Special health care needs in the school context on São Miguel Island: A descriptive cross-sectional study using the CSHCN Screener©
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DOI:
https://doi.org/10.31211/rpics.2026.12.2.432Keywords:
Adolescent, Child, Child health, Chronic disease, Prevalence, School health servicesAbstract
Objective: The frequency of special health care needs (SHCN) among students in the Azores was unknown. This study identified children and adolescents with SHCN attending public schools on São Miguel Island and characterized their needs according to the domains of the Children with Special Health Care Needs Screener (CSHCN Screener©). Method: This descriptive, exploratory cross-sectional study involved parents or guardians of students attending public schools throughout São Miguel Island. The validated Portuguese version of the CSHCN Screener© was used. A total of 1,549 responses were obtained (response rate: 8.2%). Results: In the study sample, 413 students were identified as having SHCN based on the CSHCN Screener© domains (26.7%; 95% CI [24.5%, 28.9%]). Among these students, the distribution across individual domains and their combinations was as follows: dependence on prescription medication alone, 29.1%; above-routine service use alone, 21.1%; functional limitations alone, 2.2%; medication dependence and service use, 23.7%; medication dependence and functional limitations, 1.7%; service use and functional limitations, 9.0%; and all three domains, 13.3%. Conclusions: The proportion of students with SHCN in this sample stresses the importance of early identification and coordination between health and education services. The low response rate limits the generalizability of the findings to the school population of São Miguel Island.
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References
ALLEA – All European Academies. (2024). Código europeu de conduta para a integridade da investigação – Edição revista 2023 (versão portuguesa). https://doi.org/10.26356/ECOC-Portuguese
Andreato, Á. M. de O., Neves, E. T., Santos, M. R. dos, Marcheti, M. A., & Misko, M. D. (2024). O ambiente escolar na experiência de crianças com necessidades de saúde especiais: Um estudo qualitativo. Revista da Escola de Enfermagem da USP, 58, Artigo e20240215. https://doi.org/10.1590/1980-220x-reeusp-2024-0215pt
Arrué, A. M., Hökerberg, Y. H. M., Jantsch, L. B., da Gama, S. G. N., de Oliveira, R. de V. C., Okido, A. C. C., Cabral, I. E., de Lima, R. A. G., & Neves, E. T. (2022). Prevalence of children with special healthcare ne-eds: An epidemiological survey in Brazil. Journal of Pediatric Nursing, 67, 95–101. https://doi.org/10.1016/j.pedn.2022.08.013
Bethell, C. D., Read, D., Stein, R. E. K., Blumberg, S. J., Wells, N., & Newacheck, P. W. (2002). Identifying children with special health care needs: Development and evaluation of a short screening instrument. Am-bulatory Pediatrics, 2(1), 38–48. https://doi.org/10.1367/1539-4409(2002)002<0038:ICWSHC>2.0.CO;2
Black, L. I., Ghandour, R. M., Brosco, J. P., Payne, S. I., Houtrow, A., Kogan, M. D., & Bethell, C. D. (2024). An expanded approach to the ascertainment of children and youth with special health care needs. Pedia-trics, 153(6), Artigo e2023065131. https://doi.org/10.1542/peds.2023-065131
CAHMI – The Child and Adolescent Health Measurement Initiative. (2002). Approaches to identifying children and adults with special health care needs: A resource manual for state Medicaid agencies and managed care organizations. https://bit.ly/44UZgE4
Carvalho, B. P., Tavares, F., Fanha, J., Fonseca, M., & Peralta, S. (2025). Portugal, Balanço Social 2025: Re-latório anual. Nova School of Business and Economics. https://assets.portugalbalancosocial.pt/media/cbanq5gi/251_novasbe_portugal-balanco-social-2025
Decreto-Lei n.º 54/2018, de 6 de julho. (2018). Diário da República, 1.ª série, (129), 2918–2928. https://files.diariodarepublica.pt/1s/2018/07/12900/0291802928.pdf
Direção-Geral da Saúde. (2015). Programa Nacional de Saúde Escolar (Norma n.º 015/2015). https://www.dgs.pt/ficheiros-de-upload-2013/norma-015_2015-pnse-pdf.aspx
Direção Regional da Saúde. (2025). Programa Regional de Saúde Escolar – PRSE (Circular Normativa n.º DRS-CNORM/2025/16). https://bit.ly/4lNC8gH
