Children with Special Health Care Needs in Iowa

Children with Special Health Care Needs in Iowa Results from the Iowa Child and Family Household Health Survey Third report in a series Public Policy Center The University of Iowa Iowa Department of Public Health Child Health Specialty Clinics October 22

Children with Special Health Care Needs in Iowa Results from the Iowa Child and Family Household Health Survey Third report in a series Peter Damiano, DDS, MPH Gretchen Hageman, MA Jeffrey Lobas, MD Professor and Director Community Health Consultant Professor and Director Jean Willard, MPH Iowa Department of Andrew Penziner, MD Senior Research Assistant Public Health Program Associate Elizabeth Momany, PhD Edward Schor, MD Barbara Khal, MA Assistant Research Scientist Assistant Vice President Program Consultant Margaret Tyler, MA, MSW The Commonwealth Fund Child Health Specialty Clinics Research Assistant Health Policy Research Program Public Policy Center The University of Iowa September 22 This study was supported by grant # MCH-19T29 from the Maternal and Child Health Bureau, Health Resources and Services Administration, US Department of Health and Human Services. The results and views expressed are the independent products of university research in collaboration with the Iowa Department of Public Health and Child Health Specialty Clinics and do not necessarily represent the views of the Maternal and Child Health Bureau, The Commonwealth Fund or The University of Iowa. Children with Special Health Care Needs 1

2 2 Iowa Child and Family Household Health Survey

INTRODUCTION This report focusing on issues relating to Children with Special Health Care Needs (CSHCN) in Iowa is the second in a series presenting results from the 2 Iowa Child and Family Household Health Survey. Prior to this study, there was little comprehensive information available about the health and well-being of children with special health care needs in Iowa. The study was designed to identify the number of children in Iowa with a such needs and to evaluate their access to care, health status and family functioning as compared to children without special needs in Iowa. The 2 Iowa Child and Family Household Health Survey The 2 Iowa Child and Family Household Health Survey is the first comprehensive statewide attempt to evaluate the health status, access to health care, and social environment of children in Iowa s families. The 2 Iowa Child and Family Household Health Survey included questions about: children s functional health status whether children had special health care needs children s access to and utilization of health care services including: - medical care - dental care - behavioral and emotional health care health insurance coverage of the child and parent school performance child care socialization and self-esteem of the child family environment The survey was a collaborative effort of the University of Iowa Public Policy Center, the Iowa Department of Public Health and the Child Health Specialty Clinics. The intent of the study was to provide information for policymakers and health planners about children in Iowa from a social health perspective. It was funded by a competitive grant from the Maternal and Child Health Bureau, Health Resources and Services Administration, US Department of Health and Human Services. Children with Special Health Care Needs 3 3

Identification of children with special health care needs Children in Iowa with special health care needs were identified using the Foundation for Accountability (FACCT) Children with Special Health Care Needs screening instrument. 1 A child qualified as having a special health care need if, at the time of the survey, he or she experienced one or more of the following consequences AND the consequence was attributable to a medical, behavioral or other health condition that had lasted or was expected to last at least 12 months: has limitations in daily functioning needs or uses medicines prescribed by a doctor has greater than routine need for or use of health and related services needs or uses special therapy such as physical, occupational or speech therapy needs or uses treatment/counseling for emotional, developmental or behavioral problems. SURVEY METHODOLOGY The 2 Iowa Child and Family Household Health Survey was a telephone interview conducted with a stratified random sample of 3,2 families with children in Iowa. The interview included approximately 125 questions, depending on the number of questions relevant to the family being interviewed. The survey instrument was developed by the research team after existing survey instruments such as the National Survey of American Families (NSAF) and the National Health Interview Survey (NHIS) had been evaluated. 2,3 To identify families with children in Iowa, researchers began with a random list of phone numbers provided by a private vendor. To allow for regional comparisons, 4 interviews were completed in each of eight regions of the state. Each region consisted of multiple counties with two exceptions Polk and Scott counties were single-county regions. The design of this study yielded a representative sample of families with children in Iowa. To make statewide estimates, the survey results were weighted and post-stratified using the countylevel 2 US Census data. 4 1 See http://www.facct.org/ 2 See http://newfederalism.urban.org/nsaf/ 3 See http://www.cdc.gov/nchs/nhis.htm 4 See http://factfinder.census.gov/home/en/sf1.html 4 2 Iowa Child and Family Household Health Survey

The survey process began with a screening question to determine if the number dialed reached the home of a family with children. If it had, the adult most knowledgeable about the health and health care of a randomly selected child under age 18 in the household was asked to complete the interview. The dispositions of calls made to complete the 3,2 interviews were as follows: Number completing the interview: 3,241 Number of refusals or unable to complete interview: 1,349 Participation rate: 71% The telephone interviews were conducted between May and October 2 by the Center for Social and Behavioral Research at the University of Northern Iowa. The University of Northern Iowa Human Subjects review board approved the protocol regarding the telephone interview portion of this study. In any telephone-based survey, there is a possibility that results may be biased because those without telephones are not interviewed; people without telephones may have different health conditions and health care needs than those with telephones. In Iowa, it is estimated that three percent of households do not have telephones. 5 Comparison to children without special health care needs For this report, children with a special health care need, as identified using the FACCT special needs screening instrument, were compared with children without a special need on several factors including: demographics functional health status health insurance coverage access to care and use of services child and family well-being including school performance, child care and the family environment Questions about access to therapy services, care coordination and respite care were asked only of parents of children with special health care needs (CSHCN). 5 2 Telephone Information by State. Survey Sampling, Inc., One Post Road, Fairfield, CT 643 Children with Special Health Care Needs 5

RESULTS FOR CSHCN The following is a summary of the results of the comparison between CSHCN and children without special health care needs in Iowa. For those wishing more detail, the results for each question are available in the back of this report. Seventeen percent of Iowa s children (127,) had a special health care need Demographics of families with CSHCN in Iowa According to the 2 US Census, there are 737,212 children under the age of 18 living in Iowa (25% of Iowa s population). This is similar to national statistics indicating that 25.7% of the United States population is under age 18. There are 361,153 families with children under age 18 in Iowa. Seventeen percent of Iowa s children (127,) were identified as having a special health care need as defined by the FACCT screening instrument used in this study. Nationally, a different CSHCN identification method found a similar percentage of children (18%) with a special health care need. 6 Children with special health care needs in Iowa were similar to children without such needs regarding size of household (average of 2 adults and 2.4 children), and racial distribution (9 percent white, three percent African-American, just over one percent Native American and Asian, and five percent other ; within this distribution, three percent of Iowa s children were considered to be of more than one race and three percent were of Spanish or Hispanic origin). Children with special needs were more likely to live in single parent households (15% vs 1%) and tended to live in lower income households. Almost one in four CSHCN (23%) lived in a family with a household income of less than $25, compared to 18% of children without special needs. Almost one in four CSHCN lived in households with annual incomes below Functional health status of children As expected, the reported health status of children with special needs in Iowa was lower than for other Iowa children. Over nine out of ten children without special needs (94%) were considered to be in excellent (73%) or very good (21%) health compared to only 75% of CSHCN. $25, 6 Newacheck PW, McManus M, Fox HB, Hung YY, Halfon N. Access to health care for children with special health care needs. Pediatrics. 15(4 Pt 1):76-6, 2 Apr. 6 2 Iowa Child and Family Household Health Survey

