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Your Child’s Health 
& Health Care

What are your experiences with
 your child’s health care?

Child health care is an area of special interest in MEPS. Please take a few minutes to answer the questions in this booklet about the health and health care of the child named below. The questions should be answered by the adult household member who knows the most about this child’s health care.

Complete this
booklet for: -->
RUID: _________________ VERSION:____________

NAME:______________________________________

DOB: _________________ PID: _________________

Name of person completing booklet:__________________________________________

Relationship to child named above:___________________________________________

SURVEY INSTRUCTIONS: Please answer every question by checking one box  .  If you are unsure about how to answer a question, please give the best answer you can.

Your participation is voluntary and all of your answers will be kept confidential. If you have any questions about this booklet, please call Alex Scott at 1-800-945-MEPS (6377).

YOUR CHILD’S HEALTH CARE IN THE LAST 12 MONTHS

1. A health provider could be a general doctor, a specialist doctor, a nurse practitioner, a physician assistant, a nurse, or anyone else your child would see for health care.

In the last 12 months, did you make any appointments for your child with a doctor or other health provider for regular or routine health care?

Yes
1
No
2  --> GO TO 
 QUESTION 3

 

2. In the last 12 months, how often did your child get an appointment for regular or routine health care as soon as you wanted?
Never
1
Sometimes
2
Usually
3
Always
4
My child didn’t need an appointment for regular or routine care in the last
12 months
96

 

3. In the last 12 months, did your child have an illness or injury that needed care right away from a doctor’s office, clinic, or emergency room?
Yes
1
No
2  --> GO TO 
 QUESTION 5

 

4. In the last 12 months, when your child needed care right away for an illness or injury, how often did your child get care as soon as you wanted?
Never
1
Sometimes
2
Usually
3
Always
4
My child didn't need care right away for an illness or injury in the last
12 months
96

 

5. In the last 12 months (not counting times your child went to an emergency room), how many times did your child go to a doctor’s office or clinic?
None
0
1
1
2
2
3
3
4
4
5 to 9
5
10 or more
6
 
GETTING NEEDED CARE

6. In the last 12 months, how much of a problem, if any, was it to get care for your child that you or a doctor believed necessary?

A big problem
1
A small problem
2
Not a problem
3
My child had no visits in the last
12 months
96

 

7. In the last 12 months, how often did your child’s doctors or other health providers listen carefully to you?
Never
1
Sometimes
2
Usually
3
Always
4
I don't know
8
My child had no visits in the last
12 months
96

8. In the last 12 months, how often did your child’s doctors or other health providers explain things in a way you could understand?
Never
1
Sometimes
2
Usually
3
Always
4
I don't know
8
My child had no visits in the last
12 months
96

 

9. In the last 12 months, how often did your child's doctors or other health providers show respect for what you had to say?
Never
1
Sometimes
2
Usually
3
Always
4
I don't know
8
My child had no visits in the last
12 months
96

 

10. In the last 12 months, how often did doctors or other health providers spend enough time with you and your child? 
Never
1
Sometimes
2
Usually
3
Always
4
I don't know
8
My child had no visits in the last
12 months
96

 

 

Thank you for taking the time to complete this survey.

OVERALL RATING OF CHILD'S HEALTH CARE

11. We want to know your rating of all your child’s health care in the last 12 months from all doctors and other health providers.

Use any number from 0 to 10 where 0 is the worst health care possible, and 10 is the best health care possible. How would you rate all your child’s health care? 

0 Worst health care possible
1
2
3
4
5
6
7
8
9
10 Best  health care possible
My child had no visits in the last
12 months
96
GETTING HEALTH CARE FROM A SPECIALIST

When answering the next questions, do not include dental visits.


12. Specialists are doctors like surgeons, heart doctors, allergy doctors, skin doctors, and others who specialize in one area of health care.

In the last 12 months, did you or a doctor think your child needed to see a specialist?

Yes
1
No
2  --> GO TO 
 QUESTION 14

13. In the last 12 months, how much of a problem, if any, was it to get a referral to a specialist that your child needed to see?
A big problem
1
A small problem
2
Not a problem
3
My child didn't need to see a specialist in the last
12 months
96
QUESTIONS ABOUT YOUR CHILD’S HEALTH 
 The next questions are about your child’s health needs and whether your child has a health condition. A health condition can be physical, mental, or behavioral. Health conditions may affect a child’s development, daily function, or need for services.

14. Does your child currently need or use medicine prescribed by a doctor, other than vitamins?
Yes
1
No
2  --> GO TO 
 QUESTION 15
    A. Is this because of any medical,
    behavioral, or other health condition?
    Yes
1
    No
2  --> GO TO 
 QUESTION 15
    B. Is this a condition that has lasted or
    is expected to last for at least 12
    months?
   Yes
1
   No
2

15. Does your child need or use more medical care, mental health, or educational services than is usual for most children of the same age?
Yes 
1
No
2  --> GO TO 
 QUESTION 16
    A. Is this because of any medical,
    behavioral, or other health condition?
  Yes
1
  No
2  --> GO TO 
 QUESTION 16
    B. Is this a condition that has lasted or
    is expected to last for at least 12
    months?
  Yes
1
  No
2

16. 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? 
Yes
1
No
2  --> GO TO 
 QUESTION 17

   A. Is this because of any medical,
   behavioral, or other health condition?
  Yes
1
  No
2  --> GO TO 
 QUESTION 17

   B. Is this a condition that has lasted or
   is expected to last for at least 12
   months?
   Yes
1
   No
2

17. Does your child need or get special therapy, such as physical, occupational, or speech therapy?
Yes
1
No
2  --> GO TO 
 QUESTION 18

   A. Is this because of any medical,
   behavioral, or other health condition?
   Yes
1
  No
2  --> GO TO 
 QUESTION 18

   B. Is this a condition that has lasted or is
   expected to last for at least 12 months?
  Yes
1
  No
2

18. Does your child have any kind of emotional, develop-mental, or behavioral problem for which he or she needs or gets treatment or counseling?
Yes
1
No
2

 --> Thank You
 For Your
 Participation
   A. Has this problem lasted or is it
   expected to last for at least 12 months?
  Yes
1
  No
2
Internet Citation:
Your Child’s Health & Health Care  Agency for Healthcare Research and Quality, Rockville, MD. http://www.meps.ahrq.gov/SAQ_PAQ/childpaq_eng.htm
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