Johns Hopkins UniversityChild Health and Illness Profile
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Background

The CHIP-CE instruments provide a comprehensive assessment of health status that can be completed by children 6-11 years old and by their parents. It describes aspects of health that can be influenced by health systems, school health systems, and health promotion efforts:

• Satisfaction
• Comfort
• Resilience
• Risk Avoidance

T-scores with an average score of 50 (standard deviation = 10) allow scores to be compared across domains and populations. This supports reporting, monitoring, and evaluating the health of groups of children ages 6 through 11 years.

Description of the CHIP-CE

Children report symptoms and signs of illness and of well-being, health-related behaviors, problem behavior, school performance, and involvement with family and peers. The majority of items assess frequency of events, typically over the past 4 weeks, using a five-point response format. Items on the Child Report Form (CRF) are illustrated with cartoon-type characters ‘anchoring’ the ends of each set of five graduated-circle responses. The scenes feature a race-, age-, and gender neutral character.

There is also a parent report form (PRF) developed in tandem with the Child Report Form (CHIP-CE) to describe children’s health status from the vantage point of the parents.

Sample Questions

After reading the question and looking at the two illustrations representing the response extremes, children mark an ‘X’ in the circle that is ‘right’ for them. Scores from each of the 45 items are used to calculate five domains of health.

The following examples are items included in the scoring of:

the Comfort Domain:

and the Resilience Domain:

Administration of the CHIP-CE CRF to Children

Children who can read at a third-grade level can self-administer the CRF with a very brief initial instruction: “Start on the first page and read all the instructions. Tell me if you have a question and hand it back to me when you are finished.”

Children who cannot read as well can follow a verbal presentation and effectively choose and mark their own answers without additional help. Classroom administration is quite feasible. It is important to ensure confidentiality and to tell children who will and will not see their answers. In group administrations, children were observed to and reported that they had concern about the privacy of their answers. As a result, a tear-off sheet is provided so children can cover their answers while they complete the CHIP.

A child usually completes the CRF in approximately 20 minutes, either by reading on his/her own or by marking his/her responses as an interviewer reads it. Teacher administration in classroom works well and requires no more than 45 minutes. Teachers read the items and children follow along to mark their answers. However, in the upper elementary grades (grade 3 and higher), children can easily complete the form on their own.

Psychometric Testing of the CHIP-CE PRF

Validation of the CRF is significant both because it scientifically supports the first conceptually driven, illustrated, comprehensive assessment of children’s health and because it demonstrates that children can do it. Extensive reliability and validity analyses indicate that the CHIP-CE Child Report Form has good psychometric qualities.

Scoring of the CHIP-CE

Data Entry: The data from the CHIP need to be entered into the computerized data entry program to be automatically scored. Once the data are entered, the scoring program is run, and the individual respondent and average scores are produced for the domains. When the Parent Report Form-76 of the CHIP-CE is used, subdomain scores are also produced.

Reports: The CHIP provides a comprehensive description of the health status and quality of life of youth in 5 domains of health. Optional modules can also be used to describe the child and family sociodemographics and the child’s disorders and medical conditions.

The standard reports produced by the data entry and scoring programs provide a score on the domains of Satisfaction, Comfort, Risks, Resilience, and Achievement. The Parent Report Form-76 of the CHIP-CE also provides scores for the subdomains within each domain. Responses to individual items can be obtained from the scoring program. All the CHIP data can be converted to another database or statistical package format.

Interpreting Scores: :Health status is reported to the domain level and as a profile-type. ‘Average’ health on the CHIP domains is within .6 of a standard deviation of the mean of 50. That is, average/good health is in the range from 44 to 56 points (+/- 6 points, since the CHIP standard deviation = 10).

A score of 43 or below indicates poor health in that domain. A score of 57 or higher indicates excellent health.

Profiles or patterns of health can be described to more fully indicate the proportion of students who have good, fair, and poor health (see articles below). The profiles also help indicate the types of interventions that are likely to be most helpful for groups of students within a profile-type.

Riley AW, Green BF, Forrest CB, Starfield B, Kang M, Ensminger ME. A taxonomy of adolescent health: development of the adolescent health profile-types. Med Care 1998;36:1228-36.

Riley AW, Forrest CB, Starfield B, Green B, Kang M, Ensminger M. Reliability and validity of the adolescent health profile-types. Med Care 1998;36:1237-48.