At the lower end of the health spectrum, 6 percent of CSHCN were considered to be in either fair or poor health compared to less than 1% of other children. The activities of CSHCN were also more likely to be limited both physically (23% of CSHCN vs 8% of the non-special needs children) and due to behavioral or emotional issues (11% vs <1%). The five most common chronic conditions reported for CSHCN were asthma (24%), chronic allergies/sinus problems (21%), Attention Deficit Hyperactivity Disorder (ADHD) (19%), CSHCN were more likely to have insurance but also more likely to be without health insurance at some point during the year behavioral problems other than ADHD or depression (5%), and depression (4%). Health insurance coverage Children with special health care needs were more likely to have had health insurance at the time of the survey but were twice as likely to have been without insurance at some point in the previous year. Three percent of CSHCN were without health insurance at the time of the survey compared to seven percent of children without special needs. Ten percent of CSHCN were without insurance at some point in the previous year compared to five percent of other children. Forty-one percent of Iowa s special needs children had parents that worried about their ability to pay for their child s health care in the past year, and 15% worried about it a great deal while parents of only 32% of children without special health care needs expressed worry. Twice as many CSHCN were covered by Medicaid as their primary source of health insurance (19% vs 8%). The parents of 58% of the CSHCN rated their child s insurance as either excellent or very good, while 15% rated it either fair or poor. Access to medical care and use of services Nine out of ten children in Iowa have a regular source of medical care, defined as one person the parent or guardian thinks of as their child s personal doctor or nurse. Nationally, 93% of children have a regular source of care. 7 There were differences for Iowa s CSHCN regarding access to care and use of services. Reported need for care varied: CSHCN were much more likely to need medical care (72%) than children without CSHCN were twice as likely to be covered by the Medicaid program 7 See http://www.cdc.gov/nchs/data/nhis/measure2.pdf Children with Special Health Care Needs 7

Unmet need for medical, dental and behavioral/ emotional care was higher for CSHCN special needs (48%). Unmet need for medical care was also more common for CSHCN (7% vs 2%). In both groups, about half of those with unmet need reported cost as the reason for having been stopped from receiving care at some point in the previous year; CSHCN were much more likely to have been stopped because their insurance did not cover the needed care (38% vs 12%). Children with special needs had more physician visits (47% had 5 or more visits vs 19% ) and were more likely to have been to a hospital emergency room (ER) in previous year (44% vs 28%). Six percent of CSHCN had been to a hospital ER five or more times within the year. Preventive care Children with special needs were more likely to have had a preventive health care visit in the previous year. Over three-quarters (76%) of children without special needs in Iowa had a preventive visit in the previous year, compared to 82 percent of CSHCN. Children with special needs were also more likely to have received anticipatory guidance (39% vs 26%), defined as whether the parent had received information about seat belts, car seats, bicycle safety or nutrition counseling, depending on the age of the child. Specialty care CSHCN were less likely to be engaged in school and their school performance was more likely to be rated fair or poor Sixty percent of CSHCN reported needing a specialist in the previous year compared to 23% of children without special needs. CSHCN were also more likely to have had a problem getting specialty care. About one-quarter of CSHCN had a problem getting care, and among those 12 percent reported having a big problem. Eleven percent of children without special health care needs reported that getting specialty care was a problem, and among those, two percent reported it to be a big problem. One-quarter of CSHCN had a problem receiving needed specialty care Dental care More than four out of five (82%) CSHCN had a dental visit in the previous year compared to less than three quarters of the other children (73%). Parents of children with special needs were more likely to say their child needed dental care (57% vs 44%). Although CSHCN were more likely to have dental insurance (84% vs 73%), they were also more likely to have unmet need for dental care (11% vs 7%). While most of the unmet need was related to cost issues, more than twice as many CSHCN reported that the unmet need was related to trouble getting a dental appointment (55% of CSHCN with unmet dental need compared to 22%). 8 2 Iowa Child and Family Household Health Survey

Behavioral/emotional care Thirty percent of Iowa s CSHCN needed behavioral or emotional care in the previous year. Only four percent of children without special needs reported need for this type of service. More CSHCN were also unable to get needed behavioral/emotional care (i.e., unmet need) in the previous year (12% vs 8%). School performance Parents were asked several questions regarding their child s education, including questions about their child s engagement in school, their performance in school, and their expected school advancement. A series of four questions were used to evaluate the degree to which school-age children in Iowa were engaged in school: 1) how much the child cared about doing well, 2) how much they needed to be forced to complete homework, 3) whether they did just enough homework to get by, and 4) if they completed homework on time. CSHCN were much more likely to be identified as having a low engagement in school (29% vs 1%) and much less likely to be considered highly engaged in school (28% vs 44%). School performance compared to other children in their child s grade was rated either excellent or very good for half of CSHCN. The performance of almost three quarters of children without special needs was rated as excellent or very good. CSHCN were also much more likely to have their school performance rated as fair or poor (22% vs 7%). While the vast majority of all children s parents (87%) would like to see their child attend a 4-year college, almost one-quarter of the parents of CSHCN thought their child would receive a two-year degree or less compared to 11 percent of other children. Child care CSHCN were less likely to be engaged in school and their school performance was more likely to be rated fair or poor Almost half (46%) of all children under age 1 in Iowa received child care from someone other than a parent. The child care setting differed between the two groups for children who were in child care more than five hours per week. Among children under age four, CSHCN were more likely to receive care from a sibling (8% vs 2%) and were less likely to be cared for by a grandparent (9% vs 16%). CSHCN over age four were more likely to be in a day care setting (27% vs 19%) and more likely to be with an unrelated babysitter (37% vs 26%). Although One in three parents of CSHCN had difficulty finding child care because of the child s special health care need. Children with Special Health Care Needs 9

