

. . . Category not applicable.

NOTE: NS-CSHCN is National Survey of Children with Special Health Care Needs.

Page 6 [ Series 1, No. 57

same manner as the NIS sample and

categorized as augmentation sample.

Table B shows by state the proportion of

the NS-CSHCN sample that was

augmented for each state. That is, for

each state in Table B, the proportion

listed is the proportion of NS-CSHCN

sample telephone numbers that were

called specifically from an augmentation

sample.

As mentioned earlier, there was no

available cell sample from NIS-Child in

Quarter 3, 2010. Augmentation-cell

sample was fielded for all states and DC

during that quarter. However, in Quarter

4, 2010, NIS-Child fielded a national

cell-phone component, and certain states

(California, Florida, Georgia, Illinois,

Michigan, Missouri, North Carolina,

New York, Ohio, Pennsylvania, and

Texas) had sufficient NIS-Child sample

to achieve NS-CSHCN targets. As a

result, no NS-CSHCN augmentation

sample was needed in that quarter for

those states. Table B also shows by state

the proportion of the NS-CSHCN cell

sample that was augmented for each

state.

Conducting the NS-CSHCN

Interviews

Each telephone number selected for

NS-CSHCN was called and screened for

residential status, cell-phone status, and

the presence of NIS-Child age-eligible

children, as necessary. (The augmentation

sample was an exception to this rule,

because it was selected solely to

administer NS-CSHCN and not NIS;

these households were not screened for

NIS-Child age-eligible children, but for

the presence of any children.) NIS-Child

interviews were conducted if an

NIS-Child age-eligible child lived in the

household. If multiple NIS-Child

age-eligible children lived in the

household, then the NIS-Child interview

was conducted for all eligible children.

If the household was also selected for

the NIS-Teen survey, the household was

then screened for the presence of a

teenager (aged 13–17). And if an

NIS-Teen age-eligible child lived in the

household, an interview was conducted

about the teenager’s vaccination history

before moving on to the NS-CSHCN

Screener. If there was more than one

NIS-Teen age-eligible child in the

household, one was randomly selected

for the NIS-Teen interview. For

NS-CSHCN, if there were children in

the household, the sex and age were

recorded for each child (if this

information had been collected during

the NIS interview(s), the questions were

not asked again). The respondent was

then asked a series of five questions

about the health care needs of all

children to determine the special

health care needs status of every child

in the household (see Table A). If any

children in the household were

identified as having special health care

needs, one was randomly selected
Series 1, No. 57 [ Page 7

(i.e., sampled) to be the subject of a

detailed interview.

Questionnaire

The framework for the 2001

NS-CSHCN was initially discussed in

August 1999. A panel consisting of

selected state and federal Title V

program directors, representatives from

Family Voices and the Association of

Maternal and Child Health Programs,

health services researchers, and survey

design experts identified the content

domains of greatest epidemiological and

policy importance. A subset of this

panel then assembled questions to

capture these domains. Upon approval

by MCHB, these questions were

pretested in 2000 and fielded in 2001 as

NS-CSHCN (5).

Although the overall structure of the

NS-CSHCN questionnaire remained

static across the 2001, 2005–2006, and

2009–2010 administrations,

questionnaire revisions did occur prior

to each new iteration of the survey in

order to improve data quality,

accommodate new sample, and address

research questions of interest. The

Health Insurance Control Sample and

Low-Income Uninsured Supplement that

were fielded in 2001 were not included

in 2005–2006 or 2009–2010. The

Referent Sample, Hurricane Evacuees

section, and Influenza Vaccination

section, fielded in 2005–2006, were

removed for the 2009–2010

administration. For the 2009–2010

iteration, new questions were added to

sections regarding health and functional

status, access to care, family-centered

care, impact on the family, and

household demographics.

In April 2008, a technical expert

panel was convened to review the

questionnaire, suggest revisions, and

assemble questions to address newly

proposed content areas. (See Table C for

a list of panel members.) The panel

provided recommendations to MCHB.

New and significantly revised questions

were pretested in January and February

2009, and the questionnaire was

finalized by MCHB shortly afterward.

Content

The 2009–2010 NS-CSHCN

interview was designed to immediately

follow a completed NIS-Child interview

in households with an NIS-eligible

child, or to follow the NIS-Child

screener in households without

NIS-eligible children. The NS-CSHCN

questionnaire immediately followed the

NIS-Teen interview in some households

that had been flagged for both the

NIS-Teen and NS-CSHCN surveys

(overlap sample). The questionnaire

fielded in 2009–2010 was divided into

11 sections, summarized below.

+	 Section 1: Age-Eligibility

Screening—This section consisted

of the introduction to the interview

and the question to determine if any

children under age 18 years lived in

the household.

+	 Section 2: Special Health Care

Needs Screening—In this section,

all children under age 18 in the

household were rostered, with sex

and age gathered for each child.

Rostering was followed by the

CSHCN Screener.

A special-needs status was assigned

to each rostered child. For

households with no CSHCN, the

demographics interview (beginning

with Section 10) was completed for

the household. If at least one child

screened in as having special needs,

a sampled child with special health

care needs was randomly selected

by the CATI system, and the full

CSHCN interview was conducted

regarding that child.

+	 Section 3: Health and Functional

Status—This section included

questions regarding the sampled

child’s physical, mental, behavioral,

learning, and developmental

conditions and the effects of these

conditions on the child’s life.

+	 Section 4: Access to Care:

Utilization and Unmet Needs—The

questions in this section addressed

the availability of medical services

for the sampled child and their

family and the degree to which they

used them. More specifically,

respondents were asked about the

types of medical services the child

required in the last year, whether

they had experienced any problems

accessing medical care for the

sampled child, whether they had

delayed medical treatment for the

child, and if so, the reasons for the

delay.

+	 Section 5: Care Coordination—In

this section, respondents were asked

whether referrals were needed for

any services and whether anyone

helped coordinate care for the

sampled child. Additional questions

assessed the quality of this

assistance.

+	 Section 6: Family Centered Care,

Transition Issues, and

Developmental Screening—This

section contained three subsections.

The first subsection asked how well

the child’s health care provider met

the family’s needs in terms of

spending enough time with the

child, being sensitive to family

values, discussing changes to expect

in the future, and making the family

feel like partners in the child’s care.

The second subsection was

administered only to respondents

with children aged 12 years and

over. It assessed whether the

provider talked with the family

about transitioning care to other

Table C. External (nongovernment) technical expert panel members

Name Affiliation (in 2008)

Christina Bethell, Ph.D. .......................... Oregon Health and Science University

Paul Newacheck, Dr.P.H. ......................... University of California, San Francisco

Chuck Onufer, M.D. ............................ University of Illinois at Chicago

Ginny Sharp, M.A. ............................. Sharp Research

Phyllis Sloyer, R.N., M.P.A. ........................ Florida Department of Health

Ruth Stein, M.D. .............................. Albert Einstein College of Medicine

Nora Wells, M.S.Ed. ............................ Family Voices

NOTE: Panel members made recommendations to the Maternal and Child Health Bureau regarding questionnaire content for the

2009–2010 National Survey of Children with Special Health Care Needs.
Page 8 [ Series 1, No. 57

adult providers as the child ages.

The third subsection included

questions regarding receipt of formal

developmental screening for selected

children aged 1–3 years.

+ Section 7: Health Insurance—The

goal of this section was to establish

whether sampled children had

comprehensive health insurance

coverage. Comprehensive coverage

was defined as insurance that pays

for both doctor visits and hospital

stays. The section included questions

asking whether a sampled child was

covered by any of a series of

common types of medical insurance.

Respondents with insured children

were asked about any interruptions

in the insurance coverage that might

have occurred in the previous 12

months. For uninsured children,

information was collected on how

long it had been since they last had

medical coverage.

+ Section 8: Adequacy of Health

Care Coverage—Respondents with

insured children were asked about

adequacy of health coverage. They

were asked to rate the cost and

benefits of, and their satisfaction

with, the insurance plans in which

the children were enrolled.

+ Section 9: Impact on the

Family—This section included

questions regarding the effect that a

child’s special health care needs

have on a child’s family. It assessed

financial and time burdens and the

ways in which the families were

coping with them.

+ Section 9.5: ADD/ADHD

Questions (added at the start of

Quarter 4, 2009)—Respondents who

reported in Section 3 (Health and

Functional Status) that the selected

child currently had attention deficit

disorder (ADD) or attention deficit

hyperactivity disorder (ADHD) were

administered several questions,

sponsored by CDC’s National

Center on Birth Defects and

Developmental Disabilities. The

questions addressed treatments that

the selected child may have received

for ADD or ADHD—including

medication, behavioral treatments,

and dietary supplements.

Respondents were asked if the child

received any of these treatments

either in the previous week or

within the previous 12 months. If

respondents reported that the child

had taken medication for ADD or

ADHD in the previous week but did

not know the name of the

medication, they were asked to

retrieve the medication at the end of

the interview so that the medication

type could be accurately documented.

+ Section 10: Demographics—This

section asked questions about the

number of people living in the

household, the relationship of the

respondent to the child, the

relationships of all other household

members to the child, the race and

ethnicity of all the children in the

household, and, if there was an

adoptive parent in the household, the

age of the child at the time of

adoption and whether the child had

previously been in foster care or

adopted internationally.

+ Section 11: Income—In this

section, respondents were asked

about their income and government

program participation—including the

receipt of supplemental security

income and assistance from a state

or county welfare program. The

annual household income was

mapped to the U.S. Department of

Health and Human Services (HHS)

Federal Poverty Guidelines in order

to categorize the household’s

income relative to the poverty level.

+ Section 11A: Telephone and

Household Information—This

section collected information about

the telephone lines in the household,

interruptions in telephone service

during the past year, and ZIP code

information. Starting in Quarter 1,

2010, locating information was

added to this section, which

included collecting contact

information from respondents to

facilitate recontact in the future for

possible follow-back surveys.

Beginning in Quarter 3, 2010,

questions in this section were

revised to accommodate cell-phone

dialing.

+	 California Supplemental

Questions—Specific questions in

Sections 3, 5, 6, and 11 of the

NS-CSHCN questionnaire were

asked solely of cases dialed in

California. These questions were

included at the request of and

funded by the Lucile Packard

Foundation for Children’s Health,

and are marked with an asterisk in

Appendix II.

All households with children received

sections 1, 2, 10, 11, and 11A.

Households that included at least one

child with special health care needs

completed the full CSHCN interview,

including Sections 3–9.

A copy of the questionnaire as

administered in the final quarter (Quarter

4, 2010) appears in Appendix II.

Appendix III lists the key differences

between the 2005–2006 questionnaire

and the 2009–2010 pretest

questionnaire. Appendix IV includes

changes made after the 2009–2010

pretest and before the main launch in

Quarter 3, 2009. Appendix V provides a

list of changes made to the 2009–2010

questionnaire over the course of the data

collection period. Appendix VI contains

the HHS Federal Poverty Guidelines

tables used to determine household

poverty status during interview

administration and a description of the

process for assigning poverty status to

households. Appendix VII contains the

state-specific health insurance program

names used for the health insurance

questions in Section 7, and Appendix

VIII contains the state-specific TANF

(Temporary Assistance for Needy

Families) program names used in

Section 11.

Computer-assisted

Telephone Interviewing

The 2009–2010 NS-CSHCN was

conducted using a computer-assisted

telephone interview (CATI) system. The

CATI data collection method employs

computer software that presents the

questionnaire on a computer screen to

each interviewer. The computer program

guides the interviewer through the

questionnaire, automatically routing the
Series 1, No. 57 [ Page 9

interviewer to appropriate questions

based on answers to previous questions.

Interviewers enter survey responses

directly into the computer, and the CATI

program determines if the selected

response is within an allowable range,

checks it for consistency against other

data collected during the interview, and

saves the responses into a survey data

file. On-screen help text is available to

aid interviewers in administering the

CATI questionnaire. This data collection

technology reduces the time required to

transfer, process, and release data, and

ensures accurate questionnaire flow.

The NS-CSHCN questionnaire was

programmed as a module of NIS,

integrating the two surveys into a single

questionnaire. The instrument made full

use of the CATI system’s ability to

check whether a response was within a

legitimate range, to follow skip patterns,

to fill state-specific information in

questions as applicable (e.g., names of

state Medicaid programs), and to

employ pick lists for response

categories. Certain household and

demographic questions were identical

across the NIS-Child, NIS-Teen, and

NS-CSHCN portions of the interview.

If a respondent answered these questions

during administration of the NIS

interview, the system was programmed

so that the questions were not repeated

in NS-CSHCN. Instead, answers to

these questions in NIS were copied to

the data file for NS-CSHCN as

appropriate.

NS-CSHCN Augmentation

Questionnaire

As noted earlier, the amount of

sample required to reach the target

number of completed special-needs

interviews for the NS-CSHCN sample

exceeded the NIS sample available in

some states. For these states, an

additional ‘‘NS-CSHCN-only’’

augmentation sample was drawn.

Augmentation sample respondents did

not receive any questions from the NIS

screener or interview. Rather, the CATI

system was programmed to begin with

the NS-CSHCN introduction and

proceed to the CSHCN Screener in the

same manner as the main sample.

Interviewer Training

Training Sessions

The data collection contractor

NORC and its subcontractor conducted

all interviews for the 2009–2010

NS-CSHCN. Interviewer training was

conducted by NORC staff at production

centers located in Chicago, Ill. and Las

Vegas, Nev. The use of multiple sites

ensured continuous coverage in all time

zones across the United States.

In addition, NORC employed a

small number of distributed computerassisted telephone interviewing (DCATI)

interviewers who resided in the Grand

Rapids, Mich. area. As a component of

NORC’s disaster preparedness plan, the

DCATI staff worked from their home

office spaces. NORC provided them

with the full desktop computer and

telephone setup that is required to

conduct interviews just as they would if

they were stationed at either the

Chicago or Las Vegas production

centers. All training for the DCATI staff

took place over voice and video

conferencing and was led by the

Chicago training team.

The interviewer training sessions

began with an introduction and project

overview. Interviewers were informed

about project goals, the purpose and

history of the study, study sponsors, and

the study design. An overview of the

screener and each section of the

questionnaire was provided, with

emphasis on quality data collection. The

relationship between NS-CSHCN and

NIS was also covered.

Several exercises on gaining

cooperation were conducted throughout

training to ensure that interviewers were

equipped to answer frequently asked

questions (FAQs) and handle refusals.

Part of the exercises included

pronunciations of medical conditions, as

well as a review of FAQs and other job

aids provided for interviewers.

Beginning in Quarter 3, 2010,

interviewers were specifically trained in

cell-phone sample dialing protocols.

Interviewers were trained on how to

manually dial cell-phone cases, screen

cell-phone cases appropriately, and

respond to cell-phone-specific

questions.

Two types of mock interviews were

used during training: trainer-led

interviews and dual-trainee interviews.

The trainer-led mock interviews were

conducted by the trainer, and they

focused on gaining cooperation skills

and the interviewers’ project knowledge.

For the dual-trainee mock interviews,

trainees were paired, and alternated

playing the role of respondent and

interviewer. The first dual-trainee mock

interview was integrated into the

section-by-section lecture that

progressed through the questionnaire.

The interviewers first listened to a

lecture regarding each section, then

practiced moving through that section in

CATI before moving on to a discussion

about the next section. This method

ensured that interviewers became

acclimated to the questionnaire,

navigating CATI, and gaining

cooperation as new topics were

introduced. Additional mock interviews

that simulated more realistic

interviewing situations in real time were

then conducted. Each mock interview

was designed to highlight various

sections of the screener and the main

questionnaire, and to provide different

scenarios requiring alternative

approaches for gaining cooperation.

At the end of training, interviewers

completed a certification mock interview

and written evaluation. The certification

mock interview was administered by

trained supervisors. It was

approximately 30 minutes in length and

standardized to ensure that all

interviewers were assessed equally in

reading the questionnaire verbatim,

project knowledge, pronunciation, and

the ability to answer respondent

questions. The written evaluation was

administered to reinforce what was

learned during the training sessions. The

evaluation was nine questions in length

and took approximately 15 minutes to

complete. The evaluation covered FAQs,

survey procedures, and question-specific

information. Interviewers had to pass

both the written evaluation and

certification mock interview for

certification to call NS-CSHCN cases.

Table D notes the number of

interviewers trained by location and
Page 10 [ Series 1, No. 57

month over the course of NS-CSHCN

data collection.

Data Collection

Data collection for the 2009–2010

NS-CSHCN started on July 7, 2009 and

ended on March 2, 2011. Throughout

the 6 quarters of data collection,

CSHCN screening was completed for

199,309 households with children. These

households included a total of 378,309

children. Of these children, 102,802

were identified as having special health

care needs. These children resided in

48,519 screened households. From each

household, one child with special health

care needs was randomly selected to be

the target of the special-needs interview.

Interviews were completed for 40,052 of

these sampled children and partially

completed for 534 sampled children.

Interviews were considered partially

complete if the interview was completed

through the end of the health insurance

section (Section 7). See Table E for the

total number of interviews completed by

telephone sample type in each state.

Every state started with a target of

750 completed special-needs interviews.

Throughout data collection, sample

release was determined by estimating

the number of completed interviews that

were still needed to reach the target and

achieve reasonable response rates. All

states met the overall data collection

targets of 750 completed interviews, and

only nine states failed to meet the

cell-phone target of 45 cases. Of these,

only Hawaii and DC finished with less

than 40 cell-phone completes. Adding

telephone lines at the end of the data

collection period to reach the target was

not recommended because biased

estimates may result if some lines are

called less frequently or over shorter

periods of time than others.

It should be noted that the number

of interviews completed is not the same

as the number of interviews in the

publicly released data files. Please see

‘‘Edits to Protect Confidentiality’’ and

‘‘Procedures for Developing Sampling

Weights’’ later in this report for

information regarding completed

interviews excluded from the publicly

released data files.

Pretest of the CATI

Instrument

The 2009–2010 NS-CSHCN CATI

instrument was pretested January 29, 2009

through February 2, 2009, with a total

of 546 NS-CSHCN Screener completes

and 129 completed NS-CSHCN

interviews. Table F shows the final

dispositions of the cases that completed

the NS-CSHCN Screener.

A national list sample of

households likely to include children

was purchased from Survey Sampling

International. The pretest focused on

the functionality of the CATI

instrument and respondents’

comprehension, ease of answering,

and reaction to the questionnaire.

Based on results from the pretest,

changes were made to the

questionnaire, and the production

instrument was finalized. Additional

detail regarding the CATI pretest and

resulting questionnaire changes can be

found in Appendix IV.

Table D. Number of interviewers trained, by month and telephone center location

Trained Passed

Total Total Percent

Month and year Chicago, Ill. Las Vegas, Nev. DCATI Chicago, Ill. Las Vegas, Nev. DCATI trained passed passed

2009

June .....................

July......................

August ....................

September .................

October ...................

November..................

December..................

338

360

26

–

–

17

–

102

16

14

23

12

–

–

–

–

–

–

–

–

–

338

359

26

–

–

16

–

102

15

12

22

12

–

–

–

–

–

–

–

–

–

440

376

40

23

12

17

–

440

374

38

22

12

16

–

1.00

0.99

0.95

0.96

1.00

0.94

–

2010

January ...................

February...................

March ....................

April .....................

May .....................

June .....................

July......................

August ....................

September .................

October ...................

November..................

December..................

–

46

34

21

46

97

88

–

97

140

–

–

16

29

–

–

–

31

13

46

91

78

–

–

–

–

–

–

–

–

–

–

17

–

–

–

–

45

32

15

46

94

81

–

84

117

–

–

16

28

–

–

–

29

10

45

83

73

–

–

–

–

–

–

–

–

–

–

17

–

–

–

16

75

34

21

46

128

101

46

205

218

–

–

16

73

32

15

46

123

91

45

184

190

–

–

1.00

0.97

0.94

0.71

1.00

0.96

0.90

0.99

0.90

0.87

–

–

Total ..................... 1,310 471 17 1,253 447 17 1,798 1,717 0.95

– Quantity zero.

NOTE: DCATI is distributed computer-assisted telephone interviewing.
Table E. Number of completed interviews, by state and telephone sample type

CSHCN screening interviews completed

Total Landline Cell

Area

Households

with children

(CSHCN

Screener

complete)

Children

under age

18 years

Specialneeds

interviews

Households

with children

(CSHCN Children

Screener under age

complete) 18 years

Specialneeds

interviews

Households

with children

(CSHCN

screener

complete)

Children

under age

18 years

Specialneeds

interviews

All states (excluding USVI) .......

All states (including USVI)........

Alabama...................

Alaska ....................

Arizona ...................

Arkansas ..................

California ..................

Colorado ..................

Connecticut .................

Delaware ..................

District of Columbia ............

Florida ....................

Georgia ...................

Hawaii ....................

Idaho.....................

Illinois ....................

Indiana....................

Iowa .....................

Kansas ...................

Kentucky ..................

Louisiana ..................

Maine ....................

Maryland ..................

Massachusetts ...............

Michigan...................

Minnesota..................

Mississippi .................

Missouri ...................

Montana...................

Nebraska ..................

Nevada ...................

New Hampshire ..............

New Jersey .................

New Mexico ................

New York ..................

North Carolina ...............

North Dakota ................

Ohio .....................

Oklahoma ..................

Oregon ...................

Pennsylvania ................

Rhode Island ................

South Carolina ...............

South Dakota................

Tennessee .................

Texas ....................

Utah .....................

Vermont ...................

Virginia ...................

Washington .................

West Virginia ................

Wisconsin ..................

Wyoming ..................

U.S. Virgin Islands ............

196,159

199,309

3,458

4,865

4,047

3,331

5,502

3,844

3,681

3,584

3,879

4,507

3,812

5,130

3,802

4,466

3,499

3,939

3,343

3,228

3,335

3,392

4,004

3,545

3,222

3,828

3,678

3,444

4,057

3,706

4,479

3,354

4,328

3,769

4,592

3,698

3,886

3,596

3,166

4,065

3,667

3,390

3,625

4,248

3,749

4,726

3,693

3,608

3,906

3,722

3,344

3,582

3,838

3,150

372,698

378,309

6,236

9,920

8,026

6,131

10,290

7,330

6,729

6,516

6,596

8,091

7,111

9,716

8,367

8,387

6,741

7,799

6,611

5,911

6,075

6,100

7,208

6,450

6,273

7,475

6,861

6,495

7,974

7,461

8,757

6,089

7,948

7,378

8,373

6,646

7,759

6,808

6,275

7,631

6,781

6,149

6,623

8,676

6,879

9,139

8,976

6,444

6,963

7,062

5,949

6,885

7,628

5,611

40,242

40,586

784

775

789

785

823

773

784

781

751

864

817

791

776

793

777

798

787

790

774

774

804

788

787

776

767

792

778

776

771

765

774

793

836

809

797

812

774

771

792

766

789

766

831

878

776

765

805

779

781

782

776

344

177,672

180,822

3,156

4,585

3,657

2,978

4,427

3,500

3,366

3,349

3,735

3,793

3,320

4,799

3,528

3,875

3,113

3,658

3,085

2,933

2,997

3,210

3,603

3,232

2,861

3,492

3,412

3,136

3,804

3,439

4,109

3,098

3,880

3,414

4,077

3,292

3,624

3,143

2,852

3,737

3,306

3,200

3,323

3,880

3,388

3,632

3,439

3,434

3,522

3,375

3,151

3,226

3,527

3,150

338,752

344,363

5,701

9,365

7,287

5,486

8,372

6,672

6,186

6,074

6,342

6,847

6,191

9,040

7,809

7,316

6,021

7,282

6,109

5,404

5,463

5,778

6,501

5,906

5,645

6,877

6,333

5,961

7,482

6,915

8,040

5,631

7,161

6,673

7,528

5,892

7,246

6,033

5,659

7,023

6,191

5,819

6,056

7,934

6,195

7,103

8,470

6,149

6,300

6,469

5,596

6,203

7,016

5,611

37,251

37,595

735

734

732

717

692

722

736

737

726

744

734

753

730

703

712

743

734

746

721

732

748

734

723

719

715

732

732

728

726

723

726

746

765

734

755

723

724

720

726

726

742

721

764

721

727

717

738

723

736

727

727

344

18,487

18,487

302

280

390

353

1,075

344

315

235

144

714

492

331

274

591

386

281

258

295

338

182

401

313

361

336

266

308

253

267

370

256

448

355

515

406

262

453

314

328

361

190

302

368

361

1,094

254

174

384

347

193

356

311

. . .

33,946

33,946

535

555

739

645

1,918

658

543

442

254

1,244

920

676

558

1,071

720

517

502

507

612

322

707

544

628

598

528

534

492

546

717

458

787

705

845

754

513

775

616

608

590

330

567

742

684

2,036

506

295

663

593

353

682

612

. . .

2,991

2,991

49

41

57

68

131

51

48

44

25

120

83

38

46

90

65

55

53

44

53

42

56

54

64

57

52

60

46

48

45

42

48

47

71

75

42

89

50

51

66

40

47

45

67

157

49

48

67

56

45

55

49

. . .

. . . Category not

NOTES: CSHCN is children with special health care needs. USVI is U.S. Virgin Islands.

applicable.

Series 1, No. 57 [ Page 11
Table F. 2009–2010 NS-CSHCN pretest special-needs screener completes

Description Count

Special-needs screener complete, did not complete interview........ 56

Section 7 (partial) complete with special needs ................ 2

Demographics complete, nonspecial needs ................... 359

Full CSHCN complete, special needs ...................... 129

Total special-needs screener completes ..................... 546

NOTES: NS-CSHCN is National Survey of Children with Special Health Care Needs. CSHCN is children with special health care

needs.

Page 12 [ Series 1, No. 57

Advance Letter

Advance letters have been shown to

decrease nonresponse by confirming

study legitimacy and communicating the

value of the survey (24). When a

mailing address could be identified for a

sampled landline telephone number, an

advance letter was mailed prior to any

telephone calls. Cell-phone numbers do

not have matched addresses, and are

therefore not sent advance letters. In

addition, because address matching was

not available in USVI, this sample also

did not receive advance letters. Every

household with an available mailing

address identified through reverse

address services was sent an advance

letter—23.7% of the telephone numbers

randomly generated, and 50.9% of the

telephone numbers dialed by

interviewers. Appendix IX contains the

full complement of advance letters used

over the course of data collection.

Because NS-CSHCN typically

follows NIS, the advance letter sent to

the main sample was the usual NIS

advance letter. In the letter, recipients

were asked to participate in a voluntary

study of the immunization status of their

children and the types of health and

related services that their children need

and use. The letter advised recipients

that their telephone numbers had been

chosen randomly and indicated that they

might be called in the next few weeks.

A toll-free telephone number was

provided for those who wished to

participate immediately or to learn more

about the study.

As described earlier, the main

sample was augmented with additional

sample in states where the NIS sample

was insufficient to meet NS-CSHCN

sample targets. Such households with an

identified address were sent a similar

advance letter, asking recipients to

participate in a study regarding the types

of health and related services that their

children need and use. The letter did not

mention anything about NIS or

immunizations, and it included a unique

SLAITS-only toll-free number to call

for recipients who wished to participate

immediately or to learn more about the

study.

Toll-free Telephone

Numbers

A toll-free telephone line

established for the survey offered

respondents the flexibility to call at their

convenience if they had questions about

the survey, or wanted to establish

eligibility, complete the interview, or

submit feedback on any aspect of the

survey. Advance letters, incentive letters,

answering machine scripts, and closing

scripts referenced the toll-free number,

and interviewers provided that number

to respondents who requested such a

resource during the interview.

NS-CSHCN cases in the NIS sample

frame were provided a toll-free number

accessed by both NIS and NS-CSHCN

respondents. As mentioned above,

NS-CSHCN augmentation-sample

households were given a SLAITS-only

toll-free number to call.

Both toll-free telephone lines were

answered by interviewers trained on

NS-CSHCN. During the course of the

survey, 96,405 calls were made to the

toll-free line by cases in the NS-CSHCN

sample, 38% of which were from

cell-phone sample cases. Of these calls,

35,360 households were determined

ineligible for NS-CSHCN. An additional

32,407 households were eligible for the

survey. Of these, 15,704 cases

completed the CSHCN Screener, and

3,549 of these households completed the

full survey.

Selection of Respondent

Upon contacting a household,

interviewers requested to speak with a

parent or guardian living in the

household who knew about the health

and health care of the child(ren) in the

household. The respondent’s relationship

to the child was collected in

questionnaire Section 10, and thus was

not obtained if no CSHCN resided in

the household. Table G shows the

frequency and percentage of respondents

who were randomly selected for the

detailed CSHCN interview, by their

relationship with the child. The

respondent was the parent (mother or

father of any type) of the child for

91.9% of sampled children.

A parent, guardian, or other adult

aged 18 and over was not identified in

23,328 households. No interviews were

conducted in these households even if a

minor who lived there was the parent of

an age-eligible child.

Informed Consent

After a knowledgeable respondent

came to the phone, or after the person

who answered the telephone identified

herself or himself as a knowledgeable

parent or guardian, the respondent was

informed of her or his rights as a survey

participant. Verbal consent for study

participation was then obtained and

documented in the CATI system. The

consent script informed respondents of

the voluntary nature of the survey,

assured them that their responses would

be kept confidential, and informed them

that there was no penalty for not

answering questions. Respondents also

were told that the interview might be

recorded and monitored by a supervisor

for quality purposes. If the case

qualified for a monetary incentive, the

incentive amount also was provided in

the informed consent statement. Because

the length of the interview was

dependent on whether CSHCN were in

the household, respondents were told

that the estimate of the duration of the

interview would be provided after a few

questions.
Table G. Number and percentage of respondents, by relationship to sampled child

Relationship of respondent to sampled child Number Percent

Total ............................... 40,587 100.00

Mother or female guardian ................. 30,450 75.02

Father or male guardian................... 6,996 17.24

Grandparent .......................... 2,310 5.69

Other relative or friend.................... 673 1.66

Unknown ............................ 151 0.37

Don’t know or refused .................... 7 0.02

Series 1, No. 57 [ Page 13

The NCHS Research Ethics Review

Board and the NORC Institutional

Review Board approved all study

procedures and modifications. The

federal Office of Management and

Budget control number for this

collection of information was

0920–0406.

Assurance of

Confidentiality

Participation in surveys conducted

by NCHS is voluntary, and all

individually identifiable information

collected is confidential. For

NS-CSHCN, assurance of confidentiality

was provided to potential respondents as

part of the informed consent procedures.

Interviewers read the following

statement to respondents: ‘‘We are

required by Federal laws to develop and

follow strict procedures to protect your

information and use your answers only

for statistical research. I can describe

these laws if you wish.’’

If respondents requested to hear

more about the actual laws, they were

read the following:

The Public Health Service Act is

Volume 42 of the U.S. Code,

Section 242k. The collection of

information in this survey is

authorized by Section 306 of this

Act. Through the National Center

for Health Statistics, the

confidentiality of your responses is

assured by Section 308d of this Act

and by the Confidential Information

Protection and Statistical Efficiency

Act. Would you like me to read the

Confidential Information Protection

provisions to you?

If respondents indicated that they

would like to hear the provisions,

interviewers read the following:

The information you provide will be

used for statistical purposes only. In

accordance with the Confidential

Information Protection provisions of

Title V, Subtitle A, Public Law

107–347 and other applicable

Federal laws, your responses will be

kept confidential and will not be

disclosed in identifiable form to

anyone other than employees or

agents. By law, every employee of

the National Center for Health

Statistics and its collaborating

agency and contractor, specifically

the National Center for

Immunization and Respiratory

Diseases and the National Opinion

Research Center, and their agents

and contractors who work on this

survey, has taken an oath and is

subject to a jail term of up to five

years, a fine of up to $250,000, or

both, if he or she willingly discloses

ANY identifiable information about

you or your household members.

If respondents had any additional

questions or concerns, they were

directed to the project website for more

information (www.cdc.gov/nchs/

slaits.htm) and were provided CDC’s

toll-free telephone number.

When NCHS (including its

contractors and agents) collects

personally identifiable information under

a pledge of confidentiality for exclusive

statistical purposes, Section 308(d) of

the Public Health Service Act and

Section 512(b) of the Confidential

Information Protection and Statistical

Efficiency Act (CIPSEA) require that

confidentiality be maintained without

exception. Violations of CIPSEA are a

class E felony, punishable by

imprisonment for not more than 5 years,

a fine not more than $250,000, or both.

Strict procedures are used by NCHS, its

data collection contractors, and other

agents to prevent disclosure of

confidential data in survey operations

and data dissemination.

Selection of Sampled Child

All households with children under

age 18 living or staying in the

household were screened for the

presence of children with special health

care needs. If a household only had one

child with special needs, that child was

selected as the focus of the interview by

default. In households with multiple

children with special needs, one child

with special health care needs was

randomly selected to be the focus of the

detailed interview. Households that had

no children with special needs did not

complete a detailed CSHCN interview,

and respondents were only asked a few

household demographic questions.

Finding NIS-eligible

Children in NS-CSHCN

Rostering

NS-CSHCN was designed to follow

the administration of the NIS interview

for NIS-eligible households. On

occasion, a household would indicate

that there were no NIS-eligible children

in the household, but upon rostering the

children in the NS-CSHCN Screener,

NIS-eligible children were found. When

this occurred, the interview returned to

NIS for completion prior to continuing

with the NS-CSHCN interview. There

were 225 such households identified

during data collection, and 144 of these

cases completed NIS and then returned

to the NS-CSHCN interview.

Interviews in Spanish

The questionnaire was translated

into Spanish by a professional translator.

Spanish-speaking telephone interviewers

and supervisors at NORC reviewed the

translation and evaluated it for accuracy

and cultural appropriateness. Issues

raised during this review were resolved

in consultation with the original

translator. Any necessary modifications
Page 14 [ Series 1, No. 57

were made, and the translated

questionnaire was programmed into the

CATI system for testing and eventual

production.

All households were first called by

an English-speaking interviewer. If a

potential respondent answered the

telephone in a language other than

English, interviewers asked, ‘‘What

language do you speak?’’ If it was

determined that the respondent needed a

Spanish-speaking interviewer, the case

was placed in a Spanish calling queue.

If the interviewer placing the initial call

was a Spanish speaker and trained to

administer the Spanish version of the

questionnaire, the interviewer was able

to toggle to the Spanish questionnaire

and continue the interview with no

interruption. If not, the case was flagged

in the CATI system as needing a

Spanish-speaking interviewer, and all

subsequent calls were made by

Spanish-speaking interviewers.

Nevertheless, the interview may have

been conducted in English if a

subsequent call by a Spanish-speaking

interviewer reached an English-speaking

respondent.

During data collection, 45,417

telephone numbers were placed in the

Spanish calling queue. Of these, 33,834

were determined to reach households,

and 28,170 were screened for age

eligibility. (Some telephone numbers in

the Spanish calling queue were

determined to be businesses, whereas

others remained unresolved due to

hangups, answering machines, or lack of

answer after multiple attempts by a

Spanish-speaking interviewer.)

Age-eligible children were identified in

15,705 households, and 9,442

households completed the CSHCN

Screener. Of these, 7,759 completed a

nonspecial-needs interview, and 1,048

completed a special-needs interview.

Spanish-speaking households, as

defined by the response to variable

C10Q40 (‘‘What is the primary

language spoken in your home?’’)

comprised 5.0% of all households

screened for special-needs status and

2.8% of all completed special-needs

interviews.

Interviews in Languages

Other Than English or

Spanish

Based on the experience of the

2001 NS-CSHCN, four languages were

identified as the most probable

languages that interviewers would

encounter other than English or Spanish:

Mandarin, Cantonese, Vietnamese, and

Korean. Independent translators

translated the questionnaire into these

Asian languages using the same

procedures that were used for the

Spanish questionnaire. Although the

Spanish questionnaire was programmed

into the CATI system, given the

expected low incidence of the other

languages, a different procedure was

followed to screen and interview these

Asian-language households.

When a household was first

identified as needing a language other

than English or Spanish, the case was

sent to specially trained interviewers

who would determine the necessary

language with a language service used

by NORC, Language Line Services.

Language Line Services provides a

real-time translation service in more

than 170 languages. These households

were then screened for NIS age-eligible

children, and if they were eligible for

NIS, the interviewer immediately

conducted the NIS interview with the

assistance of the Language Line

interpreter. After a completed NIS

interview, or if there were no NIS

age-eligible children living in the

household, the interviewer (with the

help of the interpreter) screened the

household for children under age 18. In

the event that the household included

children and spoke one of the four

Asian languages, the case was assigned

to the appropriate language queue to be

called by a specially trained interviewer

who spoke that language. Special

language interviewers entered the

respondent’s answers into the regular

English CATI system, while using a

book that contained the translated

questionnaire. This allowed for the data

to be captured immediately in the CATI

system and to be subject to all built-in

logic and validation checks.

Throughout the course of data

collection, 375 sampled telephone lines

were identified as needing an interview

in one of the four available Asian

languages. The full NS-CSHCN

interview was completed with 25 of the

age-eligible households. Households that

were identified as needing an Asian

language interviewer comprised 0.2% of

all screened households with children

and 0.06% of all completed full

NS-CSHCN interviews.

If the household included

age-eligible children but potential

respondents apparently did not speak

English, Spanish, or one of these four

Asian languages, the case was coded as

‘‘age eligible, interview incomplete’’ and

the case was finalized. A total of 1,241

households with children were finalized

due to language.

United States Virgin

Islands Sample

NS-CSHCN was administered in the

United States Virgin Islands (USVI) in

Quarters 3 and 4 of 2010. All USVI

sample was comprised of landline

sample, and because address matching

for this sample was not available,

advance letters were not mailed. To

ensure that the NS-CSHCN questionnaire

was appropriate for USVI residents,

certain questions were modified or

added. Rather than ask respondents for a

ZIP code, the question ‘‘On what island

do you live?’’ was asked in its place. In

addition, because Indian Health Service

is not available to USVI residents, the

question regarding access to this service

was not displayed for these cases.

Finally, all references to ‘‘state’’ in the

questionnaire were replaced with

‘‘area.’’

A total of 339 USVI cases

completed the full special-needs

interview. Of the completed cases, 327

interviews were completed in English,

and 12 were completed in Spanish. An

additional 80 USVI cases completed the

CSHCN Screener (33 with special

health care needs and 47 without special

health care needs), but did not complete

the interview.
 

Series 1, No. 57 [ Page 15

Cell-phone Sample

Cell-phone dialing began in Quarter

3, 2010 (for SLAITS augmentation

sample cases only), and continued

through Quarter 4, 2010 (for both NIS

sampling frame and SLAITS

augmentation sample). To accommodate

cell-phone dialing, several questionnaire

and system modifications were made,

including:

+	 Addition of a safety screener

question (S_WARM) to ensure

respondents were not driving or

doing anything that required their

full attention.

+	 Addition of telephone status

screener questions (LANDLINE and

CELLUSE), screening households

for cell-only or cell-mainly status

prior to continuing the interview.

+	 Modification of all introduction and

answering machine scripts to inform

respondents that they were

intentionally being called on their

cellular device.

+	 Modification of the Telephone and

Household Information section to

collect information on the number of

personal cell phones in the

household, the number of cell

phones the adults in the household

usually use, and the proportion of

calls received on a cell phone versus

a regular phone.

+	 Modification of the dialing system

so that cell-phone numbers were

manually dialed.

Interview Length

The length of time to administer the

interview depended on the special-needs

status of the children in the household.

These times also varied by NIS

eligibility, because some demographic

and household questions had already

been administered as part of the NIS

interview and were not repeated in the

NS-CSHCN interview. Mean and

median interview lengths for landline

sample interviews, by section and NIS

eligibility, appear in Table H; mean and

median interview lengths for cell-phone

sample interviews, by section and NIS

eligibility, appear in Table J.

Interview Breakoffs

Households that refused

participation in the interview were

placed into a queue that was worked by

interviewers specially trained in

refusal-conversion strategies. These

interviewers attempted to convert the

incomplete interview into a completed

interview. By the end of data collection,

26.3% of all completed special-needs

interviews were completed with

households that had refused to

participate at least once after age

Table H. Mean and median length of CSHCN interview in minutes and seconds, by interview type, section, and NIS eligibility: Landline

sample

NIS-eligible NIS-ineligible

Type and section of interview Median Mean Median Mean

Overall length ................................

Section 1: NIS/SLAITS age screeners .................

Section 2: Special-needs screening ...................

Section 2: Selection of child for interview ...............

Section 3: Health and Functional Status ................

Section 4: Access to Care.........................

Section 5: Care Coordination .......................

Section 6A: Family Centered Care ...................

Section 6B: Transition Issues1 ......................

Section 6C: Developmental Screening .................

Section 7: Health Insurance .......................

Section 8: Adequacy of Health Care Coverage ............

Section 9: Impact on the Family .....................

Section 9.5: ADD ..............................

Section 10: Demographics ........................

Section 11: Income .............................

Section 11A: Telephone Line and Household Information......

Address collection .............................

Medication reporting section .......................

0:27:26

0:00:59

0:01:40

0:00:24

0:05:58

0:06:18

0:01:19

0:02:00

0:01:04

0:00:35

0:00:38

0:00:35

0:02:09

0:00:53

0:01:50

0:00:14

0:00:16

0:01:26

0:01:11

Special-needs interview

0:28:48 0:31:46

0:01:09 0:01:51

0:01:57 0:01:40

0:00:30 0:00:32

0:06:21 0:06:21

0:06:48 0:06:37

0:01:28 0:01:22

0:02:08 0:01:22

0:01:00 0:00:26

0:00:37 0:00:34

0:00:33 0:01:05

0:00:41 0:00:37

0:02:21 0:02:14

0:01:10 0:00:55

0:02:08 0:02:15

0:00:16 0:00:48

0:00:18 0:00:55

0:01:36 0:01:28

0:02:16 0:00:43

0:33:16

0:01:58

0:01:56

0:00:36

0:06:46

0:07:10

0:01:33

0:01:33

0:00:49

0:00:38

0:01:13

0:00:42

0:02:25

0:01:09

0:02:35

0:00:57

0:00:59

0:01:35

0:01:12

Overall length ................................

Section 1: NIS/SLAITS age screeners .................

Section 2: Special-needs screening ...................

Section 10: Demographics ........................

Section 11: Income .............................

Section 11A: Telephone Line and Household Information......

Address collection .............................

0:03:05

0:00:59

0:00:40

0:00:50

0:00:00

0:00:15

0:00:44

Nonspecial-needs interview

0:03:24 0:05:37

0:01:08 0:01:47

0:00:50 0:00:42

0:00:54 0:01:12

0:00:01 0:00:37

0:00:18 0:00:58

0:00:54 0:00:43

0:05:58

0:01:53

0:00:51

0:01:20

0:00:45

0:01:04

0:00:55

1If sample child was aged 5 years and over, Section 6B was skipped.

NOTES: CSHCN is children with special health care needs; NIS is National Immunization Survey; SLAITS is State and Local Area Integrated Telephone Survey; ADD is attention deficit disorder.

NIS-eligible includes cases that completed NIS-Child (main NIS survey) or NIS-Teen. NIS-ineligible includes cases where NIS-Child and NIS-Teen were not completed. Augmentation sample is

categorized as NIS-ineligible. Overall interview length is calculated only for cases that began and completed the interview on the same call. Individual section timings are calculated only for cases that

began and completed that particular section on the same call.
 

Page 16 [ Series 1, No. 57

Table J. Mean and median length of CSHCN interview in minutes and seconds, by interview type, section, and NIS eligibility: Cell-phone

sample

NIS-eligible NIS-ineligible

Type and section of interview Median Mean Median Mean

Overall length ................................

Section 1: NIS/SLAITS age screeners .................

Section 2: Special-needs screening ...................

Section 2: Selection of child for interview ...............

Section 3: Health and Functional Status ................

Section 4: Access to Care.........................

Section 5: Care Coordination .......................

Section 6A: Family Centered Care ...................

Section 6B: Transition Issues1 ......................

Section 6C: Developmental Screening .................

Section 7: Health Insurance .......................

Section 8: Adequacy of Health Care Coverage ............

Section 9: Impact on the Family .....................

Section 9.5: ADD ..............................

Section 10: Demographics ........................

Section 11: Income .............................

Section 11A: Telephone Line and Household Information......

Address collection .............................

Medication reporting section .......................

0:31:05

0:00:57

0:01:52

0:00:23

0:06:42

0:06:55

0:01:26

0:02:08

0:01:10

0:00:36

0:00:28

0:00:37

0:02:17

0:00:57

0:02:01

0:00:20

0:00:33

0:02:34

0:00:28

Special-needs interview

0:32:28 0:34:58

0:01:05 0:01:44

0:02:10 0:01:53

0:00:28 0:00:33

0:07:04 0:06:53

0:07:33 0:07:14

0:01:35 0:01:31

0:02:18 0:02:12

0:01:07 0:00:20

0:00:39 0:00:39

0:00:37 0:01:12

0:00:43 0:00:38

0:02:30 0:02:20

0:01:13 0:01:00

0:02:13 0:02:30

0:00:22 0:00:57

0:00:38 0:01:09

0:02:46 0:02:34

0:01:04 0:00:33

0:36:38

0:01:56

0:02:10

0:00:39

0:07:19

0:07:43

0:01:42

0:02:21

0:00:42

0:00:40

0:01:20

0:00:43

0:02:34

0:01:14

0:02:50

0:01:05

0:01:15

0:02:47

0:00:54

Overall length ................................

Section 1: NIS/SLAITS age screeners .................

Section 2: Special-needs screening ...................

Section 10: Demographics ........................

Section 11: Income .............................

Section 11A: Telephone Line and Household Information......

Address collection .............................

0:03:30

0:00:56

0:00:44

0:00:53

0:00:00

0:00:32

0:01:22

Nonspecial-needs interview

0:03:53 0:05:59

0:01:04 0:01:42

0:00:55 0:00:45

0:00:59 0:01:20

0:00:00 0:00:39

0:00:37 0:01:12

0:01:26 0:01:26

0:06:27

0:01:51

0:00:56

0:01:32

0:00:48

0:01:19

0:01:31

1If sample child was aged 5 years and over, Section 6B was skipped.

NOTES: CSHCN is children with special health care needs; NIS is National Immunization Survey; SLAITS is State and Local Area Integrated Telephone Survey; ADD is attention deficit disorder.

Cell-phone sample was fielded in Quarters 3 and 4, 2010. NIS-eligible includes cases that completed NIS-Child (main NIS survey) or NIS-Teen. NIS-ineligible includes cases where NIS-Child and

NIS-Teen were not completed. Augmentation sample is categorized as NIS-ineligible. Overall interview length is calculated only for cases that began and completed the interview on the same call.

Individual section timings are calculated only for cases that began and completed that particular section on the same call.

eligibility was established; 7.1% of these

cases were cell-phone cases. The

majority (90.3%) of special-needs cases

that partially completed the interview

had refused to participate at least once

after confirmed age-eligible; 13.1% of

these cases were cell-phone cases.

Among cases that completed the

special-needs screening but did not

partially or fully complete the interview,

87.9% of households had refused at

least once; 11.6% of these cases were

cell-phone cases.

More than 100,000 cases were

found age-eligible but did not complete

the interview. See Table K for more

information about the final dispositions

of these cases. Most of these cases

(88.3%) did not complete the CSHCN

screening.

The most common places in the

interview where respondents broke off

were during the screener: specifically, at

the informed consent script, the question

asking for the most knowledgeable

respondent, or the rostering of children’s

ages.

Among cases that were neither

partial nor full completes (cases that did

not complete through Section 7), 63.7%

ended the interview prematurely,

immediately after special-needs

screening was completed. Of these,

more landline cases broke off at this

point (64.8%), compared with

cell-phone cases (55.5%). For those

special-needs screened cases that did

advance in the interview, there was little

commonality in where the interview was

ultimately terminated. Approximately

three-fourths of landline cases had

terminated the interview before the

condition list in Section 3 was reached,

compared with 71.1% of cell-phone

cases by this same point. There was no

discernible pattern in comparison of the

landline break offs compared with the

cell-phone break offs.

Of partial cases that completed

through Section 7 (n = 534) but did not

complete the full interview, more than

one-half (53.2%) broke off before

reaching the income section, and another

30.0% broke off after completing the

income section. Among these partial

cases, more cell-phone cases had

terminated the interview before Section

10 was reached (56.5%) compared with

landline cases at the same point

(52.7%).

Cases Pending at Close of

Data Collection

Approximately one-half of the cases

pending at the end of data collection

were those in which the telephone

number had not yet been resolved as

residential or nonresidential (50.7% of

pending cases and 15.1% of the initial

sample). One-third of the pending cases
 

Series 1, No. 57 [ Page 17

Table K. Final disposition of age-eligible households where the interview was not completed

Number of age-eligible Percent of age-eligible

Final disposition incompletes incompletes

Total age-eligible households, interview not completed .............. 103,862 100.0

Known age-eligible household, special-needs eligibility undetermined ..... 91,674 88.3

Special-needs eligible household, interview not completed ............ 7,933 7.6

Special-needs screened, no eligible child, interview not completed ....... 3,721 3.6

Special-needs eligible household, partially completed interview ......... 534 0.5

were dispositioned as households with

unknown age eligibility (37.9% of

pending cases and 9.9% of the initial

sample). A small number of households

were determined to be age-eligible, but

the special-needs screener was not

completed (4.4% of pending cases and

1.2% of the total sample). Finally, 0.1%

of the special-needs households had not

completed the interview as of the close

of data collection. See Table M and

Appendix X for more information about

final dispositions of cases.

Response Rates

Response rates provide one measure

of the potential for nonresponse

bias—that is, the possibility that the

sample interviewed differs from the

actual population in some meaningful

way. Three weighted overall response

rates were calculated for NS-CSHCN.

The household-level special-needs

screener response rate reflects the

potential for nonresponse bias in the

sample of households screened for

children with special needs; the

child-level special-needs screener

response rate reflects the potential for

nonresponse bias in the sample of

children screened for special needs; and

the CSHCN interview response rate

reflects the potential for nonresponse

bias in the sample of CSHCN for whom

the special-needs interview was

completed. These rates were calculated

for the landline sample, the cell-phone

sample, and the combined landline and

cell-phone samples at the national and

state levels. The CSHCN interview

response rate can be calculated as the

product of component completion

rates—the resolution rate, the age- and

cell-status screener completion rate, the

household-level special needs screener

completion rate, and the special-needs

interview completion rate, which are

discussed below. (The response rates

presented in the section were weighted

by base weights. See Appendix I for

further discussion of the base weights.)

In the tables in this section and in

the ‘‘Realization Rates’’ section below,

‘‘state’’ refers to the state to which the

telephone number was assigned at the

time the sample of telephone numbers

was selected. For the landline sample,

this ‘‘sampling’’ state is almost always

the same as the state where the

household with that telephone number

actually resides, but this is not true for

the cell-phone sample, where the

sampling state often differs from the

state of residence. However, because the

true state of residence is only known for

households that have completed the

special-needs screener, the sampling

state must be used when computing

response rates.

For the landline sample, the

national-level rates are presented both

including and excluding the USVI

sample. The national-level rates cited in

the text below exclude the USVI

sample.

Resolution rate

Response rates for telephone

surveys are typically lower than

response rates for household in-person

surveys because some telephone

numbers ring with no indication of

whether the number belongs to a

household or to a business. The national

resolution rate, which measures the

proportion of sampled telephone

numbers that could be identified as

residential or nonresidential, was 81.2%

in the landline sample, 46.6% in the

cell-phone sample, and 61.4% overall.

These resolution rates treat all

telephone numbers that resulted in no

contact (i.e., all attempts resulted in

rings with no answer or in a busy

signal) as unresolved. Because every

telephone number is dialed at least six

times at different times on different

days, it is likely that these ‘‘noncontact’’

numbers are actually not working

residential numbers. An alternative

national resolution rate, which treats

these numbers as nonworking, was

89.0% in the landline sample, 54.7% in

the cell-phone sample, and 69.4%

overall.

The original and alternative

resolution rates for each state are

presented in Tables N, O, and P for the

landline, cell-phone, and overall

samples, respectively.

Age- and cell-status screener

completion rate

After a telephone number had been

determined to belong to a household,

that household was screened for the

presence of children under age 18 years.

Each household was first screened for

NIS-Child eligibility; that is, each

household was screened for the presence

of children aged 19–35 months. A

portion of these households were also

screened for NIS-Teen (i.e., for the

presence of teenagers aged 13–17

years). If the household was found to be

age-eligible for NIS-Child or NIS-Teen,

then the household was also considered

to be age-eligible for NS-CSHCN. If the

household was age-ineligible for

NIS-Child or NIS-Teen, then that

household proceeded to the rostering

portion of NS-CSHCN, where, if the

respondent then indicated that the

household contained children under age

18, the household was considered to be

age-eligible for NS-CSHCN. (NSCSHCN landline and cell augmentation

households were not screened for

NIS-Child or NIS-Teen and so, were

age screened only during the rostering
Table M. Final dispositions of the 2009–2010 NS-CSHCN sample

Number of Percent of

selected total selected

Final disposition telephone lines telephone lines

Total ............................................. 7,878,509 100.0

Not resolved as residential or nonresidential..................... 1,190,643 15.1

Out of scope (i.e., business, nonworking, fax or modem) ............. 4,732,263 60.1

Likely household, age eligibility undetermined.................... 611,349 7.8

Known household, age eligibility undetermined ................... 169,615 2.2

Known age-eligible household, special-needs eligibility undetermined ..... 91,674 1.2

Age-screened household, no child in range ..................... 883,656 11.2

Special-needs screened, no eligible child, interview not completed ....... 3,721 0.1

Special-needs screened, no eligible child, completed interview ......... 147,069 1.9

Special-needs eligible household, interview not completed ............ 7,932 0.1

Special-needs eligible household, partially completed interview ......... 534 0.0

Special-needs eligible household, completed interview .............. 40,053 0.5

0.0 Quantity more than zero but less than 0.05.

NOTE: NS-CSHCN is National Survey of Children with Special Health Care Needs.

Page 18 [ Series 1, No. 57

portion of NS-CSHCN.) If during the

NIS-Child screener, the NIS-Teen

screener, or during the rostering portion of

NS-CSHCN the respondent indicated that

the household contained no children

whatsoever, the household was considered

to be age-ineligible for NS-CSHCN.

Prior to age screening, households

in the cell-phone sample were screened

to determine whether the cell phone was

used by an adult in a CPO or CPM

household; that is, households in the

cell-phone sample underwent a

‘‘cell-status’’ screener. If the cell phone

was used only by a minor, or if the

household had a landline phone that was

somewhat or extremely likely to be

answered, the household was ineligible

for the NS-CSHCN cell-phone sample.

During Quarter 4, 2010, an

additional age-eligibility screener was

put in place for the cell-phone

augmentation sample to quickly screen

out households with no children. In this

quarter, after a cell-phone number was

determined to belong to a household but

prior to cell-status screening, the

respondent was asked, ‘‘Are there any

kids in the household?’’ Households

reporting no children were ineligible for

NS-CSHCN. Because the age screener

was administered before the cell-status

screener for some households and after

the cell-status screener for others, the

age- and cell-status screeners were

treated as a single screener to identify

CPO or CPM households containing

children when calculating component

completion rates and response rates for

the cell-phone sample.

Some households did not complete

the age- and cell-status screeners. For

the landline sample, the age-screener

completion rate is defined as the

proportion of identified households for

which it was determined whether the

household contained children under age

18. For the cell-phone sample, the ageand cell-status screener completion rate

is defined as the proportion of identified

households for which it was determined

whether the cell phone was used by an

adult in a CPO or CPM household that

contained children under age 18. The

national age-screener completion rate

was 88.7% for the landline sample, and

the national age- and cell-status screener

completion rate was 75.4% for the

cell-phone sample. Overall, the national

age- and cell-status screener completion

rate was 80.1%. The age- and cell-status

screener completion rates for each state

are given in Tables N, O, and P for the

landline, cell-phone, and overall

samples, respectively.

Household-level special-needs

screener completion rate

Once it had been determined that a

household contained children under age

18 (and for the cell-phone sample, that

the cell phone was used by an adult in

a CPO or CPM household), each of

the household’s children were

screened for special needs. If any

child in the household had special

needs, then the household was

considered to be special-needs eligible.

If no child in the household had

special needs, then the household was

special-needs ineligible.

Due to breakoffs and refusals, not

all age- and cell-status eligible

households were screened for special

needs. The household-level specialneeds screener completion rate is

defined as the proportion of age- and

cell-status-eligible households that

completed the special-needs screener.

The national household-level

special-needs screener completion rate

was 72.6% for the landline sample,

56.5% for the cell-phone sample, and

64.3% overall. The rates for each state

are given in Tables N, O and P for the

landline, cell-phone, and overall

samples, respectively.

Child-level special-needs

screener completion rate

The child-level special-needs

screener completion rate is equivalent to

the household-level special-needs

screener completion rate, but calculated

at the child level. That is, it is the

proportion of children in age- and

cell-status-eligible households that were

screened for special health care needs.

The national child-level special-needs

screener completion rate was 71.9% in

the landline sample, 54.3% in the

cell-phone sample, and 63.0% overall.

The rates for each state are given in

Tables N, O, and P for the landline,

cell-phone, and overall samples,

respectively.
 

Series 1, No. 57 [ Page 19

Table N. Weighted NS-CSHCN completion rates, nationally and by state: Landline sample

Household-level Child-level Overall

special-needs special-needs Special-needs special-needs

Resolution Alternative Age-screener screener screener interview interview

Area rate resolution rate completion rate completion rate completion rate completion rate response rate

Percent

Total (excluding USVI) .......... 81.2 89.0 88.7 72.6 71.9 83.6 43.7

Total (including USVI)........... 81.2 89.1 88.7 72.6 71.9 83.6 43.7

Alabama................... 79.7 88.5 89.0 74.3 73.1 86.0 45.3

Alaska .................... 84.3 92.0 88.4 73.6 72.9 84.5 46.3

Arizona ................... 80.7 89.0 88.2 67.4 67.1 82.6 39.6

Arkansas .................. 85.8 91.7 91.2 76.6 75.7 83.6 50.1

California .................. 75.8 87.9 86.2 67.4 66.0 83.4 36.8

Colorado .................. 81.7 89.0 90.0 75.9 75.2 82.8 46.2

Connecticut ................. 77.2 84.3 88.0 71.9 71.5 84.1 41.0

Delaware .................. 78.0 85.9 88.2 70.9 69.9 82.2 40.1

District of Columbia ............ 81.4 92.0 89.2 70.3 68.2 84.0 42.9

Florida .................... 81.0 88.3 87.6 69.8 69.1 82.7 41.0

Georgia ................... 81.8 89.0 88.6 71.4 71.1 86.7 44.9

Hawaii .................... 84.0 90.3 86.7 67.7 66.4 81.4 40.1

Idaho..................... 84.3 91.0 91.1 74.5 74.7 86.3 49.3

Illinois .................... 83.4 90.8 89.4 75.1 74.4 79.9 44.7

Indiana.................... 85.1 91.4 91.2 74.7 74.1 83.7 48.5

Iowa ..................... 85.1 90.7 91.7 76.5 75.9 85.7 51.2

Kansas ................... 85.2 91.0 91.0 74.5 73.7 86.0 49.6

Kentucky .................. 83.1 89.6 89.9 74.2 73.9 85.0 47.1

Louisiana .................. 84.1 90.9 87.7 68.3 67.8 81.2 40.9

Maine .................... 83.2 89.6 91.0 76.4 76.0 84.3 48.7

Maryland .................. 79.2 87.9 87.8 72.9 72.5 83.6 42.4

Massachusetts ............... 78.7 85.7 87.3 72.7 72.6 80.8 40.4

Michigan................... 83.6 90.6 89.8 76.8 76.1 84.8 48.9

Minnesota.................. 84.8 90.2 91.2 76.5 75.7 85.1 50.3

Mississippi ................. 84.4 91.3 88.8 73.2 72.5 84.6 46.5

Missouri ................... 84.9 91.1 90.7 75.0 74.9 87.0 50.2

Montana................... 86.4 90.8 91.8 76.5 76.5 86.4 52.4

Nebraska .................. 85.7 91.3 90.8 76.1 75.7 88.9 52.7

Nevada ................... 77.4 87.2 86.8 67.0 66.4 84.2 37.9

New Hampshire .............. 80.6 87.0 90.1 74.6 73.7 83.5 45.2

New Jersey ................. 78.3 87.8 86.7 69.4 69.1 79.7 37.6

New Mexico ................ 82.8 89.7 89.3 74.3 74.3 85.7 47.1

New York .................. 79.7 88.2 86.5 68.2 67.2 82.5 38.8

North Carolina ............... 81.1 89.0 89.4 75.5 74.7 82.7 45.2

North Dakota ................ 87.6 92.3 92.5 78.1 77.9 87.6 55.4

Ohio ..................... 83.8 89.4 89.8 74.6 74.0 83.6 46.9

Oklahoma .................. 82.4 90.1 89.3 73.4 73.0 84.6 45.7

Oregon ................... 83.8 90.4 91.3 76.1 75.3 84.4 49.1

Pennsylvania ................ 80.5 87.9 89.8 74.6 73.6 81.6 44.0

Rhode Island ................ 80.5 86.6 88.6 75.6 75.6 83.3 44.9

South Carolina ............... 81.9 89.0 88.7 73.1 72.6 83.5 44.4

South Dakota................ 86.8 91.9 91.5 75.3 74.7 86.5 51.7

Tennessee ................. 82.6 89.4 90.2 71.3 70.7 85.9 45.6

Texas .................... 81.1 89.5 87.1 71.7 71.4 83.3 42.2

Utah ..................... 82.9 90.1 90.2 76.3 77.6 86.1 49.1

Vermont ................... 83.4 89.5 91.5 81.0 80.8 85.7 53.0

Virginia ................... 79.9 88.0 88.9 75.0 74.2 83.4 44.5

Washington ................. 83.1 88.9 89.9 76.9 76.5 84.2 48.3

West Virginia ................ 79.5 86.6 90.4 74.0 73.4 85.5 45.5

Wisconsin .................. 84.1 90.0 91.1 79.2 79.0 88.8 53.9

Wyoming .................. 83.8 90.5 91.2 75.4 75.2 85.4 49.3

U.S. Virgin Islands ............ 89.3 96.7 93.7 81.1 80.0 91.2 61.9

NOTES: NS-CSHCN is National Survey of Children with Special Health Care Needs; USVI is U.S. Virgin Islands.
 

Page 20 [ Series 1, No. 57

Table O. Weighted NS-CSHCN completion rates, nationally and by state: Cell-phone sample

Household-level Child-level Overall

Alternative Age- and cell- special-needs special-needs Special-needs special-needs

Resolution resolution status screener screener screener interview interview

Area rate rate completion rate completion rate completion rate ccompletion rate response rate

Percent

Total (excluding USVI) .......... 46.6 54.7 75.4 56.5 54.3 76.6 15.2

Total (including USVI)........... . . . . . . . . . . . . . . . . . . . . .

Alabama................... 49.3 62.4 77.1 62.4 60.5 71.6 17.0

Alaska .................... 48.2 75.3 85.0 74.9 73.7 80.7 24.7

Arizona ................... 45.3 54.5 74.5 60.0 56.7 81.4 16.5

Arkansas .................. 49.9 63.2 79.0 65.9 63.3 73.9 19.2

California .................. 48.6 52.7 73.2 47.5 44.8 79.4 13.4

Colorado .................. 43.9 52.9 76.6 60.4 61.2 81.5 16.5

Connecticut ................. 37.6 48.0 81.8 56.1 52.1 73.2 12.6

Delaware .................. 38.5 53.3 81.5 60.5 57.6 68.6 13.0

District of Columbia ............ 37.7 53.6 82.9 64.7 61.6 81.8 16.5

Florida .................... 48.6 53.7 72.9 54.6 52.5 78.0 15.1

Georgia ................... 52.6 59.6 74.4 55.8 54.6 73.1 16.0

Hawaii .................... 39.8 50.3 80.1 60.8 58.2 65.5 12.7

Idaho..................... 47.7 57.7 80.1 69.9 70.1 83.1 22.2

Illinois .................... 50.5 57.5 74.2 53.9 51.7 74.8 15.1

Indiana.................... 46.2 56.1 75.4 60.1 56.7 71.9 15.1

Iowa ..................... 48.8 60.9 79.0 60.6 56.6 83.8 19.6

Kansas ................... 51.9 63.2 80.1 65.7 62.1 74.6 20.4

Kentucky .................. 45.2 57.5 76.6 59.2 57.4 78.1 16.0

Louisiana .................. 50.7 61.9 76.6 57.5 55.7 71.1 15.9

Maine .................... 38.9 51.9 80.0 66.1 62.1 80.0 16.4

Maryland .................. 39.2 49.0 75.1 58.2 55.4 76.3 13.1

Massachusetts ............... 41.5 50.6 76.0 59.2 57.7 72.1 13.4

Michigan................... 45.5 54.5 76.0 54.9 52.2 75.0 14.2

Minnesota.................. 44.8 54.1 78.8 63.7 60.7 81.2 18.2

Mississippi ................. 52.8 69.3 76.4 55.9 54.6 78.3 17.7

Missouri ................... 46.5 54.2 76.4 55.9 53.1 76.8 15.3

Montana................... 49.9 68.4 80.6 75.1 74.5 81.8 24.7

Nebraska .................. 51.1 61.3 79.6 67.6 68.8 78.8 21.7

Nevada ................... 39.3 51.7 77.8 61.0 59.9 70.1 13.1

New Hampshire .............. 38.9 50.7 81.1 61.9 61.1 70.1 13.7

New Jersey ................. 43.1 52.4 77.4 55.5 52.1 61.5 11.4

New Mexico ................ 49.3 60.9 83.3 62.3 60.7 66.2 16.9

New York .................. 43.3 49.4 72.6 50.8 48.3 72.7 11.6

North Carolina ............... 48.8 56.0 74.1 56.2 56.2 75.6 15.3

North Dakota ................ 43.4 67.0 86.0 70.0 68.4 78.3 20.5

Ohio ..................... 44.7 52.0 75.4 55.4 51.1 77.4 14.5

Oklahoma .................. 48.1 59.7 78.9 62.2 61.1 76.6 18.1

Oregon ................... 44.1 52.3 80.7 61.8 58.4 73.3 16.1

Pennsylvania ................ 44.0 50.2 74.6 56.0 52.7 71.3 13.1

Rhode Island ................ 37.7 49.2 81.8 60.5 57.7 84.6 15.8

South Carolina ............... 46.3 56.6 75.7 60.7 59.7 80.3 17.1

South Dakota................ 56.7 68.9 85.4 67.3 63.7 71.2 23.2

Tennessee ................. 42.8 51.1 76.3 57.7 55.8 76.1 14.3

Texas .................... 49.2 54.7 73.0 55.3 53.6 78.4 15.6

Utah ..................... 46.1 57.5 76.6 63.0 60.4 85.7 19.1

Vermont ................... 38.5 50.6 81.6 68.0 67.4 87.5 18.7

Virginia ................... 42.8 50.5 74.2 59.7 57.7 86.8 16.5

Washington ................. 44.7 51.4 77.0 59.0 56.0 81.5 16.5

West Virginia ................ 38.0 49.0 77.8 63.0 60.0 80.7 15.0

Wisconsin .................. 48.6 59.0 80.0 61.3 59.0 77.9 18.6

Wyoming .................. 56.7 75.2 84.3 76.1 75.1 84.2 30.6

U.S. Virgin Islands ............ . . . . . . . . . . . . . . . . . . . . .

. . . Category not applicable.

NOTES: NS-CSHCN is National Survey of Children with Special Health Care Needs; USVI is U.S. Virgin Islands.
 

Series 1, No. 57 [ Page 21

Table P. Weighted NS-CSHCN completion rates, overall, nationally, and by state

Household-level Child-level Overall

Alternative Age- and cell- special-needs special-needs Special-needs special-needs

Resolution resolution status screener screener screener interview interview

Area rate rate completion rate1 completion rate completion rate completion rate response rate

Percent

Total (excluding USVI) .......... 61.4 69.4 80.1 64.3 63.0 80.8 25.5

Total (including USVI)........... . . . . . . . . . . . . . . . . . . . . .

Alabama................... 60.6 72.1 81.5 68.3 66.7 80.0 27.0

Alaska .................... 62.0 81.7 86.3 74.1 73.2 83.1 32.9

Arizona ................... 60.3 69.1 79.2 63.3 61.3 82.1 24.8

Arkansas .................. 63.1 73.7 83.1 69.6 67.4 77.9 28.4

California .................. 60.0 67.3 77.6 57.7 55.7 82.0 22.0

Colorado .................. 60.7 69.0 81.1 67.6 67.8 82.3 27.4

Connecticut ................. 55.8 64.7 84.4 67.0 65.5 81.7 25.8

Delaware .................. 55.7 67.5 84.1 66.4 64.3 76.7 23.8

District of Columbia ............ 54.4 68.3 84.4 66.5 63.7 82.7 25.2

Florida .................... 62.5 68.5 77.8 60.4 58.8 80.2 23.6

Georgia ................... 64.4 71.5 78.9 62.7 61.7 80.4 25.6

Hawaii .................... 60.1 68.7 82.2 63.9 61.7 73.9 23.3

Idaho..................... 64.1 72.7 83.7 71.6 71.9 84.4 32.4

Illinois .................... 64.6 71.8 79.1 63.4 61.9 77.7 25.2

Indiana.................... 64.1 72.4 81.5 67.7 65.7 79.2 28.0

Iowa ..................... 65.1 74.3 83.7 68.5 66.2 84.9 31.7

Kansas ................... 65.2 74.3 84.1 70.0 67.7 80.8 31.0

Kentucky .................. 61.5 71.4 81.6 66.5 65.7 82.5 27.6

Louisiana .................. 63.8 73.3 80.2 62.1 60.8 76.5 24.3

Maine .................... 60.9 70.6 85.0 72.2 70.2 82.6 30.8

Maryland .................. 57.1 66.4 79.7 66.2 64.7 81.1 24.4

Massachusetts ............... 57.1 65.4 80.4 67.1 66.6 78.0 24.1

Michigan................... 61.5 69.6 81.0 65.5 64.3 81.2 26.5

Minnesota.................. 63.4 70.9 83.7 71.2 69.7 83.7 31.6

Mississippi ................. 63.8 76.9 80.6 62.6 61.2 81.1 26.1

Missouri ................... 64.1 71.1 81.6 65.4 64.3 82.9 28.4

Montana................... 64.3 77.2 85.1 75.8 75.5 84.3 35.0

Nebraska .................. 66.4 74.6 83.7 71.9 72.3 84.2 33.6

Nevada ................... 54.6 65.9 80.8 63.6 62.7 77.3 21.7

New Hampshire .............. 58.0 67.3 85.1 70.0 69.3 79.7 27.5

New Jersey ................. 58.9 68.3 80.9 64.0 62.5 74.8 22.8

New Mexico ................ 62.8 72.4 85.2 66.8 65.7 75.5 27.0

New York .................. 59.3 66.5 77.5 60.1 58.9 79.2 21.9

North Carolina ............... 62.2 69.7 79.7 65.6 64.9 79.8 26.0

North Dakota ................ 58.2 75.4 88.4 74.7 73.9 84.3 32.4

Ohio ..................... 62.3 68.8 80.8 65.5 63.2 81.2 26.8

Oklahoma .................. 62.1 72.2 82.6 67.5 66.7 81.4 28.2

Oregon ................... 63.2 70.6 84.6 68.8 66.6 79.3 29.2

Pennsylvania ................ 60.4 67.1 81.0 67.8 66.3 78.6 26.1

Rhode Island ................ 56.9 66.0 84.6 70.0 69.0 83.7 28.2

South Carolina ............... 61.2 70.1 80.5 66.4 65.6 82.1 26.9

South Dakota................ 69.0 78.3 87.6 71.4 69.3 80.4 34.7

Tennessee ................. 59.3 67.0 80.9 63.4 61.9 81.0 24.6

Texas .................... 62.1 68.7 76.8 61.3 60.1 80.8 23.6

Utah ..................... 60.7 70.4 80.6 68.7 68.5 85.9 28.9

Vermont ................... 62.1 71.1 86.8 77.5 77.2 86.2 36.0

Virginia ................... 58.7 66.6 79.6 68.1 66.8 84.6 26.9

Washington ................. 62.7 69.0 81.7 68.3 67.0 83.4 29.2

West Virginia ................ 56.2 65.5 83.7 69.4 67.6 83.7 27.3

Wisconsin .................. 64.3 72.8 84.6 71.0 69.8 85.2 32.9

Wyoming .................. 64.3 79.5 86.6 75.8 75.2 84.8 35.8

U.S. Virgin Islands ............ . . . . . . . . . . . . . . . . . . . . .

. . . Category not applicable.

1For the landline sample, the proportion of identified households that completed the age screener; for the cell-phone sample, the proportion of identified households that completed both the age- and

cell-status screeners.

NOTES: NS-CSHCN is National Survey of Children with Special Health Care Needs; USVI is U.S. Virgin Islands.
To properly calculate this rate, the

total number of children in each ageand cell-status screened-eligible

household was required for the

denominator. However, some households

were determined to be age- and

cell-status eligible during NIS screening

but did not complete enough of the NIS

interview for the total number of

children in the household to be

determined. For these 4,149 age- and

cell-status-eligible households, the total

number of children under age 18 was

set to the average number of children in

NIS-eligible households where the

number of children was known. A

proper denominator could then be

calculated for the child-level specialneeds screener completion rate.

Special-needs interview

completion rate

Once a child with special health

care needs was randomly chosen from

the household, an interviewer attempted

to conduct a full interview about the

selected child. Not all households

containing CSHCN completed the

special-needs interview. The specialneeds interview completion rate is

defined as the proportion of households

known to include CSHCN that

completed the health insurance section

(Section 7) of the interview. The

national special-needs interview

completion rate was 83.6% in the

landline sample, 76.6% in the cell-phone

sample, and 80.8% overall. The rates for

each state are given in Tables N, O, and

P for the landline, cell-phone, and

overall samples, respectively.

Overall response rate

The CSHCN interview response rate

is given as the product of the resolution

rate, the age- and cell-status screener

completion rate, the special-needs

screener completion rate, and the

special-needs interview completion rate.

Using the original resolution rate, this

calculation returns response rates of

43.7% for the landline sample, 15.2%

for the cell-phone sample, and 25.5%

for the overall sample. Using the

alternative resolution rate described

above (which treats telephone numbers

with no contact as nonworking

numbers), the resulting response rates

are 47.9% for the landline sample,

17.9% for the cell-phone sample, and

28.9% for the overall sample. The

‘‘true’’ estimate of the response rate

likely lies somewhere between the

original and alternative calculation,

depending on the proportion of

noncontact numbers that were

nonworking.

There are other methods for

calculating response rates that result in

different rates. Appendix XI contains the

overall response rate for the landline,

cell-phone, and overall samples for each

state and the nation, as well as

alternative response rates and guidance

on comparing response rates across

surveys.

Realization Rates

The response rate, while providing

a measure of potential nonresponse bias,

does not account for potential bias due

to the undercoverage of the sampling

frame. As an RDD landline and

cell-phone survey using the list-assisted

method in the landline sample, the

NS-CSHCN sampling frame did not

cover children in households without

telephones or in households without cell

phones whose landline telephone

number is not in a bank of telephone

numbers containing at least one listed

number. Furthermore, the response rate

can be highly sensitive to the choice of

e, the assumed rate of eligibility among

the units for which the eligibility status

has not been observed, as can be seen

by the large difference between the

minimum and maximum response rates

given in Appendix XI. The response rate

can also be sensitive to the definitions

used when assigning final dispositions,

which determine which cases are treated

as eligible or ineligible. Ineligible cases

are treated as nonrespondents, and

among the nonrespondents, final

dispositions determine the type of

nonrespondent that is assigned (e.g.,

unresolved compared with non-agescreened, etc.).

An alternative measure of potential

bias that does not suffer from these

limitations is the realization rate (25).

The realization rate is defined as the

ratio of the unadjusted survey estimate

of the size of the target population to

the true size of that population, as

obtained from an external source. That

is,

Page 22 [ Series 1, No. 57

N| Realization Rate = , Nexternal

where Nexternal is the external estimate of

the true size of the target population,

N| = Σi

wiI(i) is the unadjusted survey

estimate of the size of the target

population, wi is the inverse probability

that the ith unit was selected, and

{1 if

th

0 if

th

the interview was completed for e ith unit I(i) = the interview was not completed for e ith unit.

For NS-CSHCN, an external

estimate of the number of children with

special health care needs in the

population does not exist; therefore, a

full realization rate for children

completing the special-needs interview

cannot be calculated. However, good

external estimates of the number of

children under age 18 do exist [from the

Census Bureau’s 2009 American

Community Survey (ACS)], and so the

realization rate can be computed for

children completing the special-needs

screener. The special-needs interview

realization rate can then be

approximated as the product of the

special-needs-screener realization rate

and the special-needs interview

completion rate:

Realization RateCSHCN = (Realization RateSCR)

(Interview Completion RateCSHCN)

To calculate the special-needsscreener realization rate, the probability

of selection for each child that

completed the special-needs screener is

required. This probability must reflect

the probability of selection for the

telephone number and the number of

telephone lines in the household (for the

landline sample, the number of landline

telephone lines; and for the cell-phone

sample, the number of cell phones

usually used by parents or guardians).

Therefore,

Pi πi = , Li
 

Series 1, No. 57 [ Page 23

where πi is the probability that the ith

child was sampled, Pi is the probability

that the telephone number associated

with the ith child was sampled, and Li is

the number of telephone lines in the ith

child’s household (i.e., the number of

landline telephone lines for landline

sample and the number of cell phones

usually used by parents or guardians for

cell-phone sample).

The number of cell phones usually

used by parents or guardians was

collected for the cell-phone sample as

part of the NS-CSHCN questionnaire.

However, NS-CSHCN did not collect

the number of landline telephone lines

in the household. Therefore, to compute

realization rates, in the landline sample,

the number of landline telephone lines

in the household for each child was

made equal to the average number of

landlines per landline household with

children, as estimated for each state

from the 2009 National H1N1 Flu

Survey, an RDD survey of U.S.

households that did collect such

information.

All households with children

identified in the landline sample were

eligible for special-needs screening, but

in the cell-phone sample, only CPO and

CPM households with children were

eligible to receive the special-needs

screener. In combining the landline and

cell-phone samples in order to calculate

N| above, it was assumed that the

samples of children screened for special

needs in the landline and cell-phone

samples were nonoverlapping. That is,

N| was calculated as

N| = N|LL + N|CELL .

The national child-level specialneeds screener realization rate was

30.1%, and the approximated national

special-needs interview realization rate

was 24.3%. The realization rates by

state are presented in Table Q. In the

2005–2006 NS-CSHCN, the national

child-level special-needs screener

realization rate was 35.4%, and the

approximated national special-needs

interview realization rate was 30.9%.

The special-needs-screener

realization rate can also be computed

separately for the landline and CPO

populations, given an external estimate

of the sizes of those populations.

Table Q. NS-CSHCN realization rates, landline and cell-only/mainly, nationally and by state

Child-level

special-needs Special-needs

Area screener interview1

Percent

Total (excluding USVI) .......... 30.1 24.3

Total (including USVI)........... ... ...

Alabama................... 30.7 24.6

Alaska .................... 44.7 37.1

Arizona ................... 23.3 19.1

Arkansas .................. 32.7 25.4

California .................. 26.7 21.9

Colorado .................. 36.1 29.7

Connecticut ................. 28.8 23.5

Delaware .................. 27.1 20.8

District of Columbia ............ 39.4 32.6

Florida .................... 25.2 20.2

Georgia ................... 29.2 23.4

Hawaii .................... 31.6 23.3

Idaho..................... 38.8 32.8

Illinois .................... 32.0 24.9

Indiana.................... 36.2 28.7

Iowa ..................... 37.7 32.0

Kansas ................... 32.9 26.6

Kentucky .................. 31.4 25.9

Louisiana .................. 28.4 21.8

Maine .................... 37.0 30.5

Maryland .................. 31.5 25.5

Massachusetts ............... 30.9 24.1

Michigan................... 31.8 25.8

Minnesota.................. 39.4 33.0

Mississippi ................. 27.2 22.0

Missouri ................... 32.9 27.3

Montana................... 40.2 33.9

Nebraska .................. 35.8 30.1

Nevada ................... 25.4 19.7

New Hampshire .............. 32.9 26.2

New Jersey ................. 28.8 21.5

New Mexico ................ 28.8 21.7

New York .................. 26.4 20.9

North Carolina ............... 32.2 25.7

North Dakota ................ 45.1 38.0

Ohio ..................... 32.0 26.0

Oklahoma .................. 29.6 24.1

Oregon ................... 33.3 26.4

Pennsylvania ................ 32.8 25.8

Rhode Island ................ 31.0 26.0

South Carolina ............... 29.0 23.8

South Dakota................ 38.1 30.6

Tennessee ................. 32.5 26.3

Texas .................... 25.6 20.7

Utah ..................... 36.4 31.3

Vermont ................... 41.1 35.5

Virginia ................... 31.9 27.0

Washington ................. 35.7 29.8

West Virginia ................ 29.1 24.3

Wisconsin .................. 37.6 32.1

Wyoming .................. 36.1 30.6

U.S. Virgin Islands ............ ... ...

. . . Category not applicable.

1Approximated as the product of the special-needs screener realization rate and the CSHCN interview completion rate.

NOTES: NS-CSHCN is National Survey of Children with Special Health Care Needs; USVI is U.S. Virgin Islands; CSHCN is

children with special health care needs.
Page 24 [ Series 1, No. 57

According to the 2009 ACS, there were

74,338,575 noninstitutionalized children

under age 18 in the United States;

according to NHIS, in the first half of

2010, 69.3% of children were in

landline households and 29.0% were in

CPO households. Applying the

distribution of children between landline

and CPO households to the total number

of children, it was estimated that

51,516,632 children lived in landline

households and 21,558,187 children

lived in CPO households. The sum of

the probability-of-selection weights for

special-needs screened children in

landline households is 14,951,775,

yielding a special-needs-screener

realization rate for children in landline

households of 29.0%. Similarly, the sum

of the probability-of-selection weights

for special-needs screened children in

CPO households is 6,200,659, yielding a

special-needs-screener realization rate

for children in CPO households of

28.8%. That is, children in CPO

households were realized through the

cell-phone sample at nearly the same

rate as children in landline households

were realized through the landline

sample.

Efforts to Improve

Response Rates

Advance letters, toll-free numbers,

refusal-conversion efforts, and translated

questionnaires were used to help

improve response rates. In addition,

other efforts included questionnaire

pretesting and updating, sample

management teams, and monetary

incentives.

A pretest was conducted before data

collection began in order to understand

how respondents would react to personal

questions, the length of the interview,

and respondent suspicions regarding

legitimacy and confidentiality, among

other issues. After the pretest was

conducted and analyzed, NORC worked

with NCHS and MCHB to make

specific improvements based on the

findings of the pretest. Also, after every

quarter of data collection, a list of

potential changes to the instrument was

reviewed and implemented if necessary.

These changes were based on analysis

of questionnaire breakoffs and reports

from interviewers of problem areas

within the questionnaire. See

Appendices III–V for a comprehensive

description of these changes.

Two integrated sample management

teams—one focused on NIS and one

focused on SLAITS—met frequently to

manage the sample in an effective and

efficient manner. Ongoing assessments

and modifications of the data-collection

instrument, data-collection procedures,

and calling rules were conducted.

Response rates were monitored

throughout the data-collection period.

Specially trained refusal converters that

targeted the case-specific source of the

refusal based on the case history

attempted to convert nonrespondents.

In addition, an extensive incentive

experiment was conducted to identify

best practices for effective timing of the

incentive offer, the value of the offer,

and how the incentive offer should be

made (i.e., prepaid or promised), as well

as the presentation of the offer to the

respondent (i.e., type of envelope and

postage used). In addition, extensive

work was done to confirm that

incentives were not biasing the collected

data. A full explanation of the incentive

experiment, the resulting incentive

model chosen, and the effect on

NS-CSHCN response rates can be found

in Appendix XII. Overall, incentives

helped improve the unweighted

special-needs interview response rate by

1.9 percentage points.

Nonresponse Bias

Although these efforts did improve

the response rate, there remained much

nonresponse to the survey. Appendix

XIII details the nonresponse bias

analysis that was performed to examine

the extent that nonresponse bias affected

survey estimates. Generally, the results

indicate that the interviewed population

was more likely to live in rural and

other areas with lower household

density when compared with the

nonresponding population. The

interviewed population was also more

likely to live in areas associated with

higher levels of home ownership, lower

home values, and a greater percentage

of non-Hispanic white persons. When

the nonresponse-adjusted weights were

used, minor differences by home

ownership, home values, and race

remained. In general, the analysis

showed that response biases could have

had a small impact on key survey

estimates, but the nonresponse

adjustment to the weights substantially

reduced the potential magnitude of

those biases. Of the nine key survey

estimates examined, seven showed

maximum estimated biases of less than

1 percentage point—in each case, these

estimated biases were within the 95%

confidence interval for the ‘‘biased’’

estimate, indicating that nonresponse

bias was smaller than potential sampling

error. Of the remaining key survey

estimates examined, one showed a

maximum estimated bias of

1.05 percentage points (just 0.15

percentage points outside the 95%

confidence interval), and the other

showed estimated biases ranging from

0.74 to 2.83 percentage points,

depending on the method used to

estimate bias. In fact, bias estimates

were so small that, for most of the key

survey variables examined, changing the

method used to estimate bias changed

the estimated direction of the bias.

Quality Control of

Interviewing

Telephone center supervisors were

available immediately to interviewing

staff at all times to resolve any

questions or concerns about a case.

Supervisors regularly observed the

data-collection process and monitored

interviewers. In addition, supervisory

staff used remote-telephone and

computer-monitoring technology to

evaluate whether interviewers performed

according to project specifications. This

formal monitoring was conducted to

ensure that introductory materials were

properly read, that item wording and

questionnaire sequence were followed

correctly, that respondent questions were

answered properly, and that any vague

responses were properly probed.

Computer monitoring also allowed

supervisors to ascertain whether answers

were entered accurately into the CATI

system.
Series 1, No. 57 [ Page 25

New supervisors attended an 8-hour

training session that introduced them to

the monitoring procedures. In addition,

supervisors participated in an exercise to

learn how to give effective feedback and

coach interviewers. After this training

session, each new supervisor was

scheduled to conduct dual-monitoring

sessions with experienced staff. Each

new monitor observed live monitoring

side-by-side with an experienced

monitor, and each completed a

Monitoring Evaluation Form. At the end

of each session, the new supervisor and

experienced monitor compared notes,

discussed proper scoring guidelines, and

created a strategy to give feedback.

These training procedures ensured that

all supervisors were monitoring

interviewers using the same criteria for

evaluation.

The CATI monitoring system

automatically selected which

interviewers to monitor, and gave newly

trained interviewers, those with the

fewest monitoring sessions, or those

with the weakest performance reviews

the highest priority for monitoring.

Experienced interviewers were

prioritized for monitoring based upon

the length of time since their last

monitoring session and recent

monitoring scores. Each interviewer was

typically monitored at least once a

week; however, some interviewers were

monitored more often.

Throughout data collection,

interviews were recorded (after

obtaining agreement from respondents)

as well. These recordings were valuable

tools for trainings, and when necessary,

they allowed supervisors to document

specific case-related performance and

provide tailored feedback to

interviewers. Recordings were then

destroyed after 1 year.

Data Files

Three separate but linkable data

files were created using SAS version

9.1. The files include data from

complete interviews (complete through

Section 7: Health Insurance) that were

conducted from July 2009 through

March 2011. In order to maintain

confidentiality, certain variables that

could be used to identify respondents

were excluded from the three files. Two

additional SAS data files include

multiply imputed household and child

poverty and demographic data. Details

about the imputation process and the

imputed data files can be found in

Appendix XIV.

Screener File

This child-level file includes data

on households that completed the

special-needs screener. The number of

records per household equals the

number of children under age 18 living

in the household. In other words, there

is one record for every age-eligible child

residing in a household where the

CSHCN Screener was completed. The

screener was determined to be complete

if question CSHCN5_A (‘‘Has the

child’s emotional, developmental, or

behavioral problem lasted or is it

expected to last 12 months or longer?’’)

had a nonmissing value for that child or

had been appropriately skipped based on

response to question CSHCN5 (‘‘Does

the child have any kind of emotional,

developmental, or behavioral problem

for which he/she needs treatment or

counseling?’’).

This file includes the answers to the

CSHCN Screener as well as the child’s

age, sex, race, ethnicity, and state of

residence. Except for the household

identification number, the variables in

this file are limited to those assessed at

the child level. This file can be used to

produce estimates of the proportion of

children who have special health care

needs and for most demographic

characteristics of those children.

This file includes 371,617 records.

Of the original 372,698 completed

screening interviews, 1,081 interviews

were suppressed to protect the

confidentiality of households with

large numbers of children. Sampling

weights were adjusted to ensure

that estimates based on the screener

file were unchanged (see ‘‘Edits to

Protect Confidentiality’’ later in this

report).

Household File

This household-level file includes

data on households that completed the

CSHCN Screener. There is one record

for each household that completed the

screener, regardless of whether the

household had a special-needs child.

This file includes all information about

the household, including state of

residence, household size, total number

of CSHCN living in the household,

household income (reported relative to

the federal poverty level), and whether

the household is in a metropolitan

statistical area (MSA). All variables in

this file are at the household level. This

file can be used to produce estimates of

the proportion of households that

contain at least one child with special

health care needs and for characteristics

of those households. This file includes

196,159 records.

CSHCN Interview File

This child-level file includes data

for each child with special health care

needs who was randomly selected to be

the subject of the detailed special-needs

interview, and for whom an interview

was completed or partially completed.

Interviews were considered partially

complete if the health insurance section

(Section 7) had been completed. Not all

respondents for CSHCN selected for an

interview went on to complete or

partially complete an interview.

This file includes information from

the detailed interview, including the

relationship of the respondent to the

sampled child, family composition,

health and functional status, access to

care, experience with care, adequacy of

health insurance, and impact of the

special health care need on the family.

This file can be used to produce a wide

range of estimates of the health of

CSHCN. This file includes 40,242

records.

Linking Files

The three data files are linkable.

Every screened child’s household has a

corresponding record in the Household

File, regardless of whether a detailed
Page 26 [ Series 1, No. 57

interview was completed. Each

interviewed child’s household has a

corresponding record in the Household

File, and each interviewed CSHCN has

a corresponding record in the Screener

File. At the household level, the files

can be linked using IDNUMR, a unique

household identification number. All

files contain the IDNUMR variable. At

the child level, these files can be linked

using IDNUMXR, a unique child

identification number. The Screener File

and the CSHCN Interview File contain

the IDNUMXR variable.

Editing

The CATI system was designed to

perform edits as an interviewer enters

data into the computer system. To

prevent interviewer error, the CATI

system was developed to include range

checks and consistency checks. If an

interviewer entered a value that was ‘out

of range,’ a warning screen would

appear, instructing the interviewer that

the data would not be accepted and that

he or she would have to enter a

different answer (and possibly re-ask the

question). As a result, the CATI system

helped to correct respondent error

during the interview (for example, a

respondent saying two children lived in

the household, but providing only one

child’s age) and to identify and correct

data-entry error by interviewers (for

example, a child being reported to have

seen a doctor 4 times in the past year,

but the interviewer attempting to enter

44 times). To the extent possible without

making the CATI system overly

complicated, out-of-range and

inconsistent responses resulted in a

warning screen for the benefit of the

interviewer, who was trained to correct

errors as they occurred. These messages

were designed primarily to prevent

data-entry errors and respondent errors

and not to challenge respondents who

gave logically inconsistent responses.

Logically inconsistent responses given

by the respondent were left inconsistent.

Even with many built-in CATI

checks, data cleaning was still

necessary. The first step in the

data-cleaning process was verification of

the valid number of cases in the data

file. After verifying the number of cases,

initial data frequencies were produced

and reviewed. Each variable’s range of

permissible values was examined for

any additional invalid values or unusual

distributions. Invalid values, where they

occurred, were deleted. If blank values

already existed for a variable, they were

checked to see whether they were

allowable (e.g., due to legitimate skip

patterns in the questionnaire) or could

be easily corrected based on related

questions. Records that were missing

responses for unknown reasons were left

missing.

Missing Data

Missing data are not desirable when

doing analyses, and are often ignored

completely. However, it can be very

helpful to know why data are missing.

The SAS data files for NS-CSHCN

include special missing value codes for

analysts who may wish to differentiate

between different types of missing

values. The following key provides a

description of the various codes that

were used to represent missing data in

the file.

(.L) Legitimate skip—Variable is

missing due to valid questionnaire paths

based on a previous answer to a root

question.

(.P) Partially completed interview—

On the household and screener files,

variable is missing because the

respondent broke off after completing

the special-needs screener. On the

CSHCN interview file, the variable is

missing because the respondent ended

the interview after completing Section 7

but before completing the full interview.

(.M) Missing in error—Variable is

missing due to interviewer or system

errors. In cases of interviewer error, the

interviewer may have deleted the data

accidentally or simply may have not

entered the response. In cases of system

error, the data may not have been

collected or saved properly after it was

entered by the interviewer in the CATI

system.

(.A) Added question—Variable is

missing because this question was added

after the start of data collection and the

interview was conducted before the

question was added.

(.D) Deleted question—Variable is

missing because this question was

removed after the start of data collection

and the interview was conducted after

the question was deleted.

Because SAS treats all of the above

codes similarly in statistical analyses

(i.e., as missing data), analysts using

SAS who are not interested in the

reasons for the missing data may

continue to analyze data as usual.

It is important to note that derived

variables (i.e., variables whose response

was not directly provided by the

respondent) do not include the detailed

coding of missing data. All missing

values for derived variables received a

‘‘.M’’ code regardless of the reason for

the missing data. Similarly, ‘‘.M’’ was

used when derived variables were

suppressed to protect the confidentiality

of the survey participants.

Data missing because the

respondent did not know the answer or

refused to provide the answer have been

treated differently. Rather than assigning

a missing value to these records, a

numeric code was used to identify these

responses. Typically, unknown answers

are coded as ‘‘6,’’ ‘‘96,’’ or ‘‘996.’’

Refused responses are coded as ‘‘7,’’

‘‘97,’’ or ‘‘997.’’ However, the codes

may be different for specific variables;

therefore, analysts are encouraged to

consult the data documentation and

frequency lists to identify the correct

codes for each variable. Failure to do so

may result in inappropriate calculations,

especially for variables measured using

ordinal, interval, or ratio scales.

Coding of Verbatim

Answers Into Question

Responses

For some questions in the

NS-CSHCN interview, respondents

provided a response that did not match

any preexisting category. If this

occurred, the interviewer chose ‘‘other’’

and typed in the exact response

provided by the respondent. At the end

of the data-collection period, the

verbatim responses were recoded into

existing response categories where

appropriate. When necessary, new

response categories were added to the
Series 1, No. 57 [ Page 27

data file to capture the verbatim

responses. However, when a verbatim

response was unique (i.e., did not match

any existing response category or other

verbatim response), the response

remained coded as ‘‘other.’’ All variables

that were altered in any way during data

cleaning or editing were replaced with a

new variable with the letter ‘R’

appended to the variable name to denote

‘‘recode.’’

+	 Place of health provider (C4Q0BR,

C4Q0CR, C4Q02R, and

C4Q02_01R): Three new response

categories were used for back-coded

responses to these variables: places

a telephone call (hotline or nurse’s

line); mental health service provider

(counselor, therapist, or psychiatrist);

and alternative health care provider

(chiropractor, homeopath, or

naturopath).

+	 Reasons the sample child ([S.C.])

did not get certain services:

•	 C4Q05_1BR01 through
 

C4Q05_1BR16
 

•	 C4Q05_2BR01 through
 

C4Q05_2BR16
 

•	 C4Q05_31BR01 through
 

C4Q05_31BR16
 

•	 C4Q05_32BR01 through
 

C4Q05_32BR16
 

•	 C4Q05_4BR01 through
 

C4Q05_4BR16
 

•	 C4Q05_5BR01 through
 

C4Q05_5BR16
 

•	 C4Q05_6BR01 through
 

C4Q05_6BR16
 

•	 C4Q05_7BR01 through
 

C4Q05_7BR16
 

•	 C4Q06_1BR01 through
 

C4Q06_1BR16
 

•	 C4Q06_2BR01 through
 

C4Q06_2BR16
 

•	 C4Q06_3BR01 through
 

C4Q06_3BR16
 

Two new response categories were used

for back-coded responses to these

variables: child was too sick to go or

prioritized other treatments, and child’s

needs made it difficult to get treatment.

+	 Reasons [S.C.]’s health problems do

not currently cause (him/her)

difficulty (C3Q35AR): The root

question, C3Q35, has response

options of yes/no/don’t know/

refused. If the response was no,

respondents were asked to provide a

verbatim response at C3Q35A.

Verbatim responses were used in the

creation of a new variable,

C3Q35AR.

+	 [S.C.]’s personal doctor or nurse

type (C4Q02BR01 through

C4Q02BR07): One new response

category was used for back-coded

responses to this variable: mental

health professional.

+	 ADD or ADHD medication

type (C95Q01AR01 through

C95Q01AR18): Four new response

categories were used for back-coded

responses to this variable: Abilify,

Clonidine, Intuniv/Guanfacine/

Tenex, and Risperdal/Risperidone/

Risperidol.

+	 For respondents who did not choose

one of the preexisting categories for

the race and ethnicity questions

(C10Q31, C10Q32X01 through

C10Q32X08, and C10Q32A),

verbatim responses were used in the

creation of the variables RACER,

RACENAAN, RACEASIA, and

RACE_HI (see the ‘‘Race’’ section

below for descriptions of these

variables).

Edits to Protect

Confidentiality

NCHS takes extraordinary measures

to assure that the identity of survey

subjects cannot be disclosed. The risk of

inadvertent disclosure of confidential

information regarding individual

respondents is higher with a publicly

released data set having detailed

geography variables, a detailed and

extensive set of survey observations, and

a sizeable proportion of the total

population of interest. Coarsening a data

set by suppressing survey variables,

collapsing multiple variables into one,

collapsing response categories for other

variables, or introducing noise in the

data are common techniques to reduce

the risk of inadvertent disclosure.

In these data files, household

income has been suppressed, but a

measure of income relative to the

federal poverty level has been included.

The date of the interview and the child’s

age in months have been suppressed, but

the child’s age in years has been

reported. The relationship of the

respondent to the child has been

suppressed when the respondent was not

the parent of the child.

Geography

Geographic information that would

identify the specific estimation area in

states with multiple estimation areas has

been suppressed. However, state

identifiers are included in all sample

files.

In addition, an indicator identifying

whether the household is inside or

outside of an MSA has been included

for some states. This indicator, called

MSASTATR, was suppressed whenever

the sum total population for all the

MSA areas in a given state was less

than 500,000 persons, or the sum total

population for all the non-MSA areas in

a given state was less than 500,000

persons. This resulted in the suppression

of the MSA identifier in 16 states. The

MSA identifier was suppressed in Idaho,

Maine, and Montana because fewer than

500,000 persons lived in metropolitan

areas. The MSA identifier was

suppressed in Connecticut, Delaware,

Hawaii, Maryland, Massachusetts,

Nevada, New Hampshire, and Rhode

Island because fewer than 500,000

persons lived in non-MSAs. The MSA

identifier was suppressed in Alaska,

North Dakota, South Dakota, Vermont,

and Wyoming because the non-MSA

population size and the MSA population

size were both below the 500,000

threshold.

Race

Respondents were permitted to

identify all possible categories that

described the child’s race. If a race

other than one of the seven possible

response options was indicated, then a

verbatim response was captured.

Verbatim responses were reviewed and

matched against a database of

alternative race terminology maintained

by the U.S. Census Bureau. Where

possible, ‘‘other’’ race responses were

back-coded into one of the seven

existing categories. Once all possible
Page 28 [ Series 1, No. 57

verbatim responses were back-coded, a

new race variable was created by

collapsing the seven categories into one

of six categories: white, black or African

American, American Indian or Alaska

Native, Asian, Native Hawaiian or

Pacific Islander, and multiple race.

‘‘Multiple race’’ was reserved for those

cases where more than one of the other

five categories applied.

To protect the confidentiality of

individual respondents and children in

the public-use files, responses for the

race variable were further collapsed to

four categories: white only, African

American or black only, other race, and

multiple race. This ‘‘other race’’

category generally includes children for

whom only one of the other three

categories (Asian, American Indian or

Alaska Native, and Native Hawaiian or

Pacific Islander) was reported. The

‘‘other race’’ category also includes

cases where the verbatim response could

not be conclusively back-coded (e.g.,

American, Indian, or Jewish) and no

other race was reported. Children for

whom more than one race was identified

(e.g., Asian and Native Hawaiian) were

included in the ‘‘multiple race’’

category. If the respondent did not know

or refused to provide the race, then race

was coded as ‘‘.M’’. This new derived

race variable (called RACER) is the

only race classification available for all

50 states and DC.

In several states, however, minority

group populations are sufficiently large

that the release of additional race

categories was possible while still

protecting the confidentiality of the

respondents and children. To identify

these states, data from the 2009 ACS

were examined to identify minority

groups that comprise at least 5% of the

total population of children in a specific

state. Based on this criterion, the data

files identify American Indian and

Alaska Native children in Alaska,

Arizona, Montana, New Mexico, North

Dakota, Oklahoma, and South Dakota.

This race classification variable is called

RACENAAN. Asian children’s race is

reported for children in California,

Massachusetts, Minnesota, Nevada, New

Jersey, New York, Virginia, and

Washington. This race classification

variable is called RACEASIA. The data

files identify both Asian children and

Native Hawaiian and Pacific Islander

children in Hawaii. This race

classification variable is called

RACE_HI.

Language

To protect confidentiality,

Spanish-language households cannot be

distinguished from other non-Englishlanguage households in the data file. Of

the households with a non-English

language as the primary language,

69.2% lived in Spanish-language

households. Because Spanish-language

households are not identified in the data

file, language of non-English interviews

has also been suppressed.