Ghandour, R. M., Hirai, A. H., & Kenney, M. K. (2022). Children and youth with special health care needs: A profile. Pediatrics, 149(Supplement 7), Artigo e2021056150D. https://doi.org/10.1542/peds.2021-056150D
Health Resources and Services Administration, Maternal and Child Health Bureau. (2023). Children and youth with special health care needs: NSCH data brief. https://mchb.hrsa.gov/sites/default/files/mchb/programs-impact/nsch-data-brief-children-youth-special-health-care-needs.pdf
Lei n.º 58/2019, de 8 de agosto. (2019). Diário da República, 1.ª série, (151), 3–40. https://diariodarepublica.pt/dr/detalhe/lei/58-2019-123815982
McPherson, M., Arango, P., Fox, H., Lauver, C., McManus, M., Newacheck, P. W., Perrin, J. M., Shonkoff, J. P., & Strickland, B. (1998). A new definition of children with special health care needs. Pediatrics, 102(1), 137–139. https://doi.org/10.1542/peds.102.1.137
Menino, E., Barbieri de Figueiredo, M., Pires, M., Silva, A., Neves, M., Rodrigues, M., Viegas, L., Batacum, C., Rodrigues, J., Neves, E., Arrué, A., Corte, A., Pissara, P., Fernandes, I., Sousa, J., Santos, L., & Silva, J. (2022). Validação para Portugal do “Children with Special Health Care Needs Screener©” e estudo de prevalência de crianças e adolescentes com necessidades de saúde especiais em contexto escolar [Pro-jeto de investigação]. Unidade de Investigação em Ciências da Saúde: Enfermagem (UICISA:E). https://rr.esenfc.pt/rr/?module=ui&target=outreach-projects&tipo=UI&id_projecto=866&id_linha_investigacao=1&dado_pedido=Descricao
Oliveira, L., Barbosa, C., Machado, C., Machado, N., Galvão, D., Pereira, L., & Vilelas, J. (2023). Guia orien-tador de boas práticas: A criança e o jovem com necessidades de saúde especiais em contexto escolar (1.ª ed.). Ordem dos Enfermeiros; Papa-Letras. https://www.ordemenfermeiros.pt/media/31169/gobp_nseemmeioescolar_v5n.pdf
Pires, M., Barbieri-Figueiredo, M. do C., & Menino, E. (2025). Envolvimento das equipas de saúde escolar no estudo de crianças e jovens com necessidades de saúde especiais em escolas portuguesas na região de Lis-boa: Relato de experiência. RevSALUS – Revista Científica da Rede Académica das Ciências da Saúde da Lusofonia, 6(Sup.), 199–203. https://doi.org/10.51126/7qzx6t25
Pires, M. do C. C. M., Barbieri-Figueiredo, M. do C. A., Silva, A. M. M., Arrué, A. M., Guarda-Rodrigues, J., Neves, E. T., & Menino, E. G. (2026). Cross-cultural adaptation and psychometric validation of the Children with Special Health Care Needs Screener© for European Portuguese in a school setting. Portugue-se Journal of Pediatrics, 57(2), 92–102. https://doi.org/10.24875/PJP.25000058
Pombal, F., Sousa, L., Almeida, S., Pereira, A., Ferreira, M., Vieira, E., & Festas, C. (2024). Tradução, adap-tação cultural e validação da versão portuguesa do Children with Special Health Care Needs Screener. Re-vista de Enfermagem Referência, VI(3), Artigo e35400. https://doi.org/10.12707/RVI24.49.35400
Schlecht, J., Hammerle, F., König, J., Kuhle, S., & Urschitz, M. S. (2024). Teachers reported that children with special health care needs displayed more attention problems. Acta Paediatrica, 113(5), 1051–1058. https://doi.org/10.1111/apa.17125
Schlecht, J., König, J., Kuhle, S., & Urschitz, M. S. (2023). School absenteeism in children with special health care needs: Results from the prospective cohort study ikidS. PLOS ONE, 18(6), Artigo e0287408. https://doi.org/10.1371/journal.pone.0287408
Vilaça, T., Darlington, E., Velasco, M. J. M., Martinis, O., & Masson, J. (2019). SHE school manual 2.0: A methodological guidebook to become a health promoting school. Schools for Health in Europe Network Foundation. https://bit.ly/3IPFT6U
World Health Organization, & UNESCO. (2021). Making every school a health-promoting school: Imple-mentation guidance. World Health Organization. https://bit.ly/45pPPg6
World Medical Association. (2025). World Medical Association Declaration of Helsinki: Ethical principles for medical research involving human participants. JAMA, 333(1), 71–74. https://doi.org/10.1001/jama.2024.21972
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Copyright (c) 2026 Fábio Sousa, Filipa Maciel, Maria Goulart, Ana Granadeiro, Clara Viveiros, Maria Bettencourt, Maria Simões, Maria Araújo, Natália Macedo, Patrícia Ferreira, Sílvia Guerreiro, Eva Menino
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