There is not a comparable instrument that allows a simple administration yet provides the comprehensive assessment of the CHIP.
Learn how the CHIP can be used in many common situations:
The CHIP-CE and CHIP-AE have been administered in many public and private schools. They were designed with teacher input. In less than 30 minutes, teachers can administer the Child Report Form (CRF) of the CHIP-CE to elementary school children, and adolescents can complete the CHIP-AE on their own.
In 15 minutes prior to the day of administration, teachers can be given the instructions about why the CHIP health status survey is being administered, the importance of confidentiality of students' responses, and the basic procedures for administration, as outlined in the Manuals.
Students can respond anonymously or they can be given an ID number that is linked to their names on a file kept confidential. It is strongly recommended that children and parents not be asked to put their names on the CHIP as it will reduce the validity of their responses. It is important to always use some demographic items so the age, gender and other characteristics can be used to understand the health needs of subgroups of students.
The CHIP-CE Parent Report Form can be sent to parents of children via their child or the postal system. It can be placed in an addressed envelope and securely sealed and returned in the same manner. A system must be developed to link the responses of students and parents, as described in the CHIP-CE manual.
Needs Assessment: In a successful effort to obtain funding from a local foundation to support the development of a school-based health and mental health clinic, a high school in Baltimore used the CHIP to document the level of health needs among the students. Their application for grant funding included a report on the proportional health of the students who had poor Satisfaction, Comfort, Resilience, and Achievement, and high Risks (more than 0.6 standard deviation from the mean), with an interpretation of what each meant. Because they also wanted to present data in the form often reported by risk surveys, they also included the number of students in each age group who were engaged in specific high risk behaviors, using 5 items from the Risk domain.
Outcome Evaluation: Planning is underway for an outcome evaluation project in which the CHIP will be used to characterize the ways in which school-based health services help students. The CHIP will be administered in schools that do and do not have school-based health clinics at the beginning and end of two academic years. Students will be given an ID number so that their responses can be linked over time. They will also be asked about health services that they have received in and out of school. It may be possible to have parents complete the CHIP-CE/PRF.
The data can be used in at least 3 ways. (1) to describe the level of health and the proportion of youth with poor health in one or more areas for the whole student body in each school and in schools with and without school-based health services at the beginning; (2) to measure the changes in health from the beginning to the last assessment, comparing the differences in health for schools with and without health services to give a gross estimate of value of the school health services (To get a more precise estimate of the value of the school-based services, a more complex analysis is needed that takes into consideration the health services used by students in and out of the school setting.); (3) the changes in health for subgroups of students can be calculated in the same ways to see if there are important differences by subgroup. For example, youth who are enrolled in the school health system compared to those who are not; young students vs. older; girls compared to boys, students in the reduced school lunch program compared to those not in that program, etc.
Health personnel in one school system report that they are using the CHIP to evaluate the changes in the overall health of the student body after implementing specific changes to the health education curriculum.
The CHIP has been completed by children, adolescents, and parents in numerous medical settings. Generally, the adolescent and parent CHIP can be filled out in the waiting room. Individuals can complete both the CHIP-AE and the CHIP-CE/PRF in about 20 minutes, if they have at least a fifth-grade reading level. Respondents with a more limited ability to read will require more time, or may require personal administration.
The CHIP-CE can also be completed by children in the waiting room, in 20 minutes, if they can read at a third-grade level. Instruct them to answer all the questions and to ask if they need help. For younger children who cannot read sufficiently well, the items and responses should be read to them, including the practice items, as described in the Manual. This should only take 20 minutes, but a private room or area is desirable.
Needs Assessment: The CHIP has been used to describe the health status of the members of several large managed care organizations, providing information on the range and nature of their health and health problems across domains. One strategy used is to have it completed in the waiting room by all parents and patients 6-18 years old (using the age-appropriate version for youth) seen during a period of time. This approach alone gives a picture of the health of the patient population that is biased in terms of children with more significant health problems and families who have sufficient resources to access care, and especially preventive care, when it is due. An additional or primary effort can be made to send the age-appropriate CHIPs to a randomly or purposively selected group of families and ask them to complete the CHIPs and return them via the mail. This would give a more representative assessment of the needs of the child and adolescent patient population.
Outcome Evaluation: Assessment of the health over time of a group of children with a health state of interest can be obtained, using either the waiting room or mailed method for having the CHIP completed. For example, the health status and quality of life of children with Attention-Deficit Hyperactivity Disorder is being monitored seven times over a two-year period in a 9-country study in Europe, beginning in the summer of 2003. This will provide a description of the effects of different treatments on the well-being of these children.
Describing, monitoring, and responding to the health needs of youth is an important responsibility that is increasingly being taken on by communities. Typically, the CHIP is administered in the school setting, with the parent CHIP mailed to parents. It is also important to consider how to obtain health information from adolescents no longer in school.
The initial assessment provides a means of demonstrating needs at that time and, very importantly, serves as a baseline for evaluating the value of health-promoting interventions undertaken subsequently. (One community in Maine has used this strategy, using a school administration format. Their Health Council, made up of representatives from the local health department, hospitals, schools, a local research group, and town government, used the initial data to understand the profiles of health that were most common in their community, among the young and older adolescents and the girls and boys. They found that the older adolescent girls were having significant problems (and they knew that they were likely to drop out of school). They could also identify patterns of health in the younger girls that appeared to be precursors for increasing distress and other health problems. Consequently, one aspect of their community health promotion effort, funded by the cigarette restitution funds, is focused primarily on girls in middle childhood and early adolescence. They will be able to evaluate the impact of these efforts over the next few years.
It is often valuable to link the child's CHIP-CE to their parent's CHIP-CE, although to describe health in a population it is not absolutely necessary. When linkage is desired, some method must be used to keep each parent's CHIP paired with their child's. Typically, this is done by assigning an identifier to the pair, such as a random number, so that their CHIP forms can always be linked, but cannot be easily traced back to them by anyone other than the researchers. A method for doing this is outlined in detail in the CHIP-CE Classroom Administration Manual.