Family Structure

To protect the confidentiality of

individual children whose families have

unique structural characteristics, a single

measure of family structure

(FAMSTRUCT) was created. The family

structure variable refers to parents living

in the household. This variable has four

levels: 1) two-parent household that

includes both a biological or adoptive

mother and a biological or adoptive

father; 2) two-parent household with

both a mother and a father that includes

at least one step-parent; 3) one-parent

household with a biological, step, foster,

or adoptive mother and no father of any

type present; and 4) all other family

structures. Any of these four family

structures may include other people who

act as parents, such as grandparents,

aunts, uncles, or unmarried partners of

the parents. Legal guardians were not

considered to be mothers or fathers.

Households identified as having

either two mothers or two fathers have

been classified as ‘‘other family

structure,’’ as have single-father

households (father present, no mother

present), nonparental caregiver

households (no mother or father

present), and foster households (either a

foster mother or foster father or both).

Other households with ambiguous

structure (e.g., where a father refused to

indicate whether he was the biological

father) were also coded as ‘‘other family

structure.’’

Number of Children in

Household

The CSHCN Screener data and

demographic information were collected

for every child in every household with

children. However, the information on

the total number of children in each

household significantly increases the

risk of inadvertent disclosure of

confidential information in households

with large numbers of children.

Therefore, the number of children

reported to be living in a household was

top-coded (i.e., the highest categories

were collapsed) to suppress the identity

of large households, with the specific

top code determined by state. To

determine the top code for a particular

state, weighted data from the 2009 ACS

were used to estimate the proportion of

households with children in each state

that include six children or more. If at

least one-half of 1% of the population

of households with children included six

children or more, then a top code of six

children was used for that state.

Otherwise, a top code of five children

was used. (In all states, at least one-half

of 1% of the population of households

with children included five children or

more.) This resulted in 16 states with a

top code of five children. To complete

the masking of households with a large

number of children, records in the

Screener File were suppressed at

random from these large households

until the apparent number of children in

these large households was five or six

(depending on the necessary top code

for the state). Only children who were

not the subject of a detailed specialneeds interview were eligible for

suppression. Less than one-half of 1%

of the records in the original Screener

File were suppressed.

Sampling weights for the remaining

records in the Screener File were

adjusted to ensure that estimates for the

prevalence of CSHCN in each state, and

for the prevalence of CSHCN from

large households in each state were

unchanged. Weights for the suppressed

records in each state were summed

based on the child’s special-needs

classification (i.e., with or without

special needs) and then redistributed by
Series 1, No. 57 [ Page 29

special-needs status to the screening

records that remained for the households

with large numbers of children in that

state. That is, weights for suppressed

CSHCN from large households were

reallocated to remaining CSHCN from

large households, and weights for

suppressed non-CSHCN from large

households were reallocated to

remaining non-CSHCN from large

households. This reallocation of weights

was accomplished using a ratio

adjustment for the weights of the

remaining records, with the exception

that weights for children who were the

subjects of a detailed CSHCN interview

were left unchanged.

Age

In these data files, the child’s age

(in completed years) at the time of the

interview has been reported. A risk of

inadvertent disclosure exists in

households with multiple children of the

same age (e.g., triplets or quadruplets)

and in households with multiple sets of

children of the same age (e.g., two sets

of twins). Randomly adding a year of

age to or subtracting a year of age from

randomly selected children in selected

households masked these records

(although a year of age was not

subtracted for any infants). Of the

households in the Household File, the

ages of children were adjusted in less

than one-quarter of 1% of households.

Other Edits to Protect

Confidentiality

Several other frequency variables

have been top-coded to suppress outliers

at the high end of the distribution of

responses. Due to their unusual

characteristics, records including these

outliers might have been more readily

identifiable.

+	 For number of days missed from

school due to illness or injury

(C3Q14R), 21 days or more is the

maximum reported, and responses

between 11 days and 20 days have

been collapsed into two categories

(11–15 and 16–20).

+	 For number of visits to the

emergency room in the past year

(C6Q00R), 14 visits or more is the

maximum reported.

+	 For the number of well-child

check-ups in the past year

(K4Q20R), 12 visits or more is the

maximum reported.

+	 For the number of visits to a dentist

for preventative dental care in the

past year (K4Q21R), 10 visits or

more is the maximum reported.

+	 For number of specialty doctors

visited within the past year

(C4Q05_2AAR), 10 specialists or

more is the maximum reported.

+	 For hours per week providing health

care at home for the child

(C9Q03R), 21 hours or more is the

maximum reported, and responses

between 11 hours and 20 hours have

been collapsed into a single

category.

+	 For hours per week arranging or

coordinating care for the child

(C9Q04R), 21 hours or more is the

maximum reported, and responses

between 11 hours and 20 hours have

been collapsed into a single

category.

+	 For the total number of adults living

in the households (TOTADULTR),

4 adults or more is the maximum

reported.

+	 For the education level of the parent

with the highest degree (EDUCR),

post-high school study is the

maximum reported, and other

responses have been collapsed into

two additional categories (less than

high school graduate, high school

graduate, or GED completed).

Data Perturbations

Despite the modifications detailed

above, there was lingering concern that

the data set might include children with

unique combinations of identifiable

characteristics. For example, some

CSHCN with specific combinations of

health conditions (based on questions in

Section 3) lived in households with

three siblings or more, some children

lived with an unusually large number of

adults, some children had unusual

combinations of race and household

size, and some children lived in

households that included five CSHCN

or more.

To address these concerns, less than

1% of children in the screener file had

household characteristics perturbed to

prevent disclosure. Perturbation could

include changing the sex of one child to

alter the sibling sex mix in the

household, randomly adding or

subtracting a year from one child’s age,

reducing the number of adults in the

household by one, or reducing the

number of children in the screener file.

(In these households, children were

deleted from the screener file, and their

weights were redistributed amongst the

remaining children with special health

care needs in that household. Children

with special health care needs that

completed the interview were excluded

from this deletion.)

Analysts interested in working with

data that were suppressed to protect

confidentiality may apply to access

unmodified data files through the NCHS

Research Data Center. This facility,

designed for the researcher outside of

NCHS, is located in Hyattsville,

Maryland. For more information about

how to apply for access, analysts may

visit the website at http://www.cdc.gov/

rdc/.

Derived Variables on

Screener File

AGE—If a child was first reported

in NIS, the respondent was asked for the

child’s date of birth. AGE_MOS and

AGE_YEARS calculate the child’s age

in months and years respectively, and

those calculations are based on the date

of birth reported the day the child was

determined to be eligible for the survey.

If the household first reported the child

in the NS-CSHCN survey, the

respondent was asked to report the

child’s age at questions AGE_1–AGE_9

(age value) and AGE1_1–AGE1_9

(months or years). If the child was

determined to be aged 0 years or 1 year,

the respondent was asked questions

AGE_1Y_1–AGE_1Y_9 to obtain the

child’s age in months. These variables

were used to code AGE, in single years.

Valid values for AGE are 0 through 17,

where ‘‘0’’ means under 1 year.

HISPANIC—This variable indicates

whether a child is of Hispanic, Latino,
Page 30 [ Series 1, No. 57

or Spanish origin. The variable includes

results of race back-coding and is based

on variable C10Q31 and race verbatim

variable C10Q32A. Respondents who

did not identify a Hispanic ethnicity

during administration of C10Q31, but

provided an answer indicating Hispanic

ethnicity as part of a verbatim response

to the race question were coded with a

value of ‘‘1’’ for the variable

HISPANIC.

INTVIEW—This variable indicates

whether a full interview (through

Section 7) was completed for the child.

NEEDTYPE—This variable is

based on CSHCN1–CSHCN5 (including

follow-up questions) and indicates

whether the child has special needs.

RACE, RACENAAN, RACEASIA,

and RACE_HI—These race

classification variables were derived

from data collected in variables

C10Q32X01 through C10Q32X08 and

race verbatim variable C10Q32A.

SEX—This indicator was created

from C2Q03_1 through C2Q03_9.

Derived Variables on

Household File

EDUCR—This variable reports the

highest level of school that any parents

in the household completed, based on

questions C10Q20, C10Q21, C10Q22,

and C10Q23. This is a three-category

variable: less than high school, high

school, or more than high school.

HHSTATUS—This variable

indicates whether the household

respondent completed a full interview

(through Section 7) on a selected child

with special needs.

MSASTATR—This indicator

identifying whether the household is

inside or outside of an MSA was

suppressed to protect confidentiality in

16 states.

NM_NSPR—This variable

represents the total number of children

in the household without a special

health care need. As noted previously,

some screener records have been

suppressed to protect the confidentiality

of large households. This variable is

based on the screener records that

remain, and therefore may be inaccurate

for large households.

NM_NSPFR—This variable

represents the total number of female

children in the household without a

special health care need. As noted for

NM_NSPR, this variable also may be

inaccurate for large households.

NM_NSPMR—This variable

represents the total number of male

children in the household without a

special health care need. As noted for

NM_NSPR, this variable also may be

inaccurate for large households.

NM_SPR—This variable represents

the total number of children in the

household with a special health care

need. As noted for NM_NSPR, this

variable also may be inaccurate for large

households.

NM_SPFR—This variable

represents the total number of female

children in the household with a special

health care need. As noted for

NM_NSPR, this variable also may be

inaccurate for large households.

NM_SPMR—This variable

represents the total number of male

children in the household with a special

health care need. As noted for

NM_NSPR, this variable also may be

inaccurate for large households.

OTH_LANGR—This variable is

based on LANG1 and indicates whether

the interview was conducted in a

language other than English.

PLANGUAGE—This variable is

based on the response to C10Q40, and

indicates the primary language spoken

in the home (English or other language).

POVERTY_LEVEL—This indicator

was created using total household

members (C10Q01) and the household

income value. If data for either of these

two components were missing, refused,

or had a ‘‘don’t know’’ response, this

measure was assigned a missing value

code. The household income value was

the actual dollar amount reported by a

respondent who reported an exact

household income (C11Q01). However,

when the respondent did not supply a

specific dollar amount for household

income, it was necessary to go through

a series (i.e., cascade) of questions

asking the respondent whether the

household income was below, exactly at,

or above threshold amounts

(C11Q01_REFUSED and W9Q03

through W9Q12A). If the respondent did

not complete the income cascade, either

because he or she refused or did not

know the answer to one of the cascade

questions, this measure was assigned a

missing value code. Once an income-tohousehold-size measure was computed,

it was compared with HHS Federal

Poverty Guidelines. More detail about

the development of this poverty

indicator is available in Appendix VI.

Missing values for this poverty indicator

were multiply imputed. Details about

the development of the imputed values

are included in Appendix XIV.

TOTADULTR—The total number

of adults in the household was derived

by subtracting the total number of

children in the household from the total

number of persons in the household

(C10Q01).

TOTKIDSR—This variable

represents the total number of children

aged 0–17 years in the household. As

noted for NM_NSPR, this variable also

may be inaccurate for large households.

TOTKIDSFR—This variable

represents the total number of female

children aged 0–17 years in the

household. As noted for NM_NSPR, this

variable also may be inaccurate for large

households.

TOTKIDSMR—This variable

represents the total number of male

children aged 0–17 years in the

household. As noted for NM_NSPR, this

variable also may be inaccurate for large

households.

Derived Variables on

CSHCN Interview File

Because the child’s type of health

insurance coverage could be reported

several ways within the health insurance

section of the questionnaire, a

categorical indicator (TYPEINS) has

been derived to simplify analyses of

coverage type. Because lack of health

care coverage could be reported several

ways, categorical indicators have been

derived also to simplify analyses of

uninsurance at the time of the survey,

uninsurance during the year prior to the

survey, and the length of the

uninsurance spell (for currently

uninsured children).
Series 1, No. 57 [ Page 31

MARCOH_PAR—This variable

indicates the marital or cohabitation

status of the child’s parent or parents

who live in the household, and is based

on variables C10Q10, C10Q10A,

C10Q11A, and C10Q12A.

MARCOH_RESP—This variable

indicates the marital or cohabitation

status of the respondent and is based on

variables C10Q10, C10Q10A,

C10Q11A, C10Q12A, C10Q13A, and

C10Q13C. This variable can be used to

impute a value for MARCOH_PAR for

cases for which no parents live in the

household. Due to how the questions

were asked, this variable is missing for

1,198 cases because one of the

following circumstances was true: the

respondent was not the mother, and the

mother lived in the household with no

father present; the respondent was not

the father, and the father lived in the

household with no mother present; or

the respondent was neither the mother

nor the father, and both mother and

father lived in the household. For those

cases, the respondents were asked about

the marital or cohabitation status of the

child’s parents, not about their own

marital or cohabitation status.

(Additional missing values are due to

partial interviews, don’t know responses

or refusals to answer questions, or

system errors.)

MARSTAT_PAR—This variable

indicates the legal marital status of the

child’s parent or parents who live in the

household, and is based on variables

C10Q10, C10Q11A, and C10Q12A.

MARSTAT_RESP—This variable

indicates the legal marital status of the

respondent and is based on variables

C10Q10, C10Q11A, C10Q12A, and

C10Q13A. This variable can be used to

impute a value for MARSTAT_PAR for

cases for which no parents lived in the

household. This variable is missing for

1,198 cases, for the same reasons

described above for MARCOH_RESP.

MS_UNINS—This variable, which

indicates the number of months without

coverage during the 12 months prior to

the survey, was derived from C7Q11,

C7Q12, C7Q13, and C7Q14. This

variable was not ascertained if the

respondent reported an insurance type

that was not considered comprehensive

insurance (e.g., by reporting Indian

Health Service coverage at C7Q10_06,

by reporting a single-service plan at

C7Q10_08, or by reporting

noncomprehensive health insurance at

C7Q10B that could not be classified as

comprehensive). If a child was

uninsured for less than 1 month,

MS_UNINS was set to 1 month. If a

child was under age 12 months and was

uninsured for his or her entire lifetime,

MS_UNINS was set to 12 months.

RELATION—This variable is based

on C10Q02A and describes the

relationship of the respondent to the

child selected for the interview.

TYPEINS—This variable, which is

a categorical indicator of health

insurance coverage type, was derived

from questions in Section 7. Private

coverage could be reported directly

(C7Q03A or C7Q08B) or by responding

yes to both C7Q10X07 and C7Q10B. To

be included, the reported private

insurance was required to cover both

doctor visits and hospital stays. Military

health care was considered to be

comprehensive private coverage.

Military health care coverage could be

reported directly (C7Q05) or by

responding yes to both C7Q10X05 and

C7Q10B. Public health insurance

includes Medicaid, Children’s Health

Insurance Program (CHIP), Medicare,

and Medigap coverage. Medicaid

coverage could be reported directly

(C7Q01) or by responding yes to both

C7Q10X01 and C7Q10B. CHIP

coverage could be reported directly

(C7Q02) or by responding yes to both

C7Q10X03 and C7Q10B. Medicare and

Medigap could be reported by

responding yes to either C7Q10X02 or

C7Q10X04, as well as C7Q10B. Public

health insurance also could be reported

directly at C7Q04, which is a single

question about both Medicaid and CHIP

coverage (see Appendix VII). Indian

Health Service coverage (C7Q10X06)

was not considered to be public or

comprehensive health insurance.

UNINS_YR—This variable

indicates that the child was uninsured at

the time of the survey or at some time

during the 12 months prior to the

survey.

UNINS—This variable indicates

that the child was uninsured at the time

of the survey. A value of 1 for this

variable indicates that the respondent

did not report any insurance coverage,

reported coverage but indicated that it

was not comprehensive, or reported only

Indian Health Service coverage or single

type of insurance. A value of 0 for this

variable indicates that the respondent

did report comprehensive insurance

coverage.

YS_UNINS—This variable, which

indicated the number of years since an

uninsured child was last insured, was

derived from C7Q13. This variable was

not ascertained if MS_UNINS was not

ascertained, and this variable is missing

for children who are currently insured

and for children who have been

uninsured for less than 12 months.

There is one exception: If a child

was under age 12 months and was

uninsured for his or her entire lifetime,

YS_UNINS was set to ‘‘never

insured.’’

Dummy Variables

When respondents were permitted

to provide multiple answers for the

same question, a variable was created

for each possible answer. The values for

these new dummy variables are ‘‘yes,

this answer was given’’ and ‘‘no, this

answer was not given.’’ When

respondents could not or did not provide

an answer to the question, a value of

‘‘don’t know’’ or ‘‘refused’’ was

reported for each of the dummy

variables.

+	 C10Q02B is represented by dummy

variables C10Q02BX01 through

C10Q02BX26.

+	 C10Q32 is represented by

C10Q32X01 through C10Q32X08.

+	 C4Q02B is represented by

C4Q02BX01 through C4Q02BX07.

+	 C4Q05_1B is represented by

C4Q05_1BX01 through

C4Q05_1BX16.

+	 C4Q05_2B is represented by

C4Q05_2BX01 through

C4Q05_2BX16.

+	 C4Q05_31B is represented by

C4Q05_31BX01 through

C4Q05_31BX16.

+	 C4Q05_32B is represented by

C4Q05_32BX01 through

C4Q05_32BX16.
Page 32 [ Series 1, No. 57

+	 C4Q05_4B is represented by

C4Q05_4BX01 through

C4Q05_4BX16.

+	 C4Q05_5B is represented by

C4Q05_5BX01 through

C4Q05_5BX16.

+	 C4Q05_6B is represented by

C4Q05_6BX01 through

C4Q05_6BX16.

+	 C4Q05_7B is represented by

C4Q05_7BX01 through

C4Q05_7BX16.

+	 C4Q06_1B is represented by

C4Q06_1BX01 through

C4Q06_1BX16.

+	 C4Q06_2B is represented by

C4Q06_2BX01 through

C4Q06_2BX16.

+	 C4Q06_3B is represented by

C4Q06_3BX01 through

C4Q06_3BX16.

+	 C5Q16 is represented by C5Q16X01

through C5Q16X11.

+	 C7Q10 is represented by C7Q10X01

through C7Q10X09.

+	 C7Q15 is represented by C7Q15X01

through C7Q15X09.

+	 C95Q01A and GOGETMED_OTH

are represented by C95Q01AX01

through C95Q01AX18.

+	 K2Q46C is represented by

K2Q46CX01 through K2Q46CX04.

+	 LANG2 is represented by

LANG2X01 through LANG2X14.

Additional Data Notes

The follow-up income cascade

questions W9Q12 and W9Q12A have

438 and 1,067 missing in error values,

respectively. It was discovered in

February 2010 that the Poverty

Reference Table being used by the CATI

instrument was the 2008 poverty table,

used during the 2009–2010 NS-CSHCN

pretest. As a result, W9Q12 and

W9Q12A were being asked based on

2008 poverty values for Quarter 3, 2009

through the beginning of Quarter 1,

2010. The 2009 Poverty Reference

Table was deployed as soon as possible

on February 18, 2010. As a result of this

error, some values of W9Q12 and

W9Q12A were lost and were set to

missing in error.

States were categorized into

program type groupings based on

whether each state’s CHIP was a

Medicaid expansion program, a separate

program, or a combination program

(part expansion or part separate).

Maryland was categorized as a

combination state, which meant that

separate questions were asked for

Medicaid and CHIP. However,

Maryland discontinued its separate

CHIP program in 2007, so analysts

using NS-CSHCN 2009–2010 data for

estimates of CHIP will inadvertently

include Maryland in their analyses.

Analysts should blank out Medicaid

responses (C7Q01) and CHIP

responses (C7Q02) for Maryland and

‘‘create’’ C7Q04, which would be

YES if either Medicaid or CHIP was

YES.

Procedures for

Developing Sampling

Weights

This section provides a nontechnical

overview of the weighting procedures

for the 2009–2010 NS-CSHCN. A more

detailed and technical description can be

found in Appendix I.

Household-screener Weight

A household weight was generated

for analysis of households that

completed a screening interview. For

example, analysis of the proportion of

households with CSHCN would use the

household-screener weight. The steps to

create this weight consist of the

calculation of a base sampling weight,

adjustments for household-level

nonresponse, an adjustment for multiple

telephone lines, and an adjustment for

combining landline and cell samples.

This weight is poststratified so that the

sum of the household weights for each

state matches the number of households

with children, as projected from 2009

ACS population estimates. As only 2

quarters of data were collected for the

cell sample while 6 quarters of data

were collected for the landline sample,

household weights were derived

separately by sample type.

Base Sampling Weights

The landline and cell-phone lines

selected for screening for the 2009–2010

NS-CSHCN represent a random sample

of all possible landline numbers in

banks of telephone numbers containing

at least one residential-listed number in

each geographic area, and all possible

cell-phone lines in each geographic area,

respectively. The probability that any

given landline or cell-phone line will be

selected from the population of all

possible landline and cell-phone lines

can be calculated by dividing the

number of telephone lines selected for

the study by the total number of

telephone lines in a given sampling area

by sample type (landline or cell phone).

Each landline or cell-phone line

selected for the 2009–2010 NS-CSHCN

represented some larger number of

telephone lines in the geographic area.

This number can be calculated as the

inverse of the probability of selection

for any telephone line within sample

type. This number is the base weight

that is associated with each completed

household screening interview in that

geographic area within sample type.

Adjustment for Unknown

Household Status

When the selected landline and

cell-phone numbers were called, some

numbers could not be resolved as

representing known households or

known nonhouseholds because the

telephone rang without an answer, the

person answering the telephone hung up

immediately, or the telephone-answering

device did not indicate whether the

telephone line belonged to a household.

The weights for the completed

household screening interviews must

be adjusted to also represent the

households in this unknown category.

This adjustment is made separately for

the landline and cell-phone samples by

proportionately increasing the weights

for those screening interviews that

could be completed so the completed

screening interviews also represent

the households in the unknown

category.
Adjustments for Unknown

Household Eligibility

Cell-phone sample cases were

screened to include only those numbers

that were associated with households

where no landline was present [cell

phone only (CPO)] or where the

respondent was unlikely to answer the

landline [cell phone mainly (CPM)].

When a cell sample household was

identified, some screening interviews

were not completed, and the eligibility

of the household was unknown. The

weights for the completed cell sample

household-screening interviews must be

adjusted to also represent the CPO or

CPM (CPO/M) households in this

unknown category. This adjustment is

made by proportionately increasing the

weights for those screening interviews

that could be completed, so the

completed interviews also represent the

CPO/M households in the unknown

category.

When a household was identified

for the landline sample or a CPO/M

household was identified for the cell

sample, the household was screened for

the presence of children. Some

screening interviews were not

completed, and the eligibility of the

household was unknown. The weights

for the completed household-screening

interviews must be adjusted to also

represent the age-eligible households in

this unknown category. This adjustment

is made by proportionately increasing

the weights for those screening

interviews that could be completed, so

the completed screening interviews also

represent the age-eligible households in

the unknown category.

Adjustment for unknown

special-needs eligibility

When an age-eligible household

was identified, some CSHCN Screeners

were not completed. The weights for the

completed household-screening

interviews must be adjusted to also

represent the households in the

incomplete category. This adjustment is

made by proportionately increasing the

weights for those screening interviews

that could be completed. The completed

screener interviews thus also represent

the age-eligible households with

incomplete CSHCN Screeners.

Adjustment for Households

With Multiple Telephone

Lines

Among the households that

completed the CSHCN Screener within

the cell sample, some reported more

than one cell-phone line for personal use

by adults. An adjustment to the weight

is required for these households to

compensate for their multiple chances of

selection. This adjustment divides the

screener weight by the number of

personal cell-phone lines used by adults

in the household. A similar adjustment

is not made for the landline sample,

because the prevalence of households

with multiple landlines is small, and a

question about the number of landlines

in the household was not asked.

Adjustments for Combined

Landline and Cell-phone

Samples and for

Noncovered Populations

The household weights for

households with a complete specialhealth-care-needs screener were adjusted

within each state and DC to accomplish

three goals:

1.Adjustment for noncoverage of

age-eligible children

2.Adjustment for overlap of the

landline and cell-phone samples

3.Attenuation of cell sample weights

to minimize variance while

controlling for bias

Adjustment for noncoverage of

age-eligible children

A Keeter adjustment (26) was

implemented to adjust weights to

account for households with children not

covered by the combined landline and

cell-phone samples (i.e., households

without telephones). In the Keeter

adjustment, weights for landline

households with an interruption in

telephone service are adjusted to also

represent phoneless households with

children. The method is based on

Series 1, No. 57 [ Page 33

empirical evidence suggesting that

phoneless households are more similar

to landline households with an

interruption in telephone service than to

landline households without an

interruption with respect to the variables

under study (26,27).

Adjustment for overlap of the

landline and cell-phone samples

The landline sample included dual

landline and cell-phone households

while the cell-phone sample included

dual landline and cell-phone households

self-identifying as CPM households

(those unlikely to receive a call on the

landline). Thus, when combining the

landline and cell samples, the weights

for CPM households must be adjusted

so the sum of the adjusted weights

across landline and cell-phone samples

provides an appropriate estimate of

CPM households. The method used to

achieve this is described in Appendix I.

Attenuation of cell sample

weights to minimize variance

while controlling for bias

Because the cell-phone sample was

sampled at a lower fraction of the

population and was fielded in only

2 quarters (rather than 6 quarters as for

the landline sample), the cell-phone

sample base weights are larger than the

landline base weights. Thus, variability

associated with the CPO portion of

estimates would tend to be large and

would adversely affect the precision of

the overall estimates. Attenuating the

CPO sample weights serves to decrease

variability; however, this requires

increasing the weight associated with

other sample cases, which can increase

bias.

Attenuation of the CPO sample

weights was achieved by compositing

the CPO sample with landline sample

cases deemed ‘‘similar’’ to CPO sample

cases, to represent the full CPO

population (28). Landline sample cases

predicted as having a relatively large

likelihood of being similar to CPO cases

serve as proxy CPO sample cases to be

weighted along with true CPO sample

cases to represent the total CPO

population. Because CSHCN interview
Page 34 [ Series 1, No. 57

variables are included in the logistic

regression model predicting similarity,

the identified proxy CPO sample cases

are expected to have low bias, relative

to the true CPO sample cases. The

resulting adjusted survey weights yield

minimum mean-squared error (MSE)

estimates. This proxy method of

attenuating the weights is described in

more detail in Appendix I and in a

proceedings paper documenting the

development of the method (28). A ratio

adjustment was implemented to adjust

the weights to population controls for

the residual set of landline households

with children. Separate adjustments were

carried out for landline-only households

and for combined landline-mostly and

landline-or-cell-mixed households.

Raking Adjustment of

Household Weight

Despite the weighting efforts and

the nonresponse adjustments, the

estimated number of households with

children is unlikely to perfectly match

the population totals. Any discrepancies

are likely due to random sampling error

and nonrandom response biases. Raking

adjusts the weights to match population

control totals for key sociodemographic

information obtained from external

sources. For NS-CSHCN, the

independent sources were the 2009

ACS and the 2009 NHIS. Control totals

were used for raking adjustment within

each state and DC, based on race and

ethnicity, number of children in the

household, household income, the

highest reported education in the

household, age of the oldest adult in

the household, telephone status, and

whether the housing unit was rented or

owned.

The various adjustments in previous

steps occasionally made some weights

substantially larger than other weights.

These extremely large weights were

truncated to prevent a small number of

cases with large weights from having

undue influence on the estimates. The

weights after truncation were raked

again and the process of truncation and

raking repeated several times to ensure

that the sum of final household weights

matched the control totals. Details on

the truncation of weights can be found

in Appendix I.

Child-screener Weight

A child-screener weight was

generated for analysis of information

available from the screening interview.

For example, the proportion of CSHCN

among all children nationally (or in each

state) would be weighted using the

child-screener weight. Demographic

information and information regarding

special health care needs status was

collected for each resident child. The

weight for screened children began with

the final household weight but was

adjusted so that the final child-screener

weight summed to the number of

children in the nation, as estimated from

the annual population estimates

published by the 2009 ACS.

Raking Adjustment of

Child-screener Weight

Despite the weighting efforts and

the nonresponse adjustments, the

estimated number of children is unlikely

to match the population totals. Any

discrepancies are likely to be due to

random sampling error and nonrandom

response biases, such as differential

nonresponse based on age, sex, or race

of the child. For the child-screener

weight, the independent source for the

population control totals was the 2009

ACS. The child-screener weights were

adjusted so that the sum of the weights

equaled control totals within each state

and DC, based on sex, age, race and

ethnicity, number of children in the

household, household income, highest

reported education in the household,

telephone status, and whether the

housing unit was rented or owned.

The various adjustments in previous

steps occasionally made some weights

substantially larger than other weights.

These extremely large weights were

truncated to prevent a small number of

cases with large weights from having

undue influence on the estimates. The

weights after truncation were raked

again and the process of truncation and

raking repeated several times to ensure

that the sum of final child-screener

weights matched the control totals.

Details on the truncation of weights can

be found in Appendix I.

Child-interview Weight

A child-interview weight was

generated for analysis of information

available from the interview. For

example, the proportion of CSHCN

with insurance or the proportion of

CSHCN with barriers to needed care

would be weighted using the

child-interview weight. This weight

began with the final raked adjustedscreener weight. This weight was

adjusted for the number of CSHCN in

the household and for interview

nonresponse.

Adjustment for MultipleCSHCN Households

One child with special health care

needs was randomly selected from

among all children with special needs in

the household. In households with

multiple eligible CSHCN, the randomly

selected child represents all of the

CSHCN in the household. Therefore, the

sampling weight for this completed

interview must be increased to reflect

the fact that this completed interview

represents multiple children in that

household. This adjustment multiplies

the adjusted child-screener weight by

the number of eligible children with

special needs in the household.

Adjustment for

Nonresponse to the

NS-CSHCN Interview

When a child with special health

care needs was randomly selected, some

interviews were not completed. The

weights for the completed child

interviews must be adjusted to also

represent the children who were selected

but for whom an interview was not

completed. This adjustment is made by

proportionately increasing the weights

for those interviews that could be

completed. The completed interviews,

therefore, also represent the sample

children with incomplete interviews.
Optimized Combined

Landline and Cell-phone

Sample

The CSHCN interview nonresponse

weights were reoptimized to account for

the combination of landline and

cell-phone samples prior to final taking

adjustments. Optimization applied to the

CPO and CPM populations and was

carried out in an analogous manner to

that performed at the household level.

Adjustment for overlap of the

landline and cell-phone samples

The CSHCN interview weights for

children in CPM households were

adjusted so the sum of the weights

across landline and cell-phone samples

provides an estimate for children in

CPM households. The composite

adjustment factor is derived based upon

the variance and bias associated with the

component estimates. The resulting

adjusted survey weights yield minimum

(MSE) estimates.

Attenuation of cell sample

weights to minimize variance

while controlling for bias

The CSHCN interview nonresponse

adjusted weights for children in CPO

households and children in proxy CPO

households were adjusted so the sum of

the adjusted weights across landline and

cell-phone samples provides an MSE

estimate for children in CPO

households. Further information about

the attenuation methods is provided in

Appendix I and in a paper documenting

the development of the method (28).

Raking Adjustment of

Child-interview Weight

The child-interview weight was

once again raked to estimated

population control totals. The

demographic subgroups used as

population control totals for the raking

adjustment to the child-interview

weights were similar to the demographic

subgroups used for the raking

adjustment of the child-screener

weight.

The various adjustments in previous

steps occasionally made some weights

substantially larger than other weights.

These extremely large weights were

truncated to prevent a small number of

cases with large weights from having

undue influence on the estimates. The

weights after truncation were raked

again and the process of truncation and

raking repeated several times to ensure

that the sum of final child-interview

weights matched the control totals.

Details on the truncation of weights can

be found in Appendix I.

Quality Control

Staff compared the formulas for the

weights and adjustments developed by

the sampling statistician with the actual

weights and adjustments constructed by

the statistical programmer. Thorough

review of both programs and data

outputs were reviewed by senior

statisticians for accuracy. In addition,

univariate statistics were produced and

reviewed for the adjustments and

weights.

Estimation and

Hypothesis Testing

NS-CSHCN data were obtained

through a complex sample design

involving clustering of children within

households, stratification of households

within states, and separate sample

frames for landline and cell-phone

numbers. To produce estimates that are

representative of children nationally and

within each state, sampling weights

must be used. These sampling weights

account for the unequal probability of

selection of each household and child,

and they include adjustments for

multiple-telephone households, unit

nonresponse, and noncoverage of

nontelephone households, as well as

adjustments to known population control

estimates.

As described earlier, three sampling

weights have been developed for

interviews from NS-CSHCN. These

weights should be used for both national

and state-level analyses of the

prevalence of special health care needs

Series 1, No. 57 [ Page 35

and the characteristics of CSHCN.

Household weight (WEIGHT_H)—

This weight is on the Household File

and is used to produce estimates that are

representative of households with

children nationally and within each

state. A household weight has been

associated with every age-eligible

household screened for CSHCN

regardless of whether a detailed

special-needs interview has been

completed. This weight should be used

only when the unit of analysis is the

household.

Screener weight (WEIGHT_S)—

This weight is on the Screener File and

is used to produce estimates that are

representative of children nationally and

within each state. A screener weight has

been associated with every child

screened for special needs, regardless of

whether a detailed special-needs

interview has been completed. This

weight should be used only when the

unit of analysis is the child and the data

analyzed come solely from the Screener

File and the Household File.

Interview weight (WEIGHT_I)—

This weight is on the CSHCN Interview

File and is used to produce estimates

that are representative of CSHCN

nationally and within each state. An

interview weight has been associated

with all CSHCN who have completed or

partially completed interviews. This

weight should be used only when the

unit of analysis is the child with special

health care needs and the data analyzed

include variables that are on the

CSHCN Interview File.

Interpretation of Weighted

Estimates

Estimates based on the screener

weights generalize only to the U.S.

noninstitutionalized population of

children aged 0–17. Estimates based on

the interview weights generalize only to

the U.S. noninstitutionalized population

of CSHCN aged 0–17. These estimates

do not generalize to the population of

parents, the population of mothers, or

the population of children’s health care

providers.

Two examples may help make this

distinction clearer. Weighted estimates
Page 36 [ Series 1, No. 57

based on question C4Q07 can be

interpreted as the proportion of CSHCN

whose parents or guardians experienced

difficulties getting referrals for the child,

but they should not be interpreted as the

proportion of parents who experienced

difficulties getting referrals. Similarly,

weighted estimates based on C6Q0A_E

can be interpreted as the proportion of

CSHCN aged 12–17 whose doctors have

talked about health insurance, but they

should not be interpreted as the

proportion of parents who have talked

about health insurance with their

children’s doctors, or as the proportion

of doctors who have talked about health

insurance with older CSHCN.

Data users should note that it is not

possible to create accurate estimates for

the landline and cell-phone populations

separately, and the data files cannot be

used to compare children from CPO

households with children from landline

households. This is because households

in the cell-phone sample include

households that have landlines but

report that they are unlikely to be

reached on them. In addition, the

weights for the cell-phone sample were

attenuated to minimize variance. Proxy

cases from the landline sample were

assigned a portion of the household

weight associated with the cell-phone

population. Therefore, limiting the

analysis to either the landline or

cell-phone sample cases only will

misrepresent the populations and give

erroneous weighted estimates.

Analysts should avoid using the

child-interview weights to directly

estimate the population number of

CSHCN with a certain characteristic.

The sum of the interview weights does

not equal the sum of the screener

weights for CSHCN. That is, the

estimated total number of CSHCN based

on the interview weight does not equal

the estimated total number of CSHCN

based on the screener weight. These

totals were equal in the 2001 and

2005–2006 iterations of the survey, but

for 2009–2010, the weighting

procedures were modified such that the

final child-interview weight was raked

to population control totals based on a

subsampling weight (see Appendix I)

rather than the screener weight. Because

the subsampling weight included an

adjustment factor that was capped to

reduce design effects, raking to control

totals based on the subsampling weight

rather than to control totals based on the

screener weight results in the sum of the

child-interview weights being slightly

smaller than the sum of child-screener

weights for CSHCN.

Practically, this change had little

impact on estimates of key indicators of

health and health care access and

utilization. Analyses suggest that, had

the 2001 or 2005–2006 raking

procedures been used for the 2009–2010

survey, the largest differences in

proportions at the state level would be

less than one-third the width of the 95%

confidence intervals based on potential

sampling error, and these differences

would not be in a consistent direction.

However, differences in weighted counts

of CSHCN at the national and state

levels would generally be slightly lower

with the 2009–2010 weighting approach

than with the 2001 or 2005–2006

weighting approach. Therefore, analysts

interested in estimating the weighted

number of CSHCN with certain

sociodemographic characteristics are

strongly encouraged to use the screener

weights (rather than the interview

weights) for such analyses. Analysts

interested in estimating the weighted

number of CSHCN with other

characteristics only available on the

interview file should obtain this estimate

by multiplying the weighted

proportional estimate based on the

interview weights and the weighted

number of CSHCN in the population of

interest based on the screener weights.

For example, an analyst can obtain a

proportional estimate of uninsurance for

CSHCN in Nebraska from the interview

file and an estimate of the number of

CSHCN in Nebraska from the screener

file, and that analyst can then multiply

these two estimates to obtain an

estimated number of CSHCN in

Nebraska who are uninsured.

Variables Used for

Variance Estimation

The sample design of NS-CSHCN

is complex, and the household records

and the child-level screener and

interview records have unequal weights.

Therefore, statistical software programs

that assume simple random sampling

will most often compute standard errors

that are too low. Tests of statistical

hypotheses may then suggest statistically

significant differences or associations

that are misleading. However, computer

programs are available that provide the

capability of variance estimation for

complex sample designs (e.g.,

SUDAAN, Stata, and WesVar). In order

to provide the user with the capability

of estimating the complex sample

variances for the NS-CSHCN data, sample

type and stratum identifiers and primary

sampling unit (PSU) codes on the data

files have been provided. These variables

and the sample weights are necessary to

properly calculate variances.

The stratum identifiers reported on

the data set are not identical to the strata

used to draw the main sample. In states

with multiple estimation areas,

independent samples were selected from

each estimation area in proportion to the

total number of households with

children in each estimation area.

Therefore, these estimation areas should

be considered strata for variance

estimation. However, disclosure of the

specific estimation area for each child

(even if the code were scrambled) could

increase the risk of disclosure of a

respondent’s identity. In the absence of

estimation area-specific identifiers, data

users should use the state identifier

(STATE) as the stratum identifier. By

using the state identifier rather than the

suppressed estimation area identifier, the

standard errors for national and state

estimates with key variables are affected

only slightly, and not in a consistent

direction. The PSU for NS-CSHCN is the

household and is represented on the data

sets by the unique household identifier,

IDNUMR. The sample type (landline or

cell phone) is represented on the data sets

by the identifier SAMPLE.

The overall number of persons in

this survey is sufficient for most

statistical inference purposes. However,

analyses of some rare responses and

analyses of subclasses can lead to

estimators that are unreliable. Small

sample sizes used in the variance

calculations may also produce unstable

estimates of the variances.
Series 1, No. 57 [ Page 37

Consequently, these analyses require that

the user pay particular attention to the

variability of estimates of means,

proportions, and totals.

Variance Estimation Using

SUDAAN or Stata

Standard errors of estimates from

NS-CSHCN can be obtained using the

Taylor series approximation method,

available in software such as SUDAAN,

SAS, and Stata. The state and sample

type should be identified as stratum

variables, and the household should be

identified as the PSU.

The simplifying assumption that

PSUs have been sampled with

replacement allows most complex

survey sample design computer

programs to calculate Taylor series

standard errors in a straightforward way.

This method requires no recoding of

design variables, but is statistically less

efficient (and therefore more

conservative) than some other methods

because the PSU unit is treated as being

sampled with replacement within the

stratum unit. For SUDAAN, the data

file needs to be sorted by stratum

(STATE), sample type (SAMPLE), and

PSU (IDNUMR). The default number of

stratum and PSU variables to be

included in the NEST statement is two;

because there are three such variables

here, the PSULEV statement is included

to indicate that PSU is the third variable

in the list. The following SUDAAN

design statements are then used for

analyses at the household level:

PROC . . . DESIGN = WR;

NEST STATE SAMPLE IDNUMR

/ PSULEV = 3;

WEIGHT WEIGHT_H;

For Stata, the following design

statements are used. Because Stata only

allows for a single strata variable,

STATE and SAMPLE should first be

combined into a single variable with

(51*2 = 102) levels (here called

STATESAMP):

svyset strata STATESAMP

svyset psu IDNUMR

svyset pweight WEIGHT_H

svyset

For analyses of the Screener File data at

the child level, replace ‘‘WEIGHT_H’’

with ‘‘WEIGHT_S.’’ For analyses of the

CSHCN Interview File data, replace

‘‘WEIGHT_H’’ with ‘‘WEIGHT_I.’’

Other variance estimation

procedures are also applicable to

NS-CSHCN. Specifically, the jackknife

method with replicate weights and the

bootstrap resampling method with

replicate weights can also be used (via

software such as WesVar) to obtain

standard errors that fully reflect the

impact of the weighting adjustments on

standard errors.

Variance Estimation for

Subsets of Data

Many analyses of NS-CSHCN data

will focus on specific population

subgroups, such as CSHCN in only one

state or CSHCN living in poverty. Some

analysts will therefore be tempted to

delete all records outside of the domain

of interest in order to work with smaller

data files and run computer jobs more

quickly. This procedure of keeping only

selected records and list-wise deleting

other records is called subsetting the

data. Subsetted data that are appropriately

weighted can be used to generate correct

point estimates (e.g., estimates of

population subgroup frequencies or

means), but many software packages that

analyze complex survey data will

incorrectly compute standard errors for

subsetted data. When complex survey data

are subsetted, the sample design structure

is often compromised because the

complete design information is not

available. Subsetting the data can delete

important design information needed for

variance estimation (e.g., deleting all

records for certain subgroups may result

in entire PSUs being removed from the

design structure).

The NS-CSHCN sample was

designed to provide independent data

sets for each of the 50 states and DC.

Subsetting the survey data to a

particular state does not compromise the

design structure of the survey. That is,

standard errors calculated in SUDAAN

for a particular state will not be affected

if the data set has been subsetted to that

particular state.

However, subsetting to specific

population subgroups (within or across

states) can result in incorrect standard

errors. For example, subsetting the data

to those CSHCN who live in poverty

within a specific state will result in

standard errors being calculated

incorrectly. Typically, the standard errors

for subsetted data will be inflated,

resulting in a higher probability of

type-II error (i.e., failing to detect

significant differences that do in fact

exist). SUDAAN has a SUBPOPN

option that allows the user to target

specific subpopulations for analysis

while retaining the full unsubsetted data

set that includes the full sample design

information; Stata has a similar option

called SUBPOP. Analysts interested in

specific population subgroups must use

these subpopulation options rather than

subsetting the data sets.

Weighted Frequencies,

Prevalence Estimates, and

Standard Errors

Weighted frequencies of the number

of households having a child with

special health care needs and the

number of CSHCN by state appear in

Appendix XV. Prevalence estimates and

standard errors are also provided.

Analysts may wish to replicate these

tables to determine if they are using the

weights correctly.

Weighted frequencies, prevalence

estimates, and standard errors for other

survey measures are available from the

Data Resource Center for Child and

Adolescent Health. This online center is

led by the Child and Adolescent Health

Measurement Initiative at Oregon Health

and Science University and is supported

through a cooperative agreement with

MCHB. The data resource center is

accessible at http://www.cshcndata.org.
Page 38 [ Series 1, No. 57

Guidelines for Data

Use

With the goal of mutual benefit,

NCHS requests that recipients of data

files cooperate in certain actions related

to their use.

Any published material derived

from the data should acknowledge

NCHS as the original source. The

suggested citation, ‘‘Data Source:

Centers for Disease Control and

Prevention, National Center for Health

Statistics, National Survey of Children

with Special Health Care Needs,

2009–2010,’’ should appear at the

bottom of all tables and figures.

Published material derived from the data

also should include a disclaimer that

credits the author, not NCHS, with any

analyses, interpretations, or conclusions

reached. NCHS is responsible only for

the initial data. Consumers who wish to

publish a technical description of the

data should make a reasonable effort to

ensure that the description is not

inconsistent with that published by

NCHS.

CIPSEA and the Public Health

Service Act (Section 308d) provide that

these data collected by NCHS may be

used only for the purpose of health

statistical reporting and analysis. Any

effort to determine the identity of any

reported case is prohibited by these

laws. NCHS takes extraordinary

measures to assure that the identity of

survey subjects cannot be disclosed. All

direct identifiers, as well as any

characteristics that might lead to

identification, have been omitted from

the data set. Any intentional

identification or disclosure of a person

or establishment violates the assurances

of confidentiality given to the providers

of the information. Therefore, users

must:

+	 Use the data in this data set for

statistical reporting and analysis

only

+	 Make no use of the identity of any

person discovered, inadvertently or

otherwise, and advise the NCHS

Director of any such discovery

(301–458–4500)

+	 Not link this data set with

individually identifiable data from

any other NCHS or non-NCHS data

sets

Use of the data set signifies users’

agreement to comply with the

above-stated, statutory-based

requirements.

Further Information

Data users can obtain the latest

information about SLAITS by

periodically checking the SLAITS

website at http://www.cdc.gov/nchs/

slaits.htm. This site features

downloadable data files and

documentation for SLAITS modules, as

well as important information about any

modifications and updates to data or

documentation. Data users also will find

current contact information if they have

any additional questions. Data users

with questions may also send e-mail to

slaits@cdc.gov.

Researchers also may wish to join

the SLAITS electronic mail listserv. To

subscribe or unsubscribe, visit

http://www.cdc.gov/nchs/about/major/

slaits/slaitslistserv.htm and follow the

directions listed. The listserv has

approximately 1,000 subscribers around

the world who use SLAITS data or are

interested in SLAITS. Subscribers

periodically receive e-mail containing

news about SLAITS surveys (e.g., new

releases or modifications to existing

data), publications, or related

conferences. The listserv is moderated

and listserv membership is private.

For more information on CDC,

users may contact CDC’s Information

Contact Center (CDC-INFO) in English

or Spanish by calling 1–800–CDC–

INFO (1–800–232–4636) or e-mailing

cdcinfo@cdc.gov. Persons with hearing

impairment may contact CDC-INFO

with a TTY machine at 1–888–232–

6348. Please note, however, that

CDC-INFO cannot respond to questions

about individual medical cases, provide

second medical opinions, or make

specific recommendations regarding

therapy. These issues should be

addressed directly with personal health

care providers.

References
 

1.	 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. 2(1):29–37. 2002.

2.	 Blumberg SJ, Olson L, Frankel M, et

al. The design and operation of the

National Survey of Children with

Special Health Care Needs, 2001.

National Center for Health Statistics,

Vital Health Stat 1(41). 2003.

3.	 Blumberg SJ, Olson L, Osborn L, et al.

The design and operation of the

National Survey of Early Childhood

Health, 2000. National Center for

Health Statistics. Vital Health Stat

1(40). 2002.

4.	 Blumberg SJ, Olson L, Frankel MR,

Osborn L, Srinath KP, Giambo P.

Design and operation of the National

Survey of Children’s Health 2003.

National Center for Health Statistics.

Vital Health Stat 1(43). 2005.

5.	 Blumberg SJ, Welch EM, Chowdhury

SR, Upchurch HL, Parker EK, Skalland

BJ. Design and operation of the

National Survey of Children with

Special Health Care Needs, 2005–2006.

National Center for Health Statistics.

Vital Health Stat 1(45). 2008.

6.	 Blumberg SJ, Foster EB, Frasier AM,

et al. Design and operation of the

National Survey of Children’s Health,

2007. National Center for Health

Statistics. Vital Health Stat 1(55). 2012.

7.	 Bramlett MD, Foster EB, Frasier AM,

et al. Design and operation of the

National Survey of Adoptive Parents,

2007. National Center for Health

Statistics. Vital Health Stat 1(50). 2010.

8.	 O’Connor KS, Brooks KS, NysseCarris KL, et al. Design and operation

of the Survey of Adult Transition and

Health, 2007. National Center for

Health Statistics. Vital Health Stat

1(52). 2011.

9.	 Bramlett MD, Brooks KS, Foster EB,

et al. Design and operation of the

National Survey of Adoptive Parents of

Children with Special Health Care

Needs, 2008. National Center for

Health Statistics. Vital Health Stat

1(51). 2010.

10.	 Ireys HT, Nelson RP. New federal

policy for children with special health

care needs: Implications for

pediatricians. Pediatrics 90(3):321–7.

1992.
Series 1, No. 57 [ Page 39

11. Health Resources and Services

Administration. Title V Maternal and

Child Health Services Block Grant

Program. Washington, DC. Available

from: http://mchb.hrsa.gov/programs/

titlevgrants/index.html.

12. McPherson M, Arango P, Fox H,

Lauver C, McManus M, Newacheck

PW, et al. A new definition of children

with special health care needs.

Pediatrics 102(1 Pt 1):137–40. 1998.

13. Westbrook LE, Silver EJ, Stein RE.

Implications of estimates of disability

in children: A comparison of our

definitional components. Pediatrics

101(6):1025–30. 1998.

14. Newacheck PW, Strickland B,

Shonkoff JP, Perrin JM, McPherson M,

McManus M, et al. An epidemiologic

profile of children with special health

care needs. Pediatrics 102(1 Pt 1):

117–23. 1998.

15. Bethell CD, Read D, Stein RE,

Blumberg SJ, Wells N, Newcheck PW.

Identifying children with special health

care needs: Development and

evaluation of a short screening

instrument. Ambul Pediatr 2(1):38–48.

2002.

16. Stein RE, Silver EJ, Bauman LJ.

Shortening the questionnaire for

identifying children with chronic

conditions: What is the consequence?

Pediatrics 107(4):E61. 2001.

17. Bramlett MD, Read D, Bethell CD,

Blumberg SJ. Differentiating subgroups

of children with special health care

needs by health status and complexity

of health care needs. Matern Child

Health J 13(2):151–63. 2009.

18. Bethell CD, Read D, Blumberg SJ,

Newacheck PW. What is the prevalence

of children with special health care

needs? Toward an understanding of

variations in findings across three

national surveys. Matern Child Health J

12(1):1–14. 2008.

19. Blumberg SJ, Zablotsky B, Avila R,

et al. Design and operation of the

Survey of Pathways to Diagnosis and

Services. National Center for Health

Statistics. [Forthcoming].

20. Blumberg SJ, Luke JV. Wireless

substitution: Early release of estimates

from the National Health Interview

Survey, January–June 2010. National

Center for Health Statistics. December

2010. Available from: http://

www.cdc.gov/nchs/data/nhis/

earlyrelease/wireless201012.pdf.

21. Zell ER, Ezzati-Rice TM, Battaglia MP,

Wright RA. National Immunization

Survey: The methodology of a

vaccination surveillance system. Public

Health Rep 115(1):65–77. 2000.

22. Lepkowski JM. Telephone sampling

methods in the United States. In:

Groves RM, Biemer PP, Lyberg LE,

Massey JT, Nicholls WL, Waksberg J,

editors. Telephone survey methodology.

New York, NY: John Wiley & Sons,

73–98. 1988.

23. Tucker C, Casady RJ, Lepkowski JM.

A hierarchy of list-assisted stratified

telephone sample design options. In:

Proceedings of the Survey Research

Methods Section. Alexandria, VA:

American Statistical Association,

982–87. 1993.

24. De Leeuw E, Callegaro M, Hox J,

Korendijk E, Lensvelt-Mulders G. The

influence of advance letters on response

in telephone surveys: A meta-analysis.

Public Opin Q 71(3):413–43. 2007.

25. Skalland, B. An alternative to the

response rate for measuring a survey’s

realization of the target population.

Public Opin Q 75(1):89–98. 2011.

26. Keeter S. Estimating telephone

noncoverage bias with a telephone

phone survey. Public Opin Q

59(2):196–217. 1995.

27. Frankel MR, Srinath KP, Hoaglin DC,

Battaglia MP, Smith PJ, Wright RA,

Khare M. Adjustments for nontelephone bias in random-digit-dialing

surveys. Stat Med 22(9):1611–26. 2003.

28. Ormson AE, Copeland KR, Blumberg

SJ, Wolter KM, Santos KB. Methods

for incorporating an undersampled cell

phone frame when weighting a

dual-frame telephone survey. In: 2012

Proceedings of the Federal Committee

on Statistical Methodology Research

Conference. Washington, DC: Office of

Management and Budget. 2012.

Available from: http://www.fcsm.gov/

events/papers2012.html.

29. Blumberg SJ, Luke JV, Ganesh N, et

al. Wireless substitution: State-level

estimates from the National Health

Interview Survey, 2010–2011. National

health statistics reports; no 61.

Hyattsville, MD: National Center for

Health Statistics. 2012.

30. The American Association for Public

Opinion Research. Standard definitions:

Final dispositions of case codes and

outcome rates for surveys. 6th ed.

2009.

31. Council of American Survey Research

Organizations. On the definition of

response rates. 1982.

32. Smith TW. A revised review of

methods to estimate the status of cases

with unknown eligibility. 2009.

Available from:

http://www.aapor.org/AM/

Template.cfm?Section=Standard_

Definitions1&Template=/CM/

ContentDisplay.cfm&ContentID=1815.

33. CDC. Behavioral Risk Factor

Surveillance System 2009 Summary

Data Quality Report. 2011. Available

from: ftp://ftp.cdc.gov/pub/Data/Brfss/

2009_Summary_Data_Quality_Report.pd

34. CDC. Behavioral Risk Factor

Surveillance System 2010 Summary

Data Quality Report. 2011. Available

from: ftp://ftp.cdc.gov/pub/Data/Brfss/

2010_Summary_Data_Quality_Report.pd

35. Groves RM. Nonresponse rates and

nonresponse bias in household surveys.

Public Opin Q 70(5):646–75. 2006.

36. Agency for Healthcare Research and

Quality. Medical Expenditure Panel

Survey: MEPS-HC response rates by

panel. Rockville, MD. Available from:

http://meps.ahrq.gov/mepsweb/

survey_comp/hc_response_rate.jsp.

37. Davis KE. Health care expenses and

utilization for children with special

health care needs, 2008: Estimates for

the U.S. civilian noninstitutionalized

population. 2011. Available from:

http://www.meps.ahrq.gov/mepsweb/

data_files/publications/st343/

stat343.pdf.

38. Fitzgerald R, Fuller L. I hear you

knocking but you can’t come in: The

effects of reluctant respondents and

refusers on sample survey estimates.

Sociol Methods Res 11(1):3–32. 1982.

39. Lin I-F, Schaeffer NC. Using survey

participants to estimate the impact of

nonparticipation. Public Opin Q

59(2):236–58. 1995.

40. Rubin DB. Multiple imputation for

nonresponse in surveys. New York, NY:

John Wiley & Sons. 1987.

41. Raghunathan TE, Lepkowski JM, Van

Hoewyk J, Solenberger P. A

multivariate technique for multiply

imputing missing values using a

sequence of regression models. Surv

Methodol 27(1):85–95. 2001.

42. Schafer JL. Analysis of incomplete

multivariate data. London: Chapman &

Hall/CRC. 1997.

43. Pedlow S, Luke JV, Blumberg SJ.

Multiple imputation of missing

household poverty level values from

the National Survey of Children with

Special Health Care Needs, 2001, and

the National Survey of Children’s

Health, 2003. 2007. Available from:

http://www.cdc.gov/nchs/data/slaits/

mimp01_03.pdf.

f.

f.
Page 40 [ Series 1, No. 57

Appendix I. Sampling and Weighting Technical Summary

Sample Design

The basic design objective of

the National Survey of Children

with Special Health Care Needs

(NS-CSHCN) sample was to select a

sample to achieve 750 completed

interviews of children under age 18

years with special health care needs in

each state and the District of Columbia

(DC). Of the 750 completed interviews,

45 were targeted to be completed from

cellular-phone (cell) lines. The landline

and cell-phone samples were selected by

first identifying households with

children under age 18 and then

screening within these households for

the presence of children with special

health care needs (CSHCN). In all

households where CSHCN were present,

one such child was selected. If more

than one CSHCN was present, one child

was randomly selected for the interview.

Drawing National

Immunization Survey sample

The sample of households selected

to be screened for NS-CSHCN was a

subsample of the households screened

for the National Immunization Survey

(NIS), a continuous, list-assisted,

random-digit-dial (RDD) telephone

survey. Starting in 2007, the base NIS

sample areas included 56 regions (50

state or ‘‘rest of state’’ areas plus 6

grantee urban areas). The six grantee

urban areas were Chicago, Ill.;

Philadelphia, Pa.; New York, N.Y.;

Bexar County, Tex.; Houston County,

Tex.; and Washington, D.C. Also

starting in 2007, state immunization

programs could identify cities or

counties of interest to be oversampled.

Eight of those regions, which may

change annually, were selected and

added to the base NIS sample areas to

equal a total of 64 sample areas.

Associating telephone numbers

with sampling areas

Drawing a sample of telephone

numbers in a sampling area requires

compiling a list of all telephone

numbers that belong to that area. For

some sampling areas, this step is

straightforward. For example, when the

sampling area is a state, the list would

consist of all phone numbers within the

central-office codes that are in service in

the area codes assigned to that state.

(Combined, an area code and a

central-office code form a ‘‘prefix area.’’

For example, 312–555–xxxx is the

prefix area corresponding to the 555

central office in the 312 area code.)

For other sampling areas, however,

this step encounters a number of

complications. When the sampling area

is a city, county, or combination of

counties, some prefix areas may cover

part of the sampling area and part of an

adjacent sampling area. In such

situations, NIS applies a majority rule:

If at least 50% of the directory-listed

households in a prefix area fall inside a

sampling area, the prefix area is

assigned to that sampling area.

For the cell sample, NIS fielded a

national cell-sample design in Quarter 4,

2010, so this was not an issue. For the

NS-CSHCN Quarters 3 and 4, 2010

cell-augmentation sample, the sample

design was state-level. Because no area

code encompasses multiple states, there

was no issue with a prefix area covering

multiple sampling areas.

Drawing the initial NIS sample

The sampling frame of landline

telephone numbers for a sampling area

consists of banks of 100 consecutive

phone numbers within the prefix areas

assigned to the sampling area. To

exclude banks that contain zero

directory-listed residential phone

numbers, the Genesys Sampling System

[a proprietary product of Marketing

Systems Group (MSG)] uses a file of

directory-listed residential numbers from

Donnelley Marketing Information

Services. The result is a file that lists

the remaining banks (the ‘‘1+ working

banks,’’ which contain one or more

directory-listed numbers). From the 1+

working banks, a random sample of

complete 10-digit phone numbers is

drawn for each quarter in such a way

that each number has a known and

equal probability of selection within

each sampling area.

This process is not applicable to the

cell sample, as there is no comparable

directory-listed file for the cell sample.

Therefore, a sample from all known

cell-phone numbers is drawn for each

quarter in such a way that each number

has a known and equal probability of

selection within each state.

Updating the NIS sampling

frame

The set of phone banks with at least

one directory-listed residential phone

number changes over time. As a result,

the sampling frame needs to be updated

on a quarterly basis. Area-code splits

produce additional changes to the

sampling frame. MSG maintains a

separate sampling frame for each

sampling area. Each quarter, MSG

examines the database to determine

whether any currently included banks

should be assigned to different sampling

areas and to assign newly included

banks to sampling areas. The rules for

assignment are the same as in the initial

definitions of the sampling areas.

Once all modifications have been

made to the Genesys database,

researchers at NORC at the University

of Chicago perform a number of checks

to ensure that all changes have been

applied correctly and that the new

database produces samples consistent

with those produced prior to the

changes. These checks compare the

numbers of active banks and RDDselectable lines in each sampling area

before and after the update. In parallel,

the numbers of exchanges assigned to

each sampling area before and after the

update are compared. Small changes

are expected because new banks are

put into service as new numbers are

assigned. In the event of a major

discrepancy in any of these checks,

MSG is notified of the difference and

asked to provide documentation of the

reasons for the change. Similar checks

are performed on the cell sample

where applicable, though these updates
Series 1, No. 57 [ Page 41

do not happen as frequently on the

cell frame.

Forming NIS sample replicates

Within each sampling area, the

landline and cell samples are then

segmented into replicates by sample type,

or representative subsamples, with each

replicate containing sample phone

numbers from each of the sampling areas.

Instead of using a single size for all

replicates in all sampling areas, NIS

divides the sample in each area into the

same number of replicates—26. This

procedure permits smoother release of

the sample (at the rate of one or two

replicates per week) for each sampling

area separately, as needed. Toward the

end of the quarter, half-size replicates

allow tighter control over the total

amount of sample that is released. The

aim is to produce an even distribution of

work in the telephone center over the

course of a quarter.

For the cell sample, replicates are

formed in the same way, but typically

consist of more than 26 replicates.

Because Quarter 3, 2010 was the first

quarter that cell sample was fielded,

more replicates were created to allow

for even tighter control of the amount of

sample that was released across the

quarter. This was also the case for both

the NIS-Child cell sample and

NS-CSHCN cell-augmentation sample

released in Quarter 4, 2010.

Preparation of the sample

Coordinated management of the

sample followed a sequence of steps.

Before a replicate was loaded into the

computer-assisted telephone interview

(CATI) system, several stages of

processing removed as many business

and nonworking numbers as possible.

A separate step matched the phone

numbers in the sample against a large

database to obtain addresses so that

advance letters could be sent. Phone

numbers on the NIS ‘‘do not call list’’

were removed from the sample. Also,

for each quarter, any duplicate phone

numbers (i.e., numbers that had

appeared in the sample in the 3 prior

quarters) were identified and omitted

from the sample files.

This process was the same for both

the landline and cell samples, with one

exception. There was no database that

contained known addresses for the cell

sample, and therefore the matching

step to obtain addresses to send

advanced letters was not implemented

for the cell sample. All other steps

were applied.

Removing business and

nonworking numbers from the

landline sample

More than two-thirds of all selected

landline phone numbers are typically

businesses or unassigned. It would be

incredibly inefficient to require the

interviewers to dial and classify all of

these landline numbers. To prevent that

potential expense, NIS used another

MSG product (a companion to the

Genesys sampling system) to quickly

and accurately reduce the size of this

task.

First, the selected landline sample

was matched against a Genesys file

containing phone numbers that are

directory-listed in a business Yellow

Pages and that are not directory-listed in

a residential White Pages. Any business

numbers so identified were removed

from the sample.

Second, landline numbers listed in

residential White Pages were identified

and temporarily set aside.

Third, a hardware system screened

the remaining landline sample to remove

a portion of the nonworking numbers.

Using personal computers with special

hardware and software, this system (the

‘‘auto-dialer’’) automatically dialed the

landline phone numbers to detect

nonworking landline numbers, which are

indicated by the familiar tritone signal

for out-of-service numbers, by an

extended period of silence, or by

continuous noise on the line.

Finally, the directory-listed

residential landline numbers were

combined with the landline numbers that

were not removed by the auto-dialer to

produce the landline sample for the

phone center. The landline numbers

removed within released replicates were

themselves considered released; they

also were considered prescreened and

were assigned disposition codes

indicating that they were resolved,

nonresidential landline numbers.

This process could not be conducted

on the cell-phone sample due to Federal

Communications Commission (FCC)

rules regarding auto-dialing cell-phone

numbers [implementing the Telephone

Consumer Protection Act of 1991

(TCPA)]. Therefore, all cell-phone

numbers were released and dialed by the

phone center, and a disposition code

was assigned by the interviewer for

business and nonworking numbers.

‘‘Do not call’’ requests

A file was maintained containing

phone numbers of people who had

requested not to be called. Each

quarter’s sample was compared with this

file, and numbers that had been added to

the ‘‘do not call list’’ in the previous

2 years were not included in the

quarterly sample of numbers loaded into

the CATI system.

Obtaining addresses for

advance letters

To obtain addresses that

corresponded to phone numbers in the

sample, the numbers for each replicate

were sent to a vendor, TARGUSinfo

(now Neustar Information Services).

Neustar maintains a large database,

updated daily, for its PhoneData Express

program, which includes more than 160

million residential and business landline

phone numbers, including unpublished

landline phone numbers. Sources for the

data include call centers and companies

in telecommunications, consumer goods,

and the insurance and credit industries.

There is no such database for cell-phone

numbers.

After the pre-resolution operations

described in the previous three sections,

the use of TARGUSinfo yielded

addresses for about 44.3% of the

landline phone numbers loaded into the

CATI system. Advance letters were sent

to this set of landline numbers. The

mailing was approximately 10 days, or 2

weekends prior to the time when the

phone numbers in the corresponding

replicates were scheduled to be called.

No advance letters were mailed to the

cell-phone sample.
Page 42 [ Series 1, No. 57

Ported cell phones

A significant recent development in

the telecommunications industry is the

new FCC regulation on portability.

Local number portability allows wireless

phone customers to switch from one

company to another while retaining the

same phone number. There are three

ways in which consumers can take

advantage of the new wireless number

portability provisions: 1) wireless-towireless, 2) wireless-to-landline, and

3) landline-to-wireless. Landline

sampling typically includes automated

dialing procedures to reduce data

collection costs, but FCC rules

(implementing TCPA) bar automated

calls to wireless phone numbers. The

first two ways that consumers can port

numbers do not impact the RDD

landline sampling strategy, because

cell-phone numbers are not in the RDD

landline sampling frame. However, the

third way—porting landline numbers to

wireless service providers—creates the

possibility of inadvertently including

wireless phone numbers in the RDD

landline sample. To preidentify landlines

that have been ported to wireless, the

selected landline sample was matched to

the Neustar database, which contains the

national list of ported phone numbers.

Details on the database can be found at

http://www.tcpacompliance.com. Each

quarterly sample was compared with the

database, and the ported numbers were

flagged accordingly. The flagged numbers

were assigned an out-of-scope disposition

code and were not called as part of the

landline sample. Classifying such cases as

out-of-scope for landline dialing did not

remove those numbers from the overall

universe, because they still could have

been randomly selected for the cell-phone

sample. Rather, classifying them as

out-of-scope for the landline sample

simply prevented the landline and

cell-phone sample frames from

overlapping. The landline numbers in

released replicates were also matched to

the Neustar database daily to identify any

new ports that had not already been

finalized within the phone center.

Consequently, sample status (landline or

cell) was initially set based on the frame

from which a case was selected, but the

status was updated in some cases

accordingly, based on information

obtained when the case was called.

Because any number selected for

the cell-phone sample was not autodialed, ported numbers were not an

issue for the cell-phone sample.

Duplicate phone numbers

Because of the repeated quarterly

sampling operations in each sampling

area by sample type (landline and cell

phone), some phone numbers were

selected more than once. To avoid any

respondent problems created by

recontacts for the same survey, a further

step of sampling identified duplicate

numbers. Each quarterly sample file was

compared with all sample files for the 3

prior quarters. The duplicate numbers

were excluded from the quarterly

sample file. Thus, the quarterly samples

were essentially selected by a method of

without-replacement sampling. However,

analysts are reminded to invoke

‘‘with-replacement sampling’’ in

SUDAAN for variance estimation, as

described earlier.

Weighting and Estimation

This section summarizes the

methodology used for weighting the

2009–2010 NS-CSHCN sample. Three

sets of weights were produced: a

household weight, a child-screener

weight, and a child-interview weight.

The weighting scheme followed as

much as possible the weighting scheme

for NIS. The weighting scheme for the

2009–2010 NS-CSHCN involved the

following steps:

1.Base sampling weight

2.Adjustment for nonresolution of

released phone numbers

3.Adjustment for incomplete

S_KIDS screener (affects

cell-sample only)

4.Adjustment for incomplete Cell

Phone Only/Mainly (CPO/M)

screener (affects cell-sample only)

5.Adjustment for incomplete

age-eligibility screener

6.Adjustment for incomplete

special-needs screener

7.Adjustment for multiple cell-phone

lines

8.Derivation of full-sample

household weights

9.Adjustment for combined landline

and cell-phone sample and

noncovered households

10.Raking adjustment of household

weights

11.Raking adjustment of childscreener weights

12.Adjustment for subsampling of

children with special health care

needs

13.Adjustment for nonresponse to the

NS-CSHCN interview

14.Optimized combined landline- and

cell-sample weights

15.Raking adjustment of the

nonresponse-adjusted NS-CSHCN

interview weights

Weighting steps 1–10 above applied to

households, step 11 applied to all

children, and steps 12–15 applied to

children with special health care needs.

Steps 1–7 were applied within each

study quarter, while steps 8–15 were

carried out for the total sample across

quarters. Steps 1 and 2 were carried out

within sampling area for the landline

sample and state for the cell sample.

Steps 3–15 were carried out within state

[including DC and U.S. Virgin Islands

(USVI)] for both landline and cell

samples. Steps 1–8 were carried out

separately by sample source type

(landline and cell), while steps 9–15

were carried out on the combined

sample across sample source type. Note

that the Q4/2010 (Quarter 4, 2010)

cell-augmentation sample was not

combined with the Q4/2010 NIS cell

sample for steps 3–5, due to the

inclusion of the extra eligibility screener

(S_KIDS) applied to the Q4/2010

cell-augmentation sample. Note that

USVI only fielded a landline sample,

and therefore some of these steps were

not necessary for this estimation area.

These modifications are noted within

each step, where applicable, for USVI.

Each individual weighting step is

discussed in detail below.

Step 1: Base weights

The weighting process started with

computing the base sampling weights of

the sampled telephone numbers, where
the base weight is the reciprocal of the

selection probability of a phone number.

Sample cases were selected from both

landline and cell-phone numbers. The

base weight for the k-th phone number

from the t-th source type (landline or

cell) in the released sample At is defined

by

1 Nt W1tk = = , where

πtk nt

πtk = probability of selecting the k-th

phone number from the t-th

source type in the initial release

for the quarter,

nt = sample size (in initial released

replicates) for the quarter from

the t-th source type in the

sampling area, and

Nt = total phone numbers on the

sampling frame for the quarter

from the t-th source type in the

sampling area, as determined by

Genesys.

For the landline sample, the base was

weight is a constant for all phone numbers

within a quarter and sampling area. The

sampling area for the landline sample is

defined as the NIS sampling area.

The sampling area for the cell

sample is defined as the state. Note that

the cell sample was comprised of the

Q4/2010 NIS cell sample, which was

selected at the national level, and the

Q4/2010 cell-augmentation sample,

which was selected at the state level.

For purposes of deriving the base

weights, however, and given that

selection of a large national sample

roughly corresponds to selection of

individual state samples (each with a

sample size proportional to their

population size), the entire Q4/2010 cell

sample was treated as having been

selected at the state level. Additionally, the

cell-sample base weights were calculated

across the 2 quarters combined, due to

large variation in the base weights

between Q3/2010 and Q4/2010.

Step 2: Adjustment for

nonresolution of phone

numbers

Once the sample of telephone

numbers was released, the first step was

to identify whether the number was a

working residential number (WRN) for

landlines or an active personal cell

number (APCN) for cell phones.

However, even after repeated callbacks,

the WRN-APCN status of many

telephone numbers remained unresolved.

An adjustment to the weight of resolved

cases was necessary to account for cases

for which the WRN-APCN status was

unknown.

To make the adjustment, a number

of adjustment cells within each sampling

area were formed by controlling for

known covariates. The adjustment in

each cell was made by assuming that

the rate of WRNs to APCNs among

unresolved numbers was the same as the

rate of WRN to APCNs among resolved

numbers. Within each sampling area, the

adjusted weights were computed as

follows.

W1tk W2tk = if k{t,Bt

,, R2t,

= 0 otherwise,

where

∑ δ2tk,

W1tk k{t,Bt R2t, = ,

∑ δ2tk,

W1tk k{t,At

Series 1, No. 57 [ Page 43

Bt =	 subset in At of resolved phone

numbers in the quarter from the

t-th source type (WRN,

non-WRN/APCN, or nonAPCN), and

δ2tk,=

1 if the k-th number from the t-th

source type is in the ,-th cell

= 0 otherwise.

The covariates used to define the

adjustment cells for the landline sample

within each sampling area are shown in

Table I. Different sets of variables were

used for sampling areas in different

census regions and by listed status. The

variables were identified through an

analysis of known variables and

nonresponse status. The adjustment cells

needed to include at least 20 resolved

cases to enable stable estimation of the

adjustment factor, R2t,. To achieve this

goal when the number of resolved cases

was less than 20, adjustment cells were

collapsed by dropping covariates in

order of importance, with cells formed

by the least important covariates

collapsed first, where importance was

defined by the strength of the

relationship between the covariate and

the observed resolution rate.

To define the adjustment cells for

the cell sample within each sampling

area, only metropolitan statistical area

(MSA) status associated with the

released case was used, due to the

smaller sample sizes for the cell sample

and the lesser correlation between

exchange and geographic area for

cell-phone numbers, relative to landline

numbers. The adjustment cells needed to

include at least 20 resolved cases to

enable stable estimation of the

adjustment factor, R2t,. To achieve this

goal when the number of resolved cases

Table I. Covariates used to create nonresolution adjustment cells within sampling area, by census region and directory-listed status:

Landline sample

Sampling area

Northeast Midwest South West

Listed Unlisted Listed Unlisted Listed Unlisted Listed Unlisted

Rent

Minority

Income

MSA

Grad

Rent

Owner

Grad

Age

Minority

Educ

Rent

Income

Owner

MSA

Owner

Grad

Minority

MSA

Grad

Owner

Age

NOTES: Covariates are listed in order of importance within a group, based on the strength of the relationship between the covariate and observed nonresponse rates. MSA is metropolitan statistical

area.
was less than 20, adjustment cells were

broadened by collapsing MSA status.

Due to lack of current census

demographic information for USVI, this

step was done at the estimation area

level with no further adjustment cells

used.

Step 3: Adjustment for

incomplete presence of children

screener

In Q4/2010, additional cell sample

was released for NS-CSHCN to

augment the NIS cell sample that had

been released in Q4/2010. This

augmentation sample was asked an

additional screener question at the

beginning of the interview to determine

whether a child lived in the household.

This screener question (labeled

‘‘S_KIDS’’) was asked in an attempt to

reduce the overall screening cost, and

was separate from the full age-eligibility

screener conducted later in the

interview. Therefore, an adjustment for

the Q4/2010 cell-augmentation sample

(AugQ4,c) was necessary to account for

incomplete S_KIDS screener cases. To

compensate for this, the weights of the

phone numbers from the Q4/2010

cell-augmentation sample with

completed S_KIDS screeners were

adjusted. The adjusted weight for the

k-th number from the t-th source type

is derived as follows.

W2k W3tk if k{t = 2,CAug,S_Kids, AugQ4,c = ,, R32,

= W2tk	 otherwise,

where

∑ � W 32k, 2k k{t,C ,Aug Aug,S_Kids Q4,c R32, = ,

∑ �32k,

W2k k{t=2,B1t

,AugQ4,c

AugQ4,c =	 subset of phone numbers

from the cell-augmentation

sample for Q4/2010,

CAug,S_Kids =

set of augmentation

cell-phone numbers for

Q4/2010 from B1Aug that

completes the S_KIDS

screener in the state,

B1Aug =

set of augmentation

cell-phone numbers for the

quarter from B1 that are

APCNs in the state, and

δ32k, =

1 if the k-th augmentation

cell number is in the ,-th

cell

=0 otherwise.

To define the adjustment cells for cell

sample within each state, only MSA

status associated with the released case

was used due to the smaller sample

sizes for the cell sample and lesser

correlation between exchange and

geographic area for cell-phone numbers,

relative to landline numbers. The

adjustment cells needed to include at

least 20 resolved cases to enable stable

estimation of the adjustment factor. To

achieve this goal when the number of

resolved cases was less than 20,

adjustment cells were broadened by

collapsing MSA status.

For all samples other than the

Q4/2010 cell-augmentation sample, the

adjustment factor was simply 1 (i.e., no

adjustment at this stage).

Step 4: Adjustment for

incomplete CPO/M Screener

Some resolved cases in the

cell-phone sample did not complete the

CPO/M screener. To account for the

cases for which the CPO/M status was

unknown, the weights of the resolved

cell-phone sample cases were adjusted.

The adjustment in each cell was made

by assuming that the rate of CPO/Ms

among screener completed APCNs is the

same as the rate of CPO/Ms among

those that did not complete the CPO/M

screener. Within each state, the adjusted

weights were derived as follows.

W3vk W4tk = if k{t = 2,v,Dt ,, R42v,

= W31k otherwise,

where

∑	 δ42k,

W3vk k{t,=2v,D

R42v, = 2

,

∑	 δ42k,

W3vk k{t=2,v,C12

ν =2 if the k-th cell number is in

AugQ4,c

=1 otherwise (including for

landline phone numbers),

Dt = set of cell-phone numbers for

the quarter from the t-th source

type in C1t that complete the

CPO/M screener in the state,

C1t = set of phone numbers for the

quarter from the t-th source

type in Bt that are WRNs or

APCNs in the state, and, if in

AugQ4,c, are also in CAug,S_Kids

(i.e., have yet to screen out),

and

δ42k, = 1 if the k-th cell number is in

the ,-th cell

= 0 otherwise.

To define the adjustment cells for cell

sample within each state, the number of

call attempts to resolve the phone

number (one, or two or more) was used.

The adjustment cells needed to include

at least 20 resolved cases to enable

stable estimation of the adjustment

factor. To achieve this goal when the

number of resolved cases was less than

20, adjustment cells were broadened by

collapsing the number of call attempts.

For this step, the Q4/2010

cell-augmentation sample and Q4/2010

NIS cell sample were treated separately,

due to the prescreening on presence of

kids for the Q4/2010 cell-augmentation

sample.

For all landline and USVI samples,

the adjustment factor was simply 1 (i.e.,

no adjustment at this stage).

Step 5: Adjustment for

incomplete age-eligibility

screener

Among the resolved landline WRNs

and cell-phone CPO/Ms, some sample

cases did not complete the ageeligibility screener. For such cases, it

was not known if any age-eligible

children live in the household. To

compensate for this, the weights of the

phone numbers from the t-th source type

with completed age-eligibility screeners

were adjusted. The adjusted weight for

the k-th number from the t-th source

type is given as:

W4tvk W5tk = if k{t,v,Et ,, R5tv,

= 0 otherwise,

Page 44 [ Series 1, No. 57
Table II. Covariates used to create nonresponse adjustment cells for age-eligibility screener within state, by census region and

directory-listed status: Landline sample

Sampling area

Northeast Midwest South West

Listed Unlisted Listed Unlisted Listed Unlisted Listed Unlisted

Minority Minority MSA

Owner

Minority Minority

Income

Age

Age Age

Rent

Age

NOTES: Variables are listed in order of importance within a group, based on the strength of the relationship between the covariate and observed nonresponse rates. MSA is metropolitan statistical

area.

where

∑ δ W 5tk,	 4tvk k{t,v,E R5tv, = t

,

∑ δ W 5tk, 4tvk k{t,v,D1t

Et =subset of phone numbers for the

quarter from the t-th source type

in D1t that complete the

age-eligibility screener in the

state,

D1t =

set of landline phone numbers

for the quarter that are WRNs

(if t = 1) or set of cell-phone

numbers for the quarterthat are

CPO/Ms (if t = 2) in the state,

and

δ5tk, =

1 if the k-th number from the

t-th source type is in the ,-th

cell

= 0 otherwise.

To define the adjustment cells for the

landline sample within each state, the

variables listed in Table II were used.

The adjustment for age screening was

made within state (as opposed to

sampling area used for the nonresolution

adjustment) due to smaller sample sizes

at this stage. Different sets of variables

were used for sampling areas in

different census regions and by listed

status. The variables were identified

through an analysis of known variables

and nonresponse status. The adjustment

cells needed to include at least 20

resolved cases to enable stable

estimation of the adjustment factor. To

achieve this goal when the number of

resolved cases was less than 20,

adjustment cells were collapsed by

dropping covariates in order of

importance, with cells formed by the

least important covariates collapsed first,

where importance was defined by the

strength of the relationship between the

covariate and the observed ageeligibility screener completion rate.

To define the adjustment cells for

cell sample within each state, the

number of call attempts to complete the

CPO/M screener (1, 2+) and whether the

phone was cell-phone only (CPO) or

cell-phone mainly (CPM) were used.

The adjustment cells needed to include

at least 20 resolved cases to enable

stable estimation of the adjustment

factor. To achieve this goal when the

number of resolved cases was less than

20, adjustment cells were collapsed by

dropping covariates (collapsing across

call attempts first).

For this step, the Q4/2010

cell-augmentation sample and Q4/2010

NIS cell sample were treated separately,

due to the prescreening on presence of

kids for the Q4/2010 cell-augmentation

sample. After this step, the Q4/2010 cell

samples were treated together.

For USVI, this step was done at the

estimation area level with no further

adjustment cells used.

Step 6: Adjustment for

incomplete CSHCN Screener

Among households with age-eligible

children, the CSHCN Screener was

applied to identify the households with

CSHCN. However, not all age-eligible

households completed the special-needs

screener. To compensate for such

nonresponding households, the weights

of the phone numbers from the t-th

source type with a complete specialneeds screener were adjusted. This

adjustment was carried out within state.

The adjusted weight for the k-th phone

number from the t-th source type is

given as:

W5tk W6tk = if k{t,Ft ,, R6tk,

= 0 otherwise,

where

∑ δ W 6tk, 5tk k{t,F R6tk, = t

,

∑ δ W 6tk, 5tk k{t,E1t

Ft =set of phone numbers for the

quarter from the t-th source type

in E1t that complete the

special-needs screener in the

state,

E1t =

set of phone numbers for the

quarter from the t-th source type

in Et that reported having

age-eligible children in the state,

and

δ6tk, =

1 if the k-th number from the

t-th source type is in the ,-th

cell

= 0 otherwise.

Series 1, No. 57 [ Page 45

To define the adjustment cells for the

landline sample within each state, the

variables listed in Table III were used.

The adjustment for CSHCN screening

nonresponse was made within state.

Different variables were used for states

in different census regions and by listed

status. The variables were identified

through an analysis of known variables

and nonresponse status. The adjustment

cells needed to include at least 20

resolved cases to enable stable

estimation of the adjustment factor. To

achieve this goal when the number of

resolved cases was less than 20,

adjustment cells were broadened by

collapsing the categories of the

adjustment cell covariate.

To define the adjustment cells for

the cell sample within each state, the
Table III. Covariates used to create nonresponse adjustment cells for CSHCN Screener within state, by census region and directory-listed

status: Landline sample

Sampling area

Northeast Midwest South West

Listed Unlisted Listed Unlisted Listed Unlisted Listed Unlisted

Owner Minority MSA MSA Age Grad MSA Educ

NOTES: CSHCN is children with special health care needs; MSA is metropolitan statistical area.

number of call attempts to complete

the age-eligibility screener and to

determine whether the phone was CPO

or CPM was used. The adjustment cells

needed to include at least 20 resolved

cases to enable stable estimation of the

adjustment factor. To achieve this goal

when the number of resolved cases

was less than 20, adjustment cells were

collapsed by dropping covariates

(collapsing across call attempts first).

For USVI, this step was done at the

estimation area level with no further

adjustment cells used.

Step 7: Adjustment for multiple

cell-phone lines

Among the households that

completed the CSHCN Screener within

the cell-phone sample, some households

reported more than one cell-phone

number for adult use. An adjustment to

the weight was required for these

households to compensate for their

multiple chances of selection. The

adjusted weight for the k-th cell-phone

number with a complete CSHCN

Screener is defined by

W7tk	 = W6tk/ρk,c ,

where

ρ'

k,c = number of cell-phone numbers

for adult use reported by the k-th

cell-phone number with a

completed CSHCN Screener,

and

ρk,c = min (3, ρ'

k,c).

The number of adult cell-phone lines

was capped at three for purposes of the

weight adjustment, both to control

variability and to guard against reporting

bias.

For all landline and USVI sample,

the adjustment factor was simply 1 (i.e.,

no adjustment at this stage).

Step 8: Derivation of

full-sample household weights

In this step, all quarterly samples

were combined, separately for the

landline and cell samples, and the

quarterly base weights were adjusted so

that the samples from all quarters jointly

represented the corresponding full

population. Because the base weights

were calculated for each quarter

separately, the sum of base weights in

each quarter represents the full

population for each state. As only 2

quarters of data were collected for the

cell sample, full-sample household

weights were derived separately by

sample source. Typically, the full-sample

weights are computed from quarterly

weights by applying composition factors

proportional to the number of released

sample phone numbers in a quarter.

Given that augmentation sampling

yielded variability in base weights for

both landline and cell samples, sample

sizes were adjusted by the design effect

(DEFF) to reflect effective sample sizes.

The full household weights can be

expressed as:

W7tk W8tk = if k{t,q, R8tk

where

�

6 n1q'

q'=1 DEFF1q'

R =

for t = 1, 8tk n1q

DEFF1q

2 n2q' ∑ 

q' = 1 DEFF2q' for t = 2, n2q

DEFF2q

2 n1q' ∑ 

q' = 1 DEFF1q'	 for t = 1 and ke

USVI, n1q

DEFF1q

2

∑W7tk
 

ket,q
 

∑ W7tk ket,q

=

( )2

n . tq ntq

ntq = number of households from

the t-th source type with a

complete CSHCN Screener in

quarter q in the state, and

DEFFtq =

DEFF from the t-th source

type in quarter q in the state

Page 46 [ Series 1, No. 57

Step 9: Adjustment for

combined landline and

cell-phone samples and for

noncovered populations

The full-sample household weights

(W8tk) with a complete CSHCN Screener

were adjusted to accomplish four goals:

+	 Adjustment for noncoverage of

age-eligible children

+	 Adjustment for overlap of the

landline and cell-phone samples

+	 Attenuation of cell sample weights

to minimize variance while

controlling for bias

+	 Adjustment to residual landline

population controls

Adjustment for noncoverage of

age-eligible children—A Keeter

adjustment (27) was carried out to adjust

weights to account for households with

children not covered by the combined

landline and cell-phone samples

(i.e., phoneless households). In the

Keeter adjustment, weights for landline

households with an interruption in

phone service are adjusted to represent

phoneless households with children. The

method is based on empirical evidence

suggesting that phoneless households are

more similar to landline households with

an interruption in phone service than

to landline households without an
interruption in service (27,28). This

adjustment is given as:

Y|NP = ωY|LL(Int),

where

ω = adjustment factor, and

Y|LL(Int) = estimated prevalence of

households with one or more

CSHCN based on sample

households from the landline

sampling frame in a household

with a service interruption,

and for which a household

interview was completed.

The adjustment factor can be expressed

as:

N

ω NP

LL(Int) = ∑ , W8k

keLL(Int)

where

NNP = population control [from the

American Community Survey

ACS)] for phoneless

households with children.

The adjusted weights for landline

sample households with a phone service

interruption, controlled to the total

population of phoneless households with

children, can then be expressed as:

W9k = ωLL(Int)W8k if k e LL(Int).

Adjustment for overlap of the

landline and cell-phone samples—The

landline and cell-phone samples, while

selected from distinct sampling frames,

partially overlap in their coverage of the

population. The landline sample includes

dual landline and cell-phone households,

while the cell-phone sample includes

dual landline and cell-phone households

self-identifying as CPM (that is, they

said they were unlikely to be reached

through their landline). Thus, survey

weights for dual landline and cell-phone

cases from the two sampling frames

must be adjusted to account for this

overlap. For purposes of weighting,

CPM cases will be treated as

cell-mostly, as the majority of CPM

cases are also self-identified as being

cell-mostly (that is, they said that they

received all or almost all calls on their

cell phone). However, CPM sample

cases will be assumed biased when

estimating for the cell-mostly

population.

The sum of the weights for the

landline sample (which estimates the

number of landline households with

children) and the sum for the cell-phone

sample (which estimates the number of

cell-phone households with children)

both include some dual landline and

cell-phone households that are

cell-mostly. Thus, when combining the

landline and cell samples, the annualized

weights for cell-mostly households must

be adjusted so the sum of the adjusted

weights across landline and cell-phone

samples provides an appropriate

estimate of cell-mostly households. This

adjustment is given as:

Y|(CM) = λY|CP(CM) + (1 ~ λ)Y|LL(CM),

where

λ = adjustment factor,

Y|CP(CM) =

estimated prevalence of

households with one or more

CSHCN based on sample

households from the

cell-phone sampling frame

that are CPM, and for which

a household interview was

completed, and

Y|LL(CM) =

estimated prevalence of

households with one or more

CSHCN based on sample

households from the landline

sampling frame that are

cell-mostly, and for which a

household interview was

completed.

The composite adjustment factor is

derived based upon the variance and

bias associated with the component

estimates. The resulting adjusted survey

weights yield minimum mean-squared

error estimates. The adjustment factor

can be expressed as:

λ =

var(Y|LL(CM)) , var(Y|CP(CM)) + [bias(Y|CP(CM))]2 + var(Y|LL(CM))

where

bias(Y|CP(CM)

)=(Y|CP(CM))–(Y|LL(CM)) =

estimated bias in prevalence of

households with one or more CSHCN

associated with CPM sample cases,

relative to cell-mostly cases from the

landline sampling frame.

The adjusted weights for cell-mostly

sample cases, controlled to the total

population of cell-mostly households

with a child, can then be expressed as:

{ NCM λ ∑ W8k if ke CP(CM) W8k

keCP(CM)

W9k = , NCM (1 – λ ∑ )W8k if k e LL(CM) W8k

keLL(CM)

where

NCM = population control calculated by

the National Center for Health

Statistics (NCHS) for cell-mostly

households with children (30).

Series 1, No. 57 [ Page 47

Attenuation of cell sample weights

to minimize variance while controlling

for bias—Given larger base weights for

the cell-phone sample, variability

associated with the CPO portion of

estimates will tend to be large, and thus

adversely affect the precision of the

overall estimates. Attenuating the CPO

sample weights would serve to decrease

variability; however, this requires

increasing the weight associated with

other sample cases, which can increase

bias.

Attenuation of the CPO sample

weights was achieved by compositing

the CPO sample with landline sample

cases deemed ‘‘similar’’ to CPO sample

cases, to represent the full CPO

population. Landline sample cases

predicted as having a relatively large

likelihood of being similar to CPO

served as proxy CPO sample cases to be

weighted along with true CPO sample

cases to represent the total CPO

population. The predicted probability for

a landline sample case being similar to

CPO is determined using parameters

estimated from a logistic regression

model for predicting CPO status run on

the full set of dual-frame sample cases

(i.e., both landline and cell), and

including both sociodemographic

characteristics and CSHCN interview

variables. As CSHCN interview

variables were included in the logistic

regression model, the identified proxy

CPO sample cases should have low bias

relative to the true CPO sample cases.
A child’s proxy CPO propensity is

the predicted probability that the child

reflects the characteristics of a child in a

CPO household, calculated from a

logistic regression model. Two separate

models were estimated—one based on

the data at the household level for all

sample cases with a completed

household interview, and one based on

the data from special-needs children.

The list of potential predictor variables

for the first model is based upon

variables available from the household

interview, whereas the list of potential

predictor variables for the second model

is based upon variables available from

both the household interview and the

special-needs interview. The propensitybased identification of proxy CPO

sample cases can be expressed as

follows:

Model 1: Let E' denote the national

sample of completed household

interviews. Consider the indicator

variable

Yj = 1 if the j-th child is in a CPO

household

= 0 otherwise,

and fit a (stepwise) logistic regression

model to the probability P(Yj = 1|j),

using the selected predictor variables.

The model was estimated at the national

level using all children in E'. Once the

final model was identified, the predicted

values (or response propensities) were

computed:

ex1j |β1

pˆ1j =	 , 1 + ex1j |β1

where for the j-th observation, x1j is

the row vector of covariates, and |β1

is the column vector of estimated

coefficients.

Model 2: Let F' denote the national

sample of special-needs children.

Consider the indicator variable

Zj =	 1 if the j-th child is in a CPO

household

= 0 otherwise,

and fit a (stepwise) logistic regression

model to the probability P(Zj = 1|j),

using the selected predictor variables.

The model was estimated at the national

level using all children in F'. Once the

final model was identified, the predicted

values (or response propensities) were

computed:

ex2j |β2

pˆ2j =	 , 1 + ex2j |β2

where for the j-th observation, x2j is the

row vector of covariates, and |β2 is the

column vector of estimated coefficients.

Values pˆ2j were used for sample

special-needs children, whereas values

pˆ1j were used for sample cases with

completed household interviews, but for

which a special-needs child interview

was not completed.

Landline sample cases for which

pˆ1j(pˆ2j

) exceeded the threshold value 0.2

were designated as ‘‘proxy’’ CPO cases.

The threshold value was defined so as

to provide a sufficient sample size of

proxy CPO cases to have a positive

impact in terms of reducing the variance

of survey estimates while controlling the

adverse impact of survey estimate bias.

Compositing of the survey weights

for the true and proxy CPO sample

cases was carried out analogous to the

process described above, wherein the

composite adjustment factor was derived

based upon the variance and bias

associated with the component

estimates. The resulting adjusted survey

weights yielded minimum mean-squared

error estimates. This adjustment is given

as:

Y|CPO = κY|CPO(True) + (1 – κ)Y|CPO(Proxy),

where
 

κ = adjustment factor,
 

Y|CPO(True) =	 estimated prevalence of

households with one or

more CSHCN based on

sample CPO households

for which a household

interview was completed,

and

Y|CPO(Proxy) =	 estimated prevalence of

households with one or

more CSHCN based on

sample proxy CPO

households for which a

household interview was

completed.

The adjustment factor can be expressed

as:

κ =

var(Y|CPO(Proxy)) + [bias(Y|CPO(Proxy))]2

, var(Y|CPO(True)) + var(Y|CPO(Proxy))+[bias(Y|CPO(Proxy))]2

where

bias(Y|CPO(Proxy) = Y|CPO(Proxy) – Y|CPO(True)

= estimated bias associated with proxy

CPO sample cases.

The adjusted weights for true CPO and

proxy CPO sample cases, controlled to

the total population of CPO households

with children, can then be expressed as:

{ NCPO κW8k if keCPΟ(True)

∑ W8k
 

keCPO(True)
 

W9k = , NCPO (1 – κ)W8k if keCPO(Proxy)

∑ W8k
 

keCPO(True)
 

where

NCPO =	 population control calculated by

NCHS for CPO households

with children (30).

Page 48 [ Series 1, No. 57

Adjustment to residual landline

population controls—A ratio adjustment

was carried out to adjust weights to

population controls for the residual set

of landline households with children.

Separate adjustments were carried out

for landline-only households and for

combined landline-mostly and

landline-cell-mixed households. These

adjustments can be expressed as:

Y|LLO =	 ψY|LLO

|LLM	 =Y τY|LLM ,

where

ψ =	 landline-only adjustment factor,

τ =	 combined landline-mostly and

landline-cell-mixed adjustment

factor,

Y|LLO =	 estimated prevalence of

households with one or more

CSHCN based on sample

landline-only households, and

for which a household interview

was completed, and

Y|LLM =	 estimated prevalence of

households with one or more

CSHCN based on combined

sample landline-mostly and

landline-cell-mixed households

from the landline sampling
frame, and for which a

household interview was

completed.

The adjustment factor can be expressed

as:

NLLO ψLLO = ∑ W7k

KeLLO

NLLO =	 ∑ W7k

τ , LLM

KeLLM

where

NLLO =

population control calculated by

NCHS for landline-only

households with children (30),

and

NLLM =

population control calculated by

NCHS for combined

landline-mostly and landlinecell-mixed households with

children (30).

The weights for landline-only sample

households were adjusted so that the

sum of the weights agreed with the total

population of landline-only households

with children, and the weights for the

combined landline-mostly and

landline-cell-mixed sample households

were adjusted so that the sum agreed

with the total population of combined

landline-mostly and landline-cell-mixed

households with children. This

adjustment can be expressed as:

W8k = ψLLOW7k , ke LLO

W8k = τLLMW7k , ke LLM.

Adjustment for USVI—A Keeter

adjustment was not possible for USVI,

as there was no current accurate

information on the number of children

in phoneless households. Additionally,

because there was no cell-phone sample

fielded in USVI, there was no need for

the above steps to be applied. Therefore,

this adjustment was carried out within

five mutually exclusive income

categories (income is correlated with

whether a household has a phone). The

adjustment can be expressed as:

W8k W9k = if k e U.S. Virgin Islands R9k

= 0 otherwise,

where

PCT9l R9k = , ∑ δ9k,W8k

ke U.S.VirginIslands

PCT9l =population control total of all

children in USVI within the

l-th adjustment cell, and

δ9k, =

1 if the k-th number is in the

l-th adjustment cell

= 0 otherwise.

Series 1, No. 57 [ Page 49

Step 10: Raking adjustment of

household weights

The combined landline and cell

sample weights (W9k) were raked within

state such that the sums of the weights

at the household level agreed with the

control totals in each category of each

margin used for raking. The required

demographic control totals were

obtained from the 2009 ACS data, and

the required telephone status control

totals were calculated by NCHS (29).

The raking adjustments within each state

and DC were made using the following

margins and categories:

+	 Number of households with children

in each of five nonoverlapping race

and ethnicity categories

+	 Number of households with one

child, two children, and three or

more children

+	 Number of households with children

that have a household income in

each of five nonoverlapping

categories

+	 Number of households with children

in which the highest reported

education is in each of three

nonoverlapping categories

+	 Number of households owning their

housing unit, number of households

renting their housing unit, and

number of households that neither

own nor rent their housing unit

(other arrangement)

+	 Age of oldest adult in household

+	 Number of households by phone

status: CPO, cell mostly, combined

landline mostly and landline-cellmixed, landline only, and phoneless

(this dimension was not used for

USVI)

The categories of raking dimensions

were collapsed where the number of

cases was small (less than 40) or if

there was any difficulty in raking

convergence. In some cases, the values

of the raking variables mentioned above

may be missing. The missing values for

all these variables were imputed using

weighted sequential hot deck imputation

after forming appropriate imputation

classes.

To allow for raking to phone status,

the combined landline and cell-phone

sample weights were decomposed into

respective component weights for each

phone status. This was not applied to

the USVI sample because there was no

cell-phone sample.

The raked weight for the k-th

household is

W10k = R10k W9k if k e F

= 0 otherwise,

where R10k is the raking adjustment

factor for the k-th household, which is

determined iteratively, and F is the set

of all phone numbers that complete the

CSHCN Screener as defined above.

At this stage, the weights were

checked, and all extreme weights were

trimmed to avoid any undue influence

on the variances of the estimates. Any

weight greater than the median plus 6

times the interquartile range of the

weights within a given state was

identified as an extreme weight and

truncated to this cutoff value. The

raking adjustment was rerun after

truncating the extreme weights. The

process of truncation and raking

adjustment was repeated a few times to

ensure that no weight was greater than

the trimming cutoff value within a state.

The raked household weight is the

final weight to be used for obtaining all

household-level estimates. Summary

statistics of the household weight by

state are presented in Table IV.

The next step in weighting shifted

to the child level. The base child-level

weight is the same as the corresponding

raked-household weight.

Step 11: Raking adjustment of

child weights

Because all children within

households that completed the CSHCN

Screener are included for the child-level

analysis, the base child-screener weight
 

Page 50 [ Series 1, No. 57

Table IV. Summary statistics for household weights, by state

Unweighted Minimum Maximum Mean Median Sum of

State sample size weight weight weight weight weights

Alabama................... 3,458 19.9 1,294.2 174.0 129.1 601,595

Alaska .................... 4,865 3.5 224.8 18.5 13.8 90,117

Arizona ................... 4,047 12.0 2,361.4 190.0 118.9 768,997

Arkansas .................. 3,331 15.4 1,129.0 114.0 90.0 379,938

California .................. 5,502 4.4 13,295.8 829.7 626.3 4,564,987

Colorado .................. 3,844 7.8 1,597.5 161.9 99.1 622,469

Connecticut ................. 3,681 13.9 818.5 124.4 93.9 458,015

Delaware .................. 3,584 0.5 285.9 30.1 22.0 108,054

District of Columbia ............ 3,879 1.0 346.1 13.6 8.7 52,817

Florida .................... 4,507 11.4 2,950.8 455.0 365.7 2,050,529

Georgia ................... 3,812 15.0 1,783.9 333.2 246.2 1,270,309

Hawaii .................... 5,130 5.6 754.2 30.8 23.8 158,178

Idaho..................... 3,802 5.0 424.9 54.3 35.0 206,431

Illinois .................... 4,466 13.9 2,834.1 360.6 275.8 1,610,525

Indiana.................... 3,499 20.2 1,346.6 236.1 184.4 826,116

Iowa ..................... 3,939 6.1 571.3 96.3 71.2 379,387

Kansas ................... 3,343 7.6 2,118.9 106.8 86.6 356,873

Kentucky .................. 3,228 33.8 2,755.2 175.6 105.0 566,780

Louisiana .................. 3,335 20.6 1,742.9 173.9 127.8 580,107

Maine .................... 3,392 7.6 325.0 46.2 32.8 156,663

Maryland .................. 4,004 5.0 1,669.1 177.3 130.3 710,062

Massachusetts ............... 3,545 7.4 1,201.0 215.4 160.5 763,665

Michigan................... 3,222 34.2 3,209.4 381.6 242.9 1,229,491

Minnesota.................. 3,828 8.3 1,062.7 172.9 136.1 661,877

Mississippi ................. 3,678 9.8 842.0 107.5 81.1 395,317

Missouri ................... 3,444 10.3 1,444.6 220.2 166.0 758,252

Montana................... 4,057 2.2 315.0 25.8 11.7 104,514

Nebraska .................. 3,706 6.5 621.3 60.7 44.5 224,848

Nevada ................... 4,479 3.2 1,030.1 74.8 40.9 335,017

New Hampshire .............. 3,354 8.5 394.5 47.4 40.6 159,017

New Jersey ................. 4,328 9.7 1,781.3 254.6 187.9 1,101,837

New Mexico ................ 3,769 6.0 1,088.4 67.0 41.7 252,395

New York .................. 4,592 9.8 3,322.5 505.1 437.4 2,319,317

North Carolina ............... 3,698 10.1 2,494.5 327.0 220.8 1,209,307

North Dakota ................ 3,886 2.9 230.7 19.3 13.8 74,851

Ohio ..................... 3,596 23.5 1,995.5 398.1 324.8 1,431,605

Oklahoma .................. 3,166 30.6 2,388.8 153.3 106.9 485,289

Oregon ................... 4,065 5.9 2,104.2 110.9 79.5 450,709

Pennsylvania ................ 3,667 7.3 3,279.1 404.8 310.6 1,484,393

Rhode Island ................ 3,390 8.5 208.5 37.2 26.3 126,024

South Carolina ............... 3,625 18.4 2,612.8 155.8 85.2 564,865

South Dakota................ 4,248 2.0 457.3 24.0 10.8 101,765

Tennessee ................. 3,749 15.5 2,072.4 216.6 167.4 811,906

Texas .................... 4,726 3.4 5,669.6 703.3 543.0 3,323,650

Utah ..................... 3,693 17.5 1,046.4 100.6 73.4 371,469

Vermont ................... 3,608 3.7 456.6 20.6 15.1 74,368

Virginia ................... 3,906 4.9 4,220.2 254.8 188.2 995,413

Washington ................. 3,722 5.7 2,143.1 219.3 155.3 816,380

West Virginia ................ 3,344 14.9 597.0 63.7 46.6 212,944

Wisconsin .................. 3,582 7.3 2,536.3 200.8 141.6 719,316

Wyoming .................. 3,838 1.3 191.1 17.5 10.1 67,031

is the same as the final household

weight. This weight was assigned to

each child in the screened households.

