Title V-CSHCN: A Closer Look at the Shaping of the National Agenda for Children with Special Health Care Needs

Abstract

ublic health and/or maternal and child health nurses who manage or deliver services to children with special health care needs (CSHCN) in the community work within the policy context of state Title V programs. Those of us who become absorbed at state and local levels sometimes can lose sight of the broader perspective-of the forest for the trees-until something compels us to ask "What led to this change?" or "Who is behind the decisions that are being made?" or "Where are we going?" This article provides a brief historical background of Title V-CSHCN program development and other key legislation that has contributed to supporting CSHCN. It particularly focuses attention on the evolution of policy during the past 20 years to explore the dynamics that transformed and shaped a national agenda for CSHCN. An understanding of the broader policy context can allow us to reflect on (a) how we do or do not operationalize the existing policy, 321 Nursing practice and policy are inextricably linked. Nurses who provide services within state Title V programs for children with special health care needs (CSHCN) are particularly cognizant of the policy context. The development of "familycentered, community-based, coordinated, and culturally competent systems of care for all children with special health care needs" is a phrase that rolls off our tongues. But how was current policy shaped? This article provides a brief historical background of the broader perspective of Title V-CSHCN programs. Kingdon's multiple streams approach to policy formation is used as a conceptual framework to explore how policy was transformed in the 1980s to shape the national agenda for CSHCN. The article also discusses the effect of internal and external forces on the refinement of that agenda during the 1990s. Relevance for nursing practice is discussed, with validation that nurses can influence future policy development and implementationin partnership with families.

How Did Youth Mental Health Make It Onto Australia’s 2011 Federal Policy Agenda?

“…John Kingdon’s (2003) multiple streams framework provides one way of understanding how and why early intervention mental health services for youth rose to the top of a crowded health policy agenda. This approach to understanding the agenda-setting phase of the policy process has been used extensively in the analysis of health and social policy (Battams & Baum, 2010; Craig, Felix, Walker, & Phillips, 2010; Guldbrandsson & Fossum, 2009; Kruger, 2001; Lancaster, Ritter, & Colebatch, 2014; Laraway & Jennings, 2002; Lenton, 2008; Sharma, 2008).…”

“…extensively in the analysis of health and social policy (Battams & Baum, 2010;Craig, Felix, Walker, & Phillips, 2010;Guldbrandsson & Fossum, 2009;Kruger, 2001;Lancaster, Ritter, & Colebatch, 2014;Laraway & Jennings, 2002;Lenton, 2008;Sharma, 2008). Kingdon (2003) conceptualized the agenda-setting phase of the policy process as comprising three streams: problems, policies, and politics (see Figure 1).…”