Supplemental Items for the CAHPS Health Plan Child Survey 5.0/5.1: Children With Chronic Conditions

Population version: Child

Learn more about the CAHPS Children With Chronic Conditions Item Set.

Users of the CAHPS Health Plan Survey are free to incorporate supplemental items in order to meet the needs of their organizations, local markets, and/or audiences. Some items cover events that occur with low frequency in the general population. You should include them only if your sample design is likely to yield a sufficient number of responses to those questions for statistical analysis and reporting.

Questions in English	Placement or Other Instructions
CC1. In the last 6 months, how often did you have your questions answered by your child’s doctors or other health providers? ¹__ Never ²__ Sometimes ³__ Usually ⁴__ Always	After core question 7
CC2. Choices for your child’s treatment or health care can include choices about medicine, surgery, or other treatment. In the last 6 months, did your child’s doctor or other health provider tell you there was more than one choice for your child’s treatment or health care? ¹__ Yes ²__ No	After CC1 Note: CC2—CC4 are not included in the HEDIS version of this survey.
CC3. In the last 6 months, did your child’s doctor or other health provider talk with you about the pros and cons of each choice for your child’s treatment or health care? ¹__ Yes ²__ No	After CC1 Note: Use with CC2. CC2—CC4 are not included in the HEDIS version of this survey.
CC4. In the last 6 months, when there was more than one choice for your child’s treatment or health care, did your child’s doctor or other health provider ask you which choice was best for your child? ¹__ Yes ²__ No	After CC1 Note: Use with CC2. CC2—CC4 are not included in the HEDIS version of this survey.
CC5. Is your child now enrolled in any kind of school or daycare? ¹__ Yes ²__ No → If No, go to #10 on page 2 [If items CC8-CC18 are included: go to #CC8]	After core question 9
CC6. In the last 6 months, did you need your child’s doctors or other health providers to contact a school or daycare center about your child’s health or health care? ¹__ Yes ²__ No → If No, go to #10 on page 2 [If items CC8-CC18 are included: go to #CC8]	After CC5 Note: Use with CC5
CC7. In the last 6 months, did you get the help you needed from your child’s doctors or other health providers in contacting your child’s school or daycare? ¹__ Yes ²__ No	After CC5 Note: Use with CC5 and CC6
CC8. Special medical equipment or devices include a walker, wheelchair, nebulizer, feeding tubes, or oxygen equipment. In the last 6 months, did you get or try to get any special medical equipment or devices for your child? ¹__ Yes ²__ No → If No, go to #CC11	After core question 9 or CC7, if used.
CC9. In the last 6 months, how often was it easy to get special medical equipment or devices for your child? ¹__ Never ²__ Sometimes ³__ Usually ⁴__ Always	After CC8 Note: Use with CC8
CC10. Did anyone from your child’s health plan, doctor’s office, or clinic help you get special medical equipment or devices for your child? ¹__ Yes ²__ No	After CC9 Note: Use with CC8
CC11. In the last 6 months, did you get or try to get special therapy such as physical, occupational, or speech therapy for your child? ¹__ Yes ²__ No → If No, go to #CC14	After CC10
CC12. In the last 6 months, how often was it easy to get this therapy for your child? ¹__ Never ²__ Sometimes ³__ Usually ⁴__ Always	After CC11 Note: Use with CC11
CC13. Did anyone from your child’s health plan, doctor’s office, or clinic help you get this therapy for your child? ¹__ Yes ²__ No	After CC12 Note: Use with CC11
CC14. In the last 6 months, did you get or try to get treatment or counseling for your child for an emotional, developmental, or behavioral problem? ¹__ Yes ²__ No → If No, go to #CC17	After CC10
CC15. In the last 6 months, how often was it easy to get this treatment or counseling for your child? ¹__ Never ²__ Sometimes ³__ Usually ⁴__ Always	After CC14 Note: Use with CC14