The weights were adjusted within state

such that the sum of the weights agreed

with the control totals in various

categories of the following margins

within each state and DC:

+	 Number of male and female children

in each of five nonoverlapping age

groups

+ Number of children in each of five

nonoverlapping race and ethnicity

categories

+ Number of children in one-child

households, two-child households,

and three-plus child households

+ Number of children in households

that have a household income in

each of five nonoverlapping

categories

+ Number of children in households in

which the highest reported education

of parents is in each of three

nonoverlapping categories

+ Number of children in owneroccupied households, renteroccupied households, and number of

children that are neither in ownernor renter-occupied households

(other arrangement)

+ Number of children in households

by phone status: CPO, cell mostly,

combined landline mostly and

landline-cell-mixed, landline only,
and phoneless (this dimension was

not used for the USVI sample)

The control totals for the categories of

the above margins were obtained from

the 2009 ACS and the National Health

Interview Survey (30). The categories of

raking dimensions were collapsed where

the number of cases was small (less

than 40) or if there was any difficulty in

raking convergence.

As with the household raking step,

the weights were decomposed into

respective component weights for each

phone status. This did not apply to the

USVI.

The raked weight for the j-th child

(j e k) can be expressed as

W11j = R11j W10k if j e G, k

= 0 otherwise,

where R11j is the raking adjustment

factor for the j-th child, and G is the set

of children in households F (i.e., the

households that complete the CSHCN

Screener).

At this stage, the weights were

checked, and all extreme weights were

trimmed to avoid any undue influence

on the variances of the estimates. Any

weight greater than the median plus 6

times the interquartile range of the

weights within a given state was

identified as an extreme weight and

truncated to this cutoff value. The

raking adjustment was rerun after

truncating the extreme weights. The

process of truncation and raking

adjustment was repeated a few times to

ensure that no weight was greater than

the trimming cutoff value within a state.

The raked child weight is the final

weight for all screener-level tabulations,

including the estimation of the

proportion of children with special

health care needs. Summary statistics of

the child-level screener weight by state

are presented in Table V.

The remaining steps in weighting

deal with child weights for analysis of

the CSHCN interview file.

Step 12: Adjustment for

subsampling of children with

special care needs

In the households with more than

one child with special health care needs,

only one child was selected randomly

per household for the NS-CSHCN

interview. The child-screener weights

were adjusted to account for the

CSHCN who were not selected. The

subsampling weight for the k-th child is

defined by

W12j	 = nkk W11j if j e H

= 0 otherwise,

where

H = subset of children in G that is

subsampled for CSHCN

interview,

n*

k = the number of CSHCN in

household k where j e k,

and

nk = min(3,n*

k ).

The factor to adjust for the number of

special-needs children in a household is

capped at three to control variability.

This is the basic child-level weight for

the CSHCN interview.

Step 13: Adjustment for

nonresponse to the CSHCN

interview

Not all households with children

subsampled for the detailed CSHCN

interview completed the interview. The

base child-interview weight assigned to

a household responding to the detailed

interview was adjusted for the

nonresponse of other subsampled

children. The adjustment was made by

forming nonresponse-adjustment cells.

The adjusted weight for the j-th child is

W12j W13j = if j e I,, R13q

= 0 otherwise,

∑ δ13j,W12k

jeI R13q = ∑ , δ13j,W12k

jeH

I =subset of all children in H that

complete the CSHCN interview,

and

δ13j, =

1 if the j-th number is in the

l-th adjustment cell

= 0 otherwise.

where

Series 1, No. 57 [ Page 51

The adjustment cells were formed by

using the following variables: household

income, mother’s education, child’s age

group, and number of children with

special needs (listed here in order of

importance, as defined by the survey

goals and objectives).

After forming the cells initially, any

cell with less than 20 responding

records was collapsed with a

neighboring cell.

Step 14: Optimized combined

landline and cell-phone sample

weights

The CSHCN interview nonresponseadjusted weights were reoptimized to

account for the combination of landline

and cell-phone samples prior to final

raking ratio adjustments. Optimization

applied to the CPO and cell-mostly

populations, and was carried out in an

analogous manner to that described

above. CSHCN interview nonresponseadjusted weights for the combined

landline-mostly and landline-cell-mixed,

landline-only, and phoneless

populations, as well as the USVI sample

do not need further reoptimization

because they consist of only landline

sample cases.

Adjustment for overlap of the

landline and cell-phone samples—The

CSHCN interview nonresponse-adjusted

weights for children in cell-mostly

households were adjusted so the sum of

the adjusted weights across landline and

cell-phone samples provided a

mean-squared error (MSE) estimate for

children in cell-mostly households. This

adjustment can be expressed as:

Y|2,CM = λ2Y|2,CP(CM) + (1 – λ2)Y|2,LL(CM),

where

λ2 = adjustment factor,

Y|2,CP(CM)= estimate based on sample

CSHCN from the cell-phone

sampling frame that are

CPM, and for which a

CSHCN interview was

completed, and

Y|LL(CM) = estimate based on sample

CSHCN from the landline

sampling frame that are

cell-mostly, and for which a
Table V. Summary statistics for child-level screener weights, by state

State

Unweighted

sample size

Minimum

weight

Maximum

weight

Mean

weight

Median

weight

Sum of

weights

Alabama...................

Alaska ....................

Arizona ...................

Arkansas ..................

California ..................

Colorado ..................

Connecticut .................

Delaware ..................

District of Columbia ............

Florida ....................

Georgia ...................

Hawaii ....................

Idaho.....................

Illinois ....................

Indiana....................

Iowa .....................

Kansas ...................

Kentucky ..................

Louisiana ..................

Maine ....................

Maryland ..................

Massachusetts ...............

Michigan...................

Minnesota..................

Mississippi .................

Missouri ...................

Montana...................

Nebraska ..................

Nevada ...................

New Hampshire ..............

New Jersey .................

New Mexico ................

New York ..................

North Carolina ...............

North Dakota ................

Ohio .....................

Oklahoma ..................

Oregon ...................

Pennsylvania ................

Rhode Island ................

South Carolina ...............

South Dakota................

Tennessee .................

Texas ....................

Utah .....................

Vermont ...................

Virginia ...................

Washington .................

West Virginia ................

Wisconsin ..................

Wyoming ..................

6,223

9,859

7,996

6,120

10,282

7,320

6,714

6,513

6,583

8,085

7,083

9,670

8,334

8,378

6,719

7,785

6,587

5,878

6,065

6,093

7,186

6,437

6,254

7,461

6,817

6,485

7,931

7,453

8,690

6,072

7,907

7,363

8,357

6,623

7,748

6,793

6,258

7,619

6,771

6,135

6,604

8,634

6,865

9,127

8,932

6,429

6,947

7,051

5,915

6,861

7,605

19.4

3.2

11.3

14.1

3.5

8.7

13.2

0.5

1.0

12.3

17.3

0.5

4.4

13.2

17.6

6.2

6.0

29.7

14.5

7.1

4.3

8.0

29.2

7.7

9.4

9.8

1.7

5.9

3.0

3.9

9.8

5.3

10.9

9.2

1.8

23.8

20.2

6.0

8.1

10.0

11.9

1.6

15.4

2.7

19.0

3.7

4.9

6.7

11.5

6.9

0.9

1,311.6

252.2

2,915.8

1,022.1

12,119.1

2,045.6

766.1

367.1

423.7

3,723.8

2,081.8

657.1

524.2

3,668.7

1,475.7

599.0

2,953.6

2,685.3

1,966.8

280.8

2,565.6

1,795.6

4,268.6

1,263.9

1,006.1

1,614.3

324.2

633.2

1,418.3

354.6

1,752.1

1,197.6

3,566.0

2,901.3

255.5

2,490.2

2,689.2

2,196.2

3,950.7

253.0

2,723.9

502.1

2,354.2

6,283.0’’

1,120.4

466.4

4,470.2

2,519.2

774.2

3,281.7

199.3

180.6

18.6

216.3

115.5

916.1

167.3

120.2

31.8

17.3

500.9

364.0

29.6

50.2

377.7

235.6

90.9

106.2

172.8

184.7

44.9

187.5

222.2

374.6

168.3

112.0

220.1

27.6

59.7

78.5

47.3

258.4

69.7

528.2

342.7

18.3

398.9

146.9

114.4

408.2

36.9

163.0

22.6

216.6

753.5

97.0

19.8

265.4

222.6

64.7

189.7

16.9

136.9

13.9

133.3

89.4

667.2

99.8

90.5

23.1

11.2

395.7

271.2

22.8

32.1

283.3

186.5

68.2

83.9

100.2

133.5

31.8

134.1

164.1

235.9

129.5

85.0

162.1

11.4

44.6

63.7

39.8

185.7

44.0

440.1

233.0

13.3

313.2

103.7

83.7

314.5

25.7

89.6

10.1

168.6

583.8

68.5

14.9

192.9

157.5

46.6

133.9

9.6

1,123,910

183,305

1,729,157

706,698

9,419,433

1,224,749

806,847

206,826

113,627

4,049,599

2,578,088

285,765

418,093

3,164,009

1,582,790

707,428

699,378

1,015,973

1,120,314

273,494

1,347,295

1,430,569

2,342,750

1,255,656

763,785

1,427,638

218,997

445,125

681,986

287,072

2,043,054

512,992

4,413,782

2,269,536

141,694

2,709,474

919,513

871,811

2,763,882

226,543

1,076,481

195,331

1,486,883

6,877,220

866,203

127,219

1,844,002

1,569,516

382,630

1,301,826

128,627

Page 52 [ Series 1, No. 57

CSHCN interview was

completed.

The composite adjustment factor was

derived based upon the variance and

bias associated with the component

estimates. The resulting adjusted survey

weights yielded minimum MSE

estimates. The adjustment factor can be

expressed as:

λ2 =

var(Y|2,LL(CM)) 

, var(Y|2,CP(CM)) + [bias(Y|2CP(CM))]2 + var(Y|2,CP(CM))

where

bias(Y|2,CP(CM)) = Y|2,CP(CM) – Y|2,LL(CM) =

estimated bias associated with

CSHCN from CPM sample cases,

relative to CSHCN from cell-mostly

cases from the landline sampling frame.

The adjusted weights for CPM

sample cases, controlled to the total
population of cell-mostly households

with a child, can then be expressed as:

{ NCM λ ∑ 2W13j , j e CP(CM) W13j

jeCP(CM)

W14j = ,

NCM (1 – λ ∑ 2)W

W 13j , j e LL(CM) 13j

jeLL(CM)

where

NCM = population control for CSHCN

in cell-mostly households

calculated from the screener

file.

Attenuation of cell sample weights

to minimize variance while controlling

for bias—The CSHCN interview

nonresponse adjusted weights for

children in CPO households and

children in proxy CPO households were

adjusted so the sum of the adjusted

weights across landline and cell-phone

samples provided an MSE estimate for

children in CPO households. This

adjustment can be expressed as:

Y|2,CPO = κ2Y|2,CPO(True) + (1 – κ2)Y|2,CPO(Proxy),

where

κ2 =

adjustment factor,

Y|2,CPO(True) =

estimated prevalence of

households with one or

more CSHCN based on

sample CPO households

for which a household

interview was completed,

and

Y|2,CPO(Proxy) =

estimated prevalence of

households with one or

more CSHCN based on

sample proxy CPO

households for which a

household interview was

completed.

The adjustment factor can be expressed

as:

κ2 =

var(Y|2,CPO(Proxy))+[bias(Y|2,CPO(Proxy))]2

, var(Y|2,CPO(True)) + var(Y|2CPO(Proxy))+[bias(Y|2,CPO(Proxy))]2

where

bias(Y|2,CPO(Proxy) = Y|2,CPO(Proxy) –

Y|2,CPO(True) = estimated bias associated

with proxy CPO sample cases.

The adjusted weights for true CPO and

proxy CPO sample cases, controlled to

the total population of CPO households

with children,

{

can then be expressed as:

NCPO κ ∑ 2W13j , jeCPO(True) W13k jeCPO(True)

W14j = ,

NCM (1 – κ ∑ 2)W

W 13j, jeCPO(Proxy)

13k jeCPO(True)

where

NCPO = population control for CSHCN

in CPO households, calculated

from the screener file.

Series 1, No. 57 [ Page 53

Step 15: Raking adjustment of

nonresponse-adjusted weights

The optimized NS-CSHCN child

weight was further adjusted such that

the weighted number of CSHCN based

on the final child-interview weight was

the same as the weighted number of

CSHCN based on the subsampling

weight. The adjustment is made by

various categories of the following

margins within each state and DC:

+	 Number of male and female

CSHCN in each of five

nonoverlapping age groups

+	 Number of CSHCN in each of five

nonoverlapping race and ethnicity

categories

+	 Number of CSHCN in one-child

households, two-children

households, and three-plus-children

households

+	 Number of CSHCN in households

that have a household income in

each of five nonoverlapping

categories

+	 Number of CSHCN in households in

which the highest reported education

of parents is in each of three

nonoverlapping categories

+ Number of CSHCN in owneroccupied households, renteroccupied households, and number of

CSHCN children that are neither in

owner- nor renter-occupied

households (other arrangement)

+	 Number of CSHCN in households

by phone status: CPO, cell mostly,

combined landline mostly and

landline-or-cell-mixed, landline only,

and phoneless (this dimension was

not used for the USVI sample)

The categories of raking dimensions

were collapsed where the number of

cases was small (less than 20) or if

there was any difficulty in raking

convergence.

The raked weight of the j-th child is

W15j = R15jW14j if j e I

= 0 otherwise,

where R15jis the raking adjustment

factor for the j-th child.

At this stage, the weights were

checked, and all extreme weights were

trimmed to avoid any undue influence

on the variances of the estimates. Any

weight greater than the median plus

6 times the interquartile range of the

weights within a given state was

identified as an extreme weight and

truncated to this cutoff value. The

raking adjustment was rerun after

truncating the extreme weights. The

process of truncation and raking

adjustment was repeated a few times to

ensure that no weight was greater than

the trimming cutoff value within a state.

This raked child weight is the final

weight for all estimation and analysis

for CSHCN based on the interview file.

Summary statistics of the childinterview weight by state are presented

in Table VI.
 

Page 54 [ Series 1, No. 57

Table VI. Summary statistics for child-level interview weights, by state

Unweighted Minimum Maximum Mean Median Sum of

State sample size weight weight weight weight weights

Alabama................... 784 55.7 1,792.9 253.4 192.0 198,672

Alaska .................... 775 4.9 162.7 25.2 17.7 19,567

Arizona ................... 789 31.0 2,610.8 297.0 209.7 234,359

Arkansas .................. 785 15.9 1,701.0 175.0 113.7 137,351

California .................. 823 28.3 9,524.2 1,206.7 926.0 993,124

Colorado .................. 773 8.0 2,681.7 215.9 137.8 166,912

Connecticut ................. 784 26.4 1,661.7 176.3 124.3 138,253

Delaware .................. 781 1.1 366.0 45.9 32.1 35,832

District of Columbia ............ 751 2.2 204.4 24.6 14.7 18,505

Florida .................... 864 36.0 5,210.0 698.9 507.8 603,866

Georgia ................... 817 88.3 4,542.7 497.9 352.2 406,745

Hawaii .................... 791 0.5 332.3 43.7 33.4 34,591

Idaho..................... 776 8.3 533.6 68.0 43.0 52,770

Illinois .................... 793 16.4 8,502.4 564.4 376.4 447,578

Indiana.................... 777 21.4 1,991.1 340.7 253.2 264,750

Iowa ..................... 798 13.4 1,150.1 130.7 94.1 104,295

Kansas ................... 787 22.2 1,492.3 153.0 108.3 120,445

Kentucky .................. 790 41.1 2,017.4 247.6 168.2 195,571

Louisiana .................. 774 43.1 2,140.4 266.7 200.8 206,405

Maine .................... 774 9.1 592.6 68.4 44.7 52,925

Maryland .................. 804 6.9 1,893.9 261.1 175.1 209,939

Massachusetts ............... 788 13.9 3,291.1 328.3 234.3 258,686

Michigan................... 787 10.9 7,207.9 537.4 354.0 422,922

Minnesota.................. 776 6.0 1,365.3 229.1 166.4 177,783

Mississippi ................. 767 12.7 1,148.4 160.7 121.0 123,238

Missouri ................... 792 4.8 2,852.9 315.8 224.1 250,128

Montana................... 778 2.9 662.6 39.0 17.0 30,350

Nebraska .................. 776 14.9 719.8 77.9 62.5 60,421

Nevada ................... 771 4.6 2.198.8 104.3 61.1 80,414

New Hampshire .............. 765 7.9 476.1 71.0 53.8 54,346

New Jersey ................. 774 36.7 2,421.8 376.5 263.3 291,390

New Mexico ................ 793 9.1 658.8 88.8 59.5 70,379

New York .................. 836 16.2 4,913.6 783.9 562.2 655,354

North Carolina ............... 809 84.2 3,794.4 477.7 347.5 386,431

North Dakota ................ 797 2.1 224.0 24.6 16.8 19,603

Ohio ..................... 812 39.0 4,461.5 593.9 434.6 482,281

Oklahoma .................. 774 30.3 872.0 206.8 167.0 160,072

Oregon ................... 771 28.2 1,355.4 154.1 113.2 118,811

Pennsylvania ................ 792 35.1 6,415.9 588.6 439.4 466,156

Rhode Island ................ 766 12.9 404.7 50.6 37.1 38,789

South Carolina ............... 789 27.6 2,130.9 221.3 155.9 174,591

South Dakota................ 766 1.2 622.5 31.6 14.6 24,232

Tennessee ................. 831 22.8 2,085.9 305.3 213.6 253,715

Texas .................... 878 16.7 13,422.2 1,038.3 725.3 911,596

Utah ..................... 776 19.7 1,334.0 142.0 100.2 110,219

Vermont ................... 765 4.0 205.2 28.1 19.1 21,527

Virginia ................... 805 13.2 3,493.4 365.8 259.9 294,455

Washington ................. 779 9.8 2,108.2 301.2 227.5 234,667

West Virginia ................ 781 12.5 887.9 89.6 64.7 69,956

Wisconsin .................. 782 10.8 2,639.5 254.3 176.4 198,869

Wyoming .................. 776 1.4 304.4 23.1 12.6 17,915
 

2009-2010 National Survey of Children with Special Health Care Needs Page 1 

2009-2010 National Survey of Children with Special Health Care Needs Page 1 

__________________________________________________________________ 

 

Series 1, No. 57 □ Page 55

Appendix II. 2009–2010 National Survey of Children with Special 

Health Care Needs Questionnaire 

2009–2010 NATIONAL SURVEY OF 

CHILDREN WITH SPECIAL HEALTH CARE NEEDS 

Section 1. NIS/SLAITS .................................................................................................................. 2
 

Section 2. INITIAL SCREENING. .............................................................................................. 16
 

Section 3. HEALTH AND FUNCTIONAL STATUS ................................................................. 24
 

Section 4. ACCESS TO CARE: UTILIZATION AND UNMET NEEDS .................................. 43
 

Section 5. CARE COORDINATION ........................................................................................... 71
 

Section 6A. FAMILY CENTERED CARE AND SHARED DECISION MAKING .................. 75
 

Section 6B. TRANSITION ISSUES............................................................................................. 79
 

Section 6C. DEVELOPMENTAL SCREENING......................................................................... 81
 

Section 7. HEALTH INSURANCE.............................................................................................. 83
 

Section 8. ADEQUACY OF HEALTH CARE COVERAGE...................................................... 91
 

Section 9. IMPACT ON THE FAMILY....................................................................................... 92
 

Section 9.5. ADD/ADHD QUESTIONS ...................................................................................... 95
 

Section 10. DEMOGRAPHICS.................................................................................................... 97
 

Section 11. INCOME.................................................................................................................. 108
 

Section 11A. TELEPHONE LINE AND HOUSEHOLD INFORMATION ............................. 116
 

*CA indicates California Supplemental Questions 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2009-2010 National Survey of Children with Special Health Care Needs Page 2 

Page 56 □ Series 1, No. 57

Section 1. NIS/SLAITS 

INTRO_1	 Hello, my name is __________. I’m calling on behalf of the Centers for Disease Control and 

Prevention. We’re conducting a nationwide immunization study to find out how many children 

under 4 years of age, are receiving all of the recommended vaccinations for childhood diseases. 

Your telephone number has been selected at random to be included in the study. 

CONTINUE WITH INTERVIEW...........................................1 GO TO S1
 

CONFIRM BUSINESS............................................................2 GO TO SALZ
 

Out of scope .............................................................................3 GO TO THANK_YOU_OOS
 

Terminate the Interview ...........................................................4 GO TO UNIVERSAL EXITT1 

Cell phone ................................................................................5 GO TO UNIVERSAL EXITCELL_1 

Answering machine .................................................................6 GO TO MSG_Y
 

R will call 800 line/verify website ...........................................7 GO TO CNOTES_1_1
 

R asks for letter ........................................................................8 GO TO UNIVERSAL EXIT 

M1_NAME 

Supervisor review.....................................................................9 GO TO CNOTES_1_1
 

Continue the case with Language Line ..................................16 GO TO S1/N_S1
 

INTRO_1_HUDI Hello, my name is ___. I’m calling on behalf of the Centers for Disease Control and Prevention. 

We’re conducting a nationwide study to prevent future outbreaks of childhood diseases. 

CONTINUE WITH INTERVIEW...........................................1 GO TO S1
 

CONFIRM BUSINESS............................................................2 GO TO SALZ
 

ANSWERING MACHINE ......................................................4 GO TO MSG_Y
 

INTRO_1 

(for partial 

completes)	 Hello, my name is ______________ and I am calling on behalf of the Centers for Disease 

Control and Prevention. We recently spoke to (MKR / an adult in this household) and began an 

important nationwide immunization study regarding (child's name or initials)'s vaccinations. I'm 

calling to complete the interview now, may I please speak with (MKR / that adult)? 

CONTINUE WITH INTERVIEW...........................................1 GO TO S1
 

CONFIRM BUSINESS............................................................2 GO TO SALZ
 

Out of scope .............................................................................3 GO TO THANK_YOU_OOS
 

Terminate the Interview ...........................................................4 GO TO UNIVERSAL EXITT1 

Cell phone ................................................................................5 GO TO UNIVERSAL EXITCELL_1 

Answering machine .................................................................6 GO TO MSG_Y
 

R will call 800 line/verify website ...........................................7 GO TO CNOTES_1_1
 

R asks for letter ........................................................................8 GO TO UNIVERSAL EXIT
 
 

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Series 1, No. 57 □ Page 57

M1_NAME 

Supervisor review.....................................................................9 GO TO CNOTES_1_1
 

(Raise your hand to get permission before using this code) 

INTRO_1 [Incentives_10/Address Available] 

Hello. I’m calling on behalf of the Centers for Disease Control and Prevention to follow up on a 

letter that was sent to your home. Earlier, we had contacted your household to participate in a 

survey regarding the immunizations of the [IF S_NUMB=1, THEN "child who lives"{IF 

S_NUMB>1, THEN "children who live"] there. I’m calling back to continue the interview. In 

appreciation for your time, we will send you $10. 

CONTINUE WITH INTERVIEW...........................................1 GO TO S1
 

CONFIRM BUSINESS............................................................2 GO TO SALZ
 

Out of scope .............................................................................3 GO TO THANK_YOU_OOS
 

Terminate the Interview ...........................................................4 GO TO UNIVERSAL EXITT1 

Cell phone ................................................................................5 GO TO UNIVERSAL EXITCELL_1 

Answering machine .................................................................6 GO TO MSG_Y
 

R will call 800 line/verify website ...........................................7 GO TO CNOTES_1_1
 

R asks for letter ........................................................................8 GO TO UNIVERSAL EXIT 

M1_NAME 

Supervisor review.....................................................................9 GO TO CNOTES_1_1
 

(Raise your hand to get permission before using this code) 

INTRO_1 [Incentives_15/Telephone Only] 

Hello. I’m calling on behalf of the Centers for Disease Control and Prevention. Earlier, we had 

contacted your household to participate in a survey regarding the immunizations of the [IF 

S_NUMB=1, THEN "child who lives"/IF S_NUMB>1, THEN "children who live"] there. I’m 

calling back to continue the interview. In appreciation for your time, we will send you $15. 

CONTINUE WITH INTERVIEW...........................................1 GO TO S1
 

CONFIRM BUSINESS............................................................2 GO TO SALZ
 

Out of scope .............................................................................3 GO TO THANK_YOU_OOS
 

Terminate the Interview ...........................................................4 GO TO UNIVERSAL EXITT1 

Cell phone ................................................................................5 GO TO UNIVERSAL EXITCELL_1 

Answering machine .................................................................6 GO TO MSG_Y
 

R will call 800 line/verify website ...........................................7 GO TO CNOTES_1_1
 

R asks for letter ........................................................................8 GO TO UNIVERSAL EXIT 

M1_NAME 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2009-2010 National Survey of Children with Special Health Care Needs Page 4 

Page 58 □ Series 1, No. 57

Supervisor review.....................................................................9 GO TO CNOTES_1_1 

(Raise your hand to get permission before using this code) 

[IF MOST KNOWLEDGEABLE PARENT HAS NOT BEEN IDENTIFIED: 

May I please speak with the parent or guardian who knows the most about the health of the 

child[ren] in the household?] 

[IF MOST KNOWLEDGEABLE PARENT HAS BEEN DETERMINED: 

May I please speak with [NAME]/the person who had started the interview?] 

THANK_YOU 

_OOS	 We are only interviewing families living in their usual place of residence, those are all the 

questions I have. Thank you. 

SALZ	 Is this telephone number for business use only? 

Yes ...........................................................................................1 GO TO SALZ_BUS
 

No.............................................................................................2 GO TO INTRO_1
 

DORM/PRISON/HOSTEL .....................................................3 GO TO SALZ_BUS
 

PAGING SERVICE .................................................................4 GO TO SALZ_BUS
 

SASERV	 BASED ON THE ANSWERING SERVICE, WAS THIS DEFINITELY A BUSINESS, A 

HOUSEHOLD, OR COULD NOT BE DETERMINED? 

BUSINESS...............................................................................1 TERMINATE
 

HOUSEHOLD .........................................................................2 TERMINATE
 

COULD NOT DETERMINE...................................................3 TERMINATE
 

ANSWERING MACHINE SAID 

“TAKE ME OFF YOUR LIST” ..............................................4 TERMINATE
 

S1	 Am I speaking to someone who lives in this household who is over 17 years old? 

IF THE RESPONDENT SAYS NO: ASK TO SPEAK WITH SOMEONE OVER 17 WHO 

LIVES IN THE HOUSEHOLD. 

I AM THAT PERSON .............................................................1	 GO TO S_NUMB 

[IFINCENTIVE=1, GO TO 

S3_INTRO_INCENT] 

THIS IS A BUSINESS.............................................................2	 GO TO SALZ
 

NEW PERSON COMES TO PHONE .....................................3	 GO TO INTRO_1
 

DOESN’T LIVE IN HOUSEHOLD ....................................... 8 GO TO INSTRUCTION: 

[ASK FOR ANOTHER 

PERSON OR SCHEDULE 

APPOINTMENT ON THE 

NEXT SCREEN] 

NO PERSON AT HOME WHO IS AT OVER 17...................9	 GO TO S2_B
 
 

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Series 1, No. 57 □ Page 59

REFUSED..............................................................................99 GO TO UNIVERSAL EXITR1 

SALZ_BUS	 WE ARE INTERVIEWING ONLY PRIVATE RESIDENCES. THANK YOU VERY MUCH. 

[TERMINATE INTERVIEW] 

S2_B	 Does anyone live in your household who is over 17 years old? 

YES, THEY ARE COMING TO THE PHONE ......................1 GO TO INTRO_1 

YES, BUT NO ONE IS HOME, SO SET A 

CALLBACK ............................................................................2 GO TO 

S2_B_WARNING_TEXT 

SCRIPT SHOWN BELOW 

NO, NO ADULTS LIVE IN THE HOUSEHOLD 

AT ANYTIME ........................................................................3 GO TO MINOR_EXIT 

TEEN LINE (COLLECT ANOTHER PHONE 

NUMBER) ...............................................................................4 GO TO S2_C 

REFUSED..............................................................................99 GO TO R1 

S2_B_ 

WARNING_ 

TEXT Thank you, we’ll try back another time. 

[CREATE AN APPOINTMENT OR SET GENERAL CALL BACK. ENTER DATE/TIME AND 

CONTACT NAME IF KNOWN] 

MINOR_EXIT	 Those are all the questions I have. I’d like to thank you on behalf of the Centers for Disease 

Control and Prevention for the time and effort you’ve spent answering these questions. 

[TERMINATE INTERVIEW] 

S2_C Is there another telephone number that I should call? ___________________________ 

GO TO INSTRUCTION: WARNING: THE PHONE NUMBER FOR THIS INTERVIEW IS 

CHANGED NOW FROM X TO X. 

GO TO CB1 (APPOINTMENT SCREEN) THEN C_NOTES_1_1 

NIS SCREENING 

S_NUMB	 How many children between the ages of 12 months and 3 years old are living or staying in your 

household? 

IF ONE OR MORE, ENTER # OF CHILDREN ....................... (ENTER 01 to 09)
 

IF NO CHILDREN ENTER 0 ................................................... GO TO S_NUMB2
 

(77) DON’T KNOW ................................................................. GO TO SOFTCHECK_77
 
 

 

 

 

 

 

 

 

 

 

 

 

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Page 60 □ Series 1, No. 57

(99) REFUSED ..........................................................................	 GO TO UNIVERSAL EXITR1 

SOFT 

CHECK_77 ASK FOR ANOTHER PERSON OR SCHEDULE APPOINTMENT ON THE NEXT SCREEN 

(1) CONTINUE........................................... GO TO S_NUMB
 

(2) APPOINTMENT.......... GO TO UNIVERSAL EXIT-CB1
 

S_NUMB2	 Just to confirm, there are 0 children between the ages of 12 months and 3 years living or staying 

in your household? 

(1) YES	 IF S-NUMB =0 AND FLAGGED FOR NS-CSHCN, GO TO NS-CSHCN, IF 1-9 

GO T0 S3_LTR 

(2) NO .......................................................... GO TO S_NUMB
 

(77) DON’T KNOW ....................... GO TO SOFTCHECK_77
 

(99) REFUSED ..................... GO TO UNIVERSAL EXIT- R1
 

ROSTER SECTION BEGINS 

INTRO_AUG IF SAMPLE_USE_CODE = 3, READ INTRO_AUG. 

Hello, my name is _________. I am calling on behalf of the Centers for Disease Control and 

Prevention. We are doing a national survey [IF RDD_NCCELL_CCELL=2, 3 "on cell phones"] 

about health services used by children and teenagers (, and I was told that you were the person to 

talk with about the health of the child or children in your household). 

(Use the parenthetical for KR call back interviews) 

(1) CONTINUE ............................................................................ SEE LOGIC BELOW
 

IF INTRO_1=1 AND RDD_NCCELL_CCELL = 1, GO TO S1 

ELSE IF INTRO_1=1 AND RDD_NCCELL_CCELL = 2 OR 3 AND TXFLG = 1 , GO 

TO S_CELL 

ELSE IF INTRO_1=1 AND RDD_NCCELL_CCELL = 2 OR 3 AND TXFLG = 0 or 2, 

GO TO S_WARM 

(2) CONFIRM BUSINESS........................................................... GO TO SALZ
 

(3) OUT OF SCOPE ..................................................................... GO TO THANK_YOU_OOS
 

(4) TERMINATE THE INTERVIEW .......................................... GO TO T1
 

IF RDD_NCCELL_CCELL = 1 DISPLAY 

(5) CELL PHONE........................................................ GO TO CELL_1 

ELSE IF RDD_NCCELL_CCELL = 2, 3 AND TXFLG = 1 DISPLAY 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2009-2010 National Survey of Children with Special Health Care Needs Page 7 

Series 1, No. 57 □ Page 61

(5) LANDLINE - YOU WILL NOT TERMINATE .................		 GO TO S1 and set 

RDD_NCCELL_CCELL = 1 

ELSE IF RDD_NCCELL_CCELL = 2, 3 AND TXFLG = 0 DISPLAY 

(5) LANDLINE...........................................................		 GO TO LANDLINE EXIT -

set ITS 88 

(6) ANSWERING MACHINE [FILL] ......................................... GO TO S1 

If message is to be left then GO TO SASERV else hang up and set ITS =35 

(7) R WILL CALL 800 LINE/VERIFY WEBSITE ..................... GO TO P1/VERIFY_INFO 

set ITS =69 

(8) R ASKS FOR LETTER........................................................... GO TO M1_NAME
 

(9) SUPERVISOR REVIEW ........................................................ (Raise your hand to get 

permission before using this code) – set ITS = 49 

(15) Test sample - use only if respondent instruct that this call was a test => set ITS =119 

(16) CONTINUE THE CASE WITH LANGUAGE LINE 

IF RDD_NCCELL_CCELL = 2, 3 DISPLAY 

(17) DROPPED CALL.............................................GO TO CNOTES_1_1> set ITS=81 

(SCHEDULE A CALL BACK FOR 1 MINUTES) 

S1 Am I speaking to someone who lives in this household who is over 17 years old? 

IF THE RESPONDENT SAYS NO: ASK TO SPEAK WITH SOMEONE OVER 17 WHO 

LIVES IN THE HOUSEHOLD. 

(1) I AM THAT PERSON ............................................................ GO TO S_NUMB 

[IFINCENTIVE=1, GO TO S3_INTRO_INCENT] 

(2) THIS IS A BUSINESS............................................................	 GO TO SALZ
 

(3) NEW PERSON COMES TO PHONE ....................................	 GO TO INTRO_1
 

(8) DOESN’T LIVE IN HOUSEHOLD ....................................... GO TO INSTRUCTION: 

[ASK FORANOTHER PERSON OR SCHEDULE APPOINTMENT ON THE NEXT SCREEN] 

(9) NO PERSON AT HOME WHO IS AT OVER 17.................. GO TO S2_B 

(99) REFUSED ............................................................................. GO TO UNIVERSAL EXITR1 

S2_B Does anyone live in your household who is over 17 years old? 

IF THE RESPONDENT SAYS NO, READ. "Just to clarify, no one 18 years of age or older lives 

in this household?") 

(1) Yes, They are coming to the phone GO TO appropriate INTRO 

(2) Yes, But no one is home, so set a callback	 GO TO S2_B_1_Warning_Text 

(3) No, No adults live in the household at any time IF call count =1 delay it for 7 

days or 21 shifts else if call 

count >1 then finalize the case 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2009-2010 National Survey of Children with Special Health Care Needs Page 8 

Page 62 □ Series 1, No. 57

(4) Teen Line (Collect another telephone number) .................. GO TO S2_C
 

(99) REFUSED ....................................................................... GO TO R1
 

S_UNDR18 [IF S_NUMB GE 1 AND NIS IS DONE, FILL S_UNDR18 FROM NIS DATA 

S_UNDR18 = C1 – C1A. C1 – C1A CANNOT BE LE 0. IF THAT IS THE CASE, ASK 

S_UNDR18] 

How many people less than 18 years old live in this household? 

(CATI: 2 NUMERIC-CHARACTER FIELD TO ALLOW FOR DK/REF VALUES, 

RANGE: 00-09) 

______ ______ 

1 OR GREATER [SKIP TO ISC200] 

(0) [SKIP TO NOCHILD] 

(77) DON’T KNOW [GO TO ASK_ANOTHER] 

(99) REFUSED [TERMINATE AND SET AS REFUSAL ((IF INCENTIVE > 0 

THEN GO TO ADDRESS COLLECTION), THEN GO TO R1, 

SET ITS = 23)] 

A CHILD IS COUNTED AS "LIVING IN THE HOUSEHOLD" IF THE CHILD: 

- HAS BEEN STAYING THERE (OR IS EXPECTED TO STAY THERE) FOR AT LEAST 

TWO MONTHS 

- THE LENGTH OF THE CURRENT STAY IS UNKNOWN, BUT THERE IS NO OTHER 

PLACE WHERE THE CHILD USUALLY STAYS 

- USUALLY STAYS IN THE HOUSEHOLD, BUT IS CURRENTLY AWAY FOR LESS THAN 

TWO MONTHS (WHETHER TRAVELING, IN THE HOSPITAL, OR AWAY FOR ANY 

OTHER REASON) 

- USUALLY STAYS IN THE HOUSEHOLD, BUT IS CURRENTLY AWAY FOR TWO 

MONTHS OR MORE BECAUSE THEY ARE AT SCHOOL (COLLEGE, BOARDING 

SCHOOL, MILITARY ACADEMY, PREP SCHOOL, ETC.) 

- ONLY LIVES PART-TIME IN THE HOUSEHOLD BECAUSE OF CUSTODY ISSUES, BUT 

IS STAYING THERE AT THE TIME OF THE CALL 

NUMBER OF CHILDREN = 0 [GO TO NOCHILD] 

NUMBER OF CHILDREN > 1 AND HH NIS-ELIGIBLE [GO TO SL_INTRO] 

NUMBER OF CHILDREN > 1 AND HH NIS-INELIGIBLE [GO TO ISC200] 

S_UNDR18_CONF 

WARNING: ACCORDING TO NIS THERE [IF S_NUMB=1 THEN FILL: IS / IF S_NUMB > 1 

THEN FILL: ARE] AT LEAST [FILL S_NUMB] [if S_NUMB=1 THEN FILL: CHILD / IF 

S_NUMB > 1 THEN FILL: CHILDREN] IN THE HOUSEHOLD. 

PLEASE RE-ASK S_UNDR18 ASKING FOR ALL OF THE CHILDREN IN THE 

HOUSEHOLD. 

(1) Count incorrect - change total number of children [SKIP BACK TO S_UNDR18] 

(2) Total number of children confirmed as correct [GO TO LL_TYPE if Language Line 

case, ELSE go to CHECKPOINT.] 

LL_TYPE WHAT LANGUAGE WAS NEEDED TO COMPLETE THIS INTERVIEW? 

(01) KOREAN [Go to LL_END] 

(02) MANDARIN [Go to LL_END] 

(03) CANTONESE [Go to LL_END] 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2009-2010 National Survey of Children with Special Health Care Needs Page 9 

Series 1, No. 57 □ Page 63

(04) VIETNEMESE [Go to LL_END] 

(05) ARABIC	 [Go to LL_END] 

(06) FRENCH/CREOLE/HAITIAN [Go to LL_END] 

(07) ITALIAN [Go to LL_END] 

(08) JAPANESE [Go to LL_END] 

(09) POLISH [Go to LL_END] 

(10) PORTUGESE [Go to LL_END] 

(11) TAGALOG/FILIPINO [Go to LL_END] 

(12) ENGLISH [CONTINUE WITH INTERVIEW AS USUAL] 

(13) SPANISH [CONTINUE WITH INTERVIEW AS USUAL] 

(14) ANOTHER LANGUAGE [Go to LL_END] 

LL_END	 IF LL_TYPE = 1,2,3, or 4 DISPLAY: 

Those are all the questions I have at this time. I’d like to thank you on behalf of the Centers for 

Disease Control and Prevention for the time and effort you’ve spent answering these questions. If 

you have any questions about this survey, you may call my supervisor toll-free at [IF SUC = 1, 2, 

4 FILL 1 - 8 6 6 - 9 9 9 - 3 3 4 0 / IF SUC = 3, 5, 6 FILL 1 - 8 8 8 - 9 9 0 - 9 9 8 6 ] . If you have 

questions about your rights as a survey participant, you may call the chairman of the Research 

Ethics Review Board at 1-800-223-8118. Thank you again. 

ELSE, DISPLAY: 

Those are all the questions I have. I’d like to thank you on behalf of the Centers for Disease 

Control and Prevention for the time and effort you’ve spent answering these questions. If you 

have any questions about this survey, you may call my supervisor toll-free at [IF SUC = 1, 2, 4 

FILL 1 - 8 6 6 - 9 9 9 - 3 3 4 0 / IF SUC = 3, 5, 6 FILL 1 - 8 8 8 - 9 9 0 - 9 9 8 6 ]. If you have 

questions about your rights as a survey participant, you may call the chairman of the Research 

Ethics Review Board at 1-800-223-8118. Thank you again. 

(1) EXIT SCRIPT READ 

(2) ASIAN LANGUAGE INTERVIEWERS CONTINUE INTERVIEW 

ISC200	 IF NIS-ELIGIBLE OR TEEN ELIGIBLE HOUSEHOLD< SKIP TO SL_INTRO 

We need to talk to the parent or guardian living in this household who knows about the health and 

health care of the [IF S_UNDR18 =1 INSERT 'child' / IF S_UNDR18 GT 1, INSERT 'children'] 

under 18. Who would that be? 

(1) MYSELF [SKIP TO CSHCN_LTR] 

(2) SOMEONE ELSE [SKIP TO ISC240] 

NOTE: THE FOLLOWING OPTION SHOULD BE USED VERY RARELY. IF YOU DO 

SELECT THIS OPTION, IT WILL BE CAREFULLY REVIEWED BY A SUPERVISOR. BE 

SURE TO LEAVE GOOD CALL NOTES!!! 

(33) THERE IS NO ONE PERSON WHO KNOWS ABOUT ALL THE CHILDREN IN THE 

HOUSEHOLD [GO TO CWEND, SET ITS CODE AS 53] 

ISC240	 Because the rest of the survey is about the health and health care of the [IF S_UNDR18 =1 

INSERT 'child' / IF S_UNDR18 GT 1, INSERT 'children'] under 18, may I speak with that person 

now? 

(1) YES [SKIP TO NEW_RESP] 

(2) NO [GO TO SCHEDULE AN APPOINTMENT] 

SCHEDULE APPOINTMENT ON THE NEXT SCREEN IF NOT AVAILABLE 
 

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Page 64 □ Series 1, No. 57

ASK_ANOTHER 

Is there anyone in your household who knows how many people in this household are less than 18 

years old? 

(1) NEW PERSON COMES TO PHONE [GO TO INTRO_SWITCH] 

(2) NO [IF INCENTIVE>0 THEN GO TO ADDRESS 

COLLECTION THEN GO TO CSHCN_TERM] 

CSHCN_TERM Thank you, we’ll try back another time. 

 

INTRO_SWITCH 

Hello, my name is ________________. I'm calling on behalf of the Centers for Disease Control 

and Prevention. We are doing a national survey about health services used by children and 

teenagers, and I was told that you were the person to talk with about the health and health care of 

the [IF S_UNDR18 =1, INSERT "child"; IF S_UNDR18 > 1 INSERT "children"] in the 

household. 

(0) CONTINUE 

GO TO S_UNDR18 

NOCHILD	 (IF INCENTIVE > 0 THEN GO TO ADDRESS COLLECTION), THEN READ NOCHILD 

Those are all the questions I have. We are only interviewing in households with children. I’d like 

to thank you on behalf of the Centers for Disease Control and Prevention for the time and effort 

you’ve spent answering these questions. 

TERMINATE > SET ITS = 61 

NEW_RESP	 Hello, my name is ________________. I'm calling on behalf of the Centers for Disease Control 

and Prevention. We are doing a national survey about health services used by children and 

teenagers, and I was told that you were the person to talk with about the health and health care of 

the [IF S_UNDR18 =1, INSERT "child"; IF S_UNDR18 > 1 INSERT "children"] in the 

household. 

(1) CONTINUE 

CSHCN_LTR	 IF NO ADVANCE LETTER SENT, THEN SKIP TO SL_INTRO 

A letter describing this survey may have been sent to your home recently. Do you remember 

seeing the letter? 

(1) YES 

(2) NO 

(77) DON’T KNOW 

(99) REFUSED 

SL_INTRO	 MONEY TEXTFILL LOGIC: 

IF CSHCN_INCENT = 1 or 7 AND CSHCN_INCENT_FLAG = 1 

OR 

IF CSHCN_INCENT = 1, 2, 4, or 7 AND CSHCN_INCENT_FLAG = 2 AND 

CSHCN_LTR_FLAG = 1 

OR 

IF CSHCN_INCENT=1,2, 4, or 7 AND CSHCN_PASSIVE = 1 OR 2 AND CSHCN_LTR_FLAG 

= 1 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2009-2010 National Survey of Children with Special Health Care Needs Page 11 

Series 1, No. 57 □ Page 65

OR
 

IF CSHCN_INCENT=3
 

THEN OFFER MONEY_1
 

IF CSHCN_INCENT = 1, 2,4,5, 6, or 7 AND CSHCN_INCENT_FLAG = 2 AND 

CSHCN_LTR_FLAG = 2 

OR 

IF CSHCN_INCENT =1,2,4,5, 6, or 7 AND CSHCN_PASSIVE = 1 OR 2 AND 

CSHCN_LTR_FLAG = 2 

THEN OFFER MONEY_2 

IF S3_INTRO OR TIS_INTRO1(full IC) or TIS_INTRO2 (short IC) READ AND NEW_RESP 

NE 1 AND INTRO_SWITCH NE 1 

READ: 

[If NIS or TEEN complete, read: I appreciate your answers about the immunizations of [IF 

SAMPLE_USE_CODE = 2 then fill with NIS-ELIGIBLE CHILDREN, IF 

SAMPLE_USE_CODE=4 AND NIS DONE BUT NO TEEN THEN FILL WITH NIS-ELIGIBLE 

CHILDREN, IF SAMPLE_USE_CODE=4 AND TEEN INTERVIEW DONE THEN FILL WITH 

ST] Next, I have some questions about some other health care needs of children. As before, you 

may choose not to answer any questions you don’t wish to answer, or end the interview at any 

time with no impact on the benefits you may receive. [IF (INCENTIVE CASE DISPLAY: In
 

appreciation for your time, we will send you $[MONEY_1 / MONEY_2].)] After a few questions,
 

I can tell you how long this survey will take. In order to review my work, my calls are recorded
 

and my supervisor may listen as I ask the questions. I’d like to continue now unless you have any
 

questions.
 

ELSE READ:
 

[IF SUC = 2 OR 4 THEN READ: "Next, I have some questions about some other health care 

needs of children."]
 

Before we continue, I’d like you to know that taking part in this research is voluntary. You may
	

choose not to answer any questions you don’t wish to answer, or end the interview at any time 

with no impact on the benefits you may receive. We are required by Federal laws to develop and
 

follow strict procedures to protect your information and use your answers only for statistical 

research. I can describe these laws if you wish. [IF (INCENTIVE CASE DISPLAY: In
 

appreciation for your time, we will send you $[MONEY_1 / MONEY_2].)] After a few
 

questions, I can tell you how long this survey will take. In order to review my work, my calls are 

recorded and my supervisor may listen as I ask the questions. I’d like to continue now unless you 

have any questions. 

DISPLAY FOR ALL: 

READ IF NECESSARY: The Public Health Service Act is Volume 42 of the US Code, Section 

242k. The collection of information in this survey is authorized by Section 306 of this Act. 

Through the National Center for Health Statistics, the confidentiality of your responses is assured 

by Section 308d of this Act and by the Confidential Information Protection and Statistical 

Efficiency Act. Would you like me to read the Confidential Information Protection provisions to 

you? 

IF RESPONDENT WOULD LIKE TO HEAR PROVISIONS, READ: The information you 

provide will be used for statistical purposes only. In accordance with the Confidential Information 

Protection provisions of Title V, Subtitle A, Public Law 107-347 and other applicable Federal 

laws, your responses will be kept confidential and will not be disclosed in identifiable form to 

anyone other than employees or agents. By law, every employee of the National Center for Health 
 

 

 

 

 

 

 

 

 

 

 

 

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Page 66 □ Series 1, No. 57

Statistics and its collaborating agency and contractor, specifically the National Center for 

Immunization and Respiratory Diseases and the National Opinion Research Center, and their 

agents and contractors who work on this survey, has taken an oath and is subject to a jail term of 

up to 5 years, a fine of up to $250,000, or both, if he or she willingly discloses ANY identifiable 

information about you or your household members. 

INTERVIEWER INSTRUCTION: If R asks, say: "The date(s) of birth you have provided do not 

qualify you for the previous section of the survey, but after a few more questions I can tell you if 

you're eligible for the next section of the survey." 

(1) CONTINUE, RECORDING ACCEPTABLE 

(2) CONTINUE, DO NOT RECORD 

AGE_X	 CATI INSTRUCTION (AGE_GRID) IF S_UNDR18 = 1, FILL “age” AND “child”. ELSE, 

FILL “ages” AND “children”. 

IF S_NUMB = 0, DISPLAY THIS TEXT WHEN ASKING ABOUT FIRST CHILD: “Many of 

my questions are only for children of certain ages. So, I’ll know which questions to ask, please 

tell me the [age/ages] of the [child/children] less than 18 years old living in this household.” FOR 

ALL SUBSEQUENT CHILDREN (LOOP UNTIL # OF CHILDREN=S_UNDR18) DISPLAY: 

(READ IF NECESSARY): "Please tell me the age of the next child who lives in this household." 

ELSE IF (S_NUMB=S_UNDR18 then FILL AGE_1 (and AGE_1Y_X as needed) with age of 

child and skip to AGE_CONF. 

ELSE IF S_NUMB > 0 AND S_UNDR18 – S_NUMB > 0, FILL: "You have already given me 

(FILL NAME OF NIS-ELIGIBLE CHILD OR CHILDREN)'s birth date(s). Now, would you 

please tell me the [age/ages] of the other [IF S_UNDER18 - S_NUMB = 1, INSERT "child"; IF 

S_UNDR18 - S_NUMB > 1, INSERT "children"] living in this household.” FOR ALL 

SUBSEQUENT CHILDREN (LOOP UNTIL # OF CHILDREN=S_UNDR18 - S_NUMB) 

DISPLAY: (READ IF NECESSARY: "Please tell me the age of the next child who lives in this 

household.") 

Display for AGE_1 

INTERVIEWER: IF R PROVIDES AGES FOR ALL CHILDREN UP FRONT, TYPE IN THE 

AGES AS CATI PROMPTS FOR THEM. 

ENTER 77 FOR DON'T KNOW AND 99 FOR REFUSED 

IF AGE IS LESS THAN 1 MONTH OLD, RECORD 0 MONTHS. A CHILD IS COUNTED AS 

"LIVING IN THE HOUSEHOLD" IF THE CHILD: 

• HAS BEEN STAYING THERE (OR IS EXPECTED TO STAY THERE) FOR AT LEAST 

TWO MONTHS 

• THE LENGTH OF THE CURRENT STAY IS UNKNOWN, BUT THERE IS NO OTHER 

PLACE WHERE THE CHILD USUALLY STAYS 

• USUALLY STAYS IN THE HOUSEHOLD, BUT IS CURRENTLY AWAY FOR LESS 

THAN TWO MONTHS (WHETHER TRAVELING, IN THE HOSPITAL, OR AWAY FOR 

ANY OTHER REASON) 

• USUALLY STAYS IN THE HOUSEHOLD, BUT IS CURRENTLY AWAY FOR TWO 

MONTHS OR MORE BECAUSE THEY ARE AT SCHOOL (COLLEGE, BOARDING 

SCHOOL, MILITARY ACADEMY, PREP SCHOOL, ETC.) 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2009-2010 National Survey of Children with Special Health Care Needs Page 13 

Series 1, No. 57 □ Page 67

• ONLY LIVES PART-TIME IN THE HOUSEHOLD BECAUSE OF CUSTODY ISSUES, BUT 

IS STAYING THERE AT THE TIME OF THE CALL 

_____ENTER VALUE 

[IF 77 GO TO WHEN_CALL,
 

IF 99 GO TO AGE_REF]
 

AGES SHOULD BE STORED IN AGE_1 - AGE_9. 

PLEASE VERIFY THAT TEEN "BACKGROUND" VARIABLES FOR ROSTER FILL 

APPROPRIATELY TO CSHCN. PLEASE ALSO VERIFY THAT MAGE AND YAGE FILL 

CORRECTLY. 

IF SAMPLE_USE_CODE = 4: FILL AGE ROSTER FROM TEEN ROSTER. 

AGE1_X	 _____(1) MONTHS 

_____(2) YEARS 

CONTINUE TO LOOP FOR ALL REMAINING CHILDREN 

IF MONTHS, RANGE CHECK = 1-24;
 

IF YEARS, RANGE CHECK = 1-17
 

THESE SHOULD APPEAR ON THE SAME SCREEN AS AGE_X. 

AFTER LOOP ENDS, GO TO AGE_1Y_1. 

WHEN_CALL	 What would be a good time to reach a person who knows the child's age? 

(1) SET APPOINTMENT FOR CALLBACK [GO TO CB1] 

(2) PERSON AVAILABLE	 [GO TO INTRO_AGE] 

ON A CALL-BACK, POR IS AGE_X. 

AGE_REF	 The reason we need your child's age is to know which health and health care questions to ask. The 

information you provide is completely confidential. 

(1) YES [GO TO AGE_X] 

(2) NO [GO TO AGE_TERM] 

AGE_TERM IF INCENTIVE>0 THEN GO TO ADDRESS COLLECTION THEN READ AGE_TERM. 

Those are all the questions I have. I’d like to thank you on behalf of the Centers for Disease 

Control and Prevention for the time and effort you’ve spent answering these questions. 

INTRO_AGE	 Hello, my name is ________________. I'm calling on behalf of the Centers for Disease Control 

and Prevention. We are doing a nationwide survey about the health of children and teenagers, and 

I was told that you were the person to talk with about the health of the (IF S_UNDR18 =1, 

INSERT "child"; IF S_UNDR18 > 1 INSERT "children") in your household 

(1) CONTINUE	 [RETURN TO AGE_X] 

AGE_1Y_1	 IF EXACTLY 1 AGE_X=1 YEAR OLD OR 0 YEARS OLD, THEN ASK "Because some of our 

questions are only for children of certain ages, can you please tell me the age of the [1-year-old/0-

year-old] child in months? " 

ELSE IF > 1 AGE_X = 1 YEAR OLD OR 0 YEARS OLD, THEN ASK "Because some of our 

questions are only for children of certain ages, can you please tell me the age of the first [1-year-
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2009-2010 National Survey of Children with Special Health Care Needs Page 14 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Page 68 □ Series 1, No. 57

old/0-year-old] child in months? " 

ELSE IF 0 AGE_X = 1 YEAR OLD THEN SKIP TO AGE_CONF. 

___ ___ MONTHS [RANGE: 0-24] 

IF EXACTLY 1 AGE_X = 1 YEAR OLD, GO TO AGE_CONF, ELSE IF > 1 AGE_X = 1 

YEAR OLD GO TO AGE_1Y_2-9. 

AGE_1Y_2-

AGE_1Y_9 And how about the next [1 year old / 0 year old]? 

 ___ ___ MONTHS [RANGE: 0-24] 

 CONTINUE TO LOOP FOR ALL REMAINING 1 YEAR OLDS. THEN GO TO AGE_CONF. 

AGE_CONF	 So, you have a [FILL WITH AGE IN YEARS FOR ALL CHILDREN 2 YEARS OLD OR 

OLDER, AND AGE IN MONTHS FOR ALL CHILDREN UNDER 24 MONTHS OLD., 

INCLUDING AGES FOR ANY NIS-ELIGIBLE CHILDREN. E.G., 16 month old, 10 year old, 

and 15 year old/ IF > 1 CHILD, INSERT 'and' BEFORE THE LAST AGE_X] living at this 

address all or most of the time. Is that correct? 

(1) YES	 [SKIP TO MULTIAGE] 

(2) NO, WRONG AGES [RETURN TO AGE_X] 

(3) NO, WRONG NUMBER OF CHILDREN [SKIP TO S_UNDR18] 

(4) NO, NOT ALL CHILDREN LIVING AT THIS ADDRESS ALL OR MOST OF THE TIME 

[RETURN TO S_UNDR18] 

MULTIAGE	 CATI INSTRUCTION (MULTIAGE): IF NO CHILDREN ARE THE SAME AGE, SKIP TO 

C2Q03_X, ELSE ASK 

Since you have more than one child who is [FILL DUPLICATE AGES FROM AGE_CONF, E.G. 

3 years old], I need a way to refer to each of them during the interview. 

RECORD NAMES IN NAME_1 – NAME_9. 

(77) DON'T KNOW	 [GO TO REFNAME1] 

(99) REFUSED	 [GO TO REFNAME1] 

IF SUC=4 THEN FILL FROM TIS_MULTIAGE. 

CATI INSTRUCTION: loop for all NAME_X. GO TO C2Q03_X. 

NAME_1 -NAME_9 

CATI INSTRUCTION: loop for all NAME_X. GO TO C2Q03_X. 

IF REFNAME1=99 THEN DISPLAY: INTERVIEWER INSTRUCTION: RESPONDENT 

REFUSED CHILD'S NAME, ENTER 99 

IF REFNAME1 not equal 99 THEN DISPLAY: What is the [other] [FILL AGE] year old child's 

name or initials? 

For all cases display the following in red: 

ENTER NAME 

(77) DON'T KNOW 

(99) REFUSED 

NAME: __________________________ 
 

2009-2010 National Survey of Children with Special Health Care Needs Page 15 

 

 IF SUC=4 THEN FILL FROM TIS_NAME_X. 

 FILL FROM NIS IF APPROPRIATE. 

IF NAME_x = 77 or 99 then the AGEID for that child="[FILL AGE] CHILD [FILL x]" (where x 

is the roster position for that child). 

REFNAME1 I would like to assure you that ALL information will be kept in strict confidence and will be 

summarized for research purposes only. Since you have two or more children of the same age, we 

must have some way to tell them apart. You could give me a first name, nickname, or their 

initials. 

 (1) RESPONDENT WILL GIVE NAMES [RETURN TO NAME_1 THROUGH NAME_9 

AND ENTER] 

 (2) REFUSED [GO TO REFNAME2] 

REFNAME2 (IF INCENTIVE > 0 THEN GO TO ADDRESS COLLECTION), THEN READ REFNAME2. 

 Those are all the questions I have. I’d like to thank you on behalf of the Centers for Disease 

Control and Prevention for the time and effort you’ve spent answering these questions. 

 TERMINATE > SET ITS = 23; POINT OF RETURN SHOULD BE MULTIAGE 

CPNIS_ELIG IF SAMPLE_USE_CODE = 2: IF AGE_X= 19-35 MONTHS AND S3_3M/D/Y_x = NULL, GO 

TO S2Q02A; ELSE SKIP TO C2Q03_X 

 ELSE IF SAMPLE_USE_CODE = 3, 4, 5, OR 6: IGNORE LOGIC ABOVE. 

S2Q02A Based on the ages you have given me, I now have some questions about [AGEID OR AGEIDs]. 

 (1) CONTINUE [GO TO S3_X] 

FILL S_NUMB APPROPRIATELY AND GO TO S3_X. 

ASK NIS FOR ALL CHILDREN THAT HAVE QUALIFIED. 

IF ALL CHILDREN ARE NIS INELIGIBLE BASED ON BIRTH DATES: 

 IF S_UNDR18 = S_NUMB, SKIP TO C2Q03_X 

 ELSE SKIP TO SL_TRANS2, 

IF ONE OR MORE CHILDREN ARE NIS ELIGIBLE AND ONCE NIS INTERVIEW IS 

FINISHED: 

 IF COUNT OF NIS ELIGIBLE CHILDREN = S_UNDR18, SKIP TO SL_TRANS 

 ELSE SKIP TO SL_TRANS2. 

SL_TRANS I appreciate your answers about the immunizations of [NIS CHILD]. 

 

(1) CONTINUE [GO TO SC1_INTRO] 

SL_TRANS2 [IF NIS INTERVIEW COMPLETED, THEN DISPLAY: I appreciate your answers about the 

immunizations of [NIS CHILD / CHILDREN].] Next I have some questions about all of the 

children under 18 years old living in this household. 

(1) CONTINUE [GO TO C2Q03_X] 

Series 1, No. 57 □ Page 69
 

Section 2. INITIAL SCREENING. 

Begin Loop 

C2Q03_X [SKIP IF NIS_WHO NE 10 OR NIS_WHO NE BLANK, FILL IN THE DATA FOR THE 

CHILD FROM NIS – S3.4] 

 Is [your AGEID OR INITIALS FROM ROSTER] male or female? 

 (1) MALE 

 (2) FEMALE 

 (77) DON’T KNOW 

 (99) REFUSED 

2009-2010 National Survey of Children with Special Health Care Needs Page 16 

Page 70 □ Series 1, No. 57
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2009-2010 National Survey of Children with Special Health Care Needs Page 17 

Series 1, No. 57 □ Page 71

End Loop 

SC1_INTRO	 The next questions are about any kind of health problems, concerns, or conditions that may affect 

your (IF S_UNDR18 = 1, INSERT ‘child’/ IF S_UNDR18 > 1, INSERT ‘children’)'s physical 

health, behavior, learning, growth, or physical development. Some of these health problems may 

affect your (IF S_UNDR18 = 1, INSERT ‘child’/ IF S_UNDR18 = 1, INSERT ‘children’)'s 

abilities and activities at school or at play. Some of these problems affect the kind or amount of 

services your (IF S_UNDR18 = 1, INSERT ‘child’/ IF S_UNDR18 > 1, INSERT ‘children’)

may need or use. 

[TIMESTAMP_SECTION23] 

CSHCN1	 (IF S_UNDR18 = 1, INSERT ‘Does your child’/ IF S_UNDR18 > 1, INSERT ‘Do any of your 

children’) currently need or use medicine prescribed by a doctor, other than vitamins? 

(1) YES 

(2) NO [SKIP TO CSHCN2] 

(77) DON’T KNOW [SKIP TO CSHCN2] 

(99) REFUSED [SKIP TO CSHCN2] 

READ IF NECESSARY: This applies to ANY medications prescribed by a doctor. Do not 

include over-the-counter medications such as cold or headache medications, or any vitamins, 

minerals, or supplements that can be purchased without a prescription. 

THIS QUESTION REFERS ONLY TO CURRENT NEED FOR PRESCRIPTION MEDICINE. 

THE RESPONDENT SHOULD REPLY WITH “YES” IF THE CHILD CURRENTLY NEEDS 

OR USES PRESCRIPTION MEDICINE. 

CSHCN1_ROS (CSHCN1_ROS_01 through CSHCN1_ROS_09) 

[IF S_UNDR18 = 1, SKIP TO CSHCN1_A] 

Is that [PICKLIST CONSISTING OF CHILDREN LISTED AS IN AGE_CONF]? 

CATI: ALLOW A “CHOOSE ALL THAT APPLY” PICKLIST OF CHILDREN. FOR 

EACH CHILD CHOSEN, ASK CSHCN1_A AND CSHCN1_B. 

FOR EXAMPLE, IF THERE ARE 2 CHILDREN, A 10 YEAR OLD AND A 12 YEAR 

OLD, AND BOTH ARE CHOSEN FROM THE PICKLIST, ASK CSHCN1_A AND 

CSHCN1_B ABOUT THE 10 YEAR OLD FIRST, AND THEN ASK THE SERIES ABOUT 

THE 12 YEAR OLD, USING APPROPRIATE FILL. 

CSHCN1_A_X	 Is (AGEID)'s need for prescription medicine because of ANY medical, behavioral, or other health 

condition? 

(1) YES 

(2) NO	 [SKIP TO CSHCN1_C_X] 

(77) DON’T KNOW [SKIP TO CSHCN1_C_X] 

(99) REFUSED [SKIP TO CSHCN1_C_X] 

CSHCN1_B_X	 Is this a condition that has lasted or is expected to last 12 months or longer? 

(1) YES [SKIP TO CSHCN2] 

(2) NO	 [SKIP TO CSHCN2] 

(77) DON’T KNOW [SKIP TO CSHCN2] 

(99) REFUSED [SKIP TO CSHCN2] 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2009-2010 National Survey of Children with Special Health Care Needs Page 18 

Page 72 □ Series 1, No. 57

INTERVIEWER INSTRUCTION: IF THE CONDITION, NEED, OR PROBLEM LASTS FOR 

SHORT PERIODS OF TIME BUT IS EXPECTED TO KEEP COMING BACK FOR 12 

MONTHS OR LONGER, THE ANSWER SHOULD BE “YES.” 

CSHCN1_C_X	 Has (AGEID)'s need for prescription medication lasted or is it expected to last 12 months or 

longer? 

(1) YES 

(2) NO 

(77) DON’T KNOW 

(99) REFUSED 

INTERVIEWER INSTRUCTION: IF THE CONDITION, NEED, OR PROBLEM LASTS FOR 

SHORT PERIODS OF TIME BUT IS EXPECTED TO KEEP COMING BACK FOR 12 

MONTHS OR LONGER, THE ANSWER SHOULD BE “YES.” 

CSHCN2	 (IF S_UNDR18 = 1, INSERT ‘Does your child’/ IF S_UNDR18 > 1, INSERT ‘Do any of your 

children’) need or use more medical care, mental health, or educational services than is usual for 

most children of the same age? 

(1) YES 

(2) NO	 [SKIP TO CSHCN3] 

(77) DON’T KNOW [SKIP TO CSHCN3] 

(99) REFUSED [SKIP TO CSHCN3] 

READ IF NECESSARY: The child requires more medical care, the use of more mental health 

services, or the use of more educational services than most children the same age. 

THIS QUESTION REFERS ONLY TO CURRENT NEED FOR SERVICES. THE 

RESPONDENT SHOULD REPLY WITH “YES” IF THE CHILD CURRENTLY NEEDS OR 

USES SERVICES 

CSHCN2_ROS (CSHCN2_ROS_01 through CSHCN2_ROS_09) 

[IF S_UNDR18 = 1, SKIP TO CSHCN2_A] 

Is that [PICKLIST CONSISTING OF CHILDREN LISTED AS IN AGE_CONF]? 

CATI: ALLOW A “CHOOSE ALL THAT APPLY” PICKLIST OF CHILDREN. FOR 

EACH CHILD CHOSEN, ASK CSHCN2_A AND CSHCN2_B. 

CSHCN2_A_X	 Is (AGEID)'s need for medical care, mental health or educational services because of ANY 

medical, behavioral, or other health condition? 

(1) YES 

(2) NO	 [SKIP TO CSHCN2_C_X] 

(77) DON’T KNOW [SKIP TO CSHCN2_C_X] 

(99) REFUSED [SKIP TO CSHCN2_C_X] 

CSHCN2_B_X	 Is this a condition that has lasted or is expected to last 12 months or longer? 

(1) YES [SKIP TO CSHCN3] 

(2) NO	 [SKIP TO CSHCN3] 

(77) DON’T KNOW [SKIP TO CSHCN3] 

(99) REFUSED [SKIP TO CSHCN3] 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2009-2010 National Survey of Children with Special Health Care Needs Page 19 

Series 1, No. 57 □ Page 73

INTERVIEWER INSTRUCTION: IF THE CONDITION, NEED, OR PROBLEM LASTS FOR 

SHORT PERIODS OF TIME BUT IS EXPECTED TO KEEP COMING BACK FOR 12 

MONTHS OR LONGER, THE ANSWER SHOULD BE “YES.” 

CSHCN2_C_X	 Has (AGEID)'s need for medical care, mental health, or educational services lasted or is it 

expected to last 12 months or longer? 

(1) YES 

(2) NO 

(77) DON’T KNOW 

(99) REFUSED 

INTERVIEWER INSTRUCTION: IF THE CONDITION, NEED, OR PROBLEM LASTS FOR 

SHORT PERIODS OF TIME BUT IS EXPECTED TO KEEP COMING BACK FOR 12 

MONTHS OR LONGER, THE ANSWER SHOULD BE “YES.” 

CSHCN3	 (IF S_UNDR18 = 1, INSERT ‘Is your child’/ IF S_UNDR18 > 1, INSERT ‘Are any of your 

children’) limited or prevented in any way in (his/ her/their) ability to do the things most children 

of the same age can do? 

(1) YES 

(2) NO	 [SKIP TO CSHCN4] 

(77) DON’T KNOW [SKIP TO CSHCN4] 

(99) REFUSED [SKIP TO CSHCN4] 

READ IF NECESSARY: A child is limited or prevented when there are things the child can’t do 

as much or can’t do at all that most children the same age can. 

THIS QUESTION REFERS ONLY TO CURRENT LIMITATIONS. THE RESPONDENT 

SHOULD REPLY WITH “YES” IF THE CHILD IS CURRENTLY LIMITED. 

CSHCN3_ROS (CSHCN3_ROS_01 through CSHCN3_ROS_09) 

[IF S_UNDR18 = 1, SKIP TO CSHCN3_A] 

Is that [PICKLIST CONSISTING OF CHILDREN LISTED AS IN AGE_CONF]? 

CATI: ALLOW A “CHOOSE ALL THAT APPLY” PICKLIST OF CHILDREN. FOR 

EACH CHILD CHOSEN, ASK CSHCN3_A AND CSHCN3_B. 

CSHCN3_A_X	 Is (AGEID)'s limitation in abilities because of ANY medical, behavioral, or other health 

condition? 

(1) YES 

(2) NO	 [SKIP TO CSHCN3_C_X] 

(77) DON’T KNOW [SKIP TO CSHCN3_C_X] 

(99) REFUSED [SKIP TO CSHCN3_C_X] 

CSHCN3_B_X	 Is this a condition that has lasted or is expected to last 12 months or longer? 

(1) YES [SKIP TO CSHCN4] 

(2) NO	 [SKIP TO CSHCN4] 

(77) DON’T KNOW [SKIP TO CSHCN4] 

(99) REFUSED [SKIP TO CSHCN4] 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2009-2010 National Survey of Children with Special Health Care Needs Page 20 

Page 74 □ Series 1, No. 57

INTERVIEWER INSTRUCTION: IF THE CONDITION, NEED, OR PROBLEM LASTS FOR 

SHORT PERIODS OF TIME BUT IS EXPECTED TO KEEP COMING BACK FOR 12 

MONTHS OR LONGER, THE ANSWER SHOULD BE “YES.” 

CSHCN3_C_X	 Has (AGEID)'s limitation in abilities lasted or is it expected to last 12 months or longer? 

(1) YES 

(2) NO 

(77) DON’T KNOW 

(99) REFUSED 

INTERVIEWER INSTRUCTION: IF THE CONDITION, NEED, OR PROBLEM LASTS FOR 

SHORT PERIODS OF TIME BUT IS EXPECTED TO KEEP COMING BACK FOR 12 

MONTHS OR LONGER, THE ANSWER SHOULD BE “YES.” 

CSHCN4	 (IF S_UNDR18 = 1, INSERT ‘Does your child’/ IF S_UNDR18 > 1, INSERT ‘Do any of your 

children’) need or get special therapy, such as physical, occupational, or speech therapy? 

(1) YES 

(2) NO	 [SKIP TO CSHCN5] 

(77) DON’T KNOW [SKIP TO CSHCN5] 

(99) REFUSED [SKIP TO CSHCN5] 

READ IF NECESSARY: Special therapy includes physical, occupational, or speech therapy. 

This is centered on physical needs, and things like psychological therapy are not included here. 

THIS QUESTION REFERS ONLY TO CURRENT NEED FOR SPECIAL THERAPY. THE 

RESPONDENT SHOULD REPLY WITH “YES” IF THE CHILD CURRENTLY NEEDS OR 

USES SPECIAL THERAPY. 

CSHCN4_ROS (CSHCN4_ROS_01 through CSHCN4_ROS_09) 

[IF S_UNDR18 = 1, SKIP TO CSHCN4_A] 

Is that (PICKLIST CONSISTING OF CHILDREN LISTED AS IN AGE_CONF)? 

CATI: ALLOW A “CHOOSE ALL THAT APPLY” PICKLIST OF CHILDREN. FOR 

EACH CHILD CHOSEN, ASK CSHCN4_A AND CSHCN4_B. 

CSHCN4_A_X	 Is (AGEID)'s need for special therapy because of ANY medical, behavioral, or other health 

condition? 

(1) YES 

(2) NO	 [SKIP TO CSHCN4_C_X] 

(77) DON’T KNOW [SKIP TO CSHCN4_C_X] 

(99) REFUSED [SKIP TO CSHCN4_C_X] 

CSHCN4_B_X	 Is this a condition that has lasted or is expected to last 12 months or longer? 

(1) YES [SKIP TO CSHCN5] 

(2) NO	 [SKIP TO CSHCN5] 

(77) DON’T KNOW [SKIP TO CSHCN5] 

(99) REFUSED [SKIP TO CSHCN5] 

INTERVIEWER INSTRUCTION: IF THE CONDITION, NEED, OR PROBLEM LASTS FOR 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Series 1, No. 57 □ Page 75

SHORT PERIODS OF TIME BUT IS EXPECTED TO KEEP COMING BACK FOR 12 

MONTHS OR LONGER, THE ANSWER SHOULD BE “YES.” 

CSHCN4_C_X	 Has (AGEID)'s need for special therapy lasted or is it expected to last 12 months or longer? 

(1) YES 

(2) NO 

(77) DON’T KNOW 

(99) REFUSED 

INTERVIEWER INSTRUCTION: IF THE CONDITION, NEED, OR PROBLEM LASTS FOR 

SHORT PERIODS OF TIME BUT IS EXPECTED TO KEEP COMING BACK FOR 12 

MONTHS OR LONGER, THE ANSWER SHOULD BE “YES.” 

CSHCN5	 (IF S_UNDR18 = 1, INSERT ‘Does your child’/ IF S_UNDR18 > 1, INSERT ‘Do any of your 

children’) have any kind of emotional, developmental, or behavioral problem for which (IF 

S_UNDR18=1, INSERT 'he/she needs'/ IF S_UNDR18>1, INSERT 'they need') treatment or 

counseling? 

(1) YES 

(2) NO	 [SKIP TO CP_CWTYPE] 

(77) DON’T KNOW [SKIP TO CP_CWTYPE] 

(99) REFUSED [SKIP TO CP_CWTYPE] 

READ IF NECESSARY: These are remedies, therapy, or guidance a child may receive for 

his/her emotional, developmental, or behavioral problem. 

THIS QUESTION REFERS ONLY TO CURRENT NEED FOR TREATMENT OR 

COUNSELING. THE RESPONDENT SHOULD REPLY WITH “YES” IF THE CHILD 

CURRENTLY NEEDS OR USES TREATMENT OR COUNSELING. 

CSHCN5_ROS (CSHCN5_ROS_01 through CSHCN5_ROS_09) 

[IF S_UNDR18 =1, SKIP TO CSHCN5_A] 

Is that (PICKLIST CONSISTING OF CHILDREN LISTED AS IN AGE_CONF)? 

CATI: ALLOW A “CHOOSE ALL THAT APPLY” PICKLIST OF CHILDREN. FOR 

EACH CHILD CHOSEN, ASK CSHCN5_A. 

CSHCN5_A_X	 Has (AGEID)'s emotional, developmental or behavioral problem lasted or is it expected to last 12 

months or longer? 

(1) YES [SKIP TO CP_CWTYPE] 

(2) NO	 [SKIP TO CP_CWTYPE] 

(77) DON’T KNOW [SKIP TO CP_CWTYPE] 

(99) REFUSED [SKIP TO CP_CWTYPE] 

INTERVIEWER INSTRUCTION: IF THE CONDITION, NEED, OR PROBLEM LASTS FOR 

SHORT PERIODS OF TIME BUT IS EXPECTED TO KEEP COMING BACK FOR 12 

MONTHS OR LONGER, THE ANSWER SHOULD BE “YES.” 

[TIMESTAMP_SECTION24] 

SCREENER DECISION INSTRUCTIONS 
 

2009-2010 National Survey of Children with Special Health Care Needs Page 22 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Page 76 □ Series 1, No. 57

CREATE VARIABLE CWTYPE 

IN CSHCN SCREENER, IF ANY OF THE FOLLOWING ARE TRUE FOR A PARTICULAR 

ROSTERED CHILD:
 

CSHCN1_B = 1;
 

CSHCN2_B = 1;
 

CSHCN3_B = 1;
 

CSHCN4_B = 1;
 

CSHCN5_A = 1;
 

THEN CWTYPE = S (SPECIAL). 

IF NONE OF THE ABOVE ARE TRUE, THEN CWTYPE = N (NON-SPECIAL NEEDS). 

IF ALL CHILDREN IN HOUSEHOLD HAVE CWTYPE = N, THEN SKIP TO C10START (IN 

SECTION 10).
 

IF ANY CHILDREN IN HOUSEHOLD HAVE CWTYPE = S, THEN AT THIS POINT, A FOCAL 

CHILD MUST BE SELECTED FOR THE REST OF THE INTERVIEW FROM ALL CHILDREN 

WITH A POSITIVE SPECIAL HEALTH CARE NEED SCREEN.
 

ONE CHILD:
 

IF ONLY ONE CHILD UNDER 18 YEARS OLD (S_UNDR18 = 1 CHILD) WITH A POSITIVE
 

SPECIAL HEALTH CARE NEED SCREEN, THAT CHILD IS THE FOCAL CHILD [S.C.] FROM
 

THIS POINT.
 

MORE THAN ONE CHILD:
 

IF THERE IS MORE THAN ONE CHILD UNDER THE AGE OF 18 (S_UNDR18 > 1 CHILD) WITH A 

POSITIVE SPECIAL HEALTH CARE NEED SCREEN, ONE OF THESE CHILDREN SHOULD BE
 

RANDOMLY SAMPLED AND THAT CHILD IS THE FOCAL CHILD [S.C.] FROM THIS POINT.
 

IF S_UNDR18 > 1 THEN GO TO SELECTION1, ELSE IF S_UNDR18 = 1 THEN GO TO
 

SELECTION
 

SELECTION	 This survey will continue to be about the health and health care of [S.C.] and will take about 25 

minutes. We know your time is valuable, and we will get through the questions as quickly as 

possible. [IF WOP_POST = 1 "Remember you can end the interview at any time without 

penalty."] 

READ AS NECESSARY: Let’s get started and see how far we get. If you have to go, let me 

know. 

(1) CONTINUE WITH INTERVIEW [GO TO SELECTION1_NAME] 

SELECTION1	 The rest of the survey will be about the health and health care of [S.C.] and will take about 25 

minutes. We know your time is valuable, and we will get through the questions as quickly as 

possible. [IF WOP_POST = 1 "Remember you can end the interview at any time without 

penalty."] 

READ AS NECESSARY:
 

The computer randomly chose this child for the interview.
 

READ AS NECESSARY: 

Let’s get started and see how far we get. If you have to go, let me know. 
 

2009-2010 National Survey of Children with Special Health Care Needs Page 23 

 

Series 1, No. 57 □ Page 77

(1) CONTINUE WITH INTERVIEW [GO TO SELECTION1_NAME] 

SELECTION1_ 

NAME [SKIP TO S3QINTRO IF NAME OF SELECTED CHILD ALREADY GATHERED 

BECAUSE FROM MULTIAGE, C2Q01N, NIS INTERVIEW, OR RESPONDENT 

REFUSED TO ANSWER NAME QUESTIONS.] 

I can continue to refer to your child as (AGEID) for the rest of the interview, or if you prefer, you 

could give me a first name or initials. 

(01) CONTINUE TO USE AGE REFERENCE [GO TO C3QINTRO] 

(02) USE NAME [GO TO SELECTION1_NAME_A] 

SELECTION1 

_NAME_A ENTER NAME/INITIALS: ____________ [GO TO C3QINTRO] 

[FILL [S.C.] WITH THIS NAME FROM THIS POINT ON IN THE INTERVIEW] 

(77) DON’T KNOW [GO TO C3QINTRO] 

(99) REFUSED [GO TO C3QINTRO] 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2009-2010 National Survey of Children with Special Health Care Needs Page 24 

Page 78 □ Series 1, No. 57

Section 3. HEALTH AND FUNCTIONAL STATUS
 

[TIMESTAMP_SECTION31] 

C3QINTRO	 You told me that [S.C.] 

IF CSHCN1_B = 1, ADD “needs prescription drugs...”
	

IF CSHCN2_B = 1, ADD “needs medical care, mental health, or education services...”
	

IF CSHCN3_B = 1, ADD “is limited or prevented in [his/her] ability to do things...”
	

IF CSHCN4_B = 1, ADD “needs special therapy....”
	

IF CSHCN5_A = 1, ADD “needs treatment or counseling....”
	

IF MORE THAN ONE OF THESE ITEMS = 1, THEN ADD “AND” BETWEEN EACH
 

ADDITIONAL STATEMENT.
 

IF CSHCN1_B, CSHCN2_B, CSHCN3_B, OR CSHCN4_B = 1, THEN CONTINUE: 

“...because of medical, behavioral, or other health conditions.”

IFCSHCN1_B = 2, CSHCN2_B = 2, CSHCN3_B = 2, CSHCN4_B = 2, AND CSHCN5_A = 1, 

THEN CONTINUE: “because of emotional, developmental, or behavioral problems.”

FOR C3Q02 AND C3Q03 FILLS, IF CSHCN1_B, CSHCN2_B, CSHCN3_B, or CSHCN4_B 

= 1 USE FIRST FILL. IF CSHCN1_B = 2, CSHCN2_B = 2, CSHCN3_B = 2, CSHCN4_B = 

2, AND CSHCN5_A = 1, USE SECOND FILL]. 

C3Q02	 [During the past 12 months/Since [his/her] birth], how often have [S.C.]’s (medical, behavioral, or 

other health conditions / emotional, developmental, or behavioral problems) affected [his/her] 

ability to do things other children [his/her] age do? Would you say: 

(1) NEVER [SKIP TO C3Q11] 

(2) SOMETIMES 

(3) USUALLY 

(4) ALWAYS 

(77) DON’T KNOW [SKIP TO C3Q11] 

(99) REFUSED [SKIP TO C3Q11] 

READ IF NECESSARY: This question asks how often your child's abilities are affected by 

his/her health. It does not ask about the severity, intensity, or magnitude of the effect. 

ADDITIONAL INFO: FOR EXAMPLE, IF A CHILD'S ASTHMA WAS SEVERE BUT THE 

ATTACKS WERE RARE, THIS QUESTION WOULD BE ANSWERED WITH 

"SOMETIMES." IF THE CONDITION IS EPISODIC, RESPONDENTS SHOULD THINK 

ABOUT HOW OFTEN THE CONDITION HAS AFFECTED THE CHILD'S ABILITIES 

DURING THE PAST ENTIRE 12 MONTHS. 

C3Q03	 Do [S.C.]’s (medical, behavioral, or other health conditions/emotional, developmental, or 

behavioral problems) affect [his/her] ability to do things a great deal, some, or very little? 

(1) A GREAT DEAL 

(2) SOME 

(3) VERY LITTLE 

(77) DON’T KNOW 

(99) REFUSED 

READ IF NECESSARY: You told me your child's health affects his/her ability to do things. 
 

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Series 1, No. 57 □ Page 79

When this occurs, how much are your child's abilities affected? 

ADDITIONAL INFO: FOR EXAMPLE, IF A CHILD'S ASTHMA WAS SEVERE BUT THE 

ATTACKS WERE RARE, THIS QUESTION WOULD BE ANSWERED WITH "A GREAT 

DEAL." IF THE CONDITION IS EPISODIC, RESPONDENTS SHOULD THINK ABOUT 

HOW SEVERE THE IMPACT HAS BEEN WHEN THE EPISODES OCCURRED OVER THE 

PAST 12 MONTHS. 

C3Q11	 Which of the following statements best describes [S.C.]’s health care needs? [S.C.]’s health care 

needs change all the time, [S.C.]’s health care needs change only once in a while, or [S.C.]’s 

health care needs are usually stable? 

(1) CHILD’S HEALTH CARE NEEDS CHANGE ALL THE TIME 

(2) CHILD’S HEALTH CARE NEEDS CHANGE ONLY ONCE IN A WHILE 

(3) CHILD’S HEALTH CARE NEEDS ARE USUALLY STABLE 

(4) NONE OF THE ABOVE 

(77) DON’T KNOW 

(99) REFUSED 

[TIMESTAMP_SECTION32] 

C3Q23	 The next questions are about ways [S.C.] might experience difficulties due to [his/her] health. 

Would you say [he/she] experiences a lot, a little, or no difficulty with breathing or other 

respiratory problems, such as wheezing or shortness of breath? 

(1) A LOT OF DIFFICULTY 

(2) A LITTLE DIFFICULTY 

(3) NO DIFFICULTY 

(77) DON’T KNOW 

(99) REFUSED 

READ IF NECESSARY: We are interested in both on-going and intermittent breathing 

problems. If the problem comes and goes, please think about the child’s breathing throughout the 

year. 

HELP SCREEN: IF RESPONDENT SAYS THAT CHILD HAS MORE THAN A LITTLE 

DIFFICULTY BUT NOT A LOT OF DIFFICULTY, PLEASE CODE THE ANSWER AS "A 

LITTLE DIFFICULTY." 

C3Q24	 Would you say [he/she] experiences a lot, a little, or no difficulty with swallowing, digesting food, 

or metabolism? 

(1) A LOT OF DIFFICULTY 

(2) A LITTLE DIFFICULTY 

(3) NO DIFFICULTY 

(77) DON’T KNOW 

(99) REFUSED 

HELP SCREEN: IF RESPONDENT SAYS THAT CHILD HAS MORE THAN A LITTLE 

DIFFICULTY BUT NOT A LOT OF DIFFICULTY, PLEASE CODE THE ANSWER AS "A 

LITTLE DIFFICULTY." 

C3Q25	 Would you say [he/she] experiences a lot, a little, or no difficulty with blood circulation? 
 

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Page 80 □ Series 1, No. 57

(1) A LOT OF DIFFICULTY 

(2) A LITTLE DIFFICULTY 

(3) NO DIFFICULTY 

(77) DON’T KNOW 

(99) REFUSED 

HELP SCREEN: IF RESPONDENT SAYS THAT CHILD HAS MORE THAN A LITTLE 

DIFFICULTY BUT NOT A LOT OF DIFFICULTY, PLEASE CODE THE ANSWER AS "A 

LITTLE DIFFICULTY." 

C3Q26	 (READ IF NECESSARY: Would you say [he/she] experiences a lot, a little, or no difficulty 

with...) 

Repeated or chronic physical pain, including headaches? 

(1) A LOT OF DIFFICULTY 

(2) A LITTLE DIFFICULTY 

(3) NO DIFFICULTY 

(77) DON’T KNOW 

(99) REFUSED 

HELP SCREEN: IF RESPONDENT SAYS THAT CHILD HAS MORE THAN A LITTLE 

DIFFICULTY BUT NOT A LOT OF DIFFICULTY, PLEASE CODE THE ANSWER AS "A 

LITTLE DIFFICULTY." 

C3Q21	 (READ IF NECESSARY: Would you say [he/she] experiences a lot, a little, or no difficulty...) 

Seeing even when wearing glasses or contact lenses? 

(1) A LOT OF DIFFICULTY 

(2) A LITTLE DIFFICULTY 

(3) NO DIFFICULTY 

(77) DON’T KNOW 

(99) REFUSED 

HELP SCREEN: IF RESPONDENT SAYS THAT CHILD HAS MORE THAN A LITTLE 

DIFFICULTY BUT NOT A LOT OF DIFFICULTY, PLEASE CODE THE ANSWER AS "A 

LITTLE DIFFICULTY." 

C3Q22	 (READ IF NECESSARY: Would you say [he/she] experiences a lot, a little, or no difficulty...) 

Hearing even when using a hearing aid or other device? 

(1) A LOT OF DIFFICULTY 

(2) A LITTLE DIFFICULTY 

(3) NO DIFFICULTY 

(77) DON’T KNOW 

(99) REFUSED 

HELP SCREEN: IF RESPONDENT SAYS THAT CHILD HAS MORE THAN A LITTLE 

DIFFICULTY BUT NOT A LOT OF DIFFICULTY, PLEASE CODE THE ANSWER AS "A 

LITTLE DIFFICULTY." 

C3Q27	 [IF S.C. IS YOUNGER THAN 36 MONTHS, SKIP TO C3Q28] 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Series 1, No. 57 □ Page 81

Compared to other [CSHCN_AGE]-year-old children, would you say [he/she] experiences a lot, a 

little, or no difficulty taking care of [himself/herself], for example, doing things like eating, 

dressing and bathing? 

(1) A LOT OF DIFFICULTY 

(2) A LITTLE DIFFICULTY 

(3) NO DIFFICULTY 

(77) DON’T KNOW 

(99) REFUSED 

HELP SCREEN: IF RESPONDENT SAYS THAT CHILD HAS MORE THAN A LITTLE 

DIFFICULTY BUT NOT A LOT OF DIFFICULTY, PLEASE CODE THE ANSWER AS "A 

LITTLE DIFFICULTY." 

C3Q28	 IF CHSCN_AGE < 24 MONTHS, THEN "Compared to other [CHSCN_AGE]-month-old 

children would you say [he/she] experiences a lot, a little, or no difficulty with coordination or 

moving around, such as....?" 

IF CHSCN_AGE > or = 24 MONTHS, THEN "Compared to other [CHSCN_AGE]-year-old 

children would you say [he/she] experiences a lot, a little, or no difficulty with coordination or 

moving around, such as..." 

(IF S.C. 0 - 9 MONTHS OLD, SAY: “crawling or moving arms or legs?” 

IF S.C. 10 – 23 MONTHS OLD, SAY: “walking or crawling?”
	

IF S.C. 24+ MONTHS OLD, SAY: “walking or running?”)
	

(1) A LOT OF DIFFICULTY 

(2) A LITTLE DIFFICULTY 

(3) NO DIFFICULTY 

(77) DON’T KNOW 

(99) REFUSED 

HELP SCREEN: IF RESPONDENT SAYS THAT CHILD HAS MORE THAN A LITTLE 

DIFFICULTY BUT NOT A LOT OF DIFFICULTY, PLEASE CODE THE ANSWER AS "A 

LITTLE DIFFICULTY." 

C3Q29	 IF CHSCN_AGE < 24 MONTHS, THEN "Compared to other [CHSCN_AGE]-month-old 

children would you say [he/she] experiences a lot, a little, or no difficulty using (his or her) hands 

such as....?" 

IF CHSCN_AGE > or = 24 MONTHS, THEN "Compared other [CHSCN_AGE]-year-old 

children would you say [he/she] experiences a lot, a little, or no difficulty using (his or her) hands 

such as..." 

(IF S.C. 0-7 MONTHS, SAY: “ grabbing small objects?”
	

IF S.C. 8-23 MONTHS, SAY: “ holding a cup or eating finger foods?”
	

IF S.C. 24+ MONTHS, SAY: “using scissors, a pencil, or a fork?”)
	

(1) A LOT OF DIFFICULTY 

(2) A LITTLE DIFFICULTY 

(3) NO DIFFICULTY 

(77) DON’T KNOW 

(99) REFUSED 

HELP SCREEN: IF RESPONDENT SAYS THAT CHILD HAS MORE THAN A LITTLE 

DIFFICULTY BUT NOT A LOT OF DIFFICULTY, PLEASE CODE THE ANSWER AS "A 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2009-2010 National Survey of Children with Special Health Care Needs Page 28 

Page 82 □ Series 1, No. 57

LITTLE DIFFICULTY." 

C3Q30	 [IF S.C. IS YOUNGER THAN 12 MONTHS, SKIP TO CPC3Q35] 

(READ IF NECESSARY: Compared to other [CHSCN_AGE]-year-old children, would you say 

[he/she] experiences a lot, a little, or no difficulty...) 

Learning, understanding, or paying attention? 

(1) A LOT OF DIFFICULTY 

(2) A LITTLE DIFFICULTY 

(3) NO DIFFICULTY 

(77) DON’T KNOW 

(99) REFUSED 

HELP SCREEN: IF RESPONDENT SAYS THAT CHILD HAS MORE THAN A LITTLE 

DIFFICULTY BUT NOT A LOT OF DIFFICULTY, PLEASE CODE THE ANSWER AS "A 

LITTLE DIFFICULTY." 

C3Q31	 (READ IF NECESSARY: Compared to other [CHSCN_AGE]-year-old children, would you say 

[he/she] experiences a lot, a little, or no difficulty...) 

Speaking, communicating, or being understood? 

(1) A LOT OF DIFFICULTY 

(2) A LITTLE DIFFICULTY 

(3) NO DIFFICULTY 

(77) DON’T KNOW 

(99) REFUSED 

HELP SCREEN: IF RESPONDENT SAYS THAT CHILD HAS MORE THAN A LITTLE 

DIFFICULTY BUT NOT A LOT OF DIFFICULTY, PLEASE CODE THE ANSWER AS "A 

LITTLE DIFFICULTY." 

C3Q32	 [IF S.C. IS YOUNGER THAN 18 MONTHS, SKIP TO CPC3Q35] 

Compared to other [CSHCN_AGE]-year-old children, would you say [he/she] experiences a lot, a 

little, or no difficulty with feeling anxious or depressed? 

(1) A LOT OF DIFFICULTY 

(2) A LITTLE DIFFICULTY 

(3) NO DIFFICULTY 

(77) DON’T KNOW 

(99) REFUSED 

HELP SCREEN: IF RESPONDENT SAYS THAT CHILD HAS MORE THAN A LITTLE 

DIFFICULTY BUT NOT A LOT OF DIFFICULTY, PLEASE CODE THE ANSWER AS "A 

LITTLE DIFFICULTY." 

C3Q33	 (READ IF NECESSARY: Compared to other [CSHCN_AGE]-year-old children, would you say 

[he/she] experiences a lot, a little, or no difficulty...) 

With behavior problems, such as acting-out, fighting, bullying, or arguing? 

(1) A LOT OF DIFFICULTY 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2009-2010 National Survey of Children with Special Health Care Needs Page 29 

Series 1, No. 57 □ Page 83

(2) A LITTLE DIFFICULTY 

(3) NO DIFFICULTY 

(77) DON’T KNOW 

(99) REFUSED 

HELP SCREEN: IF RESPONDENT SAYS THAT CHILD HAS MORE THAN A LITTLE 

DIFFICULTY BUT NOT A LOT OF DIFFICULTY, PLEASE CODE THE ANSWER AS "A 

LITTLE DIFFICULTY." 

C3Q34	 [IF S.C. IS YOUNGER THAN 36 MONTHS, SKIP TO CPC3Q35] 

(READ IF NECESSARY: Compared to other [CSHCN_AGE]-year-old children, would you say 

[he/she] experiences a lot, a little, or no difficulty..) 

Making and keeping friends? 

(1) A LOT OF DIFFICULTY 

(2) A LITTLE DIFFICULTY 

(3) NO DIFFICULTY 

(77) DON’T KNOW 

(99) REFUSED 

HELP SCREEN: IF RESPONDENT SAYS THAT CHILD HAS MORE THAN A LITTLE 

DIFFICULTY BUT NOT A LOT OF DIFFICULTY, PLEASE CODE THE ANSWER AS "A 

LITTLE DIFFICULTY." 

[TIMESTAMP_SECTION33] 

CPC3Q35	 [IF ALL C3Q21 THROUGH C3Q34 = missing, 3, 77, 99, ASK C3Q35. ELSE, SKIP TO 

K2Q31_INTRO] 

C3Q35	 You reported that [S.C.] does not experience any difficulty in any of the areas just mentioned. In 

your opinion, would you say this is because [S.C.]’s health problems are being treated and are 

under control? 

(1) YES	 [SKIP TO K2Q31_INTRO] 

(2) NO	 [SKIP TO C3Q35A] 

(77) DON’T KNOW [SKIP TO K2Q31_INTRO] 

(99) REFUSED [SKIP TO K2Q31_INTRO] 

C3Q35A Why is it that [S.C.]’s health problems do not currently cause [him/her] difficulty? 

_______________________[250 CHARACTERS MAX] 

[NOTE TO INTERVIEWERS: DO NOT RECORD ONLY THE DIAGNOSIS OR 

CONDITION. IF THE RESPONDENT GIVES ONLY THE DIAGNOSIS OR CONDITION, 

ASK: “Why doesn’t that problem cause any difficulty in the areas just mentioned?”] 

[TIMESTAMP_SECTION34] 

K2Q31_INTRO	 Now I am going to read you a list of conditions. For each condition, please tell me if a doctor or 

other health care provider ever told you that [S.C.] had the condition, even if [he/she] does not 

have the condition now. 

CPK2Q31	 If SC AGE < 24 MONTHS SKIP TO K2Q40A 
 

 

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Page 84 □ Series 1, No. 57

CATI INSTRUCTION (K2Q31A-K2Q52A): IF SC AGE < 24 MONTHS SKIP TO K2Q40A. 

K2Q31A Has a doctor or other health care provider ever told you that [S.C.] had... 

Attention Deficit Disorder or Attention Deficit Hyperactivity Disorder, that is, ADD or ADHD? 

(1) YES (2) NO (77) DON’T KNOW (99) REFUSED 

HELP SCREEN (K2Q31A): A child with Attention Deficit Disorder or Attention Deficit 

Hyperactivity Disorder has problems paying attention or sitting still. It may cause the child to be 

easily distracted. 

HELP SCREEN: IF THE RESPONDENT HAS NEVER HEARD OF THE MEDICAL 

CONDITION OR DOES NOT KNOW WHAT THE CONDITION IS, THEN A DOCTOR OR 

OTHER HEALTH CARE PROVIDER PROBABLY HAS NOT TOLD THE RESPONDENT 

THAT THE S.C. HAS THE CONDITION. IF A DOCTOR OR OTHER HEALTH CARE 

PROVIDER HAS NOT TOLD THE RESPONDENT THAT THE S.C. HAS THE CONDITION, 

BUT THE RESPONDENT INSISTS THAT THE S.C. HAS THE CONDITION, WE STILL 

NEED TO CODE THE ANSWER AS “NO.” 

K2Q32A (READ IF NECESSARY: Has a doctor or other health care provider ever told you that [S.C.] 

had...) 

Depression? 

(1) YES (2) NO (77) DON’T KNOW (99) REFUSED 

HELP SCREEN (K2Q32A): Depression is an illness that involves the body, mood, and thoughts. 

It is marked by persistent sadness or an anxious or empty mood. It affects how a child feels, and 

the way a child eats, sleeps, and functions. 

HELP SCREEN: IF THE RESPONDENT HAS NEVER HEARD OF THE MEDICAL 

CONDITION OR DOES NOT KNOW WHAT THE CONDITION IS, THEN A DOCTOR OR 

OTHER HEALTH CARE PROVIDER PROBABLY HAS NOT TOLD THE RESPONDENT 

THAT THE S.C. HAS THE CONDITION. IF A DOCTOR OR OTHER HEALTH CARE 

PROVIDER HAS NOT TOLD THE RESPONDENT THAT THE S.C. HAS THE CONDITION, 

BUT THE RESPONDENT INSISTS THAT THE S.C. HAS THE CONDITION, WE STILL 

NEED TO CODE THE ANSWER AS “NO.” 

K2Q33A (READ IF NECESSARY: Has a doctor or other health care provider ever told you that [S.C.] 

had...) 

Anxiety problems? 

(1) YES (2) NO (77) DON’T KNOW (99) REFUSED 

HELP SCREEN (K2Q33A): Anxiety is a feeling of constant worrying. Children with severe 

anxiety problems may be diagnosed as having anxiety disorders. Anxiety disorders include panic 

disorder, obsessive-compulsive disorder, post-traumatic stress disorder, and phobias. 

HELP SCREEN: IF THE RESPONDENT HAS NEVER HEARD OF THE MEDICAL 

CONDITION OR DOES NOT KNOW WHAT THE CONDITION IS, THEN A DOCTOR OR 

OTHER HEALTH CARE PROVIDER PROBABLY HAS NOT TOLD THE RESPONDENT 

THAT THE S.C. HAS THE CONDITION. IF A DOCTOR OR OTHER HEALTH CARE 

PROVIDER HAS NOT TOLD THE RESPONDENT THAT THE S.C. HAS THE CONDITION, 
 

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Series 1, No. 57 □ Page 85

BUT THE RESPONDENT INSISTS THAT THE S.C. HAS THE CONDITION, WE STILL 

NEED TO CODE THE ANSWER AS “NO.” 

K2Q34A (READ IF NECESSARY: Has a doctor or other health care provider ever told you that [S.C.] 

had...) 

Behavioral or conduct problems, such as oppositional defiant disorder or conduct disorder? 

(1) YES (2) NO (77) DON’T KNOW (99) REFUSED 

HELP SCREEN (K2Q34A): Oppositional defiant disorder is an ongoing pattern of defiant and 

hostile behavior that interferes with a child’s life and daily activities. 

HELP SCREEN: IF THE RESPONDENT HAS NEVER HEARD OF THE MEDICAL 

CONDITION OR DOES NOT KNOW WHAT THE CONDITION IS, THEN A DOCTOR OR 

OTHER HEALTH CARE PROVIDER PROBABLY HAS NOT TOLD THE RESPONDENT 

THAT THE S.C. HAS THE CONDITION. IF A DOCTOR OR OTHER HEALTH CARE 

PROVIDER HAS NOT TOLD THE RESPONDENT THAT THE S.C. HAS THE CONDITION, 

BUT THE RESPONDENT INSISTS THAT THE S.C. HAS THE CONDITION, WE STILL 

NEED TO CODE THE ANSWER AS “NO.” 

K2Q35A (READ IF NECESSARY: Has a doctor or other health care provider ever told you that [S.C.] 

had...) 

Autism, Asperger's Disorder, pervasive developmental disorder, or other autism spectrum 

disorder? 

