Christina D BethellOregon Health & Science University | OHSU · Department of Pediatrics
Christina D Bethell
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65
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Publications (65)
Objective:
To examine the association between children's quality of life (QOL) and their experience of being heard by family and/or teachers during the COVID-19 pandemic.
Design:
A cross-sectional study.
Settings:
A randomly sampled postal survey of fifth or eighth grade children conducted in December 2020 in Japan.
Participants:
Responses f...
OBJECTIVE
To describe the prevalence, characteristics, and health-related outcomes of children with diagnosed health conditions and functional difficulties who do not meet criteria for having a special health care need based on the traditional scoring of the Children with Special Health Care Needs (CSHCN) Screener.
METHODS
Data come from the 2016...
Positive childhood experiences (PCEs) promote optimal health and mitigate the effects of adverse childhood experiences, but PCE prevalence in the United States is not well-known. Using Behavioral Risk Factor Surveillance System data, this study describes the prevalence of individual and cumulative PCEs among adults residing in four states: Kansas (...
Background:
The 1997 legislation authorizing the United States Child Health Insurance Program sparked progress to measure and publicly report on children's healthcare services quality and system performance. To meet the moment, the national Child and Adolescent Health Measurement Initiative (CAHMI) public-private collaboration was launched to put...
Nearly 70% (67.6%) of US children with mental, emotional, and behavioral problems (MEB) experienced significant social health risks (SHR) and/or relational health risks (RHR). Shifts are needed in child mental health promotion, prevention, diagnosis, and treatment to address both RHR and SHR. Public health approaches are needed that engage families...
In light of concerns over the potential detrimental effects of declining care continuity, and the need for connection between patients and health care providers, our multidisciplinary group considered the possible ways that relationships might be developed in different kinds of health care encounters.We were surprised to discover many avenues to in...
In Reply We are delighted that Gong et al, using methods borrowed from economics, confirmed the validity of the associations reported in our article on the association between positive childhood experiences (PCEs) and adult mental health. Although it was a rigorous population sample and both demographic and childhood adversity exposures were contro...
In light of concerns over the potential detrimental effects of declining care continuity, and the need for connection between patients and health care providers, our multidisciplinary group considered the possible ways that relationships might be developed in different kinds of health care encounters. We were surprised to discover many avenues to i...
Importance
Associations between adverse childhood experiences (ACEs) and risks for adult depression, poor mental health, and insufficient social and emotional support have been documented. Less is known about how positive childhood experiences (PCEs) co-occur with and may modulate the effect of ACEs on adult mental and relational health.
Objective...
No single U.S. data source supports a multidimensional, population-based assessment of young children’s readiness to start school. This changed with the 2016 National Survey of Children’s Health (NSCH). This study provides an overview of the process by which content related to multiple domains of school readiness was identified, refined and selecte...
The outcome of flourishing and its predictors have not been well documented among US children, especially those who face adversity. Using data for 2016 and 2017 from the National Survey of Children's Health, we determined the prevalence and predictors of flourishing among US children ages 6-17. A three-item index included indicators of flourishing:...
eTable 1. Adjusted Associations Between Medical Home Components and Developmental Screening and Surveillance
eTable 2. Adjusted Associations With Developmental Screening and Surveillance (Without Preventive Medical Visit and Special Health Care Needs Status)
eTable 3. Unadjusted and Adjusted Developmental Screening Rates by State
eTable 4. Unadjust...
Introduction Since 2001, the Health Resources and Services Administration's Maternal and Child Health Bureau (HRSA MCHB) has funded and directed the National Survey of Children's Health (NSCH) and the National Survey of Children with Special Health Care Needs (NS-CSHCN), unique sources of national and state-level data on child health and health car...
Importance
Since 2001, the American Academy of Pediatrics has recommended universal developmental screening and surveillance to promote early diagnosis and intervention and to improve the outcomes of children with developmental delays and disabilities.
Objective
To examine the current prevalence and variation of developmental screening and surveil...
Objective
Adverse childhood experiences (ACEs) can affect health and development across the life course. Despite a general understanding that adversity is associated with lower income, we know less about how ACEs manifest at different income levels and how these income-related patterns affect children's health and development.
Methods
Data from th...
Background
Advances in human development sciences point to tremendous possibilities to promote healthy child development and well-being across life by proactively supporting safe, stable and nurturing family relationships (SSNRs), teaching resilience, and intervening early to promote healing the trauma and stress associated with disruptions in SSNR...
Objectives:
Families, clinicians and policymakers desire improved delivery of health and related services for children with special health care needs (CSHCN). We analyzed factors associated with ease of use in obtaining such services. We also explored what were specific difficulties or delays in receiving services. By examining data from the Natio...
The Title V Maternal and Child Health (MCH) Block Grant is the linchpin for US MCH services. The first national performance measures (NPMs) for MCH were instituted in 1997. Changing trends in MCH risk factors, outcomes, health services, data sources, and advances in scientific knowledge, in conjunction with budgetary constraints led the Maternal an...
