Toward Measurement for a Whole Child Health Policy: Validity and National and State Prevalence of the Integrated Child Risk Index.

OBJECTIVE: To develop, validate and estimate national and across state prevalence on a multidimensional index that assesses the complex medical, social, and relational health risks experienced by United States children. METHODS: Data from the National Survey of Children's Health were used to construct the Integrated Child Risk Index (ICRI) which includes medical health risk (MHR), social health risk (SHR) and relational health risk (RHR) domains. Confirmatory factor analysis and logistic regression analyses were employed to assess construct and predictive validity. Validity outcomes were child flourishing, school engagement/readiness, emergency room utilization and forgone care. RESULTS: Confirmatory factor analysis confirmed the ICRI 3-domain structure and greater correlation between MHR and RHR than MHR and SHR. Logistic regressions confirmed strong predictive validity of the ICRI for all study outcomes and ICRI scoring approaches. Nearly two-thirds of children (64.3%) with MHR also experienced SHR and/or RHR. Nearly one-third of United States children experienced risks on 2 or more ICRI domains and 15% of publicly insured children had risks on all domains (16.2%; 9.0%-25.7% across states). Significant variations were observed across states and by age, race/ethnicity, health insurance and household income. CONCLUSIONS: The ICRI is a valid national and state level index associated with children's flourishing and educational preparedness and emergency and forgone care. National child health policies and Medicaid risk stratification and payment models should consider children's RHR in addition to SHR and MHR. Results call for integrated systems of care with the capacity to address medical, social and relational health risks and promote well-being. Substate and clinical applications require research.

Improving child health care through federal policy: an emerging opportunity.

Policymakers considering the 2009 reauthorization of the State Children's Health Insurance Program (SCHIP) have an opportunity to strengthen federal provisions to promote primary, preventive, and developmental child health care. Several pieces of legislation introduced in 2007 focused on aspects of child health quality, but none placed a specific emphasis on primary care. This issue brief describes three legislative proposals and additional quality provisions related specifically to primary care to consider for incorporation into federal law. These provisions include: 1) establishing a core set of primary child health service outcomes for tracking within Medicaid and SCHIP; 2) creating a structure within the Centers for Medicare and Medicaid Services that focuses on strengthening primary, preventive, and developmental child health services; 3) supporting additional research on child health quality and outcomes in primary care; and 4) providing incentives to states to promote evidence-based practices in children's primary health care

ACE, Place, Race, and Poverty: Building Hope for Children.

Adverse childhood experiences research has focused attention on the importance of family safety, stability, and nurturing in ensuring healthy development. This safety, stability, and nurturing can be compromised by family poverty, discrimination and marginalization, and geographic location. Drawing upon census data, this report shows that place, race, and poverty are intertwined concepts with particular implications for young children. Examining census tracts according to their levels of poverty shows that the poorest census tracts also: 1) are the "richest" in the proportion of young children, 2) have the least realized social, physical, and educational, as well as economic capital, and 3) are highly racially segregated and separated from many sources of economic opportunity. The implications are that the country's poorest neighborhoods require substantially more supports for young children but currently have many fewer. This includes individual services to young children and their families but also publicly available services and voluntary supports, such as parks, playgrounds, and libraries. These data suggest that improving child health trajectories and reducing health disparities according to race and socioeconomic status therefore will require concerted individual service as well as community-building efforts directed to poor and usually racially segregated neighborhoods and communities.