Board on children, youth, and families

1. Board on children, youth, and families Vital Signs: Children and Families Metrics and MeasuresCollaborative of the Forum for Children’s Wellbeing: Promoting Cognitive, Affective, and Behavioral Health for Children and YouthSeptember 30, 2019

2. Collaborative Leaders Anne R. Edwards, MD, FAAP, American Academy of Pediatrics Kimberly E. Hoagwood, PhD, New York University School of Medicine Kelly J. Kelleher, MD, Nationwide Children’s Hospital Jennifer W. Kaminski, PhD, US Centers for Disease Control and Prevention Anna Cupito, National Academy of Medicine (NAM) Erin Kellogg, National Academies of Sciences, Engineering, and Medicine

3. Vital Signs: Core Metrics for Health & Health Care Progress Specifies a streamlined set of measures across 4 domains: • Healthy people • High-quality care • Affordable care • Engaged people • provide consistent benchmarks for health progressacross the nation; • improve system performance in the highest-priority areas.

4. Pediatric VSC Domain: Healthy PeopleLength of LifeLife ExpectancyInfant Mortality Measures 

5. Measures & Sources United States IM Rates • Death of infant before 1stbday • State birth certificates and death certificates • IMR = infant deaths/1,000 live births • US rate in 2017 = 5.8 deaths/1000 live births Source: https://www.cdc.gov/reproductivehealth/maternalinfanthealth/infantmortality.htm

7. Related Priority Measures • Related Priority Measures: • Life Expectancy • Average number of years a person can expect to live • US = 78.6 years • SOURCE: U.S. CDC https://www.cdc.gov/nchs/fastats/life-expectancy.htm • Preterm Birth Rate • SOURCE: U.S. CDC https://www.cdc.gov/reproductivehealth/MaternalInfantHealth/PretermBirth.htm • Percent of live births born before 37 weeks gestation • US = 10%

8. Why it Matters • Infant Mortality Rate is a strong predictor of maternal and young child health. It is highly associated with maternal mortality, young child developmental status and early medical costs • Infant Mortality Rate is considered one of the strongest predictors of healthy communities because it is related to overall wellbeing of young women and families

9. Pediatric VSC Domain: Healthy PeopleLength of LifeLife ExpectancySchool Readiness 

10. School Readiness Components Cognitive – e.g., literacy and numeracy Social – e.g., getting along with others Emotional – e.g., self-regulation skills Physical – e.g., gross and fine motor skills

11. School Readiness: Current Measures

12. Why School Readiness • School readiness is influenced by earlier… • Nurturing relationships, language input, physical health, adverse childhood experiences, socioeconomic disparities • School readiness predicts later… • Educational, social, and behavioral outcomes • Which in turn predict even later individual, family, and community outcomes

13. Pediatric VSC Domain: Healthy PeopleLength of LifeLife ExpectancyMiddle School Measures 

14. Middle School Measures Chronic Absenteeism School Suspension/Expulsion

15. Measures & Sources Chronic Absenteeism • Students miss at least 15 days of school per year • Civil Rights Data Collection (CDRC) – survey of all public schools and school districts across US • Grade-level data • Comparison community to community & state to state • Overall 16% of students experience chronic absenteeism Source: https://www2.ed.gov/datastory/chronicabsenteeism.html#intro

16. Related Priority Measures • School Discipline • Out of School Suspension • Temporarily removed from regular school for at least half a day for disciplinary reasons • 2.7 million students (2015-16) received one or more OSS (5-6% of total students) • Black male students account for 25% of OSS (8% enrolled students) • Expulsion • Removing child from regular school for disciplinary purposes • May occur with or without educational services provided to the student https://www2.ed.gov/about/offices/list/ocr/docs/school-climate-and-safety.pdf

17. https://www2.ed.gov/datastory/chronicabsenteeism.html#intro

18. Why it Matters • Chronic Absenteeism may impact achieving milestones • Third grade reading level • May be predictor of whether students will drop out prior to graduation • Impact on future in adulthood • Diminished health, poverty, involvement in criminal justice system

19. High School Graduation Rate

20. Measures & Sources Two primary measures of HS Graduation Rates • Adjusted Cohort Graduation Rate (ACGR): • The adjusted cohort graduation rate (ACGR) provides information about the percentage of public high school students who graduate on time (i.e., 4 years after starting 9th grade for the first time) with a regular diploma. The ACGR is calculated by state education agencies, and submitted to the U.S. Department of Education, via the EDFacts data collection system. • Average Freshman Graduation Rate (AFGR) • The AFGR uses aggregate student enrollment data to estimate the size of an incoming freshman class, which is compared to the number of high school diplomas awarded 4 years later. The incoming freshman class size is estimated by summing 8th grade enrollment in year one, 9th grade enrollment for the next year, and 10th grade enrollment for the year after, and then dividing by three. The averaging of the enrollment counts helps to smooth out the enrollment bump typically seen in 9th grade. The AFGR estimate is less accurate than the ACGR, but it can be estimated as far back as the 1960s since it requires only aggregate annual counts of enrollment and graduate data. Source: U.S. Department of Education; EdFacts (Data Groups 695 and 696); retrieved from: https://nces.ed.gov/ccd/tables/ACGR_RE_and_characteristics_2015-16.asp

21. Disparities: HS Graduation Rate

22. Why it Matters • High school graduation is a strong predictor of adult success, including adult physical and mental health outcomes, and involvement with the criminal justice system • Poorer health and greater health risks as adults (Cutler et al 2006) • More frequent and negative contact with law enforcement (Page et al 2007) • Linked to limited employment prospects, low wages, and poverty (Han et al 2015; Wilson et al 2013; Lee et al 2016)

23. For More Information… Vital Signs for the Health and Wellbeing of Children and Families https://goo.gl/4QeT2L National Academy of Medicine Vital Signs Initiative www.nam.edu/vitalsigns Contact: Erin Kellogg | EKellogg@nas.edu