(1) YES (2) NO (77) DON’T KNOW (99) REFUSED 

HELP SCREEN (K2Q35A): Children with autism have delays in language, communication, and 

social skills. Children with Asperger’s disorder have impaired social skills but do not have speech 

or language delays. They often have an intense interest in a single subject or topic. Children with 

pervasive developmental disorder have severe and persistent delays in language, communication, 

and social skills. 

HELP SCREEN: IF THE RESPONDENT HAS NEVER HEARD OF THE MEDICAL 

CONDITION OR DOES NOT KNOW WHAT THE CONDITION IS, THEN A DOCTOR OR 

OTHER HEALTH CARE PROVIDER PROBABLY HAS NOT TOLD THE RESPONDENT 

THAT THE S.C. HAS THE CONDITION. IF A DOCTOR OR OTHER HEALTH CARE 

PROVIDER HAS NOT TOLD THE RESPONDENT THAT THE S.C. HAS THE CONDITION, 

BUT THE RESPONDENT INSISTS THAT THE S.C. HAS THE CONDITION, WE STILL 

NEED TO CODE THE ANSWER AS “NO.” 

K2Q36A (READ IF NECESSARY: Has a doctor or other health care provider ever told you that [S.C.] 

had...) 

Any developmental delay that affects [his/her] ability to learn? 

(1) YES (2) NO (77) DON’T KNOW (99) REFUSED 

HELP SCREEN (K2Q36A): A child with a developmental delay does not achieve certain skills 

as quickly other children of the same age. A developmental delay is a major delay in motor, 

language, social, or thinking skills. 

HELP SCREEN: IF THE RESPONDENT HAS NEVER HEARD OF THE MEDICAL 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Page 86 □ Series 1, No. 57

CONDITION OR DOES NOT KNOW WHAT THE CONDITION IS, THEN A DOCTOR OR 

OTHER HEALTH CARE PROVIDER PROBABLY HAS NOT TOLD THE RESPONDENT 

THAT THE S.C. HAS THE CONDITION. IF A DOCTOR OR OTHER HEALTH CARE 

PROVIDER HAS NOT TOLD THE RESPONDENT THAT THE S.C. HAS THE CONDITION, 

BUT THE RESPONDENT INSISTS THAT THE S.C. HAS THE CONDITION, WE STILL 

NEED TO CODE THE ANSWER AS “NO.” 

K2Q37A (READ IF NECESSARY: Has a doctor or other health care provider ever told you that [S.C.] 

had...) 

Intellectual disability or mental retardation? 

(1) YES (2) NO (77) DON’T KNOW (99) REFUSED 

HELP SCREEN (K2Q37A): Children with intellectual disabilities or mental retardation learn and 

develop more slowly than a typical child. 

HELP SCREEN: IF THE RESPONDENT HAS NEVER HEARD OF THE MEDICAL 

CONDITION OR DOES NOT KNOW WHAT THE CONDITION IS, THEN A DOCTOR OR 

OTHER HEALTH CARE PROVIDER PROBABLY HAS NOT TOLD THE RESPONDENT 

THAT THE S.C. HAS THE CONDITION. IF A DOCTOR OR OTHER HEALTH CARE 

PROVIDER HAS NOT TOLD THE RESPONDENT THAT THE S.C. HAS THE CONDITION, 

BUT THE RESPONDENT INSISTS THAT THE S.C. HAS THE CONDITION, WE STILL 

NEED TO CODE THE ANSWER AS “NO.” 

K2Q40A (READ IF NECESSARY: Has a doctor or other health care provider ever told you that [S.C.] 

had...) 

Asthma? 

(1) YES (2) NO (77) DON’T KNOW (99) REFUSED 

HELP SCREEN (K2Q40A): Asthma is a disease that causes swelling in the tubes that carry air to 

the lungs. Sometimes asthma blocks or restricts the airways making it difficult to breathe. 

HELP SCREEN: IF THE RESPONDENT HAS NEVER HEARD OF THE MEDICAL 

CONDITION OR DOES NOT KNOW WHAT THE CONDITION IS, THEN A DOCTOR OR 

OTHER HEALTH CARE PROVIDER PROBABLY HAS NOT TOLD THE RESPONDENT 

THAT THE S.C. HAS THE CONDITION. IF A DOCTOR OR OTHER HEALTH CARE 

PROVIDER HAS NOT TOLD THE RESPONDENT THAT THE S.C. HAS THE CONDITION, 

BUT THE RESPONDENT INSISTS THAT THE S.C. HAS THE CONDITION, WE STILL 

NEED TO CODE THE ANSWER AS “NO.” 

K2Q41A (READ IF NECESSARY: Has a doctor or other health care provider ever told you that [S.C.] 

had...) 

Diabetes? 

(1) YES (2) NO (77) DON’T KNOW (99) REFUSED 

HELP SCREEN (K2Q41A): Diabetes is a disease in which the body does not properly make or 

use insulin. 

HELP SCREEN: IF THE RESPONDENT HAS NEVER HEARD OF THE MEDICAL 

CONDITION OR DOES NOT KNOW WHAT THE CONDITION IS, THEN A DOCTOR OR 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Series 1, No. 57 □ Page 87

OTHER HEALTH CARE PROVIDER PROBABLY HAS NOT TOLD THE RESPONDENT 

THAT THE S.C. HAS THE CONDITION. IF A DOCTOR OR OTHER HEALTH CARE 

PROVIDER HAS NOT TOLD THE RESPONDENT THAT THE S.C. HAS THE CONDITION, 

BUT THE RESPONDENT INSISTS THAT THE S.C. HAS THE CONDITION, WE STILL 

NEED TO CODE THE ANSWER AS “NO.” 

K2Q42A (READ IF NECESSARY: Has a doctor or other health care provider ever told you that [S.C.] 

had...) 

Epilepsy or seizure disorder? 

(1) YES (2) NO (77) DON’T KNOW (99) REFUSED 

HELP SCREEN (K2Q42A): Epilepsy is a brain disease that involves recurrent seizures. 

HELP SCREEN: IF THE RESPONDENT HAS NEVER HEARD OF THE MEDICAL 

CONDITION OR DOES NOT KNOW WHAT THE CONDITION IS, THEN A DOCTOR OR 

OTHER HEALTH CARE PROVIDER PROBABLY HAS NOT TOLD THE RESPONDENT 

THAT THE S.C. HAS THE CONDITION. IF A DOCTOR OR OTHER HEALTH CARE 

PROVIDER HAS NOT TOLD THE RESPONDENT THAT THE S.C. HAS THE CONDITION, 

BUT THE RESPONDENT INSISTS THAT THE S.C. HAS THE CONDITION, WE STILL 

NEED TO CODE THE ANSWER AS “NO.” 

K2Q43A (READ IF NECESSARY: Has a doctor or other health care provider ever told you that [S.C.] 

had...) 

Has a doctor or other health care provider ever told you that [S.C.] had Migraines or frequent 

headaches? 

(1) YES (2) NO (77) DON’T KNOW (99) REFUSED 

HELP SCREEN (K2Q43A): A migraine is a type of severe headache that can cause nausea and 

vomiting. 

HELP SCREEN: IF THE RESPONDENT HAS NEVER HEARD OF THE MEDICAL 

CONDITION OR DOES NOT KNOW WHAT THE CONDITION IS, THEN A DOCTOR OR 

OTHER HEALTH CARE PROVIDER PROBABLY HAS NOT TOLD THE RESPONDENT 

THAT THE S.C. HAS THE CONDITION. IF A DOCTOR OR OTHER HEALTH CARE 

PROVIDER HAS NOT TOLD THE RESPONDENT THAT THE S.C. HAS THE CONDITION, 

BUT THE RESPONDENT INSISTS THAT THE S.C. HAS THE CONDITION, WE STILL 

NEED TO CODE THE ANSWER AS “NO.” 

K2Q44A (READ IF NECESSARY: Has a doctor or other health care provider ever told you that [S.C.] 

had...) 

A head injury, concussion, or traumatic brain injury or concussion? 

(1) YES (2) NO (77) DON’T KNOW (99) REFUSED 

HELP SCREEN (K2Q44A): A concussion is an injury of the brain that causes a brief disruption 

in brain function. Developmental and neurological conditions (such as autism or cerebral palsy) 

should not be included as head or brain injuries. This question refers only to traumatic injuries. 

Brain tumors should not be considered brain injuries. 

HELP SCREEN: IF THE RESPONDENT HAS NEVER HEARD OF THE MEDICAL 
 

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Page 88 □ Series 1, No. 57

CONDITION OR DOES NOT KNOW WHAT THE CONDITION IS, THEN A DOCTOR OR 

OTHER HEALTH CARE PROVIDER PROBABLY HAS NOT TOLD THE RESPONDENT 

THAT THE S.C. HAS THE CONDITION. IF A DOCTOR OR OTHER HEALTH CARE 

PROVIDER HAS NOT TOLD THE RESPONDENT THAT THE S.C. HAS THE CONDITION, 

BUT THE RESPONDENT INSISTS THAT THE S.C. HAS THE CONDITION, WE STILL 

NEED TO CODE THE ANSWER AS “NO.” 

K2Q45A (READ IF NECESSARY: Has a doctor or other health care provider ever told you that [S.C.] 

had...) 

Heart problem, including congenital heart disease? 

(1) YES (2) NO (77) DON’T KNOW (99) REFUSED 

HELP SCREEN: Heart problems are any type of problems with a child’s heart. Congenital heart 

disease is a defect in the structure of the heart that occurs before birth. Harmless or innocuous 

heart murmurs should not be included as heart problems. 

HELP SCREEN: IF THE RESPONDENT HAS NEVER HEARD OF THE MEDICAL 

CONDITION OR DOES NOT KNOW WHAT THE CONDITION IS, THEN A DOCTOR OR 

OTHER HEALTH CARE PROVIDER PROBABLY HAS NOT TOLD THE RESPONDENT 

THAT THE S.C. HAS THE CONDITION. IF A DOCTOR OR OTHER HEALTH CARE 

PROVIDER HAS NOT TOLD THE RESPONDENT THAT THE S.C. HAS THE CONDITION, 

BUT THE RESPONDENT INSISTS THAT THE S.C. HAS THE CONDITION, WE STILL 

NEED TO CODE THE ANSWER AS “NO.” 

K2Q46A (READ IF NECESSARY: Has a doctor or other health care provider ever told you that [S.C.] 

had...) 

Blood problems such as anemia or sickle cell disease? Please do not include Sickle Cell Trait. 

(1) YES (2) NO (77) DON’T KNOW (99) REFUSED 

HELP SCREEN: Children with anemia have problems with their blood that can cause them to be 

very tired. Leukemia should be included as a blood problem. 

HELP SCREEN: IF THE RESPONDENT HAS NEVER HEARD OF THE MEDICAL 

CONDITION OR DOES NOT KNOW WHAT THE CONDITION IS, THEN A DOCTOR OR 

OTHER HEALTH CARE PROVIDER PROBABLY HAS NOT TOLD THE RESPONDENT 

THAT THE S.C. HAS THE CONDITION. IF A DOCTOR OR OTHER HEALTH CARE 

PROVIDER HAS NOT TOLD THE RESPONDENT THAT THE S.C. HAS THE CONDITION, 

BUT THE RESPONDENT INSISTS THAT THE S.C. HAS THE CONDITION, WE STILL 

NEED TO CODE THE ANSWER AS “NO.” 

K2Q47A (READ IF NECESSARY: Has a doctor or other health care provider ever told you that [S.C.] 

had...) 

Cystic Fibrosis? 

(1) YES (2) NO (77) DON’T KNOW (99) REFUSED 

HELP SCREEN (K2Q47A): Cystic Fibrosis is a disease that causes mucus to build up in the 

lungs and can cause bronchitis, frequent coughing and pneumonia. 

HELP SCREEN: IF THE RESPONDENT HAS NEVER HEARD OF THE MEDICAL 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Series 1, No. 57 □ Page 89

CONDITION OR DOES NOT KNOW WHAT THE CONDITION IS, THEN A DOCTOR OR 

OTHER HEALTH CARE PROVIDER PROBABLY HAS NOT TOLD THE RESPONDENT 

THAT THE S.C. HAS THE CONDITION. IF A DOCTOR OR OTHER HEALTH CARE 

PROVIDER HAS NOT TOLD THE RESPONDENT THAT THE S.C. HAS THE CONDITION, 

BUT THE RESPONDENT INSISTS THAT THE S.C. HAS THE CONDITION, WE STILL 

NEED TO CODE THE ANSWER AS “NO.” 

K2Q48A (READ IF NECESSARY: Has a doctor or other health care provider ever told you that [S.C.] 

had...) 

Cerebral Palsy? 

(1) YES (2) NO (77) DON’T KNOW (99) REFUSED 

HELP SCREEN (K2Q48A): Cerebral Palsy is caused by damage that occurs to the brain prior to 

or shortly after birth that can affect body movement and muscle coordination. 

HELP SCREEN: IF THE RESPONDENT HAS NEVER HEARD OF THE MEDICAL 

CONDITION OR DOES NOT KNOW WHAT THE CONDITION IS, THEN A DOCTOR OR 

OTHER HEALTH CARE PROVIDER PROBABLY HAS NOT TOLD THE RESPONDENT 

THAT THE S.C. HAS THE CONDITION. IF A DOCTOR OR OTHER HEALTH CARE 

PROVIDER HAS NOT TOLD THE RESPONDENT THAT THE S.C. HAS THE CONDITION, 

BUT THE RESPONDENT INSISTS THAT THE S.C. HAS THE CONDITION, WE STILL 

NEED TO CODE THE ANSWER AS “NO.” 

K2Q49A (READ IF NECESSARY: Has a doctor or other health care provider ever told you that [S.C.] 

had...) 

Muscular Dystrophy? 

(1) YES (2) NO (77) DON’T KNOW (99) REFUSED 

HELP SCREEN (K2Q49A): Muscular dystrophy is a group of genetic muscle diseases that 

cause muscle weakness and muscle degeneration. 

HELP SCREEN: IF THE RESPONDENT HAS NEVER HEARD OF THE MEDICAL 

CONDITION OR DOES NOT KNOW WHAT THE CONDITION IS, THEN A DOCTOR OR 

OTHER HEALTH CARE PROVIDER PROBABLY HAS NOT TOLD THE RESPONDENT 

THAT THE S.C. HAS THE CONDITION. IF A DOCTOR OR OTHER HEALTH CARE 

PROVIDER HAS NOT TOLD THE RESPONDENT THAT THE S.C. HAS THE CONDITION, 

BUT THE RESPONDENT INSISTS THAT THE S.C. HAS THE CONDITION, WE STILL 

NEED TO CODE THE ANSWER AS “NO.” 

K2Q50A (READ IF NECESSARY: Has a doctor or other health care provider ever told you that [S.C.] 

had...) 

Down Syndrome? 

(1) YES (2) NO (77) DON’T KNOW (99) REFUSED 

HELP SCREEN (K2Q50A): Down Syndrome is a condition that causes delays in the way a 

child develops, both mentally and physically. 

HELP SCREEN: IF THE RESPONDENT HAS NEVER HEARD OF THE MEDICAL 

CONDITION OR DOES NOT KNOW WHAT THE CONDITION IS, THEN A DOCTOR OR 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Page 90 □ Series 1, No. 57

OTHER HEALTH CARE PROVIDER PROBABLY HAS NOT TOLD THE RESPONDENT 

THAT THE S.C. HAS THE CONDITION. IF A DOCTOR OR OTHER HEALTH CARE 

PROVIDER HAS NOT TOLD THE RESPONDENT THAT THE S.C. HAS THE CONDITION, 

BUT THE RESPONDENT INSISTS THAT THE S.C. HAS THE CONDITION, WE STILL 

NEED TO CODE THE ANSWER AS “NO.” 

K2Q51A (READ IF NECESSARY: Has a doctor or other health care provider ever told you that [S.C.] 

had...) 

Arthritis or other joint problems? 

(1) YES (2) NO (77) DON’T KNOW (99) REFUSED 

HELP SCREEN (K2Q51A): Arthritis causes joint problems including pain, stiffness, swelling, 

and damage to joints. 

HELP SCREEN: IF THE RESPONDENT HAS NEVER HEARD OF THE MEDICAL 

CONDITION OR DOES NOT KNOW WHAT THE CONDITION IS, THEN A DOCTOR OR 

OTHER HEALTH CARE PROVIDER PROBABLY HAS NOT TOLD THE RESPONDENT 

THAT THE S.C. HAS THE CONDITION. IF A DOCTOR OR OTHER HEALTH CARE 

PROVIDER HAS NOT TOLD THE RESPONDENT THAT THE S.C. HAS THE CONDITION, 

BUT THE RESPONDENT INSISTS THAT THE S.C. HAS THE CONDITION, WE STILL 

NEED TO CODE THE ANSWER AS “NO.” 

K2Q52A (READ IF NECESSARY: Has a doctor or other health care provider ever told you that [S.C.] 

had...) 

Allergies? 

(1) YES (2) NO (77) DON’T KNOW (99) REFUSED 

HELP SCREEN (K2Q52A): An allergy is an abnormal reaction by a person's immune system 

against a normally harmless substance. 

HELP SCREEN: IF THE RESPONDENT HAS NEVER HEARD OF THE MEDICAL 

CONDITION OR DOES NOT KNOW WHAT THE CONDITION IS, THEN A DOCTOR OR 

OTHER HEALTH CARE PROVIDER PROBABLY HAS NOT TOLD THE RESPONDENT 

THAT THE S.C. HAS THE CONDITION. IF A DOCTOR OR OTHER HEALTH CARE 

PROVIDER HAS NOT TOLD THE RESPONDENT THAT THE S.C. HAS THE CONDITION, 

BUT THE RESPONDENT INSISTS THAT THE S.C. HAS THE CONDITION, WE STILL 

NEED TO CODE THE ANSWER AS “NO.” 

K2Q31B [IF K2Q31A IS NOT “1,” THEN SKIP TO K2Q32B] 

Does [S.C.] currently have ADD or ADHD? 

(1) YES 

(2) NO [SKIP TO K2Q32B] 

(77) DON’T KNOW [SKIP TO K2Q32B] 

(99) REFUSED [SKIP TO K2Q32B] 

K2Q31C Would you describe [his/her] ADD or ADHD as mild, moderate, or severe? 

(1) MILD 

(2) MODERATE 
 

2009-2010 National Survey of Children with Special Health Care Needs Page 37 

Series 1, No. 57 □ Page 91

(3) SEVERE 

(77) DON’T KNOW 

(99) REFUSED 

K2Q32B [IF K2Q32A IS NOT “1,” THEN SKIP TO K2Q33B] 

 Does [S.C.] currently have depression? 

(1) YES 

(2) NO [SKIP TO K2Q33B] 

(77) DON’T KNOW [SKIP TO K2Q33B] 

(99) REFUSED [SKIP TO K2Q33B] 

K2Q32C Would you describe [his/her] depression as mild, moderate, or severe? 

(1) MILD 

(2) MODERATE 

(3) SEVERE 

(77) DON’T KNOW 

(99) REFUSED 

K2Q33B [IF K2Q33A IS NOT “1,” THEN SKIP TO K2Q34B] 

 Does [S.C.] currently have anxiety problems? 

(1) YES 

(2) NO [SKIP TO K2Q34B] 

(77) DON’T KNOW [SKIP TO K2Q34B] 

(99) REFUSED [SKIP TO K2Q34B] 

K2Q33C Would you describe [his/her] anxiety problems as mild, moderate, or severe? 

(1) MILD 

(2) MODERATE 

(3) SEVERE 

(77) DON’T KNOW 

(99) REFUSED 

K2Q34B [IF K2Q34A IS NOT “1,” THEN SKIP TO K2Q35B] 

 Does [S.C.] currently have behavioral or conduct problems? 

(1) YES 

(2) NO [SKIP TO K2Q35B] 

(77) DON’T KNOW [SKIP TO K2Q35B] 

(99) REFUSED [SKIP TO K2Q35B] 

K2Q34C Would you describe [his/her] behavioral or conduct problems as mild, moderate, or severe? 

(1) MILD 

(2) MODERATE 

(3) SEVERE 

(77) DON’T KNOW 

(99) REFUSED 
 

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Page 92 □ Series 1, No. 57

K2Q35B [IF K2Q35A IS NOT “1,” THEN SKIP TO K2Q36B] 

 Does [S.C.] currently have autism or an autism spectrum disorder? 

(1) YES 

(2) NO [SKIP TO K2Q36B] 

(77) DON’T KNOW [SKIP TO K2Q36B] 

(99) REFUSED [SKIP TO K2Q36B] 

K2Q35C Would you describe [his/her] autism or ASD as mild, moderate, or severe? 

(1) MILD 

(2) MODERATE 

(3) SEVERE 

(77) DON’T KNOW 

(99) REFUSED 

K2Q35D How old was [S.C.] when a doctor or other health care provider first told you that [he/she] had 

autism or ASD? 

HELP SCREEN: ENTER AGE IN MONTHS FOR 0 TO 23 MONTHS. IF 2 YEARS OR 

OLDER, ENTER AGE IN YEARS. 

___ ____ VALUE (MUST BE LESS THAN OR EQUAL TO AGE OF CHILD) 

(77) DON’T KNOW 

(99) REFUSED 

K2Q35DA Months (00-23) 

 Years (Range 02-17) 

 (1) MONTHS 

 (2) YEARS 

 (77) DON’T KNOW 

 (99) REFUSED 

K2Q36B [IF K2Q36A IS NOT “1,” THEN SKIP TO K2Q37B] 

 Does [S.C.] currently have developmental delay? 

(1) YES 

(2) NO [SKIP TO K2Q37B] 

(77) DON’T KNOW [SKIP TO K2Q37B] 

(99) REFUSED [SKIP TO K2Q37B] 

K2Q36C Would you describe [his/her] developmental delay as mild, moderate, or severe? 

(1) MILD 

(2) MODERATE 

(3) SEVERE 

(77) DON’T KNOW 

(99) REFUSED 

K2Q37B [IF K2Q37A IS NOT “1,” THEN SKIP TO K2Q40B.] 
 

 Does [S.C.] currently have intellectual disability or mental retardation? 

(1) YES 

(2) NO [SKIP TO K2Q40B] 

(77) DON’T KNOW [SKIP TO K2Q40B] 

(99) REFUSED [SKIP TO K2Q40B] 

K2Q37C Would you describe [his/her] intellectual disability or mental retardation as mild, moderate, or 

severe? 

(1) MILD 

(2) MODERATE 

(3) SEVERE 

(77) DON’T KNOW 

(99) REFUSED 

K2Q40B [IF K2Q40A IS NOT “1,” THEN SKIP TO K2Q41B] 

 Does [S.C.] currently have asthma? 

(1) YES 

(2) NO [SKIP TO K2Q41B] 

(77) DON’T KNOW [SKIP TO K2Q41B] 

(99) REFUSED [SKIP TO K2Q41B] 

K2Q41B [IF K2Q41A IS NOT “1,” THEN SKIP TO K2Q42B.] 

 Does [S.C.] currently have diabetes? 

(1) YES 

(2) NO [SKIP TO K2Q42B] 

(77) DON’T KNOW [SKIP TO K2Q42B] 

(99) REFUSED [SKIP TO K2Q42B] 

K2Q41C Does [S.C.] use insulin? 

(1) YES 

(2) NO 

(77) DON’T KNOW 

(99) REFUSED 

K2Q42B [IF K2Q42A IS NOT “1,” THEN SKIP TO K2Q43B] 

 Does [S.C.] currently have epilepsy or seizure disorder? 

(1) YES 

(2) NO [SKIP TO K2Q43B] 

(77) DON’T KNOW [SKIP TO K2Q43B] 

(99) REFUSED [SKIP TO K2Q43B] 

K2Q42C Would you describe [his/her] epilepsy or seizure disorder as mild, moderate, or severe? 

(1) MILD 

(2) MODERATE 

(3) SEVERE 

2009-2010 National Survey of Children with Special Health Care Needs Page 39 

Series 1, No. 57 □ Page 93
 

2009-2010 National Survey of Children with Special Health Care Needs Page 40 

Page 94 □ Series 1, No. 57

(77) DON’T KNOW 

(99) REFUSED 

K2Q43B [IF K2Q43A IS NOT “1,” THEN SKIP TO K2Q44B] 

 Does [S.C.] currently have migraines or frequent headaches? 

(1) YES 

(2) NO 

(77) DON’T KNOW 

(99) REFUSED 

K2Q44B [IF K2Q44A IS NOT “1,” THEN SKIP TO K2Q45B] 

Does [S.C.] currently have a head injury, concussion, or traumatic brain injury? 

(1) YES 

(2) NO [SKIP TO K2Q45B] 

(77) DON’T KNOW [SKIP TO K2Q45B] 

(99) REFUSED [SKIP TO K2Q45B] 

K2Q44C Would you describe [his/her] injury as mild, moderate, or severe? 

(1) MILD 

(2) MODERATE 

(3) SEVERE 

(77) DON’T KNOW 

(99) REFUSED 

K2Q45B [IF K2Q45A IS NOT “1,” THEN SKIP TO K2Q46B] 

 

Does [S.C.] currently have a heart problem? 

(1) YES 

(2) NO 

(77) DON’T KNOW 

(99) REFUSED 

K2Q46B [IF K2Q46A IS NOT “1,” THEN SKIP TO K2Q47B] 

 

Does [S.C.] currently have a blood problem? 

(1) YES 

(2) NO [SKIP TO K2Q47B] 

(77) DON’T KNOW [SKIP TO K2Q47B] 

(99) REFUSED [SKIP TO K2Q47B] 

K2Q46C Are [his/her] blood problems related to anemia, sickle cell disease, hemophilia, or something else? 

(1) ANEMIA 

(2) SICKLE CELL DISEASE 

(3) HEMOPHILIA 

(4) SOMETHING ELSE 

(77) DON’T KNOW 

(99) REFUSED 
 

2009-2010 National Survey of Children with Special Health Care Needs Page 41 

Series 1, No. 57 □ Page 95

K2Q47B [IF K2Q47A IS NOT “1,” THEN SKIP TO K2Q48B] 

 

Does [S.C.] currently have Cystic Fibrosis? 

(1) YES 

(2) NO 

(77) DON’T KNOW 

(99) REFUSED 

K2Q48B [IF K2Q48A IS NOT “1,” THEN SKIP TO K2Q49B.] 

 

Does [S.C.] currently have Cerebral Palsy? 

(1) YES 

(2) NO 

(77) DON’T KNOW 

(99) REFUSED 

K2Q49B [IF K2Q49A IS NOT “1,” THEN SKIP TO K2Q50B] 

 

Does [S.C.] currently have Muscular Dystrophy? 

(1) YES 

(2) NO 

(77) DON’T KNOW 

(99) REFUSED 

K2Q50B [IF K2Q50A IS NOT “1,” THEN SKIP TO K2Q51B] 

 

Does [S.C.] currently have Down Syndrome? 

(1) YES 

(2) NO 

(77) DON’T KNOW 

(99) REFUSED 

K2Q51B [IF K2Q51A IS NOT “1,” THEN SKIP TO K2Q52B] 

 

Does [S.C.] currently have arthritis or other joint problems? 

(1) YES 

(2) NO 

(77) DON’T KNOW 

(99) REFUSED 

K2Q52B [IF K2Q52A IS NOT “1,” THEN SKIP TO C3Q14] 

 

Does [S.C.] currently have allergies? 

(1) YES 

(2) NO [SKIP TO C3Q14] 

(77) DON’T KNOW [SKIP TO C3Q14] 

(99) REFUSED [SKIP TO C3Q14] 

K2Q52C Are any of these food allergies? 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2009-2010 National Survey of Children with Special Health Care Needs Page 42 

Page 96 □ Series 1, No. 57

(1) YES 

(2) NO 

(77) DON’T KNOW 

(99) REFUSED 

[TIMESTAMP_SECTION35] 

C3Q14	 [IF CSHCN_AGE < 60 MONTHS (5 YEARS), SKIP TO C3Q42] 

IF SC=ST then FILL C3Q14 WITH TIS_NOSCHOOL 

During the past 12 months, that is since [ONE_YEAR_AGO], about how many days did [S.C.] 

miss school because of illness or injury? 

NOTE: A SCHOOL YEAR IS 240 DAYS 

______________NUMBER OF DAYS 

(000) NONE 

(555) DID NOT GO TO SCHOOL 

(666) HOME SCHOOLED 

(777) DON’T KNOW 

(999) REFUSED 

RANGE 000-240, 555, 666,777,999 

IF > 40 AND NOT IN 555, 666, 777, 999, GO TO SC_C3Q14 ELSE GO TO C3Q40 

SC_C3Q14	 YOU ENTERED [FILL WITH ANSWER FROM C3Q14] SCHOOL DAYS. IS THIS 

CORRECT? 

(1) YES [GO TO C3Q40] 

(2) NO [GO BACK TO C3Q14] 

C3Q40	 Do [S.C.]’s (medical, behavioral, or other health conditions / emotional, developmental, or 

behavioral problems) interfere with [his/her] ability to attend school on a regular basis? 

(1) YES 

(2) NO 

(77) DON’T KNOW 

(99) REFUSED 

C3Q41	 Do [S.C.]’s (medical, behavioral, or other health conditions / emotional, developmental, or 

behavioral problems) interfere with [his/her] ability to participate in sports, clubs, or other 

organized activities? 

(1) YES [SKIP TO NAME_SEC4] 

(2) NO	 [SKIP TO NAME_SEC4] 

(77) DON’T KNOW [SKIP TO NAME_SEC4] 

(99) REFUSED [SKIP TO NAME_SEC4] 

C3Q42	 [IF S.C. IS YOUNGER THAN 12 MONTHS, SKIP TO C3Q43] 

Do [S.C.]’s (medical, behavioral, or other health conditions / emotional, developmental, or 

behavioral problems) interfere with [his/her] ability to participate in play with other children? 

(1) YES 

(2) NO 
 

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Series 1, No. 57 □ Page 97

(77) DON’T KNOW 

(99) REFUSED 

C3Q43	 Do [S.C.]’s (medical, behavioral, or other health conditions / emotional, developmental, or 

behavioral problems) interfere with [his/her] ability to go on outings, such as to the park, library, 

zoo, shopping, church, restaurants, or family gatherings? 

(1) YES 

(2) NO 

(77) DON’T KNOW 

(99) REFUSED 

Section 4. ACCESS TO CARE: UTILIZATION AND UNMET NEEDS 

[TIMESTAMP_SECTION41] 

NAME_SEC4	 [SKIP TO C4Q0A IF NAME OF SELECTED CHILD ALREADY GATHERED FROM 

MULTIAGE, C2Q01N, SELECTION1_NAME, NIS INTERVIEW, OR RESPONDENT 

REFUSED TO ANSWER NAME QUESTIONS] 

INTERVIEWER QUESTION: DO NOT READ TO RESPONDENT! 

HAS THE HOUSEHOLD GIVEN YOU A NAME FOR THE CHILD? 

(1) YES [GO TO NAME_SEC4_A] 

(2) NO [GO TO C4Q0A] 

NAME_SEC4_A 

ENTER NAME/INITIALS: ____________ [GO TO C4Q0A] 

[FILL [S.C.] WITH THIS NAME FROM THIS POINT ON IN THE INTERVIEW] 
 

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Page 98 □ Series 1, No. 57

C4Q0A	 Is there a place that [S.C.] USUALLY goes when [he/she] is sick or you need advice about 

[his/her] health? 

(1) YES 

(2) THERE IS NO PLACE [SKIP TO C4Q0D] 

(3) THERE IS MORE THAN ONE PLACE 

(77) DON’T KNOW		 [SKIP TO C4Q0D] 

(99) REFUSED	 [SKIP TO C4Q0D] 

C4Q0B	 IF C4Q0A = 01, SAY “What kind of place is it?”

IF C4Q0A = 03, SAY “What kind of place does [S.C.] go to most often?”

Is it a doctor’s office, emergency room, hospital outpatient department, clinic, or some other 

place? 

(1) DOCTOR’S OFFICE 

(2) HOSPITAL EMERGENCY ROOM 

(3) HOSPITAL OUTPATIENT DEPARTMENT 

(4) CLINIC OR HEALTH CENTER 

(5) SCHOOL (NURSE’S OFFICE, ATHLETIC TRAINER’S OFFICE, ETC) 

(6) FRIEND/RELATIVE 

(7) MEXICO/OTHER LOCATIONS OUT OF US 

(8) SOME OTHER PLACE [SKIP TO C4Q0C] 

(9) DOES NOT GO TO ONE PLACE MOST OFTEN 

(77) DON’T KNOW [FILL 77 IN C4Q0A AND SKIP TO C4Q0D] 

(99) REFUSED [FILL 99 IN C4Q0A AND SKIP TO C4Q0D] 

FOR ALL EXCEPT (8), GO TO C4Q0D 

C4Q0C	 READ IF NECESSARY 

IF C4Q0A = 01, SAY “What kind of place is it?”

IF C4Q0A = 3, SAY “What kind of place does [S.C.] go to most often?”

RECORD VERBATIM RESPONSE________ 

C4Q0D	 Is there a place that [S.C.] USUALLY goes when [he/she] needs routine preventive care, such as a 

physical examination or well-child check-up? 

(1) YES 

(2) THERE IS NO PLACE [SKIP TO C4Q02A] 

(3) THERE IS MORE THAN ONE PLACE 

(77) DON’T KNOW		 [SKIP TO C4Q02A] 

(99) REFUSED	 [SKIP TO C4Q02A] 

READ IF NECESSARY: Routine preventive care includes check-ups, immunizations, health 

screening tests, and discussions about how to keep your child healthy. 

C4Q01	 [IF C4Q0A = 2, 77, 99, OR IF C4Q0B = 9, 77, 99, THEN GO TO C4Q02] 

[IF C4Q0B = 6, 7, 8, 77, 99 FILL WITH “place”]

Is that the same [place selected in C4Q0B] where [S.C.] goes when [he/she] is sick? 

(1) YES	 [SKIP TO C4Q02A] 

(2) NO 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2009-2010 National Survey of Children with Special Health Care Needs Page 45 

Series 1, No. 57 □ Page 99

(77) DON’T KNOW		 [SKIP TO C4Q02A] 

(99) REFUSED	 [SKIP TO C4Q02A] 

C4Q02	 IF C4Q0D = 01 OR MISSING, SAY “What kind of place does [S.C.] USUALLY go to when 

[he/she] needs routine preventive care?” 

IF C4Q0D = 03, SAY “What kind of place does [S.C.] go to most often when [he/she] needs 

routine preventive care?” 

(1) DOCTOR’S OFFICE 

(2) HOSPITAL EMERGENCY ROOM 

(3) HOSPITAL OUTPATIENT DEPARTMENT 

(4) CLINIC OR HEALTH CENTER 

(5) SCHOOL (NURSE’S OFFICE, ATHLETIC TRAINER’S OFFICE, ETC) 

(6) FRIEND/RELATIVE 

(7) MEXICO/OTHER LOCATIONS OUT OF US 

(8) SOME OTHER PLACE [SKIP TO C4Q02_01] 

(9) DOES NOT GO TO ONE PLACE MOST OFTEN 

(77) DON’T KNOW 

(99) REFUSED 

FOR ALL EXCEPT (08), GO TO C4Q02A. 

C4Q02_01	 READ IF NECESSARY 

IF C4Q0D = 1, SAY “What kind of place is it?”

IF C4Q0D = 3, SAY “What kind of place does [S.C.] go to most often?”

RECORD VERBATIM RESPONSE________ 

C4Q02A	 A personal doctor or nurse is a health professional who knows your child well and is familiar with 

your child’s health history. This can be a general doctor, a pediatrician, a specialist doctor, a nurse 

practitioner, or a physician’s assistant. Do you have one or more persons you think of as [S.C.]’s 

personal doctor or nurse? 

(1) YES, ONE PERSON 

(2) YES, MORE THAN ONE PERSON 

(3) NO [SKIP TO C4Q03] 

(77) DON’T KNOW		 [SKIP TO C4Q03] 

(99) REFUSED	 [SKIP TO C4Q03] 

C4Q02B	 IF C4Q02A = 01 THEN READ: “Is this person a general doctor, pediatrician, specialist, nurse 

practitioner, or physician’s assistant?” [MARK ALL THAT APPLY] 

IF C4Q02A = 02 THEN READ: “Are those people general doctors, pediatricians, specialists, 

nurse practitioners, or physician assistants?” [MARK ALL THAT APPLY] 

(1) GENERAL DOCTOR (GENERAL PRACTICE, FAMILY OR INTERNAL MEDICINE) 

(2) PEDIATRICIAN 

(3) SPECIALIST (FOR EXAMPLE; SURGEONS, HEART DOCTORS, PSYCHIATRISTS, 

OB/GYN) 

(4) NURSE PRACTITIONER 

(5) PHYSICIAN’S ASSISTANT 

(6) MOTHER/FRIEND/RELATIVE 

(7) OTHER	 [GO TO C4Q02B_01] 

(77) DON’T KNOW 

(99) REFUSED 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2009-2010 National Survey of Children with Special Health Care Needs Page 46 

Page 100 □ Series 1, No. 57

ALL EXCEPT (7) GO TO C4Q03_INTRO. 

C4Q02B_01	 READ IF NECESSARY: 

What type of health professional is this person? 

RECORD VERBATIM RESPONSE________ 

[TIMESTAMP_SECTION42] 

C4Q03_INTRO	 The next questions are about all the types of services children may need or use, such as medical 

care, dental care, specialized therapies, counseling, medical equipment, special education, and 

early intervention. These services can be obtained in clinics, schools, child care centers, through 

community programs, at home, and other places. 

C4Q03_A	 [During the past 12 months / Since [his/her] birth], did you have any difficulties or delays getting 

services for [S.C.] because [he/she] was not eligible for the services? 

(1) YES 

(2) NO 

(77) DON’T KNOW 

(99) REFUSED 

HELP SCREEN: These questions are about all the types of services children may need or use, 

such as medical care, dental care, specialized therapies, counseling, medical equipment, special 

education, and early intervention. These services can be obtained in clinics, schools, child care 

centers, through community programs, at home, and other places. 

C4Q03_B	 [During the past 12 months / Since [his/her] birth], did you have any difficulties or delays because 

the services [S.C.] needed were not available in your area? 

(1) YES 

(2) NO 

(77) DON’T KNOW 

(99) REFUSED 

HELP SCREEN: These questions are about all the types of services children may need or use, 

such as medical care, dental care, specialized therapies, counseling, medical equipment, special 

education, and early intervention. These services can be obtained in clinics, schools, child care 

centers, through community programs, at home, and other places. 

C4Q03_C	 [During the past 12 months / Since [his/her] birth], did you have any difficulties or delays because 

there were waiting lists, backlogs, or other problems getting appointments? 

(1) YES 

(2) NO 

(77) DON’T KNOW 

(99) REFUSED 

HELP SCREEN: These questions are about all the types of services children may need or use, 

such as medical care, dental care, specialized therapies, counseling, medical equipment, special 

education, and early intervention. These services can be obtained in clinics, schools, child care 

centers, through community programs, at home, and other places. 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2009-2010 National Survey of Children with Special Health Care Needs Page 47 

Series 1, No. 57 □ Page 101

C4Q03_D	 (READ IF NECESSARY: [During the past 12 months / Since [his/her] birth] 

Did you have any difficulties or delays because of issues related to cost? 

(1) YES 

(2) NO 

(77) DON’T KNOW 

(99) REFUSED 

HELP SCREEN: These questions are about all the types of services children may need or use, 

such as medical care, dental care, specialized therapies, counseling, medical equipment, special 

education, and early intervention. These services can be obtained in clinics, schools, child care 

centers, through community programs, at home, and other places. 

C4Q03_E	 (READ IF NECESSARY: [During the past 12 months/ Since [his/her] birth] 

Did you have any difficulties or delays because you had trouble getting the information you 

needed? 

(1) YES 

(2) NO 

(77) DON’T KNOW 

(99) REFUSED 

HELP SCREEN: These questions are about all the types of services children may need or use, 

such as medical care, dental care, specialized therapies, counseling, medical equipment, special 

education, and early intervention. These services can be obtained in clinics, schools, child care 

centers, through community programs, at home, and other places. 

C4Q03_F	 [IF ANY C4Q03_A THROUGH C4Q03_E = YES, THEN SKIP TO C4Q04.] 

(READ IF NECESSARY: [During the past 12 months / Since [his/her] birth] 

Did you have any difficulties or delays for any other reason? 

(1) YES 

(2) NO 

(77) DON’T KNOW 

(99) REFUSED 

HELP SCREEN: These questions are about all the types of services children may need or use, 

such as medical care, dental care, specialized therapies, counseling, medical equipment, special 

education, and early intervention. These services can be obtained in clinics, schools, child care 

centers, through community programs, at home, and other places. 

C4Q04	 [During the past 12 months / Since [his/her] birth], how often have you been frustrated in your 

efforts to get services for [S.C.]? 

Would you say never, sometimes, usually, or always? 

(1) NEVER [GO TO C6Q00] 

(2) SOMETIMES [GO TO C6Q00] 

(3) USUALLY [GO TO C6Q00] 

(4) ALWAYS [GO TO C6Q00] 

(77) DON’T KNOW [GO TO C6Q00] 

(99) REFUSED [GO TO C6Q00] 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2009-2010 National Survey of Children with Special Health Care Needs Page 48 

Page 102 □ Series 1, No. 57

C6Q00	 [During the past 12 months/Since [his/her] birth], how many times did [S.C.] visit a hospital 

emergency room? 

(CATI: 3 NUMERIC-CHARACTER FIELD, RANGE 000-365, 777, 999) 

READ IF NECESSARY: This includes emergency room visits that resulted in a hospital 

admission. 

READ IF NECESSARY: THIS QUESTION IS ASKING SPECIFICALLY ABOUT VISITS 

TO A HOSPITAL EMERGENCY ROOM. DO NOT INCLUDE VISITS TO URGENT CARE 

CENTERS OR CLINICS, WHICH TAKE SICK PATIENTS WHO CANNOT BE SEEN BY 

THEIR REGULAR OR PRIMARY CARE DOCTORS. 

ENTER NUMBER OF VISITS 

______________NUMBER OF VISITS 

(000) NO VISITS IN PAST 12 MONTHS 

(777) DON’T KNOW 

(999) REFUSED 

IF > 10 AND NOT IN 777, 999, GO TO SC_C6Q00 ELSE GO TO CPC3Q50 

SC_C6Q00 YOU ENTERED [FILL WITH ANSWER FROM C6Q00] VISITS. IS THIS CORRECT? 

(1) YES [GO TO CPC3Q50] 

(2) NO [GO BACKTO C6Q00] 

[TIMESTAMP_SECTION42A] 

CPC3Q50	 IF CWTYPE=S AND ASK_CALIF=1 THEN GO TO C3Q50, ELSE GO TO K4Q20 

C3Q50*CA	 [During the past 12 months\ Since [S.C.]’s birth], was [S.C.] admitted to a hospital overnight? 

HELP SCREEN: DO NOT INCLUDE OVERNIGHT STAYS IN THE EMERGENCY ROOM. 

(1) YES [GO TO K4Q20] 

(2) NO [GO TO K4Q20] 

(77) DON’T KNOW [GO TO K4Q20] 

(99) REFUSED [GO TO K4Q20] 

[TIMESTAMP_SECTION43] 

K4Q20	 IF 0, GO TO C4Q05_1, IF >6 AND NOT IN 77, 99, GO TO SC_K4Q20, ELSE GO TO 

C4Q05_1A 

(CATI: 2 NUMERIC-CHARACTER FIELD, RANGE 00-76, 77, 99) 

[During the past 12 months / Since [his/her] birth], how many times did [S.C.] receive a well-child 

check-up, that is a general check-up, when [he/she] was not sick or injured? 

________ TIMES 
 

2009-2010 National Survey of Children with Special Health Care Needs Page 49 

 

 

 

 

 

 

Series 1, No. 57 □ Page 103

(77) DON'T KNOW 

(99) REFUSED 

SC_K4Q20	 INTERVIEWER CHECK: 

YOU ENTERED [FILL WITH ANSWER FROM K4Q20] TIMES. IS THIS CORRECT? 

(1) YES [GO TO C4Q05_1A] 

(2) NO	 [GO BACK TO K4Q20] 
2009-2010 National Survey of Children with Special Health Care Needs Page 50 

C4Q05 (4.5) (CATI: THIS SERIES SHOULD BE ASKED HORIZONTALLY ACROSS THE TABLE. IN OTHER WORDS, IF THEY ANSWER Y

IN COLUMN 01, THEY SHOULD IMMEDIATELY BE ASKED THE QUESTIONS IN COLUMN 2, 3, 4, 5 AS APPLICABLE) 

ALL RECEIVE THE FOLLOWING INTRODUCTION: [During the past 12 months/ Since [his/her] birth], was there

any time when [S.C.] needed 

any of the following services: 

Did [S.C.] receive all the [fill each ‘Yes' item from first column] that [he/she] needed? 

Why did [S.C.] not get the [fill each yes item from first column] [he/she] needed? 

(CHECK ALL THAT APPLY. READ 

RESPONSES ONLY IF NECESSARY) 
2009-2010 National Survey of Children with Special Health Care Needs Page 51 

C4Q0

[During the past 12 months/ Since [his/her] birth], was there 

any time when [S.C.] needed... 

a well child check-up? 

(1) YES [SKIP TO 

C4Q05_1B] (2) NO [SKIP TO K4Q21] 

(77) DON'T KNOW [SKIP TO

K4Q21] (99) REFUSED [SKIP TO 

K4Q21] 

5_1 C4Q05_1A 

Did [S.C.] receive all the wellchild check-ups that [he/she] 

needed? (1)YES [SKIP TO K4Q21] 

(2) NO 

(77) DON'T KNOW [SKIP TO

K4Q21] (99) REFUSED [SKIP TO 

K4Q21] 

C4Q05_1B 

Why did [S.C.] not get all the well-child 

check-ups [he/she] needed? 

(1) COST WAS TOO MUCH (2) NO INSURANCE (3) HEALTH PLAN PROBLEM (4) CAN’T FIND PROVIDER WHO 

ACCEPTS CHILD’S INSURANCE (5) NOT AVAILABLE IN AREA/TRANSPORT PROBLEMS 

(6) NOT CONVENIENT TIMES/COULD NOT GET APPOINTMENT 

(7) PROVIDER DID NOT KNOW HOW TO 

TREAT OR PROVIDE CARE (8) DISSATISFACTION WITH PROVIDER (9) DID NOT KNOW WHERE TO GO FOR 

TREATMENT (10) CHILD REFUSED TO GO (11) TREATMENT IS ONGOING (13) NO REFERRAL (14) LACK OF RESOURCES AT SCHOOL 

(15) DID NOT GO TO APPT/NEGLECTED APPT/FORGOT APPT (16) OTHER [SKIP TO C4Q05_1_O] (77) DON’T KNOW (99) REFUSED ALL OTHERS, SKIP TO K4Q21 

C4Q05_1_O 

READ IF NECESSARY: Why did [S.C.] not get all the wellchild check-ups [he/she] needed? 

RECORD VERBATIM RESPONSE

________ 

[GO TO K4Q21] 
 

2009-2010 National Survey of Children with Special Health Care Needs Page 52 

Page 106 □ Series 1, No. 57

K4Q21 IF 0, GO TO C4Q05_31, IF >10 AND NOT IN 77, 99, GO TO SC_K4Q21, ELSE GO TO C4Q05_31A 

RANGE 0-76, 77, 99 

[During the past 12 months / Since [his/her] birth], how many times did [S.C.] see a dentist for preventive dental care, 

such as check-ups and dental cleanings? 

________ TIMES 

(77) DON'T KNOW 

(99) REFUSED 

SC_K4Q21 INTERVIEWER CHECK: 

YOU ENTERED [FILL WITH ANSWER FROM K4Q21] TIMES. IS THIS CORRECT? 

(1) YES [GO TO C4Q05_31A] 

(2) NO [GO BACK TO K4Q21] 

 
 

2009-2010 National Survey of Children with Special Health Care Needs Page 53

C4Q05_31

[During the past 12 months/ 

Since [his/her] birth], was there 

any time when [S.C.] needed...

Preventive dental care, such as

check-ups and dental cleanings?

(1) YES [SKIP TO

C4Q05_31B]

(2) NO [SKIP TO C4Q05_32]

(77) DON'T KNOW [SKIP TO

C4Q05_32]

(99) REFUSED [SKIP TO

C4Q05_32]

C4Q05_31A

Did [S.C.] receive all the 

preventive dental care that 

[he/she] needed?

(1)YES [SKIP TO

C4Q05_32]

(2) NO

(77) DON'T KNOW [SKIP

TO C4Q05_32]

(99) REFUSED [SKIP TO

C4Q05_32]

C4Q05_31B

Why did [S.C.] not get all the preventive 

dental care [he/she] needed?

(1) COST WAS TOO MUCH

(2) NO INSURANCE

(3) HEALTH PLAN PROBLEM

(4) CAN’T FIND PROVIDER WHO

ACCEPTS CHILD’S INSURANCE

(5) NOT AVAILABLE IN

AREA/TRANSPORT PROBLEMS

(6) NOT CONVENIENT TIMES/COULD

NOT GET APPOINTMENT

(7) PROVIDER DID NOT KNOW HOW

TO TREAT OR PROVIDE CARE

(8) DISSATISFACTION WITH

PROVIDER

(9) DID NOT KNOW WHERE TO GO

FOR TREATMENT

(10) CHILD REFUSED TO GO

(11) TREATMENT IS ONGOING

(13) NO REFERRAL

(14) LACK OF RESOURCES AT

SCHOOL

(15) DID NOT GO TO

APPT/NEGLECTED APPT/FORGOT

APPT

(16) OTHER [SKIP TO C4Q05_31_O]

(77) DON’T KNOW

(99) REFUSED

ALL OTHERS, SKIP TO C4Q05_32

C4Q05_31_O

READ IF NECESSARY: Why

did [S.C.] not get all the 

preventive dental care [he/she]

needed ?

RECORD VERBATIM

RESPONSE_________

GO TO C4Q05_32
 

 2009-2010 National Survey of Children with Special Health Care Needs Page 54

C4Q05_32

[During the past 12 months/ 

Since [his/her] birth,] was there 

any time when [S.C.] needed...

Any other dental care or

orthodontia?

HELP SCREEN: OTHER

DENTAL CARE CAN

INCLUDE ORTHODONTIAL

CARE SUCH AS BRACES 

AND RETAINERS, OR

PERIODONTIAL CARE SUCH

AS TREATMENT FOR GUM

DISEASE.

(1) YES

(2) NO [SKIP TO C4Q05_2]

(77) DON'T KNOW [SKIP TO

C4Q05_2]

(99) REFUSED [SKIP TO

C4Q05_2]

C4Q05_32A

Did [S.C.] receive all the other

dental care that [he/she]

needed?

(1)YES [SKIP TO C4Q05_2]

(2) NO

(77) DON'T KNOW [SKIP

TO C4Q05_2]

(99) REFUSED [SKIP TO

C4Q05_2]

C4Q05_32B

Why did [S.C.] not get all the other dental 

care [he/she] needed?

(1) COST WAS TOO MUCH

(2) NO INSURANCE 

(3) HEALTH PLAN PROBLEM

(4) CAN’T FIND PROVIDER WHO 

ACCEPTS CHILD’S INSURANCE

(5) NOT AVAILABLE IN

AREA/TRANSPORT PROBLEMS 

(6) NOT CONVENIENT TIMES/COULD 

NOT GET APPOINTMENT

(7) PROVIDER DID NOT KNOW HOW

TO TREAT OR PROVIDE CARE

(8) DISSATISFACTION WITH

PROVIDER (9) DID NOT KNOW WHERE TO GO 

FOR TREATMENT

(10) CHILD REFUSED TO GO

(11) TREATMENT IS ONGOING

(13) NO REFERRAL

(14) LACK OF RESOURCES AT

SCHOOL

(15) DID NOT GO TO 

APPT/NEGLECTED APPT/FORGOT

APPT

(16) OTHER [SKIP TO C4Q05_32_O]

(77) DON’T KNOW

(99) REFUSED

ALL OTHERS, SKIP TO C4Q05_32C

C4Q05_32_O

READ IF NECESSARY: Why 

did [S.C.] not get all the other

dental care [he/she] needed ?

RECORD VERBATIM

RESPONSE_________
2009-2010 National Survey of Children with Special Health Care Needs Page 55 

C4Q05_2 [During the past 12 months/ Since [his/her] birth], was there 

any time when [S.C.] needed...) 

Care from a specialty doctor? (1) YES (2) NO [SKIP TO C4Q05_4] 

(77) DON'T KNOW [SKIP TO 

C4Q05_4] (99) REFUSED [SKIP TO C4Q05_4] READ IF NECESSARY: 

Specialty doctors focus on one part of your child’s health. 

These include cardiologists, pulmonologists, ear, nose and throat doctors, surgeons, etc. Do not include dentists or psychiatrists. Needs for care from dentists and psychiatrists are asked in other questions. 

C4Q05_2A Did [S.C.] receive all the Care from a specialty doctor that [he/she] needed? (1)YES [SKIP TO C4Q05_2AA] (2) NO (77) DON'T KNOW [SKIP TO C4Q05_4] (99) REFUSED [SKIP TO 

C4Q05_4] 

C4Q05_2B Why did [S.C.] not get all the care from a specialty doctor [he/she] needed? (1) COST WAS TOO MUCH (2) NO INSURANCE (3) HEALTH PLAN PROBLEM (4) CAN’T FIND PROVIDER WHO ACCEPTS CHILD’S INSURANCE (5) NOT AVAILABLE IN AREA/TRANSPORT PROBLEMS (6) NOT CONVENIENT TIMES/COULD NOT GET APPOINTMENT (7) PROVIDER DID NOT KNOW HOW TO TREAT OR PROVIDE CARE (8) DISSATISFACTION WITH PROVIDER 

(9) DID NOT KNOW WHERE TO GO FOR TREATMENT (10) CHILD REFUSED TO GO (11) TREATMENT IS ONGOING (13) NO REFERRAL (14) LACK OF RESOURCES AT SCHOOL (15) DID NOT GO TO APPT/NEGLECTED APPT/FORGOT APPT 

(16) OTHER [SKIP TO C4Q05_2_O] 

(77) DON’T KNOW (99) REFUSED ALL OTHERS, SKIP TO C4Q05_2C 

C4Q05_2_O READ IF NECESSARY: Why did [S.C.] not get all the care froma specialty doctor [he/she] needed? RECORD VERBATIM RESPONSE_________ 
 2009-2010 National Survey of Children with Special Health Care Needs Page 56

C4Q05_4

(READ AS NECESSARY: 

[During the past 12 months/ 

Since [his/her] birth,] was there 

any time when [S.C.] needed...)

Prescription medications?

(1) YES

(2) NO [SKIP TO C4Q05_5]

(77) DON’T KNOW [SKIP TO

C4Q05_5]

(99) REFUSED [SKIP TO

C4Q05_5]

C4Q05_4A

Did [S.C.] receive all the 

prescription medications

that [he/she] needed?

(1)YES [SKIP TO C4Q05_5]

(2) NO

(77) DON’T KNOW [SKIP

TO C4Q05_5]

(99) REFUSED [SKIP TO

C4Q05_5]

C4Q05_4B

Why did [S.C.] not get all the prescriptio

medications [he/she] needed?

(1) COST WAS TOO MUCH

(2) NO INSURANCE 

(3) HEALTH PLAN PROBLEM

(4) CAN’T FIND PROVIDER WHO 

ACCEPTS CHILD’S INSURANCE

(5) NOT AVAILABLE IN

AREA/TRANSPORT PROBLEMS 

(6) NOT CONVENIENT TIMES/COULD

NOT GET APPOINTMENT

(7) PROVIDER DID NOT KNOW HOW

TO TREAT OR PROVIDE CARE

(8) DISSATISFACTION WITH

PROVIDER

(9) DID NOT KNOW WHERE TO GO 

FOR TREATMENT

(10) CHILD REFUSED TO GO

(11) TREATMENT IS ONGOING

(13) NO REFERRAL

(14) LACK OF RESOURCES AT

SCHOOL

(15) DID NOT GO TO 

APPT/NEGLECTED APPT/FORGOT

APPT

(16) OTHER [SKIP TO C4Q05_4_O]

(77) DON’T KNOW

(99) REFUSED

ALL OTHERS, SKIP TO C4Q05_4C

n

C4Q05_4_O

READ IF NECESSARY: Why 

did [S.C.] not get all the 

prescription medications [he/she

needed?

RECORD VERBATIM

RESPONSE

_________
 

2009-2010 National Survey of Children with Special Health Care Needs Page 57

C4Q05_5

(READ AS NECESSARY: 

[During the past 12 months/ 

Since [his/her] birth,] was there 

any time when [S.C.] needed...)

Physical, occupational or speech

therapy?

(1) YES

(2) NO [SKIP TO C4Q05_6]

(77) DON’T KNOW [SKIP TO

C4Q05_6]

(99) REFUSED [SKIP TO

C4Q05_6]

C4Q05_5A

Did [S.C.] receive all the 

therapy [he/she] needed?

(1)YES [SKIP TO C4Q05_6]

(2) NO

(77) DON’T KNOW [SKIP

TO C4Q05_6]

(99) REFUSED [SKIP TO

C4Q05_6]

C4Q05_5B

Why did [S.C.] not get all the therapy [he/she]

needed?

(1) COST WAS TOO MUCH

(2) NO INSURANCE 

(3) HEALTH PLAN PROBLEM

(4) CAN’T FIND PROVIDER WHO

ACCEPTS CHILD’S INSURANCE

(5) NOT AVAILABLE IN 

AREA/TRANSPORT PROBLEMS

(6) NOT CONVENIENT TIMES/COULD 

NOT GET APPOINTMENT

(7) PROVIDER DID NOT KNOW HOW TO 

TREAT OR PROVIDE CARE

(8) DISSATISFACTION WITH PROVIDER 

(9) DID NOT KNOW WHERE TO GO FOR 

TREATMENT

(10) CHILD REFUSED TO GO

(11) TREATMENT IS ONGOING

(13) NO REFERRAL

(14) LACK OF RESOURCES AT SCHOOL

(15) DID NOT GO TO APPT/NEGLECTED 

APPT/FORGOT APPT

(16) OTHER [SKIP TO C4Q05_5_O]

(77) DON’T KNOW

(99) REFUSED

ALL OTHERS, SKIP TO C4Q05_5C

C4Q05_5_O

READ IF NECESSARY: Why 

did [S.C.] not get all the thereap

[he/she] needed?

RECORD VERBATIM

RESPONSE

_________
 

2009-2010 National Survey of Children with Special Health Care Needs Page 58

C4Q05_6

(READ AS NECESSARY: 

[During the past 12 months/ 

Since [his/her] birth,], was there 

any time when [S.C.] needed...)

Mental health care or

counseling?

(1) YES

(2) NO [SKIP TO C4Q05_7]

(77) DON’T KNOW [SKIP TO

C4Q05_7]

(99) REFUSED [SKIP TO

C4Q05_7]

C4Q05_6A

Did [S.C.] receive all the 

mental health care or

counseling that [he/she]

needed?

(1)YES [SKIP TO C4Q05_7]

(2) NO

(77) DON’T KNOW [SKIP

TO C4Q05_7]

(99) REFUSED [SKIP TO

C4Q05_7]

C4Q05_6B

Why did [S.C.] not get all the mental 

health care or counseling [he/she] needed?

(1) COST WAS TOO MUCH

(2) NO INSURANCE 

(3) HEALTH PLAN PROBLEM

(4) CAN’T FIND PROVIDER WHO 

ACCEPTS CHILD’S INSURANCE

(5) NOT AVAILABLE IN

AREA/TRANSPORT PROBLEMS 

(6) NOT CONVENIENT TIMES/COULD 

NOT GET APPOINTMENT

(7) PROVIDER DID NOT KNOW HOW

TO TREAT OR PROVIDE CARE

(8) DISSATISFACTION WITH 

PROVIDER

(9) DID NOT KNOW WHERE TO GO 

FOR TREATMENT

(10) CHILD REFUSED TO GO

(11) TREATMENT IS ONGOING

(13) NO REFERRAL

(14) LACK OF RESOURCES AT

SCHOOL

(15) DID NOT GO TO 

APPT/NEGLECTED APPT/FORGOT

APPT

(16) OTHER [SKIP TO C4Q05_6_O]

(77) DON’T KNOW

(99) REFUSED

ALL OTHERS, SKIP TO C4Q05_6C

C4Q05_6_O

READ IF NECESSARY: Why

did [S.C.] not get all the mental 

health care or counseling [he/she

needed?

RECORD VERBATIM 

RESPONSE_________
 2009-2010 National Survey of Childre n with Special Health Care Needs Page 59

C4Q05_7 C4Q05_7A

id [S.C.] receive all

ubstance abuse treat

ounseling that [he/sh

eeded?

1

HELP SCREEN: SUBSTANCE

ABUSE TREATMENT INCLUDES

TREATMENT FOR ALCOHOL AND 

TOBACCO ABUSE. SOME

RESPONDENTS MAY FIND THIS

QUESTION INAPPROPRIATE.

IF THIS OCCURS, TELL THE 

RESPONDENT: I understand this

question may be more appropriate for

older children, but I am required to

ask and read verbatim.

)YES [SKI

) NO

P TO C4

2

77) DON’T KNOW [

C4Q05_7B C4Q05_7_O

D IF NECESSARY: 

[S.C.] not get all the sub

se treatment or counselin

she] needed?

ORD VERBATIM

PONSE

_________

A

/

C

S

[IF AGE IS LESS THAN D the Why did [S.C.] not get all the substance RE

YEARS OLD SKIP s ment or abuse treatment or counseling [he/she] did

C4Q05_8] c e] needed? abu

n [he

(READ AS NECESSARY: (1) COST WAS TOO MUC

[During the past 12 months/ ( Q05_8] (2) NO INSURANCE RE

Since [his/her] birth,], was there ( (3) HEALTH PLAN PROBLEM RE

any time when [S.C.] needed...) ( SKIP (4) CAN’T FIND PROVIDER WHO 

C4Q05_8] ACCEPTS CHILD’S INSURANCE

Substance abuse treatment or (99) REFUSED [SKIP (5) NOT AVAILABLE IN

counseling C4Q05_8] AREA/TRANSPORT PROBLEMS 

(6) NOT CONVENIENT TIMES/COULD

(1) YES NOT GET APPOINTMENT 

(2) [SKIP C4Q05_8] (7) PROVIDER DID NOT KNOW HOW 

(77) DON’T [SKIP TO TREAT OR PROVIDE CARE 

C4Q05_8] (8) DISSATISFACTION WITH 

(99) REFUSED [SKIP PROVIDER 

C4Q05_8] (9) DID NOT KNOW WHERE TO GO 

FOR TREATMENT

(10) CHILD REFUSED T

(11) TREATMENT IS ONGOING

(13) NO REFERRAL 

(14) LACK OF RESOURCES AT 

SCHO

(15) DID NOT GO TO 

APPT/NEGLECTED APPT/FORGOT 

APPT

(16) OTHER SKIP TO C4Q05_7_O

(77) DON’T KNOW

(99) REFUSED

ALL OTHERS, SKIP TO C4Q05_7C

8

TO

H

TO

TO

?

NO TO

KNOW TO

TO

O GO

OL

[ ]

)
2009-2010 National Survey of Children with Special Health Care Needs Page 60 

C4Q05_8 (READ AS NECESSARY: During the past 12 months/ Since [his/her] birth, was there any 

time when [S.C.] needed...) Home health care? (1) YES (2) NO [SKIP TO C4Q05_9]

(77) DON’T KNOW [SKIP TO

C4Q05_9](99) REFUSED [SKIP TOC4Q05_9]

C4Q05_9 

(READ AS NECESSARY: 

During the past 12 months/ since 

[his/her] birth, was there any 

time when [S.C.] needed...) 

Eyeglasses or vision care? (1) YES (2) NO [SKIP TO C4Q05_10]

(77) DON’T KNOW [SKIP TO

C4Q05_10](99) REFUSED [SKIP TO

C4Q05_10]

C4Q05_8A Did [S.C.] receive all the home health care that [he/she] 

needed? (1)YES 

(2) NO [SKIP TO

C4Q05_8C](77) DON’T KNOW (99) REFUSED [IF 01,77,99 THEN SKIP TOC4Q05_09]

C4Q05_9A Did [S.C.] receive all the 

eyeglasses or vision care that [he/she] needed? (1)YES 

(2) NO [SKIP TO

C4Q05_9C](77) DON’T KNOW (99) REFUSED [IF 01,77,99 THEN SKIP TOC4Q05_10]
2009-2010 National Survey of Children with Special Health Care Needs Page 61 

C4Q05_10 (READ AS NECESSARY: During the past 12 months/ Since [his/her] birth, was there any 

time when [S.C.] needed...) Hearing aids or hearing care? (1) YES (2) NO [SKIP TO C4Q05_11]

(77) DON’T KNOW [SKIP TO

C4Q05_11](99) REFUSED [SKIP TO

C4Q05_11]C4Q05_11 [IF AGE IS LESS THAN 3

YEARS OLD SKIP TO

C4Q05_14](READ AS NECESSARY: During the past 12 months/ Since [his/her] birth, was there any 

time when [S.C.] needed...) Mobility aids or devices, such as 

canes, crutches, wheelchairs, or scooters? (1) YES (2) NO [SKIP TO C4Q05_12]

(77) DON’T KNOW [SKIP TO

C4Q05_12](99) REFUSED [SKIP TOC4Q05_12]

C4Q05_10A 

Did [S.C.] receive all the 

hearing aids or hearing care that [he/she] needed? (1)YES (2) NO[SKIP TO

C4Q05_10C](77) DON’T KNOW (99) REFUSED [IF 01,77,99 THEN SKIP TOC4Q05_11]

C4Q05_11A Did [S.C.] receive all the 

mobility aids or devices that [he/she] needed? (1)YES 

(2) NO [SKIP TO

C4Q05_11C](77) DON’T KNOW (99) REFUSED [IF 01,77,99 THEN SKIP TOC4Q05_12]
2009-2010 National Survey of Children with Special Health Care Needs Page 62 

C4Q05_12 [SKIP IF AGE IS LESS THAN

3 YEARS OLD]

(During the past 12 months / 

Since [his/her] birth, was there any time when [S.C.] needed) 

Communication aids or devices, such as communication boards? (1) YES (2) NO [SKIP TO C4Q05_14]

(77) DON'T KNOW [SKIP TO

C4Q05_14](99) REFUSED [SKIP TOC4Q05_14]

C4Q05_12A Did [S.C.] receive all the communication aids or devicesthat [he/she] needed? (1)YES [SKIP TOC4Q05_14](2) NO [SKIP TO

C4Q05_12C](77) DON'T KNOW [SKIPTO C4Q05_14](99) REFUSED [SKIP TO

C4Q05_14]
2009-2010 National Survey of Children with Special Health Care Needs Page 63 

C4Q05_14 (READ AS NECESSARY: [During the past 12 months/ Since [his/her] birth,] was there any time when [S.C.] needed...) Durable medical equipment? 

(1) YES 

(2) NO [SKIP TO C4Q06_1] (77) DON’T KNOW [SKIP TO 

C4Q06_1] (99) REFUSED [SKIP TO C4Q06_1] READ IF NECESSARY: Some examples of durable medical equipment include nebulizers, blood glucose monitors, hospital beds, oxygen tanks, pressure machines, and orthotics. These are items that are not disposable. 

C4Q05_14A Did [S.C.] receive all the durable medical equipment that [he/she] needed? (1)YES (2) NO [SKIP TO 

C4Q05_14C] (77) DON’T KNOW (99) REFUSED [IF 01,77,99 THEN SKIP TO 

C4Q06_1] 
 

2009-2010 National Survey of Children with Special Health Care Needs Page 64 

Page 118 □ Series 1, No. 57

[TIMESTAMP_SECTION44]
 

C4Q06 (4.6) [IF CWTYPE = ‘N’ THEN SKIP TO C3Q12]
 

(CATI: THIS SERIES SHOULD BE ASKED HORIZONTALLY ACROSS THE TABLE. IN OTHER WORDS, IF THEY ANSWER YES TO SOMETHING
 

IN COLUMN 01, THEY SHOULD IMMEDIATELY BE ASKED THE QUESTIONS IN COLUMN 02, 03, 4 AS APPLICABLE)
 

During the past 12 months/ Since 

[his/her] birth, was there any time 

when you or other family members 

needed any of the following services 

because of {S.C.’s} health: 

Did you or your family receive

all the [fill with underlined 

words from first column] that 

was needed? 

Why did you or your family not get the 

[fill with underlined words from first 

column] that was needed? 

(CHECK ALL THAT APPLY. READ 

RESPONSES ONLY IF NECESSARY) 

Did you or your family get any 

[fill with underlined words from 

first column] during the past 12 

months? 
 

2009-2010 National Survey of Children with Special Health Care Needs Page 65 

Series 1, No. 57 □ Page 119

C4Q06_1 

[During the past 12 months/ Since 

[his/her] birth], was there any time 

when you or other family members 

needed...Respite care? 

(1) YES 

(2) NO [SKIP TO C4Q06_2] 

(77) DON’T KNOW [SKIP TO 

C4Q06_2] 

(99) REFUSED [SKIP TO 

C4Q06_2] 

READ IF NECESSARY: Respite 

care is care for the child so the family

can have a break from ongoing care 

of the child. Respite care can be 

thought of as child care or babysitting

by someone trained to meet any 

special needs the child may have. 

Both professional and nonprofessional respite care should be 

included. 

C4Q06_1A 

Did you or your family receive 

all the respite care that was 

needed? 

(1) YES [SKIP TO C4Q06_2] 

(2) NO 

(77) DON’T KNOW [SKIP 

TO C4Q06_2] 

(99) REFUSED [SKIP TO 

C4Q06_2] 

C4Q06_1B 

Why did you or your family not get all the 

respite care that was needed? 

(1) COST WAS TOO MUCH 

(2) NO INSURANCE 

(3) HEALTH PLAN PROBLEM 

(4) CAN’T FIND DOCTOR WHO ACCEPTS 

CHILD’S INSURANCE 

(5) NOT AVAILABLE IN 

AREA/TRANSPORT PROBLEMS 

(6) NOT CONVENIENT TIMES/COULD 

NOT GET APPOINTMENT 

(7) DOCTOR DID NOT KNOW HOW TO 

TREAT OR PROVIDE CARE 

(8) DISSATISFACTION WITH DOCTOR 

(9) DID NOT KNOW WHERE TO GO FOR 

TREATMENT 

(10) CHILD REFUSED TO GO 

(11) TREATMENT IS ONGOING 

(13) NO REFERRAL 

(14) LACK OF RESOURCES AT SCHOOL 

(15) DID NOT GO TO APPT/NEGLECTED 

APPT/FORGOT APPT 

(16) OTHER [GO TO C4Q06_1_O] 

(77) DON’T KNOW 

(99) REFUSED 

ALL EXCEPT 16 GO TO C4Q06_1C 

C4Q06_1_O 

READ IF NECESSARY: Why did you or 

your family not get all the respite care that was 

needed? 

ENTER OTHER_______ 

C4Q06_1C 

Did you or your family get any 

respite care [during the past 12 

months/ since [his/her] birth]? 

(1) YES 

(2) NO 

(77) DON’T KNOW 

(99) REFUSED 
 

2009-2010 National Survey of Children with Special Health Care Needs Page 66 

Page 120 □ Series 1, No. 57

C4Q06_2 

(During the past 12 months/ Since 

[his/her] birth, was there any time 

when you or other family members 

needed...) 

Genetic counseling for advice about 

inherited conditions related to 

[S.C.]’s medical, behavioral, or other 

health conditions? 

(1) YES 

(2) NO [SKIP TO C4Q06_3] 

(77) DON’T KNOW [SKIP TO 

C4Q06_3] 

(99) REFUSED [SKIP TO 

C4Q06_3] 

C4Q06_2A 

Did you or your family receive 

all the genetic counseling that 

was needed? 

(1) YES [SKIP TO C4Q06_3] 

(2) NO 

(77) DON’T KNOW [SKIP 

TO C4Q06_3] 

(99) REFUSED [SKIP TO 

C4Q06_3] 

C4Q06_2B 

Why did you or your family not get all the 

genetic counseling that was needed? 

(1) COST WAS TOO MUCH 

(2) NO INSURANCE 

(3) HEALTH PLAN PROBLEM 

(4) CAN’T FIND DOCTOR WHO ACCEPTS 

CHILD’S INSURANCE 

(5) NOT AVAILABLE IN 

AREA/TRANSPORT PROBLEMS 

(6) NOT CONVENIENT TIMES/COULD 

NOT GET APPOINTMENT 

(7) DOCTOR DID NOT KNOW HOW TO 

TREAT OR PROVIDE CARE 

(8) DISSATISFACTION WITH DOCTOR 

(9) DID NOT KNOW WHERE TO GO FOR 

TREATMENT 

(10) CHILD REFUSED TO GO 

(11) TREATMENT IS ONGOING 

(13) NO REFERRAL 

(14) LACK OF RESOURCES AT SCHOOL 

(15) DID NOT GO TO APPT/NEGLECTED 

APPT/FORGOT APPT 

(16) OTHER [SKIP C4Q06_2_O] 

(77) DON’T KNOW 

(99) REFUSED 

ALL EXCEPT 16 GO TO C4Q06_2C 

C4Q06_2_O 

READ IF NECESSARY: Why did you or 

your family not get all the genetic counseling 

that was needed? 

ENTER OTHER_______ 

C4Q06_2C 

Did you or your family get any 

genetic counseling [during the 

past 12 months/ since [his/her] 

birth]? 

(1) YES 

(2) NO 

(77) DON’T KNOW 

(99) REFUSED 
 

2009-2010 National Survey of Children with Special Health Care Needs Page 67 

Series 1, No. 57 □ Page 121

C4Q06_3 

(During the past 12 months/ Since 

[his/her] birth, was there any time 

when you or other family members 

needed...) 

Mental health care or counseling 

related to [S.C.]’s medical, 

behavioral, or other health 

conditions? 

(1) YES 

(2) NO [SKIP TO C3Q12] 

(77) DON’T KNOW [SKIP TO 

C3Q12] 

(99) REFUSED [SKIP TO C3Q12] 

C4Q06_3A 

Did you or your family receive 

all the mental health care 

counseling that was needed? 

(1) YES [SKIP TO C3Q12] 

(2) NO 

(77) DON’T KNOW [SKIP 

TO C3Q12] 

(99) REFUSED [SKIP TO 

C3Q12] 

C4Q06_3B 

Why did you or your family not get all 

the mental health care or counseling that 

was needed? 

(1) YES 

(2) NO 

(77) DON’T KNOW 

(99) REFUSED 

(1) COST WAS TOO MUCH 

(2) NO INSURANCE 

(3) HEALTH PLAN PROBLEM 

(4) CAN’T FIND DOCTOR WHO ACCEPTS

CHILD’S INSURANCE 

(5) NOT AVAILABLE IN 

AREA/TRANSPORT PROBLEMS 

(6) NOT CONVENIENT TIMES/COULD 

NOT GET APPOINTMENT 

(7) DOCTOR DID NOT KNOW HOW TO 

TREAT OR PROVIDE CARE 

(8) DISSATISFACTION WITH DOCTOR 

(9) DID NOT KNOW WHERE TO GO FOR 

TREATMENT 

(10) CHILD REFUSED TO GO 

(11) TREATMENT IS ONGOING 

(13) NO REFERRAL 

(14) LACK OF RESOURCES AT SCHOOL 

(15) DID NOT GO TO APPT/NEGLECTED 

APPT/FORGOT APPT 

(16) OTHER [SKIP C4Q06_3_O] 

(77) DON’T KNOW 

(99) REFUSED 

ALL EXCEPT 16 GO TO C4Q06_3C 

C4Q06_3_O 

C4Q06_3C 

Did you or your family get any 

mental health care or counseling 

[during the past 12 months/ since 

[his/her] birth]? 

(1) YES 

(2) NO 

(77) DON’T KNOW 

(99) REFUSED 
 

2009-2010 National Survey of Children with Special Health Care Needs Page 68 

Page 122 □ Series 1, No. 57

READ IF NECESSARY: Why did you or 

your family not get all the mental health 

care or counseling that was needed? 

ENTER OTHER_______ 
 

2009-2010 National Survey of Children with Special Health Care Needs Page 69 

Series 1, No. 57 □ Page 123

CPC3Q12 [IF AGE FROM C2Q01 OR C2Q02 IS 36 MONTHS (3 YEARS) OR GREATER, SKIP TO 

C3Q13] 

C3Q12 Does [S.C.] receive services from a program called Early Intervention Services? Children 

receiving these services often have an Individualized Family Service Plan. 

 (1) YES 

 (2) NO 

 (77) DON’T KNOW 

 (99) REFUSED 

READ IF NECESSARY: Early Intervention Services are defined as: family training, counseling, 

and home visits; health services; medicine; nursing; nutrition; occupational therapy; physical 

therapy; psychological services; service coordination services; social work services; special 

instruction; speech-language therapy; transportation, communication or mobility devices; and 

vision and hearing services. 

 [ALL SKIP TO C3Q15] 

C3Q13 Does [S.C.] receive services from a program called Special Educational Services? Children 

receiving these services often have an Individualized Education Plan. 

 (1) YES 

 (2) NO [SKIP TO C3Q15] 

 (77) DON’T KNOW [SKIP TO C3Q15] 

 (99) REFUSED [SKIP TO C3Q15] 

READ IF NECESSARY: Special Education is any kind of special school, classes or tutoring. 

C3Q13A How old was [S.C.] when [he/she] first began receiving Special Educational Services? 

 

HELP SCREEN: ENTER AGE IN MONTHS FOR 0 TO 23 MONTHS. IF 2 YEARS OR 

OLDER, ENTER AGE IN YEARS. 

 ___ ____ VALUE (MUST BE LESS THAN OR EQUAL TO AGE OF CHILD) 

 (77) DON’T KNOW 

 (99) REFUSED 

C3Q13AA Months (00-23) 

 Years (Range 02-17) 

 

 (1) MONTHS 

 (2) YEARS 

 (77) DON’T KNOW 

 (99) REFUSED 

C3Q13B At any time before [S.C.] was 3 years old, did [he/she] receive services from a program called 

Early Intervention Services? Children receiving these services often have an Individualized 

Family Service Plan. 

 

 (1) YES 

 (2) NO 

 (77) DON'T KNOW 

 (99) REFUSED 
 

2009-2010 National Survey of Children with Special Health Care Needs Page 70 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Page 124 □ Series 1, No. 57

C3Q15	 Alternative health care can include acupuncture, chiropractic care, relaxation therapies, herbal 

supplements, and others. Some therapies involve seeing a practitioner, while others can be done 

on your own. 

[During the past 12 months/ Since [his/her] birth], did [S.C.] use any type of alternative health 

care or treatment? 

HELP SCREEN: RESPONDENTS SHOULD INCLUDE ANY ALTERNATIVE CARE OR 

THERAPIES REGARDLESS OF WHETHER THE CARE IS FOR THE CHILD'S 

CONDITIONS. IF THE RESPONDENT CONSIDERS THE HEALTH CARE TO BE 

ALTERNATIVE, IT SHOULD BE INCLUDED. DO NOT TRY TO DETERMINE IF ANY 

PARTICULAR TYPE OF TREATMENT IS AN "ALTERNATIVE" TREATMENT. 

READ IF NECESSARY: Generally, alternative care and treatments are those not typically 

provided in conventional medical care settings. Examples of relaxation therapies include 

biofeedback, deep breathing exercises, and yoga. Examples of herbal supplements include any 

non-vitamin and non-mineral supplement, as well as homeopathic treatments. Other examples of 

alternative health care could include chelation therapy, energy healing therapy, hypnosis, massage, 

naturopathy, and use of traditional healers such as an espiritista or a Native American medicine 

man. 

(1) YES 

(2) NO 

(77) DON’T KNOW 

(99) REFUSED 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2009-2010 National Survey of Children with Special Health Care Needs Page 71 

Series 1, No. 57 □ Page 125

Section 5. CARE COORDINATION
 

[TIMESTAMP_SECTION51] 

C5Q00	 IF K4Q20 NOT 1-76 AND K4Q21 NOT 1-76 AND (NONE C4Q05_1A THROUGH 

C4Q05_14A = 01) AND (NONE C4Q05_2C THROUGH C4Q05_14C = 01) AND (NONE 

C3Q12, C3Q13, OR C3Q15 = 01), SKIP TO C5Q01 

[IF K4Q20 = 1-76 OR K4Q21 = 1-76 OR (ANY C4Q05_1A THROUGH C4Q05_14A = 01) OR
 

(ANY C4Q05_2C THROUGH C4Q05_14C = 01) OR (ANY C3Q12, C3Q13, OR C3Q15 = 01),
 

SAY:
 

“You told me that, [in the past 12 months/ [WHEN S.C. IS YOUNGER THAN 12 MONTHS]
 

since (his/her) birth], [S.C.] used [FILL WITH ALL NAMES OF SERVICES USED AS 

REPORTED IN SECTION 4, INCLUDING K4Q20, K4Q21, C3Q12, C3Q13 AND C3Q15].” 

[SUM UP HOW MANY TIMES THE RESPONSE (01) IS USED IN THE FOLLOWING 

VARIABLES: C4Q05_1A THROUGH C4Q05_14A, C4Q05_2C THROUGH C4Q05_14C, 

C3Q12, C3Q13, AND C3Q15. 

IF K4Q20 = 1-76 THEN ADD 1 TO THE SUM.
 

IF K4Q21 = 1-76 THEN ADD 1 TO THE SUM.
 

IF THE TOTAL SUM IS GE 2 THEN SKIP TO C5Q11, ELSE SKIP TO C5Q01] 

C5Q01	 Did [S.C.] use any other health-related medical, educational, or social services [in the past 12 

months/ Since [his/her] birth]? 

(1) YES 

(2) NO 

(77) DON’T KNOW 

(99) REFUSED 

READ IF NECESSARY: There are many types of services children might use to improve their 

education, their health, or their well-being. We listed 15 of these services earlier, but there could 

be others that your child uses. 

C5Q11	 [During the past 12 months/ Since [his/her] birth], did [S.C.] need a referral to see any doctors or 

receive any services? 

(1) YES 

(2) NO	 [SKIP TO C5Q12] 

(77) DON’T KNOW [SKIP TO C5Q12] 

(99) REFUSED	 [SKIP TO C5Q12] 

C4Q07	 Was getting referrals a big problem, a small problem, or not a problem? 

(1) BIG PROBLEM 

(2) SMALL PROBLEM 

(3) NOT A PROBLEM 

(77) DON’T KNOW 

(99) REFUSED 

[TIMESTAMP_SECTION52] 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2009-2010 National Survey of Children with Special Health Care Needs Page 72 

Page 126 □ Series 1, No. 57

C5Q12	 [SUM UP HOW MANY TIMES THE RESPONSE (01) IS USED IN THE FOLLOWING 

VARIABLES: C4Q05_1A THROUGH C4Q05_14A, C4Q05_2C THROUGH C4Q05_14C, 

C5Q01, C3Q12, C3Q13, AND C3Q15. 

IF K4Q20 = 1-76 THEN ADD 1 TO THE SUM.
 

IF K4Q21 = 1-76 THEN ADD 1 TO THE SUM.
 

IF THE TOTAL SUM IS LT 2 AND C4Q05_2AA is (missing,0,1,77,99) THEN SKIP TO 

C6Q01] 

Does anyone help you arrange or coordinate [S.C.]’s care among the different doctors or services 

that [he/she] uses? 

READ IF NECESSARY: By “arrange or coordinate,” I mean: Is there anyone who helps you 

make sure that [S.C.] gets all the health care and services [he/she] needs, that health care providers 

share information, and that these services fit together and are paid for in a way that works for you? 

READ IF NECESSARY: Anyone means anyone. 

(1) YES 

(2) NO	 [SKIP TO C5Q17] 

(77) DON’T KNOW [SKIP TO C5Q17] 

(99) REFUSED	 [SKIP TO C5Q17] 

C5Q13	 Does a doctor or someone in a doctor’s office provide this help arranging or coordinating [S.C.]’s 

care? 

(1) YES [SKIP TO C5Q15] 

(2) NO	 [SKIP TO C5Q16] 

(77) DON’T KNOW [SKIP TO C5Q16] 

(99) REFUSED	 [SKIP TO C5Q16] 

C5Q15	 Is there anyone else who helps arrange or coordinate [S.C.]’s care? 

(1) YES 

(2) NO	 [SKIP TO C5Q17] 

(77) DON’T KNOW [SKIP TO C5Q17] 

(99) REFUSED	 [SKIP TO C5Q17] 

C5Q16	 IF C5Q13=01 THEN DISPLAY: Is this person a parent, guardian, other family member, friend, 

nurse, therapist, social worker, hospital discharge planner, case manager, or someone else? 

IF C5Q13=02,77,99 THEN DISPLAY: 

Who does provide help arranging or coordinating [S.C.]’s care? 

A parent, guardian, other family member, friend, nurse, therapist, social worker, hospital discharge 

planner, case manager, or someone else? [MARK ALL THAT APPLY] 

(1) PARENT 

(2) GUARDIAN 

(3) OTHER FAMILY MEMBER 

(4) FRIEND 

(5) NURSE 

(6) THERAPIST 
 

2009-2010 National Survey of Children with Special Health Care Needs Page 73 

Series 1, No. 57 □ Page 127

(7) SOCIAL WORKER 

(8) HOSPITAL DISCHARGE PLANNER 

(9) CASE MANAGER 

(10) SOMEONE AT CHILD'S SCHOOL 

(11) SOMEONE ELSE [SKIP to C5Q16_XOE] 

(77) DON’T KNOW 

(99) REFUSED 

ALL OTHERS SKIP TO C5Q17 

 

C5Q16_XOE Who would that be? 

ENTER RESPONSE ___________________ [30 CHARACTERS MAX] 

C5Q17 [During the past 12 months/ Since [his/her] birth], have you felt that you could have used extra 

help arranging or coordinating [S.C.]’s care among these different health care providers or 

services? 

 

 (1) YES 

 (2) NO [SKIP TO C5Q10] 

 (77) DON’T KNOW [SKIP TO C5Q10] 

(99) REFUSED [SKIP TO C5Q10] 

C5Q09 [During the past 12 months/ Since [his/her] birth], how often did you get as much help as you 

wanted with arranging or coordinating [S.C.]’s care? Would you say never, sometimes, or 

usually? 

(1) NEVER 

(2) SOMETIMES 

(3) USUALLY 

 (77) DON’T KNOW 

(99) REFUSED 

 

C5Q10 Overall, are you very satisfied, somewhat satisfied, somewhat dissatisfied, or very dissatisfied 

with the communication among [S.C.]’s doctors and other health care providers? 

(1)VERY SATISFIED 

(2) SOMEWHAT SATISFIED 

(3) SOMEWHAT DISSATISFIED 

(4) VERY DISSATISFIED 

(5) NO COMMUNICATION NEEDED OR WANTED 

 (77) DON’T KNOW 

 (99) REFUSED 

C5Q05 Do [S.C.]’s doctors or other health care providers need to communicate with [his/her] school, 

early intervention program, child care providers, vocational education or rehabilitation program? 

(1) YES 

(2) NO [SKIP TO CPC5Q20] 

(77) DON’T KNOW [SKIP TO CPC5Q20] 

(99) REFUSED [SKIP TO CPC5Q20] 

C5Q06 Overall, are you very satisfied, somewhat satisfied, somewhat dissatisfied, or very dissatisfied 

with that communication? 

(1) VERY SATISFIED 
 

2009-2010 National Survey of Children with Special Health Care Needs Page 74 

 

 

 

 

 

Page 128 □ Series 1, No. 57

(2) SOMEWHAT SATISFIED 

(3) SOMEWHAT DISSATISFIED 

(4) VERY DISSATISFIED 

(77) DON’T KNOW 

(99) REFUSED 

[TIMESTAMP_SECTION52A] 

CPC5Q20 IF CWTYPE=S AND ASK_CALIF=1 THEN GO TO C5Q20, ELSE GO TO C6Q01 

C5Q20*CA If there were a web site that could help you arrange or coordinate [S.C.]'s care, would you say that 

it is very likely, somewhat likely, somewhat unlikely, or very unlikely that you would use it? 

 (1) VERY LIKELY 

 (2) SOMEWHAT LIKELY 

 (3) SOMEWHAT UNLIKELY 

 (4) VERY UNLIKELY 

 (77) DON’T KNOW 

 (99) REFUSED 
 

2009-2010 National Survey of Children with Special Health Care Needs Page 75 

Series 1, No. 57 □ Page 129

Section 6A. FAMILY CENTERED CARE AND 

SHARED DECISION MAKING
 

[TIMESTAMP_SECTION61] 

C6Q01 [SUM UP HOW MANY TIMES THE RESPONSE (1) IS USED IN THE FOLLOWING 

VARIABLES: C4Q05_1A THROUGH C4Q05_10A, C4Q05_2C THROUGH C4Q05_10C. 

 IF K4Q20 = 1-76 THEN ADD 1 TO THE SUM. 

 IF K4Q21 = 1-76 THEN ADD 1 TO THE SUM. 

 IF THE TOTAL SUM IS GREATER THAN ZERO, THEN SKIP TO C6Q02] 

 Did [S.C.] visit any doctors or other health care providers [in the past 12 months/ since [his/her] 

birth]? 

 (1) YES [SKIP TO C6Q02] 

 (2) NO [SKIP TO C6Q07] 

 (77) DON’T KNOW [SKIP TO C6Q07] 

 (99) REFUSED [SKIP TO C6Q07] 

C6Q02 [During the past 12 months/ Since [his/her] birth], how often did [S.C.]’s doctors and other health 

care providers spend enough time with [him/her]? Would you say never, sometimes, usually, or 

always? 

(1) NEVER 

(2) SOMETIMES 

(3) USUALLY 

(4) ALWAYS 

(77) DON’T KNOW 

(99) REFUSED 

C6Q03 [During the past 12 months/ Since [his/her] birth], how often did [S.C.]’s doctors and other health 

care providers listen carefully to you? Would you say never, sometimes, usually, or always? 

(1) NEVER 

(2) SOMETIMES 

(3) USUALLY 

(4) ALWAYS 

(77) DON’T KNOW 

(99) REFUSED 

C6Q04 When [S.C.] is seen by doctors or other health care providers, how often are they sensitive to your 

family’s values and customs? Would you say never, sometimes, usually, or always? 

(1) NEVER 

(2) SOMETIMES 

(3) USUALLY 

(4) ALWAYS 

(77) DON’T KNOW 

(99) REFUSED 

C6Q05 Information about a child’s health or health care can include things such as the causes of any 

health problems, how to care for a child now, and what changes to expect in the future. [During 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Page 130 □ Series 1, No. 57

the past 12 months/ Since [his/her] birth], how often did you get the specific information you 

needed from [S.C.]’s doctors and other health care providers? Would you say never, sometimes, 

usually, or always? 

(1) NEVER 

(2) SOMETIMES 

(3) USUALLY 

(4) ALWAYS 

(77) DON’T KNOW 

(99) REFUSED 

C6Q06	 [During the past 12 months/ Since [his/her] birth], how often did [S.C.]’s doctors or other health 

care providers help you feel like a partner in [his/her] care? Would you say never, sometimes, 

usually, or always? 

(1) NEVER 

(2) SOMETIMES 

(3) USUALLY 

(4) ALWAYS 

(77) DON’T KNOW 

(99) REFUSED 

[TIMESTAMP_SECTION61A] 

CPC6Q11	 IF CWTYPE=S AND ASK_CALIF=1 THEN GO TO C6Q11, ELSE GO TO C6Q21 

C6Q11*CA	 IF S.C. >36 MONTHS, FILL [or S.C.]. ELSE, DO NOT FILL 

An interpreter is someone who repeats what one person says in a language used by another person. 

[During the past 12 months\Since [S.C.]’s birth], did you [or S.C.] need an interpreter to help 

speak with [his/her] doctors or other health care providers? 

(1) YES 

(2) NO [SKIP TO C6Q21] 

(77) DON’T KNOW [SKIP TO C6Q21] 

(99) REFUSED [SKIP TO C6Q21] 

C6Q12*CA	 IF S.C. >36 MONTHS, FILL [or S.C.]. ELSE, DO NOT FILL 

When you [or S.C.] needed an interpreter, how often were you able to get someone other than a 

family member to help you speak with [his/her] doctors or other health care providers? Would 

you say never, sometimes, usually, or always? 

(1) NEVER 

(2) SOMETIMES 

(3) USUALLY 

(4) ALWAYS 

(77) DON’T KNOW 

(99) REFUSED 

[TIMESTAMP_SECTION62] 

C6Q21	 We want to know about how [S.C.]’s doctors or other health care providers work with you to 

make decisions about [his/her] health care services and treatment. 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2009-2010 National Survey of Children with Special Health Care Needs Page 77 

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[During the past 12 months/ Since [his/her] birth], how often did [S.C.]’s doctors or other health 

care providers discuss with you the range of options to consider for [his/her] health care or 

treatment? 

Would you say never, sometimes, usually, or always? 

READ IF NECESSARY: The options may include things like whether or not to start, stop or 

change a medication, treatment or therapy; whether to have certain tests or procedures, see a 

specialist, consent for surgery, and so on. 

(1) NEVER 

(2) SOMETIMES 

(3) USUALLY 

(4) ALWAYS 

(5) THERE WERE NO OPTIONS TO CONSIDER 

(77) DON’T KNOW 

(99) REFUSED 

C6Q22	 How often did they encourage you to ask questions or raise concerns? 

READ IF NECESSARY: [During the past 12 months/ Since [his/her] birth], how often did 

[S.C.]’s doctors or other health care providers encourage you to ask questions or raise concerns? 

Would you say never, sometimes, usually, or always? 

(1) NEVER 

(2) SOMETIMES 

(3) USUALLY 

(4) ALWAYS 

(77) DON’T KNOW 

(99) REFUSED 

C6Q23	 How often did they make it easy for you to ask questions or raise concerns? 

READ IF NECESSARY: [During the past 12 months/ Since [his/her] birth], how often did 

[S.C.]’s doctors or other health care providers make it easy for you to ask questions or raise 

concerns? Would you say never, sometimes, usually, or always? 

(1) NEVER 

(2) SOMETIMES 

(3) USUALLY 

(4) ALWAYS 

(77) DON’T KNOW 

(99) REFUSED 

C6Q24	 How often did they consider and respect what health care and treatment choices you thought 

would work best for [S.C.]? 

READ IF NECESSARY: [During the past 12 months/ Since [his/her] birth], how often did 

[S.C.]’s doctors or other health care providers consider and respect what health care and treatment 

choices you thought would work best for [him/her]? Would you say never, sometimes, usually, or 

always? 

(1) NEVER 

(2) SOMETIMES 

(3) USUALLY 
 

 

 

 

2009-2010 National Survey of Children with Special Health Care Needs Page 78 

Page 132 □ Series 1, No. 57

(4) ALWAYS 

(77) DON’T KNOW 

(99) REFUSED 

Section 6B. TRANSITION ISSUES 

[TIMESTAMP_SECTION63] 
 

 

2009-2010 National Survey of Children with Special Health Care Needs Page 79 

Series 1, No. 57 □ Page 133

C6Q07 [IF CHILD IS LESS THAN 5 YEARS OF AGE, SKIP TO C6Q30. IF CHILD IS 5-11 

YEARS OF AGE, SKIP TO C6Q08] 

The next questions are about preparing for [S.C.]’s health care needs as [he/she] becomes an adult. 

Do any of [S.C.]’s doctors or other health care providers treat only children? 

 (1) YES 

(2) NO [SKIP TO C6Q0A] 

 (77) DON’T KNOW [SKIP TO C6Q0A] 

(99) REFUSED [SKIP TO C6Q0A] 

C6Q0A_B Have they talked with you about having [S.C.] eventually see doctors or other health care 

providers who treat adults? 

 (1) YES [SKIP TO C6Q0A] 

(2) NO 

 (77) DON’T KNOW [SKIP TO C6Q0A] 

 (99) REFUSED [SKIP TO C6Q0A] 

 HELP SCREEN: THIS QUESTION REFERS TO DISCUSSIONS BETWEEN THE 

RESPONDENT AND THE DOCTORS OR OTHER HEALTH CARE PROVIDERS WHO 

TREAT ONLY CHILDREN. 

C6Q0A_C Would a discussion about doctors who treat adults have been helpful to you? 

 (1) YES 

(2) NO 

 (77) DON’T KNOW 

 (99) REFUSED 

C6Q0A Have [S.C.]’s doctors or other health care providers talked with you about [his/her] health care 

needs as [he/she] becomes an adult? 

 

 (1) YES [SKIP TO C6Q0A_E] 

(2) NO 

 (77) DON’T KNOW [SKIP TO C6Q0A_E] 

(99) REFUSED [SKIP TO C6Q0A_E] 

C6Q0A_D Would a discussion about [S.C.]’s health care needs have been helpful? 

 (1) YES 

(2) NO 

 (77) DON’T KNOW 

 (99) REFUSED 

C6Q0A_E Eligibility for health insurance often changes as children reach adulthood. Has anyone discussed 

with you how to obtain or keep some type of health insurance coverage as [S.C.] becomes an 

adult? 

 

 (1) YES [SKIP TO C6Q08] 

(2) NO 

 (77) DON’T KNOW [SKIP TO C6Q08] 

(99) REFUSED [SKIP TO C6Q08] 
 

2009-2010 National Survey of Children with Special Health Care Needs Page 80 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Page 134 □ Series 1, No. 57

HELP SCREEN: Anyone means anyone. 

C6Q0A_F	 Would a discussion about health insurance have been helpful to you? 

(1) YES 

(2) NO 

(77) DON’T KNOW 

(99) REFUSED 

C6Q08	 How often do [S.C.]’s doctors or other health care providers encourage (him/her) to take 

responsibility for [his/her] health care needs, such as: 

[IF CHILD IS 5-11 YEARS OF AGE, THEN READ: “learning about [his/her] conditions or 

helping with treatments and medications?” 

[IF CHILD IS 12+ YEARS OF AGE, THEN READ : “taking medication, understanding [his/her] 

diagnosis, or following medical advice?” 

Would you say never, sometimes, usually, or always? 

(1) NEVER 

(2) SOMETIMES 

(3) USUALLY 

(4) ALWAYS 

(77) DON’T KNOW 

(99) REFUSED 
 

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Series 1, No. 57 □ Page 135

Section 6C. DEVELOPMENTAL SCREENING
 

[TIMESTAMP_SECTION64] 

CPC6Q30 IF AGE >= 72 MONTHS, SKIP TO CPSEC7. IF AGE < 12 MONTHS, SKIP TO CPSEC7. 

C6Q30 Sometimes a child’s doctor or other health care provider will ask a parent to fill out a 

questionnaire at home or during their child’s visit. During the past 12 months, did a doctor or 

other health care provider have you fill out a questionnaire about specific concerns or observations 

you may have about [S.C.]’s development, communication, or social behaviors? 

HELP SCREEN: IF ANOTHER PERSON READ THE QUESTIONNAIRE TO THE PARENT 

AND FILLED IN THE ANSWERS FOR THE PARENT, THEN THIS QUESTION SHOULD 

BE ANSWERED YES. BUT IF A DOCTOR OR NURSE JUST ASKED ABOUT CONCERNS 

AND DID NOT FILL OUT A QUESTIONNAIRE, THEN THIS QUESTION SHOULD BE 

ANSWERED NO. 

(1) YES 

(2) NO [SKIP TO CPSEC7] 

(77) DON’T KNOW [SKIP TO CPSEC7] 

(99) REFUSED [SKIP TO CPSEC7] 

CPC6Q31A IF AGE = 24-71 MONTHS, SKIP TO C6Q32A. 

C6Q31A Did this questionnaire ask about your concerns or observations about how [S.C.] talks or makes 

speech sounds? 

(1) YES 

(2) NO 

(77) DON’T KNOW 

(99) REFUSED 

C6Q31B Did this questionnaire ask about your concerns or observations about how [S.C.] interacts with 

you and others? 

(1) YES 

(2) NO 

(77) DON’T KNOW 

(99) REFUSED 

[ALL SKIP TO CPSEC7] 

C6Q32A Did this questionnaire ask about your concerns or observations about words and phrases [S.C.] 

uses and understands? 

(1) YES 

(2) NO 

(77) DON’T KNOW 

(99) REFUSED 
 

2009-2010 National Survey of Children with Special Health Care Needs Page 82 

 

 

 

 

 

Page 136 □ Series 1, No. 57

C6Q32B Did this questionnaire ask about your concerns or observations about how [S.C.] behaves and gets 

along with you and others? 

(1) YES 

(2) NO 

(77) DON’T KNOW 

(99) REFUSED 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Series 1, No. 57 □ Page 137

Section 7. HEALTH INSURANCE
 

[TIMESTAMP_SECTION71] 

CPSEC7 [SKIP TO C7Q03 IF NAME OF SELECTED CHILD ALREADY GATHERED FROM 

MULTIAGE, C2Q01N, SELECTION1_NAME, NAME_SEC4_A, NIS INTERVIEW, OR 

RESPONDENT REFUSED TO ANSWER NAME QUESTIONS] 

NAME_SEC7 INTERVIEWER QUESTION: DO NOT READ TO RESPONDENT! 

HAS THE HOUSEHOLD GIVEN YOU A NAME FOR THE CHILD? 

(1) YES	 [GO TO NAME_SEC7_A] 

(2) NO	 [GO TO C7Q03] 

NAME_SEC7_A 

ENTER NAME/INITIALS: ____________ GO TO C7Q03 

[FILL [S.C.] WITH THIS NAME FROM THIS POINT ON IN THE INTERVIEW] 

C7Q03	 Now I have a few questions about health insurance and health care coverage for [S.C.]. 

[IF IAP = 095 and (S.C. = NIS-ELIG CHILD OR S.C.=S.T.) THEN DISPLAY: "They may sound 

similar to questions I have asked previously, but they are slightly different. Please bear with me."] 

At this time, is [S.C.] covered by health insurance that is provided through an employer or union? 

