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

1. An Index of Child Well-Being for States, the Nation and Low-Income Children Utilizing the National Survey of Children’s Health Kristin A. Moore, Laura Lippman, Christina Theokas, Margot Bloch & Sharon VandivereChild Trends Bill O’HareAnnie E. Casey Foundation 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. Purposes • 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.

4. Data Base • 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

5. Method • 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.

6. CHILD WELL-BEING PHYSICAL HEALTH Health Status Limiting Conditions Health Risk Behaviors Health Promoting Behaviors PSYCHOLOGICAL HEALTH Internalizing Problems Externalizing Problems Self-Esteem Coping Skills SOCIAL HEALTH Parent-Child Relationship Activity Engagement Positive Social Behaviors Negative Social Behaviors EDUCATIONAL ACHIEVEMENT & COGNITIVE DEVELOPMENT School Problems Learning Difficulties Cognitive Development Achievement CONTEXTUAL WELL-BEING FAMILY CONTEXT Parental Engagement Guardian Functioning Home Environment Health Coverage COMMUNITY CONTEXT Neighborhood: Supportive Environment Neighborhood: Support for Parenting Safe Neighborhood Safe School SOCIODEMOGRAPHIC CONTEXT Socioeconomic Well-Being Human Capital Family Structure Family Size Index Domains and Subdomains Note: For a complete list of the 69 indicators please see the authors.

7. Method, continued • 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).

8. Micro vs. Macro Indices • 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.

9. Micro data present a picture of the actual circumstances experienced by individual children # of Domains in which Children are Faring Well* *Score of 75+ in a domain

10. Understanding the Mean Scores • 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

11. Child Well-Being is Lower for Teens

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

13. Child Well-Being is Higher for Girls

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

15. Child Well-Being Varies by State Mean Child Well-Being Score WA MT ME ND ID OR MN NH VT MI WI NY MA SD RI WY CT PA IA NJ NE OH DE UT NV MD DC IN IL WV CA CO VA KS MO KY NC TN OK AZ NM AR SC GA AL MS HI TX LA FL AK 70 to 75 65 to 70 60 to 65 55 to 60 50 to 55

16. Mean Child Well-Being Score Child Well-Being for Low-Income Children Also Varies by State

17. Contextual Well-Being Varies by State Mean Contextual Well-Being Score *Note the ranges of contextual well-being mean scores differ from child well-being mean scores.

18. Summary of Results Based on the NSCH Micro Data • 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.

19. Limitations • 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.

20. Conclusions • 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.

21. For more information please contact Laura Lippman at: llippman@childtrends.org www.childtrends.org www.aecf.org/kidscount