CSHCN were about as likely as children without special health care needs to participate in extracurricular activities Sixteen percent of CSHCN lived in a household where substance use was a problem most parents were satisified with their child care situation, the parents of four percent of CSHCN were very dissatisfied with their child care arrangements compared with 1% of other children. CSHCN were more likely to have parents reporting trouble finding sick care for their child (33% vs 25%). About one-third of parents of CSHCN had difficulty finding child care because of the child s special health care need. Family environment Several topics were evaluated to investigate the environment in which CSHCN and their families function in Iowa. For this report, results are included for: participation in extracurricular activities marital status and satisfaction substance use/abuse in the household Most children in Iowa (83%) over the age of 4 participated in activities such as clubs, team sports, band or a religious group. CSHCN were about as likely to participate in these activities as other children (81% vs 84%). Although ninety percent of Iowa s children had parents who reported knowing all or most of their child s friends, parents of CSHCN were less likely to report knowing all or most of their child s friends (84% vs 91%). Although most marital relationships acheived high satisfaction ratings, CSHCN were more likely to have parents who were less satisfied with their marital situation. Seventy-nine percent of CSHCN lived in a household where the parent rated the quality of their relationship with their spouse or partner as either excellent or very good compared to 86% of children without special needs. Five percent of CSHCN had parents who rated their relationship as fair or poor compared to 3% of other children. Ten percent of all children lived in a household where substance use was reported to be a problem. However, 16 percent of CSHCN were in a household with a reported substance use problem compared with nine percent of children without special needs. Substance abuse was also more likley to be a big problem in the households of CSHCN (6% vs 3%). 1 2 Iowa Child and Family Household Health Survey

Issues specific to CSHCN The parents of children identified as having a special health care need were asked questions about access to: physical, occupational, or speech therapy, durable medical supplies, care coordination, home health care, genetic counseling, respite care and family counseling. Two percent of CSHCN, estimated at between 2,4 and 3, children in Iowa, were unable to receive physical/occupational therapy, home health, or durable medical supplies at some time Twelve percent of CSHCN reported receiving carecoordination in the previous year. While much of this unmet need was due to cost, there were other barriers depending on the type of service. For example, 53 percent of those with unmet need for physical, occupational, or speech therapy did not believe these services were available in their area. Just over one-quarter of those with unmet need for medical supplies and home health did not believe they were available in their area. Seventy percent of those with unmet need for medical supplies reported that lack of insurance coverage was the reason why they could not receive needed services. Twelve percent of children received care coordination, and about two percent of CSHCN (about 2,5 children) reported unmet need for this service. Two percent of children had families reporting a need for respite services, with 8 percent of those children s families able to receive the service. Four percent of children were in families reporting need for genetic counseling, and just over half received it. Fifteen percent of CSHCN were in families that were in need of mental health care, and about 2 percent of these families (about 3,8 families) were unable to receive it. CONCLUSIONS Identifying CSHCN is a challenge. From a public health perspective, it is often beneficial to broadly classify CSHCN so that the number of children at risk may be estimated and resources appropriately allocated for program planning. On the other hand, specific programs designed to treat CSHCN, such as the Iowa Child Health Specialty Clinics, may need to more narrowly define CSHCN to prioritize limited resources and serve those most in need. It is our belief that the FACCT CSHCN screener, used to Creative responses can help get services to a lowvolume areas of need (e.g., respite care) Children with Special Health Care Needs 11

identify CSHCN in the 2 Iowa Child and Family Household Health Survey, broadly defines children with special needs, which is appropriate for this type of statewide analysis. An estimated 127, children in Iowa identified as having a special health care need from this study. Children with special health care needs in Iowa were found to have a lower health status and more physical and behavioral/emotional limitations, as would be expected with a special needs population. While they were as likely to have a regular source of medical care as other children, CSHCN were more likely to need and have unmet needs for medical and specialty care. Allergies/asthma and behavioral/emotional problems were the most common chronic conditions of CSHCN. Although CSHCN were more likely to have health insurance, they were more likely to rate this health insurance lower. They were also more likely to have been without health insurance at some point in the past year, and more likely to receive public health insurance (i.e., Medicaid). CSHCN had more physician visits and more visits to an ER. They were also more likely, however, to have had a preventive visit and to have received anticipatory guidance (i.e., preventive counseling). Compared to other children in Iowa, parents of CSHCN rated school performance lower and had lower expectations for their child s advancement. On the other hand, CSHCN were equally likely to be involved in extracurricular activities. The parents of CSHCN were less satisfied with their marital relationships. CSHCN were also more likely to be in households where substance use was a problem. Further study is needed to determine if and how families of CSHCN could benefit from programs that help address issues in the family environment. Further research and investigation is needed to determine how best to improve the access to care for CSHCN in Iowa and how best to identify CSHCN at the local level. Some difficulties in accessing services, especially specialized services such as genetic counseling and care coordination, may require more education about services that are already available in an area. Other barriers to care may require a more creative solution to get services to a low-volume area of need. 12 2 Iowa Child and Family Household Health Survey

Responses to Questions Comparing CSHCN with Other Children in Iowa Table of Contents 1. Child has a special health care need (from screening questions) 16 2. What is the number of children in your family? 16 3. In general, how would you rate [CHILD] s overall health now? 16 4. During the last 4 weeks, how many days has your child not been able to do his/her normal activities because of sickness? 17 5. During the past 12 months, has [HE/SHE] been limited because of [HIS/HER] PHYSICAL health? 17 6. During the past 12 months, has [HE/SHE] been limited because of [HIS/HER] BEHAVIORAL OR EMOTIONAL health? 17 7. Do you have any kind of health care coverage for [CHILD], including health insurance, prepaid plans such as HMOs, or government plans such as Medicaid or Title 19? 18 8. What type of health care coverage do you use to pay for most of [child s] medical care? 18 9. In the past 12 months has there been any time that [CHILD] has not had any health insurance coverage? 18 1. In the last 12 months, how much, if at all, have you worried about your ability to pay for [CHILD] s health care? 19 11. Thinking about how well that health care coverage meets [CHILD] s health care needs, how would you rate that health care coverage? 19 12. Do you have any kind of health care coverage for yourself, including health insurance, prepaid plans such as HMOs, or government plans such as Medicaid or Title 19? 19 13. Do you have one person you think of as [CHILD] s personal doctor or nurse? 19 14. During the last 12 months, was there any time when you or a health professional thought your child needed medical care of any kind? 2 15. In the last 12 months, was there any time when [CHILD] needed medical care but could not get it for any reason? 2 16. Was there anything else that stopped you from getting medical care for [CHILD] in the last 12 months? 2 17. In the last 12 months, when [CHILD] needed care right away for an illness or injury, how often did your child get care as soon as you wanted? 21 18. In the last 12 months, was there any time when you or a health professional thought your child needed care from a specialist? 21 19. In the last 12 months, how much of a problem, if any, was it to get the care your child needed from a specialist? 21 2. In the last 12 months, how many times did [CHILD] go to a hospital emergency room? 22 21. In the last 12 months, not counting times he/she went to an emergency room, how many times did [CHILD] go to a doctor s office or clinic? This includes all types of visits including routine check ups, care for illness, injury, or preventive care. 22 Children with Special Health Care Needs 13