Since 2000, the Children with Special Health Care Needs (CSHCN) Screener (CS) has been widely used nationally, by states, and locally as a standardized and brief survey-based method to identify populations of children who experience chronic physical, mental, behavioral, or other conditions and who also require types and amounts of health and relate...
The ongoing longitudinal Adverse Childhood Experiences Study of adults has found significant associations between chronic conditions; quality of life and life expectancy in adulthood; and the trauma and stress associated with adverse childhood experiences, including physical or emotional abuse or neglect, deprivation, or exposure to violence. Less...
To provide a national, population-based assessment of the quality of the health care system for children and youth with special health care needs using a framework of six health care system quality indicators. 49,242 interviews with parents of children with special health care needs from the 2009-10 National Survey of Children with Special Health C...
Autism spectrum disorder (ASD) is becoming an increasingly prevalent chronic health condition in childhood. Therefore, the quality of health care among children with ASD has gained increased importance for health-care providers and policymakers. As this chapter demonstrates, health-care experiences, quality, and outcomes for children with ASD are p...
The Children's Health Insurance Program Reauthorization Act (CHIPRA) of 2009 seeks to expand insurance coverage and ensure quality of care provided for children under the Children's Health Insurance Program and Medicaid. The currently embargoed 2011/12 National Survey of Children's Health (NSCH) is the most recent national and state-specific sample...
The Well-Visit Planner (WVP) was developed under an R40 grant from the Maternal and Child Health Bureau of the Health Resources and Services Administration and was recognized in the 2012 Relevant Evidence to Advance Care and Health (REACH) Challenge. It is one of few existing IT driven, patient engagement tools featuring pre-well-child visit planni...
Resiliency, optimism, curiosity and engagement in learning are elements of positive health development in children. Positive health indicators were newly included in the embargoed 2011/12 National Survey of Children's Health (2011/12), which provides an opportunity to look at associations across demographic subgroups, and environments in which chil...
The Adverse Childhood Experience (ACE) Study found significant association between childhood abuse, neglect and exposure to violence with adult health problems (Felitti et al, 1998). A modified version of the adverse childhood experiences list was newly included in the embargoed 2011/12 National Survey of Children's Health (2011/12). National and s...
Purpose
Children with complex health problems, particularly children with special health care needs (CSHCN), have higher medical expenditures, experience more barriers to care and gaps in quality of medical care than other children. Less is known about population-based associations between complementary and alternative medicine (CAM) use and conv...
Objective:
To identify prevalence and patterns of complementary and alternative medicine (CAM) use among youth with recurrent headaches (HA) and evaluate associations with co-occurring health problems and limitations as well as with the use and expenditures for conventional medical care.
Methods:
Variables were constructed for youth aged 10 to 1...
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 comorbidi...
Background: Shared decision making (SDM) measures family-professional partnerships to provide quality care for children with special health care needs (CSHCN). We evaluate psychometric properties of a new measure of SDM, estimate prevalence and variations in SDM among CSHCN, examine associations with complexity of health needs and other measures of...
Background: Breastfeeding is accepted as the best possible feeding for infants; however the prevalence remains well below national goals. Previously identified barriers include social norms, inadequate support, infant admission into intensive care, hospital policy and practices, and infant becoming sick. Methods: Data source is the 2007 National Su...
Background: A pre-visit, online tool can educate parents prior to a visit, elicit priorities for care and enable linkage of parent reported information in the EMR for use before a well child visit.
Objective: To design and assess the acceptability and feasibility of an online, parent-completed tool, inserted into the EMR, to promote adherence to...
Background: At the center of MCH goals for children with special health care needs (CSHCN) is the development of integrated systems of care optimized to address their broad and changing needs over time. The growing body of LifeCourse research compels a careful assessment of systems of care for CSHCN using this perspective. Methods: Data from all ye...
Purpose To review existing methods to specify condition specific prevalence of and experience of the use of CAM in children in the US and begin to specify a strategic data plan to support evaluation of pediatric integrative medicine. Methods Qualitative (structured interviews; focus groups; concept and best practice methods mapping) and quantitativ...
School success predicts many pathways for health and well-being across the life span. Factors promoting or potentially impeding school success are critical to understand for all children and for children with special health care needs (CSHCN), whose life course trajectories are already impacted by their chronic health problems. The 2007 National Su...
Background: Population-based information on use of complementary and alternative health care by children with specific health conditions is critical but lacking. Objective: To provide a population-based profile of the prevalence of CAM use among all children, children with special health care needs and children with specific health conditions. Desi...
Children with special health care needs (CSHCN) are defined as children with ongoing physical, mental, behavioral or other conditions who also require a type or amount of health and related services beyond that required by children generally. Since 2000, the CSHCN Screener has been used in national and international surveys as an efficient way to i...
Background: The CSHCN Screener has been used since 1999 as an efficient way to identify populations of children with ongoing physical, mental, behavioral or other conditions who also require above normal health care and related services.
