Children at risk for special health care needs.
OBJECTIVE
Despite the widespread use of the Maternal and Child Health Bureau definition of children with special health care needs, no published studies have considered the "at-risk" component of the definition. The purpose of this article is to present a conceptual model of risk for special health care needs.


METHODS
The conceptual model presented here was developed based on a comprehensive review of the literature on the determinants of population health and the etiologic literature for selected representative childhood chronic conditions.


RESULTS
Our conceptual model is built on 5 key pillars derived from the literature. First, determinants of health have been demonstrated to include genetic endowment, the physical and social environment, health-related behaviors, and the health care system. Second, the model recognizes that the relative importance of each of these domains in contributing to the presence of a special health care need is likely to vary across the major chronic conditions experienced by children. Third, these domains can be conceptualized as acting at the child, family, community, or societal level. Fourth, the model recognizes the presence of a complex interplay of causal factors influencing the development of chronic conditions and associated special health care needs. Fifth, the model incorporates a temporal aspect to the development of special health care needs.


CONCLUSIONS
The conceptual model presented here represents a starting point for thinking about the risk factors that influence the occurrence and severity of a special health care need. The model incorporates many of the important breakthroughs by social epidemiologists over the past 25 years by including a broad range of genetic, social, and environmental risk factors; multiple pathways by which they operate; a time dimension; the notion of differential susceptibility and resilience; and a multilevel approach to considering risk. Nevertheless, we recognize that the conceptual model represents an oversimplification of reality. The study of risk factors for special health care needs remains largely in its infancy and is ripe for additional development.
Newacheck
Paul W
PW
Health Policy Institute for Health Policy Studies, University of California, San Francisco, 3333 California St, Suite 265, San Francisco, California 94118, USA. paul.newacheck@ucsf.edu
Rising
Joshua P
JP
Kim
Sue E
SE
D002648:Child; D002662:Child Health Services; D002908:Chronic Disease; D019988:Children with Disabilities; D006291:Health Policy; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006801:Humans; D017146:Models, Organizational; D020380:Needs Assessment; D018570:Risk Assessment; D012307:Risk Factors