An Index of Child Well-Being for States, the Nation and

Low-Income Children

Kristin A. Moore, Laura Lippman, Christina Theokas, Margot Bloch & Sharon Vandivere

Child Trends

Bill O’Hare Annie E. Casey Foundation

Utilizing the National Survey of Children’s Health

Funded by the Annie E. Casey Foundation

2

Research Questions

Can an index of child well-being be developed from one micro dataset rather than by aggregating across multiple macro datasets?

Can an index be developed that represents and is balanced across all domains of child well-being?

Can an index be developed that represents children’s normative development at different stages of development?

Can the National Survey of Children’s Health (NSCH) support robust state indices for low-income children?

3

To develop an index of child well-being and an index of contextual well-being at the micro level for the nation, and for states and for low-income children by state.

To distinguish between child outcomes and children’s contexts.

To develop indices for each stage of child development. To introduce a new source of state level child well-being

data, the National Survey of Children’s Health (NSCH), To explore whether composite indices are valid, reliable

and descriptive, and what value is added by using micro data compared with aggregate data.

Purposes

4

National Survey of Children’s Health (NSCH) Sponsored by the Maternal and Child Health

Bureau, U.S. Department of Health and Human Services

Nationally representative data collected from all 50 states and the District of Columbia

Interviews completed from 2003 to 2004 N= 102,353 children ages 0-17, with

approximately 2,000 children per state

Data Base

5

The index is comprised of 7 domains: 4 Child Well-Being Domains

Physical Health, Psychological Health, Social Health and Educational Achievement & Cognitive Development

3 Contextual Well-Being Domains Family Context, Community Context and Sociodemographic

Context Each domain has 4-15 indicators organized into 4

subdomains. Indicators dichotomized using a conceptual threshold

of well-being. Subdomains dichotomized and summed to produce

overall domain scores.

Method

6

CHILD WELL-BEING

PHYSICAL HEALTH1. Health Status2. Limiting Conditions3. Health Risk Behaviors4. Health Promoting BehaviorsPSYCHOLOGICAL HEALTH1. Internalizing Problems 2. Externalizing Problems3. Self-Esteem4. Coping SkillsSOCIAL HEALTH1. Parent-Child Relationship2. Activity Engagement3. Positive Social Behaviors4. Negative Social BehaviorsEDUCATIONAL ACHIEVEMENT &

COGNITIVE DEVELOPMENT1. School Problems 2. Learning Difficulties3. Cognitive Development4. Achievement

Index Domains and Subdomains

CONTEXTUAL WELL-BEING

FAMILY CONTEXT1. Parental Engagement2. Guardian Functioning3. Home Environment4. Health CoverageCOMMUNITY CONTEXT1. Neighborhood: Supportive Environment2. Neighborhood: Support for Parenting3. Safe Neighborhood4. Safe SchoolSOCIODEMOGRAPHIC CONTEXT1. Socioeconomic Well-Being2. Human Capital3. Family Structure4. Family Size

Note: For a complete list of the 69 indicators please see the authors.

7

Summary scores calculated for child well-being and contextual well-being separately for each child.

Indices developed separately for 6-11 and 12-17 year olds to represent child development stages.

Child well-being and contextual well-being indices calculated for states, the nation and low-income children (<200% poverty).

Method, continued

8

Macro indices capture trends in well-being by aggregating population-based rates.

As a result, macro indices reflect average social conditions that many children do not experience.

By using individual child-level data, micro indices present a picture of the circumstances actually experienced by individual children.

Based on NSCH data for 2003-2004, about 1/4 of teens fare well in all four domains of well-being, and 1/8 are not faring well in any domain.

Micro vs. Macro Indices

9

Micro data present a picture of the actual circumstances experienced by individual children

*Score of 75+ in a domain

# of Domains in which Children are Faring Well*

Cumulative Child Well-Being Across Domains

9 12

1619

1921

2525

3123

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

1 2

4

3

2

1

0

Ages 6-11 Ages12-17

10

Child Well-Being and Contextual Well-Being Index scores for individual children range from 0 to 100. Children in our sample represent the full range.

Mean Child Well-Being score for children ages 6-17 in the U.S.= 67.9

Mean Contextual Well-Being score for children ages 6-17 in the U.S.= 53.8

Mean Child Well-Being score for low-income children (<200% poverty) ages 6-17 in the U.S.= 61.5

Highest state child well-being score: Vermont= 74.0 Lowest state child well-being score: Mississippi= 60.0