(1) YES 

(2) NO	 [SKIP TO C7Q01] 

(77) DON’T KNOW [SKIP TO C7Q01] 

(99) REFUSED [SKIP TO C7Q01] 

READ ONLY IF NECESSARY: These plans may be provided in part or fully by a current 

employer, a former employer, a union, or a professional organization. 

IF ONLY PLAN NAME OFFERED, PROBE (READ IF NECESSARY): Is this insurance 

provided through an employer or union? Do not include dental, vision, school, or accident 

insurance. 

IF NECESSARY, TO HELP THE RESPONDENT DETERMINE WHAT KIND OF 

INSURANCE THEY HAVE, PROBE (READ IF NECESSARY): Did you get that insurance 

through an employer? Does it help pay for both doctor visits and hospital stays? 

C7Q03A	 [IF IAP not equal 095 and INS-1 = 1 AND S.C. = ‘NIS-ELIG CHILD’, THEN FILL WITH

INS-1A] 

IF IAP not equal 095 and SC=ST then FILL WITH TIS_INS_1A. 

Does this health insurance help pay for both doctor visits and hospital stays? 

(1) YES 

(2) NO 

(77) DON’T KNOW 

(99) REFUSED 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2009-2010 National Survey of Children with Special Health Care Needs Page 84 

Page 138 □ Series 1, No. 57

C7Q01	 [IF STATE = AK, CT, DC, FL, HI, IL, IN, KS, LA, ME, MN, MO, NE, NJ, NM, NY, OH, 

OK, RI, SC, SD, VI, WI, THEN SKIP TO C7Q04] 

[IF IAP not equal 095 and S.C. = ‘NIS-ELIG CHILD,’ THEN FILL WITH INS-2] 

IF IAP not equal 095 and SC=ST then FILL WITH TIS_INS_2. 

At this time, is [S.C.] covered by any Medicaid plan? Medicaid is a health insurance program for 

persons with certain income levels and persons with disabilities. [FILL IF APPLICABLE: In this 

state, the program is sometimes called [FILL NAME FROM “TEXT FILLS” SPREADSHEET]. 

READ IF NECESSARY: Medicaid is a federal-state medical assistance program. It serves lowincome people of every age. Medical bills are paid from federal, state and local tax funds. It is run 

by state and local governments within federal guidelines. 

IF NECESSARY, TO HELP THE RESPONDENT DETERMINE WHAT KIND OF 

INSURANCE THEY HAVE, PROBE (READ IF NECESSARY): Did you get that insurance 

through an employer? Does it help pay for both doctor visits and hospital stays? 

(1) YES 

(2) NO 

(77) DON’T KNOW 

(99) REFUSED 

READ IF NECESSARY: Medicaid is a federal-state medical assistance program. It serves lowincome people of every age. Medical bills are paid from federal, state and local tax funds. It is run 

by state and local governments within federal guidelines. 

IF NECESSARY, TO HELP THE RESPONDENT DETERMINE WHAT KIND OF 

INSURANCE THEY HAVE, PROBE (READ IF NECESSARY): Did you get that insurance 

through an employer? Does it help pay for both doctor visits and hospital stays? 

C7Q02	 [IF IAP not equal 095 and S.C. = ‘NIS-ELIG CHILD,’ THEN FILL WITH INS-3] 

IF IAP not equal 095 and SC=ST then FILL WITH TIS_INS_3. 

At this time, is [S.C.] covered by the State Children’s Health Insurance Program or S-CHIP? In 

this state, the program is sometimes called [FILL NAME FROM “TEXT FILLS”

SPREADSHEET]. 

(1) YES 

(2) NO 

(77) DON’T KNOW 

(99) REFUSED 

READ IF NECESSARY: The State Children's Health Insurance Program (SCHIP), created under 

Title XXI of the Social Security Act, expands health coverage to uninsured children whose 

families earn too much for Medicaid but too little to afford private coverage. 

IF NECESSARY, TO HELP THE RESPONDENT DETERMINE WHAT KIND OF 

INSURANCE THEY HAVE, PROBE (READ IF NECESSARY): Did you get that insurance 

through an employer? Does it help pay for both doctor visits and hospital stays? 

[ALL SKIP TO C7Q05] 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2009-2010 National Survey of Children with Special Health Care Needs Page 85 

Series 1, No. 57 □ Page 139

C7Q04	 [IF IAP not equal 095 and S.C. = ‘NIS-ELIG CHILD,’ THEN FILL WITH INS-3A] 

IF IAP not equal 095 and SC=ST then FILL WITH TIS_INS_3A. 

At this time, is [S.C.] covered by any Medicaid plan or the State Children’s Health Insurance 

Program, which are health insurance programs for persons with certain income levels and persons 

with disabilities? In this state, it is sometimes called [FILL NAME FROM “TEXT FILLS”

SPREADSHEET]. 

(1) YES 

(2) NO 

(77) DON’T KNOW 

(99) REFUSED 

READ IF NECESSARY: Medicaid and SCHIP are federal-state medical assistance programs. 

They serve low-income people of every age. Medical bills are paid from federal, state and local 

tax funds. Patients usually pay little or no part of costs for covered medical expenses. These 

programs are run by state and local governments within federal guidelines. 

IF NECESSARY, TO HELP THE RESPONDENT DETERMINE WHAT KIND OF 

INSURANCE THEY HAVE, PROBE (READ IF NECESSARY): Did you get that insurance 

through an employer? Does it help pay for both doctor visits and hospital stays? 

C7Q05	 [IF IAP not equal 095 and S.C. = ‘NIS-ELIG CHILD,’ THEN FILL WITH INS-5] 

IF IAP not equal 095 and SC=ST then FILL WITH TIS_INS_5. 

At this time, is [S.C.] covered by military health care, TRICARE, CHAMPUS, OR CHAMP-VA? 

(1) YES 

(2) NO 

(77) DON’T KNOW 

(99) REFUSED 

READ IF NECESSARY: CHAMPUS, CHAMP-VA, and TRICARE are health care plans that 

are offered to persons in the military (and their dependents). TRICARE is a managed health care 

program for active duty and retired members of the uniformed services, their families, and 

survivors. CHAMPUS is a program of medical care for dependents of active or retired military 

personnel. CHAMP-VA is medical insurance for dependents or survivors of disabled veterans.. 

IF NECESSARY, TO HELP THE RESPONDENT DETERMINE WHAT KIND OF 

INSURANCE THEY HAVE, PROBE (READ IF NECESSARY): Did you get that insurance 

through an employer? Does it help pay for both doctor visits and hospital stays? 

C7Q07	 [IF IAP not equal 095 and S.C. = ‘NIS-ELIG CHILD,’ THEN FILL WITH INS-6 AND USE 

CSHCN LOGIC] 

IF IAP not equal 095 and S.C. = ST then FILL WITH TIS_INS_6. 

IF C7Q01, C7Q02, C7Q03, C7Q04, OR C7Q05 = 01, THEN SHOW: “Besides what you have 

already told me about,” 

Is [S.C.] covered by any other health insurance or health care plan? 

INTERVIEWER INSTRUCTION: IF RESPONDENT REPORTS DENTAL, VISION, SCHOOL, 

OR ACCIDENT INSURANCE, MARK NO. 

(1) YES 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Page 140 □ Series 1, No. 57

(2) NO	 [SKIP TO C7Q09] 

(77) DON’T KNOW [SKIP TO C7Q09] 

(99) REFUSED	 [SKIP TO C7Q09] 

C7Q08A	 [IF IAP not equal 095 and S.C. = ‘NIS-ELIG CHILD,’ THEN FILL WITH INS-6A AND 

USE CSHCN LOGIC] 

IF IAP not equal 095 and S.C. = ST then FILL WITH TIS_INS_6A. 

Does this health insurance help pay for both doctor visits and hospital stays? 

(1) YES 

(2) NO	 [SKIP TO C7Q09] 

(77) DON’T KNOW [SKIP TO C7Q09] 

(99) REFUSED	 [SKIP TO C7Q09] 

C7Q08B	 [IF IAP not equal 095 and S.C. = ‘NIS-ELIG CHILD,’ THEN FILL WITH INS-6B AND 

USE CSHCN LOGIC] 

IF IAP not equal 095 and S.C. = ST then FILL WITH TIS_INS_6B. 

Is this health insurance provided through an employer or union? 

(1) YES	 [SKIP TO C7Q11] 

(2) NO 

(77) DON’T KNOW 

(99) REFUSED 

C7Q08C	 [IF IAP not equal 095 and S.C. = ‘NIS-ELIG CHILD,’ THEN FILL WITH INS-6C] 

IF IAP not equal 095 and SC=ST then FILL WITH TIS_INS_6C. 

Is this health insurance purchased directly from an insurance company? 

(1) YES 

(2) NO 

(77) DON’T KNOW 

(99) REFUSED 

C7Q09	 (IF C7Q01, C7Q02, C7Q03A, C7Q04, C7Q05, OR C7Q08A = 01, SKIP TO C7Q11; ELSE IF 

( (S.C. = ‘NIS-ELIG CHILD’ AND INS-4 = 1) OR (S.C. = S.T. AND TIS_INS_4 = 1) ), 

THEN GO TO C7Q10; ELSE ASK C7Q09) 

[IF IAP not equal 095 and S.C. = ‘NIS-ELIG CHILD,’ THEN FILL WITH INS-7] 

IF IAP not equal 095 and SC=ST then FILL WITH TIS_INS_7. 

It appears that [S.C.] does not have any health insurance coverage to pay for both hospitals and 

doctors and other health professionals. Is that correct? 

(1) YES [SKIP TO C7Q13] 

(2) NO 

(77) DON’T KNOW [SKIP TO C9Q01] 

(99) REFUSED [SKIP TO C9Q01] 

C7Q10	 [IF IAP not equal 095 and ( (S.C. = ‘NIS-ELIG CHILD’ AND INS-4 = 1) OR (S.C. = S.T. AND 

TIS_INS_4 = 1) ), THEN FILL “Now I have a few questions about health insurance and health 

care coverage for [S.C.]. Earlier you told me that [S.C.] is covered by Indian Health Service. 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Series 1, No. 57 □ Page 141

Does [S.C.] have any other kind of health coverage?”/ 

ELSE FILL “At this time, what kind of health coverage does [S.C.] have? Any other kind?” 

INTERVIEWER INSTRUCTION: MARK ALL THAT APPLY. MARK SINGLE SERVICE 

PLAN ONLY IF VOLUNTEERED AS TYPE OF HEALTH INSURANCE. 

IF IAP NOT EQUAL 095 AND S.C. = ‘NIS-ELIG CHILD,’ AND INS-7A NE MISSING, THEN 

FILL WITH INS-7A. 

IF IAP NOT EQUAL 095 AND S.C. = S.T. AND TIS_INS_7A NE MISSING, THEN FILL 

WITH TIS_INS_7A. 

[CATI INSTRUCTIONS: IF IAP NOT EQUAL 095 AND S.C. = ‘NIS-ELIG CHILD’ AND INS4 = 1, THEN PRE-FILL C7Q10 = 6] 

[CATI INSTRUCTIONS: IF IAP NOT EQUAL 095 AND S.C. = S.T. AND TIS_INS_4 = 1, 

THEN PRE-FILL C7Q10 = 6] 

IF ONLY (8) IS SELECTED, SKIP TO C7Q13. 

(1) MEDICAID [STATE NAME] 

(2) MEDICARE 

(3) SCHIP	 [STATE NAME] 

(4) MEDIGAP 

(5) MILITARY 

(6) INDIAN HEALTH SERVICE 

(7) PRIVATE INSURANCE 

(8) SINGLE SERVICE PLAN (DENTAL, VISION, PRESCRIPTIONS, ETC) 

(9) OTHER 

(77) DON'T KNOW 

(99) REFUSED 

C7Q10B	 [IF IAP not equal 095 and S.C. = 'NIS-ELIG CHILD,' AND INS-7A-1, INS-7A-3, INS-7A-5, OR 

INS-7A-6 = 1, THEN FILL C7Q10B = 1. 

IF IAP not equal 095 and S.C. = 'NIS-ELIG CHILD,' INS-7A-2, INS-7A-4, INS-7A-7 OR INS7A-9 = 1, THEN FILL WITH INS-7B.] 

[IF IAP not equal 095 and S.C. = S.T., AND TIS_INS_7A-1, TIS_INS_7A-3, TIS_INS_7A-5, OR 

TIS_INS_7A-6 = 1, THEN FILL C7Q10B = 1. 

IF IAP not equal 095 and S.C. = S.T., AND TIS_INS_7A-2, TIS_INS_7A-4, TIS_INS_7A-7 OR 

TIS_INS_7A-9 = 1, THEN FILL WITH TIS_INS_7B.] 

Does this health insurance help pay for both doctor visits and hospital stays? 

(1) YES 

(2) NO	 [SKIP TO C7Q13] 

(77) DON’T KNOW		 [SKIP TO C9Q01] 

(99) REFUSED	 [SKIP TO C9Q01] 

C7Q11	 IF IAP not equal 095 and S.C. = ‘NIS-ELIG CHILD,’ AND INS-11 = 1, THEN DISPLAY 

“Earlier you told me that since [S.C.]’s birth there was a time when [he/she] was not covered by 

any health insurance. DURING THE PAST 12 MONTHS, was there any time when [S.C.] was 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2009-2010 National Survey of Children with Special Health Care Needs Page 88 

Page 142 □ Series 1, No. 57

not covered by any health insurance?” 

ELSE DISPLAY: 

IF IAP not equal 095 and S.C. = S.T. AND TIS_INS_11 = 1, THEN DISPLAY “Earlier you told 

me that since [S.C.] was 11 years old there was a time when [he/she] was not covered by any 

health insurance. DURING THE PAST 12 MONTHS, was there any time when [S.C.] was not 

covered by any health insurance?” 

ELSE DISPLAY: 

During the past 12 months/ [WHEN S.C. IS YOUNGER THAN 12 MONTHS: Since [his/her] 

birth], was there any time when [S.C.] was not covered by ANY health insurance? 

(1) YES 

(2) NO [SKIP TO C8Q01_A] 

[DISPLAY RESPONSE (03) IF (S.C. = ‘NIS-ELIG CHILD’ AND INS-11 =1) OR (S.C. = S.T. 

AND TIS_INS_11=1)] 

(3) CHILD ALWAYS COVERED BY INSURANCE [SKIP TO C8Q01_A] 

(77) DON’T KNOW		 [SKIP TO C8Q01_A] 

(99) REFUSED [SKIP TO C8Q01_A] 

IF IAP not equal 095 and S.C. = ‘NIS-ELIG CHILD’ AND INS-11 = 2, 77, 99, THEN FILL 2, 77, 

99 AND USE CURRENT LOGIC 

IF IAP not equal 095 and S.C. = S.T. AND TIS_INS_11 = 2, 77, 99, THEN FILL 2, 77, 99 AND 

USE CURRENT LOGIC 

C7Q12 [IF S.C. = ‘NIS-ELIG CHILD,’ AND C7Q11 = 1 AND IF INS-8 = 1, THEN FILL WITH ‘12’] 

During the past 12 months/ Since [his/her] birth, about how many months was [S.C.] without any 

health insurance or coverage? 

[IF LESS THAN ONE MONTH, ROUND UP TO ONE MONTH, 

IF VALUE LT CWAGE, DISPLAY WARNING: ‘TIME WITHOUT INSURANCE CAN’T

BE GREATER THAN CHILD’S AGE’]

RANGE 01-12, 77, 99
 

[CATI: 02 NUMERIC-CHARACTER-FIELD, RANGE 01-12, 7, 9]
 

_____ _____ MONTHS 

(77) DON’T KNOW 

(99) REFUSED 

[IF IAP not equal 095 and S.C. = ‘NIS-ELIG CHILD,’ AND C7Q11 = 1 AND IF INS-8 = 1, 

THEN FILL WITH ‘12’] 

[IF IAP not equal 095 and S.C. = S.T, AND C7Q11 = 1 AND IF TIS_INS_8 = 1, THEN FILL 

WITH ‘12’] 

[ALL SKIP TO C8Q01_A] 

C7Q13	 [IF IAP not equal 095 and ( (S.C. = ‘NIS-ELIG CHILD’ AND INS-8 = 2, 77, 99) OR (S.C. = S.T. 

AND TIS_INS_8 = 1, 2, 77, 99) ) THEN DISPLAY: “Earlier you told me that [S.C.] is not 

covered by health insurance that pays for all types of care.”] 

IF C7Q10X08 = 1 OR C7Q10B = 2, THEN SAY: About how long has it been since [S.C.] last had 
 

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Series 1, No. 57 □ Page 143

health coverage that helps pay for all types of care?]
 

[ELSE, READ: About how long has it been since [S.C.] last had health coverage?]
 

[IF (C7Q13 GE 2 AND CWAGE LT 6) OR (C7Q13 GE 3 AND CWAGE LT 12) OR (C7Q13 GE
 

4 AND CWAGE LT 36) OR (CWAGE=6 and (02) CHOSEN), DISPLAY WARNING: ‘TIME
	

WITHOUT INSURANCE CAN’T BE GREATER THAN CHILD’S AGE’]
	

(1) 6 MONTHS OR LESS 

(2) MORE THAN 6 MONTHS, BUT NOT MORE THAN 01 YEAR AGO 

(3) MORE THAN 1 YEAR, BUT NOT MORE THAN 3 YEARS AGO [GO TO C9Q01] 

(4) MORE THAN 3 YEARS [GO TO C9Q01] 

(5) NEVER	 [GO TO C9Q01] 

[DISPLAY RESPONSE (66) IF (S.C. = ‘NIS ELIG CHILD’ AND INS-8 = 2, 77, OR 99) OR 

(S.C. = S.T. AND TIS_INS_8= 1, 2, 77, 99)] 

(66) CHILD IS COVERED BY INSURANCE	 [GO TO C7Q10 

AND FOLLOW 

CSHCN 

LOGIC] 

(77) DON’T KNOW		 [GO TO C9Q01] 

(99) REFUSED [GO TO C9Q01] 

IF IAP not equal 095 and S.C. = ‘NIS-ELIG CHILD,’ AND IF INS-8 = 1, THEN FILL C7Q13=5. 

C7Q14	 (During the past 12 months/ Since [his/her] birth), about how many months was [S.C.] without 

any health insurance or coverage? 

[IF LESS THAN ONE MONTH, ROUND UP TO ONE MONTH 

IF VALUE GT CWAGE, DISPLAY WARNING: ‘TIME WITHOUT INSURANCE CAN’T BE 

GREATER THAN CHILD’S AGE’] 

RANGE 01-12, 77, 99 

[CATI: 02 NUMERIC-CHARACTER-FIELD, RANGE 01-12, 6, 7] 

_____ _____ MONTHS 

(77) DON’T KNOW 

(99) REFUSED 

C7Q15	 [IF S.C. AGE=0 MONTHS, THEN GO TO C9Q01] 

[IF C7Q14=12, DK, OR REF, GO TO C9Q01] 

[WHEN S.C. IS YOUNGER THAN 12 months, IF C7Q14=AGE OF S.C. IN MONTHS, GO TO 

C9Q01] 

(During the (12 - C7Q14) / [IF S.C. IS YOUNGER THAN 12 MONTHS, During the (S.C. AGE 

IN MONTHS –C7Q14)] months) when [S.C.] DID have health coverage, what kind of health 

coverage did [S.C.] have? 

[PROBE: Any other kind?] 

(1) MEDICAID [STATE NAME] 

(2) MEDICARE 

(3) SCHIP [STATE NAME] 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Page 144 □ Series 1, No. 57

(4) MEDIGAP 

(5) MILITARY 

(6) INDIAN HEALTH SERVICE 

(7) PRIVATE INSURANCE 

(8) SINGLE SERVICE PLAN (DENTAL, VISION, PRESCRIPTIONS, ETC) 

(9) OTHER [SKIP TO C7Q15A] 

(77) DON'T KNOW 

(99) REFUSED 

C7Q15A ENTER OTHER______ [CATI: 255 CHARACTER-FIELD] 

IF ONLY (8) IS SELECTED, SKIP TO C9Q01 

C7Q15B Did this health insurance help pay for both doctor visits and hospital stays? 

(1) YES 

(2) NO 

(77) DON’T KNOW 

(99) REFUSED 

[ALL SKIP TO C9Q01] 
 

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Series 1, No. 57 □ Page 145

Section 8. ADEQUACY OF HEALTH CARE COVERAGE
 

[TIMESTAMP_SECTION81] 

C8Q01_A	 The next questions are about [S.C.]’s health insurance or health care plans. Does [S.C.]’s health 

insurance offer benefits or cover services that meet [his/her] needs? 

Would you say never, sometimes, usually, or always? 

(1) NEVER 

(2) SOMETIMES 

(3) USUALLY 

(4) ALWAYS 

(77) DON’T KNOW 

(99) REFUSED 

C8Q01_B	 Are the costs not covered by [S.C.]’s health insurance reasonable? 

Would you say never, sometimes, usually, or always? 

(1) NEVER 

(2) SOMETIMES 

(3) USUALLY 

(4) ALWAYS 

(5) NO OUT OF POCKET COSTS 

(77) DON’T KNOW 

(99) REFUSED 

IF THE PARENT SEEMS CONFUSED BY HOW TO ANSWER, ASK: Do you have any out-ofpocket costs for your child's health care? 

IF YES, THEN ASK: Are those costs reasonable? 

C8Q01_C	 Does [S.C.]’s health insurance allow (him/her) to see the health care providers [he/she] needs? 

Would you say never, sometimes, usually, or always? 

(1) NEVER 

(2) SOMETIMES 

(3) USUALLY 

(4) ALWAYS 

(77) DON’T KNOW 

(99) REFUSED 
 

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Section 9. IMPACT ON THE FAMILY
 

[TIMESTAMP_SECTION91] 

C9Q01	 The next question is about the amount of money paid [during the past 12 months/ Since [his/her] 

birth] for [S.C.]’s medical care. Please do not include health insurance premiums or costs that 

were or will be reimbursed by insurance or another source. But do include out-of-pocket 

payments for all types of health-related needs such as co-payments, dental or vision care, 

medications, special foods, adaptive clothing, durable equipment, home modifications, and any 

kind of therapy. (During the past 12 months/ Since [his/her] birth), would you say that the family 

paid more than $500, $250-$500, less than $250, or nothing for [S.C.]’s medical care? 

(1) MORE THAN $500 

(2) $250-$500 [SKIP TO C9Q02] 

(3) LESS THAN $250 [SKIP TO C9Q02] 

(4) NOTHING, $0 [SKIP TO C9Q02] 

(77) DON’T KNOW [SKIP TO C9Q02] 

(99) REFUSED [SKIP TO C9Q02] 

HELP SCREEN: RESPONDENT MAY GIVE A RANGE AS AN ANSWER TO THIS 

QUESTION. BE PREPARED TO PROBE FOR A MORE ACCURATE ANSWER. 

C9Q01_A	 [During the past 12 months/ Since [his/her] birth], would you say that the family paid more than 

$5000, $1000 to $5000, or less than $1000 for [S.C.]’s medical care? 

(1) MORE THAN $5000 

(2) $1000-$5000 

(3) LESS THAN $1000 

(77) DON’T KNOW 

(99) REFUSED 

C9Q02	 Many families provide health care at home such as changing bandages, care of feeding or 

breathing equipment, and giving medication and therapies. 

Do you or other family members provide health care at home for [S.C.]? 

READ IF NECESSARY: Please base your answer on the last several weeks. 

READ IF NECESSARY: Only include care related to the child’s condition. 

(1) YES 

(2) NO	 [SKIP TO C9Q04] 

(77) DON’T KNOW [SKIP TO C9Q04] 

(99) REFUSED [SKIP TO C9Q04] 
 

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Series 1, No. 57 □ Page 147

C9Q03 How many hours per week do you or other family members spend providing this kind of care? 

READ IF NECESSARY: It is fine to provide an average number of hours per week based on 

several weeks. Please give your best estimate. 

READ IF NECESSARY: Only include care related to the child’s condition. 

(CATI: 3 NUMERIC-CHARACTER-FIELD, RANGE 000-168, 777, 999) 

_____ _____ HOURS PER WEEK 

(000) LESS THAN ONE HOUR 

(168) AROUND THE CLOCK 

(777) DON’T KNOW 

(999) REFUSED 

[IF C9Q03 < 30 OR = 168, 777, 999, SKIP TO C9Q04] 

 

C9Q03_A I have [FILL ANSWER FROM C9Q03] hours. Is that correct? 

(1) YES 

(2) NO [SKIP BACK TO C9Q03] 

C9Q04 How many hours per week do you or other family members spend arranging or coordinating 

[S.C.]’s care? By this I mean making appointments, making sure that care providers are 

exchanging information, and following up on [S.C.]’s care needs. 

 READ IF NECESSARY: It is fine to provide an average number of hours per week based on 

several weeks. Please give your best estimate. 

[CATI: 3 NUMERIC-CHARACTER-FIELD, RANGE 000-168, 555, 777, 999] 

_ _ _ HOURS PER WEEK 

(000) NONE / LESS THAN ONE HOUR 

(168) AROUND THE CLOCK 

(777) DON'T KNOW 

(999) REFUSED 

[IF C9Q04 = 000 OR 555, OR IF C9Q04 < 30 or C9Q04 = 168, 777, 999, SKIP TO C9Q05] 

C9Q04_A I have [FILL ANSWER FROM C9Q04] hours. Is that correct? 

(1) YES 

(2) NO [SKIP BACK TO C9Q04] 

C9Q05 Have [S.C.]’s health conditions caused financial problems for your family? 

 

 (1) YES 

 (2) NO 

 (77) DON’T KNOW 

 (99) REFUSED 

C9Q10 Have you or other family members stopped working because of [S.C.]’s health 

 conditions? 

 (1) YES 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Page 148 □ Series 1, No. 57

(2) NO 

(77) DON’T KNOW 

(99) REFUSED 

C9Q06	 [IF C9Q10 = 01, THEN SHOW: Not including the family members who stopped working] 

Have you or other family members cut down on the hours you work because of [S.C.]’s health 

conditions? 

(1) YES 

(2) NO 

(77) DON’T KNOW 

(99) REFUSED 

C9Q11	 Have you or other family members avoided changing jobs because of concerns about maintaining 

health insurance for [S.C.]? 

(1) YES 

(2) NO 

(77) DON’T KNOW 

(99) REFUSED 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Series 1, No. 57 □ Page 149

Section 9.5. ADD/ADHD QUESTIONS
 

[TIMESTAMP_ADD_START] 

CP_ADD IF ASK_ADD=1 AND K2Q31B=1 THEN GO TO C95Q01. ELSE GO TO CPC10. 

C95Q01 Earlier you told me that [S.C.] currently has ADD or ADHD. At any time during the past week, 

did [he/she] take medication for ADD or ADHD? 

 (1) YES 

(2) NO [SKIP TO C95Q02] 

(77) DON'T KNOW [SKIP TO C95Q02] 

(99) REFUSED [SKIP TO C95Q02] 

C95Q01 A What medications did [S.C.] take for ADD or ADHD? 

INTERVIEWER INSTRUCTIONS: MARK ALL THAT APPLY AMONG 1-18. DO NOT 

READ LIST. 

PROBE: Did (he/she) take any other medications for ADD or ADHD during the past week? 

(1) ADDERALL (ADD-ur-all), ADDERALL XR, AMPHETAMINE (am-FET-a-meen) 

(2) CELEXA, CITALOPRAM (si-TAL-o-pram) 

(3) CONCERTA 

(4) DAYTRANA PATCH 

(5) DEXEDRINE, DEXEDRINE SPANSULE, DEXTROSTAT, DEXTRO-AMPHETAMINE 

(6) DEXMETHYLPHENIDATE 

(7) FLUOXETINE (floo-ox-e-teen) 

(8) FOCALIN, FOCALIN XR 

(9) METADATE, METADATE CD 

(10) METHYLIN 

(11) METHYLPHENIDATE 

(12) PROZAC 

(13) RITALIN, RITALIN LA, RITALIN SR 

(14) SERTRALINE (SER-tra-leen) 

(15) STRATTERA, ATOMOXETINE (AT-oh-mox-e-teen) 

(16) VYVANSE, LISDEXAMFETAMINE (lis-dex-am-FET-a-meen) 

(17) ZOLOFT 

(18) OTHER 

(66) NOT CURRENTLY TAKING MEDICATION [SKIP TO C95Q02] 

(77) DON’T KNOW 

(99) REFUSED 

IF 18, SKIP TO C95Q01B. IF 1 - 17, 77, 99, SKIP TO C95Q03. 

C95Q01B	 ENTER OTHER MEDICATION. IF MORE THAN ONE MEDICATION IS GIVEN ENTER 

ALL MEDICATIONS ON ONE LINE. 

_________________ENTER TEXT [SKIP TO C95Q03] 

C95Q02	 In the past 12 months, did [S.C] take any medication for ADD or ADHD? 

(1) YES 

(2) NO 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Page 150 □ Series 1, No. 57

(77) DON'T KNOW 

(99) REFUSED 

C95Q03	 At any time during the past 12 months, did [S.C.] receive behavioral treatment for ADD or 

ADHD, such as classroom management, peer interventions, social skills training, or cognitivebehavioral therapy? 

HELP TEXT: Cognitive-behavioral therapy, or CBT, is a type of therapy that aims to change 

negative emotions and behaviors through carious techniques used by a trained psychologist or 

counselor. 

(1) YES 

(2) NO 

(77) DON'T KNOW 

(99) REFUSED 

C95Q04	 At any time during the past 12 months, did [S.C.] take a dietary supplement to treat ADD or 

ADHD? 

HELP TEXT: Dietary supplements are products such as viatmins, minerals, or herbs that are 

taken to supplement a person's diet. 

HELP TEXT: Some common supplements include megavitamins, zinc, chamomile; kava hops; 

lemon balm; passionflower; melatonin; and ginko biloba. 

(1) YES 

(2) NO [SKIP TO CPC10] 

(77) DON'T KNOW [SKIP TO CPC10] 

(99) REFUSED [SKIP TO CPC10] 

C95Q04A	 In the past week, did [S.C.] take a dietary supplement to treat ADD or ADHD? 

(1) YES [SKIP TO CPC10] 

(2) NO [SKIP TO CPC10] 

(77) DON'T KNOW [SKIP TO CPC10] 

(99) REFUSED [SKIP TO CPC10] 

[TIMESTAMP_ADD_END] 
 

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Series 1, No. 57 □ Page 151

Section 10. DEMOGRAPHICS
 

[TIMESTAMP_SECTION101] 

CPC10	 IF CWTYPE = S, THEN SKIP TO C10Q01 ELSE GO TO C10START. 

C10START	 Next, I have some more general questions about you and your household. The rest of the survey 

will take about 5 minutes. 

IF RESPONDENT IS CONCERNED ABOUT THE TIME ESTIMATE, READ ANY OF THE 

FOLLOWING:
 

We know your time is valuable, and we will get through the questions as quickly as possible.
 

Let’s get started and see how far we get. If you have to go, let me know. 

(1) CONTINUE WITH INTERVIEW 

C10Q01	 [IF NIS IS DONE, FILL C10Q01 FROM NIS DATA C1, SKIP TO C10Q02A.] 

[IF CWTYPE = S, THEN DISPLAY: Now I have some questions about your household.] 

Including the adults and all the children, how many people live in your household? 

[CATI: 02 NUMERIC-CHARACTER FIELD, RANGE 01-30, 77, 99 

VALUE MUST BE =/> S_UNDR18 + 1] [DISPLAY WARNING IF VALUE < S_UNDR18+1 -

> “NUMBER OF PEOPLE IN THIS HOUSEHOLD CANNOT BE LESS THAN NUMBER 

OF KIDS + 1.”

_______ PERSONS 

(77) DON’T KNOW 

(99) REFUSED 

READ AS NECESSARY: Please include anyone who normally lives there even if they are not 

there now, like someone who is away traveling or in a hospital. 

HELP SCREEN: EACH PERSON IN THE HOUSEHOLD MUST BE A CURRENT RESIDENT 

OF THE HOUSEHOLD. A CURRENT RESIDENCE IS DEFINED AS A PLACE WHERE THE 

PERSON IS STAYING FOR MORE THAN TWO MONTHS AT THE TIME OF THE SURVEY 

CONTACT. IF A PERSON HAS NO PLACE WHERE HE OR SHE USUALLY STAYS, THE 

PERSON SHOULD BE CONSIDERED A CURRENT RESIDENT REGARDLESS OF THE 

LENGTH OF THE CURRENT STAY. 

PERSONS AWAY FROM THEIR RESIDENCE FOR TWO MONTHS OR LESS, WHETHER 

TRAVELING OR IN THE HOSPITAL, ARE CONSIDERED “IN RESIDENCE.” 

PERSONS AWAY FROM THEIR RESIDENCE FOR MORE THAN TWO MONTHS ARE 

CONSIDERED “NOT IN RESIDENCE” UNLESS THE PERSON IS AWAY AT SCHOOL (I.E., 

BOARDING SCHOOL, MILITARY ACADEMY, PREP SCHOOL, ETC.). 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Page 152 □ Series 1, No. 57

CPC10Q02A IF CWTYPE = N, THEN SKIP TO C10Q14. 

C10Q02A What is your relationship to [S.C.]? 

IF R RESPONDS “Mother” or “Father,” YOU MUST PROBE:: Are you [S.C.]’s biological, step, 

foster, or adoptive mother/father? 

IF R RESPONDS “Partner,” PROBE IF NOT SURE: Are you male or female? 

PARENT 

(01) BIOLOGICAL MOTHER (06) BIOLOGICAL FATHER 

(02) STEP MOTHER (07) STEP FATHER 

(03) FOSTER MOTHER (08) FOSTER FATHER 

(04) ADOPTIVE MOTHER (09) ADOPTIVE FATHER 

(05) MOTHER, but TYPE REFUSED (10) FATHER, but TYPE REFUSED 

OLDER RELATIVES OR GUARDIANS 

(11) GRANDMOTHER (14) UNCLE 

(12) GRANDFATHER (15) FEMALE GUARDIAN 

(13) AUNT (16) MALE GUARDIAN 

OTHER RELATIVES 

(17) SISTER (BIOLOGICAL, STEP, FOSTER, HALF, ADOPTIVE) 

(18) BROTHER (BIOLOGICAL, STEP, FOSTER, HALF, ADOPTIVE) 

(19) COUSIN 

(20) IN-LAW OF ANY TYPE 

(22) OTHER RELATIVE / FAMILY MEMBER 

OTHER NON-RELATIVES 

(23) PARENT’S BOYFRIEND / MALE PARTNER 

(24) PARENT’S GIRLFRIEND / FEMALE PARTNER 

(25) PARENT’S PARTNER, but SEX REFUSED 

(26) OTHER NON-RELATIVE OR FRIEND 

(77) DON’T KNOW 

(99) REFUSED 

C10Q02B [IF C10Q01= 2, SKIP TO C10Q02C.] 

IF C10Q01=77,99 THEN READ: 

For the other people that live in your household with you and [S.C.], what is their relationship to 

[S.C.]? 

IF C10Q01 NOT 77,99 THEN READ: 

In addition to you and [S.C.], I have that [FILL: C10Q01 - 2] [other person lives/other people 

live] in your household. What is their relationship to [S.C.]? [MARK ALL THAT APPLY] 

IF R RESPONDS “Mother” or “Father,” YOU MUST PROBE: Is that [S.C.]’s biological, 

step, foster, or adoptive mother/father? 

IF R RESPONDS “Partner,” PROBE: Is the partner male or female? 

PARENT 

(01) BIOLOGICAL MOTHER (06) BIOLOGICAL FATHER 

(02) STEP MOTHER (07) STEP FATHER 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Series 1, No. 57 □ Page 153

(03) FOSTER MOTHER (08) FOSTER FATHER 

(04) ADOPTIVE MOTHER (09) ADOPTIVE FATHER 

(05) MOTHER, but TYPE REFUSED (10) FATHER, but TYPE REFUSED 

OLDER RELATIVES OR GUARDIANS 

(11) GRANDMOTHER (14) UNCLE 

(12) GRANDFATHER (15) FEMALE GUARDIAN 

(13) AUNT (16) MALE GUARDIAN 

OTHER RELATIVES 

(17) SISTER 

(18) BROTHER 

(19) COUSIN 

(20) IN-LAW OF ANY TYPE 

(21) [S.C.]’S CHILD, SON, OR DAUGHTER 

(22) OTHER RELATIVE / FAMILY MEMBER 

OTHER NON-RELATIVES 

(23) PARENT’S BOYFRIEND / MALE PARTNER 

(24) PARENT’S GIRLFRIEND / FEMALE PARTNER 

(25) PARENT’S PARTNER, but SEX REFUSED 

(26) OTHER NON-RELATIVE OR FRIEND 

(77) DON’T KNOW 

(99) REFUSED 

IF C10Q02A = 1 and C10Q02B = 1, THEN DISPLAY WARNING TEXT. 

IF C10Q02A = 6 and C10Q02B = 6, THEN DISPLAY WARNING TEXT. 

C10Q02B_ IF C10Q02B_CONF= 2 IS SELECTED AND C10Q01 HAS BEEN FILLED FROM NIS OR 

CONF TEEN VARIABLES, ALLOW THE CASE TO GO BACK TO C10Q01 AND DISPLAY THE 

FILL VALUE AND ALLOW IT TO BE CHANGED. 

I am now going to list all the people that live in your household.
 

I have that 

[LIST OF RELATIONSHIPS ROSTERED]
 

live in this household with [S.C.].
 

Is this a correct list of everyone living in your household?
 

(1) CONFIRM - THIS LIST IS CORRECT 

(2) NOT CORRECT - RETURN TO TOTAL NUMBER OF PEOPLE IN HOUSEHOLD AND 

START PROCESS AGAIN [GO TO C10Q01] 

C10Q02B_ Earlier you told me that there are [VALUE FROM C10Q01] people living in your household. 

WARNING However, based on the relationships you just gave, I have [COUNT OF RELATIONSHIPS 

INCLUDING R & SC] people living in your household. Let's re-confirm your answers. 

(1) RETURN TO RE-CONFIRM ANSWERS [GO TO C10Q02B_CONF C10Q01] 

USE RARELY: 

(2) ISSUE CANNOT BE RESOLVED - CONTINUE ON [GO TO CPC10Q02C] 

CPC10Q02C IF ANY BIOLOGICAL MOTHER OR BIOLOGICAL FATHER IN HH [(C10Q02A = 1 OR 
 

 

 

 

 

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Page 154 □ Series 1, No. 57

C10Q02B = 1) OR (C10Q02A = 6 OR C10Q02B = 6)], SKIP TO C10Q03. 

IF RESPONDENT IS ADOPTIVE MOTHER OR ADOPTIVE FATHER (C10Q02A = 4 or 9), 

SKIP TO C10Q03 ELSE, ASK C10Q02C. 

C10Q02C	 CATI INSTRUCTION (C10Q02C): IF ANY BIOLOGICAL MOTHER OR BIOLOGICAL 

FATHER IN HH [(C10Q02A = 1 OR C10Q02B = 1) OR (C10Q02A = 6 OR C10Q02B = 6)], 

SKIP TO C10Q03. IF RESPONDENT IS ADOPTIVE MOTHER OR ADOPTIVE FATHER 

(C10Q02A = 4 or 9), SKIP TO C10Q03. 

ELSE, ASK C10Q02C 

Have you legally adopted [S.C.]? 

(1) YES 

(2) NO 

(77) DON’T KNOW 

(99) REFUSED 

C10Q03	 IF C10Q02A = 01 OR 06 OR C10Q02B = 01 OR 06, SKIP TO CPC10Q10. ELSE, IF 

C10Q02A = 04 OR 09 OR C10Q02B = 04 OR 09 OR C10Q02C = 1, CONTINUE WITH 

C10Q03. ELSE, SKIP TO C10Q10. 

The next questions will help us better understand the health needs of adopted children. 

How old was [S.C.] when the adoption was finalized? By “finalized,” I mean when the court 

papers were signed that completed the adoption process. 

HELP SCREEN: IF CHILD WAS LESS THAN 1 MONTH AT THE TIME OF ADOPTION, 

ENTER 0 MONTHS. 

HELP SCREEN: ENTER AGE IN MONTHS FOR 0 TO 23 MONTHS. IF 2 YEARS OR 

OLDER, ENTER AGE IN YEARS. 

___ ____ VALUE (MUST BE LESS THAN OR EQUAL TO AGE OF CHILD) 

(55) ADOPTION NOT FINALIZED 

(77) DON’T KNOW 

(99) REFUSED 

C10Q03A	 Months (00-23) 

Years (Range 02-17) 

(1) MONTHS 

(2) YEARS 

(77) DON'T KNOW 

(99) REFUSED 

C10Q04	 Was [S.C.] adopted from another country? 

IF RESPONDENT SEEMS UPSET BY THIS QUESTION, READ: We ask this question for all 

children with adoptive parents. 

(1) YES [SKIP TO C10Q10] 

(2) NO 
 

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Series 1, No. 57 □ Page 155

(77) DON’T KNOW 

(99) REFUSED 

C10Q05	 Prior to being adopted, was [S.C.] in the legal custody of a state or county child welfare agency in 

the United States? That is, was [S.C.] in the U.S. foster care system? 

IF THE CHILD WAS ADOPTED THROUGH A PRIVATE AGENCY AND THE PRIVATE 

AGENCY WAS ACTING IN ASSOCIATION WITH OR IN COOPERATION WITH A STATE 

OR COUNTY WELFARE AGENCY, THEN THIS QUESTION SHOULD BE ANSWERED 

"YES." 

IF A FOSTER PARENT ADOPTED ONE OF THEIR OWN FOSTER CHILDREN, THEN THIS 

QUESTION SHOULD BE ANSWERED "YES." 

IF RESPONDENT SEEMS UPSET BY THIS QUESTION, READ: We ask this question for all 

children with adoptive parents. 

(1) YES 

(2) NO 

(77) DON’T KNOW 

(99) REFUSED 

CPC10Q10	 IF HOUSEHOLD INCLUDES A MOTHER (C10Q02A = 1-5 OR C10Q02B = 1-5) AND A 

FATHER (C10Q02A = 6-10 OR C10Q02B = 6-10), ASK C10Q10. ELSE, SKIP TO C10Q11A. 

C10Q10	 CATI INSTRUCTION (C10Q10): IF THE RESPONDENT IS THE MOTHER (C10Q02A = 1-

5), THEN READ: Are you and [S.C.]’s [FATHER TYPE] currently married, separated, divorced, 

or never married? 

IF THE RESPONDENT IS THE FATHER (C10Q02A = 6-10), THEN READ: Are you and 

[S.C.]’s [MOTHER TYPE] currently married, separated, divorced, or never married? 

IF THE RESPONDENT IS NEITHER THE MOTHER NOR THE FATHER, THEN READ: Are 

[S.C.]’s [MOTHER TYPE] and [FATHER TYPE] currently married, separated, divorced, or never 

married? 

(1) MARRIED [SKIP TO C10Q14] 

(2) SEPARATED [SKIP TO C10Q10A] 

(3) DIVORCED [SKIP TO C10Q10A] 

(4) NEVER MARRIED [SKIP TO C10Q10A] 

(77) DON’T KNOW [SKIP TO C10Q10A] 

(99) REFUSED [SKIP TO C10Q10A] 

HELP SCREEN: THIS QUESTION ASKS ABOUT THE MARITAL STATUS OF THE 

CHILD’S PARENTS WHO LIVE IN THE HOUSEHOLD. 

C10Q10A	 IF THE RESPONDENT IS THE MOTHER (C10Q02A = 1-5), THEN READ: Are you and 

[S.C.]’s [FATHER TYPE] currently living together as partners? 

IF THE RESPONDENT IS THE FATHER (C10Q02A = 6-10), THEN READ: Are you and 

[S.C.]’s [MOTHER TYPE] currently living together as partners? 

IF THE RESPONDENT IS NEITHER THE MOTHER NOR THE FATHER, THEN READ: Are 

[S.C.]’s [MOTHER TYPE] and [FATHER TYPE] currently living together as partners? 
 

2009-2010 National Survey of Children with Special Health Care Needs Page 102 

Page 156 □ Series 1, No. 57

(1) YES [SKIP TO C10Q14] 

(2) NO [SKIP TO C10Q14] 

(77) DON'T KNOW [SKIP TO C10Q14] 

(99) REFUSED [SKIP TO C10Q14] 

CPC10Q11A IF HOUSEHOLD INCLUDES A MOTHER (C10Q02A = 1-5 OR C10Q02B = 1-5) BUT NOT A 

FATHER (C10Q02A <> 6-10 AND C10Q02B <> 6-10), ASK C10Q11A. ELSE, SKIP TO 

C10Q12A. 

C10Q11A IF THE RESPONDENT IS THE MOTHER (C10Q02A = 1-5), THEN READ: Are you currently 

married, separated, divorced, widowed, or never married? 

IF THE RESPONDENT IS NOT THE MOTHER, THEN READ: Is [S.C.]’s [MOTHER TYPE] 

currently married, separated, divorced, widowed, or never married? 

(1) MARRIED 

(2) SEPARATED [SKIP TO C10Q11C] 

(3) DIVORCED [SKIP TO C10Q11C] 

(4) WIDOWED [SKIP TO C10Q11C] 

(5) NEVER MARRIED [SKIP TO C10Q11C] 

(77) DON’T KNOW [SKIP TO C10Q11C] 

(99) REFUSED [SKIP TO C10Q11C] 

CPC10Q11B IF MOTHER TYPE IS FOSTER OR ADOPTIVE (C10Q02A = 3-4 OR C10Q02B = 3-4), THEN 

SKIP TO C10Q14. 

C10Q11B CATI INSTRUCTION (C10Q11B): IF RESPONDENT IS THE MOTHER (C10Q02A = 1, 2, 

or 5), FILL “Are you”; ELSE FILL “Is [S.C.]’S [MOTHER TYPE]”. 

(Are you / Is [S.C.]’s [MOTHER TYPE]) married to [S.C.]’s biological father? 

(1) YES [SKIP TO C10Q14] 

(2) NO [SKIP TO C10Q14] 

(77) DON’T KNOW [SKIP TO C10Q14] 

(99) REFUSED [SKIP TO C10Q14] 

C10Q11C IF THE RESPONDENT IS THE MOTHER (C10Q02A = 1-5), THEN READ: Are you currently 

living with anyone as partners? 

IF THE RESPONDENT IS NOT THE MOTHER, THEN READ: Is [S.C.]’s [MOTHER TYPE] 

currently living with anyone as partners? 

(1) YES [SKIP TO C10Q14] 

(2) NO [SKIP TO C10Q14] 

(77) DON’T KNOW [SKIP TO C10Q14] 

(99) REFUSED [SKIP TO C10Q14] 

CPC10Q12A IF HOUSEHOLD INCLUDES A FATHER (C10Q02A = 6-10 OR C10Q02B = 6-10) BUT NOT 

A MOTHER (C10Q02A <> 6-10 OR C10Q02B <> 6-10), ASK C10Q12A. ELSE, SKIP TO 

C10Q13A. 

C10Q12A CATI INSTRUCTION (C10Q12A): IF THE RESPONDENT IS THE FATHER (C10Q02A= 6-

10), THEN READ: Are you currently married, separated, divorced, widowed, or never married? 

IF THE RESPONDENT IS NOT THE FATHER, THEN READ: Is [S.C.]’s [FATHER TYPE] 

currently married, separated, divorced, widowed, or never married? 
 

(1) MARRIED 

(2) SEPARATED [SKIP TO C10Q12C] 

(3) DIVORCED [SKIP TO C10Q12C] 

(4) WIDOWED [SKIP TO C10Q12C] 

(5) NEVER MARRIED [SKIP TO C10Q12C] 

(77) DON’T KNOW [SKIP TO C10Q12C] 

(99) REFUSED [SKIP TO C10Q12C] 

CPC10Q12B IF FATHER TYPE IS FOSTER OR ADOPTIVE (C10Q02A = 8-9 OR C10Q02B = 8-9), THEN 

SKIP TO C10Q14. 

C10Q12B CATI INSTRUCTION (C10Q12B): IF RESPONDENT IS THE FATHER (C10Q02A = 6, 7, or 

10) FILL “Are you”; ELSE FILL “Is [S.C.]’s [FATHER TYPE]”. 

(Are you / Is [S.C.]’s [FATHER TYPE]) married to [S.C.]’s biological mother? 

(1) YES [SKIP TO C10Q14] 

(2) NO [SKIP TO C10Q14] 

(77) DON’T KNOW [SKIP TO C10Q14] 

(99) REFUSED [SKIP TO C10Q14] 

C10Q12C IF THE RESPONDENT IS THE FATHER (C10Q02A= 6-10), THEN READ: Are you currently 

living with anyone as partners? 

IF THE RESPONDENT IS NOT THE FATHER, THEN READ: Is [S.C.]’s [FATHER TYPE] 

currently living with anyone as partners? 

(1) YES [SKIP TO C10Q14] 

(2) NO [SKIP TO C10Q14] 

(77) DON’T KNOW [SKIP TO C10Q14] 

(99) REFUSED [SKIP TO C10Q14] 

C10Q13A Are you currently married, separated, divorced, widowed, or never married? 

(1) MARRIED 

(2) SEPARATED [SKIP TO C10Q13C] 

(3) DIVORCED [SKIP TO C10Q13C] 

(4) WIDOWED [SKIP TO C10Q13C] 

(5) NEVER MARRIED [SKIP TO C10Q13C] 

(77) DON’T KNOW [SKIP TO C10Q13C] 

(99) REFUSED [SKIP TO C10Q13C] 

C10Q13B Does your spouse currently live in the household with [S.C.]? 

(1) YES [SKIP TO C10Q14] 

(2) NO [SKIP TO C10Q14] 

(77) DON’T KNOW [SKIP TO C10Q14] 

(99) REFUSED [SKIP TO C10Q14] 

C10Q13C Are you currently living with a partner? 

(1) YES 

(2) NO 

(77) DON’T KNOW 

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(99) REFUSED 

C10Q14 What is the age of the oldest adult living in the household? 

____ YEARS 

(777) DON’T KNOW 

(999) REFUSED 

SC_C10Q14 INTERVIEWER CHECK: 

YOU ENTERED [FILL WITH ANSWER FROM C10Q14] YEARS OLD. IS THIS CORRECT? 

(1) YES [GO TO CPC10Q20] 

(2) NO [GO BACKTO C10Q14] 

CPC10Q20 IF CWTYPE = N, THEN SKIP TO C10Q23. 

 IF C10Q02A = 1-5 OR C10Q02B = 1-5, ASK C10Q20. ELSE, SKIP TO C10Q21. 

C10Q20 IF S.C. = NIS-ELIG CHILD AND (C10Q02A=1 OR C10Q02B=1), THEN FILL with NIS 

variable C6_06Q3_x as appropriate. 

 IF S.C. = S.T. AND (C10Q02A=1 OR C10Q02B=1), THEN FILL FROM TIS_C6 

 CATI INSTRUCTION (C10Q20): IF C10Q02A = 1-5, FILL “you have”. ELSE, FILL 

“[S.C.]’s [MOTHER TYPE] has” 

 What is the highest grade or year of school [you have / [S.C.]’s [MOTHER TYPE] has] 

completed? 

(1) 8th GRADE OR LESS 

(2) 9th-12th GRADE NO DIPLOMA 

(3) HIGH SCHOOL GRADUATE OR GED COMPLETED 

(4) COMPLETED A VOCATIONAL, TRADE, OR BUSINESS SCHOOL PROGRAM 

(5) SOME COLLEGE CREDIT BUT NO DEGREE 

(6) ASSOCIATE DEGREE (AA, AS) 

(7) BACHELOR’S DEGREE (BA, BS, AB) 

(8) MASTER’S DEGREE (MA, MS, MSW, MBA) 

(9) DOCTORATE (PhD, EdD) or PROFESSIONAL DEGREE (MD, DDS, DVM, JD) 

(77) DON’T KNOW 

(99) REFUSED 

HELP SCREEN (C10Q20): AT THIS QUESTION, COLLECT INFORMATION ABOUT 

THE MOTHER (BIOLOGICAL, STEP, FOSTER, ADOPTIVE) LIVING IN THIS HOUSE. 

CPC10Q21 IF C10Q02A = 6-10 OR C10Q02B = 6-10, ASK C10Q21. ELSE, SKIP TO C10Q22. 

C10Q21 CATI INSTRUCTION (C10Q21): IF C10Q20 NOT BLANK AND C10Q02A = 6-10, ASK: 

“And how about you?” 

 READ AS NECESSARY: “What is the highest grade or year of school you have completed?” 

 IF C10Q20 NOT BLANK AND C10Q02A <> 6-10, ASK: “And how about [S.C.]’s [FATHER 

TYPE]?” 

 READ AS NECESSARY: “What is the highest grade or year of school [S.C.]’s [FATHER TYPE] 

has completed?” 

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Series 1, No. 57 □ Page 159

IF C10Q20 IS BLANK AND C10Q02A = 6-10, ASK: “What is the highest grade or year of 

school you have completed?” 

IF C10Q20 IS BLANK AND C10Q02A <> 6-10, ASK: “What is the highest grade or year of 

school [S.C.]’s [FATHER TYPE] has completed?” 

IF C10Q20 FILLED FROM NIS AND C10Q02A = 6-10, ASK: "What is the highest grade or year 

of school you have completed?" 

IF C10Q20 FILLED FROM NIS AND C10Q02A <> 6-10, ASK: "What is the highest grade or 

year of school [S.C.]'s [FATHER TYPE] has completed?" 

HELP SCREEN: AT THIS QUESTION, COLLECT INFORMATION ABOUT THE FATHER 

(BIOLOGICAL, STEP, FOSTER, ADOPTIVE) LIVING IN THIS HOUSE. 

(1) 8th GRADE OR LESS 

(2) 9th-12th GRADE NO DIPLOMA 

(3) HIGH SCHOOL GRADUATE OR GED COMPLETED 

(4) COMPLETED A VOCATIONAL, TRADE, OR BUSINESS SCHOOL PROGRAM 

(5) SOME COLLEGE CREDIT BUT NO DEGREE 

(6) ASSOCIATE DEGREE (AA, AS) 

(7) BACHELOR’S DEGREE (BA, BS, AB) 

(8) MASTER’S DEGREE (MA, MS, MSW, MBA) 

(9) DOCTORATE (PhD, EdD) or PROFESSIONAL DEGREE (MD, DDS, DVM, JD) 

(77) DON’T KNOW 

(99) REFUSED 

HELP SCREEN (C10Q21): AT THIS QUESTION, COLLECT INFORMATION ABOUT 

THE FATHER (BIOLOGICAL, STEP, FOSTER, ADOPTIVE) LIVING IN THIS HOUSE. 

CPC10Q22 IF C10Q02A <> 1-10, ASK C10Q22. ELSE SKIP TO ETH. 

C10Q22 CATI INSTRUCTION (C10Q22): IF (C10Q20 IS NOT BLANK AND NOT FILLED FROM 

NIS OR TEEN) OR C10Q21 IS NOT BLANK, ASK: “And how about you?” 

READ AS NECESSARY: “What is the highest grade or year of school you have completed?” 

IF C10Q20 AND C10Q21 ARE BLANK, ASK: “What is the highest grade or year of school you 

have completed?” 

HELP SCREEN: AT THIS QUESTION, COLLECT INFORMATION ABOUT THE 

[TEXTFILL: answer from C10Q02A (see TEXTFILL logic)] LIVING IN THIS HOUSE. 

(1) 8th GRADE OR LESS 

(2) 9th-12th GRADE NO DIPLOMA 

(3) HIGH SCHOOL GRADUATE OR GED COMPLETED 

(4) COMPLETED A VOCATIONAL, TRADE, OR BUSINESS SCHOOL PROGRAM 

(5) SOME COLLEGE CREDIT BUT NO DEGREE 

(6) ASSOCIATE DEGREE (AA, AS) 

(7) BACHELOR’S DEGREE (BA, BS, AB) 

(8) MASTER’S DEGREE (MA, MS, MSW, MBA) 

(9) DOCTORATE (PhD, EdD) or PROFESSIONAL DEGREE (MD, DDS, DVM, JD) 

(77) DON’T KNOW 

(99) REFUSED 
 

 

 

2009-2010 National Survey of Children with Special Health Care Needs Page 106 

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HELP SCREEN (C10Q22): AT THIS QUESTION, COLLECT INFORMATION ABOUT 

THE RESPONDENT. 

CPC10Q23 IF CWTYPE = S, THEN SKIP TO ETH ELSE GO TO C10Q23. 

C10Q23 What is the highest level of school that any parent in the household has completed or the highest 

degree any parent in the household has received? 

(1) 8th GRADE OR LESS 

(2) 9th-12th GRADE NO DIPLOMA 

(3) HIGH SCHOOL GRADUATE OR GED COMPLETED 

(4) COMPLETED A VOCATIONAL, TRADE, OR BUSINESS SCHOOL PROGRAM 

(5) SOME COLLEGE CREDIT BUT NO DEGREE 

(6) ASSOCIATE DEGREE (AA, AS) 

(7) BACHELOR’S DEGREE (BA, BS, AB) 

(8) MASTER’S DEGREE (MA, MS, MSW, MBA) 

(9) DOCTORATE (PhD, EdD) or PROFESSIONAL DEGREE (MD, DDS, DVM, JD) 

(77) DON’T KNOW 

(99) REFUSED 

HELP SCREEN (C10Q23): IF RESPONDENT INDICATES THAT NO PARENTS LIVE 

IN THE HOUSEHOLD, THEN ASK FOR THE HIGHEST LEVEL OF SCHOOL 

COMPLETED BY ANY ADULT IN THE HOUSEHOLD. 

ETH IF S_UNDR18=1 THEN DISPLAY: Is [S.C./AGEID] of Hispanic, Latino, or Spanish origin? 

 IF S_UNDR18=2 THEN DISPLAY: 

 My next questions are about all of the children in your household. 

 Are either of the [S_UNDR18] children in your household of Hispanic, Latino, or Spanish origin? 

 IF S_UNDR18 > 2 THEN DISPLAY: My next questions are about all of the children in your 

household. 

 Are any of the [S_UNDR18] children in your household of Hispanic, Latino, or Spanish origin? 

 

 (1) YES [IF S_UNDR18 > 1 GO TO ETH_B ] 

 (2) NO [GO TO C10Q32 _X] 

 (77) DON’T KNOW [GO TO C10Q32 _X] 

 (99) REFUSED [GO TO C10Q32 _X] 

ETH_B Is that [PICKLIST CONSISTING OF CHILDREN LISTED AS IN AGEID]? 

C10Q32_X DISPLAY FOR C10Q32_1: Please choose one or more of the following categories to describe 

[FILL IN S.C./AGEID for Roster Position 1]'s race. 

 Is [FILL IN S.C./AGEID for Roster Position 1] White, Black or African American, American 

Indian, Alaska Native, Asian, Native Hawaiian, or other Pacific Islander? 

 FOR C10Q32_2 - C10Q32_9, if all questions C10Q32_x prior have been filled from NIS or Teen, 

DISPLAY: Please choose one or more of the following categories to describe [FILL IN 

S.C./AGEID for Roster Position]'s race. 

Is [FILL IN S.C./AGEID for Roster Position] White, Black or African American, American 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2009-2010 National Survey of Children with Special Health Care Needs Page 107 

Series 1, No. 57 □ Page 161

Indian, Alaska Native, Asian, Native Hawaiian, or other Pacific Islander?
 

FOR C10Q32_2 - C10Q32_9, if any previous C10Q32_x question has been asked (not filled from
 

NIS or Teen), THEN DISPLAY:
 

And how about [FILL IN S.C./AGEID]?
 

HELP SCREEN: RACE INFORMATION IS COLLECTED BY SELF-IDENTIFICATION. IT
 

IS "WHATEVER RACE YOU CONSIDER YOURSELF TO BE." DO NOT TRY TO EXPLAIN 

OR DEFINE ANY OF THE GROUPS. MULTIPLE RACES MAY BE SELECTED.
 

[MARK ALL THAT APPLY]
 

(1) WHITE / CAUCASIAN 

(2) BLACK/ AFRICAN AMERICAN 

(3) AMERICAN INDIAN / NATIVE AMERICAN 

(4) ALASKA NATIVE 

(5) ASIAN 

(6) NATIVE HAWAIIAN 

(7) PACIFIC ISLANDER 

(8) OTHER (SPECIFY) 

IF 8, ASK C10Q32A_X. ELSE SKIP TO C10Q40. 

ASK FOR ALL CHILDREN IN THE HOUSEHOLD. 

[IF C10Q32X08	 = 1, ASK C10Q32A. ELSE SKIP TO C10Q40]. 

C10Q32A_X	 ENTER OTHER DESCENT 

[Fill with NIS variable C3_OTHR as 

appropriate if S.C.= NIS eligible child. 

IF S.C. = ST then FILL WITH TIS_C4_OTHR] 

C10Q40	 What is the primary language spoken in your home? 

[READ RESPONSES ONLY IF NECESSARY] 

(1) ENGLISH 

(2) SPANISH 

(3) ANY OTHER LANGUAGE 

(77) DON’T KNOW 

(99) REFUSED 

C10Q41	 Do you own or rent your home? 

HELP SCREEN: IF THE HOME IS OWNED OR BEING BOUGHT BY SOMEONE IN THE 

HOUSEHOLD, THE ANSWER SHOULD BE MARKED AS “OWNED.” IF THE HOME IS 

NOT OWNED BY SOMEONE IN THE HOUSEHOLD AND IS BEING OCCUPIED 

WITHOUT PAYMENT OF RENT, THE ANSWER SHOULD BE MARKED AS “SOME 

OTHER ARRANGEMENT.” 

(1) OWNED OR BEING BOUGHT 

(2) RENTED 

(3) SOME OTHER ARRANGEMENT 

(77) DON’T KNOW 

(99) REFUSED 
 

 

 

 

 

 

 

2009-2010 National Survey of Children with Special Health Care Needs Page 108 

Page 162 □ Series 1, No. 57

Section 11. INCOME 

IF ANY NIS INTERVIEW WAS DONE IN THIS HH, SKIP TO C11Q12 – FILL DATA FROM NIS 

VARIABLE – CFAMINC; ELSE CONTINUE 

[TIMESTAMP_SECTION111] 

C11Q01	 What was the total combined income of your household in [CATI: FILL LAST CALENDAR 

YEAR], including income from all sources such as wages, salaries, unemployment payments, 

public assistance, Social Security or retirement benefits, help from relatives and so forth? Can you 

tell me that amount before taxes? 
 

 [CATI: 9 NUMERIC-CHARACTER FIELD] 

RECORD INCOME $___________________ 

(77) DON’T KNOW [SKIP TO C11Q01_DONT_KNOW] 

(99) REFUSED [SKIP TO C11Q01_REFUSED] 

HELP SCREEN: RESPONDENT MAY GIVE A RANGE AS AN ANSWER TO THIS 

QUESTION. BE PREPARED TO PROBE FOR A MORE ACCURATE ANSWER. 

IF NIS VARIABLE CFAMINC IS ANSWERED, FILL DATA FROM NIS VAR CFAMINC. 

IF SUC=4 AND NO NIS INTERVIEW COMPLETED AND TEEN WAS COMPLETED, FILL 

FROM TIS_CFAMINC. 

C11CONF (NIS VARIABLE - CINC) 

Just to confirm that I entered it correctly, your household income was about (FILL AMOUNT 

FROM C11Q01). Is that correct? 

(1) YES [SKIP TO C11Q12] 

(2) NO [SKIP BACK TO C11Q01] 

C11Q01 _ (NIS VARIABLE - C12_DONT_KNOW) 

DON’T You may not be able to give us an exact figure for your total combined household income, but was 

KNOW your total household income during [FILL LAST CALENDAR YEAR] more or less than 

 $20,000. 

 (1) MORE THAN $20,000 [SKIP TO W9Q06] 

(2) $20,000 [SKIP TO CPC11Q12] 

(3) LESS THAN $20,000 [SKIP TO W9Q03] 

(77) DON'T KNOW [SKIP TO CPC11Q12] 

(99) REFUSED [SKIP TO CPC11Q12] 

C11Q01_ (NIS VARIABLE C12_REFUSED) 

REFUSED Income is important in analyzing the health care information we collect. For example, this 

information helps us to learn whether persons in one group use these medical services more or less 

than those in another group. Now you may not be able to give us an exact figure for your total 

combined household income, but was your total household income during [FILL LAST 

CALENDAR YEAR] more or less than $20,000? 

 (1) MORE THAN $20,000 [SKIP TO W9Q06] 

(2) $20,000 [SKIP TO CPC11Q12] 

(3) LESS THAN $20,000 [SKIP TO W9Q03] 

(77) DON'T KNOW [SKIP TO CPC11Q12] 

(99) REFUSED [SKIP TO CPC11Q12] 

W9Q03 (NIS VARIABLE - C13) 

Was the total combined household income more or less than $10,000? 

(1) MORE THAN $10,000 [SKIP TO W9Q05] 

(2) $10,000 [SKIP TO C11Q12] 

(3) LESS THAN $10,000 [SKIP TO W9Q04] 

(77) DON’T KNOW [SKIP TO C11Q12] 

(99) REFUSED [SKIP TO C11Q12] 

2009-2010 National Survey of Children with Special Health Care Needs Page 109 

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Page 164 □ Series 1, No. 57

W9Q04 (NIS VARIABLE - C14A) 

Was it more than $7,500? 

(1) YES [SKIP TO W9Q12] 

(2) NO [SKIP TO W9Q12] 

(77) DON’T KNOW [SKIP TO C11Q12] 

(99) REFUSED [SKIP TO C11Q12] 

W9Q05 (NIS VARIABLE - C15) 

Was it more than $15,000? 

(1) YES [SKIP TO W9Q05A] 

(2) NO [SKIP TO W9Q05B] 

(77) DON’T KNOW [SKIP TO C11Q12] 

(99) REFUSED [SKIP TO C11Q12] 

W9Q05A (NIS VARIABLE - C15A) 

 Was it more than $17,500? 

(1) YES [SKIP TO W9Q12] 

(2) NO [SKIP TO W9Q12] 

(77) DON’T KNOW [SKIP TO C11Q12] 

(99) REFUSED [SKIP TO C11Q12] 

W9Q05B (NIS VARIABLE - C15B) 

 Was it more than $12,500? 

(1) YES [SKIP TO W9Q12] 

(2) NO [SKIP TO W9Q12] 

(77) DON’T KNOW [SKIP TO C11Q12] 

(99) REFUSED [SKIP TO C11Q12] 

W9Q06 (NIS VARIABLE - C16) 

(READ IF NECESSARY: Was the total combined household income) 

more or less than $40,000? 

(1) MORE THAN $40,000 [SKIP TO W9Q06A] 

(2) $40,000	 [SKIP TO C11Q12] 

(3) LESS THAN $40,000 [SKIP TO W9Q07] 

(77) DON’T KNOW [SKIP TO C11Q12] 

(99) REFUSED	 [SKIP TO C11Q12] 

W9Q06A	 (NIS VARIABLE - C16A) 

(READ IF NECESSARY: Was the total combined household income) 

more or less than $60,000? 

(1) MORE THAN $60,000 [SKIP TO W9Q08] 

(2) $60,000	 [SKIP TO C11Q12] 

(3) LESS THAN $60,000 [SKIP TO W9Q06B] 

(77) DON’T KNOW [SKIP TO C11Q12] 

(99) REFUSED	 [SKIP TO C11Q12] 

W9Q06B	 (NIS VARIABLE - C16B) 

(READ IF NECESSARY: Was the total combined household income) 

more or less than $50,000? 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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(1) MORE THAN $50,000 [SKIP TO W9Q12] 

(2) $50,000	 [SKIP TO C11Q12] 

(3) LESS THAN $50,000 [SKIP TO W9Q06C] 

(77) DON’T KNOW [SKIP TO C11Q12] 

(99) REFUSED	 [SKIP TO C11Q12] 

W9Q06C	 (NIS VARIABLE - C16C) 

(READ IF NECESSARY: Was the total combined household income) 

more or less than $45,000? 

(1) MORE THAN $45,000 [SKIP TO W9Q12] 

(2) $45,000	 [SKIP TO C11Q12] 

(3) LESS THAN $45,000 [SKIP TO W9Q12] 

(77) DON’T KNOW [SKIP TO C11Q12] 

(99) REFUSED	 [SKIP TO C11Q12] 

W9Q07	 (NIS VARIABLE - C17) 

(READ IF NECESSARY: Was the total combined household income) 

income more or less than $30,000? 

(1) MORE THAN $30,000 [SKIP TO W9Q07A] 

(2) $30,000	 [SKIP TO C11Q12] 

(3) LESS THAN $30,000 [SKIP TO W9Q07B] 

(77) DONT KNOW [SKIP TO C11Q12] 

(99) REFUSED	 [SKIP TO C11Q12] 

W9Q07A	 (NIS VARIABLE - C17A) 

(READ IF NECESSARY: Was the total combined household income) 

more or less than $35,000? 

(1) MORE THAN $35,000 [SKIP TO W9Q12] 

(2) $35,000	 [SKIP TO C11Q12] 

(3) LESS THAN $35,000 [SKIP TO W9Q12] 

(77) DON’T KNOW [SKIP TO C11Q12] 

(99) REFUSED	 [SKIP TO C11Q12] 

W9Q07B	 (NIS VARIABLE - C17B) 

(READ IF NECESSARY: Was the total combined household income) 

more or less than $25,000? 

(1) MORE THAN $25,000 [SKIP TO W9Q12] 

(2) $25,000	 [SKIP TO C11Q12] 

(3) LESS THAN $25,000 [SKIP TO W9Q12] 

(77) DONT KNOW [SKIP TO C11Q12] 

(99) REFUSED	 [SKIP TO C11Q12] 

W9Q08	 (NIS VARIABLE - C18) 

(READ IF NECESSARY: Was the total combined household income) 

more or less than $75,000? 

(1) MORE THAN $75,000 [SKIP TO W9Q12] 

(2) $75,000	 [SKIP TO C11Q12] 

(3) LESS THAN $75,000 [SKIP TO W9Q12] 

(77) DONT KNOW [SKIP TO C11Q12] 

(99) REFUSED	 [SKIP TO C11Q12] 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Page 166 □ Series 1, No. 57

W9Q12 (CHECK_I12) 

BASED ON THE RANGE ALREADY IDENTIFIED, THIS NEXT QUESTION WILL BE 

FILLED WITH A DOLLAR AMOUNT THAT FALLS WITHIN THE RANGE AND IS 

EQUIVALENT TO 50%, 100%, 133%, 150%, 185%, 200%, 300%, OR 400% OF THE 

FEDERAL POVERTY LEVEL BASED ON THE NUMBER OF FAMILY MEMBERS. IF 

THE RANGE IDENTIFIED IS NARROW ENOUGH THAT NONE OF THESE POVERTY 

LEVEL CUTOFFS FALL WITHIN THE RANGE, THEN SKIP TO C11Q12. FOR A 

FEW RANGES, TWO ADDITIONAL QUESTIONS WILL BE NEEDED. 

Would you say this income was above or below [$REF]? 

(1) MORE THAN [$REF] [WHEN INDICATED, ASK W9Q12A] 

(2) EXACTLY [$REF] [SKIP TO C11Q12] 

(3) LESS THAN [$REF] [SKIP TO C11Q12] 

(77) DON’T KNOW [SKIP TO C11Q12] 

(99) REFUSED	 [SKIP TO C11Q12] 

W9Q12A	 Would you say this income was above or below [$REF]? 

(1) MORE THAN [$REF] [SKIP TO C11Q12] 

(2) EXACTLY [$REF] [SKIP TO C11Q12] 

(3) LESS THAN [$REF] [SKIP TO C11Q12] 

(77) DON’T KNOW [SKIP TO C11Q12] 

(99) REFUSED	 [SKIP TO C11Q12] 

IF NIS OR TEEN COMPLETED, SKIP TO CPC11Q12. 

CPC11Q12	 [IF CWTYPE=N, SKIP TO C11Q11] 

C11Q12	 Does [S.C.] receive SSI, that is, Supplemental Security Income? 

(1) YES 

(2) NO	 [SKIP TO C11Q11] 

(77) DON’T KNOW [SKIP TO C11Q11] 

(99) REFUSED	 [SKIP TO C11Q11] 

C11Q13	 Is this for a disability [he/she] has? 

(1) YES 

(2) NO 

(77) DON’T KNOW 

(99) REFUSED 

CPC11Q11	 IF CWTYPE = N, GO TO CPC11Q14 ELSE ASK C11Q11 ONLY IN HH WITH INCOME 

UNDER 200% POVERTY, BASED ON RESULTS FROM TABLE, ELSE SKIP TO 

CPK11Q30. 

C11Q11	 At any time during the past 12 months, even for one month, did anyone in this household 

receive any cash assistance from a state or county welfare program, such as [FILL STATE 

NAME]? 

(1) YES 

(2) NO 

(77) DON’T KNOW 
 

 

2009-2010 National Survey of Children with Special Health Care Needs Page 113 

Series 1, No. 57 □ Page 167

(99) REFUSED 

[TIMESTAMP_SECTION111A] 

CPK11Q30 IF CWTYPE=S AND ASK_CALIF=1 THEN GO TO K11Q30, ELSE GO TO CPC11Q14, 

K11Q30*CA IF C10Q02A=1-5, FILL “WERE YOU”. ELSE, FILL “WAS [S.C.]’S [MOTHER TYPE]” 

 [WERE YOU / WAS [S.C.]’S [MOTHER TYPE]] BORN IN THE UNITED STATES? 

HELP SCREEN: AT THIS QUESTION, COLLECT INFORMATION ABOUT THE MOTHER 

(BIOLOGICAL, STEP, FOSTER, ADOPTIVE) LIVING IN THIS HOUSE. 

(1) YES 

(2) NO 

(77) DON’T KNOW 

(99) REFUSED 

 IF (C10Q02A=1-5 OR C10Q02B=1-5), ASK K11Q30. ELSE, SKIP TO K11Q31. 

K11Q31*CA IF K11Q30 NOT BLANK AND C10Q02A=6-10, ASK: “And how about you?” 

 READ AS NECESSARY: “Were you born in the United States?” 

IF K11Q30 NOT BLANK AND C10Q02A NOT equal 6-10, ASK: “And how about [S.C.]’s 

[FATHER TYPE]?” 

 READ AS NECESSARY: “Was [S.C.]’s [FATHER TYPE] born in the United States?” 

 IF K11Q30 IS BLANK AND C10Q02A=6-10, ASK: “Were you born in the United States?” 

IF K11Q30 IS BLANK AND C10Q02A not equal 6-10, ASK: “Was [S.C.]’s [FATHER 

TYPE] born in the United States?” 

HELP SCREEN: AT THIS QUESTION, COLLECT INFORMATION ABOUT THE 

FATHER (BIOLOGICAL, STEP, FOSTER, ADOPTIVE) LIVING IN THIS HOUSE. 

(1) YES 

(2) NO 

(77) DON’T KNOW 

(99) REFUSED 

IF (C10Q02A=6-10 OR C10Q02B=6-10), ASK K11Q31. ELSE, SKIP TO CPK11Q32. 

CPK11Q32 IF C10Q02A NOT equal 1-10, ASK K11Q32. ELSE SKIP TO K11Q33. 

K11Q32*CA IF K11Q30 OR K11Q31 ARE NOT BLANK, ASK: “And how about you?” 

 

 READ AS NECESSARY: “Were you born in the United States?” 

 

 IF K11Q30 AND K11Q31 ARE BLANK, ASK: “Were you born in the United States?” 

HELP SCREEN: AT THIS QUESTION, COLLECT INFORMATION ABOUT THE 

[TEXTFILL: answer from C10Q02A (see TEXTFILL logic)] LIVING IN THIS HOUSE. 

(1) YES 

(2) NO 
 

2009-2010 National Survey of Children with Special Health Care Needs Page 114 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Page 168 □ Series 1, No. 57

(77) DON’T KNOW 

(99) REFUSED 

K11Q33*CA And how about [S.C.]? 

READ AS NECESSARY: Was [S.C.] born in the United States? 

(1) YES 

(2) NO 

(77) DON’T KNOW 

(99) REFUSED 

K11Q34A*CA	 IF C10Q02A=1-5, FILL “have you”. ELSE, FILL “has [S.C.]’s [MOTHER TYPE]” 

How long [have you / has [S.C.]’s [MOTHER TYPE]] been in the United States? 

HELP SCREEN: AT THIS QUESTION, COLLECT INFORMATION ABOUT THE 

MOTHER(BIOLOGICAL, STEP, FOSTER, ADOPTIVE) LIVING IN THIS HOUSE. 

ENTER NUMBER: ________ 

(777) DON’T KNOW 

(999) REFUSED 

K11Q34B*CA [MARK PERIOD] 

(1) DAYS 

(2) WEEKS 

(3) MONTHS 

(4) YEARS 

K11Q35A*CA	 IF K11Q34A NOT BLANK AND C10Q02A=6-10, ASK: “And how about you?” 

READ AS NECESSARY: “How long have you been in the United States?” 

IF K11Q34A NOT BLANK AND C10Q02A NOT equal 6-10, ASK: “And how about [S.C.]’s 

[FATHER TYPE]?”
	

READ AS NECESSARY: “How long has [S.C.]’s [FATHER TYPE] been in the United States?”
	

IF K11Q34A IS BLANK AND C10Q02A=6-10, ASK: “How long have you been in the United
 

States?”
	

IF K11Q34A IS BLANK AND C10Q02A NOT equal 6-10, ASK: “How long has [S.C.]’s
	

[FATHER TYPE] been in the United States?”
	

HELP SCREEN: AT THIS QUESTION, COLLECT INFORMATION ABOUT THE FATHER 

(BIOLOGICAL, STEP, FOSTER, ADOPTIVE) LIVING IN THIS HOUSE. 

ENTER NUMBER: ________ 

(777) DON’T KNOW 

(999) REFUSED 

K11Q35B*CA [MARK PERIOD] 

(1) DAYS 

(2) WEEKS 
 

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Series 1, No. 57 □ Page 169

(3) MONTHS 

(4) YEARS 

CPK11Q36A IF C10Q02A NOT equal 1-10 AND K11Q32 = 2, ASK K11Q36A. ELSE SKIP TO K11Q37A. 

K11Q36A*CA IF K11Q34A OR K11Q35A ARE NOT BLANK, ASK: “And how about you?” 

READ AS NECESSARY: “How long have you been in the United States?”
	

IF K11Q34A AND K11Q35A ARE BLANK, ASK: “How long have you been in the United
	

States?”
	

HELP SCREEN: AT THIS QUESTION, COLLECT INFORMATION ABOUT THE 

[TEXTFILL: answer from C10Q02A (see TEXTFILL logic)] LIVING IN THIS HOUSE. 

ENTER NUMBER: ________ 

(777) DON’T KNOW 

(999) REFUSED 

K11Q36B*CA [MARK PERIOD] 

(1) DAYS 

(2) WEEKS 

(3) MONTHS 

(4) YEARS 

K11Q37A*CA	 IF K11Q33 = 2, ASK K11Q37A. ELSE SKIP TO CPC11Q14. 

IF K11Q34A, K11Q35A, OR K11Q36A ARE NOT BLANK, ASK: “And how about [S.C.]?” 

READ AS NECESSARY: “How long has [S.C.] been in the United States?” 

IF K11Q34A, K11Q35A, AND K11Q36A ARE BLANK, ASK: “How long has [S.C.] been in the 

United States?” 

ENTER NUMBER: ________ 

(777) DON’T KNOW 

(999) REFUSED 

K11Q37B*CA [MARK PERIOD] 

(1) DAYS 

(2) WEEKS 

(3) MONTHS 

(4) YEAR 
 

 

 

 

2009-2010 National Survey of Children with Special Health Care Needs Page 116 

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Section 11A. TELEPHONE LINE AND HOUSEHOLD INFORMATION 

[TIMESTAMP_SECTION112] 

CPC11Q14	 IF NIS OR TEEN INTERVIEW PERFORMED IN THIS HOUSEHOLD, FILL DATA FROM 

NIS OR TEEN VARIABLES AND SKIP TO CP_CELLUSUALLY. ELSE GO TO 

C11Q15_CELL. 

C11Q15_CELL FILL FROM NIS VARIABLE C21_06Q3_CELL OR TEEN VARIABLE TIS_C21_06Q3_CELL 

The next few questions are about the telephones in your household. 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2009-2010 National Survey of Children with Special Health Care Needs Page 117 

Series 1, No. 57 □ Page 171

In total, how many working cell phones do you and your household members have available for 

personal use? Please do not count cell phones that are used exclusively for business purposes [IF 

RDD_NCCELL_CELL=2,3 then display: "and please include the number we called."] 

(1) ONE 

(2) TWO 

(3) THREE OR MORE 

(4) NONE [GO TO C11Q20] 

(77) DON'T KNOW 

(99) REFUSED 

CP_CELLUSUALLY 

IF NIS OR TEEN COMPLETED AND C21_06Q3_CELL OR TIS_C21_06Q3_CELL = 2 OR 3, 

GO TO C11Q15_CELL_USUALLY 

ELSE IF NIS OR TEEN COMPLETED AND C21_06Q3_CELL OR TIS_C21_06Q3_CELL = 

1,4, 77, 99, GO TO CP_CELLOM 

ELSE GO TO C11Q15_CELL_USUALLY 

C11Q15_CELL_USUALLY 

[IF NIS OR TEEN COMPLETED AND C21_06Q3_CELL = 2 OR 3, DISPLAY: “Earlier you 

told me that you have at least one cell phone in your household.”] 

How many of these cell phones do the adults in this household usually use? [If 

RDD_NCCELL_CELL=2,3 DISPLAY: "Please include the number we called."] 

[IF RDD_NCCELL_CELL=2,3 then display: "INTERVIEWER NOTE: THE NUMBER WE 

CALLED IS ASSUMED TO BE USUALLY USED, SO THE ANSWER MUST BE AT LEAST 

"ONE""] 

(1) ONE 

(2) TWO 

(3) THREE OR MORE 

(4) NONE 

(77) DON’T KNOW 

(99) REFUSED 

CP_CELLOM	 IF CELL_OM = 1 THEN GO TO CP_CELLONLY, ELSE GO TO C11Q16 

C11Q16	 (NIS VARIABLE – C11Q78) 

[(IF NIS DONE AND C11Q78 EQ MISSING AND C21_06Q3_CELL NE 4) OR (IF TEEN 

DONE AND TIS_C11Q78 EQ MISSING AND TIS_C21_06Q3_CELL NE 4), THEN READ 

"Earlier you told me that you have at least one cell phone in your household."] 

Of all the telephone calls that you and your household receive, are nearly all received on cell 

phone, nearly all received on regular phones, or some received on cell phones and some received 

on regular phones? 

(1) NEARLY ALL RECEIVED ON CELL PHONES 

(2) NEARLY ALL RECEIVED ON REGULAR PHONES 

(3) SOME RECEIVED ON CELL PHONES AND SOME RECEIVED ON REGULAR PHONES 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 On what island do you live? 

 (1) SAINT CROIX [GO TO CP_ADDRESS] 

 (2) SAINT THOMAS [GO TO CP_ADDRESS] 

 (3) SAINT JOHN [GO TO CP_ADDRESS] 

 (4) WATER ISLAND [GO TO CP_ADDRESS] 

 (5) DON’T LIVE IN VIRGIN ISLANDS [GO TO C11Q22] 

 (77) DON’T KNOW [GO TO C11Q22] 

 (99) REFUSED [GO TO C11Q22] 

C11Q22 (NIS VARIABLE – C19A) 

 Please tell me your zip code. 

 

 

 

 

 

 

 

 

 

2009-2010 National Survey of Children with Special Health Care Needs Page 118 

Page 172 □ Series 1, No. 57

(77) DON’T KNOW 

(99) REFUSED 

CP_ CELLONLY IF CELL_OM = 1 THEN GO TO CPC11Q17, ELSE GO TO C11Q20 

C11Q20	 (NIS VARIABLE – CNOSERV) 

Not including cell phones, has your household been without telephone service for 1 week or more 

during the past 12 months? 

(1) YES [SKIP TO CPC11Q17] 

(2) NO [SKIP TO CPC11Q17] 

(77) DON’T KNOW [SKIP TO CPC11Q17] 

(99) REFUSED [SKIP TO CPC11Q17] 

[TIMESTAMP_SECTION113] 

CPC11Q17 IF CWTYPE=S AND ASK_CALIF=1 THEN GO TO C11Q17, ELSE GO TO CPV_ISLAND. 

C11Q17*CA Do you have access to the internet at home? 

(1) YES 

(2) NO 

(77) DON’T KNOW 

(99) REFUSED 

[TIMESTAMP_SECTION114] 

CPV_ISLAND IF IAP=95 THEN GO TO V_ISLAND, ELSE GO TO C11Q22. 

V_ISLAND IF NIS COMPLETE FILL FROM C_ISLAND. 

IF TEEN COMPLETE FROM TIS_C_ISLAND. 

[CATI: 5 NUMERIC-CHARACTER-FIELD, RANGE 00001-99998] 

_____ _____ _____ ____ _____ (00001-99998) 

(77777) DON’T KNOW 

(99999) REFUSED 

C11Q22_CONF	 [IF C11Q22 FILLED FROM C19A or TIS_C19A, THEN "Earlier you told me your zip code is" / 

IF C11Q22 ASKED, THEN "I entered"] [FILL C11Q22], is that correct? 

(1) YES	 [GO TO LOC_STATE] 

(2) NO	 [GO TO C11Q22] 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2009-2010 National Survey of Children with Special Health Care Needs Page 119 

Series 1, No. 57 □ Page 173

LOC_STATE	 What state do you live in? 

______________(DROP DOWN MENU OF STATE NAMES) [THIS DOES NOT CHANGE 

‘STATE’ FROM THE SAMPLE PRE-FILL TABLE] 

CSHCN_END 

CP_ADDRESS 

IF LOCATE_FLAG = 1 THEN GO TO LOCATE_TRANSITION. 

IF LOCATE_FLAG = 0 AND CASE DID NOT QUALIFY FOR NIS OR CSHCN 

INCENTIVES, GO TO CWEND. 

ELSE IF LOCATE_FLAG = 0 AND CASE DID QUALIFY FOR INCENTIVES, GO TO 

INCENTIVE_ADDRESS 

LOCATE 

_TRANSITION	 We may want to contact you in the future to ask questions about the health and health care of 

[S.C.]. By participating in future surveys, you will help us better understand the health and health 

care needs of children and adolescents in your state and the nation. 

LOCATE
 

_NUMBER Is there another number where we can reach you if this number isn't working for some reason?
 

(1) YES [GO TO LOCATE_NUMBERGIVEN] 

(2) NO [GO TO LOCATE_ADDRESS] 

LOCATE
 

_NUMBERGIVEN _ _ _ - _ _ _ - _ _ _ _
 

ENTER TELEPHONE NUMBER 

LOCATE 

_NUMBERGIVEN_A 

(1) TELEPHONE NUMBER COMPLETE [GO TO TELETYPE] 

(2) ENTER TELEPHONE EXTENSION [GO TO LOCATE_NUMBER_EXT] 

LOCATE 

_NUMBER_EXT 

INTERVIEWER INSTRUCTION: ENTER EXTENSION TO TELEPHONE NUMBER. 

____ TELEPHONE EXTENSION 

ALLOW FOR UP TO FIVE NUMBERS 

TELETYPE	 Is this telephone number a cell phone, landline, work number or other type? 

(1) CELL 

(2) LANDLINE 

(3) WORK 

(4) OTHER GO TO LOCATE_ADDRESS 

LOCATE_ADDRESS 

If we call you back in the future, we may want to mail you a letter explaining more about the 

survey and the questions we will ask. 

IF CASE QUALIFIED FOR CSHCN INCENTIVE 

THEN READ: We'd also like to mail you [MONEY_1 / MONEY_2] as a token of our 

appreciation for taking the time to answer our questions.] 
 

[FOR SECOND FILL: If INCENT_GRP=1 USE $10, IF INCENT_GRP = 2 USE $15] 

[If INCENTIVE > 0 and AC_NIS_INCENT_EXIT not previously read, READ: In addition, the 

National Immunization Study will be sending you $[10/15], which you may have already 

received.] 

[IF NO ADDRESS, READ: 

Would you please give me your address?] 

[IF ADDRESS ALREADY OBTAINED, READ: 

Would you please verify your address?] 

GO TO AC_NAME AND PROCEED THROUGH ADDRESS COLLECTION OR 

VERIFICATION THEN GO TO LOCATING_NAME. 

CPNAME IF NAME OF SC GIVEN DURING SURVEY, THEN SKIP TO PNAME 

ELSE GO TO LOCATING_NAME. 

LOCATING 

_NAME I could refer to your child as [AGEID] if we call you back, or if you prefer, you could give me a 

first name or initials. 

 

(1) CONTINUE TO USE AGE REFERENCE, GO TO PNAME 

(2) USE NAME > GO TO LOCATING_NAME_A 

LOCATING 

_NAME_A ENTER NAME/INITIALS: ____________ GO TO PNAME 

(99) REFUSED > GO TO PNAME 

PNAME Since following up with your household may be easier if we have your name, could you please 

give me your name or initials? 

(1) YES [GO TO PNAME_A] 

(2) NO [GO TO CWEND] 

PNAME_A ENTER NAME/INITIALS ____________ [GO TO CWEND] 

CSHCN 

_ADDRESS 

_CONF Those are all the questions I have. Before I go, I'll need your mailing address. 

[[IF CASE QUALIFIES FOR CSHCN INCENTIVE BY FULFILLING ANY OF THE 

FOLLOWING LOGIC: 

 IF CSHCN_INCENT = 1 AND CSHCN_INCENT_FLAG = 1 

 OR 

IF CSHCN_INCENT = 1 OR 2 AND CSHCN_INCENT_FLAG = 2 AND CSHCN_LTR_FLAG 

= 1 

 OR 

IF CSHCN_INCENT = 1 OR 2 AND CSHCN_PASSIVE = 1 OR 2 AND CSHCN_LTR_FLAG = 

1 THEN OFFER MONEY_1 

IF CSHCN_INCENT = 1 OR 2 AND CSHCN_INCENT_FLAG = 2 AND CSHCN_LTR_FLAG 

= 2 

 OR 

IF CSHCN_INCENT = 1 OR 2 AND CSHCN_PASSIVE = 1 OR 2 AND CSHCN_LTR_FLAG = 

2 THEN OFFER MONEY_2 

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2009-2010 National Survey of Children with Special Health Care Needs Page 121 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Series 1, No. 57 □ Page 175

OR
 

IF CSHCN_INCENT = 3 THEN OFFER MONEY_1]
 

THEN READ: so we can send you [MONEY_1 / MONEY_2] as a token of our appreciation for 

taking the time to answer our questions. 

[FOR SECOND FILL: IF INCENT_GRP=1 USE $10, IF INCENT_GRP = 2 USE $15] 

[If INCENTIVE > 0 AND AC_NIS_INCENT_EXIT NOT PREVIOUSLY READ AND 

QUALIFIED FOR CSHCN INCENTIVES, READ: In addition, the National Immunization Study 

will be sending you $[10/15], which you may have already received in the mail.] 

[IF INCENTIVE > 0 AND AC_NIS_INCENT_EXIT NOT PREVIOUSLY READ AND CASE 

DID NOT QUALIFY FOR CSHCN INCENTIVES, READ: so the National Immunization Study 

can send you $[10/15], which you may have already received in the mail.] 

[TIMESTAMP_ADD_EXTRA] 

CPGOGETMED 

IF ASK_ADD=1 AND C95Q01A = 77 GO TO GOGETMED. ELSE GO TO CPC12 

GOGETMED	 Earlier you told me that [S.C.] has taken medication for ADD or ADHD in the past week, however 

you did not know the name of the medication. Before we finish the interview, can you please take 

a moment to get [S.C.]'s medication so we may record the name of the medication? 

READ IF NECESSARY: If [S.C.] takes more than one medication for ADD or ADHD, please 

get all the medications so we can record each name. 

(1) YES [SKIP TO GOGETMED_CNFM] 

(99) REFUSED [GO TO CPC12] 

GOGETMED_CNFM 

READ AS NECESSARY: Please read the name of each medication that [S.C.] takes for ADD or 

ADHD. 

READ AS NECESSARY: Thank you for taking the time to get the medication. 

INTERVIEWER INSTRUCTIONS: MARK ALL THAT APPLY AMONG 1-18. DO NOT 

READ LIST. 

(1) ADDERALL (ADD-ur-all), ADDERALL XR, AMPHETAMINE (am-FET-a-meen) 

(2) CELEXA, CITALOPRAM (si-TAL-o-pram) 

(3) CONCERTA 

(4) DAYTRANA PATCH 

(5) DEXEDRINE, DEXEDRINE SPANSULE, DEXTROSTAT, DEXTRO-AMPHETAMINE 

(6) DEXMETHYLPHENIDATE 

(7) FLUOXETINE (floo-ox-e-teen) 

(8) FOCALIN, FOCALIN XR 

(9) METADATE, METADATE CD 

(10) METHYLIN 

(11) METHYLPHENIDATE 

(12) PROZAC 

(13) RITALIN, RITALIN LA, RITALIN SR 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2009-2010 National Survey of Children with Special Health Care Needs Page 122 

Page 176 □ Series 1, No. 57

(14) SERTRALINE (SER-tra-leen) 

(15) STRATTERA 

(16) VYVANSE 

(17) ZOLOFT 

(18) OTHER 

(55) COULD NOT FIND BOTTLE/NAME OF MEDICATION 

(99) REFUSED 

IF 1-17 OR 55, GO TO CPC12, IF 18 GO TO GOGETMED_OTH 

GOGETMED_OTH 

ENTER OTHER MEDICATION. IF MORE THAN ONE MEDICATION IS GIVEN ENTER 

ALL MEDICATIONS ON ONE LINE. 

_________________ENTER TEXT [SKIP TO CPC12] 

[TIMESTAMP_GOGET_END] 

CPC12	 IF SUC = 2 OR 4 AND HH HAS CHILD OR CHILDREN 0-18 MONTHS AND/OR 36-155 

MONTHS THEN COMPLETE A RANDOM SELECTION OF THIS CHILD/CHILDREN AND 

GO TO C12_INTRO. 

ELSE GO TO CWEND. 

[TIMESTAMP_PAN_SELECTION] 

CWEND	 Those are all the questions I have. I’d like to thank you on behalf of the Centers for Disease 

Control and Prevention for the time and effort you’ve spent answering these questions. If you 

have any questions about this survey, you may call my supervisor toll-free at [TEXTFILL: If 

Sample Use Code = 1, 2, or 4: 1 - 8 6 6 - 9 9 9 - 3 3 4 0, if sample use code = 3, 5, or 6: 1 - 8 8 8 -

9 9 0 - 9 9 8 6] . If you have questions about your rights as a survey participant, you may call the 

chairman of the Research Ethics Review Board at 1 - 8 0 0 - 2 2 3 - 8 1 1 8 . Thank you again. 

Language 

LANG1 APPEARS AFTER COMPLETED INTERVIEWS ONLY. 

INTERVIEWER: WAS THIS INTERVIEW COMPLETED USING ENGLISH ONLY? 

 (1) YES [TERMINATE] 

(2) NO [SKIP TO LANG2] 

LANG2 INTERVIEWER: WHICH LANGUAGES WERE NEEDED TO COMPLETE THIS 

INTERVIEW? 

 (1) ENGLISH [SKIP TO LANG3] 

(2) SPANISH [SKIP TO LANG3] 

(4) CANTONESE [SKIP TO LANG3] 

(8) KOREAN [SKIP TO LANG3] 

(9) MANDARIN [SKIP TO LANG3] 

(13) VIETNAMESE [SKIP TO LANG3] 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2009-2010 National Survey of Children with Special Health Care Needs Page 123 

Series 1, No. 57 □ Page 177

(14) ANOTHER LANGUAGE [SKIP TO LANG2_OTHER] 

LANG2_ ________ OTHER LANGUAGE 

OTHER 

[IF LANG2X01 AND ANY LANG2X02-LANGX14 SELECTED > GO TO LANG3 / ELSE 

TERMINATE INTERVIEW, GO TO COMMENTS] 

LANG3 THIS INTERVIEW COMPLETED “MOSTLY IN ENGLISH” OR “MOSTLY IN OTHER 

LANGUAGE”? 

(1) MOSTLY IN ENGLISH 

(2) MOSTLY IN OTHER LANGUAGE 

(3) ABOUT HALF AND HALF 

[TERMINATE INTERVIEW. GO TO COMMENTS.] 

Callback/Refusal Conversion Script 

INTRO_1	 [FOR ANY CALLBACKS IN LCS 5 WHERE S_UNDR18 IS > 0 AND CSHCN IS NOT YET 

FINALIZED AND CSHCN_INCENT = 0 OR IS <NULL>] 

Hello, my name is ____. I’m calling on behalf of the Centers for Disease Control and Prevention 

[(CSHCN_INCENT_FLAG = 2 OR CSHCN_PASSIVE = 1 or 2) AND CSHCN_LTR_FLAG = 1 

THEN, "to follow up on a letter that was sent to your home"/ ELSE NO FILL]. Earlier, we 

contacted your household to participate in a survey about health services used by children and 

teenagers. I’m calling back to continue the interview. 

[IF NAME WAS GIVEN FOR APPOINTMENT, ASK FOR THAT PERSON.] 

INTRO_1A	 [FOR ANY CALLBACKS (IN LCS 5 or SUC 3, 5, 6) WHERE S_UNDR18 IS <null>] 

Hello, my name is ____. I’m calling on behalf of the Centers for Disease Control and Prevention. 

Earlier we contacted your household to participate in a survey about health services used by 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2009-2010 National Survey of Children with Special Health Care Needs Page 124 

Page 178 □ Series 1, No. 57

children and teenagers. After just a few questions I can determine if your household is eligible to 

participate. 

[IF NAME WAS GIVEN FOR APPOINTMENT, ASK FOR THAT PERSON.] 

INTRO_1B [FOR CALLBACKS IN LCS 5 WHERE S_UNDR18 IS > 0 AND CSHCN_INCENT > 0] 

[IF CSHCN_INCENT = 1 AND CSHCN_INCENT_FLAG = 1 

OR 

IF CSHCN_INCENT = 1 OR 2 AND CSHCN_INCENT_FLAG = 2 AND CSHCN_LTR_FLAG 

= 1 

OR 

IF CSHCN_INCENT = 1 OR 2 AND CSHCN_PASSIVE = 1 OR 2 AND CSHCN_LTR_FLAG = 

1 THEN OFFER MONEY_1 

IF CSHCN_INCENT = 1 OR 2 AND CSHCN_INCENT_FLAG = 2 AND CSHCN_LTR_FLAG 

= 2 

OR 

IF CSHCN_INCENT = 1 OR 2 AND CSHCN_PASSIVE = 1 OR 2 AND CSHCN_LTR_FLAG = 

2 THEN OFFER MONEY_2 

IF CSHCN_INCENT = 3 THEN OFFER MONEY_1] 

Hello, my name is ____. I'm calling on behalf of the Centers for Disease Control and Prevention. 

Earlier, someone in your household started a survey about health services used by children and 

teenagers. I'm calling back now to continue the interview. [IF (CSHCN_INCENT=1 AND 

CSHCN_INCENT_FLAG ge 1) OR (CSHCN_INCENT=2 AND CSHCN_INCENT_FLAG ge 2) 

OR CSHCN_INCENT=3, THEN DISPLAY: "In appreciation for your time, we will send you 

$[MONEY_1 / MONEY_2]."] 

(IF NAME WAS GIVEN FOR APPOINTMENT, ASK FOR THAT PERSON.) 

S1	 Am I speaking to someone who lives in this household who is over 17 years old? 

(1) YES, I AM THAT PERSON > IF SUC =2 or 3 and [S.C.] IS SELECTED, GO TO REMIND1/ 

ELSE CONTINUE WITH INTERVIEW 

(2) THIS IS A BUSINESS	 [GO TO SALZ] 

(3) NEW PERSON COMES TO PHONE [GO BACK TO INTRO_1] 

(8) DOES NOT LIVE IN HOUSEHOLD [ASK FORANOTHER PERSON OR SCHEDULE 

APPOINTMENT ON THE NEXT SCREEN] 

(9) NO PERSON AT HOME WHO IS OVER 17 [GO TO S2_B] 

(99) REFUSED	 [GO TO REFUSAL CONVERSION, SET DISP AND TERMINATE] 

REMIND1	 [CONTINUE WITH INTERVIEW AT POINT OF BREAKOFF] 

I want to remind you that we will be asking questions about [S.C.] for the rest of this interview. 

Answering Machine Messages 

MSG_AUG	 [PLEASE READ SLOWLY AND CLEARLY.] Hello. The Centers for Disease Control and 

Prevention is conducting a survey about health services used by children and teenagers. Your 

telephone number has been selected at random to participate in this survey. For most people, it 

will take only a few minutes. We’re sorry we missed you and will try back at another time. Or, 
 

2009-2010 National Survey of Children with Special Health Care Needs Page 125 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Series 1, No. 57 □ Page 179

you can call us at [IF SUC = 1, 2, 4, FILL 1-866-999-3340 / IF SUC = 3, FILL 1-888-990-9986]. 

Thank you. 

MSG_Y_APPT [IF CSHCN_INCENT = 1 AND CSHCN_INCENT_FLAG = 1 

OR 

IF CSHCN_INCENT = 1 OR 2 AND CSHCN_INCENT_FLAG = 2 AND CSHCN_LTR_FLAG 

= 1 

OR 

IF CSHCN_INCENT = 1 OR 2 AND CSHCN_PASSIVE = 1 OR 2 AND CSHCN_LTR_FLAG = 

1 THEN OFFER MONEY_1 

IF CSHCN_INCENT = 1 OR 2 AND CSHCN_INCENT_FLAG = 2 AND CSHCN_LTR_FLAG 

= 2 

OR 

IF CSHCN_INCENT = 1 OR 2 AND CSHCN_PASSIVE = 1 OR 2 AND CSHCN_LTR_FLAG 

= 2 THEN OFFER MONEY_2 

IF CSHCN_INCENT = 3 THEN OFFER MONEY_1] 

[PLEASE READ SLOWLY AND CLEARLY.] Hello. I am calling on behalf of the Centers for 

Disease Control and Prevention regarding a national study about the health services used by 

children and teenagers. I'm sorry that we've missed you. When we spoke previously about this 

important study, you requested that we call you back at this time. We'll try to contact you again 

soon but please feel free to return our call anytime at [IF SUC = 1, 2, 4 FILL 1-866-999-334 0 / IF 

SUC = 3, 5, 6 FILL 1-888-990-9986]. [If INCENTIVE CASE, DISPLAY "In appreciation for 

your time, we will send you $[MONEY_1 / MONEY_2]."]. Thank you. 

