Elsevier

Academic Pediatrics

Volume 11, Issue 2, March–April 2011, Pages 128-135
Academic Pediatrics

New Research on Children With Special Health Care Needs
Internal Psychometric Properties of the Children with Special Health Care Needs Screener

https://doi.org/10.1016/j.acap.2009.11.006Get rights and content

Abstract

Objective

Insufficient research has established the measurement properties of the Children with Special Health Care Needs (CSHCN) Screener. This leaves unclear whether CSHCN Screener–based estimates reliably identify CSHCN. We used classical and modern test theory to establish the CSHCN Screener’s internal psychometric properties.

Methods

Data came from the 2005-2006 National Survey of Children with Special Health Care Needs (NS-CSHCN), a nationally representative survey of US children (N = 359 154).

Results

Cronbach’s α, a measure of internal reliability, equaled .76. Confirmatory factor analysis for ordered-categorical measures indicated that a single underlying trait that we label health-condition-complexity underlies CSHCN Screener responses. Item response theory showed that responses provide particularly precise measurement among children experiencing elevated health-condition-complexity trait levels.

Conclusions

Findings demonstrate that responses to the CSHCN Screener as used in the NS-CSHCN have good internal psychometric properties and include minimal random measurement error. Epidemiologists, clinicians and others can rely on CSHCN Screener responses to reliably identify CSHCN experiencing 1 or more of the 5 consequences included on the CSHCN Screener.

Section snippets

Data Source

The National Survey of CSHCN provides national and state level data on the prevalence of special health care needs and their impact on children and their families.17 The National Center for Health Statistics, with funding and direction from MCHB, has conducted this random-digit-dial telephone survey every 4 years since 2001. In 2005 to 2006, survey interviewers contacted 192 083 households with children and screened 364 841 children <18 years of age. A parent or guardian knowledgeable about the

Classical Test Theory

Using the first-question approach, overall standardized α = .716. For all but the “medications” item, deleting items decreased reliability. Removing the services item created the largest negative change (Δα ≈ −.1). These findings indicated acceptable reliability for the questions that provided the basis for skip patterns related to CSHCN Screener follow-up questions. Poor reliability (ie, random measurement error) did not lead some parents to incorrectly fail to receive follow-up questions and

Discussion

In this study, we examined the internal psychometric properties of responses to the CSHCN Screener in the 2005–2006 NS-CSHCN. Classical test theory, CFA-OCM, and IRT supported the hypothesis that CSHCN Screener responses reliably describe whether children experience 1 of the 5 health-related consequences included on the CSHCN Screener and whether the consequences result from a medical, behavioral, or other health condition lasting at least 12 months. IRT demonstrated that CSHCN Screener

Acknowledgments

We thank the U.S. Health Resources and Services Administration, Maternal and Child Health Bureau, and the U.S. Centers for Disease Control and Prevention, National Center for Health Statistics, for making the data publicly available, and Ruth Stein, Christina Bethell, Michael Seid, and Lisa Opipari-Arrigan for their collegial support and insightful comments on our work. Adam Carle thanks Tara J. Carle and Margaret Carle, whose unending support and thoughtful comments make his work possible.

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