22. In the last 12 months, has the child s health care professional encouraged you to take any type of preventive health steps for [CHILD] such as watching what [HE/SHE] eats or using bicycle helmets and seat belts? 22 23. When was your child s last visit to [HIS/HER] personal doctor or nurse for routine preventive care such as a check-up or vaccination shots? 23 24. In the last 12 months, how much of a problem, if any, was it to get this type of care (preventive care) for [CHILD]? 23 25. Does [CHILD] currently have insurance that covers dental care? 23 26. When was [CHILD] s last dental check-up? 24 27. During the past 12 months, was there any time when you or a health professional thought [CHILD] needed dental care? 24 28. In the last 12 months, was there any time when [CHILD] needed dental care but could not get it for any reason? 24 29. Did any of the following stop you from getting dental care for [CHILD] in the last 12 months? (Indicate all that apply.) 24 3. During the past 12 months, was there any time when you or a health professional thought [CHILD] needed care for behavioral or emotional problems? 25 31. In the last 12 months, was there any time when [CHILD] needed care for behavioral or emotional problems but could not get it for any reason? 25 32. Please tell me if any of these stopped you from getting behavioral or emotional care for [CHILD] in the last 12 months. 25 33. During the past 12 months, was there any time when you or a health professional thought [CHILD] needed prescription medicine for any reason? 26 34. In the last 12 months, how much of a problem, if any, was it to get a prescription filled or medicine for [CHILD]? 26 35. What grade in school is [CHILD] attending? 27 36. Would you say [CHILD] cares about doing well in school? 28 37. Would you say [CHILD] needs to be forced to complete [HIS/HER] schoolwork? 28 38. Would you say [CHILD] does just enough schoolwork to get by? 28 39. Would you say [CHILD] completes homework on time? 29 4. Compared to other children in [CHILD] s grade, how would you rate [HIS/HER] performance at school? 29 41. How far would you like to see [CHILD] go in school? 29 42. School engagement scale 3 43. In the last year, has [CHILD] participated in any clubs, teams, or organizations such as student government, sports, drama, band, chorus, scouts, or a religious group? 3 44. Regarding [CHILD] s friends, how many would you say that you have met? 3 45. Who took care of [CHILD] most often when you were at work or school during the past month, not counting [HIS/HER] regular school hours or times [HE/SHE] cared for [HIM/HER] self? [OVER AGE 4 ONLY] 31 46. Who took care of [CHILD] most often when you were at work or school during the past month? [UNDER AGE 4 ONLY] 31 14 2 Iowa Child and Family Household Health Survey

47. How satisfied are you with [CHILD] s child care situation? 32 48. In the last 12 months when [CHILD] was sick, how much of a problem, if any, was it to find childcare when you needed to work or go to school? 32 49. How would you rate the overall quality of your relationship with your spouse/partner? 32 5. In the last 12 months, how much of a problem for your family, if any, has been caused by a family member s drug or alcohol use? 33 51. Is [CHILD] of Spanish or Hispanic origin? 33 52. Race (indicate one or more) 33 53. Household income 34 Children with Special Health Care Needs 15

1. Child has a special health care need (from screening questions) Yes 8.4% 15751 No 91.6% 172662 Total 188413 Ages -4 Ages 5-9 Ages 1-14 Ages 15-17 All 18.4% 3738 81.6% 165295 2263 21.1% 44553 78.9% 166566 211119 22.% 29773 78.% 1534 1357 17.3% 127385 82.7% 69827 737212 2. What is the number of children in your family? 1 24.3% 383 2 46.% 7249 3 21.4% 3364 4 3.9% 611 5 or more 4.4% 696 Total 1575 Ages -4 Ages 5-9 Ages 1-14 Ages 15-17 All 24.6% 42527 35.4% 61172 25.1% 43292 12.6% 21764 2.3% 397 172662 11.8% 4389 29.9% 11147 35.7% 1333 17.2% 6429 5.5% 241 3739 14.2% 23399 36.5% 6337 33.6% 55564 9% 14821 6.8% 11174 165295 18.6% 8292 39.1% 17432 32.2% 14343 5.5% 2436 4.6% 25 44553 14.9% 24877 38.2% 63658 3.3% 5538 11.9% 19862 4.6% 763 166565 38.4% 1144 34.% 1129 17.3% 5146 2.1% 624 8.2% 2434 29773 31.9% 33543 42.3% 44587 14.8% 15542 6.4% 6693 4.7% 494 1535 21.9% 27951 36.% 45957 28.4% 36156 7.9% 11 5.7% 7221 127385 2.4% 124346 37.7% 229754 27.% 164936 1.4% 6314 4.5% 27651 69827 3. In general, how would you rate [CHILD] s overall health now? Excellent 17.3% 273 Very Good 47.8% 7441 Good 22.3% 3469 Fair 12.6% 1969 Poor % Total 15582 Ages -4 Ages 5-9 Ages 1-14 Ages 15-17 All 74.3% 12827 19.8% 34242 5.8% 147.1% 87 % 172663 28.3% 156 47.8% 17817 19.1% 7131 3.8% 1435 1.% 365 3738 75.8% 12526 2.4% 33713 3.5% 5749.3% 573.% 165295 4.3% 17971 36.3% 16182 19.9% 8851 2.8% 1259.7% 291 44554 73.1% 12187 21.3% 35435 5.1% 8578.4% 746.% 166566 37.9% 11287 39.9% 11892 13.7% 479 4.3% 129 4.1% 1225 29773 66.7% 7239 25.4% 26747 7.5% 7937.4% 381.% 1534 33.4% 42521 41.9% 53332 18.5% 23529 4.7% 5953 1.5% 1881 127216 73.1% 445594 21.3% 13137 5.3% 32311.3% 1786.% 69828 16 2 Iowa Child and Family Household Health Survey

