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

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Abstract

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

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Notes

  1. The “Adverse Child and Family Experiences Among US Children” measure referenced here is summarized in the “Overview of Adverse Events in Childhood” data brief [20]. ACEs assess include serious financial hardship; divorce; racial discrimination; incarceration of parent; witness violence in the home; victim of violence; alcohol or substance abuse in the home; parent with mental health problems.

  2. Based on an analysis of data from the 2008 Medical Expenditures Panel Survey (MEPS) by the authors. A standard two-part model was used to estimate health expenditures controlling for child’s age, sex, race, US geographic region, and family income.

Abbreviations

LCT:

Life course theory

CSHCN:

Children with special health care needs

NSCH:

National Survey of Children’s Health

NS-CSHCN:

National Survey of Children with Special Health Care Needs

EBD:

Emotional, behavioral or development problems

MCHB:

Maternal and Child Health Bureau

SDBS:

Standardized developmental and behavioral screening

DBS:

Developmental, behavioral and/or social

IFSP:

Individualized Family Services Plan

IEP:

Individualized Education Plan

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Conflict of interest

The authors have no conflicts of interest to disclose.

Author information

Authors and Affiliations

  1. The Child and Adolescent Health Measurement Initiative, Oregon Health and Science University, Portland, OR, USA

    Christina D. Bethell & Cambria L. Wilhelm

  2. Department of Pediatrics, Philip R Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, USA

    Paul W. Newacheck

  3. Center for the Study of Social Policy, Washington, DC, USA

    Amy Fine

  4. Maternal and Child Health Bureau, Health Resources and Services Administration, Rockville, MD, USA

    Bonnie B. Strickland & Lynda E. Honberg

  5. Division of General Pediatrics, Harvard Medical School, Children’s Hospital Boston, Boston, MA, USA

    Richard C. Antonelli

  6. Family Voices, Lexington, MA, USA

    Nora Wells

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  1. Christina D. Bethell
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Correspondence to Christina D. Bethell.

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Bethell, C.D., Newacheck, P.W., Fine, A. et al. Optimizing Health and Health Care Systems for Children with Special Health Care Needs Using the Life Course Perspective. Matern Child Health J 18, 467–477 (2014). https://doi.org/10.1007/s10995-013-1371-1

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