Office of Epidemiology and Research, Division of Research

Advancing Applied MCH Research

Characterizing Children at Risk for Special Health Needs

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Project Number: R40 MC 03619-02
Grantee: University of California San Francisco
Department/Center: Institute for Health Policy Studies
Project Date: 09/01/2004

Final Report

Characterizing Children at Risk for Special Health Needs Final Report (PDF) Exit Disclaimer

Principal Investigator

Paul Newacheck, DrPH
3333 California Street, #265
San Francisco, CA  94118
Phone: (415) 476-3896


  • Perinatal/Infancy (0-12 months)
  • Toddlerhood (13-35 months)
  • Early Childhood (3-5 years)
  • Middle Childhood (6-11 years)
  • Adolescence (12-18 years)


In 1998, the Maternal and Child Health Bureau published a new definition of children with special health care needs that included children with existing special needs and those at increased risk for developing a special health care need. The population at-risk was included to incorporate a preventive perspective in the definition. However, the population at increased risk has never been defined conceptually or described empirically. Consequently, almost all uses of the definition have been limited to children with existing special needs. Until progress is made in this area, no inroads can be made in designing and implementing primary and secondary prevention programs to reduce the number of children developing special needs. This project seeks to identify the factors that lead to an increased likelihood that children will develop special health care needs. The proposed project will be conducted in two phases. Phase 1 includes the development of the conceptual framework for assessing risk factors for CSHCN. The conceptual model will incorporate major determinants of health identified in previous studies of population health but tailed to CSHCN. Phase 2 consists of empirical analyses, using multivariate methods, to identify the independent effects and contributions of the risk factors identified in Phase 1. The 2003 National Survey of Children's Health, a population-based survey of approximately 100,000 children, will serve as the primary data source. Geo-coded contextual data will be merged to this data set. The project will be guided by an expert panel of respected practitioners, health service researchers, and epidemiologists. The resulting products will be helpful in informing health practitioners, families, health policymakers and health services researchers concerning risk factors for special health care needs. They will also be useful in establishing a literature on this topic and providing a foundation for additional conceptual and empirical work. Although subject to certain limitations, the results will be useful in providing a starting point for the development of prevention strategies. This proposal is responsive to MCHB Strategic Research Issue #IV: Promoting the healthy development of MCH populations.


Listed is descending order by year published.

Newacheck PW, Kim SE, Blumberg SJ, Rising JP. Who is at risk for special health care needs: findings from the National Survey of Children's Health. Pediatrics. 2008 Aug; 122(2): 347-59.

Newacheck PW, Rising JP, Kim SE. Children at risk for special health care needs. Pediatrics. 2006 Jul;118(1):334-42.


Special Health Care Needs

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