4. During the last 4 weeks, how many days has your child not been able to do his/her normal activities because of sickness? 76.1% 11835 1-2 days 9.2% 1434 3-4 days.7% 16 5-7 days 11.2% 1739 8-1 days 1.4% 212 11-2 days 1.5% 228 21 + days % Total 15554 Ages -4 Ages 5-9 Ages 1-14 Ages 15-17 All 9.1%% 155643 7.6% 1361 1.9% 3274.2% 424.2% 261 % % 172663 78.2% 2898 12.1% 4465 3.% 195 2.1% 783 2.4% 881 % 2.3% 849 3753 89.3% 147435 7.5% 12426 2.1% 347 1.% 1668.1% 85.1% 171 % 165192 83.% 36963 9.9% 4423 4.4% 1951 1.9% 868.2% 16.5% 243 % 44554 88.3% 1474 8.7% 14476 2.2% 3689.4% 592.3% 466.1% 243 % 16647 83.9% 24992 6.6% 1963 3.3% 972 2.2% 662.7% 221 1.1% 339 2.1% 624 29773 89.2% 93981 7.5% 7865 1.3% 1412.8% 852.3% 348.4% 443.4% 43 1534 81.% 1277 9.7% 12284 3.2% 4124 3.2% 451 1.1% 142.6% 81 1.2% 1473 126932 89.2% 54463 7.8% 47828 1.9% 11782.6% 3536.2% 116.1% 856.1% 43 69628 5. During the past 12 months, has [HE/SHE] been limited because of [HIS/HER] PHYSICAL health? Limited a lot 8.5% 1337 Limited some 9.5% 153 Limited a little 8.% 1261 Not limited 74.% 1165 Total 15751 Ages -4 Ages 5-9 Ages 1-14 Ages 15-17 All.3% 432 1.% 1767 4.4% 7646 94.3% 162818 172663 4.4% 1649 5.8% 2175 12.4% 4611 77.4% 28873 3738.5% 81 1.5% 2447 5.% 8335 93.% 153475 16558 3.5% 1542 5.% 2214 15.1% 6718 76.5% 348 44554.5% 855 2.2% 3629 5.2% 8665 92.1% 153417 166566 11.2% 3329 5.6% 1662 5.9% 1755 77.3% 2327 29773.5% 511 3.4% 3529 7.5% 7863 88.7% 9341 1534 6.2% 7856 5.9% 7554 11.3% 14345 76.6% 9763 127385.4% 2599 1.9% 11371 5.3% 3259 92.4% 563111 6959 6. During the past 12 months, has [HE/SHE] been limited because of [HIS/HER] BEHAVIORAL OR EMOTIONAL health? Limited a lot 2.6% 43 Limited some 1.4% 228 Limited a little 3.2% 59 Not limited 92.8% 14611 Total 15751 Ages -4 Ages 5-9 Ages 1-14 Ages 15-17 All.%.1% 87.4% 637 99.6% 171938 172662 2.1% 767 3.8% 1414 4.4% 1635 89.8% 33492 3738.%.4% 652.5% 841 99.1% 16382 165295 2.5% 1132 5.9% 2613 4.% 1791 87.5% 38921 44457.1% 194.1% 92.8% 1334 99.% 164945 166565.9% 257 5.7% 1683 4.5% 1349 89.% 26485 29774.%.2% 22.2% 166 99.6% 14919 1535 2.% 2558 4.7% 5938 4.2% 5284 89.2% 11358 127288 <.1% 194.2% 151.5% 2978 99.3% 6565 69828 Children with Special Health Care Needs 17

7. Do you have any kind of health care coverage for [CHILD], including health insurance, prepaid plans such as HMOs, or government plans such as Medicaid or Title 19? Yes 93.9% 14792 No 6.1% 959 Total 15751 Ages -4 Ages 5-9 Ages 1-14 Ages 15-17 All 91.5% 157837 8.5% 14711 172548 99.9% 37257.1% 51 3738 95.5% 157762 4.5% 738 165142 96.1% 42813 3.9% 174 44553 92.8% 154531 7.2% 1235 166566 94.8% 28239 5.2% 1534 29773 93.7% 98721 6.3% 6583 1534 96.6% 12311 3.4% 4284 127385 93.3% 568851 6.7% 479 6956 8. What type of health care coverage do you use to pay for most of [child s] medical care? Is it coverage through Your employer 12.4% 1831 Someone else s employer Plan you or someone else buys on your own Ages -4 Ages 5-9 Ages 1-14 Ages 15-17 All 37.8% 5594 12.9% 193 HAWK-I 5.6% 832 Medicaid (TitleXIX) Military, CHAMPUS or VA 31.3% 4633 % Other source % None % Total 14793 34.2% 53967 46.% 72628 4.3% 6773.8% 1239 13.8% 2172.1% 132.8% 1273 % 157732 3.1% 1121 43.2% 1612 4.8% 18 1.5% 545 16.9% 6287 1.% 356 1.1% 419 1.5% 548 37258 31.6% 49847 48.1% 75783 8.9% 1496.8% 1279 7.7% 12141.4% 57 2.% 312.5% 855 157673 36.2% 1558 42.6% 18219 4.8% 237.3% 116 14.9% 6372 % 1.3% 562 % 42814 37.4% 57778 46.9% 72427 8.9% 1372.4% 543 5.3% 8254.1% 16 1.1% 1649 % 154531 38.1% 1747 35.7% 177 3.5% 994 2.2% 623 19.9% 5633 %.6% 166 % 2824 36.7% 36143 49.2% 48458 6.8% 6662.1% 11 4.9% 4792.8% 759 1.6% 169 % 98524 31.9% 39287 4.6% 49991 5.5% 6733 1.7% 2116 18.6% 22924.3% 356.9% 1146.4% 548 12311 34.8% 19736 47.4% 269296 7.3% 41251.6% 3162 8.3% 4697.3% 1622 1.3% 7632.2% 855 568461 9. In the past 12 months has there been any time that [CHILD] has not had any health insurance coverage? Yes 13.1% 1942 No 86.9% 12849 Total 14791 Ages -4 Ages 5-9 Ages 1-14 Ages 15-17 All 6.6% 1456 93.4% 147316 157772 8.4% 3139 91.6% 34118 37257 5.5% 8627 94.5% 149135 157762 7.5% 3155 92.5% 39172 42327 5.2% 876 94.8% 146455 154531 14.7% 414 85.3% 2499 28239 3.3% 3222 96.7% 9539 98612 1.1% 12377 89.9% 11238 122615 5.3% 3381 94.7% 538296 568677 18 2 Iowa Child and Family Household Health Survey