MSG_CSHCN [IF CSHCN_INCENT = 1 AND CSHCN_INCENT_FLAG = 1 

OR 

IF CSHCN_INCENT = 1 OR 2 AND CSHCN_INCENT_FLAG = 2 AND CSHCN_LTR_FLAG 

= 1 

OR 

IF CSHCN_INCENT = 1 OR 2 AND CSHCN_PASSIVE = 1 OR 2 AND CSHCN_LTR_FLAG 

= 1 THEN OFFER MONEY_1 

IF CSHCN_INCENT = 1 OR 2 AND CSHCN_INCENT_FLAG = 2 AND CSHCN_LTR_FLAG 

= 2 

OR 

IF CSHCN_INCENT = 1 OR 2 AND CSHCN_PASSIVE = 1 OR 2 AND CSHCN_LTR_FLAG 

= 2 THEN OFFER MONEY_2 

IF CSHCN_INCENT = 3 THEN OFFER MONEY_1] 

(PLEASE READ SLOWLY AND CLEARLY.) Hello. I’m calling on behalf of the Centers for 

Disease Control and Prevention [(IF CSHCN_INCENT_FLAG = 2 AND CSHCN_LTR_FLAG = 

1 ) OR (CSHCN_PASSIVE = 1 OR 2 AND CSHCN_LTR_FLAG = 1 ) THEN, “ to follow up on 

a letter that was sent to your home”/ ELSE NO FILL]. We recently contacted your household and 

began a children's health survey. I’m calling back to continue the survey. (If INCENTIVE CASE, 

DISPLAY: "In appreciation for your time, we will send you $[MONEY_1 / MONEY_2]."). If 

you would like to participate right away, please call our toll-free number, at [IF SUC = 1, 2, 4 

FILL 1-866-999-3340 / IF SUC = 3, 5, 6 FILL 1-888-990-9986]. Thank you. 
Page 180 [ Series 1, No. 57

Appendix III. Summary of Key Differences Between the 2005–2006 and

2009–2010 Questionnaires

This appendix summarizes the key

differences between the 2005–2006

questionnaire and the 2009–2010 pretest

questionnaire. Please see Appendix V

for changes that were made following

the pretest and before the main

2009–2010 survey was launched.

Section 2: Initial Screening

For 2009–2010, new follow-up

questions to determine whether reported

consequences have lasted or are

expected to last 12 months or longer

(CSHCN1_C_X, CSHCN2_C_X,

CSHCN3_C_X, and CSHCN4_C_X)

were asked only when parents reported

that the consequences were not due to

medical, behavioral, or other health

conditions. These follow-up questions

permitted estimates of prevalence of

chronic consequences among children

without special health care needs

(non-CSHCN), but were not used to

identify children with special health care

needs (CSHCN).

Section 3: Child Health

and Functional Status

Deletions

+	 For 2009–2010, the questions

regarding difficulty seeing or

hearing without assistive devices

(S3Q01, S3Q01A, S3Q02, and

S3Q02A) were removed. Questions

about difficulty seeing or hearing

even with assistive devices,

however, remained in the

2009–2010 survey.

+	 The rating of overall severity of the

functional difficulties (C3Q10) was

removed from the 2009–2010

questionnaire.

+	 The question regarding the number

of doctor visits (C6Q01) also was

removed prior to 2009–2010.

Revisions

+	 The response options for functional

difficulty questions (C3Q23 through

C3Q34) were changed from ‘‘any

difficulty’’ to ‘‘a lot, a little, or no

difficulty.’’

Several changes also were made to the

condition list between 2005–2006 and

2009–2010:

+	 ‘‘Autism or autism spectrum

disorder’’ was changed to ‘‘autism,

Asperger’s disorder, pervasive

developmental delay, or other autism

spectrum disorder.’’

+	 ‘‘Mental retardation or developmental

delay’’ was changed to ‘‘any

developmental delay that affects

his/her ability to learn’’ and

‘‘intellectual disability or mental

retardation.’’

+	 ‘‘Depression, anxiety, an eating

disorder, or other emotional

problem’’ was changed to

‘‘depression,’’ ‘‘anxiety problems,’’

and ‘‘behavioral or conduct

problems, such as oppositional

defiant disorder or conduct

disorder.’’

+	 ‘‘Has a doctor or other health care

provider ever told you that child had

the condition?’’ was added for all

conditions. Existing condition

questions (‘‘Does child currently

have condition?’’) were changed to

follow-up questions to the initial

(i.e., ‘‘ever told’’) questions.

+	 Questions were added to record the

severity of reported attention deficit

disorder and attention deficit

hyperactivity disorder, depression,

anxiety problems, behavioral and

conduct problems, autism,

developmental delay, intellectual

disability, epilepsy, and brain injury.

+	 ‘‘A brain injury or concussion’’ was

added to the condition list.

+	 A follow-up to the blood problems

question was added: ‘‘Are his/her

blood problems related to anemia,

sickle cell disease, hemophilia, or

something else?’’

+	 Questions were added regarding

limits on participation in activities,

including play and going on outings

(for children aged 0–5 years) and

attending school and participating in

organized activities (for children

aged 6–17 years).

Section 4: Access to

Care—Use of Services and

Unmet Needs

Deletion

The questions regarding delayed or

foregone health care (C4Q03 and

C4Q04_A through C4Q04_L) were

removed prior to 2009–2010.

Additions

+	 Questions assessing the reasons for

difficulties or delays obtaining

services were added:

•	 You could not get the information

you needed?

•	 Child was not eligible for the

services?

•	 You needed help to pay for the

services?

•	 The services child needed were

not available in your area?

•	 Any other reason?

+	 A question regarding frustration

obtaining needed services was added

(C4Q04: ‘‘During the past 12

months, how often have you been

frustrated in your efforts to obtain

services for your child?’’).

Section 5: Care

Coordination

No changes were made to Section 5

between the 2005–2006 questionnaire

and the 2009–2010 pretest

questionnaire.

Section 6A: Family

Centered Care

Deletion

For 2009–2010, the questions

regarding need and unmet need for

interpreters (S5Q13, S5Q13A) were

removed.
Revision

The denominator for familycentered care questions changed from

one or more doctor visits to any report

of services used from the list of health

care services or from the new ‘‘any

doctor visit’’ question (see below).

Additions

+	 A question asking whether the child

visited any doctors or other health

care providers in the past 12 months

(‘‘yes/no’’) was asked only if no

health care services were reported in

Section 4 (C6Q01).

+	 Shared decision-making questions

were added:

•	 During the past 12 months, how

often did child’s doctors or other

health care providers:

–	 Explain that there was more

than one choice for his/her

treatment or health care?

–	 Discuss with you reasons for

and reasons against each

choice?

–	 Ask you which treatment or

service you thought would

work best for him/her?

–	 Make it easy for you to ask

questions and raise concerns

about decisions related to

his/her treatment or care?

Section 6B: Transition

Issues

No changes were made to Section

6B between the 2005–2006

questionnaire and the 2009–2010 pretest

questionnaire.

Section 6C: Developmental

Screening

In 2005–2006, Section 6C was

titled ‘‘Ease of Service Use,’’ but was

renamed to ‘‘Developmental Screening’’

in 2009–2010.

Deletion

In 2009–2010, two questions

regarding any difficulty using services

and reasons for difficulties (C6Q0D and

C6Q0E) were removed.

Revision

The answer choices for the question

on satisfaction with care (C6Q40,

dropped after pretest) changed from

‘‘very satisfied, somewhat satisfied,

somewhat dissatisfied, very dissatisfied’’

to an 11-point scale (0–10).

Additions

Questions regarding the receipt of

formal developmental screening were

added for selected children aged 1–3

years (inclusive):

+	 C6Q30: During the past 12 months,

did a doctor or other health care

provider have you fill out a

questionnaire about specific

concerns or observations you may

have about child’s development,

communication, or social behaviors?

+	 C6Q31A: Did this questionnaire ask

about your concerns or observations

about how child talks or makes

speech sounds?

+	 C6Q31B: Interacts with you and

others?

+	 C6Q32A: About words and phrases

child uses and understands?

+	 C6Q32B: Behaves and gets along

with you and others?

Section 6D: Hurricane

Evacuees

Section deleted.

Section 7: Health

Insurance

No changes were made to Section 7

between the 2005–2006 questionnaire

and the 2009–2010 pretest

questionnaire.

Section 8: Adequacy of

Health Insurance

No changes were made to Section 8

between the 2005–2006 questionnaire

and the 2009–2010 pretest

questionnaire.

Series 1, No. 57 [ Page 181

Section 9: Impact on the

Family

Deletion

The question regarding the need for

additional income to cover the child’s

medical expenses (C9Q07) was removed

from the 2009–2010 questionnaire.

Additions

+	 A question regarding perceived

difficulty arranging or coordinating

child’s care was added to the

2009–2010 questionnaire (C9Q04_B,

later dropped: ‘‘How difficult is it

for you or other family members to

arrange and coordinate child’s

care?’’).

+	 A question regarding reduced job

opportunities due to child’s health

also was added to the 2009–2010

administration (C9Q11: ‘‘Did you or

other family members avoid

changing jobs because of concerns

about maintaining health insurance

for child?’’).

Section 10: Demographics

Revisions

+	 The wording for the question on

total number of persons in

household (C10Q01) was revised

from ‘‘Please tell me how many

people live in this household’’ to

‘‘Including the adults and all the

children, how many people live in

this household?’’

+	 The household roster (C10Q02B)

was modified from identification of

‘‘parents or people who act as

parents’’ to a family roster of all

relationships to the child with

special health care needs.

+	 The wording for identifying CSHCN

adopted from foster care was revised

from ‘‘Was child residing in foster

care prior to being placed for

adoption?’’ to ‘‘Prior to being

adopted, was child in the legal

custody of a state or county child

welfare agency in the United States?

That is, was the child in the U.S.

foster care system?’’ (C10Q05).
Page 182 [ Series 1, No. 57

+	 The 2005–2006 survey asked for the

highest education in the household.

In 2009–2010, the survey asked for

the highest education of mother and

father and guardian (for full CSHCN

interviews), or highest education of

parents (for non-CSHCN).

+	 The questions about race and

ethnicity of children, as well as the

primary language spoken in the

household, were moved from

Section 2 to Section 10.

Additions

+	 For sampled CSHCN in households

with no biological or adoptive

parents, a question was added asking

whether the child has been legally

adopted (C10Q02C).

+	 A question asking the age of the

oldest adult in the household

(C10Q14) was added for all

households.

+	 Questions assessing the marital

status of the selected child’s parents

were asked only for cases that

completed the full CSHCN

interview.

+	 A question asking if the respondent

owns or rents the home (C10Q41)

was added for all households.

Section 10B: Influenza

Vaccination Module

Section deleted.

Section 11A: Income

No changes were made to Section

11A between the 2005–2006

questionnaire and the 2009–2010 pretest

questionnaire.

Section 11B: Phone Line

and Household

Information

Additions

+	 A question regarding cellular- (cell)

phone ownership for all households

(C11Q15) was added to the

2009–2010 survey.

+	 A question regarding cell-phone use

relative to landline use for

households with both services

(C11Q16) also was added, allowing

a household to be categorized as

either a ‘‘cell phone mostly’’ or

‘‘landline mostly’’ household.

Confirmation questions for ZIP code and

state of residence were added for all

households (C11Q22 and LOC_STATE).
Series 1, No. 57 [ Page 183

Appendix IV. Computer-assisted Telephone Interview Pretest

A pretest of the computer-assisted

telephone interview (CATI) instrument

was conducted from January 29, 2009

through February 1, 2009. A total of 546

households were screened for the

presence of children with special health

care needs (CSHCN); 129 completed

special health-care-needs interviews

about children aged 0–17 years were

obtained over the course of 4 days. The

pretest sample was drawn from a

national list sample of households likely

to include children (purchased from

Survey Sampling International), to

facilitate a swift and efficient pretest.

Detailed section timings were

captured to assist the National Center

for Health Statistics and the Health

Resources and Services Administration’s

Maternal and Child Health Bureau in

making decisions about potential

revisions to the questionnaire, should the

pretest have indicated that the

administration time was too long. The

administration time for the full CSHCN

interview averaged 33 minutes and 31

seconds, which was nearly 6 minutes

longer than the 2005–2006 interviews.

The targeted administration time was 25

minutes. Modifications of questions and

overall questionnaire content were made

after the pretest and prior to the main

data collection in order to meet that

target, and to provide clarity for the

interviewers and respondents as needed.

The changes made to the pretest

questionnaire prior to the start of

Quarter 3, 2009 are listed below.

Training

Twenty interviewers were trained

for the National Survey of Children

with Special Health Care Needs

(NS-CSHCN) pretest. One 5-hour

training was held in Chicago, Ill.,

with experienced phone interviewers.

See ‘‘Interviewer Training’’ in the

body of this report for further detail

about the training techniques that were

utilized.

Modifications to the

Questionnaire After Pretest

Changes made to the 2009–2010

NS-CSHCN questionnaire following the

pretest and before the main data

collection (Quarter 3, 2009) are

summarized below.

Section 1—NIS/SLAITS

screening

Revisions

+	 The text of NOCHILD was

modified to include the following

sentence: ‘‘We are only interviewing

in households with children.’’

+	 In the text of SL_INTRO, the

sentence ‘‘You may choose not to

answer any questions you don’t

wish to answer, or end the interview

at any time’’ was changed to ‘‘You

may choose not to answer any

questions you don’t wish to answer,

or end the interview at any time

without penalty.’’

Section 2—CSHCN Screener

Revisions

+	 The interviewer help text for the

CSHCN Screener questions was

modified to more appropriately fit

the question text. The text ‘‘a

current condition’’ was changed to

the following: ‘‘current need for

prescription medicine’’ (CSHCN1);

‘‘current need for services’’

(CSHCN2); ‘‘current limitations’’

(CSHCN3); ‘‘current need for

special therapy’’ (CSHCN4); and

‘‘current need for treatment or

counseling’’ (CSHCN5).

+	 For each CSHCN Screener question,

the text ‘‘currently has a special

health care need’’ was changed to

the following: ‘‘currently needs or

uses prescription medicine’’

(CSHCN1); ‘‘currently needs or uses

services’’ (CSHCN2); ‘‘is currently

limited’’ (CSHCN3); ‘‘currently

needs or uses special therapy’’

(CSHCN4); ‘‘currently needs or uses

treatment or counseling’’
 

(CSHCN5).
 

+	 Help text for the CSHCN Screener

follow-up questions

(CSHCN1_B_X–CSHCN5_A_X and

CSHCN1_C_X–CSHCN4_C_X) was

added: ‘‘If the condition, need or

problem lasts for short periods of

time but is expected to keep coming

back for 12 months or longer, the

answer should be ‘yes.’’’

Section 3—Health and

Functional Status

Additions

+	 Question K2Q35D (‘‘How old was

[S.C.] when a doctor or other health

care provider first told you that

[he/she] had autism or ASD?’’) was

added to the questionnaire.

+	 C3Q13A (‘‘How old was [S.C.]

when [he/she] first began receiving

Special Educational Services?’’) and

C3Q15B (‘‘At any time before

[S.C.] was 3 years old, did [he/she]

receive services from a program

called Early Intervention Services?

Children receiving these services

often have an Individualized Family

Service Plan.’’) were added to the

questionnaire.

+	 C3Q21 and C3Q22, assessing

difficulty seeing even with glasses

or contact lenses, or hearing even

with a hearing aid or other device

were reordered from before C3Q23

to after C3Q26.

•	 C3Q21: ‘‘Would you say [he/she]

experiences a lot, a little, or no

difficulty seeing even when

wearing glasses or contact

lenses?’’

•	 C3Q22: ‘‘Would you say [he/she]

experiences a lot, a little, or no

difficulty hearing even when

using a hearing aid or other

device?’’

•	 C3Q23: ‘‘Would you say [he/she]

experiences a lot, a little, or no

difficulty with breathing or other

respiratory problems, such as

wheezing or shortness of breath?’’
Page 184 [ Series 1, No. 57

•	 C3Q26: ‘‘(READ IF

NECESSARY: Would you say

[he/she] experiences a lot, a little,

or no difficulty with repeated or

chronic physical pain, including

headaches?’’

Revisions

+	 K2Q44A and K2Q44B were

expanded to read ‘‘a head injury,

concussion, or traumatic brain

injury?’’

+	 The help screens of K2Q44A–

K2Q46 were modified to further

clarify the definition of the

condition referenced.

+	 C3Q23 was modified to add ‘‘such

as wheezing or shortness of breath.’’

Interviewer instructions also were

added to clarify coding of ongoing

and intermittent breathing problems.

+	 A help screen was added to

C3Q21–C3Q34: ‘‘If respondent says

that child has more than a little

difficulty but not a lot of difficulty,

please code the answer as ‘a little

difficulty.’’’

+	 K2Q44C was changed from ‘‘brain

injury’’ to ‘‘injury.’’

+	 Additional help text was added to

K2Q45A: ‘‘Harmless or innocuous

heart murmurs should not be

included as heart problems.’’

Section 4—Access to Care

Revisions

+	 Question C4Q01 was shortened to

‘‘Is that the same [place selected in

C4Q0B] where [S.C.] goes when

[he/she] is sick?’’

+	 Question C4Q03_INTRO was

modified. The word ‘‘therapies’’ was

replaced with ‘‘specialized

therapies;’’ ‘‘medical equipment’’

and ‘‘early intervention’’ were

added; ‘‘provided by’’ was changed

to ‘‘obtained in;’’ and ‘‘home’’ and

‘‘other places’’ were added. Help

screens also were added to

C4Q03_A through C4Q03_F with

the text from this question.

+	 Questions C4Q03_A through

C4Q03_F were modified. The order

was changed, the question allowing

an open-ended response was deleted,

C4Q01_C was added, and C4Q03_D

was changed from ‘‘needed help to

pay for the services’’ to ‘‘issues

related to cost.’’

+	 Question C4Q05_1 was shortened to

‘‘a well-child check-up?’’

+	 Question C4Q04 was changed from

‘‘obtain services’’ to ‘‘get services.’’

+	 In C4Q05_1 through C4Q05_1_0,

‘‘Routine preventive care, such as a

physical examination or well-child

check-up’’ was changed to ‘‘a

well-child check-up.’’

+	 Questions C4Q05_1B, and

C4Q05_2B through C4Q05_32B,

including _O, as well as C4Q06_1B

to C4Q06_3_0 were changed from

‘‘not get the’’ to ‘‘not get all the...’’

+	 The text ‘‘or orthodontia’’ was

added to the end of C4Q05_32, and

a help screen was added to clarify

the definition of orthodontial care.

+	 The ‘‘read if necessary’’ text in

question C4Q05_14 was modified to

drop ‘‘wheelchairs’’ and add

‘‘nebulizers, blood glucose

monitors.’’

Additions

+	 Questions C6Q00 and SC_C6Q00,

which ask about hospital visits.

+	 Question C3Q50 was added for all

CSHCN cases in the state of

California.

+	 Question K4Q20: ‘‘[During the past

12 months/since [his/her] birth],

how many times did [S.C.] receive a

well-child check-up, that is a general

check-up, when [he/she] was not

sick or injured?’’ SC_K4Q20, an

interviewer check, was also added.

+	 The interviewer check SC_K4Q21

was added.

+	 Question K4Q21: ‘‘[During the past

12 months/since [his/her] birth],

how many times did [S.C.] see a

dentist for preventive dental care,

such as check-ups and dental

cleanings?’’

+	 Question C3Q13A: ‘‘How old was

[S.C.] when [he/she] first began

receiving Special Educational

Services?’’

+	 Question C3Q13B, which asks about

receiving Early Intervention

Services.

+	 Question C3Q15, which asks about

alternative health care.

Deletions

+	 The answer choice ‘‘12) Vaccine

shortage’’ was dropped from all

locations in Section 4.

+	 C4Q05_1C and C4Q05_31C were

deleted.

+	 Questions C4Q05_13, C4Q05_13A,

and C4Q05_13C, which ask about

medical supplies were deleted.

Section 5—Care Coordination

Addition

+	 Question C5Q20, which asks about

using a website to coordinate care,

was added for CSHCN in California.

Revisions

+	 The instructions in C5Q00 were

modified to accommodate the

addition of C3Q15.

+	 C5Q12 was modified so that the

second sentence (‘‘By arrange or

coordinate, I mean...’’) was removed

from the question and was added as

a ‘‘read if necessary’’ (as in the

2007 National Survey of Children’s

Health). The help screen was also

removed.

+	 The response option, ‘‘someone at

child’s school,’’ was added to the

response options for C5Q16.

Deletions

+	 C5Q14 and C5Q14_XOE were

deleted to reduce redundancy, and

skip patterns were readjusted

throughout the questions C5Q12

through C5Q16.

Section 6A—Family Centered

Care

Additions

+	 Questions C6Q11 and C6Q12,

which ask about the use of

interpreters, were added for all

CSHCN in California.

Deletions

+	 C6Q01A and C6Q01B, which ask

about the respondent attending

doctor visits, were dropped. The

skip instructions at C6Q01 were

modified accordingly.
Series 1, No. 57 [ Page 185

+	 C6Q20: ‘‘We want to know how

you and [S.C.]’s doctors or other

health care providers make decisions

about services and health care for

[him/her]. This includes things like

whether or not to try a new

medication, have certain tests or

procedures, change existing

treatments or therapies, see a

specialist, consent for surgery, and

so on.’’

Revisions

+	 C6Q21 through C6Q24 were

modified to be shorter and clearer.

Section 6B—Transition Issues

C6Q0A was changed from ‘‘talked

with you or [S.C.] about’’ to ‘‘talked

with you about.’’

Section 6C—Developmental

Screening

C6Q40 (satisfaction rating) was

dropped. The skip instructions in

Section 6C were modified accordingly.

Section 7—Health Insurance

No changes were made to Section

7, except CATI instructions for

interviewers.

Section 8—Adequacy of Health

Care Coverage

No changes were made to Section 8

following the pretest.

Section 9—Impact on the

Family

Revisions

+	 The ‘‘read if necessary’’ text for

questions C9Q02, C9Q03, and

C9Q04 was modified to tell

respondents to base their answers on

the last several weeks. The text

‘‘only include care related to the

child’s condition’’ also was added to

the ‘‘read if necessary’’ text of

C9Q02 and C9Q03.

+	 A modification was made to the

answer choices for C9Q04.

Response option ‘‘555’’ was

dropped, and the option ‘‘000’’ was

edited to incorporate ‘‘none’’ or

‘‘does not coordinate care’’ and

‘‘less than one hour.’’

Deletion

+	 C9Q04_B (difficulty coordinating)

was dropped. The skip instructions

in C9Q04 were modified

accordingly.

Section 10—Demographics

Revisions

+	 C10Q01 was changed from ‘‘live in

this household’’ to ‘‘live in your

household.’’ A modification also was

made so that the second sentence

(‘‘Please include anyone...’’) was

removed from the question and was

added as a ‘‘read if necessary’’

instruction. In the new ‘‘read if

necessary’’ text, ‘‘lives here even if

they are not here now’’ was changed

to ‘‘lives there even if they are not

there now.’’

+	 The interviewer help text for the

education questions was adjusted to

specify which adult the question was

referencing.

+	 The race and ethnicity questions

were revised to lessen respondent

burden. If there was more than one

child in the household, ETH (‘‘Are

any of the children in your

household of Hispanic, Latino, or

Spanish origin?’’) was asked rather

than repeating C10Q31_X for each

child. If respondents answered yes at

ETH, they were then asked to

identify which children they were

referring to from a pick list at

ETH_B.

+	 C10Q41 was shortened to: ‘‘Do you

own or rent your home?’’

+	 Questions C10Q10 through

C10Q13C were modified and added

to help delineate relationships of the

parents and adults living in the

household.

+	 An option of ‘‘Adoption not

finalized’’ was added at C10Q03.

Section 11—Income

Revisions

+	 In question C11CONF, ‘‘your

income was’’ was changed to ‘‘your

income was about.’’

+	 In C11Q01 _DONT_KNOW and

C11Q01_REFUSED, the phrase

‘‘total family income’’ was replaced

with ‘‘total household income.’’

+	 A modification was made to the skip

instructions at C11Q11 (TANF) so

that this question was skipped if

there were no CSHCN in the

household.

Additions

+	 K11Q30 through K11Q37B, which

ask about immigrant status, were

added for California respondents.

Section 11A—Phone

Revisions

+	 C11Q15 was modified to include a

‘‘read if necessary’’ section

explaining the purpose of the

question.

+	 The response categories of C11Q16

were modified.

+	 The second sentence of C11Q20

(‘‘Do not include interruptions of

phone service due to weather or

natural disasters.’’) was deleted.

Additions

+	 C11Q17, which asks about Internet

access, was added for all California

respondents.

+	 V_ISLAND was added for the U.S.

Virgin Islands sample to ask on

which island the respondent lived,

instead of asking for ZIP code and

state.

Deletions

+	 C11Q14 and C11Q14_A, which ask

about multiple phone numbers, were

dropped.
Page 186 [ Series 1, No. 57

Appendix V. Summary of Questionnaire Changes During Data Collection

During the course of data

collection, a number of changes were

made to the questionnaire in order to

improve the quality of data collected, to

accommodate methodological changes,

and to address concerns voiced by

respondents or interviewers.

Questionnaire changes made following

the launch of Quarter 3, 2009 are listed

by the date on which they were

implemented.

On October 1, 2009 (Quarter 4,

2009), the following changes were

made:

+	 An experiment was conducted to

test the effect of varying informed

consent language on survey

break-off rates. Quarter 4, 2009

cases were randomly assigned to

one of two groups:

•	 The first group received the

sentence, ‘‘You may choose not to

answer any questions you don’t

wish to answer, or end the

interview at any time without

penalty.’’

•	 The second group received a

modified version of the consent

language, specifically informing

respondents that survey

participation is not connected to

government benefits: ‘‘You may

choose not to answer any

questions you don’t wish to

answer, or end the interview at

any time. Your choice has no

effect on current or future

benefits.’’

+	 Section 9.5 (ADD/ADHD

Questions) was added to the

questionnaire and was administered

to respondents who reported that the

selected child currently has ADD

(attention deficit disorder) or ADHD

(attention deficit hyperactivity

disorder). This section contained

several questions addressing

treatments that the selected child

may have received for ADD or

ADHD.

+	 As a follow-up to Section 9.5,

GOGETMED and GOGETMED_

CNFM also were added to the

questionnaire in Quarter 4, 2009.

These variables allowed respondents

who did not know the name of an

ADD or ADHD medication or

medications to get the medication

bottle and read the correct name to

the interviewer at the end of the

interview.

+	 Revisions were made to the

household roster confirmation

question (C10Q02B_CONF) and

warning screen (C10Q02B_

WARNING) to more clearly convey

to the respondent that the goal of

the household roster was to list each

person in the household in relation

to the selected child. The revisions

also involved new skip logic that

allowed the interviewer to

reconfirm, clarify, or correct the

number of people in the household

by returning to question C10Q01.

+	 At C11CONF, ‘‘income’’ was

changed to ‘‘household income’’ to

make the question clearer to

respondents.

On January 7, 2010 (Quarter 1, 2010),

the following changes were made:

+	 In order to be consistent with the

Centers for Disease Control and

Prevention’s National Immunization

Survey consent language, the

National Survey of Children with

Special Health Care Needs

(NS-CSHCN) consent language was

altered so that all respondents were

read the sentence: ‘‘You may choose

not to answer any questions you

don’t wish to answer, or end the

interview at any time with no impact

on the benefits you may receive.’’

+	 C11Q15 was replaced with

C11Q15_CELL: ‘‘The next few

questions are about the phones in

your household. In total, how many

working cell phones do you and

your household members have

available for personal use? Please do

not count cell phones that are used

exclusively for business purposes.’’

+	 C11Q15_CELL_USUALLY (‘‘How

many of these cell phones do the

adults in this household usually

use?’’) was added to the Telephone

Line section and directly followed

C11Q15_CELL.

+	 The question ‘‘For how long was

your household without phone

service in the past 12 months?’’

(C11Q21A) was removed from the

questionnaire.

On March 4, 2010, the following

changes were made:

+	 Respondents who completed the full

children with special health care

needs (CSHCN) interview were

asked to provide locating

information for possible recontact in

the future. These questions were

displayed at the end of the survey

and involved gathering an alternate

phone number, the type of that

given phone number, respondent

address, name or initials of selected

child (if not already provided), and

name or initials of the respondent.

On April 1, 2010 (Quarter 2, 2010), the

following changes were made:

+	 The skip logic at C11Q15_CELL

was changed so that cases that

reported having one cellular (cell)

phone in the household were

directed to C11Q15_CELL_

USUALLY, rather than skipping this

question. Also, the response option

‘‘None’’ was added to C11Q15_CELL_

USUALLY.

On July 1, 2010 (Quarter 3, 2010), the

following changes were made:

+	 The phrase ‘‘please include the

number we called’’ was added to

C11Q15_CELL and C11Q15_

CELL_USUALLY for the cell-phone

sample to clarify that the sampled

phone number should be included in

the respondent’s response to these

questions. Interviewer help text also

was added to C11Q15_CELL_

USUALLY for cell-phone cases to

explain that the number being called

is assumed to be ‘‘usually used,’’

and thus, the response should be at

least one.
Series 1, No. 57 [ Page 187

+	 The phrase ‘‘on cell phones’’ was

added to the augmentation sample

introduction and answering machine

scripts to alert respondents that calls

made to cell phones were

intentional.

+	 Prior to age screening, a safety

screener (S_WARM) was added for

cell-phone cases to ensure that the

respondent was not doing any

activity that required their full

attention, such as driving. Questions

were also added to assess cellphone respondents’ phone status

(LANDLINE and CELLUSE) and to

screen out households that were not

cell-phone-only or cell-phone-mainly.

+	 The question C11_AWAY was added

to the Phone section of the

instrument and was administered to

the cell-phone sample to determine

if the respondent was away from

home during the interview.

+	 To accommodate calling cases in the

United States Virgin Islands (USVI),

C7Q04 was modified to use the text

‘‘area’’ instead of ‘‘state’’ for the

USVI sample only.

+	 Question S1 was modified so that

cell-phone respondents were read,

‘‘Am I speaking to someone who is

over 17 years old?’’ and landline

respondents were read, ‘‘Am I

speaking to someone who lives in

this household who is over 17 years

old?’’ Similarly, S2_B was modified

so that the phrase ‘‘uses this cell

phone’’ was used for cell-phone

sample, whereas ‘‘live in your

household’’ was displayed for

landline sample.

On October 7, 2010 (Quarter 4, 2010),

the following changes were made:

+	 The ‘‘Teen Line’’ response option at

S2_B was modified so that it was

displayed only for landline cases.

+	 Help text was added to LOCATE_

NUMBER to alleviate potential

respondent concerns when providing

an alternative phone number to call

back for future studies. Interviewers

could use this text to inform

respondents that NORC at the

University of Chicago would

not sell or disclose their phone

number to any other party, and if

respondents were to be contacted in

the future, they would be able to

choose whether to participate at that

time.

+ The frequency of cell-phone usage

was also added to be asked of

respondents who previously

answered ‘‘don’t know’’ or refused

answer to whether they owned a cell

phone.

+ For more clarity, the phrase ‘‘Earlier

you told me that you have at least

one cell phone in your household...’’

was removed prior to C11Q16 while

determining the proportion of calls

received on landlines compared with

cell phones, for those respondents

who owned both types.

+ The screener S_KIDS (‘‘Do you

have any children living in the

household?’’) was added as an

expedited age screening mechanism

for the cell-phone augmentation

sample and was asked immediately

after the NS-CSHCN augmentation

introduction script.

+ For cell-phone cases that received

the S_KIDS screener, S_UNDR18

was changed to ‘‘Please tell me how

many children under 18 live in this

household.’’

+ The interviewer help text at S1 (‘‘If

the respondent says no: ask to speak

with someone over 17 who lives in

the household’’) was modified so

that it only displayed for landline

cases.

+ The following interviewer help text

was added to C11Q15_CELL,

C11Q15_CELL_USUALLY, and

S_WARM to alert the interviewer to

cases where cell-phone respondents

changed their contact number on a

previous call—potentially to a

landline phone number: Interviewer

note: The number for this case was

changed by the respondent on a

previous call.

+ CSHCN_FU_1A, CSHCN_FU_2A,

CSHCN_FU_2B, and

CSHCN_FU_APPT were added at

the end of the survey to inform

respondents that they were

potentially eligible for the

NS-CSHCN follow-up survey—The

Survey of Pathways to Diagnosis

and Services. Respondents were

informed that they may be contacted

in the future, but that they could

decide if they would like to

participate at the time of recontact.
 

Page 188 [ Series 1, No. 57

Appendix VI. Procedures for Assigning Household Poverty Status

The U.S. Department of Health and

Human Services (HHS) publishes

federal Poverty Guidelines for the

determination of household poverty

status (http://aspe.hhs.gov/poverty).

These guidelines are produced annually

and developed separately for the 48

contiguous states (plus the District of

Columbia), Alaska, and Hawaii.

The 2009–2010 National Survey of

Children with Special Health Care

Needs (NS-CSHCN) used HHS

guidelines to assign household poverty

status. Year 2008 guidelines

(Tables VII–IX) were used with 2008

income for interviews conducted from

July 7, 2009 through February 17, 2010.

Year 2009 guidelines (Tables X–XII)

were used with 2009 income for

interviews conducted from February 18,

2010 through March 3, 2011. Because

HHS extended the 2009 guidelines

through May 31, 2011, and later

determined that the 2010 guidelines

were the same as the 2009 guidelines,

no change was made to the guidelines

used by NS-CSHCN in 2010.

The tables were used to group

households into the following poverty

status categories:

+	 Category AA—At or below 50% of

poverty level

+	 Category A—Above 50%, but at or

below 100% of poverty level

+	 Category B—Above 100%, but at or

below 133% of poverty level

+	 Category C—Above 133%, but at or

below 150% of poverty level

+	 Category D—Above 150%, but at or

below 185% of poverty level

+	 Category E—Above 185%, but at or

below 200% of poverty level

+	 Category F—Above 200%, but at or

below 300% of poverty level

+	 Category G—Above 300%, but at or

below 400% of poverty level

+	 Category H—Above 400% of

poverty level

Two variables were used to

determine an NS-CSHCN household’s

poverty status: the number of people

residing in a household and the

household’s income during the prior

year. It was possible for income data to

be gathered using one of three different

methods during NS-CSHCN

administration. A respondent could

provide an exact income, provide an

income range based on a closed-ended

series of questions, or provide an

income range using a set of cascade

questions revised to allow exact

determination of household poverty

status in cases where that would not

otherwise be possible. A brief

description of each method and the

household poverty status assignment

process appears in the following text.

Respondent reported exact

income—When a respondent reported an

exact income, poverty status was

assigned by simply comparing the

number of household members and the

exact income reported with the

appropriate guidelines table.

Respondent reported income range

based on a closed-ended series of

questions—When respondents did not

supply a specific dollar amount for

household income, it was necessary to

ask a series of questions on whether the

household income was below, exactly at,

or above threshold amounts. A matrix

was then created to categorize these

responses. Each cell in the matrix was

assigned to one of the following income

categories:

+	 Less than $7,500

+	 $7,500 to $9,999

+	 $10,000 to $12,499

Table VII. Year 2008 household poverty guidelines for families in the 48 contiguous states and the District of Columbia

Percent of federal poverty level

50 100 133 150 185 200 300 400

Status categories

Family size AA A B C D E F G

2 ....................... $7,000 14,000 18,620 21,000 25,900 28,000 42,000 56,000

3 ....................... $8,800 17,600 23,408 26,400 32,560 35,200 52,800 70,400

4 ....................... $10,600 21,200 28,196 31,800 39,220 42,400 63,600 84,800

5 ....................... $12,400 24,800 32,984 37,200 45,880 49,600 74,400 99,200

6 ....................... $14,200 28,400 37,772 42,600 52,540 56,800 85,200 113,600

7 ....................... $16,000 32,000 42,560 48,000 59,200 64,000 96,000 128,000

8 ....................... $17,800 35,600 47,348 53,400 65,860 71,200 106,800 142,400

9 ....................... $19,600 39,200 52,136 58,800 72,520 78,400 117,600 156,800

10. . . . . . . . . . . . . . . . . . . . . . . $21,400 42,800 56,924 64,200 79,180 85,600 128,400 171,200

11. . . . . . . . . . . . . . . . . . . . . . . $23,200 46,400 61,712 69,600 85,840 92,800 139,200 185,600

12. . . . . . . . . . . . . . . . . . . . . . . $25,000 50,000 66,500 75,000 92,500 100,000 150,000 200,000

13. . . . . . . . . . . . . . . . . . . . . . . $26,800 53,600 71,288 80,400 99,160 107,200 160,800 214,400

14. . . . . . . . . . . . . . . . . . . . . . . $28,600 57,200 76,076 85,800 105,820 114,400 171,600 228,800

15. . . . . . . . . . . . . . . . . . . . . . . $30,400 60,800 80,864 91,200 112,480 121,600 182,400 243,200

16. . . . . . . . . . . . . . . . . . . . . . . $32,200 64,400 85,652 96,600 119,140 128,800 193,200 257,600

17. . . . . . . . . . . . . . . . . . . . . . . $34,000 68,000 90,440 102,000 125,800 136,000 204,000 272,000

18. . . . . . . . . . . . . . . . . . . . . . . $35,800 71,600 95,228 107,400 132,460 143,200 214,800 286,400

NOTE: See Appendix VI for full definitions of poverty status categories.
Table VIII. Year 2008 household poverty guidelines for families in Hawaii

Percent of federal poverty level

50 100 133 150 185 200 300 400

Status categories

Family size AA A B C D E F G

2 ....................... $8,050 16,100 21,413 24,150 29,785 32,200 48,300 64,400

3 ....................... $10,120 20,240 26,919 30,360 37,444 40,480 60,720 80,960

4 ....................... $12,190 24,380 32,425 36,570 45,103 48,760 73,140 97,520

5 ....................... $14,260 28,520 37,932 42,780 52,762 57,040 85,560 114,080

6 ....................... $16,330 32,660 43,438 48,990 60,421 65,320 97,980 130,640

7 ....................... $18,400 36,800 48,944 55,200 68,080 73,600 110,400 147,200

8 ....................... $20,470 40,940 54,450 61,410 75,739 81,880 122,820 163,760

9 ....................... $22,540 45,080 59,956 67,620 83,398 90,160 135,240 180,320

10. . . . . . . . . . . . . . . . . . . . . . . $24,610 49,220 65,463 73,830 91,057 98,440 147,660 196,880

11. . . . . . . . . . . . . . . . . . . . . . . $26,680 53,360 70,969 80,040 98,716 106,720 160,080 213,440

12. . . . . . . . . . . . . . . . . . . . . . . $28,750 57,500 76,475 86,250 106,375 115,000 172,500 230,000

13. . . . . . . . . . . . . . . . . . . . . . . $30,820 61,640 81,981 92,460 114,034 123,280 184,920 246,560

14. . . . . . . . . . . . . . . . . . . . . . . $32,890 65,780 87,487 98,670 121,693 131,560 197,340 263,120

15. . . . . . . . . . . . . . . . . . . . . . . $34,960 69,920 92,994 104,880 129,352 139,840 209,760 279,680

16. . . . . . . . . . . . . . . . . . . . . . . $37,030 74,060 98,500 111,090 137,011 148,120 222,180 296,240

17. . . . . . . . . . . . . . . . . . . . . . . $39,100 78,200 104,006 117,300 144,670 156,400 234,600 312,800

18. . . . . . . . . . . . . . . . . . . . . . . $41,170 82,340 109,512 123,510 152,329 164,680 247,020 329,360

NOTE: See Appendix VI for full definitions of poverty status categories.

Series 1, No. 57 [ Page 189

+ $12,500 to $14,999

+ $15,000 to $17,499

+ $17,500 to $19,999

+ $20,000 to $24,999

+ $25,000 to $29,999

+ $30,000 to $34,999

+ $35,000 to $39,999

+ $40,000 to $44,999

+ $45,000 to $49,999

+ $50,000 to $59,999

+ $60,000 to $74,999

+ $75,000 or higher

Respondents who went through the

cascade of income questions were

assigned a household poverty status by

comparing the number of household

members and the assigned income range

with the appropriate guidelines table.

For example, a respondent living in

Alaska reporting a household size of

three persons and an income (based on

the cascade) of $35,000 to $39,000

would be classified into category D

(more than 150% of poverty, but at or

below 185% of poverty) based on the

2009 guidelines in Table XII. A

respondent living in the 48 contiguous

states reporting a household size of

three persons and an income of $75,000

or higher would be classified into

Table IX. Year 2008 household poverty guidelines for families in Alaska

Percent of federal poverty level

50 100 133 150 185 200 300 400

Status categories

Family size AA A B C D E F G

2 ....................... $8,750 17,500 23,275 26,250 32,375 35,000 52,500 70,000

3 ....................... $11,000 22,000 29,260 33,000 40,700 44,000 66,000 88,000

4 ....................... $13,250 26,500 35,245 39,750 49,025 53,000 79,500 106,000

5 ....................... $15,500 31,000 41,230 46,500 57,350 62,000 93,000 124,000

6 ....................... $17,750 35,500 47,215 53,250 65,675 71,000 106,500 142,000

7 ....................... $20,000 40,000 53,200 60,000 74,000 80,000 120,000 160,000

8 ....................... $22,250 44,500 59,185 66,750 82,325 89,000 133,500 178,000

9 ....................... $24,500 49,000 65,170 73,500 90,650 98,000 147,000 196,000

10. . . . . . . . . . . . . . . . . . . . . . . $26,750 53,500 71,155 80,250 98,975 107,000 160,500 214,000

11. . . . . . . . . . . . . . . . . . . . . . . $29,000 58,000 77,140 87,000 107,300 116,000 174,000 232,000

12. . . . . . . . . . . . . . . . . . . . . . . $31,250 62,500 83,125 93,750 115,625 125,000 187,500 250,000

13. . . . . . . . . . . . . . . . . . . . . . . $33,500 67,000 89,110 100,500 123,950 134,000 201,000 268,000

14. . . . . . . . . . . . . . . . . . . . . . . $35,750 71,500 95,095 107,250 132,275 143,000 214,500 286,000

15. . . . . . . . . . . . . . . . . . . . . . . $38,000 76,000 101,080 114,000 140,600 152,000 228,000 304,000

16. . . . . . . . . . . . . . . . . . . . . . . $40,250 80,500 107,065 120,750 148,925 161,000 241,500 322,000

17. . . . . . . . . . . . . . . . . . . . . . . $42,500 85,000 113,050 127,500 157,250 170,000 255,000 340,000

18. . . . . . . . . . . . . . . . . . . . . . . $44,750 89,500 119,035 134,250 165,575 179,000 268,500 358,000

NOTE: See Appendix VI for full definitions of poverty status categories.
Table X. Year 2009 household poverty guidelines for families in the 48 contiguous states and the District of Columbia

Percent of federal poverty level

50 100 133 150 185 200 300 400

Status categories

Family size AA A B C D E F G

2 ....................... $7,285 14,570 19,378 21,855 26,955 29,140 43,710 58,280
 

3 ....................... $9,155 18,310 24,352 27,465 33,874 36,620 54,930 73,240
 

4 ....................... $11,025 22,050 29,327 33,075 40,793 44,100 66,150 88,200
 

5 ....................... $12,895 25,790 34,301 38,685 47,712 51,580 77,370 103,160
 

6 ....................... $14,765 29,530 39,275 44,295 54,631 59,060 88,590 118,120
 

7 ....................... $16,635 33,270 44,249 49,905 61,550 66,540 99,810 133,080
 

8 ....................... $18,505 37,010 49,223 55,515 68,469 74,020 111,030 148,040
 

9 ....................... $20,375 40,750 54,198 61,125 75,388 81,500 122,250 163,000
 

10. . . . . . . . . . . . . . . . . . . . . . . $22,245 44,490 59,172 66,735 82,307 88,980 133,470 177,960
 

11. . . . . . . . . . . . . . . . . . . . . . . $24,115 48,230 64,146 72,345 89,226 96,460 144,690 192,920
 

12. . . . . . . . . . . . . . . . . . . . . . . $25,985 51,970 69,120 77,955 96,145 103,940 155,910 207,880
 

13. . . . . . . . . . . . . . . . . . . . . . . $27,855 55,710 74,094 83,565 103,064 111,420 167,130 222,840
 

14. . . . . . . . . . . . . . . . . . . . . . . $29,725 59,450 79,069 89,175 109,983 118,900 178,350 237,800
 

15. . . . . . . . . . . . . . . . . . . . . . . $31,595 63,190 84,043 94,785 116,902 126,380 189,570 252,760
 

16. . . . . . . . . . . . . . . . . . . . . . . $33,465 66,930 89,017 100,395 123,821 133,860 200,790 267,720
 

17. . . . . . . . . . . . . . . . . . . . . . . $35,335 70,670 93,991 106,005 130,740 141,340 212,010 282,680
 

18. . . . . . . . . . . . . . . . . . . . . . . $37,205 74,410 98,965 111,615 137,659 148,820 223,230 297,640
 

NOTE: See Appendix VI for full definitions of poverty status categories.

Page 190 [ Series 1, No. 57

category H (above 400% of poverty)

based on the 2009 guidelines in Table X.

When respondents did not complete

the income cascade, either because

they refused or did not know the

answer to one of the cascade

questions, household poverty status

could not be assigned.

Respondent reported income range

based on revised series of cascade

questions—In some cases, the income

categories described above encompassed

one or more income category limits for

determining household poverty status. In

such cases, additional income cascade

questions beyond the standard set were

asked to permit definitive assignment of

poverty status. For these questions,

customized income reference values,

based on household size and state of

residence, were used to obtain a range

that would fit into the poverty-level

table. For example, the income category

cutoff indicating that a two-person

household in the contiguous 48 states

was below 150% of poverty (using the

2009 guidelines) was $21,855. This

income category cutoff is encompassed

in the income category of ‘‘$25,000 or

less.’’ Therefore, for respondents who

Table XI. Year 2009 household poverty guidelines for families in Hawaii

Percent of federal poverty level

50 100 133 150 185 200 300 400

Status categories

Family size AA A B C D E F G

2 ....................... $8,380 16,760 22,291 25,140 31,006 33,520 50,280 67,040
 

3 ....................... $10,530 21,060 28,010 31,590 38,961 42,120 63,180 84,240
 

4 ....................... $12,680 25,360 33,729 38,040 46,916 50,720 76,080 101,440
 

5 ....................... $14,830 29,660 39,448 44,490 54,871 59,320 88,980 118,640
 

6 ....................... $16,980 33,960 45,167 50,940 62,826 67,920 101,880 135,840
 

7 ....................... $19,130 38,260 50,886 57,390 70,781 76,520 114,780 153,040
 

8 ....................... $21,280 42,560 56,605 63,840 78,736 85,120 127,680 170,240
 

9 ....................... $23,430 46,860 62,324 70,290 86,691 93,720 140,580 187,440
 

10. . . . . . . . . . . . . . . . . . . . . . . $25,580 51,160 68,043 76,740 94,646 102,320 153,480 204,640
 

11. . . . . . . . . . . . . . . . . . . . . . . $27,730 55,460 73,762 83,190 102,601 110,920 166,380 221,840
 

12. . . . . . . . . . . . . . . . . . . . . . . $29,880 59,760 79,481 89,640 110,556 119,520 179,280 239,040
 

13. . . . . . . . . . . . . . . . . . . . . . . $32,030 64,060 85,200 96,090 118,511 128,120 192,180 256,240
 

14. . . . . . . . . . . . . . . . . . . . . . . $34,180 68,360 90,919 102,540 126,466 136,720 205,080 273,440
 

15. . . . . . . . . . . . . . . . . . . . . . . $36,330 72,660 96,638 108,990 134,421 145,320 217,980 290,640
 

16. . . . . . . . . . . . . . . . . . . . . . . $38,480 76,960 102,357 115,440 142,376 153,920 230,880 307,840
 

17. . . . . . . . . . . . . . . . . . . . . . . $40,630 81,260 108,076 121,890 150,331 162,520 243,780 325,040
 

18. . . . . . . . . . . . . . . . . . . . . . . $42,780 85,560 113,795 128,340 158,286 171,120 256,680 342,240
 

NOTE: See Appendix VI for full definitions of poverty status categories.
Table XII. Year 2009 household poverty guidelines for families in Alaska

50 100 133

Percent of federal poverty level

150 185 200 300 400

Family size AA A B

Status categories

C D E F G

2 ....................... $9,105 18,210 24,219 27,315 33,689 36,420 54,630 72,840

3 ....................... $11,445 22,890 30,444 34,335 42,347 45,780 68,670 91,560

4 ....................... $13,785 27,570 36,668 41,355 51,005 55,140 82,710 110,280

5 ....................... $16,125 32,250 42,893 48,375 59,663 64,500 96,750 129,000

6 ....................... $18,465 36,930 49,117 55,395 68,321 73,860 110,790 147,720

7 ....................... $20,805 41,610 55,341 62,415 76,979 83,220 124,830 166,440

8 ....................... $23,145 46,290 61,566 69,435 85,637 92,580 138,870 185,160

9 ....................... $25,485 50,970 67,790 76,455 94,295 101,940 152,910 203,880

10. . . . . . . . . . . . . . . . . . . . . . . $27,825 55,650 74,015 83,475 102,953 111,300 166,950 222,600

11. . . . . . . . . . . . . . . . . . . . . . . $30,165 60,330 80,239 90,495 111,611 120,660 180,990 241,320

12. . . . . . . . . . . . . . . . . . . . . . . $32,505 65,010 86,463 97,515 120,269 130,020 195,030 260,040

13. . . . . . . . . . . . . . . . . . . . . . . $34,845 69,690 92,688 104,535 128,927 139,380 209,070 278,760

14. . . . . . . . . . . . . . . . . . . . . . . $37,185 74,370 98,912 111,555 137,585 148,740 223,110 297,480

15. . . . . . . . . . . . . . . . . . . . . . . $39,525 79,050 105,137 118,575 146,243 158,100 237,150 316,200

16. . . . . . . . . . . . . . . . . . . . . . . $41,865 83,730 111,361 125,595 154,901 167,460 251,190 334,920

17. . . . . . . . . . . . . . . . . . . . . . . $44,205 88,410 117,585 132,615 163,559 176,820 265,230 353,640

18. . . . . . . . . . . . . . . . . . . . . . . $46,545 93,090 123,810 139,635 172,217 186,180 279,270 372,360

NOTE: See Appendix VI for full definitions of poverty status categories.

Series 1, No. 57 [ Page 191

went through the cascade and reported

income less than $25,000, an additional

cascade question asked whether the

household was above, at, or below

$21,900 (based on rounding rules

described in the notes to the poverty

guideline tables). If the household

reported an income below $21,900 but

above $20,000, their assigned household

poverty status would be category C

(above 133%, but at or below 150% of

poverty).

Using the HHS guidelines, tables

were developed to provide reference

values for the additional income cascade

questions. Reference values using the

2008 guidelines are presented in

Tables XIII–XV. Reference values using

the 2009 guidelines are presented in

Tables XVI–XVIII.
for additional income cascade questions for families in the 48 contiguous states and the District of Columbia

Reported range of household income

500– $10,000– $12,500– $15,000– $17,500– $20,000– $25,000– $30,000– $35,000– $40,000– $45,000– $50,000– $60,000– $75,000

999 $12,499 $14,999 $17,499 $19,999 $24,999 $29,999 $34,999 $39,999 $44,999 $49,999 $59,999 $74,999 and over

A A 14,000 B 18,600 21,000 28,000 F F 42,000 G 56,000 H H

800 A A A B 23,400 26,400 32,600 F F F 52,800 70,400 H

AA 10,600 A A A 21,200 28,200 31,800 D 42,400 F F 63,600 85,000

AA AA A A A A B 33,000 37,200 D E F F 100,000

AA AA AA A A A 28,400 B 37,800 42,600 D 52,500/ F 85,000/

56,800 115,000

AA AA AA 16,000 A A A 32,000 B 42,600 48,000 D 64,000 95,000/

130,000

AA AA AA AA A A A A B B 47,300 53,400 65,900/ 105,000/

71,200 140,000

AA AA AA AA AA A A A A B B 52,100/ 72,500 80,000/

58,800 120,000

AA AA AA AA AA 21,400 A A A 42,800 B 56,900 64,200 85,000/

130,000

AA AA AA AA AA 23,200 A A A A 46,400 B 61,700/ 90,000/

69,600 140,000

AA AA AA AA AA AA A A A A A B 66,500 100,000/

150,000

AA AA AA AA AA AA 26,800 A A A A 53,600 71,300 110,000/

160,000

AA AA AA AA AA AA 28,600 A A A A 57,200 75,000 115,000/

170,000

AA AA AA AA AA AA AA A A A A A B 120,000/

180,000

AA AA AA AA AA AA AA 32,200 A A A A 64,400 130,000/

195,000

AA AA AA AA AA AA AA 34,000 A A A A 68,000 135,000/

205,000

AA AA AA AA AA AA AA AA A A A A 71,600 145,000/

215,000

ome was included within two or more poverty ranges, additional questions (W9Q12 and W9Q12A) were asked to determine the poverty range for the household. Values within the body of this table

Additional income questions were asked with this value (‘‘Would you say this income was above or below [value]?’’) to identify the proper poverty range for the household. Values were rounded to the

he nearest $5,000 if income was over $75,000. When income was less than $20,000, the additional income questions were not asked if the value (i.e., the range border) was less than $900 from either

e. Letters, rather than values, signify that the reported range of household income was entirely within one poverty range. See Appendix VI for full definitions of poverty status categories.

Page 192[ Series 1, No. 57
for additional income cascade questions for families in Alaska

Reported range of household income

500– $10,000– $12,500– $15,000– $17,500– $20,000– $25,000– $30,000– $35,000– $40,000– $45,000– $50,000– $60,000– $75,000

999 $12,499 $14,999 $17,499 $19,999 $24,999 $29,999 $34,999 $39,999 $44,999 $49,999 $59,999 $74,999 and over

800 A A A B 23,300 26,300 32,400 F F F 52,500 70,000 H

AA 11,000 A A A 22,000 B 33,000 D 44,000 F F 66,000 90,000

AA AA 13,300 A A A 26,500 B C D 49,000 53,000 F 80,000/

105,000

AA AA AA A A A A 31,000 B 41,200 46,500 57,400 62,000 95,000/

125,000

AA AA AA AA A A A A B B 47,200 53,300 65,700/ 105,000/

71,000 140,000

AA AA AA AA AA A A A A B B 53,200 74,000 80,000/

120,000

AA AA AA AA AA 22,300 A A A A B B 66,800 90,000/

135,000

AA AA AA AA AA AA A A A A 49,000 B 65,200/ 100,000/

73,500 145,000

AA AA AA AA AA AA 26,800 A A A A 53,500 71,200 105,000/

160,000

AA AA AA AA AA AA 29,000 A A A A 58,000 B 115,000/

175,000

AA AA AA AA AA AA AA 31,300 A A A A 62,500 125,000/

190,000

AA AA AA AA AA AA AA 33,500 A A A A 67,000 135,000/

200,000

AA AA AA AA AA AA AA AA A A A A 71,500 145,000/

215,000

AA AA AA AA AA AA AA AA 38,000 A A A A 150,000/

230,000

AA AA AA AA AA AA AA AA AA A A A A 160,000/

240,000

AA AA AA AA AA AA AA AA AA 42,500 A A A 170,000/

255,000

AA AA AA AA AA AA AA AA AA AA A A A 180,000/

270,000

ome was included within two or more poverty ranges, additional questions (W9Q12 and W9Q12A) were asked to determine the poverty range for the household. Values within the body of this table

Additional income questions were asked with this value (‘‘Would you say this income was above or below [value]?’’) to identify the proper poverty range for the household. Values were rounded to the

he nearest $5,000 if income was over $75,000. When income was less than $20,000, the additional income questions were not asked if the value (i.e., the range border) was less than $900 from either

e. Letters, rather than values, signify that the reported range of household income was entirely within one poverty range. See Appendix VI for full definitions of poverty status categories.

Series 1, No. 57[ Page 193
for additional income cascade questions for families in Hawaii

Reported range of household income

500– $10,000– $12,500– $15,000– $17,500– $20,000– $25,000– $30,000– $35,000– $40,000– $45,000– $50,000– $60,000– $75,000

999 $12,499 $14,999 $17,499 $19,999 $24,999 $29,999 $34,999 $39,999 $44,999 $49,999 $59,999 $74,999 and over

A A A 16,100 B 21,400 D 32,200 F F 48,300 G 64,400 H

AA A A A A B 26,900 D 37,400 F F F G 81,000AA AA A A A A B 32,400 36,600 D 48,800 F 73,100 100,000

AA AA AA A A A 28,500 B 37,900 42,800 D 52,800/ F 85,000/

57,000 115,000

AA AA AA 16,300 A A A 32,700 B 43,400 49,000 D 65,300 100,000/

130,000

AA AA AA AA 18,400 A A A 36,800 B 48,900 55,200 68,100/ 110,000/

73,600 145,000

AA AA AA AA AA A A A A B B 54,500 61,400 80,000/

125,000

AA AA AA AA AA 22,500 A A A A B B 67,600 90,000/

135,000

AA AA AA AA AA AA A A A A A B 65,500/ 100,000/

73,800 150,000

AA AA AA AA AA AA 26,700 A A A A 53,400 71,000 105,000/

160,000

AA AA AA AA AA AA 28,800 A A A A 57,500 B 115,000/

175,000

AA AA AA AA AA AA AA A A A A A 61,600 125,000/

185,000

AA AA AA AA AA AA AA 32,900 A A A A 65,800 130,000/

195,000

AA AA AA AA AA AA AA AA A A A A 69,900 140,000/

210,000

AA AA AA AA AA AA AA AA 37,000 A A A 74,100 150,000/

220,000

AA AA AA AA AA AA AA AA AA A A A A 155,000/

235,000

AA AA AA AA AA AA AA AA AA 41,200 A A A 165,000/

245,000

ome was included within two or more poverty ranges, additional questions (W9Q12 and W9Q12A) were asked to determine the poverty range for the household. Values within the body of this table

Additional income questions were asked with this value (‘‘Would you say this income was above or below [value]?’’) to identify the proper poverty range for the household. Values were rounded to the

he nearest $5,000 if income was over $75,000. When income was less than $20,000, the additional income questions were not asked if the value (i.e., the range border) was less than $900 from either

e. Letters, rather than values, signify that the reported range of household income was entirely within one poverty range. See Appendix VI for full definitions of poverty status categories.

Page 194[ Series 1, No. 57
for additional income cascade questions for families in the 48 contiguous states and the District of Columbia

Reported range of household income

500– $10,000– $12,500– $15,000– $17,500– $20,000– $25,000– $30,000– $35,000– $40,000– $45,000– $50,000– $60,000– $75,000

999 $12,499 $14,999 $17,499 $19,999 $24,999 $29,999 $34,999 $39,999 $44,999 $49,999 $59,999 $74,999 and over

A A A B B 21,900 27,000 F F 43,700 G 58,300 H H

AA A A A 18,300 B 27,500 33,900 36,600 F F 54,900 73,200 H

AA 11,000 A A A 22,100 B 33,100 D E F F 66,200 88,000

AA AA A A A A B B 38,700 D 47,700 51,600 F 80,000/

105,000

AA AA AA A A A A B B C D 54,600 F 90,000/

120,000

AA AA AA 16,600 A A A 33,300 B B C D 61,600/ 100,000/

66,500 135,000

AA AA AA AA 18,500 A A A 37,000 B B 55,500 68,500/ 110,000/

74,000 150,000

AA AA AA AA AA AA A A A A B 54,200 61,100 80,000/

120,000

AA AA AA AA AA 22,200 A A A A B B 66,700 90,000/

135,000

AA AA AA AA AA 24,100 A A A A 48,200 B 64,100/ 95,000/

72,300 145,000

AA AA AA AA AA AA 26,000 A A A A 52,000 69,100 105,000/

155,000

AA AA AA AA AA AA 27,900 A A A A 55,700 B 110,000/

165,000

AA AA AA AA AA AA AA A A A A A B 120,000/

180,000

AA AA AA AA AA AA AA 31,600 A A A A 63,200 125,000/

190,000

AA AA AA AA AA AA AA 33,500 A A A A 66,900 135,000/

200,000

AA AA AA AA AA AA AA AA A A A A 70,700 140,000/

210,000

AA AA AA AA AA AA AA AA 37,200 A A A A 150,000/

225,000

ome was included within two or more poverty ranges, additional questions (W9Q12 and W9Q12A) were asked to determine the poverty range for the household. Values within the body of this table

Additional income questions were asked with this value (‘‘Would you say this income was above or below [value]?’’) to identify the proper poverty range for the household. Values were rounded to the

he nearest $5,000 if income was over $75,000. When income was less than $20,000, the additional income questions were not asked if the value (i.e., the range border) was less than $900 from either

e. Letters, rather than values, signify that the reported range of household income was entirely within one poverty range. See Appendix VI for full definitions of poverty status categories.

Series 1, No. 57[ Page 195
e for additional income cascade questions for families in Alaska

Reported range of household income

500– $10,000– $12,500– $15,000– $17,500– $20,000– $25,000– $30,000– $35,000– $40,000– $45,000– $50,000– $60,000– $75,000

999 $12,499 $14,999 $17,499 $19,999 $24,999 $29,999 $34,999 $39,999 $44,999 $49,999 $59,999 $74,999 and over

AA A A A 18,200 B 27,300 33,700 36,400 F F 54,600 72,800 H

AA 11,400 A A A 22,900 B 30,400 D 42,300 F F 68,700 90,000AA AA 13,800 A A A 27,600 B 36,700 41,400 D 51,000/ F 85,000/

55,100 110,000

AA AA AA 16,100 A A A 32,300 B 42,900 48,400 D 64,500 100,000/

130,000

AA AA AA AA 18,500 A A A 36,900 B B 55,400 68300/ 110,000/

73900 150,000

AA AA AA AA AA A A A A 41,600 B 55,300 62,400 85,000/

125,000

AA AA AA AA AA 23,100 A A A A 46,300 B 61,600/ 95,000/

69,400 140,000

AA AA AA AA AA AA AA A A A A 51,000 67,800 100,000/

155,000

AA AA AA AA AA AA 27,800 A A A A 55,700 74,000 110,000/

165,000

AA AA AA AA AA AA AA A A A A A B 120,000/

180,000

AA AA AA AA AA AA AA 32,500 A A A A 65,000 130,000/

195,000

AA AA AA AA AA AA AA 34,800 A A A A 69,700 140,000/

210,000

AA AA AA AA AA AA AA AA 37,200 A A A 74,400 150,000/

225,000

AA AA AA AA AA AA AA AA AA A A A A 160,000/

235,000

AA AA AA AA AA AA AA AA AA 41,900 A A A 165,000/

250,000

AA AA AA AA AA AA AA AA AA AA A A A 175,000/

265,000

AA AA AA AA AA AA AA AA AA AA 46,500 A A 185,000/

280,000

ome was included within two or more poverty ranges, additional questions (W9Q12 and W9Q12A) were asked to determine the poverty range for the household. Values within the body of this table

Additional income questions were asked with this value (‘‘Would you say this income was above or below [value]?’’) to identify the proper poverty range for the household. Values were rounded to the

he nearest $5,000 if income was over $75,000. When income was less than $20,000, the additional income questions were not asked if the value (i.e., the range border) was less than $900 from either

e. Letters, rather than values, signify that the reported range of household income was entirely within one poverty range. See Appendix VI for full definitions of poverty status categories.

Page 196[ Series 1, No. 57
e for additional income cascade questions for families in Hawaii

Reported range of household income

0– $10,000– $12,500– $15,000– $17,500– $20,000– $25,000– $30,000– $35,000– $40,000– $45,000– $50,000– $60,000– $75,000

9 $12,499 $14,999 $17,499 $19,999 $24,999 $29,999 $34,999 $39,999 $44,999 $49,999 $59,999 $74,999 and over

0 A A 16,800 B 22,300 D 31,000/ F F F G 67,000 H

33,500

A A A A A 21,000 28,000 31,600 39,000 42,100 F F 63,200 85,000

A AA A A A A B 33,700 38,000 D 46,900 F 75,000 100,000

A AA AA A A A A B B C D 54,900 F 90,000/

120,000

A AA AA AA A A A 34,000 B B C D 62,800/ 100,000/

67,900 135,000

A AA AA AA AA A A A 38,300 B B 57,400 70,800 75,000/

115,000

A AA AA AA AA 21,300 A A A 42,600 B 56,600 63,800 85,000/

130,000

A AA AA AA AA 23,400 A A A A 46,900 B 62,300/ 95,000/

70,300 140,000

A AA AA AA AA AA A A A A A 51,200 68,000 100,000/

155,000

A AA AA AA AA AA 27,700 A A A A 55,500 73,800 110,000/

165,000

A AA AA AA AA AA 29,900 A A A A A B 120,000/

180,000

A AA AA AA AA AA AA 32,000 A A A A 64,100 130,000/

190,000

A AA AA AA AA AA AA AA A A A A 68,400 135,000/

205,000

A AA AA AA AA AA AA AA 36,300 A A A 72,700 145,000/

220,000

A AA AA AA AA AA AA AA 38,500 A A A A 155,000/

230,000

A AA AA AA AA AA AA AA AA 40,600 A A A 165,000/

245,000

A AA AA AA AA AA AA AA AA 42,800 A A A 170,000/

255,000

ome was included within two or more poverty ranges, additional questions (W9Q12 and W9Q12A) were asked to determine the poverty range for the household. Values within the body of this table

Additional income questions were asked with this value (‘‘Would you say this income was above or below [value]?’’) to identify the proper poverty range for the household. Values were rounded to the

he nearest $5,000 if income was over $75,000. When income was less than $20,000, the additional income questions were not asked if the value (i.e., the range border) was less than $900 from either

e. Letters, rather than values, signify that the reported range of household income was entirely within one poverty range. See Appendix VI for full definitions of poverty status categories.

Series 1, No. 57[ Page 197
Page 198 [ Series 1, No. 57

Appendix VII. Program Names Used for Medicaid and Children’s

Health Insurance Program Questions

For questions regarding Medicaid

and the Children’s Health Insurance

Program (CHIP), the state-specific

program names for each type of

coverage were included in the question

text, in case respondents recognized the

state program name but not the national

program affiliation. These program

names are shown in Table XIX. States

could be divided into three classes,

depending on how they named the

expanded or created programs that use

Title XXI funds. In 2009–2010, 29

states had distinct Medicaid and CHIP

programs and used different names for

their CHIP programs than for their

Medicaid programs. Eleven states had

distinct Medicaid and CHIP programs

but used the same (or substantially

similar) name for both programs. Eleven

states (including the District of

Columbia) used Title XXI funds to

expand their Medicaid program without

establishing a distinct CHIP program.

Eligibility for specific health

insurance questions and the use of

state-specific program names were based

on this classification. For states that did

not have a distinct CHIP program or

that used similar names for both the

Medicaid and CHIP programs, a single

question about both Medicaid and CHIP

was asked. This question (C7Q04)

included the state-specific program

names (if any) for both types of

programs. For all other states, the name

of the Medicaid program was used for

the question regarding Medicaid

(C7Q01), and the name of the CHIP

program was used for the question

regarding CHIP (C7Q02).

Because a single question about

both Medicaid and CHIP was asked for

nearly one-half of the states, survey

analysts will not be able to distinguish

between Medicaid and CHIP coverage

in national or regional analyses.

Analysts may be required to report on

‘‘public’’ insurance only.

Maryland was categorized as a

combination state, which meant that

separate questions were asked for

Medicaid and CHIP. However, Maryland

discontinued its separate CHIP program

in 2007. So analysts using 2009–2010

data from the National Survey of

Children with Special Health Care

Needs for estimates of CHIP will

inadvertently include Maryland in their

analyses. Analysts should blank out

Medicaid responses (C7Q01) and CHIP

responses (C7Q02) for Maryland and

‘‘create’’ C7Q04, which would be YES

if either Medicaid or CHIP was YES.
 

Series 1, No. 57 [ Page 199

Table XIX. State-specific program names for Medicaid and CHIP

State

Type of

program Category1

Name used

with Medicaid

questions

Name used

with CHIP

questions

Name used

with combination

questions

Alabama .................. Separate A Patient 1st ALL Kids . . .

Alaska ................... Expansion B . . . . . . Denali

KidCare

Arizona ................... Separate A Arizona Health

Care Cost

Containment

System

KidsCare . . .

Arkansas .................. Combination A ConnectCare ARKids First . . .

California .................. Combination A Medi-Cal Healthy

Families

Program

...

Colorado .................. Separate A . . . Child Health

Plan Plus

...

Connecticut ................ Separate C . . . . . . HUSKY Health

Delaware .................. Combination A Diamond

State Health

Plan

Delaware

Healthy

Children

Program

...

District of Columbia ........... Expansion B . . . . . . DC Healthy

Families

Florida ................... Combination C . . . . . . Florida KidCare

(includes

Healthy Kids

and MediKids

programs)

Georgia ................... Separate A Georgia Better

Health Care

Program,

Georgia Families,

or Georgia

Enhanced Care

Program

PeachCare

for Kids

...

Hawaii ................... Expansion B . . . . . . Hawaii QUEST

Idaho .................... Combination A Healthy

Connections

Children’s

Health Insurance

Program

...

Illinois .................... Combination C . . . . . . All Kids

Indiana ................... Combination C . . . . . . Hoosier

Healthwise

Iowa ..................... Combination A MediPASS Healthy and

Well Kids

in Iowa

...

Kansas ................... Separate C . . . . . . HealthWave

Kentucky .................. Combination A KyHealth

Choices

or Kentucky

Patient

Access

and Care

Kentucky

Children’s

Health

Insurance

Program

...

Louisiana .................. Combination C . . . . . . CommunityCARE

or Louisiana

Children’s

Health Insurance

Program

Maine .................... Combination C . . . . . . MaineCare

Maryland .................. Combination A Medical

Assistance

Program or

HealthChoice

Maryland

Children’s

Health Program

...

Massachusetts .............. Combination A MassHealth Massachusetts

Children’s

Medical

Security Plan

...

See footnotes at end of table.
 

Page 200 [ Series 1, No. 57

Table XIX. State-specific program names for Medicaid and CHIP—Con.

State

Type of

program Category1

Name used

with Medicaid

questions

Name used

with CHIP

questions

Name used

with combination

questions

Michigan .................. Combination A Healthy

Kids or

Low Income

Families

MIChild . . .

Minnesota ................. Combination C . . . . . . Medical

Assistance or

MinnesotaCare

Mississippi ................. Separate A Medical

Assistance

Program

Mississippi

Children’s

Health Insurance

Program

...

Missouri .................. Combination C . . . . . . MC-Plus and

MC-Plus

for Kids

Montana .................. Combination A Passport

to Health

Montana Child

Health

Insurance

Plan

...

Nebraska .................. Expansion B . . . . . . Kids Connection

or Nebraska

Health

Connection

Nevada ................... Separate A . . . Nevada

Check Up

...

New Hampshire .............. Combination A . . . Healthy Kids

Gold or

Healthy Kids

Silver

...

New Jersey ................ Combination C . . . . . . NJ FamilyCare

New Mexico ................ Expansion B . . . . . . SALUD!, or

New MexiKids

New York .................. Combination C . . . . . . Child Health Plus

North Carolina ............... Combination A Carolina

ACCESS

North Carolina

Health Choice

...

North Dakota ................ Combination A . . . Healthy Steps . . .

Ohio ..................... Expansion B . . . . . . Healthy Start

and Healthy

Families

Oklahoma .................. Expansion B . . . . . . SoonerCare

Oregon ................... Separate A Oregon Health

Plan

Oregon State

Children’s

Health Insurance

Program

...

Pennsylvania ................ Separate A HealthChoices

Program or the

ACCESS card

Pennsylvania

Children’s

Health Insurance

Program

...

Rhode Island ................ Combination C . . . . . . RIteCare or

RIteShare

South Carolina ............... Expansion B . . . . . . Partners for

Healthy Children

South Dakota................ Combination C . . . . . . The PRIME

program or the

Children’s Health

Insurance

Program

Tennessee ................. Combination A TennCare CoverKids . . .

Texas .................... Separate A State of

Texas Access

Reform program,

STAR program,

or STAR+PLUS

Texas Children’s

Health Insurance

Program

...

See footnotes at end of table.
 

Series 1, No. 57 [ Page 201

Table XIX. State-specific program names for Medicaid and CHIP—Con.

Name used Name used Name used

Type of with Medicaid with CHIP with combination

State program Category1 questions questions questions

Utah ..................... Separate A . . . Utah Children’s ...

Health Insurance

Program

Vermont ................... Separate A . . . Dr. Dynasaur or ...

the Vermont

Children’s

Health Care

Program

Virgin Islands................ Expansion B . . . . . . Medical

Assistance

Program

Virginia ................... Combination A Medallion Family Access to ...

program Medical

Insurance

Security Plan

Washington ................. Separate A Healthy Options Washington ...

or Basic Children’s

Health Plus Health Insurance

Program

West Virginia ................ Separate A Physician West Virginia ...

Assured Access Children’s

System, Health Insurance

Mountain Program

Health

Choices, or

Mountain

Health Trust

Wisconsin .................. Expansion B . . . . . . BadgerCare

Wyoming .................. Separate A EqualityCare Wyoming ...

KidCare or

KidCare CHIP

. . . Category not applicable.
 

1States in category A had separate Medicaid and a Children’s Health Insurance Program (CHIP) and used different names for their CHIP programs than for their Medicaid programs. For states in
 

category B, the CHIP program was an expansion of the Medicaid program. States in category C had separate Medicaid and CHIP programs but used the same name (or a substantially similar name)
 

for both programs. For states in categories B and C, a single question about public insurance coverage was asked using the program name.
 
 

Page 202 [ Series 1, No. 57

Appendix VIII. Program Names Used for Temporary Assistance for

Needy Families Questions

When respondents were asked if

their household received any cash

assistance from a state or county welfare

program within the past year (C11Q11),

state-specific Temporary Assistance for

Needy Families program names were

included in the question text, in case

respondents recognized the state

program name but not the welfare

program affiliation. These program

names are shown in Table XX.

Table XX. State-specific program names for Temporary Assistance for Needy Families

State TANF program name

Alabama .............................. Family Assistance Program
 

Alaska ............................... Alaska Temporary Assistance Program
 

Arizona ............................... Employing and Moving People off Welfare and Encouraging Responsibility
 

Arkansas .............................. Transitional Employment Assistance
 

California .............................. California Work Opportunity and Responsibility to Kids
 

Colorado .............................. Colorado Works
 

Connecticut ............................ Jobs First
 

Delaware .............................. A Better Chance
 

District of Columbia ....................... Temporary Assistance for Needy Families
 

Florida ............................... Welfare Transition Program
 

Georgia ............................... Temporary Assistance for Needy Families
 

Hawaii ............................... Temporary Assistance for Needy Families
 

Idaho ................................ Temporary Assistance for Families in Idaho
 

Illinois ................................ Temporary Assistance for Needy Families
 

Indiana ............................... Temporary Assistance for Needy Families
 

Iowa ................................. The Family Investment Program
 

Kansas ............................... KANSASWORKS
 

Kentucky .............................. Kentucky Transitional Assistance Program
 

Louisiana .............................. Family Independence Temporary Assistance Program
 

Maine ................................ Temporary Assistance for Needy Families
 

Maryland .............................. Family Investment Program
 

Massachusetts .......................... Traditional Aid to Families with Dependent Children
 

Michigan .............................. Family Independence Program
 

Minnesota ............................. Minnesota Family Investment Program
 

Mississippi ............................. Temporary Assistance for Needy Families
 

Missouri .............................. Beyond Welfare
 

Montana .............................. FAIM or Families Achieving Independence in Montana
 

Nebraska .............................. Employment First
 

Nevada ............................... Temporary Assistance for Needy Families
 

New Hampshire .......................... Family Assistance Program or the NH Employment Program
 

New Jersey ............................ Work First New Jersey
 

New Mexico ............................ New Mexico Works
 

New York .............................. Family Assistance Program
 

North Carolina ........................... Work First
 

North Dakota ............................ Training, Employment, Education Management
 

Ohio ................................. Ohio Works First
 

Oklahoma .............................. Temporary Assistance for Needy Families
 

Oregon ............................... Job Opportunities and Basic Skills program
 

Pennsylvania ............................ Pennsylvania Temporary Assistance for Needy Families
 

Rhode Island ............................ Family Independence program
 

South Carolina ........................... Family Independence
 

South Dakota............................ Temporary Assistance for Needy Families
 

Tennessee ............................. Families First
 

Texas ................................ Texas Works
 

Utah ................................. Family Employment Program
 

Vermont ............................... Aid to Needy Families with Children
 

Virgin Islands............................ Family Improvement Program
 

Virginia ............................... Virginia Initiative for Employment Not Welfare
 

Washington ............................. WorkFirst
 

West Virginia ............................ WV WORKS
 

Wisconsin .............................. Wisconsin Works
 

Wyoming .............................. Personal Opportunities with Employment Responsibility
 
Series 1, No. 57 [ Page 203
 

Appendix IX. Letters Sent to Sampled Households

This appendix contains the full complement of National Survey of Children with Special Health Care Needs (NS-CSHCN)

letters that were sent to households. Differences among the various types of incentive groups are discussed in detail in Appendix

XII. The following letters are included:

NS-CSHCN Advance Letter (Augmentation Sample) ............................................................ 204 
 

Refusal Converter Letter (No Offer) ......................................................................... 206 
 

$5 Promise Refusal Converter Letter ......................................................................... 208 
 

$1 Prepaid/$10 Promise Refusal Converter Letter............................................................... 210 
 

$1 Prepaid/No Promise Refusal Converter Letter ............................................................... 212 
 

$5 Prepaid/$10 Promise Refusal Converter Letter............................................................... 214 
 

$5 Prepaid/No Promise Refusal Converter Letter ............................................................... 216 
 

$5 Thank You Letter ...................................................................................... 218 
 

$10 Thank You Letter ..................................................................................... 219 
 

$11 Thank You Letter ..................................................................................... 220 
 

$15 Thank You Letter ..................................................................................... 221 
 
http://www.cdc.gov/nchs/slaits/nscnc.htmhttp://www.cdc.gov/nchs/slaits/nscnc.htm

 

 

 

NS-CSHCN Advance Letter (Augmentation Sample) 

Dear Resident,
 

The CDC needs your help!
 

In the next few weeks, the Centers for Disease Control and Prevention (CDC) will call your 

household to participate in a study about the health of children and teenagers. 

Information about all children will help the U.S. Department of Health and Human Services 

develop programs to promote the health of children in your state and throughout the United 

States. 

Your household is very important to the study because it has been scientifically selected and 

cannot be replaced. It is important that we talk to your household to learn about the health of 

children in your community. When we call you, we will ask a few questions to see if your 

household is eligible for this study. 

We hope you will share this important information with us by phone when an interviewer calls to 

ask you to take part in the study. If you do, you can choose not to answer any questions you do 

not wish to answer. All information collected for this study is confidential and protected by
 

federal law. The back of this letter provides answers to some questions you may have and ways 

to get more information about the survey.
 

To learn more about the study or to take part right away, call 1-866-999-3340, toll-free. CDC
 

has hired the National Opinion Research Center (NORC) at the University of Chicago to conduct 

the survey. Our website shows how we have used the data from the 2005 survey -

http://mchb.hrsa.gov/cshcn05/.
 

Thank you very much for your help with this important research. 

Sincerely, 

/ Edward J. Sondik, Ph.D/ 

Edward J. Sondik, Ph.D. 

Director, National Center for Health Statistics 

Centers for Disease Control and Prevention 

If you prefer to use TTY 

Please call the AT&T Relay Service at 1-800-855-2880 and request that 

1-866-999-3340 be called. The call is toll-free.
 

Page 204 □ Series 1, No. 57
 

 

National Survey of Children with Special Health Care Needs
 

Frequently Asked Questions
 

What is the purpose of this study? 

This survey is designed to count the number of children with special health care needs in each 

state, to describe the types of services that they need and use, and to identify any problems they 

have in getting care. People have very different experiences with their children’s health and 

health care. In order to improve children’s health and well-being, it is important that we learn 

about how children use health care services and about any problems that they have in getting 

care that they need. 

Does this study apply to me? 

The CDC is interested in talking with all households. We need your information to get a 

complete picture of your area’s special health needs. It will take a few minutes or less to 

determine if you are eligible for the study. 

How will you protect my privacy? 

We are bound by law to maintain strict confidentiality standards. Your information and the 

child’s information will never be associated with any results. 

If you would like more information about the confidentiality of the research or the federal laws 

that ensure the protection of your information, including the Public Health Service Act and the 

Confidential Information Protection and Statistical Efficiency Act, these are described in detail 

at: http://www.cdc.gov/nchs/about/policy/confidentiality.htm. If you want to know more about 

your rights as a study participant you may call 1-800-223-8118, toll-free. This is the number for 

the Research Ethics Review Board at CDC. You will be asked to leave a message and say you 

are calling about Protocol 2009-04. 

How will this information be used? 

Maternal and child health agencies in your state will use this information to improve health care 

services for children and their families. The federal government will also use this information to 

learn about the types of support services that states need for children’s health care. 

You may visit http://www.cdc.gov/nchs/slaits.htm to find general information about the study. 

To find results from the last time the survey was done, please visit 

http://mchb.hrsa.gov/cshcn05/. 

NORC's Toll-Free Number: 1-866-999-3340 

You can call NORC's toll-free number to take part in the study right away, learn more about the 

study, and hear what you will be asked. 

Series 1, No. 57 □ Page 205
 

Refusal Converter Letter (No Offer) 

Dear Parent or Guardian, 

The CDC needs your help! 

Recently, your family was asked to take part in a survey about the health services used by 

children and teenagers, but we have not been able to complete the interview yet. We hope you 

will reconsider our request. Information about all children will help the U.S. Department of 

Health and Human Services develop programs to promote the health of children in your state and 

throughout the United States. 

We hope you will share this important information with us by phone when an interviewer calls to 

ask you to take part in the study. If you would like to participate right away or find out more 

about the survey, please call the toll-free phone number 1-866-999-3340. 

Your household is very important to the study because it has been scientifically selected and 

cannot be replaced. All information collected for this study is confidential and protected by 

federal law. The back of this letter provides answers to some questions you may have and ways 

to get more information about the survey. 

Thank you very much for your help with this important research. 

Sincerely, 

/ Edward J. Sondik, Ph.D/ 

Edward J. Sondik, Ph.D. 

Director, National Center for Health Statistics 

Centers for Disease Control and Prevention 

Page 206 □ Series 1, No. 57
 

 

 

 

National Survey of Children with Special Health Care Needs 

Frequently Asked Questions
 

Why is this study being conducted? 

This survey is designed to count the number of children with special health care needs in each 

state, to describe the types of services that they need and use, and to identify any problems they 

have in getting care. People have very different experiences with their children’s health and 

health care. In order to improve children’s health and well-being, it is important that we learn 

about how children use health care services and about any problems that they have in getting 

care that they need. 

How will this information be used? 

Maternal and Child Health Agencies in your state will use this information to improve programs 

and services for children and their families. The federal government will also use this 

information to learn about the types of support services that states need for children’s health and 

well-being. You may visit http://www.cdc.gov/nchs/slaits.htm to find general information 

about the study. To find results from the last time the survey was done, please visit 

http://mchb.hrsa.gov/cshcn05/. 

Does this study apply to me? 

The CDC is interested in talking with all households. We need your information to get a 

complete picture of your area’s special health needs. It will take a few minutes or less to 

determine if you are eligible for the study. 

How will you protect my privacy? 

We are bound by law to maintain strict confidentiality standards. Your information and the 

child’s information will never be associated with any results. 

If you would like more information about the confidentiality of the research, the federal laws, 

including the Public Health Service Act and the Confidential Information Protection and 

Statistical Efficiency Act, that ensure the protection of your information have been described in 

detail at: http://www.cdc.gov/nchs/about/policy/confidentiality.htm. If you want to know more 

about your rights as a study participant you may call 1-800-223-8118, toll free. This is the 

number for the Research Ethics Review Board at CDC. You will be asked to leave a message 

and say you are calling about Protocol 2009-04. 

How can I find out more about this survey? 

If you have any questions about this research study, please call 1-866-999-3340. 

Series 1, No. 57 □ Page 207
 

 

 

$5 Promise Refusal Converter Letter 

Dear Parent or Guardian, 

The CDC needs your help! 

Recently, your family was asked to take part in a survey about health services used by children 

and teenagers, but we have not been able to complete the interview yet. We hope you will 

reconsider our request. Information about all children will help the U.S. Department of Health 

and Human Services develop programs to promote the health of children in your state and 

throughout the United States. 

We hope you will share this important information with us by phone when an interviewer calls to 

ask you to take part in the study. If you would like to participate right away or find out more 

about the survey, please call the toll-free phone number 1-866-999-3340. 

Your household is very important to the study because it has been scientifically selected and 

cannot be replaced. All information collected for this study is confidential and protected by 

federal law. The back of this letter provides answers to some questions you may have and ways 

to get more information about the survey. 

Thank you very much for your help with this important research. 

Sincerely, 

/ Edward J. Sondik, Ph.D/ 

Edward J. Sondik, Ph.D. 

Director, National Center for Health Statistics 

Centers for Disease Control and Prevention 

P.S. In appreciation for your time and effort, we will send you $5 in cash once you complete the 

interview. 

Page 208 □ Series 1, No. 57
 

 

 

 

National Survey of Children with Special Health Care Needs
 

Frequently Asked Questions
 

Why is this study being conducted? 

This survey is designed to count the number of children with special health care needs in each 

state, to describe the types of services that they need and use, and to identify any problems they 

have in getting care. People have very different experiences with their children’s health and 

health care. In order to improve children’s health and well-being, it is important that we learn 

about how children use health care services and about any problems that they have in getting 

care that they need. 

How will this information be used? 

Maternal and Child Health Agencies in your state will use this information to improve programs 

and services for children and their families. The federal government will also use this 

information to learn about the types of support services that states need for children’s health and 

well-being. You may visit http://www.cdc.gov/nchs/slaits.htm to find general information 

about the study. To find results from the last time the survey was done, please visit 

http://mchb.hrsa.gov/cshcn05/. 

Does this study apply to me? 

The CDC is interested in talking with all households. We need your information to get a 

complete picture of your area’s special health needs. It will take a few minutes or less to 

determine if you are eligible for the study. 

How will you protect my privacy? 

We are bound by law to maintain strict confidentiality standards. Your information and the 

child’s information will never be associated with any results. 

If you would like more information about the confidentiality of the research, the federal laws, 

including the Public Health Service Act and the Confidential Information Protection and 

Statistical Efficiency Act, that ensure the protection of your information have been described in 

detail at: http://www.cdc.gov/nchs/about/policy/confidentiality.htm. If you want to know more 

about your rights as a study participant you may call 1-800-223-8118, toll free. This is the 

number for the Research Ethics Review Board at CDC. You will be asked to leave a message 

and say you are calling about Protocol 2009-04. 

How can I find out more about this survey? 

If you have any questions about this research study, please call 1-866-999-3340. 

Series 1, No. 57 □ Page 209
 

 

$1 Prepaid/$10 Promise Refusal Converter Letter 

Dear Parent or Guardian, 

The CDC needs your help! 

Recently, your family was asked to take part in a survey about health services used by children 

and teenagers, but we have not been able to complete the interview yet. We hope you will 

reconsider our request. Information about your child and other children will help the U.S. 

Department of Health and Human Services develop programs to promote the health of children 

in your state and throughout the United States. 

We hope you will share this important information with us by phone when an interviewer calls to 

ask you to take part in the study. If you would like to participate right away or find out more 

about the survey, please call the toll-free phone number 1-866-999-3340. 

Your household is very important to the study because it has been scientifically selected and 

cannot be replaced. All information collected for this study is confidential and protected by 

federal law. The back of this letter provides answers to some questions you may have and ways 

to get more information about the survey. 

Thank you very much for your help with this important research. 

Sincerely, 

/ Edward J. Sondik, Ph.D/ 

Edward J. Sondik, Ph.D. 

Director, National Center for Health Statistics 

Centers for Disease Control and Prevention 

P.S. In appreciation for your time and effort, we have enclosed $1. We will send an additional 

$10 in cash once you complete the interview. 

Page 210 □ Series 1, No. 57
 

 

 

 

Series 1, No. 57 □ Page 211

National Survey of Children with Special Health Care Needs
 

Frequently Asked Questions
 

Why is this study being conducted? 

This survey is designed to count the number of children with special health care needs in each 

state, to describe the types of services that they need and use, and to identify any problems they 

have in getting care. People have very different experiences with their children’s health and 

health care. In order to improve children’s health and well-being, it is important that we learn 

about how children use health care services and about any problems that they have in getting 

care that they need. 

How will this information be used? 

Maternal and Child Health Agencies in your state will use this information to improve programs 

and services for children and their families. The federal government will also use this 

information to learn about the types of support services that states need for children’s health and 

well-being. You may visit http://www.cdc.gov/nchs/slaits.htm to find general information 

about the study. To find results from the last time the survey was done, please visit 

http://mchb.hrsa.gov/cshcn05/. 

Does this study apply to me? 

The CDC is interested in talking with all households. We need your information to get a 

complete picture of your area’s special health needs. It will take a few minutes or less to 

determine if you are eligible for the study. 

How will you protect my privacy? 

We are bound by law to maintain strict confidentiality standards. Your information and the 

child’s information will never be associated with any results. 

If you would like more information about the confidentiality of the research, the federal laws, 

including the Public Health Service Act and the Confidential Information Protection and 

Statistical Efficiency Act, that ensure the protection of your information have been described in 

detail at: http://www.cdc.gov/nchs/about/policy/confidentiality.htm. If you want to know more 

about your rights as a study participant you may call 1-800-223-8118, toll free. This is the 

number for the Research Ethics Review Board at CDC. You will be asked to leave a message 

and say you are calling about Protocol 2009-04. 

How can I find out more about this survey? 

If you have any questions about this research study, please call 1-866-999-3340. 
 

 

 

Page 212 □ Series 1, No. 57

$1 Prepaid/No Promise Refusal Converter Letter 

Dear Parent or Guardian, 

The CDC needs your help! 

Recently, your family was asked to take part in a survey about health services used by children 

and teenagers, but we have not been able to complete the interview yet. We hope you will 

reconsider our request. Information about all children will help the U.S. Department of Health 

and Human Services develop programs to promote the health of children in your state and 

throughout the United States. 

We hope you will share this important information with us by phone when an interviewer calls to 

ask you to take part in the study. If you would like to participate right away or find out more 

about the survey, please call the toll-free phone number 1-866-999-3340. 

Your household is very important to the study because it has been scientifically selected and 

cannot be replaced. All information collected for this study is confidential and protected by 

federal law. The back of this letter provides answers to some questions you may have and ways 

to get more information about the survey. 

Thank you very much for your help with this important research. 

Sincerely, 

/ Edward J. Sondik, Ph.D/ 

Edward J. Sondik, Ph.D. 

Director, National Center for Health Statistics 

Centers for Disease Control and Prevention 

P.S. In appreciation for your time and effort, we have enclosed $1. 
 

 

 

 

Series 1, No. 57 □ Page 213

National Survey of Children with Special Health Care Needs
 

Frequently Asked Questions
 

Why is this study being conducted? 

This survey is designed to count the number of children with special health care needs in each 

state, to describe the types of services that they need and use, and to identify any problems they 

have in getting care. People have very different experiences with their children’s health and 

health care. In order to improve children’s health and well-being, it is important that we learn 

about how children use health care services and about any problems that they have in getting 

care that they need. 

How will this information be used? 

Maternal and Child Health Agencies in your state will use this information to improve programs 

and services for children and their families. The federal government will also use this 

information to learn about the types of support services that states need for children’s health and 

well-being. You may visit http://www.cdc.gov/nchs/slaits.htm to find general information 

about the study. To find results from the last time the survey was done, please visit 

http://mchb.hrsa.gov/cshcn05/. 

Does this study apply to me? 

The CDC is interested in talking with all households. We need your information to get a 

complete picture of your area’s special health needs. It will take a few minutes or less to 

determine if you are eligible for the study. 

How will you protect my privacy? 

We are bound by law to maintain strict confidentiality standards. Your information and the 

child’s information will never be associated with any results. 

If you would like more information about the confidentiality of the research, the federal laws, 

including the Public Health Service Act and the Confidential Information Protection and 

Statistical Efficiency Act, that ensure the protection of your information have been described in 

detail at: http://www.cdc.gov/nchs/about/policy/confidentiality.htm. If you want to know more 

about your rights as a study participant you may call 1-800-223-8118, toll free. This is the 

number for the Research Ethics Review Board at CDC. You will be asked to leave a message 

and say you are calling about Protocol 2009-04. 

How can I find out more about this survey? 

If you have any questions about this research study, please call 1-866-999-3340. 
 

 

Page 214 □ Series 1, No. 57

$5 Prepaid/$10 Promise Refusal Converter Letter 

Dear Parent or Guardian, 

The CDC needs your help! 

Recently, your family was asked to take part in a survey about health services used by children 

and teenagers, but we have not been able to complete the interview yet. We hope you will 

reconsider our request. Information about your child and other children will help the U.S. 

Department of Health and Human Services develop programs to promote the health of children 

in your state and throughout the United States. 

We hope you will share this important information with us by phone when an interviewer calls to 

ask you to take part in the study. If you would like to participate right away or find out more 

about the survey, please call the toll-free phone number 1-866-999-3340. 

Your household is very important to the study because it has been scientifically selected and 

cannot be replaced. All information collected for this study is confidential and protected by 

federal law. The back of this letter provides answers to some questions you may have and ways 

to get more information about the survey. 

Thank you very much for your help with this important research. 

Sincerely, 

/ Edward J. Sondik, Ph.D/ 

Edward J. Sondik, Ph.D. 

Director, National Center for Health Statistics 

Centers for Disease Control and Prevention 

P.S. In appreciation for your time and effort, we have enclosed $5. We will send an additional 

$10 in cash once you complete the interview. 
 

 

 

 

Series 1, No. 57 □ Page 215

National Survey of Children with Special Health Care Needs
 

Frequently Asked Questions
 

Why is this study being conducted? 

This survey is designed to count the number of children with special health care needs in each 

state, to describe the types of services that they need and use, and to identify any problems they 

have in getting care. People have very different experiences with their children’s health and 

health care. In order to improve children’s health and well-being, it is important that we learn 

about how children use health care services and about any problems that they have in getting 

care that they need. 

How will this information be used? 

Maternal and Child Health Agencies in your state will use this information to improve programs 

and services for children and their families. The federal government will also use this 

information to learn about the types of support services that states need for children’s health and 

well-being. You may visit http://www.cdc.gov/nchs/slaits.htm to find general information 

about the study. To find results from the last time the survey was done, please visit 

http://mchb.hrsa.gov/cshcn05/. 

Does this study apply to me? 

The CDC is interested in talking with all households. We need your information to get a 

complete picture of your area’s special health needs. It will take a few minutes or less to 

determine if you are eligible for the study. 

How will you protect my privacy? 

We are bound by law to maintain strict confidentiality standards. Your information and the 

child’s information will never be associated with any results. 

If you would like more information about the confidentiality of the research, the federal laws, 

including the Public Health Service Act and the Confidential Information Protection and 

Statistical Efficiency Act, that ensure the protection of your information have been described in 

detail at: http://www.cdc.gov/nchs/about/policy/confidentiality.htm. If you want to know more 

about your rights as a study participant you may call 1-800-223-8118, toll free. This is the 

number for the Research Ethics Review Board at CDC. You will be asked to leave a message 

and say you are calling about Protocol 2009-04. 

How can I find out more about this survey? 

If you have any questions about this research study, please call 1-866-999-3340. 
 

 

Page 216 □ Series 1, No. 57

$5 Prepaid/No Promise Refusal Converter Letter 

Dear Parent or Guardian, 

The CDC needs your help! 

Recently, your family was asked to take part in a survey about health services used by children 

and teenagers, but we have not been able to complete the interview yet. We hope you will 

reconsider our request. Information about all children will help the U.S. Department of Health 

and Human Services develop programs to promote the health of children in your state and 

throughout the United States. 

We hope you will share this important information with us by phone when an interviewer calls to 

ask you to take part in the study. If you would like to participate right away or find out more 

about the survey, please call the toll-free phone number 1-866-999-3340. 

Your household is very important to the study because it has been scientifically selected and 

cannot be replaced. All information collected for this study is confidential and protected by 

federal law. The back of this letter provides answers to some questions you may have and ways 

to get more information about the survey. 

Thank you very much for your help with this important research. 

Sincerely, 

/ Edward J. Sondik, Ph.D/ 

Edward J. Sondik, Ph.D. 

Director, National Center for Health Statistics 

Centers for Disease Control and Prevention 

P.S. In appreciation for your time and effort, we have enclosed $5 cash. 
 

 

 

 

Series 1, No. 57 □ Page 217

National Survey of Children with Special Health Care Needs
 

Frequently Asked Questions
 

Why is this study being conducted? 

This survey is designed to count the number of children with special health care needs in each 

state, to describe the types of services that they need and use, and to identify any problems they 

have in getting care. People have very different experiences with their children’s health and 

health care. In order to improve children’s health and well-being, it is important that we learn 

about how children use health care services and about any problems that they have in getting 

care that they need. 

How will this information be used? 

Maternal and Child Health Agencies in your state will use this information to improve programs 

and services for children and their families. The federal government will also use this 

information to learn about the types of support services that states need for children’s health and 

well-being. You may visit http://www.cdc.gov/nchs/slaits.htm to find general information 

about the study. To find results from the last time the survey was done, please visit 

http://mchb.hrsa.gov/cshcn05/. 

Does this study apply to me? 

The CDC is interested in talking with all households. We need your information to get a 

complete picture of your area’s special health needs. It will take a few minutes or less to 

determine if you are eligible for the study. 

How will you protect my privacy? 

We are bound by law to maintain strict confidentiality standards. Your information and the 

child’s information will never be associated with any results. 

If you would like more information about the confidentiality of the research, the federal laws, 

including the Public Health Service Act and the Confidential Information Protection and 

Statistical Efficiency Act, that ensure the protection of your information have been described in 

detail at: http://www.cdc.gov/nchs/about/policy/confidentiality.htm. If you want to know more 

about your rights as a study participant you may call 1-800-223-8118, toll free. This is the 

number for the Research Ethics Review Board at CDC. You will be asked to leave a message 

and say you are calling about Protocol 2009-04. 

How can I find out more about this survey? 

If you have any questions about this research study, please call 1-866-999-3340. 
Page 218 □ Series 1, No. 57

$5 Thank You Letter 

Dear Parent or Guardian, 

Thank you for taking part in the National Survey of Children with Special Health Care Needs. 

The information that you gave about your child will help the Centers for Disease Control and 

Prevention develop programs to promote the health of children in your state and throughout the 

United States. 

In appreciation for your time and effort spent answering our questions, we have enclosed $5. 

If you would like more information about the survey, you may visit 

http://www.cdc.gov/nchs/slaits.htm, or call the toll-free phone number for the study at 1-866-

999-3340. To find results from the last time the survey was done, please visit 

http://mchb.hrsa.gov/cshcn05/. 

Thank you again for your help with this important research. 

Sincerely, 

/ Edward J. Sondik, Ph.D/ 

Edward J. Sondik, Ph.D. 

Director, National Center for Health Statistics 

Centers for Disease Control and Prevention 
Series 1, No. 57 □ Page 219

$10 Thank You Letter 

Dear Parent or Guardian, 

Thank you for taking part in the National Survey of Children with Special Health Care Needs. 

The information that you gave about your child will help the Centers for Disease Control and 

Prevention develop programs to promote the health of children in your state and throughout the 

United States. 

In appreciation for your time and effort spent answering our questions, we have enclosed $10. 

If you would like more information about the survey, you may visit 

http://www.cdc.gov/nchs/slaits.htm, or call the toll-free phone number for the study at 1-866-

999-3340. To find results from the last time the survey was done, please visit 

http://mchb.hrsa.gov/cshcn05/. 

Thank you again for your help with this important research. 

Sincerely, 

/ Edward J. Sondik, Ph.D/ 

Edward J. Sondik, Ph.D. 

Director, National Center for Health Statistics 

Centers for Disease Control and Prevention 
Page 220 □ Series 1, No. 57

$11 Thank You Letter 

Dear Parent or Guardian, 

Thank you for taking part in the National Survey of Children with Special Health Care Needs. 

The information that you gave about your child will help the Centers for Disease Control and 

Prevention develop programs to promote the health of children in your state and throughout the 

United States. 

In appreciation for your time and effort spent answering our questions, we have enclosed $11. 

If you would like more information about the survey, you may visit 

http://www.cdc.gov/nchs/slaits.htm, or call the toll-free phone number for the study at 1-866-

999-3340. To find results from the last time the survey was done, please visit 

http://mchb.hrsa.gov/cshcn05/. 

Thank you again for your help with this important research. 

Sincerely, 

/ Edward J. Sondik, Ph.D/ 

Edward J. Sondik, Ph.D. 

Director, National Center for Health Statistics 

Centers for Disease Control and Prevention 
 

Series 1, No. 57 □ Page 221

$15 Thank You Letter 

Dear Parent or Guardian, 

Thank you for taking part in the National Survey of Children with Special Health Care Needs. The 

information that you gave about your child will help the Centers for Disease Control and Prevention 

develop programs to promote the health of children in your state and throughout the United States. 

In appreciation for your time and effort spent answering our questions, we have enclosed $15. 