CC16. Did anyone from your child’s health plan, doctor’s office, or clinic help you get this treatment or counseling for your child? ¹__ Yes ²__ No	After CC15 Note: Use with CC14
CC17. In the last 6 months, did your child get care from more than one kind of health care provider or use more than one kind of health care service? ¹__ Yes ²__ No → If No, go to core question #10	After CC16
CC18. In the last 6 months, did anyone from your child’s health plan, doctor’s office, or clinic help coordinate your child’s care among these different providers or services? ¹__ Yes ²__ No	After CC17 Note: Use with CC17
CC19. Does your child have any medical, behavioral, or other health conditions that have lasted for more than 3 months? ¹__ Yes ²__ No → If No, go to core question #20	After core question 19
CC20. Does your child’s personal doctor understand how these medical, behavioral, or other health conditions affect your child’s day-to-day life? ¹__ Yes ²__ No	After CC19 Note: Use with CC19
CC21. Does your child’s personal doctor understand how your child’s medical, behavioral, or other health conditions affect your family’s day-to-day life? ¹__ Yes ²__ No	After CC20 Note: Use with CC19
CC22. In the last 6 months, did you get or refill any prescription medicines for your child? ¹__ Yes ²__ No → If No, go to core question #30	After core question 29 Note: Before CC22-CC24, add a new heading: Prescription Medicines
CC23. In the last 6 months, how often was it easy to get prescription medicines for your child through his or her health plan? ¹__ Yes ²__ No	After CC22 Note: Use with CC22
CC24. Did anyone from your child’s health plan, doctor’s office, or clinic help you get your child’s prescription medicines? ¹__ Yes ²__ No	After CC22 Note: Use with CC22
CC25. Does your child currently need or use medicine prescribed by a doctor (other than vitamins)? ¹__ Yes ²__ No → If No, go to #CC28	After core question 31
CC26. Is this because of any medical, behavioral, or other health condition? ¹__ Yes ²__ No → If No, go to #CC28	After CC25 Note: Use with CC25
CC27. Is this a condition that has lasted or is expected to last for at least 12 months? ¹__ Yes ²__ No	After CC26 Note: Use with CC25 and CC26
CC28. Does your child need or use more medical care, more mental health services, or more educational services than is usual for most children of the same age? ¹__ Yes ²__ No → If No, go to #CC31	After CC27
CC29. Is this because of any medical, behavioral, or other health condition? ¹__ Yes ²__ No → If No, go to #CC31	After CC28 Note: Use with CC28
CC30. Is this a condition that has lasted or is expected to last for at least 12 months? ¹__ Yes ²__ No	After CC29 Note: Use with CC28 and CC29
CC31. Is your child limited or prevented in any way in his or her ability to do the things most children of the same age can do? ¹__ Yes ²__ No → If No, go to #CC34	After CC30
CC32. Is this because of any medical, behavioral, or other health condition? ¹__ Yes ²__ No → If No, go to #CC34	After CC31 Note: Use with CC31
CC33. Is this a condition that has lasted or is expected to last for at least 12 months? ¹__ Yes ²__ No	After CC32 Note: Use with CC31 and CC32
CC34. Does your child need or get special therapy such as physical, occupational, or speech therapy? ¹__ Yes ²__ No → If No, go to #CC37	After CC33
CC35. Is this because of any medical, behavioral, or other health condition? ¹__ Yes ²__ No → If No, go to #CC37	After CC34 Note: Use with CC34
CC36. Is this a condition that has lasted or is expected to last for at least 12 months? ¹__ Yes ²__ No	After CC35 Note: Use with CC34 and CC35
CC37. Does your child have any kind of emotional, developmental, or behavioral problem for which he or she needs or gets treatment or counseling? ¹__ Yes ²__ No → If No, go to #CC32	After CC33
CC38. Has this problem lasted or is it expected to last for at least 12 months? ¹__ Yes ²__ No	After CC37 Note: Use with CC37

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Supplemental Items for the CAHPS Health Plan Child Survey 5.0/5.1: Children With Chronic Conditions