1. In the last 12 months, how much, if at all, have you worried about your ability to pay for [CHILD] s health care? A great deal 13.6% 2139 Somewhat 8.4% 1321 A little 11.9% 178 Not at all 66.1% 1413 Total 15751 Ages -4 Ages 5-9 Ages 1-14 Ages 15-17 All 8.6% 14829 12.5% 21575 14.6% 25158 64.3% 11111 172663 11.9% 4457 13.6% 563 13.8% 5158 6.7% 2263 3738 7.8% 12921 11.9% 19647 9.7% 15959 7.6% 116717 165244 13.8% 6157 17.2% 7651 11.9% 5311 57.1% 25433 44552 8.4% 1434 12.1% 262 9.4% 15678 7.1% 11667 166381 22.1% 6569 11.8% 3525 11.2% 3328 54.9% 1635 29772 7.6% 7998 13.1% 13721 1.9% 11431 68.4% 71685 14835 15.2% 19323 13.8% 1756 12.3% 15675 58.7% 74827 127385 8.2% 49782 12.3% 755 11.2% 68226 68.3% 416111 69124 11. Thinking about how well that health care coverage meets [CHILD] s health care needs, would you say that the health care coverage is Excellent 36.2% 5359 Very Good Ages -4 Ages 5-9 Ages 1-14 Ages 15-17 All 27.4% 446 Good 22.5% 3326 Fair 8.6% 1275 Poor 5.3% 785 Total 14791 34.% 53226 34.2% 53587 23.5% 36841 7.2% 11242 1.1% 172 156616 21.9% 887 34.1% 12562 3.8% 11344 7.7% 2837 5.5% 235 36865 38.6% 6148 33.% 51437 2.7% 32261 6.3% 9814 1.5% 2286 155946 23.5% 9855 33.2% 13931 27.8% 11642 12.1% 581 3.4% 1431 4194 28.9% 43782 38.5% 58393 22.4% 3418 8.1% 12311 2.1% 3164 151668 24.6% 652 36.1% 9539 23.4% 6178 12.7% 3364 3.1% 86 26389 26.5% 25693 37.9% 36846 24.5% 23828 7.5% 7241 3.6% 3512 9712 24.8% 2983 33.4% 478 27.1% 32491 1.5% 12556 4.2% 557 119985 32.6% 182849 35.7% 2263 22.6% 126948 7.2% 469 1.9% 1682 561351 12. Do you have any kind of health care coverage for yourself, including health insurance, prepaid plans such as HMOs, or government plans such as Medicaid or Title 19? Yes 73.9% 11634 No 26.1% 4117 Total 15751 Ages -4 Ages 5-9 Ages 1-14 Ages 15-17 All 87.% 15145 13.% 22518 172663 92.8% 34615 7.2% 2693 3738 91.% 1529 9.% 14916 16526 91.8% 497 8.2% 3646 445535 89.9% 149722 1.1% 16843 166565 89.4% 2662 1.6% 317 29772 89.8.% 94521 1.2% 1784 1535 89.3% 113758 1.7% 13626 127384 87.4% 544678 12.6% 78687 623365 13. Do you have one person you think of as [CHILD] s personal doctor or nurse? Yes 93.8% 14778 No 6.2% 972 Ages -4 Ages 5-9 Ages 1-14 Ages 15-17 All 94.6% 163167 5.4% 9255 86.3% 32191 13.7% 5117 92.6% 152863 7.4% 12199 89.9% 3996 1.1% 4496 86.2% 14358 13.8% 22986 94.3% 27984 5.7% 1688 86.3% 9881 13.7% 14423 9.3% 114913 9.7% 12274 9.3% 55491 9.7% 58864 Children with Special Health Care Needs 19

Total 1575 172422 3738 16562 44456 166566 29672 1534 127187 69355 14. During the last 12 months, was there any time when you or a health professional thought your child needed medical care of any kind? Yes 89.% 1423 No 11.% 1727 Total 1575 Ages -4 Ages 5-9 Ages 1-14 Ages 15-17 All 51.6% 8936 48.4% 83626 172662 69.6% 25975 3.4% 11333 3738 49.9% 82372 5.1% 82837 16529 63.3% 2822 36.7% 16333 44553 45.6% 75841 54.4% 9619 16646 76.8% 22864 23.2% 698 29772 44.% 46313 56.% 58835 15148 71.5% 9183 28.5% 3632 127385 48.2% 293562 51.8% 315918 6948 15. In the last 12 months, was there any time when [CHILD] needed medical care but could not get it for any reason? Yes 4.4% 624 No 95.6% 13399 Total 1423 Ages -4 Ages 5-9 Ages 1-14 Ages 15-17 All 2.2% 1926 97.8% 8711 8936 6.3% 1627 93.7% 24348 25975 1.3% 173 98.7% 81385 82458 6.6% 1871 93.4% 26349 2822.9% 658 99.1% 75289 75947 8.7% 1985 91.3% 2879 22864 1.9% 875 98.1% 45594 46469 6.7% 618 93.3% 84975 9183 1.5% 4532 98.5% 289377 29399 16. Was there anything else that stopped you from getting medical care for [CHILD] in the last 12 months? Couldn t afford/no insurance Insurance didn t cover care Trouble getting appointment Travel/transportation problems Uncomfortable with providers Ages -4 Ages 5-9 Ages 1-14 Ages 15-17 All.% 33.9% 212 66.1% 413 76.9% 48 57.% 356 58.8% 1133 16.2% 312 47.2% 91 % 24.6% 473 29.3% 477.% 77.% 1252 % % 61.8% 663 23.% 375 38.2% 41 % 51.1% 832 Total N* 625 1926 1627 173 1871 658 1986 876 618 4532 * Total percent does not equal 1 due to multiple responses 5.8% 951 24.3% 455 63.2% 1183 37.3% 698 12.5% 233 67.6% 445 32.4% 213 67.6% 445 % 35.4% 233 87.3% 1733 64.6% 1283 52.4% 14 46.4% 921 28.4% 565 38.7% 339 % 61.3% 536 % 48.6% 426 51.7% 316 38.1% 2325 63.7% 3888 34.4% 299 32.5% 1985 56.9% 258 11.6% 525 5.8% 232 % 25.% 1131 2 2 Iowa Child and Family Household Health Survey