If you would like more information about the survey, you may visit 

http://www.cdc.gov/nchs/slaits.htm, or call the toll-free phone number for the study at 1-866-999-

3340. To find results from the last time the survey was done, please visit 

http://mchb.hrsa.gov/cshcn05/. 

Thank you again for your help with this important research. 

Sincerely, 

/ Edward J. Sondik, Ph.D/ 

Edward J. Sondik, Ph.D. 

Director, National Center for Health Statistics 

Centers for Disease Control and Prevention 
 

Page 222 [ Series 1, No. 57

Appendix X. Disposition Code Frequencies and Response Rate

Calculations

This appendix consists of Tables XXI–XXIV, which show the disposition code frequencies and how response rates were

calculated.

Table XXI. Unweighted response rate calculations for 2009–2010 National Survey of Children with Special Health Care Needs: All sample

Frequency or Disposition category code

Disposition categories and response rates calculated rate for formulas or formula

Summary of disposition categories

Not resolved as residential or nonresidential ......................... 1,801,992 UH

Nonresidential out of scope (i.e., business, nonworking, fax or modem)......... 4,657,759 ZN

Residential, out of scope (i.e., landline only or minor only cell) .............. 74,504 ZR

Known household, age eligibility undetermined ........................ 183,208 UOC

Age- and cell-screened household, no child in range .................... 883,656 XC

Known age- and cell-eligible household, special-needs eligibility undetermined .... 78,081 UOS

Special-needs screened, no eligible child ........................... 150,790 XS

Special-needs eligible household, interview not completed................. 7,933 R

Special-needs eligible household, partially completed interview .............. 534 P

Completed interview ........................................ 40,052 I

Total .................................................. 7,878,509 T

Calculation of response rates (percent)

Interview completion rate (ICR) ................................. 83.65 (P+I)/(R+P+I)

Special-needs screener completion rate (SNSCR) ...................... 71.85 (XS+R+P+I)/ (UOS+XS+R+P+I)

Age- and cell-status screener completion rate (ASCR) ................... 87.09 (ZR+XC+UOS+XS+R+P+I)/

(ZR+UOC+XC+UOS+XS+R+P+I)

Resolution rate (RR) ........................................ 77.13 (ZN+ZR+UOC+XC+UOS+XS+R+P+I)/

(UH+ZN+ZR+UOC+XC+UOS+XS+R+P+I)

Council of American Survey Research Organizations rate ................. 40.37 ICR*SNSCR*ASCR*RR
 

Series 1, No. 57 [ Page 223

Table XXII. Unweighted response rate calculations for 2009–2010 National Survey of Children with Special Health Care Needs: Landline

sample

Frequency or Disposition category code

Disposition categories and response rates calculated rate for formulas or formula

Summary of disposition categories

Not resolved as residential or nonresidential ......................... 1,175,038 UH

Nonresidential out of scope (i.e., business, nonworking, fax or modem)......... 4,325,961 ZN

Residential, out of scope (i.e., landline only or minor only cell) .............. – ZR

Known household, age eligibility undetermined ........................ 122,503 UOC

Age-screened household, no child in range .......................... 777,356 XC

Known age-eligible household, special-needs eligibility undetermined .......... 64,480 UOS

Special-needs screened, no eligible child ........................... 133,440 XS

Special-needs eligible household, interview not completed................. 6,981 R

Special-needs eligible household, partially completed interview .............. 460 P

Completed interview ........................................ 36,791 I

Total .................................................. 6,643,010 T

Calculation of response rates (percent)

Interview completion rate (ICR) ................................. 84.22 (P+I)/(R+P+I)

Special-needs screener completion rate (SNSCR) ...................... 73.37 (XS+R+P+I)/(UOS+XS+R+P+I)

Age-screener completion rate (ASCR) ............................. 89.27 (ZR+XC+UOS+XS+R+P+I)/

(ZR+UOC+XC+UOS+XS+R+P+I)

Resolution rate (RR) ........................................ 82.31 (ZN+ZR+UOC+XC+UOS+XS+R+P+I)/

(UH+ZN+ZR+UOC+XC+UOS+XS+R+P+I)

Council of American Survey Research Organizations rate ................. 45.41 ICR*SNSCR*ASCR*RR

– Quantity zero.
 

NOTE: Sample excludes the U.S. Virgin Islands.
 
 

 

Page 224 [ Series 1, No. 57

Table XXIII. Unweighted response rate calculations for 2009–2010 National Survey of Children with Special Health Care Needs: Landline

sample for U.S. Virgin Islands only

Frequency or Disposition category code

Disposition categories and response rates calculated rate for formulas or formula

Summary of disposition categories

Not resolved as residential or nonresidential ......................... 10,117 UH

Nonresidential out of scope (i.e., business, nonworking, fax or modem)......... 70,566 ZN

Residential, out of scope (i.e., landline only or minor only cell) .............. – ZR

Known household, age eligibility undetermined ........................ 896 UOC

Age-screened household, no child in range .......................... 9,373 XC

Known age-eligible household, special-needs eligibility undetermined .......... 736 UOS

Special-needs screened, no eligible child ........................... 2,773 XS

Special-needs eligible household, interview not completed................. 33 R

Special-needs eligible household, partially completed interview .............. 5 P

Completed interview ........................................ 339 I

Total .................................................. 94,838 T

Calculation of response rates (percent)

Interview completion rate (ICR) ................................. 91.25 (P+I)/(R+P+I)

Special-needs screener completion rate (SNSCR) ...................... 81.06 (XS+R+P+I)/

(UOS+XS+R+P+I)

Age-screener completion rate (ASCR) ............................. 93.67 (ZR+XC+UOS+XS+R+P+I)/

(ZR+UOC+XC+UOS+XS+R+P+I)

Resolution rate (RR) ........................................ 89.33 (ZN+ZR+UOC+XC+UOS+XS+R+P+I)/

(UH+ZN+ZR+UOC+XC+UOS+XS+R+P+I)

Council of American Survey Research Organizations rate ................. 61.89 ICR*SNSCR*ASCR*RR

– Quantity zero.
 

Series 1, No. 57 [ Page 225

Table XXIV. Unweighted response rate calculations for 2009–2010 National Survey of Children with Special Health Care Needs: Cell-phone

sample

Frequency or Disposition category code

Disposition categories and response rates calculated rate for formulas or formula

Summary of disposition categories

Not resolved as residential or nonresidential ......................... 616,837 UH

Nonresidential out of scope (i.e., business, nonworking, fax or modem)......... 261,232 ZN

Residential, out of scope (i.e., landline only or minor only cell) .............. 74,504 ZR

Known household, age eligibility undetermined ........................ 59,809 UOC

Age- and cell-screened household, no child in range .................... 96,927 XC

Known age- and cell-eligible household, special-needs eligibility undetermined .... 12,865 UOS

Special-needs screened, no eligible child ........................... 14,577 XS

Special-needs eligible household, interview not completed................. 919 R

Special-needs eligible household, partially completed interview .............. 69 P

Completed interview ........................................ 2,922 I

Total .................................................. 1,140,661 T

Calculation of response rates (percent)

Interview completion rate (ICR) ................................. 76.50 (P+I)/(R+P+I)

Special-needs screener completion rate (SNSCR) ...................... 58.97 (XS+R+P+I)/(UOS+XS+R+P+I)

Age and cell status screener completion rate (ASCR).................... 77.22 (ZR+XC+UOS+XS+R+P+I)/

(ZR+UOC+XC+UOS+XS+R+P+I)

Resolution rate (RR) ........................................ 45.92 (ZN+ZR+UOC+XC+UOS+XS+R+P+I)/

(UH+ZN+ZR+UOC+XC+UOS+XS+R+P+I)

Council of American Survey Research Organizations rate ................. 16.00 ICR*SNSCR*ASCR*RR
Appendix XI. Alternative Response Rates

By definition, the response rate is

the number of completed interviews as a

proportion of the number of eligible

units in the sample. For the specialneeds detailed interview response rate,

the numerator is the number of

households that completed Section 7,

and the denominator is the number of

households in the sample that contain a

special-needs child. For the specialneeds screener response rate, the

numerator is the number of households

that completed the special-needs

screener, and the denominator is the

number of age- and cell-status eligible

households (or the number of children

in such households) in the sample. In

either case, the response rate is given as:

Complete Interviews. Eligibles

However, due to nonresponse prior

to completion of the screeners, the

eligibility status is not observed for all

sample units, and the number of eligible

units in the sample must be estimated.

The response rate formula is therefore

often written as:

Complete Interviews , Observed Eligibles + eU

where U is the number of sampled

telephone numbers for which the

eligibility status has not been observed,

and e is the assumed rate of eligibility

among these unobserved units. This

equation is of the form of the response

rate formulae from the American

Association for Public Opinion

Research’s (AAPOR) ‘‘Standard

Definitions: Final Dispositions of Case

Codes and Outcome Rates for

Surveys’’ (31). The value for e must be

assumed, and the calculated response

rate value can vary a great deal

depending on the assumption used to

estimate e.

Setting e = 1—that is, assuming

that all sample units with unobserved

eligibility status are actually eligible—

represents the minimum response rate

and corresponds to AAPOR Response

Rate 1 (31). For the National Survey of

Children with Special Health Care

Needs (NS-CSHCN), the minimum

household-level special-needs screener

response rate was 11.3% for the landline

sample, 2.7% for the cellular- (cell)

phone sample, and 4.6% overall; the

minimum child-level special-needs

screener response rate was 11.2% for

the landline sample, 2.6% for the

cell-phone sample, and 4.5% overall;

and the minimum special-needs

interview response rates were 2.6%,

0.4%, and 0.9% for the landline sample,

cell-phone sample, and overall,

respectively.

Setting e = 0 represents the

maximum response rate, reflecting an

assumption that all of the sample units

with unobserved eligibility status are

actually ineligible and correspond to

AAPOR Response Rate 5 (31). For

NS-CSHCN, the maximum householdlevel special-needs screener response

rate was 72.6% for the landline sample,

56.5% for the cell-phone sample, and

64.3% overall; the maximum child-level

special-needs screener response rate was

71.9% for the landline sample, 54.3%

for the cell-phone sample, and 63.0%

overall; and the maximum special-needs

interview response rates were 83.6%,

76.6%, and 80.8% for the landline

sample, cell-phone sample, and overall,

respectively.

Setting e somewhere between 0 and

1 corresponds to AAPOR Response Rate

3 (31). Survey researchers have used

several methods to choose a value for

e (32). Perhaps the most commonly used

method is to set e equal to the observed

eligibility rate among those sample units

for which the eligibility status has been

determined. That is,

Observed Eligibles , e = Observed Eligibles + Observed Ineligibles

where the observed ineligibles include

all types of ineligible units. This

proportional allocation method is

recommended by the Council of

American Survey Research

Organizations (32). This approach

yielded a household-level special-needs

screener response rate of 57.7% for the

landline sample, 23.0% for the

cell-phone sample, and 36.7% overall;

the child-level special-needs screener

response rates under this approach were

57.0% for the landline sample, 22.1%

for the cell-phone sample, and 36.0%

overall; and the special-needs interview

response rates under this approach were

65.4%, 30.2% and 45.2%, respectively.

The method above used a single

value of e for all sample units for which

eligibility status was not determined.

Another method commonly used in

telephone surveys divides the units with

undetermined eligibility into groups

corresponding to nonrespondents to

different components of the survey and

assumes a separate e value for each

group. For NS-CSHCN, the formula for

the special-needs interview response rate

under this approach becomes

Completed Interviews , Observed Eligibles + e1e2e3U1 + e2e3U2 + e3U3

Page 226 [ Series 1, No. 57

where

U1 = the number of unresolved

telephone numbers,

e1 = the assumed residential number

rate among U1,

U2 = the number of known residential

telephone numbers that did not

complete the age- and cell-status

screener,

e2 = the assumed age- and cell-status

eligibility rate among U2,

U3 = the number of age- and

cell-status-eligible households

that did not complete the

special-needs screener, and

e3 = the assumed special-needs

eligibility rate among U3.

For the special-needs screener

response rate, the numerator is the

number of special-needs screened

households (or children), and the

denominator excludes the e3 and U3

parameters. Again, it is common to use

the proportional allocation (33) method

to estimate e1, e2, and e3: letting e1 equal

the observed working residential number

rate among the resolved telephone

numbers, letting e2 equal the observed

age- and cell-status eligibility rate

among the age- and cell-status screened
Series 1, No. 57 [ Page 227

households, and letting e3 equal the

observed special-needs eligibility rate

among the households that completed

the special-needs screener. This

approach yielded a household-level

special-needs screener response rate of

52.3% for the landline sample, 19.9%

for the cell-phone sample, and 31.6%

overall; the child-level special-needs

screener response rates under this

approach were 51.8% for the landline

sample, 19.1% for the cell-phone

sample, and 30.9% overall; and the

special-needs interview response rates

under this approach were 43.7% for the

landline sample, 15.2% for the

cell-phone sample, and 25.5% overall.

Note that these rates are the same as the

overall response rates given in

Tables N–P.

The response rates above treat all

telephone numbers that resulted in no

contact (i.e., all attempts resulted in

rings with no answer or in a busy

signal) as unresolved. Using an

alternative approach for calculating the

resolution rate that treats these

‘‘noncontact’’ numbers as nonworking

numbers results in a household-level

special-needs screener response rate of

57.3% for the landline sample, 23.3%

for the cell-phone sample, and 35.7%

overall; the child-level special-needs

screener response rates under this

approach were 56.8% for the landline

sample, 22.4% for the cell-phone

sample, and 35.0% overall; and the

special-needs interview response rates

under this approach were 47.9% for the

landline sample, 17.9% for the

cell-phone sample, and 28.9% overall.

The various household-level

special-needs screener response rates for

each state are given in Tables XXV,

XXVI, and XXVII for the landline,

cell-phone, and overall sample,

respectively; the child-level specialneeds screener response rates for each

state are given in Tables XXVIII–XXX;

and the special-needs interview response

rates for each state are given in

Tables XXXI–XXXIII.

The variability in calculated

response rates in Tables XXV–XXXIII

demonstrates that response rates can be

highly sensitive to the choice of e and

to the choice of using a single estimate

of e or multiple estimates of e for

different types of nonrespondents.

Comparisons of response rates across

different surveys should only be made

when the response rates have been

calculated similarly. For example, the

method above using a single value of e

for all sample units for which eligibility

status was not determined is the

approach used by the Behavioral Risk

Factor Surveillance System (BRFSS), a

landline random-digit dial survey of

American adults (34,35). Thus, if one

were interested in comparing 2009–2010

NS-CSHCN and BRFSS response rates,

the appropriate NS-CSHCN response

rate to be used in such comparisons is

the special-needs interview response rate

for the landline sample using the

proportional allocation method and a

single value of e (i.e., 65.4%).
 

Page 228 [ Series 1, No. 57

Table XXV. Weighted NS-CSHCN household-level special-needs screener response rates, nationally and by state: Landline sample

Separate e

Separate e for each type of

for each type of nonrespondent,

Single e, nonrespondent, proportional

proportional proportional allocation

Area Minimum Maximum allocation allocation (alternative)

Rate (percent)

Total (excluding USVI) .......... 11.3 72.6 57.5 52.3 57.3

Total (including USVI)........... 11.3 72.6 57.5 52.3 57.3

Alabama................... 10.7 74.3 57.7 52.7 58.5

Alaska .................... 15.3 73.6 60.7 54.9 59.9

Arizona ................... 9.5 67.4 53.0 48.0 52.9

Arkansas .................. 12.5 76.6 64.6 59.9 64.1

California .................. 9.8 67.4 49.4 44.1 51.1

Colorado .................. 12.8 75.9 60.7 55.8 60.7

Connecticut ................. 10.9 71.9 53.7 48.8 53.4

Delaware .................. 9.5 70.9 53.7 48.8 53.8

District of Columbia ............ 6.1 70.3 56.4 51.1 57.7

Florida .................... 7.6 69.8 55.2 49.5 54.0

Georgia ................... 11.0 71.4 57.2 51.8 56.4

Hawaii .................... 10.5 67.7 55.4 49.3 53.0

Idaho..................... 13.7 74.5 61.7 57.2 61.7

Illinois .................... 12.6 75.1 61.3 56.0 61.0

Indiana.................... 15.5 74.7 62.3 58.0 62.3

Iowa ..................... 13.9 76.5 64.1 59.7 63.7

Kansas ................... 14.2 74.5 62.3 57.7 61.7

Kentucky .................. 12.6 74.2 60.2 55.4 59.8

Louisiana .................. 10.4 68.3 56.1 50.3 54.4

Maine .................... 12.6 76.4 62.3 57.8 62.2

Maryland .................. 11.3 72.9 56.1 50.7 56.2

Massachusetts ............... 10.8 72.7 55.4 50.0 54.4

Michigan................... 11.8 76.8 63.0 57.7 62.4

Minnesota.................. 15.9 76.5 63.6 59.1 62.9

Mississippi ................. 11.8 73.2 60.4 54.9 59.4

Missouri ................... 14.5 75.0 62.3 57.7 62.0

Montana................... 14.3 76.5 65.1 60.7 63.7

Nebraska .................. 14.3 76.1 64.1 59.3 63.1

Nevada ................... 8.7 67.0 50.3 45.0 50.7

New Hampshire .............. 12.5 74.6 58.7 54.2 58.5

New Jersey ................. 9.9 69.4 52.8 47.2 52.9

New Mexico ................ 10.5 74.3 60.2 54.9 59.5

New York .................. 9.3 68.2 52.8 47.0 52.1

North Carolina ............... 12.5 75.5 59.6 54.7 60.0

North Dakota ................ 16.7 78.1 67.4 63.3 66.7

Ohio ..................... 12.7 74.6 61.1 56.1 59.9

Oklahoma .................. 11.3 73.4 59.1 54.0 59.1

Oregon ................... 13.3 76.1 62.5 58.2 62.8

Pennsylvania ................ 12.7 74.6 58.4 53.9 58.8

Rhode Island ................ 12.3 75.6 59.1 53.9 58.0

South Carolina ............... 10.6 73.1 58.4 53.2 57.8

South Dakota................ 13.9 75.3 64.4 59.8 63.3

Tennessee ................. 11.2 71.3 57.6 53.1 57.5

Texas .................... 9.9 71.7 56.8 50.6 55.9

Utah ..................... 17.4 76.3 61.9 57.1 62.0

Vermont ................... 15.0 81.0 66.2 61.9 66.4

Virginia ................... 12.4 75.0 58.4 53.3 58.7

Washington ................. 14.2 76.9 62.4 57.4 61.4

West Virginia ................ 11.6 74.0 57.2 53.2 58.0

Wisconsin .................. 14.9 79.2 65.3 60.7 65.0

Wyoming .................. 11.7 75.4 62.2 57.6 62.2

U.S. Virgin Islands ............ 21.1 81.1 71.6 67.8 73.4

NOTES: NS-CSHCN is National Survey of Children with Special Health Care Needs; USVI is U.S. Virgin Islands.
 

Series 1, No. 57 [ Page 229

Table XXVI. Weighted NS-CSHCN household-level special-needs screener response rates, nationally and by state: Cell-phone sample

Separate e

Separate e for each type of

for each type of nonrespondent,

Single e, nonrespondent, proportional

proportional proportional allocation

Area Minimum Maximum allocation allocation (alternative)

Rate (percent)

Total (excluding USVI) .......... 2.7 56.5 23.0 19.9 23.3

Total (including USVI)........... . . . . . . . . . . . . . . .

Alabama................... 2.5 62.4 28.2 23.7 30.0

Alaska .................... 2.1 74.9 34.3 30.7 47.9

Arizona ................... 3.0 60.0 23.4 20.2 24.4

Arkansas .................. 4.0 65.9 30.2 26.0 32.9

California .................. 2.4 47.5 19.7 16.9 18.3

Colorado .................. 3.4 60.4 22.7 20.3 24.5

Connecticut ................. 1.4 56.1 18.7 17.3 22.0

Delaware .................. 2.0 60.5 20.7 19.0 26.3

District of Columbia ............ 2.3 64.7 21.8 20.2 28.8

Florida .................... 2.8 54.6 23.0 19.4 21.4

Georgia ................... 3.1 55.8 26.0 21.8 24.8

Hawaii .................... 3.1 60.8 20.7 19.4 24.5

Idaho..................... 5.7 69.9 29.4 26.7 32.3

Illinois .................... 3.1 53.9 23.6 20.2 23.0

Indiana.................... 3.2 60.1 24.0 20.9 25.4

Iowa ..................... 3.1 60.6 26.6 23.4 29.2

Kansas ................... 3.2 65.7 31.5 27.3 33.3

Kentucky .................. 2.9 59.2 23.5 20.5 26.1

Louisiana .................. 2.8 57.5 26.4 22.3 27.3

Maine .................... 2.4 66.1 22.7 20.5 27.4

Maryland .................. 2.4 58.2 19.1 17.1 21.4

Massachusetts ............... 1.9 59.2 21.4 18.6 22.8

Michigan................... 2.2 54.9 22.3 19.0 22.8

Minnesota.................. 2.7 63.7 25.2 22.5 27.2

Mississippi ................. 2.9 55.9 27.1 22.6 29.6

Missouri ................... 3.0 55.9 22.3 19.9 23.1

Montana................... 2.9 75.1 35.1 30.2 41.4

Nebraska .................. 3.3 67.6 31.4 27.5 33.0

Nevada ................... 2.9 61.0 20.8 18.7 24.6

New Hampshire .............. 1.9 61.9 21.6 19.5 25.4

New Jersey ................. 1.8 55.5 20.9 18.5 22.5

New Mexico ................ 3.7 62.3 28.2 25.6 31.6

New York .................. 1.9 50.8 18.5 16.0 18.2

North Carolina ............... 2.9 56.2 23.8 20.3 23.3

North Dakota ................ 1.6 70.0 29.0 26.1 40.3

Ohio ..................... 2.4 55.4 21.6 18.7 21.7

Oklahoma .................. 2.9 62.2 27.0 23.6 29.3

Oregon ................... 3.4 61.8 23.7 22.0 26.1

Pennsylvania ................ 1.8 56.0 21.3 18.4 21.0

Rhode Island ................ 1.8 60.5 20.2 18.7 24.4

South Carolina ............... 2.8 60.7 24.8 21.3 26.0

South Dakota................ 3.0 67.3 36.4 32.5 39.6

Tennessee ................. 3.0 57.7 21.2 18.8 22.5

Texas .................... 3.5 55.3 23.3 19.9 22.1

Utah ..................... 4.7 63.0 24.8 22.2 27.8

Vermont ................... 1.7 68.0 23.6 21.4 28.1

Virginia ................... 2.4 59.7 21.8 19.0 22.4

Washington ................. 3.1 59.0 22.5 20.3 23.3

West Virginia ................ 2.1 63.0 20.9 18.6 24.0

Wisconsin .................. 2.9 61.3 27.1 23.8 28.9

Wyoming .................. 2.8 76.1 41.6 36.3 48.2

U.S. Virgin Islands ............ . . . . . . . . . . . . . . .

. . . Category not applicable.
 

NOTES: NS-CSHCN is National Survey of Children with Special Health Care Needs; USVI is U.S. Virgin Islands.
 
 

Page 230 [ Series 1, No. 57

Table XXVII. Weighted NS-CSHCN household-level special-needs screener response rates, overall, nationally, and by state

Separate e

Separate e for each type of

for each type of nonrespondent,

Single e, nonrespondent, proportional

proportional proportional allocation

Area Minimum Maximum allocation allocation (alternative)

Rate (percent)

Total (excluding USVI) .......... 4.6 64.3 36.7 31.6 35.7

Total (including USVI)........... . . . . . . . . . . . . . . .

Alabama................... 4.2 68.3 39.1 33.7 40.1

Alaska .................... 4.7 74.1 44.4 39.6 52.2

Arizona ................... 4.5 63.3 35.4 30.2 34.7

Arkansas .................. 5.3 69.6 41.7 36.5 42.6

California .................. 4.4 57.7 31.5 26.8 30.1

Colorado .................. 5.5 67.6 38.2 33.3 37.8

Connecticut ................. 4.0 67.0 35.1 31.6 36.6

Delaware .................. 3.8 66.4 34.7 31.1 37.7

District of Columbia ............ 2.9 66.5 34.2 30.5 38.3

Florida .................... 3.9 60.4 35.0 29.4 32.2

Georgia ................... 4.9 62.7 37.7 31.8 35.3

Hawaii .................... 4.6 63.9 35.8 31.6 36.1

Idaho..................... 7.4 71.6 43.3 38.4 43.5

Illinois .................... 5.2 63.4 38.0 32.4 36.0

Indiana.................... 5.9 67.7 40.6 35.4 40.0

Iowa ..................... 5.5 68.5 42.3 37.3 42.6

Kansas ................... 5.3 70.0 43.5 38.4 43.8

Kentucky .................. 5.0 66.5 38.4 33.4 38.7

Louisiana .................. 4.3 62.1 37.3 31.7 36.4

Maine .................... 4.9 72.2 41.7 37.3 43.3

Maryland .................. 4.5 66.2 34.7 30.1 35.0

Massachusetts ............... 4.0 67.1 35.6 30.8 35.3

Michigan................... 4.1 65.5 38.0 32.7 37.0

Minnesota.................. 5.7 71.2 42.6 37.7 42.2

Mississippi ................. 4.4 62.6 37.7 32.2 38.8

Missouri ................... 5.5 65.4 39.0 34.2 38.0

Montana................... 4.9 75.8 46.9 41.5 49.8

Nebraska .................. 5.7 71.9 45.4 40.0 44.9

Nevada ................... 4.1 63.6 32.1 28.0 33.9

New Hampshire .............. 4.5 70.0 38.5 34.5 40.1

New Jersey ................. 3.9 64.0 35.1 30.5 35.4

New Mexico ................ 5.1 66.8 39.8 35.7 41.2

New York .................. 3.7 60.1 32.8 27.6 31.0

North Carolina ............... 5.1 65.6 37.8 32.5 36.4

North Dakota ................ 3.5 74.7 42.1 38.4 49.8

Ohio ..................... 4.6 65.5 38.2 33.0 36.4

Oklahoma .................. 4.7 67.5 39.5 34.6 40.2

Oregon ................... 5.8 68.8 40.9 36.8 41.1

Pennsylvania ................ 4.5 67.8 38.0 33.2 36.9

Rhode Island ................ 4.3 70.0 37.4 33.7 39.1

South Carolina ............... 4.5 66.4 38.0 32.7 37.5

South Dakota................ 5.2 71.4 47.8 43.2 49.0

Tennessee ................. 4.6 63.4 34.9 30.4 34.4

Texas .................... 4.8 61.3 34.9 29.2 32.3

Utah ..................... 7.2 68.7 38.5 33.6 39.0

Vermont ................... 5.3 77.5 46.1 41.8 47.8

Virginia ................... 4.7 68.1 36.9 31.8 36.1

Washington ................. 5.8 68.3 39.9 35.0 38.5

West Virginia ................ 4.4 69.4 36.5 32.7 38.1

Wisconsin .................. 5.6 71.0 43.5 38.6 43.7

Wyoming .................. 4.1 75.8 47.3 42.2 52.1

U.S. Virgin Islands ............ . . . . . . . . . . . . . . .

. . . Category not applicable.
 

NOTES: NS-CSHCN is National Survey of Children with Special Health Care Needs; USVI is U.S. Virgin Islands.
 
 

Series 1, No. 57 [ Page 231

Table XXVIII. Weighted NS-CSHCN child-level special-needs screener response rates, nationally and by state: Landline sample

Separate e

Separate e for each type of

for each type of nonrespondent,

Single e, nonrespondent, proportional

proportional proportional allocation

Area Minimum Maximum allocation allocation (alternative)

Rate (percent)

Total (excluding USVI) .......... 11.2 71.9 57.0 51.8 56.8

Total (including USVI)........... 11.2 71.9 57.0 51.8 56.8

Alabama................... 10.5 73.1 56.8 51.8 57.5

Alaska .................... 15.1 72.9 60.2 54.3 59.3

Arizona ................... 9.5 67.1 52.8 47.7 52.7

Arkansas .................. 12.4 75.7 63.8 59.2 63.3

California .................. 9.6 66.0 48.4 43.2 50.0

Colorado .................. 12.6 75.2 60.2 55.3 60.2

Connecticut ................. 10.9 71.5 53.4 48.5 53.0

Delaware .................. 9.3 69.9 53.0 48.1 53.0

District of Columbia ............ 5.9 68.2 54.7 49.5 56.0

Florida .................... 7.5 69.1 54.6 49.0 53.4

Georgia ................... 11.0 71.1 56.9 51.5 56.1

Hawaii .................... 10.3 66.4 54.4 48.3 52.0

Idaho..................... 13.7 74.7 61.9 57.4 61.9

Illinois .................... 12.5 74.4 60.7 55.5 60.4

Indiana.................... 15.4 74.1 61.8 57.5 61.8

Iowa ..................... 13.8 75.9 63.5 59.2 63.1

Kansas ................... 14.0 73.7 61.6 57.1 61.0

Kentucky .................. 12.6 73.9 60.0 55.2 59.6

Louisiana .................. 10.4 67.8 55.7 50.0 54.0

Maine .................... 12.6 76.0 61.9 57.5 61.9

Maryland .................. 11.2 72.5 55.8 50.4 55.9

Massachusetts ............... 10.8 72.6 55.3 49.9 54.3

Michigan................... 11.7 76.1 62.4 57.2 61.9

Minnesota.................. 15.7 75.7 62.9 58.5 62.2

Mississippi ................. 11.6 72.5 59.8 54.3 58.7

Missouri ................... 14.5 74.9 62.2 57.7 62.0

Montana................... 14.3 76.5 65.0 60.6 63.7

Nebraska .................. 14.2 75.7 63.8 59.0 62.7

Nevada ................... 8.6 66.4 49.8 44.6 50.3

New Hampshire .............. 12.4 73.7 58.0 53.5 57.8

New Jersey ................. 9.9 69.1 52.5 46.9 52.6

New Mexico ................ 10.5 74.3 60.2 54.9 59.5

New York .................. 9.2 67.2 52.0 46.3 51.3

North Carolina ............... 12.4 74.7 59.0 54.1 59.4

North Dakota ................ 16.7 77.9 67.3 63.1 66.5

Ohio ..................... 12.6 74.0 60.7 55.7 59.4

Oklahoma .................. 11.2 73.0 58.7 53.7 58.7

Oregon ................... 13.1 75.3 61.9 57.6 62.2

Pennsylvania ................ 12.5 73.6 57.6 53.1 58.0

Rhode Island ................ 12.3 75.6 59.1 53.9 58.1

South Carolina ............... 10.6 72.6 58.0 52.8 57.3

South Dakota................ 13.8 74.7 63.8 59.3 62.8

Tennessee ................. 11.2 70.7 57.2 52.7 57.1

Texas .................... 9.9 71.4 56.6 50.4 55.6

Utah ..................... 17.7 77.6 63.0 58.1 63.1

Vermont ................... 14.9 80.8 66.0 61.7 66.2

Virginia ................... 12.2 74.2 57.8 52.7 58.1

Washington ................. 14.1 76.5 62.1 57.1 61.0

West Virginia ................ 11.5 73.4 56.7 52.8 57.5

Wisconsin .................. 14.9 79.0 65.1 60.5 64.8

Wyoming .................. 11.6 75.2 62.0 57.5 62.1

U.S. Virgin Islands ............ 20.9 80.0 70.7 66.9 72.4

NOTES: NS-CSHCN is National Survey of Children with Special Health Care Needs; USVI is U.S. Virgin Islands.
 

Page 232 [ Series 1, No. 57

Table XXIX. Weighted NS-CSHCN child-level special-needs screener response rates, nationally and by state: Cell-phone sample

Separate e

Separate e for each type of

for each type of nonrespondent,

Single e, nonrespondent, proportional

proportional proportional allocation

Area Minimum Maximum allocation allocation (alternative)

Rate (percent)

Total (excluding USVI) .......... 2.6 54.3 22.1 19.1 22.4

Total (including USVI)........... . . . . . . . . . . . . . . .

Alabama................... 2.4 60.5 27.3 23.0 29.1

Alaska .................... 2.0 73.7 33.8 30.2 47.2

Arizona ................... 2.9 56.7 22.1 19.1 23.0

Arkansas .................. 3.8 63.3 29.0 25.0 31.6

California .................. 2.3 44.8 18.6 16.0 17.3

Colorado .................. 3.5 61.2 23.0 20.6 24.8

Connecticut ................. 1.3 52.1 17.3 16.0 20.5

Delaware .................. 1.9 57.6 19.7 18.1 25.0

District of Columbia ............ 2.2 61.6 20.8 19.3 27.4

Florida .................... 2.7 52.5 22.1 18.6 20.5

Georgia ................... 3.0 54.6 25.5 21.3 24.2

Hawaii .................... 2.9 58.2 19.9 18.5 23.4

Idaho..................... 5.8 70.1 29.5 26.8 32.4

Illinois .................... 3.0 51.7 22.7 19.4 22.1

Indiana.................... 3.1 56.7 22.6 19.8 24.0

Iowa ..................... 2.9 56.6 24.9 21.8 27.3

Kansas ................... 3.0 62.1 29.7 25.8 31.5

Kentucky .................. 2.8 57.4 22.8 19.9 25.3

Louisiana .................. 2.8 55.7 25.5 21.6 26.4

Maine .................... 2.3 62.1 21.3 19.3 25.8

Maryland .................. 2.3 55.4 18.2 16.3 20.4

Massachusetts ............... 1.8 57.7 20.8 18.2 22.2

Michigan................... 2.1 52.2 21.2 18.1 21.6

Minnesota.................. 2.6 60.7 24.0 21.4 25.9

Mississippi ................. 2.8 54.6 26.5 22.1 28.9

Missouri ................... 2.9 53.1 21.2 18.9 22.0

Montana................... 2.8 74.5 34.8 30.0 41.1

Nebraska .................. 3.4 68.8 31.9 28.0 33.6

Nevada ................... 2.8 59.9 20.4 18.3 24.1

New Hampshire .............. 1.9 61.1 21.4 19.3 25.1

New Jersey ................. 1.7 52.1 19.6 17.4 21.2

New Mexico ................ 3.6 60.7 27.5 25.0 30.8

New York .................. 1.8 48.3 17.6 15.2 17.3

North Carolina ............... 2.9 56.2 23.8 20.3 23.3

North Dakota ................ 1.6 68.4 28.3 25.5 39.4

Ohio ..................... 2.2 51.1 19.9 17.2 20.0

Oklahoma .................. 2.9 61.1 26.5 23.2 28.8

Oregon ................... 3.3 58.4 22.4 20.8 24.6

Pennsylvania ................ 1.7 52.7 20.0 17.3 19.7

Rhode Island ................ 1.7 57.7 19.3 17.8 23.2

South Carolina ............... 2.8 59.7 24.4 20.9 25.6

South Dakota................ 2.8 63.7 34.5 30.8 37.5

Tennessee ................. 2.9 55.8 20.6 18.2 21.8

Texas .................... 3.4 53.6 22.5 19.2 21.4

Utah ..................... 4.5 60.4 23.8 21.3 26.6

Vermont ................... 1.7 67.4 23.4 21.2 27.8

Virginia ................... 2.3 57.7 21.1 18.3 21.6

Washington ................. 3.0 56.0 21.4 19.3 22.1

West Virginia ................ 2.0 60.0 20.0 17.7 22.9

Wisconsin .................. 2.8 59.0 26.1 22.9 27.9

Wyoming .................. 2.8 75.1 41.1 35.9 47.6

U.S. Virgin Islands ............ . . . . . . . . . . . . . . .

. . . Category not applicable.
 

NOTES: NS-CSHCN is National Survey of Children with Special Health Care Needs; USVI is U.S. Virgin Islands.
 
 

Series 1, No. 57 [ Page 233

Table XXX. Weighted NS-CSHCN child-level special-needs screener response rates, overall, nationally, and by state

Separate e

Separate e for each type of

for each type of nonrespondent,

Single e, nonrespondent, proportional

proportional proportional allocation

Area Minimum Maximum allocation allocation (alternative)

Rate (percent)

Total (excluding USVI) .......... 4.5 63.0 36.0 30.9 35.0

Total (including USVI)........... . . . . . . . . . . . . . . .

Alabama................... 4.1 66.7 38.2 32.9 39.2

Alaska .................... 4.6 73.2 43.8 39.2 51.6

Arizona ................... 4.3 61.3 34.2 29.3 33.6

Arkansas .................. 5.2 67.4 40.5 35.4 41.3

California .................. 4.2 55.7 30.5 25.9 29.1

Colorado .................. 5.5 67.8 38.3 33.4 37.9

Connecticut ................. 3.9 65.5 34.3 30.8 35.8

Delaware .................. 3.7 64.3 33.7 30.2 36.5

District of Columbia ............ 2.8 63.7 32.8 29.2 36.7

Florida .................... 3.8 58.8 34.1 28.6 31.3

Georgia ................... 4.8 61.7 37.1 31.3 34.8

Hawaii .................... 4.5 61.7 34.6 30.5 34.8

Idaho..................... 7.5 71.9 43.4 38.6 43.7

Illinois .................... 5.0 61.9 37.2 31.6 35.2

Indiana.................... 5.8 65.7 39.4 34.3 38.8

Iowa ..................... 5.3 66.2 40.9 36.1 41.2

Kansas ................... 5.2 67.7 42.1 37.1 42.4

Kentucky .................. 4.9 65.7 37.9 33.0 38.2

Louisiana .................. 4.2 60.8 36.5 31.1 35.7

Maine .................... 4.8 70.2 40.5 36.3 42.1

Maryland .................. 4.4 64.7 34.0 29.5 34.2

Massachusetts ............... 3.9 66.6 35.3 30.6 35.0

Michigan................... 4.1 64.3 37.3 32.0 36.3

Minnesota.................. 5.6 69.7 41.7 36.9 41.3

Mississippi ................. 4.3 61.2 36.9 31.4 37.9

Missouri ................... 5.4 64.3 38.3 33.6 37.3

Montana................... 4.9 75.5 46.7 41.3 49.6

Nebraska .................. 5.7 72.3 45.6 40.2 45.1

Nevada ................... 4.1 62.7 31.6 27.6 33.4

New Hampshire .............. 4.4 69.3 38.1 34.2 39.7

New Jersey ................. 3.8 62.5 34.3 29.8 34.5

New Mexico ................ 5.0 65.7 39.2 35.1 40.6

New York .................. 3.6 58.9 32.1 27.1 30.4

North Carolina ............... 5.0 64.9 37.4 32.2 36.1

North Dakota ................ 3.5 73.9 41.7 38.0 49.3

Ohio ..................... 4.5 63.2 36.9 31.9 35.2

Oklahoma .................. 4.6 66.7 39.0 34.2 39.7

Oregon ................... 5.6 66.6 39.6 35.6 39.8

Pennsylvania ................ 4.4 66.3 37.2 32.4 36.1

Rhode Island ................ 4.3 69.0 36.9 33.3 38.6

South Carolina ............... 4.4 65.6 37.5 32.3 37.0

South Dakota................ 5.0 69.3 46.4 41.9 47.6

Tennessee ................. 4.5 61.9 34.1 29.7 33.6

Texas .................... 4.7 60.1 34.3 28.6 31.7

Utah ..................... 7.2 68.5 38.4 33.5 38.9

Vermont ................... 5.3 77.2 45.9 41.6 47.6

Virginia ................... 4.6 66.8 36.2 31.2 35.4

Washington ................. 5.7 67.0 39.2 34.4 37.8

West Virginia ................ 4.3 67.6 35.6 31.8 37.1

Wisconsin .................. 5.5 69.8 42.7 38.0 42.9

Wyoming .................. 4.1 75.2 47.0 41.8 51.7

U.S. Virgin Islands ............ . . . . . . . . . . . . . . .

. . . Category not applicable.
 

NOTES: NS-CSHCN is National Survey of Children with Special Health Care Needs; USVI is U.S. Virgin Islands.
 
 

Page 234 [ Series 1, No. 57

Table XXXI. Weighted NS-CSHCN interview response rates, nationally and by state: Landline sample

Separate e

Separate e for each type of

for each type of nonrespondent,

Single e, nonrespondent, proportional

proportional proportional allocation

Area Minimum Maximum allocation allocation (alternative)

Rate (percent)

Total (excluding USVI) .......... 2.6 83.6 65.4 43.7 47.9

Total (including USVI)........... 2.6 83.6 65.4 43.7 47.9

Alabama................... 2.7 86.0 66.0 45.3 50.3

Alaska .................... 2.8 84.5 68.7 46.3 50.6

Arizona ................... 2.0 82.6 64.0 39.6 43.7

Arkansas .................. 3.3 83.6 69.9 50.1 53.6

California .................. 1.7 83.4 59.9 36.8 42.6

Colorado .................. 2.9 82.8 65.4 46.2 50.3

Connecticut ................. 2.6 84.1 61.7 41.0 44.9

Delaware .................. 2.2 82.2 61.4 40.1 44.2

District of Columbia ............ 1.2 84.0 66.9 42.9 48.5

Florida .................... 1.6 82.7 64.7 41.0 44.7

Georgia ................... 2.7 86.7 68.5 44.9 48.9

Hawaii .................... 1.8 81.4 65.8 40.1 43.2

Idaho..................... 3.2 86.3 70.6 49.3 53.3

Illinois .................... 2.6 79.9 64.5 44.7 48.7

Indiana.................... 4.0 83.7 68.9 48.5 52.2

Iowa ..................... 3.2 85.7 71.0 51.2 54.6

Kansas ................... 3.8 86.0 71.0 49.6 53.0

Kentucky .................. 3.5 85.0 68.2 47.1 50.8

Louisiana .................. 2.7 81.2 65.9 40.9 44.2

Maine .................... 3.2 84.3 67.9 48.7 52.4

Maryland .................. 2.6 83.6 63.4 42.4 47.0

Massachusetts ............... 2.6 80.8 60.7 40.4 43.9

Michigan................... 3.3 84.8 68.9 48.9 52.9

Minnesota.................. 3.7 85.1 69.9 50.3 53.5

Mississippi ................. 2.7 84.6 69.0 46.5 50.2

Missouri ................... 3.8 87.0 71.4 50.2 53.9

Montana................... 3.1 86.4 72.8 52.4 55.1

Nebraska .................. 3.4 88.9 74.1 52.7 56.1

Nevada ................... 1.7 84.2 62.1 37.9 42.7

New Hampshire .............. 3.2 83.5 64.8 45.2 48.8

New Jersey ................. 2.0 79.7 59.6 37.6 42.1

New Mexico ................ 2.5 85.7 68.7 47.1 51.0

New York .................. 2.0 82.5 62.8 38.8 43.0

North Carolina ............... 3.1 82.7 64.5 45.2 49.6

North Dakota ................ 4.0 87.6 74.9 55.4 58.4

Ohio ..................... 3.2 83.6 67.8 46.9 50.0

Oklahoma .................. 3.1 84.6 67.3 45.7 50.0

Oregon ................... 2.8 84.4 68.6 49.1 53.1

Pennsylvania ................ 3.1 81.6 63.0 44.0 48.0

Rhode Island ................ 3.1 83.3 64.2 44.9 48.3

South Carolina ............... 2.6 83.5 66.0 44.4 48.2

South Dakota................ 2.9 86.5 73.2 51.7 54.8

Tennessee ................. 2.8 85.9 68.6 45.6 49.4

Texas .................... 2.2 83.3 65.2 42.2 46.5

Utah ..................... 4.2 86.1 68.7 49.1 53.4

Vermont ................... 3.5 85.7 69.4 53.0 56.9

Virginia ................... 2.9 83.4 64.0 44.5 49.0

Washington ................. 3.4 84.2 67.5 48.3 51.7

West Virginia ................ 3.0 85.5 65.1 45.5 49.5

Wisconsin .................. 3.8 88.8 72.4 53.9 57.7

Wyoming .................. 2.6 85.4 69.7 49.3 53.2

U.S. Virgin Islands ............ 2.8 91.2 79.9 61.9 67.0

NOTES: NS-CSHCN is National Survey of Children with Special Health Care Needs; USVI is U.S. Virgin Islands.
Table XXXII. Weighted NS-CSHCN interview response rates, nationally and by state: Cell-phone sample

Separate e

Separate e for each type of

for each type of nonrespondent,

Single e, nonrespondent, proportional

proportional proportional allocation

Area Minimum Maximum allocation allocation (alternative)

Rate (percent)

Total (excluding USVI) .......... 0.4 76.6 30.2 15.2
 17.9

Total (including USVI)........... ... ... ... ... ...

Alabama................... 0.4 71.6 31.7 17.0 21.5
 

Alaska .................... 0.3 80.7 36.7 24.7 38.7
 

Arizona ................... 0.5 81.4 30.8 16.5 19.8
 

Arkansas .................. 0.7 73.9 33.0 19.2 24.3
 

California .................. 0.3 79.4 31.6 13.4 14.6
 

Colorado .................. 0.6 81.5 29.4 16.5 20.0
 

Connecticut ................. 0.2 73.2 23.8 12.6 16.1
 

Delaware .................. 0.4 68.6 22.9 13.0 18.0
 

District of Columbia ............ 0.4 81.8 26.9 16.5 23.5
 

Florida .................... 0.5 78.0 31.8 15.1 16.7
 

Georgia ................... 0.5 73.1 33.1 16.0 18.1
 

Hawaii .................... 0.3 65.5 21.4 12.7 16.0
 

Idaho..................... 1.0 83.1 33.7 22.2 26.8
 

Illinois .................... 0.5 74.8 31.6 15.1 17.2
 

Indiana.................... 0.6 71.9 27.7 15.1 18.3
 

Iowa ..................... 0.7 83.8 35.8 19.6 24.5
 

Kansas ................... 0.6 74.6 35.0 20.4 24.9
 

Kentucky .................. 0.5 78.1 30.1 16.0 20.4
 

Louisiana .................. 0.5 71.1 31.7 15.9 19.4
 

Maine .................... 0.6 80.0 26.8 16.4 21.9
 

Maryland .................. 0.4 76.3 24.1 13.1 16.3
 

Massachusetts ............... 0.3 72.1 25.4 13.4 16.4
 

Michigan................... 0.4 75.0 29.6 14.2 17.1
 

Minnesota.................. 0.5 81.2 31.4 18.2 22.0
 

Mississippi ................. 0.6 78.3 37.0 17.7 23.2
 

Missouri ................... 0.6 76.8 29.5 15.3 17.8
 

Montana................... 0.5 81.8 37.8 24.7 33.9
 

Nebraska .................. 0.7 78.8 35.9 21.7 26.0
 

Nevada ................... 0.4 70.1 23.0 13.1 17.2
 

New Hampshire .............. 0.3 70.1 24.0 13.7 17.8
 

New Jersey ................. 0.2 61.5 22.6 11.4 13.9
 

New Mexico ................ 0.5 66.2 29.1 16.9 20.9
 

New York .................. 0.3 72.7 25.6 11.6 13.3
 

North Carolina ............... 0.5 75.6 31.0 15.3 17.6
 

North Dakota ................ 0.3 78.3 32.1 20.5 31.6
 

Ohio ..................... 0.5 77.4 29.2 14.5 16.8
 

Oklahoma .................. 0.5 76.6 32.4 18.1 22.4
 

Oregon ................... 0.6 73.3 27.2 16.1 19.1
 

Pennsylvania ................ 0.3 71.3 26.4 13.1 14.9
 

Rhode Island ................ 0.4 84.6 27.5 15.8 20.6
 

South Carolina ............... 0.5 80.3 31.9 17.1 20.9
 

South Dakota................ 0.4 71.2 38.0 23.2 28.2
 

Tennessee ................. 0.6 76.1 26.9 14.3 17.1
 

Texas .................... 0.5 78.4 31.6 15.6 17.3
 

Utah ..................... 0.9 85.7 32.3 19.1 23.8
 

Vermont ................... 0.5 87.5 29.9 18.7 24.6
 

Virginia ................... 0.5 86.8 30.8 16.5 19.4
 

Washington ................. 0.4 81.5 30.0 16.5 19.0
 

West Virginia ................ 0.5 80.7 26.1 15.0 19.4
 

Wisconsin .................. 0.4 77.9 33.7 18.6 22.6
 

Wyoming .................. 0.4 84.2 45.7 30.6 40.6
 

U.S. Virgin Islands ............ ... ... ... ... ... 
 

. . . Category not applicable.
 

NOTES: NS-CSHCN is National Survey of Children with Special Health Care Needs; USVI is U.S. Virgin Islands.
 

Series 1, No. 57 [ Page 235
 

Page 236 [ Series 1, No. 57

Table XXXIII. Weighted NS-CSHCN interview response rates, overall, nationally, and by state

Separate e

Separate e for each type of

for each type of nonrespondent,

Single e, nonrespondent, proportional

proportional proportional allocation

Area Minimum Maximum allocation allocation (alternative)

Rate (percent)

Total (excluding USVI) .......... 0.9 80.8 45.2 25.5 28.9

Total (including USVI)........... . . . . . . . . . . . . . . .

Alabama................... 0.9 80.0 45.1 27.0 32.1

Alaska .................... 0.8 83.1 49.2 32.9 43.4

Arizona ................... 0.8 82.1 44.8 24.8 28.4

Arkansas .................. 1.1 77.9 45.9 28.4 33.2

California .................. 0.7 82.0 43.6 22.0 24.7

Colorado .................. 1.1 82.3 45.4 27.4 31.1

Connecticut ................. 0.8 81.7 41.9 25.8 29.9

Delaware .................. 0.8 76.7 39.4 23.8 28.9

District of Columbia ............ 0.5 82.7 41.9 25.2 31.7

Florida .................... 0.7 80.2 45.6 23.6 25.8

Georgia ................... 1.0 80.4 47.3 25.6 28.4

Hawaii .................... 0.6 73.9 40.5 23.3 26.6

Idaho..................... 1.5 84.4 49.9 32.4 36.8

Illinois .................... 0.9 77.7 45.6 25.2 28.0

Indiana.................... 1.3 79.2 46.5 28.0 31.7

Iowa ..................... 1.2 84.9 51.6 31.7 36.2

Kansas ................... 1.2 80.8 49.5 31.0 35.4

Kentucky .................. 1.1 82.5 46.6 27.6 32.0

Louisiana .................. 0.9 76.5 45.1 24.3 27.9

Maine .................... 1.2 82.6 47.0 30.8 35.8

Maryland .................. 0.9 81.1 41.6 24.4 28.4

Massachusetts ............... 0.8 78.0 40.6 24.1 27.5

Michigan................... 0.9 81.2 46.3 26.5 30.0

Minnesota.................. 1.2 83.7 49.2 31.6 35.3

Mississippi ................. 0.9 81.1 47.9 26.1 31.5

Missouri ................... 1.2 82.9 48.4 28.4 31.5

Montana................... 0.9 84.3 51.6 35.0 42.0

Nebraska .................. 1.2 84.2 52.4 33.6 37.8

Nevada ................... 0.6 77.3 38.0 21.7 26.2

New Hampshire .............. 1.0 79.7 43.1 27.5 32.0

New Jersey ................. 0.6 74.8 40.3 22.8 26.4

New Mexico ................ 0.9 75.5 44.2 27.0 31.1

New York .................. 0.7 79.2 42.2 21.9 24.6

North Carolina ............... 1.1 79.8 45.0 26.0 29.1

North Dakota ................ 0.7 84.3 47.1 32.4 42.0

Ohio ..................... 1.0 81.2 46.5 26.8 29.6

Oklahoma .................. 1.0 81.4 46.9 28.2 32.7

Oregon ................... 1.1 79.3 46.3 29.2 32.6

Pennsylvania ................ 1.0 78.6 43.3 26.1 29.0

Rhode Island ................ 1.0 83.7 44.0 28.2 32.7

South Carolina ............... 0.9 82.1 46.1 26.9 30.8

South Dakota................ 0.9 80.4 53.2 34.7 39.4

Tennessee ................. 1.0 81.0 43.6 24.6 27.8

Texas .................... 0.9 80.8 44.9 23.6 26.1

Utah ..................... 1.5 85.9 46.7 28.9 33.5

Vermont ................... 1.2 86.2 50.7 36.0 41.2

Virginia ................... 1.0 84.6 44.9 26.9 30.5

Washington ................. 1.1 83.4 47.7 29.2 32.1

West Virginia ................ 1.0 83.7 43.2 27.3 31.9

Wisconsin .................. 1.1 85.2 51.4 32.9 37.3

Wyoming .................. 0.7 84.8 52.5 35.8 44.2

U.S. Virgin Islands ............ . . . . . . . . . . . . . . .

. . . Category not applicable.
 

NOTES: NS-CSHCN is National Survey of Children with Special Health Care Needs; USVI is U.S. Virgin Islands.
 
Series 1, No. 57 [ Page 237

Appendix XII. Incentive Effort

To improve the likelihood that

eligible households would participate in

the 2009–2010 National Survey of

Children with Special Health Care

Needs (NS-CSHCN) and would

contribute to a more complete data set, a

detailed incentive plan was executed

during NS-CSHCN data collection.

Guided by successful incentive efforts in

the 2005–2006 NS-CSHCN and the

2007 National Survey of Children’s

Health (NSCH), a very extensive

incentive experiment was conducted on

NS-CSHCN cases from Quarters 3 and

4, 2009 to identify best practices for

mail delivery, monetary amount

included, timing of the incentive offer,

and other features. This appendix

summarizes the design and results of the

experiment, as well as the performance

of the incentive model ultimately chosen

for the remaining quarters of data

collection. The model chosen for

landline cases was refusal-based and

included a prepaid incentive. Soon after

the start of cellular- (cell) phone dialing

in Quarter 3, 2010, a different incentive

model was applied to cell-phone cases,

due to the fact that addresses were not

available for the cell-phone sample in

NS-CHSCN.

Eligible Cases

Cases eligible for an incentive were

known age-eligible households that had

not completed the NS-CSHCN

interview. The incentive models

included in the experiment, and those

that were ultimately chosen, were

primarily refusal-based. Refusals were

defined by specific combinations of

cases in which potential respondents

hung up during introduction (HUDI) and

cases with active (or verbal) refusals.

For cases that were eligible for the main

National Immunization Survey

(NIS-Child) or NIS-Teen, and had

refusals in either of these surveys, those

refusals counted toward NS-CSHCN

incentive eligibility.

Passive refusals, or cases with zero

or one active refusal to which multiple

attempts resulted in no contact for 21

days, also were eligible for incentives

and received similar treatment as

incentive cases with two active refusals

(or the equivalent HUDI-refusal

combination). Hostile refusals and cases

that requested to be taken off the list of

sampled phone numbers were not

eligible for incentives and were not

dialed again. Cases that had been

offered an incentive previously by NIS

also were eligible for an NS-CSHCN

incentive.

Incentive Experiment

Starting in Quarter 3, 2009, the

incentive experiment was designed to

evaluate the comparative effectiveness

of a variety of different incentive

treatments—eight in total. The

experiment was conducted on Quarters 3

and 4, 2009 sample cases.

To implement the experiment, each

case flagged for NS-CSHCN Quarters 3

and 4, 2009 was randomly assigned to

an incentive treatment group during

sample preparation. The groups—

designed to explore the effect of prepaid

incentives compared with promised

incentives, as well as variations in the

monetary amount offered—were

primarily refusal-based. However, a

control group (Group 1) was offered no

incentive, and a second group (Group 2)

was offered $5 as soon as the case

became age eligible, regardless of

refusal status. The eight incentive

models tested are summarized in

Table XXXIV. Group 3A represents the

incentive model implemented in the

previous State and Local Area Integrated

Telephone Survey, the 2007 NSCH.

On average, each incentive group

had approximately 9,380 age-eligible

households identified with 7,770

completed screeners, 1,590 completed

special-needs interviews, and 5,720

completed without special-needs

interviews.

As seen in Table XXXV, Group 3A

provided the highest screener

completion rate, the highest specialneeds interview completion rate, the

highest without-special-needs interview

completion rate, and the third lowest

special-needs prevalence rate.

Differences in the special-needs

prevalence rates were taken into account

because the incentives may have

differentially affected participation rates

of households with children with special

health care needs (CSHCN) compared

with households without CSHCN.

Ultimately, Group 5B was selected in

consideration of both costs and rates.

Implementation of Group 5B was

determined to be less expensive than

Group 3A, and Group 5B provided the

second highest special-needs interview

completion rate.

Table XXXVI summarizes the

overall response rates for special-needs

and without-special-needs cases for each

incentive group.

Selected Incentive Models

Although the incentive experiment

was designed to be fielded for Quarters

3 and 4, 2009 sample cases, the protocol

continued to be fielded during the

experiment analysis and decision stages

through most of Quarter 2, 2010. A later

sample in Quarter 2, 2010 was fielded

with the experiment decision protocol

(Group 5B). Quarter 3, 2010 was the

first quarter for which the selected

incentive model was fielded for the

entire quarter for landline cases.

Shortly after cell-phone dialing

began in Quarter 3, 2010, it was

determined that the design of Group 5B

may not be as effective for cell-phone

cases due to the nature of cell-phone

sampling. Because addresses were not

available for this sample, incentiveeligible cases were not benefitting from

the prepaid incentive mailed to

households. The design of Group 3A,

which involved a verbal incentive offer

after the first refusal, was determined to

be more appropriate for cell-phone

respondents. As the model with the

highest overall response rates and the

model utilized in the 2007 NSCH, as

well as a top performer in the incentive

experiment, Group 3A had proven

successful in the past. This model was
Table XXXIV. Incentive experiment groups

Second refusal

Group

First

refusal

Cases with

mailing address

Cases with no

mailing address

Group 1 (control) .............

Group 2 ...................

No incentives offered at any point (cases with mailing address sent refusal conversion letter after two refusals)

Offer of $5 directly after age eligibility established (cases with mailing address sent refusal conversion letter after two refusals)

Age eligibility established

Group 3

3A .................. Offer of $10

upon call back

$5 mailing

with promise of $10

Offer of $15

upon call back

3B .................. No offer $5 mailing

with promise of $10

Offer of $15

upon call back

Group 4 ................... No offer $5 mailing

with no promise

Offer of $5

upon call back

Group 5

5A .................. Offer of $10

upon call back

$1 coin mailing

with promise of $10

Offer of $11

upon call back

5B .................. No offer $1 coin mailing

with promise of $10

Offer of $11

upon call back

Group 6 ................... No offer $1 coin mailing

with no promise

Offer of $5

upon call back

Page 238 [ Series 1, No. 57

applied to cell-phone cases shortly after

the start of cell-phone dialing in Quarter

3, 2010. The procedures involved in

executing both Group 5B and Group 3A

are described below.

Experimental Procedures

Experiment Group 5B

In incentive model 5B, no incentive

treatment was applied after the first

active refusal. Following the second

refusal, age-eligible cases were put on

hold for a period of 2 weeks. During

this period, cases received a prepaid

incentive of a $1 coin, which was

mailed first class. With this mailing,

respondents were promised an additional

$10 for participation. (See Appendix IX

for the letters used for incentive

mailings.) Age-eligible cases without

addresses were promised $11 for

participation upon call back after the

second refusal. As noted above,

age-eligible, passive-refusal cases—zeroor one-refusal cases with no contact for

a period of 21 days—received similar

treatment as those cases with two active

refusals. Figure 1 below maps the

incentive treatment for both active- and

passive-refusal cases.

Experiment Group 3A

In incentive model Group 3A, on

the next call, age-eligible one-refusal

cases received a verbal promise of $10

upon completion of the survey. The

incentive offer of $10 was introduced in

various interview scripts (i.e., consent

script, callback script, and answering

Table XXXV. Response rates, by incentive group

WithoutGroup

First

refusal

Second

refusal

Screener

completion

rate

Special-needs

prevalence

rate

Special-needs

interview

completion

rate

special-needs

interview

completion

rate

Group 1 ................... No offer Refusal conversion

letter (no offer)

81.7 24.8 81.5 97.6

Group 2 ................... Offer of $5 directly after age eligibility established

(refusal conversion letter after second refusal)

82.6 24.0 83.1 98.1

Group 3

3A .................. Offer of

$10 upon call back

$5 prepay

$10 promise

83.7 24.6 84.5 98.2

3B .................. No offer $5 prepay

$10 promise

83.5 24.8 82.7 97.6

Group 4 ................... No offer $5 prepay only 83.3 24.8 81.6 97.5

Group 5

5A .................. Offer of $10

upon call back

$1 coin prepay

$10 promise

82.9 25.8 82.6 97.8

5B .................. No offer $1 coin prepay

$10 promise

82.9 24.9 83.4 97.4

Group 6 ................... No offer $1 coin

prepay only

82.3 24.2 82.0 98.0

NOTE: Rates are percentages.
Table XXXVI. Overall response rates, by incentive group

WithoutSpecial-needs special-needs

overall overall

First Second response rate response rate

Group refusal refusal (percent) (percent)

Group 1 ................... No offer Refusal conversion 66.6 79.7

letter (no offer)

Group 2 ................... Offer of $5 directly after age-eligibility established 68.6 81.0

(refusal conversion letter after 2nd refusal)

Group 3

3A . . . . . . . . . . . . . . . . . . Offer of $10 $5 prepay 70.8 82.2

upon call back $10 promise

3B . . . . . . . . . . . . . . . . . . No offer $5 prepay 69.1 81.3

$10 promise

Group 4 ................... No offer $5 prepay only 67.9 81.5

Group 5

5A . . . . . . . . . . . . . . . . . . Offer of $10 $1 coin prepay 68.5 81.1

upon call back $10 promise

5B . . . . . . . . . . . . . . . . . . No offer $1 coin prepay 69.1 80.8

$10 promise

Group 6 ................... No offer $1 coin prepay only 67.4 80.6

Series 1, No. 57 [ Page 239

machine script). If a household

completed the NS-CSHCN interview, or

if a respondent requested the incentive

without completing the interview,

address information for the household

was either confirmed or collected. The

$10 payment was mailed to the

household, along with a letter expressing

appreciation for the respondent’s time

and effort.

Cases that received the $10

incentive offer but refused a second

time prior to completing the interview

received the two-refusal incentive

treatment unique to Group 3A. These

cases were put on hold for a period of 2

weeks. Upon recontact, cases were then

verbally offered $15 upon completion of

the interview. Because addresses were

not available for cell-phone cases for

NS-CSHCN, the prepaid component of

this incentive model was not utilized for

this survey. Similar to Group 5B,

passive-refusal cases received the

two-refusal incentive treatment as well.

Figure 2 maps the Group 3A incentive

treatment for both active- and

passive-refusal cases.

Once households met the criteria for

the incentive group to which they were

assigned, upon recontact, they were read

an introductory script that varied the

dollar amount depending on sample type

and whether an incentive letter had been

sent, and that content varied slightly

depending on where in the interview the

case had broken off.

Response Rates

A total of 107,705 cases—37% of

all age-eligible cases—became eligible

for some type of an incentive across all

6 quarters of NS-CSHCN data

collection. Active-refusal cases

accounted for 80.9% (n = 87,158) of all

cases eligible for incentive treatment (as

applicable according to the case’s

incentive group), and passive-refusal

cases accounted for the remainder

(19.1% or n = 20,547). Of the cases

eligible for an incentive treatment,

R did not Passive pick up refusal: phone after One refusal for refusal 21 days 

 

Completed 

interview 

without 

incentive 

Two-refusal 

treatment: 

No address available: 

$11 incentive offer 

over the phone 

Address available: 

Mail $1 prepaid 

incentive, $10 offer 

Completed 

interview 

with $11 

incentive 

R did not 

pick up 

phone after 

screening 

for 21 days 

Screened:
 

Household 


has 


children 


under 


age 18
 

Active No 

refusal: incentive 

Verbally offered 

refused upon

first time callback 

Active 

refusal: 

Verbally 

refused 

second 

time 

Passive 

refusal: 

No 

refusals 

NOTE: R is respodent.
 

SOURCE: CDC/NCHS, 2009–2010.
 

Figure 1. Incentive Group 5B eligibility
 

 

Screened: 

Household 

has 

children 

under 

age 18 

Passive 

refusal: 

One 

refusal 

R did not 

pick up 

phone after 

refusal for 

21 days 

One-refusal 

treatment: 

$10 

incentive 

offer over 

the phone 

Active 

refusal: 

Verbally 

refused 

first time 

Active 

refusal: 

Verbally 

refused 

second 

time 

Two-refusal 

treatment: 

R did not No address available: pick up $15 incentive offer phone after over the phone screening 
 Passive
 for 21 days refusal: Address available: 

Completed 

interview 

with $15 

incentive 

No 

refusals 

NOTE: R is respodent.
 

SOURCE: CDC/NCHS, 2009–2010.
 

Figure 2. Incentive Group 3A eligibility

Completed 

interview 

without 

incentive 

Completed 

interview 

with $10 

incentive 

Mail $5 prepaid 

incentive, $10 offer 

Page 240 [ Series 1, No. 57

46.7% (n = 50,312) completed the

CSHCN Screener, 9.8% (n = 10,545) of

households with CSHCN completed the

interview, and 30.5% (n = 32,791) of

households without CSHCN completed

the interview. Final dispositions of cases

that received incentive treatment are

shown in Table XXXVII.

Table XXXVIII provides

information on incentive completion

rates by incentive group solely for

Quarters 3 and 4, 2010—the quarters

following the incentive experiment.

Group 3A was comprised solely of a

cell-phone sample, whereas Group 5B

was predominantly comprised of a

landline sample, but it included a

cell-phone sample as well (for cases

released prior to the decision to apply

Group 3A to all cell-phone samples). A

total of 643 special-needs interviews

were completed from cases that received

Group 3A incentive treatment, and a

total of 1,556 special-needs interviews

were completed following Group 5B

incentive treatment.

Table XXXVII. Number and percentage of active and passive incentive cases by final case disposition, all quarters

Active-refusal cases Passive-refusal cases

Disposition One refusal Two refusals Total No refusals One refusal Total

All cases ....................... 43,404 43,754 87,158 14,039 6,508 20,547

Completed interview (households with

CSHCN)....................... 5,704 (13.14) 2,774 (6.34) 8,478 (9.73) 1,648 (11.74) 419 (6.44) 2,067 (10.06)

Completed special-needs screening but did

not complete the interview............ 1,033 (2.38) 3,457 (7.90) 4,490 (5.15) 1,726 (12.29) 760 (11.68) 2,486 (12.1)

Completed interview (households without

CSHCN)....................... 21,658 (49.90) 7,443 (17.01) 29,101 (33.39) 2,739 (19.51) 951 (14.61) 3,690 (17.96)

All other dispositions ................ 15,009 (34.58) 30,080 (68.75) 45,089 (51.73) 7,926 (56.46) 4,378 (67.27) 12,304 (59.88)

NOTE: CSHCN is children with special health care needs.
 

Series 1, No. 57 [ Page 241

Table XXXVIII. Completion rates by incentive group: Quarters 3 and 4, 2010

Quarter 3 Quarter 4

Special- Nonspecial- Special- NonspecialNumber needs needs Percent Number needs needs Percent

Group of cases completes completes completed of cases completes completes completed

Group 3A

Age-eligible cases ................. 4,983 481 2,044 50.67 34,368 1,990 9,602 33.73

Active-refusal cases ............... 1,252 80 304 30.67 3,511 332 1,347 47.82

One refusal ($10 offer) ............ 573 66 251 55.32 1,980 274 1,178 73.33

Two refusal ($15 offer) ............ 679 14 53 9.87 1,531 58 169 14.83

Passive-refusal cases .............. 787 53 103 19.82 2,631 178 350 20.07

No refusal ($15 offer)............. 596 42 83 20.97 1,876 143 279 22.49

One refusal ($15 offer) ............ 191 11 20 16.23 755 35 71 14.04

Total incentive cases .............. 2,039 133 407 26.48 6,142 510 1,697 35.93

Group 5B

Age-eligible cases ................. 51,665 7,616 28,051 69.04 29,843 4,328 16,054 68.30

Active-refusal cases ............... 16,115 1,552 5,505 43.79 7,493 828 2,873 49.39

One refusal (no offer)............. 7,790 988 4,028 64.39 3,867 532 2,259 72.17

Two refusals ($1 prepay and $10

offer; $11 offer if no address) ....... 8,325 564 1,477 24.52 3,626 296 614 25.10

Passive-refusal cases .............. 3,899 438 777 31.16 2,045 258 429 33.59

No refusal ($1 prepay and $10

offer; $11 offer if no address) ....... 2,705 344 602 34.97 1,304 201 301 38.50

One refusal ($1 prepay and $10

offer; $11 offer if no address) ....... 1,194 94 175 22.53 741 57 128 24.97

Total incentive cases .............. 20,014 1,990 6,282 41.33 9,538 1,086 3,302 46.01

NOTES: ‘‘Age-eligible cases’’ includes all age-eligible cases flagged for the incentive group. Incentives are offered only after age eligibility has been confirmed and the refusal criteria has been met.

‘‘Number of cases’’ includes all cases in the incentive group regardless of special-needs status. Cases that were not incentivized (i.e., no refusal cases) are not displayed.
Appendix XIII. Nonresponse Bias Analysis

Nonresponse in the

2009–2010 National Survey

of Children with Special

Health Care Needs

The stages of the 2009–2010

National Survey of Children with

Special Health Care Needs

(NS-CSHCN) and the types of

nonrespondents are shown in Figure 3.

A cellular- (cell) phone sample and a

landline sample were drawn in each

state, and an attempt was made to

identify households containing children

under age 18 years. In order to

contribute to the survey estimates, a

telephone number first had to be

‘‘resolved’’; that is, it had to be

determined whether the telephone

number belonged to a household, as

opposed to being a nonworking number

or used only for business purposes.

If a household was identified, it

then needed to be screened for the

presence of children under age 18. The

cell-phone sample underwent additional

screening to determine whether the cell

phone was used by an adult in a

cell-phone-only (CPO) or cell-phonemainly (CPM) household; that is,

households identified in the cell-phone

sample underwent a ‘‘cell-phone-status’’

screener. If the cell phone was used only

by a minor, or if the household had a

landline phone that was somewhat or

extremely likely to be answered, the

cell-phone number was screened out as

ineligible for the survey.

Once it was determined that the

household contained children under age

18 (and for the cell-phone sample, that

the cell phone was used by an adult in a

CPO or CPM household), the children

in the household were screened for

special health care needs. If one or more

children in the household had special

needs, a special-needs child was

randomly selected, and a detailed

interview about that child was

administered.

Nonresponse occurred at each stage:

For some telephone numbers, it was

never determined whether the number

belonged to a household. That is, some

numbers remained unresolved; some

households that were identified did not

complete the age-eligibility or

cell-phone-status screeners; some

households that were screened for

age-eligibility and cell-phone status and

were found to be eligible did not

complete the special-needs screener; and

some households that were identified as

having special-needs children did not

complete the detailed special-needs

interview. This appendix examines the

effect of the nonresponse, that is,

unresolved telephone numbers, age- and

cell-phone-status screener nonresponse,

special-needs screener nonresponse, and

special-needs-interview nonresponse on

key national survey estimates.

Nonresponse Bias	 

Nonresponse bias in a survey

estimate yr can be expressed in two

forms (36), given the data collection

protocol. The first formulation assumes

that each unit in the target population is,

a priori, either a respondent or a

nonrespondent:

M Bias(yr) = N (Yr – Ym), (1)

respondents in the population, N is the

total number of units in the target

population, Yr is the respondent mean in

the target population, and Ym is the

nonrespondent mean in the target

where M is the number of nonpopulation. The second formulation

assumes that each unit (i) in the target

population has a propensity pi to

respond:

σyp Bias(yr) = , (2) p

where σyp is the correlation between the

survey variable and the response

propensity, and p is the mean response

propensity in the population. In either

Page 242 [ Series 1, No. 57
 

Series 1, No. 57 [ Page 243

formulation, the bias is related to both

the response rate and the degree to

which the respondents differ from the

nonrespondents with respect to the

survey variable.

Nonresponse rates represent a

potential for substantial nonresponse

bias. However, this is only a potential.

In a meta-analysis of nonresponse bias

studies, Robert Groves found little to no

relationship between the magnitude of

nonresponse and nonresponse bias. In

fact, Groves found more variation in

nonresponse bias between estimates

from the same survey than between

estimates from different surveys with

differing response rates (36).

The more important factor

contributing to nonresponse bias is the

degree to which respondents differ from

nonrespondents with respect to the

survey variables. This quantity is

generally unknown, and nonresponse

bias analyses attempt to measure this

difference in either a direct or an

indirect way. Groves summarizes the

typical approaches (36):

1.Response rate comparisons across

subgroups

2.Using rich sampling frame data or

supplemental matched data

3.Comparison to similar estimates

from other sources

4.Studying variation within the

existing survey

5.Contrasting alternative postsurvey

adjustments for nonresponse

This appendix presents the results

of analyses using approaches 1–4 for the

2009–2010 NS-CSHCN. (Alternative

postsurvey adjustments for nonresponse

are not available for NS-CSHCN.) Each

of these approaches has its weaknesses;

using many different approaches may

arrive at conclusions that overcome the

weaknesses of any individual approach

and provide an accurate picture of the

nonresponse bias.

Information Available on

Nonrespondents

Several of the approaches used to

assess nonresponse bias rely on the

availability of information for both

respondents and nonrespondents.

Because NS-CSHCN is a random-digitdial (RDD) survey, the information

available on the nonrespondents was

very limited. Table XXXIX shows the

information known for both respondents

and nonrespondents in the 2009–2010

NS-CSHCN landline sample. The first

two variables—residential listed status

and advance letter status—are

case-specific, and the remaining

variables are ecological. That is, they

contain information not about each case

specifically but about the telephone

exchange containing the case’s

telephone number. (The telephone

exchange is the area code plus the first

three digits of the telephone number.)

For example, while the income of each

case was unknown, the median income

for households sharing the case’s

telephone exchange was known. This

ecological information is based on

census tract-level data, aggregated to the

telephone-exchange level. Because there

are no directories of cell-phone

numbers, and because cell-phone

numbers are not tied to geography the

way landline numbers are, these frame

variables were available only for the

landline sample and were not available

for the cell-phone sample.

Key Survey Estimates

The assessment of nonresponse bias

focused on nine key survey estimates:

1.The child-level special-needs

prevalence rate

2.The percentage of children with

special health care needs (CSHCN)

with a medical home

3.The percentage of CSHCN with

adequate insurance

4.The percentage of CSHCN with any

unmet need for specific health care

services

5.The percentage of CSHCN whose

conditions affect their activities

usually, always, or a great deal

6.The percentage of CSHCN whose

conditions cause family members to

cut back or stop working

7.The percentage of CSHCN without

family-centered care

8.The percentage of CSHCN with a

routine preventive medical visit and

a routine preventive dental visit

Table XXXIX. Information available for both respondents and nonrespondents

Variable name Description

Listed .................... Indicator of residential listed status

Advance_letter ............... Indicator of advance letter sent status

MSA ..................... Indicator of metropolitan statistical area status

Median_HH_income ........... Median household income in the telephone exchange

Median_home_val............. Median home value in the telephone exchange

Median_rent ................ Median rent in the telephone exchange

Median_years_educ............ Median years of education of the population in the telephone exchange

College_graduate ............. Percentage of the population in the telephone exchange that are college graduates

Approx_median_age ........... Approximate median age of the population in the telephone exchange

Hispanic_p ................. Percentage of the population in the telephone exchange that is Hispanic

White_p ................... Percentage of the population in the telephone exchange that is non-Hispanic white

Black_p ................... Percentage of the population in the telephone exchange that is non-Hispanic black

Asian_pacif_p ............... Percentage of the population in the telephone exchange that is non-Hispanic Asian or Pacific Islander

Household_density ............ Household density in the telephone exchange

Percent_listed ............... Percentage of telephone numbers in the telephone exchange that are residential listed

Owner_occupied_p ............ Percentage of homes in the telephone exchange that are owner-occupied

Rent_other_p................ Percentage of homes in the telephone exchange that are rented or otherwise not owner-occupied
Page 244 [ Series 1, No. 57

9.The percentage of CSHCN whose

families pay $1,000 or more out of

pocket in medical expenses per

year

The child-level special-needs

prevalence rate was calculated as the

percentage of CSHCN among children

for whom the CSHCN Screener was

completed. The remainder of the key

survey estimates above was computed

among CSHCN with a completed

CSHCN interview.

NS-CSHCN Weighting

While it is important to understand

how nonrespondents differ from

respondents, the more important

consideration for data users is how well

the weighting adjustments that were

made to correct for nonresponse actually

did that. Thus, the following analyses

attempted to answer two questions:

1.What level of bias would be present

in the key survey estimates if no

postsurvey adjustments for

nonresponse were performed? That

is, what is the effect of nonresponse

on the raw estimates?

2.How well do the postsurvey

adjustments for nonresponse

mitigate the raw nonresponse bias?

To answer these questions, each of

the analyses is presented twice, first

using only the base weights—the

weights that reflect the probabilities of

telephone number selection but do not

reflect postsurvey adjustments—and

then using either the nonresponseadjusted weights (the weights that have

been adjusted for nonresponse at each

stage) or the final weights that have

been both adjusted for nonresponse at

each stage and raked to population

control totals. Table XL shows the

weight variables used in these

analyses.

Assessing Nonresponse

Bias in the 2009–2010

NS-CSHCN

Response rate comparisons

across subgroups

A comparison of response rates

across subgroups could reveal the

presence of nonresponse bias in a

survey. If the response rate is lower

(or higher) for a particular subgroup

relative to that of other subgroups, then

that would indicate that the subgroup is

underrepresented (or overrepresented) in

the final sample, and, to the extent that

the key survey estimate is different for

that particular subgroup compared with

other subgroups, there would be bias in

the overall survey estimate. If, on the

other hand, the response rate is the same

across subgroups, or if the key survey

estimate does not differ by these

subgroups, the key survey estimate

could still be biased, but unequal

response rates across these subgroups

will have been ruled out as a source of

bias.

Table XLI presents the national

response rates for various subgroups.

The response rates are presented first

using only the base weights and then

using the weights that have been

sequentially adjusted for nonresponse at

each stage. The subgroups were formed

based on the sample frame information

listed in Table XXXIX. For each of the

continuous variables in Table XXXIX,

cases were classified into two

subgroups: those with values above and

those with values below the median

value of the variable for all cases in the

landline sample. Because the frame

information was available only for the

landline sample, the response rate

comparisons in Table XLI are presented

only for the landline sample.

Table XLI shows that it was more

difficult to interview households in

urban areas, in wealthier areas, and in

areas with larger nonwhite populations.

The response rates were more than

5 percentage points higher for cases

outside of metropolitan statistical areas

(MSAs) than for cases inside MSAs,

and about 3 to 4 percentage points lower

for areas with higher household density.

The response rates were lower in areas

above the median in terms of measures

associated with wealth (household

income, home value, and rental costs)

and higher in areas with a relatively

older population. Finally, the response

rates were 5 to 6 percentage points

higher in areas above the median in

terms of percentage of the population

that is white, and lower in areas above

the median in terms of percentage of the

Table XL. Weight variables used in the nonresponse analysis

Weight name Description

BASE_WT ................. Weight reflecting the initial selection probability of each telephone number in the sample.

RES_WT .................. BASE_WT, adjusted for nonresolution of telephone numbers. This weight is valid for all resolved telephone numbers.

AGE_SCR_WT ..............

RES_WT, adjusted for nonresponse to the age- and cell-phone-status eligibility screeners. This weight is valid for all households

that completed the age- and cell-status-eligibility screeners.

TLINE_WT .................

AGE_SCR_WT, adjusted for nonresponse to the special-needs screener. This weight is valid for all households that completed

the special-needs screener.

WEIGHT_H .................

TLINE_WT, adjusted for multiple telephone lines, adjusted for combining the landline and cell-phone samples, and raked to

population control totals. This is the final dual-frame household-level weight for households completing the special-needs screener.

WEIGHT_CH ................

WEIGHT_H, converted to the child level and raked to population control totals. This is the final dual-frame child-level weight for

children for whom the special-needs screener was completed.

CH_INT_WT ................

WEIGHT_H, adjusted for the selection of one CSHCN per household, and adjusted for nonresponse to the CSHCN interview.

This weight is valid for all children for whom the CSHCN interview was completed.

WEIGHT_I ................. CH_INT_WT, raked to population control totals. This is the final dual-frame child-level CSHCN interview weight.

NOTE: CSHCN is children with special health care needs.
Series 1, No. 57 [ Page 245

Table XLI. Special-needs screener and interview response rates, by subgroup: Landline sample

Special-needs screener response rate CSHCN interview response rate

Using Using Using Using

base adjusted base adjusted

Frame variable Subgroup weight weights weight weights

Listed .................... Not listed 49.1 49.1 39.6 39.2
 

Listed .................... Listed 47.3 47.2 39.7 39.7
 

Advance_letter ............... Not sent 50.0 50.0 40.2 40.0
 

Advance_letter ............... Sent 45.1 45.1 38.2 38.3
 

MSA . . . . . . . . . . . . . . . . . . . . . Outside of MSA 56.9 57.0 48.2 48.5
 

MSA . . . . . . . . . . . . . . . . . . . . . In MSA 51.4 51.4 42.8 42.8
 

Median_HH_income ........... Below median 53.5 53.5 45.0 44.9
 

Median_HH_income ........... Above median 51.1 51.2 42.6 42.6
 

Median_home_val............. Below median 54.9 55.0 46.5 46.4
 

Median_home_val............. Above median 49.8 49.9 41.2 41.3
 

Median_rent ................ Below median 54.8 54.8 46.2 46.2
 

Median_rent ................ Above median 50.0 50.1 41.4 41.5
 

Median_years_educ............ Below median 51.9 51.9 43.6 43.6
 

Median_years_educ............ Above median 52.5 52.6 43.8 43.8
 

College_graduate ............. Below median 52.2 52.2 44.0 44.0
 

College_graduate ............. Above median 52.3 52.4 43.5 43.5
 

Approx_median_age ........... Below median 50.8 50.9 42.5 42.7
 

Approx_median_age ........... Above median 54.0 54.0 45.1 44.9
 

Hispanic_p ................. Below median 55.3 55.4 46.5 46.6
 

Hispanic_p ................. Above median 49.3 49.4 41.0 41.0
 

White_p ................... Below median 49.2 49.3 40.8 40.9
 

White_p ................... Above median 55.1 55.1 46.3 46.4
 

Black_p ................... Below median 53.5 53.5 45.0 44.9
 

Black_p ................... Above median 51.0 51.1 42.4 42.5
 

Asian_pacif_p ............... Below median 54.5 54.6 46.0 45.9
 

Asian_pacif_p ............... Above median 50.2 50.3 41.6 41.8
 

Household_density ............ Below median 54.7 54.8 45.9 45.6
 

Household_density ............ Above median 50.9 51.0 42.5 42.6
 

Percent_listed ............... Below median 52.4 52.5 43.8 43.8
 

Percent_listed ............... Above median 51.7 51.7 43.2 43.2
 

Owner_occupied_p ............ Below median 50.7 50.7 42.3 42.2
 

Owner_occupied_p ............ Above median 53.6 53.6 44.9 45.0
 

Rent_other_p................ Below median 53.6 53.6 44.9 45.0
 

Rent_other_p................ Above median 50.7 50.7 42.3 42.2
 

NOTES: CSHCN is children with special health care needs; MSA is metropolitan statistical area.

population that is Hispanic, black, or

Asian. As can be seen when comparing

the base-weighted response rates with

those using the adjusted weights, the

weighting adjustments for nonresponse

did little to remove these response rate

differences. These results are nearly

identical to those observed in the

2005–2006 NS-CSHCN.

There are three limitations to this

approach. First, to form subgroups, each

continuous sampling frame variable in

Table XXXIX had to be categorized into

groups, resulting in a loss of some of

the information contained in these

variables. Second, the adjusted response

rates presented in Table XLI necessarily

reflect only the weighting adjustments

for nonresponse at each stage and not

the final raking of the weights to

population control totals; the extent to

which this final raking reduced the

under- or overrepresentativeness of a

particular subgroup in the final weighted

sample was not captured by this

analysis. Finally, because the frame

information was not available for the

cell-phone sample, the analysis was

limited to the landline sample.

The next section presents a similar

approach that is not subject to the first

limitation.

Using rich sampling frame data

or supplemental matched data

Using the frame information,

respondents were compared at each

stage of the survey with all of the cases

eligible for the stage. That is, the

nonresponse bias in each frame variable

was directly measured at each stage

(because the frame information was

available for both respondents and

nonrespondents at each stage, the

stage-specific nonresponse bias in these

variables can be measured directly). The

overall nonresponse bias for the survey

was estimated for each frame variable

(i.e., the stage-specific measures of bias

in the frame variables were used to

estimate the total nonresponse bias in

each frame variable across the stages of

the survey). Logistic regression models

were used to translate the estimated

overall biases in the frame variables into

estimates of bias in the key survey

estimates.

Table XLII shows, for each stage of

the survey, a comparison of the frame

information for the entire landline

sample eligible for the stage and the

landline sample respondents to the stage,

first using the base weights only and

then using the weights that have been

sequentially adjusted for nonresponse at

each stage.
Page 246 [ Series 1, No. 57

Table XLII. Comparing respondents and nonrespondents at each stage using frame information: Landline sample

Using base weight Using nonresponse adjusted weight

All cases Respondent/all All cases Respondent/all

eligible for Respondents cases percent eligible for Respondents cases percent

Frame variable Stage the stage at the stage difference the stage at the stage difference

1. Resolution 40.81 36.23 –11.22 40.81 40.84 0.08

2. Age screener 89.20 89.80 67.00 90.81 90.81 –

3. Special-needs screener 87.18 88.17 113.00 88.41 88.41 –

4. Interview 88.11 88.54 49.00 85.79 85.86 0.09

Overall (stages 1–3)1 . . . . . . –9.61 . . . . . . 0.08

Listed .................... Overall (stages 1–4)2 . . . . . . –9.17 . . . . . . 0.17

1. Resolution 25.63 21.23 –17.18 25.63 23.64 –7.76

2. Age screener 72.78 73.61 1.14 73.32 73.93 0.83

3. Special-needs screener 70.22 72.27 2.92 70.61 72.26 2.33

4. Interview 73.53 74.56 1.40 70.96 71.12 0.23

Overall (stages 1–3) . . . . . . –13.79 . . . . . . –4.82

Advance letter sent ............ Overall (stages 1–4) . . . . . . –12.58 . . . . . . –4.60

1. Resolution 81.79 81.24 –0.67 81.79 81.84 0.06

2. Age screener 81.53 81.14 –0.47 81.75 81.68 –0.09

3. Special-needs screener 83.82 83.27 –0.66 84.35 84.25 –0.12

4. Interview 82.66 82.44 –0.26 82.83 82.96 0.15

Overall (stages 1–3) . . . . . . –1.80 . . . . . . –0.15

In MSA ................... Overall (stages 1–4) . . . . . . –2.05 . . . . . . 0.01

1. Resolution 56,217 55,818 –0.71 56,217 56,220 0.00

2. Age screener 57,283 57,188 –0.17 57,488 57,468 –0.03

3. Special-needs screener 59,661 59,713 0.09 59,970 60,143 0.29

4. Interview 59,262 59,052 –0.35 56,739 56,884 0.26

Overall (stages 1–3) . . . . . . –0.79 . . . . . . 0.26

Median_HH_income ........... Overall (stages 1–4) . . . . . . –1.14 . . . . . . 0.51

1. Resolution 234,083 230,091 –1.71 234,083 234,345 0.11

2. Age screener 230,878 229,252 –0.70 233,319 233,079 –0.1

3. Special-needs screener 240,028 237,230 –1.17 244,498 245,363 0.35

4. Interview 225,217 223,298 –0.85 218,218 218,965 0.34

Overall (stages 1–3) . . . . . . –3.54 . . . . . . 0.36

Median_home_val............. Overall (stages 1–4) . . . . . . –4.36 . . . . . . 0.71

1. Resolution 574 568 –0.98 574 574 –0.01

2. Age screener 571 568 –0.42 573 573 –0.07

3. Special-needs screener 590 587 –0.55 595 596 0.16

4. Interview 574 571 –0.57 561 563 0.24

Overall (stages 1–3) . . . . . . –1.94 . . . . . . 0.07

Median_rent ................ Overall (stages 1–4) . . . . . . –2.49 . . . . . . 0.31

1. Resolution 13.18 13.17 –0.06 13.18 13.18 0.01

2. Age screener 13.17 13.17 0.03 13.17 13.17 0.02

3. Special-needs screener 13.22 13.23 0.13 13.22 13.23 0.10

4. Interview 13.25 13.24 –0.05 13.14 13.15 0.03

Overall (stages 1–3) . . . . . . 0.10 . . . . . . 0.13

Median_years_educ............ Overall (stages 1–4) . . . . . . 0.06 . . . . . . 0.16

1. Resolution 26.27 26.13 –0.52 26.27 26.30 0.10

2. Age screener 25.98 26.01 0.08 26.06 26.09 0.12

3. Special-needs screener 26.85 27.02 0.66 26.92 27.09 0.62

4. Interview 26.94 26.86 –0.30 25.60 25.66 0.21

Overall (stages 1–3) . . . . . . 0.22 . . . . . . 0.84

College_graduate ............. Overall (stages 1–4) . . . . . . –0.08 . . . . . . 1.05

1. Resolution 37.65 37.66 0.03 37.65 37.66 0.01

2. Age screener 37.72 37.77 0.13 37.71 37.73 0.05

3. Special-needs screener 37.09 37.13 0.11 37.05 37.06 0.04

4. Interview 37.22 37.2 –0.04 37.00 37.01 0.02

Overall (stages 1–3) . . . . . . 0.27 . . . . . . 0.10

Approx_median_age ........... Overall (stages 1–4) . . . . . . 0.23 . . . . . . 0.12

1. Resolution 13.60 13.36 –1.73 13.60 13.56 –0.24

2. Age screener 12.60 12.29 –2.48 12.82 12.73 –0.68

3. Special-needs screener 13.57 13.05 –3.84 14.13 14.04 –0.59

4. Interview 11.33 11.39 0.50 12.98 12.97 –0.12

Overall (stages 1–3) . . . . . . –7.85 . . . . . . –1.50

See footnotes at end of table.
Series 1, No. 57 [ Page 247

Table XLII. Comparing respondents and nonrespondents at each stage using frame information: Landline sample—Con.

Using base weight Using nonresponse adjusted weight

All cases Respondent/all All cases Respondent/all

eligible for Respondents cases percent eligible for Respondents cases percent

Frame variable Stage the stage at the stage difference the stage at the stage difference

Hispanic_p ................. Overall (stages 1–4) . . . . . . –7.39 . . . . . . –1.62

1. Resolution 66.73 66.94 0.32 66.73 66.74 0.01

2. Age screener 69.47 70.01 0.78 69.31 69.45 0.21

3. Special-needs screener 68.55 69.50 1.39 67.90 68.16 0.39

4. Interview 71.48 71.55 0.09 67.78 67.81 0.04

Overall (stages 1–3) . . . . . . 2.51 . . . . . . 0.62

White_p ................... Overall (stages 1–4) . . . . . . 2.60 . . . . . . 0.66

1. Resolution 12.30 12.43 1.04 12.30 12.33 0.23

2. Age screener 11.05 10.90 –1.28 10.92 10.88 –0.37

3. Special-needs screener 10.58 10.33 –2.33 10.52 10.37 –1.43

4. Interview 10.68 10.60 –0.75 12.69 12.67 –0.11

Overall (stages 1–3) . . . . . . –2.58 . . . . . . –1.58

Black_p ................... Overall (stages 1–4) . . . . . . –3.31 . . . . . . –1.68

1. Resolution 4.55 4.44 –2.39 4.55 4.54 –0.05

2. Age screener 4.19 4.12 –1.72 4.26 4.24 –0.39

3. Special-needs screener 4.54 4.39 –3.42 4.68 4.66 –0.53

4. Interview 3.86 3.83 –1.00 3.86 3.86 0.24

Overall (stages 1–3) . . . . . . –7.36 . . . . . . –0.97

Asian_pacif_p ............... Overall (stages 1–4) . . . . . . –8.29 . . . . . . –0.73

1. Resolution 2.53 2.53 –0.18 2.53 2.53 0.01

2. Age screener 2.56 2.55 –0.28 2.56 2.56 –0.12

3. Special-needs screener 2.62 2.61 –0.39 2.63 2.63 –0.13

4. Interview 2.59 2.59 0.02 2.60 2.60 –

Overall (stages 1–3) . . . . . . –0.85 . . . . . . –0.24

Household_density ............ Overall (stages 1–4) . . . . . . –0.82 . . . . . . –0.24

1. Resolution 55.92 55.52 –0.71 55.92 55.68 –0.43

2. Age screener 60.57 60.65 0.14 60.53 60.50 –0.05

3. Special-needs screener 60.72 60.88 0.27 60.57 60.54 –0.05

4. Interview 61.30 61.25 –0.08 60.66 60.64 –0.04

Overall (stages 1–3) . . . . . . –0.31 . . . . . . –0.53

Percent_listed ............... Overall (stages 1–4) . . . . . . –0.38 . . . . . . –0.57

1. Resolution 66.26 66.30 0.07 66.26 66.27 0.02

2. Age screener 69.16 69.32 0.23 69.14 69.15 0.02

3. Special-needs screener 69.34 69.68 0.49 69.15 69.21 0.08

4. Interview 70.38 70.41 0.04 68.68 68.72 0.06

Overall (stages 1–3) . . . . . . 0.79 . . . . . . 0.11

Owner_occupied_p ............ Overall (stages 1–4) . . . . . . 0.83 . . . . . . 0.17

1. Resolution 33.74 33.70 –0.13 33.74 33.73 –0.04

2. Age screener 30.84 30.68 –0.52 30.86 30.85 –0.04

3. Special-needs screener 30.66 30.32 –1.10 30.85 30.79 –0.17

4. Interview 29.62 29.59 –0.10 31.32 31.28 –0.13

Overall (stages 1–3) . . . . . . –1.74 . . . . . . –0.25

Rent_other_p................ Overall (stages 1–4) . . . . . . –1.84 . . . . . . –0.38

– Quantity zero.

. . . Category not applicable.

0.0 Quantity more than zero but less than 0.05.

1Percent is equal to the product of the ‘‘Respondent/all cases percent difference’’ category across the resolution, age-screener, and special-needs screener stages. This provides an estimate of the

percent difference in the frame variable between the special-needs-screener respondents and the nonrespondents (at any stage) who are eligible for the special-needs questions (i.e., households with

children). That is, it is an estimate of the over- or underrepresentativeness of the special-needs-screened households compared with the eligible sample as a whole. This technique assumes that the

mean of the frame variable for the eligible nonrespondents is equal to the observed mean of the frame variable for the respondents. Using ‘‘Residential listed’’ as an example, it assumes that, among

the nonresolved numbers that are actually households, the proportion that is listed is equal to the proportion that are listed among the resolved households; and it assumes that, among the non-agescreened households that actually contain children, the proportion that are listed is equal to the proportion that are listed among the age-screened-eligible households.

2Percent is equal to the product of the ‘‘Respondent/all cases percent difference’’ category across the resolution, age-screener, special-needs screener, and interview stages. This provides an estimate

of the percent difference in the frame variable between the interviewed respondents and the nonrespondents (at any stage).

NOTES: Median_HH_income, Median_home_val, and Median_rent variables are in dollars. MSA is metropolitan statistical area.

For example, for the ‘‘Listed’’

variable in Table XLII, using the base

weights generated an estimate of 40.8%

of the entire landline sample of

telephone numbers being residentiallisted, while among the landline sample

resolved cases (i.e., the respondents to

the resolution stage), 36.2% were

residential-listed. That is, after the

resolution stage, without any adjustment

for nonresolution, the landline sample is

biased downward 11.2% in terms of

residential-listed status. However, using

the weights that have been adjusted for

nonresolution, 40.8% of the landline

sample resolved cases are residentiallisted; all of the bias in residential-listed

status due to nonresolution has been
Page 248 [ Series 1, No. 57

removed by the nonresponse adjustment.

(This is no accident; residential-listed

status was one of the variables used to

form the landline sample nonresponse

adjustment cells.)

Moving to the age-screener stage

and using only the unadjusted base

weights, among all landline sample

resolved households, 89.2% were

residential-listed, and among landline

sample age-screener respondents, 89.8%

are residential-listed (that is, the

age-screener respondents were 0.7%

more residential-listed than they would

be if there were full response at the

age-screener stage, meaning that an

upward bias of 0.7% was introduced in

residential-listed status at the agescreener stage). However, using the

nonresolution adjusted weights, 90.8%

of resolved households were listed, and,

using the weights that were adjusted for

nonresponse to the age screener, 90.8%

of age-screened households were listed.

The weighting adjustment for nonage-screening removed all of the bias

introduced by nonresponse to the

age-screener stage.

Next, moving to the special-needsscreener stage and using only the

unadjusted base weights, among all

landline sample age-eligible households,

87.2% were residential-listed, and

among landline sample special-needsscreener respondents, 88.2% were

residential-listed (that is, an upward bias

of 1.1% in residential-listed status was

introduced at the special-needs-screener

stage). Using the non-age-screened

adjusted weights, 88.4% of age-eligible

households were listed, and, using the

weights that were adjusted for

nonresponse to the special-needs

screener, 88.4% of special-needs

screened households were listed. Again,

the weighting adjustment for nonspecialneeds screening removed all of the bias

introduced by nonresponse to the

special-needs-screener stage.

Finally, moving to the CSHCN

interview stage and using only the base

weights, among households with a

special-needs child, 88.1% were

residential-listed, and 88.5% of the

completed CSHCN interviews were

residential-listed, that is, an upward bias

of 0.4% was introduced at the CSHCN

interview stage. Using the weights

adjusted for nonspecial-needs screening,

85.8% of the special-needs screened

eligible households were listed, and,

using the weights that were adjusted for

nonresponse to the CSHCN interview,

85.9% of interviewed households were

listed. Thus, the interview nonresponse

adjustment greatly lowered, but did not

completely eliminate, the residentiallisted bias introduced due to CSHCN

interview nonresponse.

Multiplying the biases at the

resolution, age-screener, and specialneeds-screener stages, calculated using

only the base weights, generated an

estimate that the eligible household

population identified and screened for

special needs; that is 9.6% less

residential-listed than the eligible

household population as a whole. (For

this calculation, the proportion

residential-listed among unresolved

cases that are actually households was

assumed to be equal to the proportion

residential-listed among the resolved

households, and the proportion

residential-listed among the non-agescreened households that are really

age-eligible was assumed to be equal to

the proportion residential-listed among

the age-screened eligible households.)

Using the same calculation, but using

the weights that were sequentially

adjusted for nonresponse to each stage,

generated an estimate that the eligible

household population identified and

screened for special needs was 0.1%

more residential-listed than the eligible

household population as a whole. That

is, while a bias of about 9.6% in

residential-listed status was introduced

due to nonresponse at the resolution,

age-screener, and special-needs-screener

stages, the weighting adjustments for

nonresponse eliminated nearly all of that

bias.

Table XLIII. Observed and expected means of frame variables for respondents: Landline sample

Through special-needs screener stage Through CSHCN interview stage

Using base weight

Using nonresponseadjusted weights Using base weightUsing nonresponseadjusted weights

Frame variable Observed Expected Observed Expected Observed Expected Observed Expected

Listed .................... 88.17 97.55 88.41 88.34 88.54 97.48 85.86 85.72

Advance_letter ...............

MSA .....................

72.27

83.27

83.83

84.79

72.26

84.25

75.92

84.37

74.56

82.44

85.29

84.17

71.12

82.96

74.55

82.95

Median_HH_income ...........

Median_home_val.............

Median_rent ................

Median_years_educ............

College_graduate .............

Approx_median_age ...........

Hispanic_p .................

White_p ...................

Black_p ...................

Asian_pacif_p ...............

Household_density ............

Percent_listed ...............

Owner_occupied_p ............

Rent_other_p................

59,713

237,230

587

13.23

27.02

37.13

13.05

69.50

10.33

4.39

2.61

60.88

69.68

30.32

60,188

245,924

598

13.22

26.96

37.03

14.16

67.80

10.60

4.74

2.63

61.07

69.14

30.86

60,143

245,363

596

13.23

27.09

37.06

14.04

68.16

10.37

4.66

2.53

60.54

69.21

30.79

59,988

244,476

596

13.21

26.86

37.03

14.26

67.74

10.54

4.70

2.54

60.86

69.13

30.87

59,052

223,298

571

13.24

26.86

37.20

11.39

71.55

10.60

3.83

2.59

61.25

70.41

29.59

59,733

233,471

586

13.23

26.88

37.12

12.30

69.73

10.97

4.17

2.61

61.49

69.83

30.15

56,884

218,965

563

13.15

25.66

37.01

12.97

67.81

12.67

3.86

2.60

60.64

68.72

31.28

56,594

217,429

561

13.13

25.39

36.97

13.18

67.36

12.89

3.89

2.61

60.99

68.60

31.40

NOTES: Median_HH_income, Median_home_val, and Median_rent variables are in dollars. CSHCN is children with special health care needs; MSA is metropolitan statistical area.
Table XLIV. Estimates of nonresponse biases in the key survey estimates attributable to biases in the frame information: Landline sample

Using base weights Using adjusted weights

Model Model

Model evaluated at Model evaluated at

evaluated at means of the evaluated at means of the

observed frame observed frame

respondent information respondent information

means of expected Estimated means of expected Estimated

the frame under full percent the frame under full percent

Key survey variable information1 response bias2 information1 response bias2

Special-needs prevalence rate ..... 16.2 16.0 1.12 15.2 15.2 –0.04

Percent of CSHCN with medical

home .................... 47.2 47.6 –0.90 43.5 43.5 –0.13

Percent of CSHCN with adequate

insurance ................. 62.8 62.8 –0.11 61.0 61.1 –0.06

Percent of CSHCN with any unmet

need for specific health care

services .................. 19.7 19.3 2.30 22.5 22.5 0.08

Percent of CSHCN whose conditions

affect their activities usually, always,

or a great deal .............. 23.8 23.1 2.97 26.1 26.1 0.15

Percent of CSHCN whose conditions

cause family members to cut back

or stop working.............. 22.4 21.9 1.90 24.2 24.2 –0.01

Percent of CSHCN without familycentered care ............... 31.0 30.7 1.09 34.3 34.3 –0.15

Percent of CSHCN with a routine

preventive medical visit and a

routine preventive dental visit ..... 81.2 81.6 –0.44 79.5 79.5 –0.04

Percent of CSHCN whose families

pay $1,000 or more out of pocket in

medical expenses per year ...... 25.0 25.4 –1.47 21.3 21.1 0.77

1Although the logistic regression models at the observed means of the frame information were evaluated, the results were not the observed means of the key survey variables (i.e., the final estimates

of special-needs prevalence, the percentage of CSHCN with a medical home, etc.), as would be the case for linear regression models.