Objectives: Revisit the construct, internal and external validity of the CSHCN Screener. Evaluate variations i...
In 2006, the American Academy of Pediatrics recommended developmental screening of young children with a standardized screening tool as a routine component of well-child care.
To assess the national and state prevalence of standardized, parent-completed developmental screening (DS-PC) in the previous 12 months and evaluate associations between scre...
Parent/consumer-reported data is valuable and necessary for population-based assessment of many key child health and health care quality measures relevant to both the Children's Health Insurance Program Reauthorization Act (CHIPRA) of 2009 and the Patient Protection and Affordable Care Act of 2010 (ACA).
The aim of this study was to evaluate nation...
Executive Summary……………….…………………………………………………………………... i A. Purpose……………………………………………………………………………………………. 1 B. Background………………………………………...…………………………………………… … 4
The US Department of Health and Human Services called for comprehensive systems of services for children with special health care needs in its Healthy People 2000 and 2010 health care objectives for the nation.
We report on the proportion of children with special health care needs receiving care in high-quality systems of services measured by attai...
We examined the specific health care needs of Hispanic children with special health care needs (CSHCN) from Spanish-language households, and we compared the needs for children in this group to those for Hispanic and non-Hispanic white CSHCN from English-language households.
We estimated the prevalence of parent-reported health care needs, health co...
New data from the 2007 National Survey of Children's Health show that the percentage of children ages 10-17 who are overweight (body mass index in the eighty-fifth to ninety-fourth percentiles) remained stable, while the national prevalence of obesity (BMI in the ninety-fifth percentile and higher) grew significantly, from 14.8 percent in 2003 to 1...
To examine the association between receiving adequate care coordination (CC) with family-provider relations and family/child outcomes.
We analyzed data from the 2005-2006 National Survey of Children With Special Health Care Needs. Eligible subjects were the 88% of families asked about experience with CC, service use, and communication. Respondents...
We examined how Hispanic children, with stratification according to language to approximate acculturation, differed with respect to sociodemographic characteristics and medication use. We also examined how different factors were associated with the use of different classes of prescription medications.
We used data from the 2004 Medical Expenditure...
The epidemic of childhood overweight and obesity is characterized by known disparities. Less is known about how these disparities vary across and within the state in which a child lives.
To examine the magnitude and patterns of across- and within-state differences in the prevalence of childhood overweight and obesity according to children's insuran...
Our objective is to use the Children with Special Health Care Needs (CSHCN) Screener to identify subgroups of CSHCN differentiated by health status and complexity of need.
Data are from the National Survey of Children with Special Health Care Needs, 2001 and the National Survey of Children's Health, 2003 (conducted by the Maternal and Child Health...
To compare and consider sources of variation in the prevalence and characteristics of children with special health care needs (CSHCN) identified using the CSHCN Screener across the 2001 National Survey of Children with Special Health Care Needs (NS-CSHCN), the 2003 National Survey of Children's Health (NSCH) and the 2001-2004 Medical Expenditures P...
The 2001 National Survey of Children with Special Health Care Needs (CSHCN) used the CSHCN Screener, a 5-item survey based tool, to identify children with special health care needs. The prevalence of special health care needs for Hispanic children was lower than that reported for all other ethnic and racial groups, with the exception of Asian child...
To examine the prevalence of parent-provider discussions of family and community health risks during well-child visits and the gaps between which issues are discussed and which issues parents would like to discuss.
Data came from the National Survey of Early Childhood Health, a nationally representative sample of parents of 2068 children aged 4 to...
To generate a national picture of performance in the area of preventive and developmental services for children aged 4 to 35 months using 4 composite quality measures in the areas of 1) anticipatory guidance and parental education, 2) screening for family psychosocial risks, 3) screening for smoking and drug and alcohol use in the home, and 4) prov...
National health goals include ensuring that all children have a medical home. Historically, medical home has been determined by the presence of a usual or primary source of care, such as a pediatrician or a family physician. More recent definitions expand on this simplistic notion of medical home. A definition of medical home set forth by the Ameri...
Interest in monitoring the quality of health care in the United States has increased in recent years. However, the policy objectives associated with collecting this information are constrained by the limited availability of timely and relevant data at a reasonable cost. Online data-collection technologies hold the promise of gathering data directly...
Public agencies, health care plans, providers, and consumer organizations share the need to monitor the health care needs and quality of care for children with special health care needs (CSHCN). Doing so requires a definition of CSHCN and a precise methodology for operationalizing that definition.
The purpose of this study was to develop an efficie...
The Children with Special Health Care Needs (CSHCN) Screener is an instrument to identify CSHCN, one that is based on parent-reported consequences experienced by children with ongoing health conditions. Information about how this instrument compares to other methods for identifying CSHCN is important for current and future uses of the CSHCN Screene...
Little is known about the population-based prevalence, socio-demographic characteristics, health status and health needs and use of children in America with frequent or severe headache, including migraine. This information is needed to guide the development and implementation effective health care and efforts to target and address the health care s...