17. In the last 12 months, when [CHILD] needed care right away for an illness or injury, how often did your child get care as soon as you wanted Never.% Sometimes 5.5% 775 Usually 3.3% 459 Always 89.2% 1258 Didn t need 2.% 282 Total 1424 Ages -4 Ages 5-9 Ages 1-14 Ages 15-17 All.% 2.8% 2473 8.5% 7599 87.4% 77846 1.3% 1118 8936 3.4% 884 6.9% 1788 1.6% 276 79.1% 2543.% 82458.2% 25 2.% 1617 9.2% 7615 86.6% 71377 2.% 1644 82458.% 4.% 1117 16.7% 4718 78.6% 22186.7% 2 28221.% 1.8% 1333 9.6% 7286 86.3% 6557 2.3% 1757 75946 1.4% 311 4.3% 978 14.2% 3243 78.2% 17793 1.9% 44 22765 1.% 45 4.7% 217 1.9% 544 81.4% 3782 2.1% 985 46469 1.3% 1195 5.1% 4658 12.3% 1118 8.3% 733 1.% 922 9985.6% 185 2.6% 7593 9.3% 27544 85.6% 252613 1.9% 554 29514 18. In the last 12 months, was there any time when you or a health professional thought your child needed care from a specialist? Yes 66.5% 9319 No 33.5% 475 Total 1424 Ages -4 Ages 5-9 Ages 1-14 Ages 15-17 All 19.3% 1722 8.7% 71816 8936 58.8% 15272 41.2% 173 25975 19.9% 16427 8.1% 6631 82458 6.5% 1767 39.5% 11154 28221 24.5% 18636 75.5% 57311 75947 58.4% 13348 41.6% 9517 22865 32.9% 15285 67.1% 31184 46469 6.4% 555 39.6% 3678 9183 23.% 67568 77.% 226342 29391 19. In the last 12 months, how much of a problem, if any, was it to get the care your child needed from a specialist? Big problem 13.4% 1245 Small problem 19.4% 1811 Not a problem 67.2% 6263 Total 9319 Ages -4 Ages 5-9 Ages 1-14 Ages 15-17 All.6% 16 7.% 1181 92.4% 15559 16846 7.4% 112 4.1% 615 88.5% 13198 14915.6% 12 16.1% 2647 83.3% 13678 16427 13.2% 2256 13.% 2227 73.7% 12584 1767 1.3% 233 4.3% 84 94.4% 17599 18636 15.% 27 11.6% 1546 73.4% 9795 13348 6.6% 13 6.7% 129 86.7% 13253 15285 12.1% 661 11.3% 6199 76.6% 4184 54649 2.1% 1443 8.4% 5661 89.4% 689 67193 Children with Special Health Care Needs 21

2. In the last 12 months, how many times did [CHILD] go to a hospital emergency room? 34.7% 4862 1 23.5% 3293 2 to 4 2.1% 2815 5 to 9 1.8% 1514 1 or more 11.% 154 Total 1424 Ages -4 Ages 5-9 Ages 1-14 Ages 15-17 All 67.9% 6433 22.3% 19883 9.3% 8264.3% 288.2% 168 8936 54.9% 14266 2.5% 5313 19.8% 514 3.5% 914 1.3% 343 25976 72.2% 59513 23.5% 19344 4.1% 3419.2% 183 % 82459 66.1% 18657 15.2% 4278 16.6% 4684.3% 92 1.8% 51 28221 77.3% 58657 18.5% 1427 4.% 35.1% 16 % 7584 56.9% 131 25.1% 5747 16.8% 3831 1.2% 277.% 22865 69.6% 32321 21.6% 134 7.8% 3637.3% 119.8% 358 46469 55.8% 5794 2.5% 18631 18.1% 16469 3.1% 2797 2.6% 2393 9184 71.8% 21924 21.5% 63287 6.3% 1837.2% 696.2% 526 29383 21. In the last 12 months, not counting times he/she went to an emergency room, how many times did [CHILD] go to a doctor s office or clinic? This includes all types of visits including routine check ups, care for illness, injury, or preventive care. 1.8% 282 1 % 2 to 4 38.1% 5995 5 to 9 11.2% 1771 1 or more 48.9% 773 Total 15751 Ages -4 Ages 5-9 Ages 1-14 Ages 15-17 All 3.8% 6519 17.% 29115 47.5% 81474 24.8% 42572 6.8% 11694 171374 5.1% 196 1.55 3926 33.45 12475 27.8% 1386 23.1% 8615 3738 1.4% 17193 26.65 43739 47.1% 7765 13.3% 2191 2.6% 427 16478 4.% 1751 3.% 5764 42.% 18595 26.% 11518 15.1% 6693 44321 13.6% 2264 28.8% 47875 43.3% 71965 11.6% 19363 2.7% 4574 166381 3.8% 1135 7.9% 2332 45.8% 13556 27.7% 8196 14.8% 4387 2966 11.% 11622 32.7% 34431 44.2% 4655 9.8% 1351 2.2% 2352 1536 4.% 574 9.5% 1222 39.9% 5621 25.1% 31872 21.6% 27398 126987 9.5% 57938 25.5% 15516 45.7% 277594 15.5% 94186 3.8% 22889 67767 22. In the last 12 months, has the child s health care professional encouraged you to take any type of preventive health steps for [CHILD] such as watching what [HE/SHE] eats or using bicycle helmets and seat belts? Yes 5.1% 7899 No 49.9% 7852 Total 15751 Ages -4 Ages 5-9 Ages 1-14 Ages 15-17 All 39.2% 67456 6.8% 14637 17293 39.2% 1464 6.8% 22668 3738 28.4% 46634 71.6% 117728 164362 33.4% 1483 66.6% 29473 44276 17.% 28114 83.% 13761 165724 4.5% 1184 59.5% 17381 29221 12.3% 12835 87.7% 9168 14515 25.6% 1554 74.4% 451654 66694 38.9% 49182 61.1% 77374 126556 22 2 Iowa Child and Family Household Health Survey

23. When was your child s last visit to [HIS/HER] personal doctor or nurse for routine preventive care such as a check-up or vaccination shots? Less than 1 year ago Ages -4 Ages 5-9 Ages 1-14 Ages 15-17 All 94.1% 14816 1-2 years ago 5.9% 934 2 years ago or more % Never been % Total 1575 89.7% 15436 8.8% 1551.9% 1534.7% 1121 171742 8.1% 29881 13.9% 5173 5.8% 2178.2% 77 3739 69.8% 114651 21.9% 35993 8.1% 13357.1% 177 164178 85.2% 37968 9.6% 4274 4.5% 1986.7% 325 44553 69.7% 114965 18.1% 29845 12.1% 19977.1% 213 1659 74.4% 22157 19.2% 573 6.4% 1912 % 29772 73.7% 77495 15.1% 15927 11.% 1166.1% 11 15129 82.3% 14822 12.6% 1684 4.8% 677.3% 42 127385 76.1% 461147 16.% 96825 7.7% 46474.3% 1612 6658 24. In the last 12 months, how much of a problem, if any, was it to get this type of care (preventive care) for [CHILD]? Big problem Small problem Not a problem Did not need Ages -4 Ages 5-9 Ages 1-14 Ages 15-17 All % 4.5% 77 95.5% 1543 % Total 1575.5% 785 4.% 6898 93.% 16643 2.5% 4337 172663 2.6% 974 1.1% 413 92.7% 34575 3.6% 1346 3738.8% 1317 2.8% 4589 9.5% 14959 5.9% 9712 165127 2.2% 981 5.8% 2585 89.% 39644 3.% 1343 44553.6% 971 3.4% 5682 87.1% 14514 8.9% 1489 166566 3.2% 95 3.1% 917 84.4% 25131 9.3% 2774 29772 1.5% 1575 3.3% 3493 88.7% 93416 6.5% 682 1534 2.3% 295 3.6% 4622 89.8% 144393 4.3% 5464 127384.8% 4649 3.4% 2662 9.% 548672 5.9% 35678 69661 25. Does [CHILD] currently have insurance that covers dental care? Yes 8.% 12185 No 2.% 339 Total 15224 Ages -4 Ages 5-9 Ages 1-14 Ages 15-17 All 7.8% 119729 29.2% 49359 16988 85.7% 3732 14.3% 5127 35859 73.3% 12469 26.7% 43964 164433 84.1% 3673 15.9% 6938 43668 74.2% 123176 25.8% 42877 16653 84.5% 24981 15.5% 4571 29552 73.5% 7624 26.5% 2741 13434 84.2% 14628 15.8% 19675 12433 72.9% 439396 27.1% 163611 637 Children with Special Health Care Needs 23