2Calculated as (model evaluated at observed means – model evaluated at expected means) / model evaluated at expected means.

NOTE: CSHCN is children with special health care needs.

Similarly, multiplying the biases at

the resolution, age-screener, specialneeds-screener, and CSHCN interview

stages, calculated using only the base

weights, generated an estimate that the

eligible population that was identified

and completed the CSHCN interview

was 9.2% less residential-listed than the

eligible household population as a

whole, but the nonresponse adjustments

reduced this to a 0.2% upward bias.

Table XLII shows that this is

generally the case for the other frame

variables as well. Nonresponse

introduced small biases, but the

nonresponse adjustments substantially

reduced those biases. The variables with

the largest biases remaining after the

nonresponse adjustments are advance

letter status (–4.8% through the

special-needs screener and –4.6%

through the CSHCN interview), the

percentage of the population that is

non-Hispanic black in the telephone

exchange (–1.6% through the

special-needs screener and –1.7%

through the CSHCN interview), and the

percentage of the population that is

Hispanic in the telephone exchange

(–1.5% through the special-needs

screener and –1.6% through the CSHCN

interview).

Table XLIII shows the observed

means of the frame variables for

landline sample respondents and the

means that would be expected under full

response. The biases in the frame

information translate into biases in the

key survey estimates only to the extent

that the frame information is related to

the key survey estimates. To examine

these relationships for each key survey

estimate, a logistic regression model was

estimated of the form

eXi

'

β

pi = , 1 + eXi

'

β

where pi is the probability that the ith

respondent’s child is positive for the key

survey variable (i.e., has special needs,

has a medical home, has adequate

insurance, etc.); X'i is a vector containing

the frame information for the ith child;

and β is a vector of unknown

Series 1, No. 57 [ Page 249

parameters to be estimated. By

evaluating the fitted model first at the

observed means of the frame

information and then at the expected

means of the frame information from

Table XLIII, an estimate of the bias in

each key survey estimate was generated

that could be attributed to biases in the

frame variables due to nonresponse.

These estimates of biases in the key

survey estimates using this approach are

shown in Table XLIV.

As Table XLIV shows, the small

biases in the frame information translate

into even smaller biases in the key

survey estimates for the landline sample.

In these analyses, the largest landline

sample bias found when the base

weights were used was in the percentage

of CSHCN whose conditions affect their

activities usually, always, or a great deal

(3.0% bias), but this bias was reduced to

0.2% when the final weights were used.

The largest landline sample absolute

bias when the nonresponse-adjusted

weights were used was in the percentage

of CSHCN whose families pay $1,000

or more out of pocket in medical

expenses per year (0.8% bias).
Page 250 [ Series 1, No. 57

Table XLV. Comparing non-HUDIs with converted HUDIs, by sample type

Landline sample Cell-phone sample

Percent Percent

difference difference

between between

Estimate for high-effort p value for Estimate for high-effort p value for

Estimate for converted and low-effort test of no Estimate for converted and low-effort test of no

Analysis variable non-HUDIs HUDIs respondents1 difference non-HUDIs HUDIs respondents1 difference

Special-needs prevalence rate ..... 16.7 15.0 –10.08 0.000000 14.9 13.3 –10.87 0.00777

Percent of CSHCN with medical

home .................... 48.6 43.4 –10.77 0.000000 39.3 36.6 –6.91 0.27856

Percent of CSHCN with adequate

insurance ................. 63.4 60.4 –4.69 0.000529 59.0 54.7 –7.30 0.09276

Percent of CSHCN with any unmet

need for specific health care

services .................. 19.4 22.5 15.70 0.000038 26.6 25.5 –4.11 0.63174

Percent of CSHCN whose conditions

affect their activities usually, always,

or a great deal .............. 23.5 25.8 –9.85 0.002760 29.2 36.1 23.68 0.00467

Percent of CSHCN whose conditions

cause family members to cut back

or stop working.............. 21.8 25.2 15.54 0.000012 28.0 34.8 24.30 0.00518

Percent of CSHCN without family

centered care ............... 30.1 35.5 17.71 0.000000 38.8 37.9 –2.52 0.69586

Percent of CSHCN with a routine

preventive medical visit and a

routine preventive dental visit ..... 81.4 78.6 –3.44 0.000100 74.3 74.5 0.22 0.94398

Percent of CSHCN whose families

pay $1,000 or more out of pocket in

medical expenses per year ...... 26.7 23.4 –12.28 0.000010 19.9 19.7 –0.87 0.93213

1Calculated as (converted HUDI respondent mean – non-HUDI respondent mean) / non-HUDI respondent mean.

NOTES: Estimates in this table are weighted by the base weights reflecting the probability of selection of the telephone number. HUDI is hung up during introduction; CSHCN is children with special

health care needs.

Although these results suggest that

differences between landline sample

respondents and nonrespondents in

terms of the frame information lead to

very little bias in the key survey

estimates, this does not necessarily mean

that the key survey estimates are biased

very little. It is possible that there are

differences between the landline sample

respondents and nonrespondents that are

not reflected in the frame information.

In fact, the relationship between the

frame information and the key survey

variables is poor. One method of

assessing how well the logistic

regression model relates the frame

information to the key survey variable is

to examine the receiver operating

characteristic (ROC) curve. For each

child, the model produces a predicted

probability of, for example, the child

having special health care needs; the

ROC curve shows how well the model

prediction of whether the child has

special needs agrees with whether the

child truly has special needs, using

various cutoff values for turning the

model’s predicted probability into a

binary prediction of special-needs status.

If the area under the ROC curve equals

1.0, then the model perfectly predicts

the response for all cutoff values; if the

area under the ROC curve equals 0.5,

then the model does no better than

random chance in predicting the

response. The models relating the frame

information to the key survey variables

had areas under the ROC curves ranging

from 0.53 to 0.61, indicating that the

models do not do very much better than

randomly choosing the response.

Therefore, while the models indicate

little bias in the key survey estimates,

they have little power to detect such

bias because the frame information is

not well-related to the key survey

variables.

The results in this section include

only the landline sample and do not

reflect the final raking of the nonresponseadjusted weights to population control

totals. This final raking could have

reduced or increased bias, but if so, that

reduction or increase was not captured in

the analysis in this section. The next

sections present analyses that made use of

the final, raked weights for the dual-frame

sample.

Comparison to similar

estimates from other sources

While key survey estimates for

CSHCN are not available from other

sources, the Medical Expenditure Panel

Survey (MEPS) produces an estimate of

the special-needs prevalence rate. The

most recent year for which the MEPS

national special-needs prevalence rate is

available is 2008. Whereas NS-CSHCN

is a telephone survey, the MEPS

Household Component is an in-person

survey and reports a 2008 response rate

of 59.3% (37); thus, MEPS may be a

higher-quality source for the national

special-needs prevalence rate estimate.

The 2008 MEPS national child-level

special-needs prevalence rate estimate

was 17.9% (38); the corresponding

estimate from the 2009–2010

NS-CSHCN is somewhat lower, at

15.1%; that is, the NS-CSHCN estimate

is 15.8% lower than the MEPS estimate.

The difference could be attributable to

nonresponse bias in NS-CSHCN, but it

could also be due to other factors such

as nonresponse bias in MEPS, mode

differences between MEPS and

NS-CSHCN (MEPS is in-person and
Series 1, No. 57 [ Page 251

Table XLVI. Comparing non-HUDIs with converted HUDIs: Dual-frame sample

Using base weight Using final weight

Percent Percent

difference difference

between between

Estimate for high-effort p value for Estimate for high-effort p value for

Estimate for converted and low-effort test of no Estimate for converted and low-effort test of no

Key survey outcome non-HUDIs HUDIs respondents1 difference non-HUDIs HUDIs respondents1 difference

Special-needs prevalence rate ..... 15.9 14.3 –9.90 0.000000 15.6 13.7 –12.02 0.000000

Percent of CSHCN with medical

home .................... 44.9 40.9 –8.99 0.000179 44.2 39.3 –10.94 0.000003

Percent of CSHCN with adequate

insurance ................. 61.7 58.4 –5.38 0.002294 61.2 58.6 –4.21 0.016008

Percent of CSHCN with any unmet

need for specific health care

services .................. 22.2 23.6 6.01 0.165721 23.0 25.4 10.47 0.015675

Percent of CSHCN whose conditions

affect their activities usually, always,

or a great deal .............. 25.7 29.5 14.69 0.000228 26.4 29.1 10.48 0.006151

Percent of CSHCN whose conditions

cause family members to cut back

or stop working.............. 24.2 28.6 18.23 0.000015 24.1 27.6 14.32 0.000460

Percent of CSHCN without

family-centered care........... 33.5 36.3 8.31 0.008489 34.3 38.9 13.43 0.000016

Percent of CSHCN with a routine

preventive medical visit and a

routine preventive dental visit ..... 78.7 77.2 –1.91 0.114882 79.2 76.3 –3.71 0.001789

Percent of CSHCN whose families

pay $1,000 or more out of pocket in

medical expenses per year ...... 24.0 22.1 –8.12 0.027506 22.9 19.7 –14.11 0.000035

1Calculated as (converted HUDI respondent mean – non-HUDI respondent mean) / non-HUDI respondent mean.

NOTES: HUDI is hung up during introduction; CSHCN is children with special health care needs.

NS-CSHCN is via telephone),

measurement error in one or both

surveys, or the different data-collection

periods for the surveys (2008 for MEPS

and 2009–2010 for NS-CSHCN).

Studying variation within the

existing survey

In a ‘‘level-of-effort’’ analysis,

respondents who respond only after a

great deal of interviewing effort has

been applied are assumed to resemble

nonrespondents. Given this assumption,

a difference in a survey estimate

between ‘‘high-effort’’ respondents and

‘‘low-effort’’ respondents would indicate

that a difference exists between the

respondents and nonrespondents, and

therefore, the survey estimate is biased.

‘‘Interviewing effort’’ was measured

in three ways: verbal-refusal status,

nonverbal-refusal status [i.e., whether

the respondent ‘‘hung up during the

introduction’’ (HUDI)], and the number

of calls placed. It was assumed that

respondents who verbally refused at

least once, who nonverbally refused at

least once, or who required more calls

before completing the interview are

high-effort respondents and would

resemble the nonrespondents with

respect to the key survey variables.

Table XLV compares, by sample

type, the key survey estimates for

converted verbal-refusal cases with

those for cases that completed the

interview without verbally refusing,

using base weights. Table XLVI shows

the same comparison for the dual-frame

sample, first using the base weights, and

then using the final weights.

Tables XLVII and XLVIII show the

comparisons for converted HUDIs

compared with cases that completed

without HUDI. Tables XLIX and L

show the comparisons for households

completing the interview in five calls or

more compared with those completing it

in four calls or fewer. If high-effort

respondents resemble nonrespondents,

then a difference in the survey estimate

between converted refusals and

nonrefusals, between converted HUDIs

and non-HUDIs, or between those

completing the interview in five calls or

more and those completing it in four

calls or less would suggest the presence

of nonresponse bias.

The findings of the level-of-effort

analyses for each of the key survey

estimates presented in the tables are

summarized below:

+	 The special-needs prevalence rate

was significantly higher for

converted refusals and was

significantly lower for converted

HUDIs and households completing

in five calls or more. These results

hold both for the dual-frame

estimates as well as for the landline

and cell-phone samples individually.

+	 The percentage of CSHCN with

medical homes was not

significantly different for converted

refusals or households completing in

five calls or more, but it was lower

for converted HUDIs. The

magnitudes of the significant

differences were similar for both the

landline and cell-phone samples.

+	 The percentage of CSHCN with

adequate insurance was not

significantly different for converted

refusals, but it was significantly

lower for converted HUDIs and

marginally significantly lower for

households completing in five calls

or more. The magnitudes of the

significant differences were similar
Page 252 [ Series 1, No. 57

Table XLVII. Comparing nonrefusals with converted refusals, by sample type

Landline sample Cell-phone sample

Key survey outcome

Estimate for

nonrefusals

Estimate for

converted

refusals

Percent

difference

between

high-effort

and low-effort

respondents1

p value for

test of no

difference

Estimate for

nonrefusals

Estimate for

converted

refusals

Percent

difference

between

high-effort

and low-effort

respondents1

p value for

test of no

difference

Special-needs prevalence rate .....

Percent of CSHCN with medical

home ....................

Percent of CSHCN with adequate

insurance .................

Percent of CSHCN with any unmet

need for specific health care

services ..................

Percent of CSHCN whose conditions

affect their activities usually, always,

or a great deal ..............

Percent of CSHCN whose conditions

cause family members to cut back

or stop working..............

Percent of CSHCN without

family-centered care...........

Percent of CSHCN with a routine

preventive medical visit and a

routine preventive dental visit .....

Percent of CSHCN whose families

pay $1,000 or more out of pocket in

medical expenses per year ......

15.9

47.7

62.7

20.2

23.9

22.7

31.1

81.0

25.8

18.1

45.5

62.8

19.8

24.6

22.1

33.0

79.7

26.5

13.52

–4.57

0.09

–1.97

2.85

–2.87

6.31

–1.67

2.61

0.0000

0.0265

0.9506

0.6154

0.4275

0.4355

0.0357

0.0900

0.4349

14.3

38.2

57.9

26.9

30.4

29.3

38.7

74.7

19.5

16.5

42.0

59.4

22.8

32.8

30.1

38.5

72.0

22.0

15.25

9.78

2.59

–15.35

8.13

2.68

–0.42

–3.69

12.92

0.0051

0.2196

0.6230

0.1149

0.3930

0.7838

0.9570

0.3198

0.3210

1Calculated as (converted

NOTES: Estimates in this

refusal respondent

table are weighted

mean

by the

– nonrefusal respondent mean) / nonrefusal respondent mean.
 

base weights reflecting the probability of selection of the telephone number. CSHCN is children with special health care needs.
 

for both the landline and the

cell-phone samples.

+ The percentage of CSHCN with an

unmet need was not significantly

different for converted refusals or

households completing in five calls

or more, but it was significantly

higher for converted HUDIs (using

final weights). This difference was

observed in the landline sample but

not in the cell-phone sample.

+ The percentage of CSHCN with

activities affected was not

significantly different for converted

refusals or households completing in

five calls or more, but it was

significantly higher for converted

HUDIs. This difference was

observed in both the landline and

cell-phone samples.

+ The percentage of CSHCN whose

conditions cause family members

to cut back or stop working was

not significantly different for

converted refusals or households

completing in five calls or more, but

it was significantly higher for

converted HUDIs. This difference

was observed in both the landline

and cell-phone samples.

+ The percentage of CSHCN without

family-centered care was not

significantly different for converted

refusals, but it was significantly

higher for converted HUDIs and

households completing in five calls

or more. The difference for

converted HUDIs was observed in

the landline sample but not in the

cell-phone sample; the magnitudes

of the difference for households

completing in five calls or more

were similar in the landline and

cell-phone samples.

+ The percentage of CSHCN with a

routine preventive medical visit

and a routine preventive dental

visit was not significantly different

for converted refusals or households

completing in five calls or more, but

it was significantly lower for

converted HUDIs. This difference

was observed in the landline sample

but not in the cell-phone sample.

+ The percentage of CSHCN whose

families pay $1,000 or more out of

pocket in medical expenses per

year was not significantly different

for converted refusals or households

completing in five calls or more, but

it was significantly lower for

converted HUDIs. This difference

was observed in the landline sample

but not in the cell-phone sample.

The conclusions that one might

draw from this level-of-effort analysis

rely on the assumption that high-effort

respondents resemble nonrespondents

with respect to the survey variables.

The validity of this assumption is

questionable, and some studies have

found that it does not hold (39,40). As

part of the 2005–2006 NS-CSHCN

nonresponse analysis and the 2007

National Survey of Children’s Health

nonresponse analysis, this assumption

was tested using the frame information,

which was available for both respondents

and nonrespondents at each stage of the

survey. (Because these surveys utilized

only a landline sample, these tests of the

level-of-effort assumption were limited

to landline sample.) In both tests,

converted refusals did not resemble

nonrespondents in terms of the frame

information. While converted HUDIs

resembled nonrespondents better than

converted refusals, respondents

completing in five calls or more most

resembled nonrespondents in terms of

the frame information.
Series 1, No. 57 [ Page 253

Table XLVIII. Comparing nonrefusals with converted refusals: Dual-frame sample

Using base weight Using final weight

Percent Percent

difference difference

between between

Estimate for high-effort p value for Estimate for high-effort p value for

Estimate for converted and low-effort test of no Estimate for converted and low-effort test of no

Key survey outcome nonrefusals refusals respondents1 difference nonrefusals refusals respondents1 difference

Special-needs prevalence rate ..... 15.2 17.5 15.15 0.0000 14.8 16.5 11.49 0.0000

Percent of CSHCN with medical

home .................... 44.0 44.3 0.84 0.7638 43.2 41.7 –3.61 0.1827

Percent of CSHCN with adequate

insurance ................. 60.8 61.6 1.38 0.4860 60.4 61.2 1.31 0.4995

Percent of CSHCN with any unmet

need for specific health care

services .................. 22.9 20.8 –8.95 0.0499 23.7 23.0 –2.95 0.5161

Percent of CSHCN whose conditions

affect their activities usually, always,

or a great deal .............. 26.4 27.3 3.27 0.4474 26.8 28.4 5.96 0.1581

Percent of CSHCN whose conditions

cause family members to cut back

or stop working.............. 25.3 24.7 –2.36 0.5941 25.2 24.0 –4.74 0.2643

Percent of CSHCN without

family-centered care........... 34.0 34.8 2.28 0.5167 35.1 37.0 5.23 0.1213

Percent of CSHCN with a routine

preventive medical visit and a

routine preventive dental visit ..... 78.5 77.1 –1.81 0.1893 78.6 77.6 –1.33 0.3155

Percent of CSHCN whose families

pay $1,000 or more out of pocket in

medical expenses per year ...... 23.3 25.0 7.18 0.1065 22.0 22.7 3.13 0.4598

1Calculated as (converted refusal respondent mean – nonrefusal respondent mean) / nonrefusal respondent mean.

NOTE: CSHCN is children with special health care needs.

The tests of the assumptions, then,

supported the idea that high-effort

respondents resemble nonrespondents

when ‘‘effort’’ is defined in terms of the

number of call attempts. Under the

assumption that respondents requiring

five calls or more to complete the

interview resemble nonrespondents, the

analysis of the key survey variables by

the number of calls needed to complete

the survey (Table L) suggests that the

final survey estimates of the specialneeds prevalence rate are too high. That

is, it is biased upward—and the final

survey estimate of the percentage of

CSHCN without family-centered care is

too low; that is, it is biased downward.

To translate the differences between

those completing in five calls or more

and those completing in four calls or

less into numerical estimates of bias for

each key survey estimate, the

five-or-more-calls respondent mean of

the key survey estimate was assigned to

all nonrespondents. The results are

presented in Table LI. For example,

when using the base weights, the

special-needs prevalence rate based on

all respondents was 15.6%, and Table LI

shows that this rate for respondents

completing in five calls or more was

14.6%. The dual-frame response rate

through the special-needs screener was

30.9% (and therefore, the nonresponse

rate was 69.1%). By assigning a weight

of 0.309 to the 15.6% estimate for

respondents, and by assuming an

estimate of 14.6% for the

nonrespondents and assigning them a

weight of 0.691, an overall specialneeds prevalence rate estimate for both

respondents and nonrespondents of

14.9% was derived.

This method results in estimates of

bias in the key survey estimates that are

small in absolute value (i.e., 1 percentage

point or less). Because the estimates of

the biases are similar when the base

weights and final weights are used, the

weighting adjustments seem to have had

little effect on the bias.

Conclusions

Assessing the extent to which

nonresponse produces biased survey

estimates is difficult, particularly in a

multistage RDD survey where little

information about the nonrespondents

is known. This analysis has applied

the most commonly used methods,

each of which has its shortcomings.

By taking multiple approaches, it was

hoped that reasonably accurate

conclusions about the level of

nonresponse bias in key survey

estimates could be drawn.

Generally, the results indicate that

the interviewed population was more

likely to live in rural and other areas

with lower household density when

compared with the nonresponding

population. The interviewed population

also was more likely to live in areas

associated with higher levels of home

ownership, lower home values, and a

greater percentage of non-Hispanic

white persons. When the nonresponseadjusted weights were used, minor

differences by home ownership, home

values, and race remained. In general,

the analysis suggests that nonresponse

introduced small biases, but nonresponse

adjustments to the weights substantially

reduced biases. Table LII presents

estimates of bias for each key survey

estimate; the findings are summarized

below.

Note that here, as elsewhere in this

appendix, the biases are presented as

percentage terms, not absolute terms. So

a 5.1% bias in an estimate of 15.1%

means that the reported estimate is 5.1%
Page 254 [ Series 1, No. 57

Table XLIX. Comparing low-call-attempt respondents with high-call-attempt respondents, by sample type

Landline sample Cell-phone sample

Percent Percent

difference difference

Estimate for Estimate for between Estimate for Estimate for between

respondents respondents high-effort p value for respondents respondents high-effort p value for

with four with five and low-effort test of no with four with five and low-effort test of no

Analysis variable calls or less calls or more respondents1 difference calls or less calls or more respondents1 difference

Special-needs prevalence rate ..... 17.3 15.2 –11.75 0.0000 15.3 13.7 –10.25 0.0023

Percent of CSHCN with medical

home .................... 48.5 46.2 –4.87 0.0016 38.6 38.8 0.59 0.9109

Percent of CSHCN with adequate

insurance ................. 63.5 61.9 –2.50 0.0265 59.6 56.6 –5.12 0.1401

Percent of CSHCN with any unmet

need for specific health care

services .................. 19.9 20.4 2.20 0.4660 26.3 26.4 0.39 0.9560

Percent of CSHCN whose conditions

affect their activities usually, always,

or a great deal .............. 23.8 24.2 1.64 0.5386 29.4 31.9 8.49 0.1951

Percent of CSHCN whose conditions

cause family members to cut back

or stop working.............. 22.4 22.8 1.78 0.5255 27.5 31.3 13.77 0.0477

Percent of CSHCN without

family-centered care........... 29.8 32.9 10.23 0.0000 37.6 39.6 5.22 0.3361

Percent of CSHCN with a routine

preventive medical visit and a

routine preventive dental visit ..... 81.2 80.4 –0.95 0.1855 74.1 74.6 0.68 0.7851

Percent of CSHCN whose families

pay $1,000 or more out of pocket in

medical expenses per year ...... 25.9 25.9 0.05 0.9830 18.9 20.8 10.14 0.2467

1Calculated as (five calls or more respondent mean – four calls or less respondent mean) / four calls or less respondent mean.
 

NOTES: Estimates in this table are weighted by the base weights reflecting the probability of selection of the telephone number. CSHCN is children with special health care needs.
 

higher than the ‘‘true’’ value; that is, the

true value is 15.1% / 1.051 = 14.3%. In

absolute terms, the maximum estimated

bias for either the frame information or

level-of-effort analyses presented in

Table LII was 1.05 percentage points

(for the percentage of CSHCN without

family-centered care).

Special-needs prevalence rate

The analyses revealed inconsistent

measures of the bias in the estimate of

the percentage of CSHCN. The final

prevalence rate estimate and 95%

confidence limits were 15.1%, and

14.8% and 15.3%, respectively; the

estimates of bias in this estimate were

–0.04% (from the frame analysis based

on only the landline sample), 5.1%

(from the level-of-effort analysis), and

–15.8% (based on the comparison with

the MEPS estimate). The 2005–2006

NS-CSHCN nonresponse bias analysis

suggested that the special-needs

prevalence estimate was biased upwards

slightly, which is consistent with the

finding here for the 2009–2010

NS-CSHCN, based on the level-of-effort

analysis.

Percentage of CSHCN with a

medical home

The analysis detected little bias in

the estimates of the percentage of

CSHCN with a medical home. The final

estimate and confidence interval of the

percentage of CSHCN with a medical

home was 43.0%, and 42.1% and

43.8%, and the estimates of bias in this

estimate were –0.1% (from the frame

analysis based only on the landline

sample) and 1.3% (from the level-ofeffort analysis). Both of these bias

estimates imply that the true value is

within the calculated 95% confidence

interval. These results are very similar

to those found in the 2005–2006

NS-CSHCN nonresponse bias analysis.

Percentage of CSHCN with

adequate insurance

The analysis found little evidence of

bias in the percentage of CSHCN with

adequate insurance. The final estimate

of the percentage of CSHCN with

adequate insurance was 60.6% (95%

confidence limits 59.7% and 61.5%).

The estimates of the bias in this

estimate were –0.1% (from the frame

analysis) and 1.0% (from the

level-of-effort analysis). These bias

estimates are nearly identical to those

estimated in the 2005–2006 NS-CSHCN

nonresponse bias analysis.

Percentage of CSHCN with any

unmet need for specific health

care services

The analysis did not detect

significant bias in the estimate of the

percentage of CSHCN with any unmet

need for specific health care services.

The final estimate of the percentage of

CSHCN with an unmet need was 23.6%

(22.8%, 24.4%), and the bias was

estimated to be 0.1% (frame analysis)

and –0.7% (level-of-effort analysis).

Percentage of CSHCN whose

conditions affect their activities

usually, always, or a great deal

The analysis detected little bias in

the estimate of the percentage of

CSHCN whose conditions affect their

activities usually, always, or a great

deal. The final estimate of the

percentage of CSHCN with activities

affected was 27.1% (26.2%, 27.9%).
 

Series 1, No. 57 [ Page 255

Table L. Comparing low-call-attempt respondents with high-call-attempt respondents: Dual-frame sample

Using base weight Using final weight

Percent Percent

difference difference

Estimate for Estimate for between Estimate for Estimate for between

respondents respondents high-effort p value for respondents respondents high-effort p value for

with four with five and low-effort test of no with four with five and low-effort test of no

Key survey outcome calls or less calls or more respondents1 difference calls or less calls or more respondents1 difference

Special-needs prevalence rate ..... 16.4 14.6 –10.87 0.0000 16.1 14.0 –13.02 0.0000

Percent of CSHCN with medical

home .................... 44.7 43.3 –3.15 0.1248 43.7 42.3 –3.35 0.1059

Percent of CSHCN with adequate

insurance ................. 62.0 59.9 –3.48 0.0176 61.4 59.7 –2.76 0.0631

Percent of CSHCN with any unmet

need for specific health care

services .................. 22.4 22.7 1.46 0.6854 23.4 23.8 1.90 0.5906

Percent of CSHCN whose conditions

affect their activities usually, always,

or a great deal .............. 26.0 27.2 4.66 0.1501 26.5 27.6 4.37 0.1719

Percent of CSHCN whose conditions

cause family members to cut back

or stop working.............. 24.4 26.1 7.03 0.0397 24.3 25.6 5.24 0.1273

Percent of CSHCN without

family-centered care........... 32.8 35.5 8.11 0.0030 33.9 36.8 8.63 0.0013

Percent of CSHCN with a routine

preventive medical visit and a

routine preventive dental visit ..... 78.5 78.2 –0.39 0.6974 79.1 77.9 –1.41 0.1490

Percent of CSHCN whose families

pay $1,000 or more out of pocket in

medical expenses per year ...... 23.2 23.9 3.11 0.3382 22.4 21.8 –2.51 0.4260

1Calculated as (five calls or more respondent mean – four calls or less respondent mean) / four calls or less respondent mean.

NOTE: CSHCN is children with special health care needs.

The bias in this estimate was estimated

to be 0.2% (frame analysis) and –1.5%

(level-of-effort analysis).

Percentage of CSHCN whose

conditions cause family

members to cut back or stop

working

The analysis found little bias in the

estimate of the percentage of CSHCN

whose conditions caused family

members to cut back or stop working.

The final estimate was 25.0% (24.2%,

25.8%). The bias in this estimate was

estimated to be –0.01% (frame analysis)

and –1.8% (level-of-effort analysis).

Percentage of CSHCN without

family-centered care

The estimate of the percentage of

CSHCN without family-centered care

may be slightly too low. The final

survey estimate was 35.4% (34.5%,

36.3%). The bias in this estimate was

estimated to be –0.2% (frame analysis)

and –2.9% (level-of-effort analysis). If

the estimated bias based on the

level-of-effort analysis is accurate, then

the true value of the percentage of

CSHCN without family-centered care

was higher than the calculated survey

estimate and falls outside the 95%

confidence range.

Percentage of CSHCN with a

routine preventive medical visit

and a routine preventive dental

visit

The analysis did not detect

significant bias in the estimate of the

percentage of CSHCN with a routine

preventive medical visit and a routine

preventive dental visit. The final

estimate of the percentage of CSHCN

with routine preventive visits was 78.5%

(77.7%, 79.3%), and the bias was

estimated to be –0.04% (frame analysis)

and 0.5% (level-of-effort analysis).

Percentage of CSHCN whose

families pay $1,000 or more out

of pocket in medical expenses

per year

The analysis did not detect

significant bias in the estimate of the

percentage of CSHCN whose families

pay $1,000 or more out of pocket in

medical expenses per year. The final

survey estimate and confidence interval

were 22.1%, and 21.4% and 22.8%, and

the bias was estimated to be 0.8%

(frame analysis) and 0.9% (level-ofeffort analysis).
 

 

 

Page 256 [ Series 1, No. 57

Table LI. Estimates of nonresponse biases in the key survey estimates, based on the comparison of respondents with five calls or more

with all respondents: Dual-frame sample

Using base weights Using final weights

Estimate, Estimate, Estimate, Estimate,

respondents respondents Estimated respondents respondents Estimated

Estimate, all with five and percent Estimate, all with five and percent

Key survey outcome respondents calls or more nonrespondents1 bias2 respondents calls or more nonrespondents1 bias2

Special-needs prevalence rate ..... 15.55 14.59 14.89 4.43 15.07 14.01 14.34 5.13

Percent of CSHCN with medical

home .................... 44.02 43.33 43.51 1.18 42.96 42.25 42.43 1.25

Percent of CSHCN with adequate

insurance ................. 60.92 59.86 60.13 1.31 60.56 59.74 59.95 1.02

Percent of CSHCN with any unmet

need for specific health care

services .................. 22.53 22.69 22.65 –0.53 23.62 23.84 23.78 –0.68

Percent of CSHCN whose conditions

affect their activities usually, always,

or a great deal .............. 26.57 27.16 27.01 –1.64 27.07 27.63 27.49 –1.52

Percent of CSHCN whose conditions

cause family members to cut back

or stop working.............. 25.22 26.06 25.84 –2.42 24.99 25.61 25.45 –1.81

Percent of CSHCN without

family-centered care........... 34.16 35.47 35.13 –2.76 35.41 36.83 36.47 –2.89

Percent of CSHCN with a routine

preventive medical visit and a

routine preventive dental visit ..... 78.31 78.15 78.19 0.14 78.47 77.93 78.07 0.51

Percent of CSHCN whose families

pay $1,000 or more out of pocket in

medical expenses per year ...... 23.58 23.93 23.84 –1.1 22.11 21.84 21.91 0.92

1Calculated as (estimate for all respondents × response rate) + (estimate for respondents with five calls or more × nonresponse rate).

2Calculated as (estimate for all respondents – estimate for respondents and nonrespondents) / estimate for respondents and nonrespondents.

NOTE: CSHCN is children with special health care needs.

Table LII. Estimates of survey bias in key survey variables, by method used to estimate the bias

Estimates of bias1

Comparison with

Key survey estimate Frame information Level-of-effort MEPS estimate

Analysis variable (95% confidence interval) analysis2 analysis analysis

Special-needs prevalence rate ................. 15.07 (14.84, 15.30) –0.04 5.13 –15.81

Percent of CSHCN with medical home ............ 42.96 (42.07, 43.84) –0.13 1.25 . . .

Percent of CSHCN with adequate insurance ........ 60.56 (59.67, 61.45) –0.06 1.02 . . .

Percent of CSHCN with any unmet need for specific

health care services ....................... 23.62 (22.81, 24.43) 0.08 –0.68 . . .

Percent of CSHCN whose conditions affect their

activities usually, always, or a great deal .......... 27.07 (26.24, 27.91) 0.15 –1.52 . . .

Percent of CSHCN whose conditions cause family

members to cut back or stop working ............ 24.99 (24.17, 25.81) –0.01 –1.81 . . .

Percent of CSHCN without family-centered care ...... 35.41 (34.52, 36.31) –0.15 –2.89 . . .

Percent of CSHCN with a routine preventive medical

visit and a routine preventive dental visit .......... 78.47 (77.71, 79.23) –0.04 0.51 . . .

Percent of CSHCN whose families pay $1,000 or more

out of pocket in medical expenses per year ........ 22.11 (21.42, 22.80) 0.77 0.92 . . .

. . . Category not applicable.
 

1Biases are presented in percentage terms, not absolute terms. So, a 5.13% bias in an estimate of 15.07 means that the reported estimate is 5.13% higher than the true value; that is, the true value is
 

15.07 / 1.0513 = 14.33.
 

2Because the frame information was available only for the landline sample, the bias estimates presented here apply only to the landline sample.
 

NOTES: Key survey estimates use final weights that have been adjusted for nonresponse and raked to population control totals; estimates of bias use the nonresponse-adjusted or raked weights,
 

depending on the analysis. MEPS is Medical Expenditure Panel Survey; CSHCN is children with special health care needs.
 
Series 1, No. 57 [ Page 257

Appendix XIV. Multiple Imputation of Income and Demographic

Variables

The 2009–2010 National Survey of

Children with Special Health Care

Needs (NS-CSHCN) provides a rich

source of data for studying the

relationships between income and health

and for monitoring health and health

care for children with special health care

needs (CSHCN) at different income

levels. However, as is common for most

household interview surveys,

nonresponse rates were high for the

questions on total combined household

income for the previous calendar year.

Answers to these questions, along with

the number of people living in the

household, are used to create an index

of income relative to the Department of

Health and Human Services Federal

Poverty Guidelines. If data for either of

these two components were missing,

refused, or had a ‘‘don’t know’’

response, the household poverty status

indicator was assigned a missing value

code in the publicly released data sets.

(Further details about the procedures for

assigning household poverty status are

available in Appendix VI.)

For the 2009–2010 NS-CSHCN,

poverty status is missing for 18.8% of

the households (36,907 of 196,159

households). Missing values for poverty

status were predominately the result of

missing data for income, rather than

missing data for household size. Only

7,572 households (3.9%) had missing

data for household size.

Nonresponse analysis shows that

missingness is related to several

variables, including items pertaining to

health, neighborhood and community

characteristics, and demographics. Thus,

the respondents cannot be treated as a

random subset of the original sample. It

follows that the most common method

for handling missing data in software

packages, ‘‘complete-case analysis’’

(also known as ‘‘listwise deletion’’), will

generally be biased because this method

deletes cases that are missing any of the

variables involved in the analysis.

Moreover, because deletion of

incomplete cases discards some of the

observed data, complete-case analysis is

generally inefficient as well; that is, it

produces inferences that are less precise

than those produced by methods that use

all of the observed data.

Imputation is a more appropriate

approach to handling nonresponse on

items in a survey for several reasons.

First, imputation adjusts for observed

differences between item

nonrespondents and item respondents;

such an adjustment is generally not

made by complete-case analysis.

Second, imputation results in a

completed data set, so that the data can

be analyzed using standard software

packages without discarding any

observed values. Third, when a data set

is being produced for analysis by the

public, imputation by the data producer

allows the incorporation of specialized

knowledge about the reasons for missing

data in the imputation procedure,

including confidential information that

cannot be released to the public.

Moreover, the nonresponse problem is

addressed in the same way for all users

so that analyses will be consistent across

users. Imputed values are flagged in the

public-use microdata, so analysts who

prefer to work only with unimputed data

have that option.

Although single imputation, that is,

imputing one value for each missing

datum, enjoys the positive attributes just

mentioned, analysis of a singly imputed

data set using standard software

generally fails to reflect the uncertainty

stemming from the fact that the imputed

values are plausible replacements for the

missing values but are not the true

values themselves. As a result, analyses

of singly imputed data tend to produce

estimated standard errors that are too

small, confidence intervals that are too

narrow, and significance tests that reject

the null hypothesis too often when it is

true.

Multiple imputation is a technique

that seeks to retain the advantages of

single imputation while also allowing

the uncertainty due to imputation to be

reflected in the analysis (41). The idea is

to first simulate M > 1 plausible sets of

replacements for the missing values,

which are then combined with the

nonmissing values to generate M

complete data sets. The M complete data

sets are then analyzed separately using a

standard method for analyzing complete

data, and finally, the results of the M

analyses are combined in a way that

reflects the uncertainty due to

imputation. For public-use data, M is

not usually greater than five, which is

the value that has been used here in

multiply imputing missing data for

NS-CSHCN.

This appendix describes the

procedures used in multiply imputing

household income and household size

for NS-CSHCN. Household poverty

status is expressed as a percentage;

households with income below 100% of

the federal poverty level are considered

to be living in poverty. For each of the

multiply imputed data sets, household

poverty status was derived from the

imputed values for household income

and household size.

Income relative to the poverty level

and household size were not the only

variables with missing data. Item

nonresponse rates for questions on race,

ethnicity, highest education in the

household, and primary household

language were higher in 2009–2010 than

in 2001 or 2005–2006. The position of

these questions in the questionnaire had

been moved from very early in the

interview (in the CSHCN Screener

section) to very late in the interview for

the 2009–2010 survey. The higher level

of item nonresponse on these questions

in the 2009–2010 survey was

nonrandom with respect to the presence

of CSHCN in the household—households

with CSHCN were more likely than

households without CSHCN to have

missing data on these variables—and

thus it was decided to impute missing

data for these variables as well. The

highest education in the household was

missing for 11,741 households (5.9% of

households); primary language was

missing for 10,326 households (5.2%);

child’s ethnicity was missing for 20,059
Page 258 [ Series 1, No. 57

children (5.3% of children) in 8,922

households (4.5% of households); and

child’s race was missing for 43,132

children (11.4% of children) in 19,245

households (9.7% of households).

Imputation Procedures

Income, household size, and the

other demographic variables listed above

were each imputed five times. The

literature on multiple imputation

suggests that this is a sufficient number

of imputations unless the amount of

missing information is extreme (41). As

noted earlier, the number of survey

records with missing household size

values was much smaller than the

number of survey records with missing

household income values. Because there

was very little missingness in household

size to explain, predictors for household

size were not explored separately from

predictors for household income.

Therefore, household size was imputed

using the same predictors used for

household income (and the same

decision was made for the other

demographic variables to be imputed).

When both household size and

household income were missing for a

single case, five pairs of imputed values

were produced.

Five data sets at the household level

were created, containing imputed values

for income, household size, highest

education in the household, and primary

language in the household. Five data

sets were created at the child level,

containing imputed values for child race

and ethnicity. However, because children

in most households with multiple

children share the same race and

ethnicity as their siblings, race and

ethnicity were imputed at the household

level with the other variables, and all

children with missing race or ethnicity

in a particular household were given the

same imputed values of race and

ethnicity that were generated for the

household.

The imputation of household

income and household size was

complicated by two issues. First,

household income was not normally

distributed. This is a disadvantage

because linear regression modeling

assumes that the dependent variable

being modeled has a normal

distribution. Therefore, a transformed

variable was used for modeling and

imputation. To determine the suitable

transformation for income to conform to

the normality assumption in the

imputation model, Box-Cox

transformations were estimated from

the observed data. The optimal

transformation was the fifth-root

(income to the power of 0.2). After the

imputation procedure was completed,

the imputed values were transformed

back to their original scale.

Second, in some cases, the imputed

values of household income and

household size needed to be constrained

within certain bounds. Household

respondents were asked to provide an

exact household income. However, when

respondents did not provide an exact

household income, a series (i.e., cascade)

of questions asking whether the

household income was below, exactly at,

or above threshold amounts were then

asked. The multiple-imputation

procedures employed for NS-CSHCN

needed to impute the income value so

that it was consistent with any

information gathered from the cascade

questions. For households with missing

data on household size, the imputed

values needed to be restricted so that

they were consistent with other

information provided in the survey

(e.g., household size is greater than the

number of children in the household).

The software IVEware (available

online at http://www.isr.umich.edu/src/

smp/ive) allows the user to specify

lower and upper limits of imputed

values, constraining the imputation

distribution from which draws are made.

This software has been used to impute

family income and family earnings for

the National Health Interview Survey,

and to impute household income and

household size (to derive household

poverty status) for the 2001 and

2005–2006 NS-CSHCNs and the 2003

and 2007 National Survey of Children’s

Health (NSCH).

IVEware uses sequential regression

multivariate imputation (SRMI). With

sequential regression imputations,

income and household size had separate

models that used the same covariates,

including each other. This technique was

not as robust as some other imputation

techniques that specify a joint model for

both income and household size

conditional on the predictor variables

(42,43). However, this slight

disadvantage of using SRMI is

outweighed by IVEware’s ability to

constrain the imputed values within

specified lower and upper limits.

IVEware builds regression models,

and then multiply imputes variables

based on the models built. For

understanding relationships between

variables, parsimony is desired, but in

prediction (imputation can be thought of

as ‘‘predicting’’ the missing values),

more complicated models are often

better for two reasons. First, using more

variables leads to a higher correlation

between the observed and predicted

values for a model. Second, the validity

of analyses conducted on multiply

imputed data sets is broader when more

variables are included in the model.

In the imputation model, as many

predictors as possible were included. To

produce high-quality imputations,

variables that were potentially related to

household income and potentially

related to the missingness of household

income were included. Another

important consideration was to include

variables that account for features of the

sampling design. Inclusion of variables

to reflect the sampling design is

necessary so that approximately valid

inferences will be obtained when the

multiply imputed data are analyzed.

The imputation model included

variables related to the questionnaire

items on demographics (for the child

and household), health and functional

status of the child, health insurance

coverage, health care access and

utilization, medical home, and

characteristics of the telephone

exchange. For most of the variables, the

‘‘refused’’ or ‘‘don’t know’’ answers

were recoded to missing. For some

variables having logical skips, logical

imputation was used to obtain more

complete variables. For example, the

variable C11Q11 (receipt of cash

assistance) is missing when the

household’s income does not qualify for

the cash assistance. Therefore, it was

recoded as a no response for such

households. Also, some categorical
variables were recoded or collapsed to

reduce the number of rarer categories,

and some continuous variables with

long-tailed distributions were recoded

with top-coding. For example, for the

variable C6Q00 (number of emergency

room visits), the values ranged from 0

to 365, with small frequencies for values

greater than 3. The number of categories

was reduced to four with category ‘‘3’’

defined as three visits or more.

In addition, for the CSHCN

interview variables, it was necessary to

make a decision regarding the

noninterview cases; most (79.6%)

households in the main sample were not

selected for the interview. It was

decided that the noninterview cases

were most likely to be children without

special needs, so the most appropriate

values given that assumption were

logically imputed (for example,

variables C3_Q21 through C3_Q29 were

set to ‘‘child experiences no difficulty’’).

This was preferable to leaving these

values missing, which would lead the

modeling to behave as though the

noninterview cases were equivalent to

the interview cases.

Because fitting the regressions in

the SRMI procedure does not

automatically account for features of the

sample design, variables reflecting the

design were included as predictors in

the regression models. The strata for this

design were the 50 states and the

District of Columbia. To account for the

stratum effect, states, in the form of 50

indicator variables, and state-level

income summary variables (mean and

standard deviation with log

transformation) were considered as

possible covariates in the imputation

model. Survey weights also were

considered as covariates in the model,

after transforming the weights to a

logarithmic scale. Ultimately, the

state-level income summary variables

were dropped before the final imputations

were carried out, while the state indicator

variables and the weight variable were

retained in the final model.

Any variables that were included in

the imputation models but were missing

in some survey records were imputed in

IVEware iteratively with the imputation

of income and the other demographic

variables.

Results of Modeling

Table LIII shows the 119 variables

used in the imputation modeling, with

full text descriptions of the variables

and grouped by data category: interview,

household, screener, design, or Genesys

(the sample vendor provided contextual

data measured at the telephone exchange

level). Table LIV shows the same 119

variables in order of their stepwise

selection for the income imputation

model; 115 out of 119 variables were

eventually included in the model. Most,

but not all, have a significant

relationship with income. Those with

negative parameters decrease predicted

income, whereas those with positive

parameters increase predicted income.

The model was highly significant,

F(262, 143,765) = 463.41, p < 0.0001.

The R-squared value for the final model

was 0.4579. The square root of the

R-squared value (0.6767) shows a strong

correlation between the observed values

of income and the values predicted by

the model.

It should be noted that the imputed

values for family income were not

obtained from this regression model.

The imputed values were drawn from

the posterior distribution of missing

family income based on the model

derived from this regression.

Use of Multiply Imputed

Values

The derived poverty level variable

that is available for public use was

calculated from household income and

household size. When either or both

were missing, the derived poverty level

was calculated from the imputed values.

Regardless of whether the derived

poverty level was based on reported

or imputed values, the variable has

been given the same name

(POVLEVEL_IMP). A flag

(POVLEVEL_F) indicates whether the

derived poverty level was based on

reported or imputed values.

When missing, household income

and household size were imputed five

times. Therefore, the resulting data set

contains five times as many

observations as were in the original data

Series 1, No. 57 [ Page 259

set. For the 2009–2010 NS-CSHCN, the

data sets have 5(196,159) = 980,795

records. Each complete set of derived

poverty level values is distinguished by

the SAS variable IMPUTATION.

Therefore, each IDNUMR value appears

five times in the file, with

IMPUTATION having values of 1, 2, 3,

4, and 5 corresponding to the five

separate complete sets of derived

poverty level values.

The public-use data files for

NS-CSHCN do not include household

income to protect against inadvertent

disclosure of survey subjects’ identities.

Only poverty level is reported on the

public-use data files. Similarly, imputed

household income will not be released

as public-use data. Researchers

interested in accessing the original and

imputed household income data may

access the data through the National

Center for Health Statistics’ Research

Data Center.

The other imputed variables on the

household file consist of highest

education in the household

(EDUCR_IMP, with flag variable

EDUCR_F indicating whether cases

were imputed); primary language in the

household (PLANGUAGE_IMP, with

flag variable PLANGUAGE_F

indicating whether cases were imputed);

and number of adults in the household,

top-coded at 4 (TOTADULTR_IMP,

with flag variable TOTADULTR_F

indicating whether cases were imputed).

Imputed child race and ethnicity

appear on the imputed-screener file.

Again, when missing, values were

imputed five times, and the resulting

screener data set contains five times as

many observations as in the original

data set, or 5(371,617) = 1,858,085

records. The imputed variables on the

screener file consist of HISPANIC_IMP,

with flag variable HISPANIC_F;

RACER_IMP, with flag variable

RACER_F; RACEASIA_IMP, with flag

variable RACEASIA_F;

RACE_HI_IMP, with flag variable

RACE_HI_F; and RACENAAN_IMP,

with flag variable RACENAAN_F.

Three possible ways to analyze the

data are described below. One invalid

way to use the data that researchers

should not attempt is also described.
Page 260 [ Series 1, No. 57

Considering valid methods, a

complete-case (only) analysis is the

simplest, which uses only the cases with

observed values. This can be done by

using the poverty-level variable

(POVLEVEL) in the NS-CSHCN data

file. Any analysis using this variable

could be biased due to nonresponse, and

the variability will be larger because of

the missing values.

The second possible method is to

use only a single imputation from the

multiple-imputation files. Each of the

five imputations has been drawn from a

valid distribution based on a regression

model, but this model and the

distribution are slightly different for

each imputation. To analyze only one

imputation, choose only the subset of

cases with IMPUTATION = c, where c

is 1, 2, 3, 4, or 5. Single imputation

analyses result in estimated standard

errors that are too small because the

imputed values are treated as if they

were observed. This ignores the inherent

uncertainty resulting from lack of

knowledge about the true (unobserved)

value but is superior to the completecase analysis. Note that slightly different

results will be obtained depending on

which subset of cases is chosen, but no

subset is superior to another.

The most statistically valid way to

analyze the data is to analyze all five

imputed data sets together. To do this,

five separate analyses are conducted,

one on each of the five imputed data

sets. These analyses are then combined

following the standard multipleimputation combining rules (41). This is

superior to the previous two methods.

An invalid way to analyze the data

is to combine the five imputed values

into one analysis. For example, taking

the average poverty level (which might

not be an integer) to derive one

‘‘average’’ poverty status value per case

is invalid. Poverty status must be

analyzed as a multiply imputed variable

with SAS, SUDAAN, IVEware, or

another appropriate statistical software

package to make use of the multiply

imputed data.

Regardless of the statistical software

used to analyze the data, one must

merge the survey data from the

public-use analysis files with the data

from the multiple-imputation file by the

unique household identifier (IDNUMR).

To combine the imputation and

child-interview files, analysts must first

sort both files by IDNUMR and then

merge them using this identifier as the

merge variable. To combine the

imputation and screener files, this

technique will not work because there

will be multiple records for each

IDNUMR value in each of the two files

(multiple children per household in the

screener file and five records per

household in the imputation file).

Instead, analysts should create five

separate data sets from the imputation

file (one for each iteration of the

IMPUTATION variable) and merge each

of these with the public-screener data by

IDNUMR. Then, the five merged data

sets can be combined into one analysis

file.

For SAS analyses, it is also very

important to have the data set sorted by

IMPUTATION because analyses of the

multiply imputed data need to be done

separately by IMPUTATION. Separate

analyses are specified in SAS by using

the procedure option keyword BY (‘‘BY

IMPUTATION’’; there should be one

line within the analysis). In SAS, the

two basic steps to using the multiply

imputed data are to 1) analyze the data

separately by IMPUTATION as if each

were a separate data set, and 2) combine

the results from the different imputed

data sets using the SAS procedure

PROC MIANALYZE. In the first step,

separate analyses are done with options

set to keep the covariances that are

needed to combine the analyses. Then,

PROC MIANALYZE combines these

different analyses using the standard

multiple-imputation combining rules.

For SUDAAN analyses, a separate

analytical file is necessary for each of

the five imputations. The five data sets

should then be sorted by the stratum

variables (STATE and SAMPLE) and

the primary sampling unit (IDNUMR)

variable as described in ‘‘Estimation and

Hypothesis Testing’’ in the main text

section. To analyze the data using the

five imputation files, the MI_COUNT

command should be added to the

SUDAAN procedure call. The

MI_COUNT command tells SUDAAN

how many imputation files to expect.

Further instructions and examples

for using SAS and SUDAAN are

available in the ‘‘User’s Guide,’’

included as part of an earlier report on

the multiple imputation of missing

household poverty-level values from

the 2001 NS-CSHCN and the 2003

NSCH (44).
Table LIII. Independent variables used in multiple-imputation model

Model variable Category Description

COLLEGE_GRADUATE_Q ....... Genesys	 Number of college graduates by exchange
 

TOTAL_HHN_Q .............. Genesys	 Total number of HH
 

TOTAL_POPULATION_Q ........ Genesys	 Total population
 

AGE_0_17_P_Q.............. Genesys	 Percentage of people aged 0–17 years by exchange
 

AGE_18_34_P_Q ............. Genesys	 Percentage of people aged 18–34 by exchange
 

AGE_35_54_P_Q ............. Genesys	 Percentage of people aged 35–54 by exchange
 

AGE_55_P_Q ............... Genesys	 Percentage of people aged 55 and over by exchange
 

INC_0_25_P_Q .............. Genesys	 Percentage of income $0–$25,000 by exchange
 

INC_25_50_P_Q ............. Genesys	 Percentage of income $25,000–$50,000 by exchange
 

INC_50_75P_Q .............. Genesys	 Percentage of income $50,000–$75,000 by exchange
 

INC_75_P_Q ................ Genesys	 Percentage of income $75,000 or more by exchange
 

HOUSEHOLD_DENSITY_Q....... Genesys	 HH density by exchange
 

MEDIAN_HH_INCOME_Q........ Genesys	 Median household income by exchange
 

MEDIAN_HOME_VAL_Q......... Genesys	 Median home value by exchange
 

MEDIAN_RENT_Q ............ Genesys	 Median rent by exchange
 

MEDIAN_YEARS_EDUC_Q....... Genesys	 Median years of education by exchange
 

OWNER_OCCUPIED_P_Q ....... Genesys	 Percentage of housing ownership by exchange
 

ASIAN_PACIF_P_Q............ Genesys	 Percentage of Asian or Pacific Islander persons by exchange
 

BLACK_P_Q ................ Genesys	 Percentage of black persons by exchange
 

HISPANIC_P_Q .............. Genesys	 Percentage of Hispanic persons by exchange
 

WHITE_P_Q ................ Genesys	 Percentage of white persons by exchange
 

C11Q12_R ................. Interview	 Receive supplemental security income?
 

C3Q02_R .................. Interview	 How often has child’s [medical, behavioral, or other health conditions/ emotional, developmental, or behavioral

problems] affected [his/her] ability to do things other children age do?

C3Q11_R .................. Interview	 Best describes child’s health care needs: child’s health care needs change all the time, child’s health care needs
 

change only once in a while, or child’s health care needs are usually stable?

C3Q15_R .................. Interview	 Did child use any type of alternative health care or treatment?
 

C3Q21_R .................. Interview	 Would you say child experiences a lot, a little, or no difficulty seeing even when wearing glasses or contact lenses?
 

C3Q22_R .................. Interview	 Would you say child experiences a lot, a little, or no difficulty hearing even when using a hearing aid or other device?
 

C3Q23_R .................. Interview	 Would you say child experiences a lot, a little, or no difficulty with breathing or other respiratory problems, such as
 

wheezing or shortness of breath?

C3Q24_R .................. Interview	 Would you say child experiences a lot, a little, or no difficulty with swallowing, digesting food, or metabolism?
 

C3Q25_R .................. Interview	 Would you say child experiences a lot, a little, or no difficulty with blood circulation?
 

C3Q26_R .................. Interview	 Would you say child experiences a lot, a little, or no difficulty with repeated or chronic physical pain, including
 

headaches?

C3Q28_R .................. Interview	 Compared with other [s.c.’s age] -old children would you say child experiences a lot, a little, or no difficulty with

coordination or moving around?

C3Q29_R .................. Interview	 Compared with other [s.c.’s age] -old children, would you say child experiences a lot, a little,
 

or no difficulty using [his/her] hands?

C4Q02A_R ................. Interview	 Do you have one or more persons you think of as child’s personal doctor or nurse?
 

C4Q02BX08_NBC_R ........... Interview	 Personal doctor or nurse—mental health professional
 

C4Q03_A_R ................ Interview	 Did you have any difficulties or delays getting services for child because child was not eligible for the services?
 

C4Q03_B_R ................ Interview	 Did you have any difficulties or delays because the services child needed were not available in your area?
 

C4Q03_C_R ................ Interview	 Did you have any difficulties or delays because there were waiting lists, backlogs, or other problems
 

getting appointments?

C4Q03_D_R ................ Interview	 Did you have any difficulties or delays because of issues related to cost?
 

C4Q03_E_R ................ Interview	 Did you have any difficulties or delays because you had trouble getting the information you needed?
 

C4Q0A_R .................. Interview	 Is there a place that child usually goes when child is sick or you need advice about [his/her] health?
 

C4Q0B_R .................. Interview	 Place child goes to most often
 

C4Q0D_R.................. Interview	 Is there a place that child usually goes when child needs routine preventive care, such as a physical
 

examination or well-child check-up?

C6Q00_R .................. Interview	 How many times did child visit a hospital emergency room?
 

C6Q02_R .................. Interview	 How often did child’s doctors and other health care providers spend enough time with [him/her]?
 

Would you say never, sometimes, usually, or always?

C6Q03_R .................. Interview	 How often did child’s doctors and other health care providers listen carefully to you? Would you say

never, sometimes, usually, or always?

C6Q04_R .................. Interview	 When child is seen by doctors or other health care providers, how often are they sensitive to your

family’s values and customs? Would you say never, sometimes, usually, or always?

C6Q05_R .................. Interview	 How often did you get the specific information you needed from child’s doctors and other health care providers?

Would you say never, sometimes, usually, or always?

C6Q06_R .................. Interview	 How often did child’s doctors or other health care providers help you feel like a partner in [his/her] care?
 

Would you say never, sometimes, usually, or always?

C7Q01_R .................. Interview	 Is child covered by any Medicaid plan?
 

C7Q02_R .................. Interview	 Is child covered by the state children’s health insurance program or CHIP? In this state, the program
 

is sometimes called [program name].

C7Q03_R .................. Interview	 Child covered by health insurance that is provided through an employer or union?
 

C7Q04_R .................. Interview	 Is child covered by any Medicaid plan or the state children’s health insurance program?
 

C7Q05_R .................. Interview	 Is child covered by military health care, Tricare, Champus, or Champ-VA?
 

See footnotes at end of table.

Series 1, No. 57 [ Page 261
 

Page 262 [ Series 1, No. 57

Table LIII. Independent variables used in multiple-imputation model—Con.

Model variable Category Description

C7Q07_R .................. Interview Is child covered by any other health insurance or health care plan?

C7Q09_R .................. Interview It appears that child does not have any health insurance coverage to pay for both hospitals and doctors and

other health professionals. Is that correct?

C7Q11_R .................. Interview Was there any time when child was not covered by any health insurance?

C8Q01_A_R ................ Interview Does child’s health insurance offer benefits or cover services that meet [his/her] needs? Would you

say never, sometimes, usually, or always?

C8Q01_C_R ................ Interview Does child’s health insurance allow [him/her] to see the health care providers child needs? Would you say

never, sometimes, usually, or always?

C9Q01_R .................. Interview Would you say that the family paid more than $500, $250–$500, less than $250, or nothing for child’s medical care?

C9Q01_A_R ................ Interview Would you say that the family paid more than $5,000, $1,000–$5,000, or less than $1,000 for child’s medical care?

C9Q02_R .................. Interview Do you or other family members provide health care at home for child?

C9Q03_R .................. Interview How many hours per week do you or other family members spend providing this kind of care?

C9Q04_R .................. Interview How many hours per week do you or other family members spend arranging or coordinating child’s care?

C9Q05_R .................. Interview Have child’s health conditions caused financial problems for your family?

C9Q06_R .................. Interview [Not including the family members who stopped working,] have you or other family members cut down on the hours you

work because of child’s health conditions?

C9Q10_R .................. Interview Have you or other family members stopped working because of child’s health conditions?

C9Q11_R .................. Interview Have you or other family members avoided changing jobs because of concerns about maintaining health insurance for

child?

K2Q40A_R ................. Interview Has a doctor or other health care provider ever told you that child had asthma?

K2Q41A_R ................. Interview Has a doctor or other health care provider ever told you that child had diabetes?

K2Q42A_R ................. Interview Has a doctor or other health care provider ever told you that child had epilepsy or seizure disorder?

K2Q43A_R ................. Interview Has a doctor or other health care provider ever told you that child had migraines or frequent headaches?

K2Q44A_R ................. Interview Has a doctor or other health care provider ever told you that child had a head injury, concussion, or traumatic brain

injury?

K2Q45A_R ................. Interview Has a doctor or other health care provider ever told you that child had heart problem, including congenital heart

disease?

K2Q46A_R ................. Interview Has a doctor or other health care provider ever told you that child had blood problems such as anemia or sickle cell

disease?

K2Q47A_R ................. Interview Has a doctor or other health care provider ever told you that child had cystic fibrosis?

K2Q48A_R ................. Interview Has a doctor or other health care provider ever told you that child had cerebral palsy?

K2Q49A_R ................. Interview Has a doctor or other health care provider ever told you that child had muscular dystrophy?

K2Q50A_R ................. Interview Has a doctor or other health care provider ever told you that child had down syndrome?

K2Q51A_R ................. Interview Has doctor or other health care provider ever told you that child had arthritis or other joint problems?

K2Q52A_R ................. Interview Has a doctor or other health care provider ever told you that child had allergies?

RELATION_R ............... Interview DERIVED. Respondent’s relation to selected child

CASHASST................. Household HH member received cash assistance from welfare

OWNHOME ................ Household Own home

CELLPHONE................ Household Do you or anyone in your household have a working cell phone?

NUMCELL ................. Household How many working cell phones do you and your household members have?

INTERUPT ................. Household Has your household been without landline service for 1 week or more during the past 12 months?

EDUC .................... Household Highest education level of anyone in HH

NM_NSP .................. Household Total number of children in household without a special health care need

NM_NSPF ................. Household Total number of female children in household without a special health care need

NM_SP ................... Household Total number of children in household with a special health care need

WEEKNOPH ................ Household Without telephone service for 1 week or more during the past 12 months

OLDESTAGE................ Household IMPUTED. What is the age of the oldest adult living in the household?

NOTENG .................. Household Interview done in language other than English

TELSTATUS ................ Household IMPUTED. Household telephone status for landline sample (telephone_status)

TOTKIDS .................. Household DERIVED. Total number of children in household aged 0–17 years

TOTKIDSF ................. Household DERIVED. Total number of female children in household

TOTPERS.................. Household DERIVED. Total number of people living in household

MSA ..................... Household True metropolitan statistical area status (three categories)

WEIGHT_H ................. Household HH weight

STATE .................... Household DERIVED. True state of residence

HHSTATUS ................. Household FLAG. Interview status of this household

PLANG3................... Household What is the primary language spoken in your home?

CALLYRF .................. Screen Interview begin year

ALLMALE .................. Screen All male children in HH

ALLFEM................... Screen All female children in HH

MIXGEND.................. Screen Both female and male child in HH

HMORECARE ............... Screen Any child in HH needs more med care/mental hlth/educ than peers

HPRESCRIPT ............... Screen Any child in HH currently needs prescription medication

HLMTABIL ................. Screen Any child in HH limited in ability to do things

HSPEECH ................. Screen Any child in HH needs physical, occupational, or speech therapy

HEMOTPROB ............... Screen Any child in HH has emotional, developmental, or behavioral problem

HHASNEED ................ Screen FLAG. Special-needs child or nonspecial-needs child, based on the screener

See footnotes at end of table.
Table LIII. Independent variables used in multiple-imputation model—Con.

Model variable Category Description

OLDEST................... Screen Age of oldest child in HH
 

YOUNG ................... Screen Age of youngest child in HH
 

RACEARRAY_11CAT........... Screen All responses to race of child (after back coding)
 

HISPANIC_HH ............... Screen Indicates whether child is of Hispanic origin or ethnicity
 

STATE_MEAN ............... Design Transformed income mean by state
 

STATE_STD ................ Design Transformed income STD by state
 

NOTE: HH is household.

Series 1, No. 57 [ Page 263
 

Page 264 [ Series 1, No. 57

Table LIV. Parameter estimates for the multiple-imputation model

Standard p value of

Parameter Estimate error t value t statistic

Intercept............................... 8.3032 0.6433 12.91 <0.0001

educ 1 ................................ –1.4979 0.0197 –76.01 <0.0001

educ 2 ................................ –1.1289 0.0101 –111.55 <0.0001

educ 3 ................................ –0.6998 0.0078 –90.03 <0.0001

educ 4 (reference)......................... . . . . . . . . . . . .

ownhome 0 ............................. –0.8936 0.0092 –97.48 <0.0001

ownhome 1 (reference) ..................... . . . . . . . . . . . .

Inc_75_p_q 1............................ –0.0534 0.0351 –1.52 0.1300

Inc_75_p_q 2............................ 0.0023 0.0309 0.07 0.9400

Inc_75_p_q 3............................ –0.0043 0.0255 –0.17 0.8700

Inc_75_p_q 4 (reference) .................... . . . . . . . . . . . .

telstatus 1.............................. –1.4299 0.5183 –2.76 0.0058

telstatus 2.............................. –0.0837 0.0567 –1.48 0.1400

telstatus 3 (reference) ...................... . . . . . . . . . . . .

numcell 0 .............................. 0.4433 0.5200 0.85 0.3900

numcell 1 .............................. –0.6320 0.0127 –49.96 <0.0001

numcell 2 .............................. –0.1804 0.0095 –19.05 <0.0001

numcell 3 (reference) ....................... . . . . . . . . . . . .

racearray_hh 1........................... 0.0580 0.0556 1.04 0.3000

racearray_hh 2........................... –0.4363 0.0567 –7.70 <0.0001

racearray_hh 3........................... –0.0024 0.0577 –0.04 0.9700

racearray_hh 4........................... –0.2712 0.0599 –4.53 <0.0001

racearray_hh 5........................... –0.0893 0.0642 –1.39 0.1600

racearray_hh 6........................... –0.1480 0.0608 –2.43 0.0150

racearray_hh 7........................... 0.1750 0.0615 2.85 0.0044

racearray_hh 8........................... –0.1421 0.0626 –2.27 0.0230

racearray_hh 9........................... –0.2219 0.0721 –3.08 0.0021

racearray_hh 10 .......................... –0.0062 0.0741 –0.08 0.9300

racearray_hh 11 (reference)................... . . . . . . . . . . . .

State : Alaska ........................... –0.0868 0.0318 –2.73 0.0063

State : Alabama .......................... –0.1741 0.0347 –5.02 <0.0001

State : Arkansas .......................... –0.0441 0.0343 –1.28 0.2000

State : Arizona ........................... –0.2256 0.0343 –6.57 <0.0001

State : California.......................... –0.4860 0.0389 –12.48 <0.0001

State : Colorado .......................... –0.2431 0.0332 –7.32 <0.0001

State : Connecticut ........................ –0.0603 0.0349 –1.73 0.0840

State : Washington, D.C. .................... 0.3604 0.0362 9.95 <0.0001

State : Delaware.......................... –0.0341 0.0351 –0.97 0.3300

State : Florida ........................... –0.3127 0.0348 –8.99 <0.0001

State : Georgia........................... –0.1736 0.0345 –5.03 <0.0001

State : Hawaii ........................... –0.2715 0.0380 –7.14 <0.0001

State : Iowa............................. –0.1347 0.0325 –4.15 <0.0001

State : Idaho ............................ –0.2622 0.0321 –8.16 <0.0001

State : Illinois............................ –0.1922 0.0333 –5.78 <0.0001

State : Indiana ........................... –0.1788 0.0338 –5.29 <0.0001

State : Kansas ........................... –0.1671 0.0329 –5.07 <0.0001

State : Kentucky .......................... –0.1097 0.0347 –3.16 0.0016

State : Louisiana.......................... –0.0458 0.0355 –1.29 0.2000

State : Massachusetts ...................... –0.1588 0.0353 –4.50 <0.0001

State : Maryland .......................... 0.0155 0.0348 0.45 0.6600

State : Maine ............................ –0.1505 0.0344 –4.37 <0.0001

State : Michigan .......................... –0.2506 0.0352 –7.11 <0.0001

State : Minnesota ......................... –0.1682 0.0325 –5.18 <0.0001

State : Missouri .......................... –0.2368 0.0336 –7.05 <0.0001

State : Mississippi ......................... –0.1696 0.0357 –4.75 <0.0001

State : Montana .......................... –0.1743 0.0309 –5.64 <0.0001

State : North Carolina ...................... –0.2220 0.0343 –6.48 <0.0001

State : North Dakota ....................... –0.0384 0.0323 –1.19 0.2300

State : Nebraska.......................... –0.0652 0.0320 –2.04 0.0410

State : New Hampshire ..................... –0.0851 0.0350 –2.44 0.0150

State : New Jersey ........................ –0.1449 0.0351 –4.12 <0.0001

State : New Mexico ........................ –0.1269 0.0361 –3.52 0.0004

State : Nevada ........................... –0.1337 0.0345 –3.87 0.0001

State : New York.......................... –0.1926 0.0353 –5.46 <0.0001

State : Ohio............................. –0.2940 0.0349 –8.41 <0.0001

State : Oklahoma ......................... –0.1756 0.0347 –5.06 <0.0001

See footnotes at end of table. .................
 

Series 1, No. 57 [ Page 265

Table LIV. Parameter estimates for the multiple-imputation model—Con.

Standard p value of

Parameter Estimate error t value t statistic

State : Oregon ........................... –0.2194 0.0331 –6.63 <0.0001

State : Pennsylvania ....................... –0.2279 0.0351 –6.50 <0.0001

State : Rhode Island ....................... –0.1342 0.0360 –3.73 0.0002

State : South Carolina ...................... –0.1524 0.0348 –4.38 <0.0001

State : South Dakota ....................... –0.1199 0.0312 –3.84 0.0001

State : Tennessee ......................... –0.2397 0.0338 –7.10 <0.0001

State : Texas ............................ –0.2694 0.0363 –7.43 <0.0001

State : Utah............................. –0.3241 0.0340 –9.52 <0.0001

State : Virginia ........................... –0.1082 0.0340 –3.18 0.0015

State : Vermont .......................... –0.1638 0.0339 –4.84 <0.0001

State : Washington ........................ –0.2530 0.0337 –7.50 <0.0001

State : Wisconsin ......................... –0.1468 0.0331 –4.43 <0.0001

State : West Virginia ....................... –0.1357 0.0349 –3.89 <0.0001

State : Wyoming (reference) .................. . . . . . . . . . . . .

C7Q01_R 0............................. 0.3140 0.0268 11.72 <0.0001

C7Q01_R 1 (reference) ..................... . . . . . . . . . . . .

C7Q04_R 0............................. 0.3572 0.0282 12.67 <0.0001

C7Q04_R 1 (reference) ..................... . . . . . . . . . . . .

C7Q03_R 0............................. –0.3513 0.0228 –15.38 <0.0001

C7Q03_R 1 (reference) ..................... . . . . . . . . . . . .

College_Graduate_q 1 ...................... –0.1253 0.0243 –5.16 <0.0001

College_Graduate_q 2 ...................... –0.0911 0.0200 –4.55 <0.0001

College_Graduate_q 3 ...................... –0.0725 0.0154 –4.70 <0.0001

College_Graduate_q 4 (reference)............... . . . . . . . . . . . .

plang3 1............................... 0.3124 0.0235 13.28 <0.0001

plang3 2............................... 0.0897 0.0411 2.18 0.0290

plang3 3 (reference) ....................... . . . . . . . . . . . .

WEIGHT_H ............................. 0.0004 – 23.19 <0.0001

weeknoph 0 ............................ 0.7177 0.1935 3.71 0.0002

weeknoph 1 (reference) ..................... . . . . . . . . . . . .

Median_Home_Val_q 1...................... –0.1947 0.0223 –8.72 <0.0001

Median_Home_Val_q 2...................... –0.1437 0.0178 –8.09 <0.0001

Median_Home_Val_q 3...................... –0.1260 0.0126 –9.96 <0.0001

Median_Home_Val_q 4 (reference) .............. . . . . . . . . . . . .

C9Q05_R 0............................. 0.2593 0.0206 12.57 <0.0001

C9Q05_R 1 (reference) ..................... . . . . . . . . . . . .

TOTPERS.............................. 0.0743 0.0045 16.50 <0.0001

cashasst 0 ............................. 0.4605 0.0344 13.37 <0.0001

cashasst 1 (reference) ...................... . . . . . . . . . . . .

Median_Rent_q 1 ......................... –0.1312 0.0229 –5.73 <0.0001

Median_Rent_q 2 ......................... –0.0958 0.0172 –5.57 <0.0001

Median_Rent_q 3 ......................... –0.0793 0.0122 –6.49 <0.0001

Median_Rent_q 4 (reference).................. . . . . . . . . . . . .

Oldestage .............................. –0.0055 0.0003 –16.02 <0.0001

C9Q01_A_R 1 ........................... 0.3219 0.0371 8.67 <0.0001

C9Q01_A_R 2 ........................... 0.1155 0.0229 5.05 <0.0001

C9Q01_A_R 3 (reference).................... . . . . . . . . . . . .

Owner_Occupied_p_q 1 ..................... 0.1348 0.0166 8.11 <0.0001

Owner_Occupied_p_q 2 ..................... 0.0411 0.0119 3.45 0.0006

Owner_Occupied_p_q 3 ..................... 0.0270 0.0093 2.90 0.0037

Owner_Occupied_p_q 4 (reference).............. . . . . . . . . . . . .

noteng 0............................... 0.4034 0.0351 11.49 <0.0001

noteng 1 (reference) ....................... . . . . . . . . . . . .

RELATION_R 1 .......................... –0.3245 0.0528 –6.14 <0.0001

RELATION_R 2 .......................... –0.1755 0.0549 –3.20 0.0014

RELATION_R 3 .......................... –0.0183 0.0598 –0.31 0.7600

RELATION_R 4 (reference) ................... . . . . . . . . . . . .

HHSTATUS 1. . . . . . . . . . . . . . . . . . . . . . . . . . . . –0.3195 0.0674 –4.74 <0.0001

HHSTATUS 2 (reference) .................... . . . . . . . . . . . .

Median_HH_Income_q 1..................... –0.2215 0.0361 –6.13 <0.0001

Median_HH_Income_q 2..................... –0.1311 0.0307 –4.27 <0.0001

Median_HH_Income_q 3..................... –0.0473 0.0250 –1.89 0.0580

Median_HH_Income_q 4 (reference) ............. . . . . . . . . . . . .

Inc_50_75p_q 1 .......................... 0.1328 0.0147 9.02 <0.0001

Inc_50_75p_q 2 .......................... 0.0497 0.0120 4.14 <0.0001

Inc_50_75p_q 3 .......................... 0.0303 0.0094 3.21 0.0013

See footnotes at end of table. ................. 
 
 

Page 266 [ Series 1, No. 57

Table LIV. Parameter estimates for the multiple-imputation model—Con.

Standard p value of

Parameter Estimate error t value t statistic

Inc_50_75p_q 4 (reference)................... . . . . . . . . . . . .

C9Q01_R 1............................. 0.2112 0.0283 7.47 <0.0001

C9Q01_R 2............................. 0.1848 0.0251 7.36 <0.0001

C9Q01_R 3............................. 0.0874 0.0242 3.61 0.0003

C9Q01_R 4 (reference) ..................... . . . . . . . . . . . .

C4Q03_D_R 0 ........................... 0.1605 0.0240 6.69 <0.0001

C4Q03_D_R 1 (reference).................... . . . . . . . . . . . .

Young ................................ 0.0049 0.0014 3.52 0.0004

TOTKIDS .............................. –0.2205 1.1548 –0.19 0.8500

Age_35_54_p_q 1......................... –0.0662 0.0146 –4.55 <0.0001

Age_35_54_p_q 2......................... –0.0228 0.0123 –1.85 0.0640

Age_35_54_p_q 3......................... 0.0067 0.0103 0.65 0.5200

Age_35_54_p_q 4 (reference) ................. . . . . . . . . . . . .

hprescript 0 ............................. 0.0724 0.0112 6.47 <0.0001

hprescript 1 (reference) ..................... . . . . . . . . . . . .

mixgend 0.............................. –0.0573 0.0106 –5.40 <0.0001

mixgend 1 (reference) ...................... . . . . . . . . . . . .

C9Q11_R 0 ............................. 0.1034 0.0191 5.42 <0.0001

C9Q11_R 1 (reference) ..................... . . . . . . . . . . . .

HISPANIC_HH 0.......................... 0.0722 0.0135 5.35 <0.0001

HISPANIC_HH 1 (reference) .................. . . . . . . . . . . . .

C7Q07_R 0............................. –0.1037 0.0237 –4.37 <0.0001

C7Q07_R 1 (reference) ..................... . . . . . . . . . . . .

hlmtabil 0 .............................. 0.1048 0.0174 6.02 <0.0001

hlmtabil 1 (reference) ....................... . . . . . . . . . . . .

Asian_Pacif_p_q 1 ........................ –0.0677 0.0176 –3.84 0.0001

Asian_Pacif_p_q 2 ........................ –0.0427 0.0143 –2.99 0.0028

Asian_Pacif_p_q 3 ........................ –0.0343 0.0117 –2.94 0.0033

Asian_Pacif_p_q 4 (reference) ................. . . . . . . . . . . . .

C3Q02_R 1............................. –0.0807 0.0280 –2.88 0.0040

C3Q02_R 2............................. –0.0732 0.0253 –2.89 0.0039

C3Q02_R 3............................. –0.0088 0.0300 –0.29 0.7700

C3Q02_R 4 (reference) ..................... . . . . . . . . . . . .

C8Q01_A_R 1 ........................... –0.1198 0.0743 –1.61 0.1100

C8Q01_A_R 2 ........................... –0.0764 0.0271 –2.82 0.0048

C8Q01_A_R 3 ........................... –0.0582 0.0172 –3.38 0.0007

C8Q01_A_R 4 (reference).................... . . . . . . . . . . . .

Inc_25_50_p_q 1 ......................... 0.0940 0.0201 4.68 <0.0001

Inc_25_50_p_q 2 ......................... 0.0361 0.0133 2.71 0.0068

Inc_25_50_p_q 3 ......................... 0.0120 0.0104 1.15 0.2500

Inc_25_50_p_q 4 (reference) .................. . . . . . . . . . . . .

C11Q12_R 0 ............................ 0.1137 0.0264 4.30 <0.0001

C11Q12_R 1 (reference)..................... . . . . . . . . . . . .

C9Q06_R 0............................. –0.0793 0.0208 –3.81 0.0001

C9Q06_R 1 (reference) ..................... . . . . . . . . . . . .

msa 1 ................................ 0.0352 0.0112 3.14 0.0017

msa 2 ................................ 0.0430 0.0105 4.09 <0.0001

msa 3 (reference) ......................... . . . . . . . . . . . .

Total_Population_q 1 ....................... 0.0437 0.0595 0.73 0.4600

Total_Population_q 2 ....................... 0.0373 0.0291 1.28 0.2000

Total_Population_q 3 ....................... 0.0367 0.0160 2.30 0.0220

Total_Population_q 4 (reference)................ . . . . . . . . . . . .

Inc_0_25_p_q 1 .......................... 0.0536 0.0247 2.17 0.0300

Inc_0_25_p_q 2 .......................... 0.0548 0.0204 2.68 0.0073

Inc_0_25_p_q 3 .......................... 0.0545 0.0156 3.48 0.0005

Inc_0_25_p_q 4 (reference)................... . . . . . . . . . . . .

C7Q02_R 0............................. 0.1087 0.0293 3.71 0.0002

C7Q02_R 1 (reference) ..................... . . . . . . . . . . . .

NM_NSPF ............................. –0.0094 0.0129 –0.73 0.4700

Age_0_17_p_q 1 ......................... –0.0598 0.0158 –3.79 0.0002

Age_0_17_p_q 2 ......................... –0.0628 0.0129 –4.85 <0.0001

Age_0_17_p_q 3 ......................... –0.0260 0.0107 –2.44 0.0150

Age_0_17_p_q 4 (reference) .................. . . . . . . . . . . . .

Age_55_p_q 1 ........................... –0.0688 0.0188 –3.67 0.0002

Age_55_p_q 2 ........................... –0.0352 0.0149 –2.37 0.0180

Age_55_p_q 3 ........................... –0.0165 0.0117 –1.40 0.1600

See footnotes at end of table. ................. 
 
 

Series 1, No. 57 [ Page 267

Table LIV. Parameter estimates for the multiple-imputation model—Con.

Standard p value of

Parameter Estimate error t value t statistic

Age_55_p_q 4 (reference).................... . . . . . . . . . . . .

Age_18_34_p_q 1......................... –0.0200 0.0151 –1.32 0.1900

Age_18_34_p_q 2......................... –0.0388 0.0126 –3.07 0.0021

Age_18_34_p_q 3......................... –0.0265 0.0107 –2.48 0.0130

Age_18_34_p_q 4 (reference) ................. . . . . . . . . . . . .

C3Q29_R 1............................. 0.1086 0.0435 2.50 0.0130

C3Q29_R 2............................. 0.0464 0.0251 1.85 0.0640

C3Q29_R 3 (reference) ..................... . . . . . . . . . . . .

C7Q09_R 0............................. 0.1487 0.0507 2.93 0.0034

C7Q09_R 1 (reference) ..................... . . . . . . . . . . . .

C4Q03_B_R 0 ........................... –0.0618 0.0253 –2.44 0.0150

C4Q03_B_R 1 (reference).................... . . . . . . . . . . . .

hmorecare 0 ............................ 0.0334 0.0133 2.51 0.0120

hmorecare 1 (reference) ..................... . . . . . . . . . . . .

White_p_q 1 ............................ 0.0190 0.0211 0.90 0.3700

White_p_q 2 ............................ 0.0238 0.0171 1.39 0.1600

White_p_q 3 ............................ 0.0279 0.0118 2.36 0.0190

White_p_q 4 (reference) ..................... . . . . . . . . . . . .

C6Q06_R 1............................. 0.0597 0.0531 1.12 0.2600

C6Q06_R 2............................. –0.0277 0.0317 –0.87 0.3800

C6Q06_R 3............................. –0.0172 0.0204 –0.84 0.4000

C6Q06_R 4 (reference) ..................... . . . . . . . . . . . .

Household_Density_q 1 ..................... 0.0377 0.0152 2.48 0.0130

Household_Density_q 2 ..................... 0.0197 0.0129 1.53 0.1300

Household_Density_q 3 ..................... 0.0183 0.0108 1.70 0.0900

Household_Density_q 4 (reference) .............. . . . . . . . . . . . .

C3Q26_R 1............................. –0.0259 0.0349 –0.74 0.4600

C3Q26_R 2............................. –0.0420 0.0185 –2.26 0.0240

C3Q26_R 3 (reference) ..................... . . . . . . . . . . . .

Hispanic_p_q 1 .......................... –0.0340 0.0180 –1.89 0.0590

Hispanic_p_q 2 .......................... –0.0206 0.0156 –1.32 0.1900

Hispanic_p_q 3 .......................... –0.0264 0.0133 –1.98 0.0480

Hispanic_p_q 4 (reference) ................... . . . . . . . . . . . .

interupt 0 .............................. –0.4397 0.1938 –2.27 0.0230

interupt 1 (reference) ....................... . . . . . . . . . . . .

C9Q04_R .............................. –0.0012 0.0005 –2.58 0.0098

C8Q01_C_R 1 ........................... 0.0451 0.0787 0.57 0.5700

C8Q01_C_R 2 ........................... 0.0193 0.0298 0.65 0.5200

C8Q01_C_R 3 ........................... –0.0288 0.0190 –1.52 0.1300

C8Q01_C_R 4 (reference).................... . . . . . . . . . . . .

C3Q15_R 0............................. 0.0416 0.0206 2.02 0.0440

C3Q15_R 1 (reference) ..................... . . . . . . . . . . . .

C4Q03_C_R 0 ........................... –0.0396 0.0208 –1.91 0.0570

C4Q03_C_R 1 (reference).................... . . . . . . . . . . . .

C3Q11_R 1 ............................. –0.2755 0.2173 –1.27 0.2000

C3Q11_R 2 ............................. –0.2566 0.2156 –1.19 0.2300

C3Q11_R 3 ............................. –0.2345 0.2154 –1.09 0.2800

C3Q11_R 4 (reference) ..................... . . . . . . . . . . . .

NM_SP ............................... 0.2063 1.1549 0.18 0.8600

C6Q00_R 0............................. 0.0208 0.0258 0.81 0.4200

C6Q00_R 1............................. 0.0273 0.0284 0.96 0.3400

C6Q00_R 2............................. 0.0546 0.0324 1.69 0.0910

C6Q00_R 3 (reference) ..................... . . . . . . . . . . . .

C6Q03_R 1............................. –0.0692 0.0717 –0.97 0.3300

C6Q03_R 2............................. –0.0406 0.0324 –1.25 0.2100

C6Q03_R 3............................. –0.0258 0.0199 –1.30 0.2000

C6Q03_R 4 (reference) ..................... . . . . . . . . . . . .

C3Q22_R 1............................. 0.1115 0.0646 1.73 0.0840

C3Q22_R 2............................. –0.0118 0.0337 –0.35 0.7300

C3Q22_R 3 (reference) ..................... . . . . . . . . . . . .

C9Q03_R .............................. 0.0005 0.0003 1.31 0.1900

hspeech 0.............................. 0.0199 0.0128 1.55 0.1200

hspeech 1 (reference) ...................... . . . . . . . . . . . .

C4Q0A_R 1 ............................ –0.0450 0.0308 –1.46 0.1400

C4Q0A_R 2 ............................ –0.0644 0.0596 –1.08 0.2800

C4Q0A_R 3 (reference) ..................... . . . . . . . . . . . .

See footnotes at end of table.
 

Page 268 [ Series 1, No. 57

Table LIV. Parameter estimates for the multiple-imputation model—Con.

Standard p value of

Parameter Estimate error t value t statistic

C3Q23_R 1............................. –0.0284 0.0322 –0.88 0.3800

C3Q23_R 2............................. –0.0386 0.0192 –2.02 0.0440

C3Q23_R 3 (reference) ..................... . . . . . . . . . . . .

callyrf 2009 ............................. –0.0392 0.0314 –1.25 0.2100

callyrf 2010 ............................. –0.0231 0.0275 –0.84 0.4000

callyrf 2011 (reference)...................... . . . . . . . . . . . .

K2Q40A_R 0 ............................ –0.0254 0.0190 –1.34 0.1800

K2Q40A_R 1 (reference) .................... . . . . . . . . . . . .

K2Q50A_R 0 ............................ –0.1040 0.0698 –1.49 0.1400

K2Q50A_R 1 (reference) .................... . . . . . . . . . . . .

K2Q46A_R 0 ............................ –0.0453 0.0378 –1.20 0.2300

K2Q46A_R 1 (reference) .................... . . . . . . . . . . . .

Median_Years_Educ_q 1 .................... –0.0002 0.0237 –0.01 0.9900

Median_Years_Educ_q 2 .................... –0.0053 0.0192 –0.28 0.7800

Median_Years_Educ_q 3 .................... –0.0143 0.0149 –0.96 0.3400

Median_Years_Educ_q 4 (reference) ............. . . . . . . . . . . . .

K2Q47A_R 0 ............................ –0.1288 0.1073 –1.20 0.2300

K2Q47A_R 1 (reference) .................... . . . . . . . . . . . .

C6Q05_R 1............................. –0.0262 0.0393 –0.67 0.5100

C6Q05_R 2............................. –0.0180 0.0264 –0.68 0.4900

C6Q05_R 3............................. 0.0088 0.0184 0.48 0.6300

C6Q05_R 4 (reference) ..................... . . . . . . . . . . . .

cellphone 0 ............................. 0.5877 0.5202 1.13 0.2600

cellphone 1 (reference)...................... . . . . . . . . . . . .

C9Q02_R 0............................. –0.0158 0.0142 –1.11 0.2700

C9Q02_R 1 (reference) ..................... . . . . . . . . . . . .

C4Q0D_R 1 ............................ 0.0375 0.0656 0.57 0.5700

C4Q0D_R 2 ............................ –0.0123 0.0841 –0.15 0.8800

C4Q0D_R 3 (reference) ..................... . . . . . . . . . . . .

K2Q44A_R 0 ............................ –0.0257 0.0263 –0.98 0.3300

K2Q44A_R 1 (reference) .................... . . . . . . . . . . . .

C3Q25_R 1............................. 0.0859 0.0806 1.07 0.2900

C3Q25_R 2............................. 0.0133 0.0343 0.39 0.7000

C3Q25_R 3 (reference) ..................... . . . . . . . . . . . .

hemotprob 0 ............................ 0.0167 0.0153 1.09 0.2800

hemotprob 1 (reference) ..................... . . . . . . . . . . . .

K2Q51A_R 0 ............................ 0.0382 0.0383 1.00 0.3200

K2Q51A_R 1 (reference) .................... . . . . . . . . . . . .

C3Q28_R 1............................. 0.0066 0.0432 0.15 0.8800

C3Q28_R 2............................. 0.0217 0.0229 0.95 0.3400

C3Q28_R 3 (reference) ..................... . . . . . . . . . . . .

C3Q24_R 1............................. –0.0080 0.0366 –0.22 0.8300

C3Q24_R 2............................. –0.0185 0.0209 –0.88 0.3800

C3Q24_R 3 (reference) ..................... . . . . . . . . . . . .

allfem 0 ............................... –0.0183 0.0141 –1.30 0.1900

allfem 1 (reference) ........................ . . . . . . . . . . . .

TOTKIDSF ............................. –0.0147 0.0140 –1.05 0.2900

Total_HHn_q 1 ........................... –0.0389 0.0590 –0.66 0.5100

Total_HHn_q 2 ........................... –0.0193 0.0289 –0.67 0.5000

Total_HHn_q 3 ........................... –0.0120 0.0158 –0.76 0.4500

Total_HHn_q 4 (reference) ................... . . . . . . . . . . . .

Black_p_q 1 ............................ 0.0018 0.0180 0.10 0.9200

Black_p_q 2 ............................ 0.0030 0.0158 0.19 0.8500

Black_p_q 3 ............................ –0.0057 0.0134 –0.43 0.6700

Black_p_q 4 (reference) ..................... . . . . . . . . . . . .

K2Q43A_R 0 ............................ –0.0204 0.0248 –0.82 0.4100

K2Q43A_R 1 (reference) .................... . . . . . . . . . . . .

C6Q04_R 1............................. –0.0203 0.0578 –0.35 0.7300

C6Q04_R 2............................. 0.0210 0.0330 0.64 0.5200

C6Q04_R 3............................. 0.0029 0.0199 0.15 0.8800

C6Q04_R 4 (reference) ..................... . . . . . . . . . . . .

C7Q05_R 0............................. –0.0281 0.0339 –0.83 0.4100

C7Q05_R 1 (reference) ..................... . . . . . . . . . . . .

C9Q10_R 0............................. –0.0182 0.0238 –0.76 0.4500

C9Q10_R 1 (reference) ..................... . . . . . . . . . . . .

K2Q45A_R 0 ............................ 0.0228 0.0310 0.74 0.4600

See footnotes at end of table.
 

Series 1, No. 57 [ Page 269

Table LIV. Parameter estimates for the multiple-imputation model—Con.

Standard p value of

Parameter Estimate error t value t statistic

K2Q45A_R 1 (reference) .................... . . . . . . . . . . . .

C3Q21_R 1............................. –0.0242 0.0382 –0.63 0.5300

C3Q21_R 2............................. 0.0062 0.0227 0.27 0.7900

C3Q21_R 3 (reference) ..................... . . . . . . . . . . . .

C4Q02A_R 1 ............................ 0.0154 0.0301 0.51 0.6100

C4Q02A_R 2 ............................ 0.0202 0.0308 0.66 0.5100

C4Q02A_R 3 (reference) .................... . . . . . . . . . . . .

C6Q02_R 1............................. 0.0226 0.0419 0.54 0.5900

C6Q02_R 2............................. 0.0048 0.0231 0.21 0.8300

C6Q02_R 3............................. 0.0043 0.0187 0.23 0.8200

C6Q02_R 4 (reference) ..................... . . . . . . . . . . . .

C4Q0B_R 1 ............................ –0.0152 0.0461 –0.33 0.7400

C4Q0B_R 2 ............................ –0.0009 0.0784 –0.01 0.9900

C4Q0B_R 3 ............................ –0.0231 0.0609 –0.38 0.7100

C4Q0B_R 4 ............................ –0.0191 0.0495 –0.39 0.7000

C4Q0B_R 5 (reference) ..................... . . . . . . . . . . . .

Oldest ................................ 0.0007 0.0014 0.49 0.6200

C4Q03_A_R 0 ........................... –0.0119 0.0282 –0.42 0.6700

C4Q03_A_R 1 (reference).................... . . . . . . . . . . . .

K2Q42A_R 0 ............................ –0.0139 0.0341 –0.41 0.6800

K2Q42A_R 1 (reference) .................... . . . . . . . . . . . .

K2Q52A_R 0 ............................ 0.0058 0.0145 0.40 0.6900

K2Q52A_R 1 (reference) .................... . . . . . . . . . . . .

C4Q03_E_R 0 ........................... –0.0101 0.0294 –0.34 0.7300

C4Q03_E_R 1 (reference).................... . . . . . . . . . . . .

K2Q49A_R 0 ............................ 0.0291 0.1164 0.25 0.8000

K2Q49A_R 1 (reference) .................... . . . . . . . . . . . .

C7Q11_R 0 ............................. 0.0074 0.0341 0.22 0.8300

C7Q11_R 1 (reference) ..................... . . . . . . . . . . . .

K2Q48A_R 0 ............................ 0.0117 0.0571 0.21 0.8400

K2Q48A_R 1 (reference) .................... . . . . . . . . . . . .

NM_NSP .............................. 0.1778 1.1548 0.15 0.8800

C4Q02BX08_NBC_R 0 ..................... 0.0090 0.0943 0.10 0.9200

C4Q02BX08_NBC_R 1 (reference) .............. . . . . . . . . . . . .

K2Q41A_R 0 ............................ 0.0036 0.0460 0.08 0.9400

K2Q41A_R 1 (reference) .................... . . . . . . . . . . . .

K2Q42A_R 0 ............................ –0.0139 0.0341 –0.41 0.6800

K2Q42A_R 1 (reference) .................... . . . . . . . . . . . .

K2Q52A_R 0 ............................ 0.0058 0.0145 0.40 0.6900

K2Q52A_R 1 (reference) .................... . . . . . . . . . . . .

C4Q03_E_R 0 ........................... –0.0101 0.0294 –0.34 0.7300

C4Q03_E_R 1 (reference).................... . . . . . . . . . . . .

K2Q49A_R 0 ............................ 0.0291 0.1164 0.25 0.8000

K2Q49A_R 1 (reference) .................... . . . . . . . . . . . .

C7Q11_R 0 ............................. 0.0074 0.0341 0.22 0.8300

C7Q11_R 1 (reference) ..................... . . . . . . . . . . . .

K2Q48A_R 0 ............................ 0.0117 0.0571 0.21 0.8400

K2Q48A_R 1 (reference) .................... . . . . . . . . . . . .

NM_NSP .............................. 0.1778 1.1548 0.15 0.8800

C4Q02BX08_NBC_R 0 ..................... 0.0090 0.0943 0.10 0.9200

C4Q02BX08_NBC_R 1 (reference) .............. . . . . . . . . . . . .

K2Q41A_R 0 ............................ 0.0036 0.0460 0.08 0.9400

K2Q41A_R 1 (reference) .................... . . . . . . . . . . . .

C7Q11_R 0 ............................. 0.0074 0.0341 0.22 0.8300

C7Q11_R 1 (reference) ..................... . . . . . . . . . . . .

K2Q48A_R 0 ............................ 0.0117 0.0571 0.21 0.8400

K2Q48A_R 1 (reference) .................... . . . . . . . . . . . .

NM_NSP .............................. 0.1778 1.1548 0.15 0.8800

C4Q02BX08_NBC_R 0 ..................... 0.0090 0.0943 0.10 0.9200

C4Q02BX08_NBC_R 1 (reference) .............. . . . . . . . . . . . .

K2Q41A_R 0 ............................ 0.0036 0.0460 0.08 0.9400

K2Q41A_R 1 (reference) .................... . . . . . . . . . . . .

. . . Category not applicable.

– Quantity zero.
Page 270 [ Series 1, No. 57

Appendix XV. Key Prevalence Estimates and Weighted Frequencies

This appendix consists of Table LV,

which shows weighted frequencies of

the number of households with a child

with special health care needs and the

number of children with special health

care needs, by state. Prevalence

estimates and standard errors are also

provided. Analysts may wish to replicate

this table to determine if they are using

the weights correctly.

Table LV. Unweighted and weighted estimates of the frequency and prevalence of households with children with special health care needs

Total Weighted

Total weighted Unweighted estimate of

unweighted estimate of number of number of

number of number of households households

State households households with CSHCN with CSHCN

Standard

error of

weighted

estimate of

number of

households

with CSHCN

Percent of

households

with children

that include

CSHCN

Standard

error of

percentage of

households

with children

that include

CSHCN

Total (excluding U.S. Virgin Islands) .......... 196,159 38,145,781 48,142 8,765,468.14 63,846.18 22.98 0.1617
 

Total (including U.S. Virgin Islands) .......... 199,309 38,162,661 48,519 8,767,766.06 63,846.40 22.97 0.1617
 

Alabama .......................... 3,458 601,595 921 155,916.55 5,725.94 25.92 0.9058
 

Alaska ........................... 4,865 90,117 919 16,133.18 602.20 17.90 0.6543
 

Arizona ........................... 4,047 768,997 960 166,810.66 6,865.13 21.69 0.8686
 

Arkansas.......................... 3,331 379,938 950 105,841.47 4,396.34 27.86 1.0635
 

California.......................... 5,502 4,564,987 992 810,506.79 31,709.98 17.75 0.6744
 

Colorado .......................... 3,844 622,469 936 135,769.65 5,717.75 21.81 0.8931
 

Connecticut ........................ 3,681 458,015 944 113,739.36 4,013.70 24.83 0.8458
 

Delaware.......................... 3,584 108,054 961 27,430.05 1,096.76 25.39 0.9577
 

District of Columbia.................... 3,879 52,817 899 12,746.86 548.64 24.13 0.9819
 

Florida ........................... 4,507 2,050,529 1,058 453,943.96 15,117.08 22.14 0.7194
 

Georgia........................... 3,812 1,270,309 958 304,631.80 11,168.11 23.98 0.8444
 

Hawaii ........................... 5,130 158,178 982 28,778.83 1,189.28 18.19 0.7287
 

Idaho ............................ 3,802 206,431 901 43,960.58 1,635.85 21.30 0.7832
 

Illinois............................ 4,466 1,610,525 994 350,669.87 12,655.90 21.77 0.7535
 

Indiana ........................... 3,499 826,116 942 212,736.38 7,612.18 25.75 0.8837
 

Iowa ............................ 3,939 379,387 933 84,011.40 2,995.73 22.14 0.7698
 

Kansas ........................... 3,343 356,873 923 94,253.34 3,380.84 26.41 0.9220
 

Kentucky .......................... 3,228 566,780 935 152,632.94 6,943.14 26.93 1.1567
 

Louisiana.......................... 3,335 580,107 962 158,253.79 6,009.72 27.28 0.9884
 

Maine............................ 3,392 156,663 922 42,480.38 1,562.22 27.12 0.9410
 

Maryland .......................... 4,004 710,062 966 164,024.09 6,308.11 23.10 0.8483
 

Massachusetts ...................... 3,545 763,665 982 203,039.41 6,749.44 26.59 0.8599
 

Michigan .......................... 3,222 1,229,491 939 329,120.26 13,513.32 26.77 1.0566
 

Minnesota ......................... 3,828 661,877 915 148,692.31 5,157.46 22.47 0.7675
 

Mississippi ......................... 3,678 395,317 912 96,529.45 3,754.36 24.42 0.8983
 

Missouri .......................... 3,444 758,252 917 196,603.75 6,955.04 25.93 0.8825
 

Montana .......................... 4,057 104,514 903 21,814.32 1,102.56 20.87 0.9765
 

Nebraska.......................... 3,706 224,848 881 49,814.86 1,858.13 22.15 0.8079
 

Nevada........................... 4,479 335,017 928 60,447.50 3,140.60 18.04 0.8970
 

New Hampshire...................... 3,354 159,017 928 43,286.97 1,417.59 27.22 0.8659
 

New Jersey ........................ 4,328 1,101,837 988 239,279.19 8,322.00 21.72 0.7380
 

New Mexico ........................ 3,769 252,395 941 55,088.05 2,262.23 21.83 0.8883
 

New York. . . . . . . . . . . . . . . . . . . . . . . . . . 4,592 2,319,317 1,027 518,443.14 17,519.26 22.35 0.7297
 

North Carolina....................... 3,698 1,209,307 985 304,357.70 11,499.32 25.17 0.9100
 

North Dakota ....................... 3,886 74,851 915 16,222.86 687.78 21.67 0.8873
 

Ohio ............................ 3,596 1,431,605 984 391,454.45 13,122.77 27.34 0.8706
 

Oklahoma ......................... 3,166 485,289 921 126,408.17 5,153.36 26.05 1.0440
 

Oregon ........................... 4,065 450,709 924 96,807.93 3,491.82 21.48 0.7598
 

Pennsylvania ....................... 3,667 1,484,393 990 374,967.69 13,130.37 25.26 0.8619
 

Rhode Island ....................... 3,390 126,024 920 32,188.98 1,121.03 25.54 0.8727
 

South Carolina ...................... 3,625 564,865 948 133,451.01 6,202.80 23.63 1.0577
 

South Dakota ....................... 4,248 101,765 898 19,262.58 1,162.26 18.93 1.0740
 

Tennessee ......................... 3,749 811,906 978 196,785.99 6,842.66 24.24 0.8233
 

Texas ............................ 4,726 3,323,650 1,066 707,050.44 26,335.07 21.27 0.7551
 

Utah ............................ 3,693 371,469 903 86,569.95 3,534.09 23.30 0.9060
 

Vermont .......................... 3,608 74,368 892 18,283.01 688.74 24.58 0.8894
 

Virginia ........................... 3,906 995,413 962 232,924.84 8,600.62 23.40 0.8351
 

See footnote at end of table.
Table LV. Unweighted and weighted estimates of the frequency and prevalence of households with children with special health care needs—Con.

Standard Standard

error of error of

Total

unweighted

number of

Total

weighted

estimate of

number of

Unweighted

number of

households

Weighted

estimate of

number of

households

weighted

estimate of

number of

households

Percent of

households

with children

that include

percentage of

households

with children

that include

State households households with CSHCN with CSHCN with CSHCN CSHCN CSHCN

Washington ........................ 3,722 816,380 925 191,052.24 7,256.00 23.40 0.8596
 

West Virginia ....................... 3,344 212,944 916 56,736.15 2,202.59 26.64 0.9699
 

Wisconsin ......................... 3,582 719,316 888 168,716.86 6,401.03 23.46 0.8767
 

Wyoming.......................... 3,838 67,031 908 14,796.12 697.74 22.07 0.9731
 

U.S. Virgin Islands .................... 3,150 16,880 377 2,297.92 166.54 0.14 0.0093
 

NOTE: CSHCN is children with special health care needs.

Series 1, No. 57 [ Page 271
Vital and Health Statistics

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