Understanding the impact of special health care needs on early school functioning: a conceptual model

Children with special health care needs (SHCN) have or are at increased risk for a chronic condition that necessitates more health and related supports than their peers. While it is generally accepted that these children are at risk for school failure, the mechanisms through which SHCN impact on children's experiences (and therefore opportunities to intervene) at school are still relatively poorly understood. Based on the current literature, this paper provides a conceptual framework to guide further discussion of this issue in research, policy and practice. Evidence from the literature was reviewed and existing frameworks examined. We propose that SHCN impact on four interrelated domains of children's functioning: (1) body functions and structures; (2) activities of daily living; (3) social participation; and (4) educational participation. Children's functioning is further influenced by risk and protective factors that can be identified at the level of the child, family and service systems. Together, these processes contribute to shaping either positive or negative trajectories of school functioning. The mechanisms influencing school experiences for children with special health care needs are complex, with opportunities for positive interventions at a range of levels. The proposed conceptual model provides an accessible tool for guiding discussion of the support needs of this vulnerable population.