26. When was [CHILD] s last dental check-up? Less than 1 year ago Ages -4 Ages 5-9 Ages 1-14 Ages 15-17 All 44.5% 6578 1-2 years ago 4.% 587 2 years ago or more % Never been 51.5% 7613 Total 14778 36.5% 55822 3.4% 5245.1% 114 6% 91878 15359 87.3% 3227 5.4% 1983 5.9% 217 1.4% 535 36958 87.6% 13293 7.% 1578 1.7% 253 3.7% 5655 15829 89.9% 3951 8.4% 3659 1.8% 766 % 43476 87.4% 13954 9.8% 15559 2.5% 3944.4% 562 159119 84.4% 2539 11.3% 3348 4.3% 1276 % 29663 81.1% 8567 15.2% 15944 3.4% 3527.3% 354 14892 82.4% 12938 7.7% 9577 3.4% 4212 6.5% 8147 124874 72.6% 41236 8.3% 47326 1.8% 187 17.3% 98448 567897 27. During the past 12 months, was there any time when you or a health professional thought [CHILD] needed dental care? Yes 22.2% 3288 No 77.8% 1149 Total 14778 Ages -4 Ages 5-9 Ages 1-14 Ages 15-17 All 18.5% 28486 81.5% 125796 154282 54.4% 21 45.6% 16857 36957 47.1% 71433 52.9% 82. 151763 64.3% 2818 35.7% 15574 43592 58.3% 9295 41.7% 665715 159467 66.6% 1974 33.7% 133 29773 52.8% 55442 47.2% 4954 14946 56.9% 71146 43.1% 53954 1251 43.5% 248311 56.5% 322147 57458 28. In the last 12 months, was there any time when [CHILD] needed dental care but could not get it for any reason? Yes 17.1% 563 No 82.9% 2724 Total 3287 Ages -4 Ages 5-9 Ages 1-14 Ages 15-17 All 9.9% 287 9.1% 25679 28486 19.4% 394 8.6% 16196 21 4.3% 392 95.7% 68342 71434 6.9% 1928 93.1% 269 2818 6.5% 631 93.5% 86918 92949 7.3% 1388 92.7% 17688 1976 11.8% 6572 88.2% 49228 558 11.% 7783 89.% 62699 7482 7.4% 1852 92.6% 23167 248669 29. Did any of the following stop you from getting dental care for [CHILD] in the last 12 months? (Indicate all that apply.) Ages -4 Ages 5-9 Ages 1-14 Ages 15-17 All Couldn t afford/no insurance Insurance didn t cover care Trouble getting appointment Travel/transportation problems Uncomfortable with dentists available at the time 82.4 563 % % % 82.4% 2313 32.9% 924 38.8% 19 4.8% 134 438% 134 64.3% 259 14.4% 459 78.6% 368 35.5% 1384 18.7% 731 75.6% 2339 26.4% 815 49.1% 1518 4.% 1238 26.7% 827 68.3% 1316 65.3% 1258 25.7% 496 % 1.4% 2 631 44.6% 2585 5.8% 349 % % 88.8% 1233 69.% 958 5.7% 74 3.5% 423 18.6% 221 91.3% 5999 4.2% 264 15.4% 114 1.1% 663 4.8% 317 72.2% 5622 45.8% 3239 54.8% 4268 23.2% 187 15.2% 1153 9.2% 16683 38.1% 6963 21.5% 397 11.% 236 6.9% 1278 24 2 Iowa Child and Family Household Health Survey

N who could not get care* 563 286 394 392 1928 631 1388 6572 7783 1851 3. During the past 12 months, was there any time when you or a health professional thought [CHILD] needed care for behavioral or emotional problems? Yes 14.3% 2246 No 85.7% 1355 Total 15751 Ages -4 Ages 5-9 Ages 1-14 Ages 15-17 All 1.9% 3234 98.1% 169428 172662 36.2% 13513 63.8% 23795 3738 3.6% 67 96.4% 159288 165295 3.1% 13393 69.9% 3116 44553 4.1% 6776 95.9% 159557 166333 3.8% 9157 69.2% 2615 29772 5.8% 614 94.2% 98965 1515 3.1% 3839 69.9% 8976 127385 3.6% 22158 96.4% 587237 69395 31. In the last 12 months, was there any time when [CHILD] needed care for behavioral or emotional problems but could not get it for any reason? Yes 23.9% 537 No 76.1% 178 Total 2245 Ages -4 Ages 5-9 Ages 1-14 Ages 15-17 All % 3234 3234 6.8% 917 93.2% 12596 13513 % 67 67 1.8% 1446 89.2% 11947 13393 15.% 153 85.% 5956 79 17.9% 1639 82.1% 7519 9158 1.2% 648 89.8% 5691 6339 11.8% 4539 88.2% 3377 3839 7.5% 171 92.5% 2889 2259 32. Please tell me if any of these stopped you from getting behavioral or emotional care for [CHILD] in the last 12 months. Couldn t afford/no insurance Insurance didn t cover needed care Family not comfortable seeking care Trouble getting an appointment Travel or transportation problems Not comfortable with doctors or therapists available at the time Ages -4 Ages 5-9 Ages 1-14 Ages 15-17 All 537 75.% 43 25.% 134 25.% 134 25.% 134 N.A. % N.A. % N.A. % N.A. 917 N.A. 39.8% 365 N.A. 51.8% 475 N.A. 75.8% 196 N.A. 36.3% 525 N.A. 18.8% 272 N.A. 38.6% 558 N.A. 6.4% 92 N.A. 6.4% 92 153 47.4% 499 % 2.2% 213 % 42.2% 669 6.% 918 % 3.2% 495 27.8% 456 648 648 25.6% 42 35.6% 231 % 51.3% 232 41.7% 1845 18.2% 826 46.4% 214 2.1% 913 171 67.4% 1147 % 26.1% 444.% N * 537 917 1446 153 4538? 171 18.4% 194 12.3% 21 % 19.9% 93 11.4% 194 Children with Special Health Care Needs 25