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

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.

Factors associated with involuntary hospital admissions in technology-dependent children

“…In the literature, there are several co-existent denominations for referring to these children, such as medically fragile children -referring to those that have serious health problems and frequently need technological devices to maintain their vital functions (3) , and children with medical complexity (CMC) -those that have multi-systemic disorders of a congenital or acquired nature, require intensive care and may be dependent on technological devices (4) . It is estimated that 15% to 20% of children in the United States up to the age of 17 have some special health need (5) . A study that aimed to estimate the number of medically fragile children, and the cost of their health services, showed that 0.25% of the children of the US State of North Carolina fitted this definition.…”

Trajectories and Outcomes Among Children With Special Health Care Needs

“…This raises the importance of appropriate care across the health and education sectors, which is a stated responsibility of the medical home paradigm. 24 Our findings also point to providing care using a life course approach, 15,25 given that child and parent outcomes vary according to long-term SHCN profiles. One potential way to achieve this care is by implementing the overarching principles of the learning health care system.…”

“…11,12 There is currently limited knowledge about the natural history and variability over time of SHCN as a broad grouping and about how outcomes may vary by differing trajectories (eg, emerging, persistent), if such exist. 11 Newacheck et al 13,14 and, more recently, Bethell et al 15 have argued that this missing longitudinal information is crucial to inform the planning of medical, developmental, and education support services for these children across their life course.…”

Improving Maternal and Child Health Across the Life Course: Where Do We Go from Here?

“…Horizontal integration refers to service coordination and systems integration not only within healthcare but also across multiple sectors-education, economic, and community development. And, longitudinal integration focuses on the continuum of care across the life course, especially across transition points [13,15,[18][19][20].…”