Parents and children do not always agree in their
assessments of the child's health. Parents usually report
that their children are feeling better than the children
say they are. Researchers at the Johns Hopkins
Bloomberg School of Public
Health found that children as young as 6 can accurately
report on their health and well-being when questions are
presented in an illustrated, informative format. They have
developed a set of new assessment tools to measure
children's perceptions of their own health and well-being
called the Child Health and Illness Profile, Child Edition,
or CHIP-CE. The researchers also found that the Child
Report Form of the CHIP-CE is an accurate predictor of
children's future health care service use. Three
manuscripts in the March 2004 edition of the journal
Medical Care present the development and validation
of the instruments.
The CHIP-CE is a measure of self-assessed health that
can provide a valuable new means for describing the health
needs of community children as well as those in clinical
settings, evaluating the impact of health and social
policies and health interventions as well as for
understanding the development of health as children
mature.
"The concept of what it means to be healthy has
evolved beyond the mere absence of illnesses to encompass
the idea that health is a resource that allows individuals
to adapt to demands and to flourish in their lives," said
study author Anne Riley, associate professor with the
school's
Department of Health Policy and Management and lead
developer of the CHIP-CE. "Health perceptions and
well-being are central to this integrated concept of
health. Previously, we could not measure the health of
children from their own viewpoint. The CHIP-CE is an
effective new tool for assessing child health from the
perspectives of children themselves and their parents."
The CHIP-CE questionnaire is designed for children
ages 6 through 11. A companion parent report form measures
caregivers' perceptions of their children's health.
Illustrations and multiple-choice questions are used in the
CHIP-CE to assess well-being, comfort, risk avoidance,
resilience and achievement. The child and parent forms were
developed by working with children, parents and other
experts. The research was done in dozens of school and
health care settings in multiple states.
The CHIP-CE instruments have been shown to be reliable
and valid in studies involving more than 2,000 children and
their parents in geographically, racially and
socio-economically diverse areas of the United States. The
CHIP-CE also has been demonstrated to be practical for use
in schools and clinical settings. One of the validation
studies found that child and parent reports on the CHIP-CE
were predictive of the number of doctor visits the children
made in the following year.
Co-author and pediatrician Christopher Forrest,
associate professor of health policy and management, said,
"A child's sense of well-being and burden of symptoms
predict health care use in the future. Children's perceived
well-being, as assessed by the CHIP-CE, is a better
predictor of children's service use than parent reports or
physician-diagnosed disorders."
The CHIP-CE builds upon the earlier success of the
CHIP-Adolescent Edition, which was developed for children
ages 11 to 18 by the same team, led by Barbara Starfield,
University Distinguished Professor in the Department of
Health Policy and Management. The CHIP assessment tools
were developed and tested over a 12-year period. Together,
they provide the means to assess the health of children
from their early school years through adolescence, using a
consistent model of health and many of the same questions.
The CHIP instruments address the need for methods to study
life transitions and other influences on the health of
youth, which is known to be an important factor in
successful school achievement and transition to adulthood.
"The Child Report Form of the CHIP-Child Edition,
Reliability and Validity" was written by Anne W. Riley,
Christopher B. Forrest, George W. Rebok, Barbara Starfield,
Bert F. Green, Judith A. Robertson and Phyllis Friello.
"The Parent Report Form of the CHIP-Child Edition,
Reliability and Validity" was written by Anne W. Riley,
Christopher B. Forrest, Barbara Starfield, George W. Rebok,
Judith A. Robertson and Bert F. Green.
"Predictor of Children's Health Care Use, the Value of
Child vs. Parental Perspectives on Health Care Needs" was
written by Christopher B. Forrest, Anne W. Riley, Patrick
M. Vivier, Nancy Gordon and Barbara Starfield.
A majority of the funding for the CHIP-CE studies was
provided by the Agency for Healthcare Quality and Research
of the U.S. Department of Health and Human Services.
Additional funding was provided by a grant from the
National Institute of Child Health and Human
Development.
For more information about CHIP instruments, go to www.chip.jhu.edu.
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