Community Health Needs Assessment (CHNA)
The data collection and analysis for our most recent Community Health Needs Assessment are now complete. Please find our full 2021 CHNA report and implementation strategies here.
Find our most recent CHNA Parent and Community Leader survey results by visiting our interactive data dashboard or clicking on the dashboard image.
For more information contact CHNAFeedback@cookchildrens.org. Cook Children's Community Health Needs Assessment applied academic research standards for both primary and secondary data collection.
Our Community Health Needs Assessment utilizes the following methodologies:
- Parent Survey (CCHAPS). Administered to primary caregivers by a combination of mail, phone, or the Internet to a stratified random sample of 25,000 households representative of families with children ages 0 –17 in the primary service area. Surveys are available in English & Spanish.
- Face-to-Face Survey Interviews. Parent survey available to a purposive sample of homeless caregivers and/or caregivers in families with at least one undocumented member. The target for responses is a minimum of 150 homeless caregivers and 50 undocumented participants.
- Focus groups or Case Studies. Provide an opportunity for caregivers to provide information not covered in the survey. Priority topics include: Abuse, Asthma, Dental Health, Mental Health, Obesity, Safety / Injury Prevention, COVID-19, and Access to Care.
- Community Leader Survey. A purposive sample of city, county, government, public agency/health, not-for-profit, school district, and business community leaders working in the eight-county region receives an invitation to complete an online survey focused on the community impact of health issues.
- Secondary data. Using from four to eight sources for each of the eight priority geography areas to determine national, state, and if available, local trends.
Our CHNA partners included
- CHNA Administrator, Linda Fulmer
- ETC Institute, Chris Tatham, CEO
- University of North Texas Health Science Center - School of Public Health
Frequently asked questions about the CHNA
CHNA is the acronym for Community Health Needs Assessment. Cook Children's conducts an assessment every three years to collect comprehensive data about children's health (ages 0-17) in our now eight-county service region (Tarrant, Johnson, Hood, Parker, Wise, Denton, Grayson, and Collin Counties).
Everything we do at Cook Children's focuses on the Promise we've made to our community to improve the health of every child in our region through the prevention and treatment of illness, disease and injury. The CHNA helps us fulfill this Promise by providing credible data that guides our strategies for preventing illness and injury to children. The CHNA also meets federal requirements for non-profit hospitals to focus community benefit strategies on the most critical health care needs in the communities we serve.
Cook Children's conducts a stratified random sample survey of parents to ask questions about how various health issues impact their children and how easy or difficult it is to obtain care. We also conduct focus groups to provide an opportunity for parents to tell us about issues not included in the survey. The CHNA also includes health data from government and other reliable sources as well as a survey of community leaders. A children's art contest helps us better understand how children feel about their health.
There are multiple obstacles to maintaining good health for many families such as poverty, discrimination, lack of access to good jobs with fair pay, quality education, housing and safe environments. Addressing these obstacles requires a collaborative, community approach. One organization cannot act alone and be successful. Effective partnerships create a shared vision and increase the community's capacity to shape outcomes.
With accurate information representative of the needs of a community, partners can increase understanding about children's health and the factors that influence it, identify priority needs for community action, develop solutions to address priorities, and evaluate the results of their efforts.
Frequently asked questions about CCHAPS
CCHAPS is the acronym for Community-wide Children's Health Assessment and Planning Survey. CCHAPS plays a key role in our Community Health Needs Assessment (CHNA) and is a household survey of parents and caregivers of children ages 0 -14 to assess the caregiver's perspective about children's health in our service region of Denton, Hood, Johnson, Parker, Tarrant, and Wise Counties. Our 2021 survey will also include Collin and Grayson Counties and has been extended to households with children ages 0-17.
For CCHAPS 2021:
- The 56-question survey is mailed to a representative sample of households with options for primary caregivers to respond by mail, online, or toll-free phone. The survey is available in English and Spanish.
- This parent survey contains trend questions from previous years and new questions to assess social determinants of health, COVID-19, and equitable access.
- Questions align with national and state data, when applicable; Some questions from prior years revised to align with national and state data benchmarks such as National Survey for Children's Health, Healthy People 2030, Youth Risk Behavior Surveillance, US Gallup Poll, Mental Health America, and Safe Kids Worldwide
CCHAPS was administered by ETC Institute on behalf of Cook Children's Health Care System.
All forms of research have limitations which is why methodology is especially important.
Cook Children's contracts with research experts to collect our CHNA data so that high standards of methodology are practiced, mitigating limitations as much as possible. Some limitations of our CHNA research include:
Survey provides the parent's perspective:
- Responses to this survey reflect the parent's or other caregiver's point of view, which may or may not be a reflection of the actual situation. Parents may be unconsciously concerned that certain responses may not reflect well on their parenting practices, or they may not actually have first-hand knowledge of certain behaviors/situations. However, for the purposes of community education and awareness efforts it is sometimes helpful to know the level of knowledge respondents have on a particular issue.
Survey data is descriptive:
- Survey research is a descriptive research design since the questions are only asked once at a particular point in time. Therefore while analysts may draw associations between variables when appropriate, conclusions about a cause-and-effect relationship require an experimental research design.
Focus group findings are contextual:
- The sample size of parents participating in face-to-face interviews or focus groups is considerably smaller than the parent survey sample size. For this reason, the findings from these methods should serve as additional qualitative insight into the parent survey findings rather than a statistically valid comparison. Limitations of focus group methodology in general may also affect data quality.
The overall results for questions that are included on the survey for the random sample of households have a precision of at least +/-1.3% at the 95% level of confidence.
- Margin of Error. How much error we can live with --the number of people who respond a certain way will always fall within a range of 1.3% less or more than the statistic quoted.
- Confidence level. How sure we can be --if we repeat the survey 100 times, we would expect the same answer 95 out of 100 times.
For CCHAPS 2021, is the sample size large enough to be representative of the eight-county service region?
The sample size is very large (5,000+) to ensure our data is representative of the diverse population within our region---representative in each county and representative for different race/ethnic groups, etc.
Our sample is address-based and selected at random from households that are likely to have children under age 18. The number of households selected for the survey will initially be 5x the goal for each area. We also oversample respondents in hard-to-reach areas and less responsive demographic groups.
For comparison purposes, the 2019 National Survey of Children's Health utilizes a representative sample size between 600 –620 for the state of Texas.
So we believe our data accurately reflects what parents report despite limitations inherent in all research. Sometimes there are logical explanations for why data doesn't seem to reflect what we "know" to be true. Sometimes it's easy to assume that the population in a particular work setting represents the total population of children. Our CHNA survey is representative of all parents in the region with children ages 0 –17 (not just those with a particular health issue or those with low incomes, etc.).
Suggested citation when referencing CCHAPS data files:
Community-wide Children's Health Assessment and Planning Survey (year of data). Cook Children's Health Care System; Fort Worth, Texas; or CCHAPS (year of data) at www.centerforchildrenshealth.org accessed (month/year).
Specific CCHAPS data and cross-tabulations are available upon request.