Children and Youth with Special Healthcare NeedsDefinition Framework
This framework is designed to offer a clear, structured overview of the diverse populations that fall within the CDPH/MCAH definition of Children and Youth with Special Health Care Needs (CYSHCN). CYSHCN are individuals from birth through age 21 who have, or are at increased risk for chronic phys-ical, developmental, behavioral, or emotional conditions that require health care, educational services, and other related supports beyond those needed by the general pediatric population. Chronic conditions are defined as those lasting one year or longer and that require ongoing medical care, limit activities of daily living, or both.
By outlining condition categories, risk factors, and subgroups at increased risk, this framework helps public health professionals recognize the broad and interconnected factors that may contribute to
a child or youth being identified as a CYSHCN. It can be used as a foundational reference for needs assessments, program planning, workforce training, and cross-sector collaboration to ensure CYSHCN are accurately identified and effectively supported.
Please note that the conditions and risk factors included in this framework are not exhaustive and do not represent all circumstances in which a child or youth may be considered CYSHCN. The California Department of Public Health encourages using this framework as a dynamic resource and adapting it to include additional populations or risk factors relevant to the needs and context of your community.
Defining the Categories
Have a Condition
Children and youth who already have a diagnosed chronic physical, developmental, behavioral, or emotional condition. These conditions require ongoing health care or related supports beyond what is needed by the general pediatric population.
Behavioral and Emotional Conditions
"Behavioral" and "Emotional" conditions are used to align with the Health Resources and Services Administration (HRSA)
definition. Clinicians and other professionals may categorize these conditions differently. Some conditions may apply to multiple categories (i.e. neurodevelopmental disorders (NDD), intellectual and developmental disabilities (IDD)).
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Physical Conditions: epilepsy, sickle cell disease, asthma, cystic fibrosis, congenital heart disease, diabetes mellitus, etc.
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Developmental Conditions: autism, learning disabilities, Down syndrome, fragile X syndrome, fetal alcohol syndrome, Prader-Willi syndrome, phenylketonuria, etc.
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Behavioral Conditions: ADHD, conduct disorder, eating disorders, etc.
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Emotional Conditions: anxiety, depression, PTSD, suicidal ideation, etc.
At Increased Risk for a Condition
Children and youth who do not currently have a diagnosed condition but are at heightened risk due to biological, environmental, or social factors, inclusive of
social determinants of health (SDOH). These risk factors may lead to the development of chronic conditions.
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Childhood Trauma: adverse childhood experiences (e.g., abuse, neglect, household challenges), exposure to violence, family instability, loss, and other traumatic experiences
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Biological Risks: very low birth weight, prematurity, presence of certain metabolic deficiencies, genetic changes/differences, family history, etc.
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Environmental Risks: absence of social support, air pollution, second-hand smoke, and Infestations that can exacerbate conditions such as asthma, etc.
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Systemic and Structural Barriers: racism/ discrimination, limited culturally and linguistically appropriate services, immigration-related fear, under-resourced communities (e.g. rural areas), and lack of insurance, etc.
Groups At Increased Risk
Specific populations or subgroups who, due to systemic, structural, or situational factors, are more likely to develop chronic conditions or face barriers to care. These groups may not have a condition or risk factor themselves but are exposed to circumstances that increase their vulnerability.
- Justice-involved youth
- Child welfare system involved children and youth: emancipated, kinship, and guardianship, differential response, adopted. etc.
- LGBTQIA+
- Neonatal intensive care unit and infants that experienced birth trauma
- Homeless and unaccompanied youth
- Pediatric intensive care unit
- Pregnant or parenting youth
- Exploited youth: sexual, financial, criminal and labor exploitation
- Transition aged youth with special health care needs
- Children whose parent(s) and caregiver(s) have special health care needs or serious illness
- Infants with prenatal substance exposure
Resources