Nursing practice and policy are inextricably linked. Nurses who provide services within state Title V programs for children with special health care needs (CSHCN) are particularly cognizant of the policy context. The development of “family-centered, community-based, coordinated, and culturally competent systems of care for all children with special health care needs” is a phrase that rolls off our tongues. But how was current policy shaped? This article provides a brief historical background of the broader perspective of Title V-CSHCN programs. Kingdon’s multiple streams approach to policy formation is used as a conceptual framework to explore how policy was transformed in the 1980s to shape the national agenda for CSHCN. The article also discusses the effect of internal and external forces on the refinement of that agenda during the 1990s. Relevance for nursing practice is discussed, with validation that nurses can influence future policy development and implementation—in partnership with families.
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