Office of Epidemiology and Research, Division of Research

Advancing Applied MCH Research

Measuring the Performance of State CSHCN Systems

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Project Number: R40 MC 04295-01
Grantee: Univ. of North Carolina, Chapel Hill
Department/Center: Dept. of Maternal and Child Health
Project Date: 01/01/2005

Final Report

Measuring the Performance of State CSHCN Systems Final Report (PDF) Exit Disclaimer

Principal Investigator

Lewis Margolis, M.D., MPH
Associate Professor
CB # 7445, Rosenau Hall
Chapel Hill, NC  27599
Phone: (919) 966-5974


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


From Neurons to Neighborhoods, the National Research Council's recent major report on factors that influence child development, articulates seven inter-related social, economic and political challenges facing those who care for children, whether at the level of families or the level of public policy. Among these is the "devolution of some important responsibilities for the implementation of child and family policies to the state and local levels." Title V of the Social Security Act (beginning with its predecessor, the Sheppard-Towner Act) represents the fundamental federal role in maternal and child health programs and through the years Title V has reflected the swinging of the pendulum between state and federal roles. While the MCH Services provide core funding for infrastructure, population-based services, enabling services, and gap­ filling for clinical and other services that may not be readily available, the capacity of MCH agencies or programs to meet the needs of the population is a function of multiple political and economic characteristics of the states. In the political domain, the structure and capacity of governors' and the legislatures' roles may influence policy. In the economic domain, state domestic product, total taxable resources, per capita personal income, special education spending and other variables may have an impact on allocation decisions. Similarly, in the health domain state-level health insurance coverage, the supply of health care providers and other health system indicators may constrain or advance MCH programs. Given the understandable, but nevertheless disproportionate, impact of services for Children and Youth with Special Health Care Needs (C/YSHCN) on state resources, it is especially important to understand the relationship between state capacity and outcomes for these children and their families. The National Survey of CSHCN provides state level health status process measures to enable analysis of the relationship between state social, political and economic capacity and the health status of C/YSHCN. Using multivariable techniques, the proposed research project will examine contextual factors that affect the capacity of MCH professionals and programs to assure the health of C/YSHCN.


Listed is descending order by year published.

Margolis LH, Rosenberg A, Umble K, et al. Effects of interdisciplinary training on MCH professionals, organizations and systems. Matern Child Health J. 2012 Jul 14.[Epub ahead of print.]

Margolis LH, Mayer M, Clark KA, Farel AM. Associations between state economic and health systems capacities and service use by children with special health care needs. Matern Child Health J. 2010 Jul 14. [epub ahead of print].

Margolis LH, Mayer M, Clark KA, Farel AM. The relationship between state capacity measures and allocations to children and youth with special needs within the MCH Services Block Grant. Matern Child Health J. 2009 Jul;13(4):435-44.


Special Health Care Needs, Health Care Costs, Capacity & Personnel

Title V in Your State