Understanding the Mean Scores

11

Child Well-Being is Lower for Teens

Mean Scores on Child Well-Being Index by Age

73727171 6665

5668 70 67

0.00

10.00

20.00

30.00

40.00

50.00

60.00

70.00

80.00

90.00

100.00

OVERALL CHILD WELL-BEING INDEX SCORE

PHYSICAL HEALTH DOMAIN

PSYCHOLOGICALHEALTH DOMAIN

SOCIAL HEALTH DOMAIN

EDUCATIONAL ACHIEVEMENT &

COGNITIVE DEVELOPMENT

DOMAIN

Mea

n S

core

Ages6-11

Ages12-17

12

Contextual Well-Being Varies Less by Child Age Than Child Well-Being

Mean Scores on Child Well-Being Index and Contextual Well-Being Index by Age

71

56

52

65

0.00

10.00

20.00

30.00

40.00

50.00

60.00

70.00

80.00

90.00

100.00

OVERALL CHILD WELL-BEING INDEX SCORE

OVERALL CONTEXTUAL WELL-BEING INDEX SCORE

Mean

Sco

re

Ages6-11

Ages12-17

13

Child Well-Being is Higher for Girls

Mean Scores on Child Well-Being Index by Gender: Children Ages 12-17

6767 69

63 63

55

727269

57

0.00

10.00

20.00

30.00

40.00

50.00

60.00

70.00

80.00

90.00

100.00

OVERALL CHILD WELL-BEING INDEX SCORE

PHYSICAL HEALTH DOMAIN

PSYCHOLOGICALHEALTH DOMAIN

SOCIAL HEALTH DOMAIN

EDUCATIONAL ACHIEVEMENT &

COGNITIVE DEVELOPMENT

DOMAIN

Mean

Sco

re

MALE

FEMALE

14

Child Well-Being Varies by Race/Ethnicity and is Lowest for Black Children

Note: ‘Other’ Race includes Asian, Native American, Alaska Native, Native Hawaiian and Pacific Islanders

Mean Scores on Child Well-Being Index by Race/Ethnicity: Children Ages 12-17

68 7073

70

60

48

56

6264

57

65

71

6567

56

7468

7170

57

66

49

6164 63

0.00

10.00

20.00

30.00

40.00

50.00

60.00

70.00

80.00

90.00

100.00

OVERALL CHILD WELL-BEING INDEX SCORE

PHYSICAL HEALTH DOMAIN

PSYCHOLOGICALHEALTH DOMAIN

SOCIAL HEALTH DOMAIN

EDUCATIONAL ACHIEVEMENT &

COGNITIVE DEVELOPMENT

DOMAIN

Me

an

Sc

ore

WHITE (NONHISPANIC)

BLACK (NONHISPANIC)

MULTIRACIAL

OTHER

HISPANIC

15

WY

WV

WI

WA

VT

VA

UT

TX

TN

SD

SC

RI

PA

OR

OK

OH

NY

NV

NM

NJ

NH

NE

ND

NC

MT

MS

MO

MN

MI

ME

MD

MA

LA

KYKS

INIL

ID

IA

HI

GA

FL

DEDC

CT

COCA

AZAR

AL

AK

70 to 7565 to 7060 to 6555 to 6050 to 55

Child Well-Being Varies by State

Mean Child Well-Being Score

16

W Y

W V

W I

W A

V T

V A

U T

T X

T N

S D

S C

R I

P A

O R

O K

O H

N Y

N V

N M

N J

N H

N E

N D

N C

M T

M S

M O

M N

M I

M E

M D

M A

L A

K YK S

I NI L

I D

I A

H I

G A

F L

D ED C

C T

C OC A

A ZA R

A L

A K

7 0 t o 7 56 5 t o 7 06 0 t o 6 55 5 t o 6 05 0 t o 5 5

Child Well-Being for Low-Income Children Also Varies by State

Mean Child Well-Being Score

17

W Y

W V

W I

W A

V T

V A

U T

T X

T N

S D

S C

R I

P A

O R

O K

O H

N Y

N V

N M

N J

N H

N E

N D

N C

M T

M S

M O

M N

M I

M E

M D

M A

L A

K YK S

I NI L

I D

I A

H I

G A

F L

D ED C

C T

C OC A

A ZA R

A L

A K

6 0 t o 6 55 5 t o 6 05 0 t o 5 54 5 t o 5 04 0 t o 4 5

Contextual Well-Being Varies by State

*Note the ranges of contextual well-being mean scores differ from child well-being mean scores.

Mean Contextual Well-Being Score

18

Child and contextual well-being is lower for teens than for children ages 6-11.

Child well-being is higher for girls than for boys. Child well-being is lower for Blacks and Hispanics when

compared to other racial/ethnic groups. State child well-being indices range from 64 to 74. State indices of contextual well-being range from 42

to 61. State indices of child well-being for low-income children

range from 55 to 70.

Summary of Results Based on the NSCH Micro Data

19

Some domains are more comprehensive than others due to limitations in the dataset.

All indicators are not available for children of all ages.

The data are based on parent-reports and therefore have gaps and are subject to social desirability.

Objective assessments, such as weight or academic achievement, are missing.

Limitations

20

The NSCH enables index development across all domains of child well-being by developmental stage, and by state, and for low-income children by state and the nation.

Separating contextual indicators from well-being indicators clarifies levels of well-being for child outcomes versus context.

An index, even limited to child well-being, masks variations of well-being by domain, but provides a simple reporting tool.

Micro indices add to existing indices of child well-being by representing the actual cumulative circumstances experienced by individual children. Macro and micro indices, however, both need better data and theory.

Conclusions

For more information please contact Laura Lippman at:

llippman@childtrends.org

www.childtrends.org www.aecf.org/kidscount