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7 Conclusions and Recommendations
Pages 192-210

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From page 192...
... Nonethe ess, the routine approaches to defining and measuring hea th in many national, state, and loca data collection and measurement efforts are adult-based and capture neither the developments essence of nor the multiple influences on children's hea th. In the committee's view, healthy development is both a component of children's hea th and a manifestation of it.
From page 193...
... Filling data gaps requires knowledge about the gaps that exist, understanding which gaps are important and how they can be filled, and appreciatmg what new research and methodologies must be de e aped to accomplish this. This report has provided a framework for national, state, and loca policy makers to identify and fill data gaps and thus secure information needed for consistent, focused, responsive, and effective policy.
From page 194...
... We then oudme severa specific recommendations to address gaps in current children's hea th measurement efforts and improve state and loca use of existing data. We conclude by identifymg specific research needs.
From page 195...
... Furthermore, the committee sought to acknowledge the relationships and mteractions among influences, as we I as how the larger service environments and policies structure those influences. While much has been learned about chi dren's development and how specific factors affect it and are embedded in biopsychosocia pathways, mcreased understandmg of how these pathways develop is critica, if cost-effective service and
From page 196...
... The committee began its work with the genera model of the mu iiplc determuntnts of hea th adopted by the Healthy People 2010 report We moved from this generic model of the determinants of hea th to a more interactive and developmentally appropriate mode that captures the interaction of multiple influences and acknowledges changes m the relative weight of those influences m relation to developments stage. This common framework of children's hea th shou d be adopted by the diverse group of federal, state, and loca agencies with some purview over children's hea th (e.g., delivery, assessment, assurance, and policy development functions)
From page 197...
... The designated agency shou d be charged with better integration of the existing portfolio of hea th surveys so that the identified gaps, particu arly re ated to measures of functioning and hea th potentia, can be addressed in a strategic and systematic fashion. Strategies to integrate measures and to compare and contrast data from existing surveys should be developed.
From page 198...
... Simi arly the committee reviewed how both negative and positive influences on hea th develop, aggregate, and interact to produce different levels of vu nerability or bestow greater hea th capacity and rest ience. The committee a so conduded that, srnce prevention and hea th promotion should be key Boa s of the hea th care system, better specification of the relative effect of positive and negative influences, and their origin and timing, wou d provide important information for improved targeting of prevention and hea th promotion strategies to optimize the hea thy .- cue opment of all chi dren.
From page 199...
... and the National Children's Study initiative, should address gaps im what is now collected and reported to reflect a more comprehensive, developmentally oriented conceptualization of children's health and its influences. Particular attention should be paid to adding data on fimc'don'mg and health potential.
From page 200...
... For example, comprehensive surveys could include data on family process and neighborhood characteristics, through systematic socia observation and parent report, as we I as biologica markers of hea th status, and environments samples. Individua groups defined by race, ethnicity, low socioeconomic status, or specia needs (e.g., chi dren with a chronic physica or menta hea th problem, those in foster care)
From page 201...
... Over the longer term, approaches need to be developed that incorporate the followmg e ements: oversampling of disadvantaged groups; tracking of chi dren early in life, collecting prenata information; frequent interviews and assessments with these children throughout childhood and rota adulthood measurement of assets as well as deficits; comprehensive measurement of multiple contexts that affect chi dren's hea th, inc uding the biological, demographic, and socioeconomic, at both the fame y and neighborhood levels, and services and policy environments; measurement of genebehavior-envrronment and other deve opmentally specific contextua interactions; and charting of hea th and disease trajectories md the relative contribution of various influences on hea th outcomes. The Nationa Children's Study being considered by HHS and the Environmenta Protection Agency is a possible vehic e for not only collecting data on the functioning and hea th potentia domains, but a so implementing a comprehensive, longitudina assessment of children's hea th and its influences as envisioned here.
From page 202...
... However, ample methodologica research has led to thoughtful recommendations regarding how survqs and administrative records could gather re iable measures of the educahon' household income, or occupationa dimensions of socioeconomic status. Such recommendations should be considered m the design of surveys and collection of administrative data.
From page 203...
... The Census Bureau should continue to collect and distribute local-area data and facilitate efforts to match these data to e misting sources of information on children's health and its influences. Recommenda'don 6: Government and private agencies and academic organiza'dons that conduct health-related surveys or compile administrative data should geocode addresses (i.e., provide geographiciden'dEers)
From page 204...
... Safeguards include obtarning appropriate parenta consent for the collection and sharing of data, limiting access to integrated data, ensurmg that data security protocols are in place, and in some instances reporting only aggregated data. The committee is encouraged by the many surveys and records systems that have developed geographic identifiers that both safeguard data and make them available to the research and planning communities.
From page 205...
... They shou d provide preferenha funds for model demonstrations that use standardized data collection methods, aggregate data by local geographic units, and disseminate aggregated data on web sites designed with two to three levels of complexity to meet the needs of the public and researchers while simultaneously protecting confidentia ity. Federa guidance and assistance are necessary but not sufficient for states and localities to rea ize the potentia of records data to inform hea th po icy and research.
From page 206...
... Use of integrated data to produce school readiness trajectories cou d provide communities with powerfu information to improve the de Dery of various services and target prevention and prompt on activities. It is a so important to consider Innking data across different se vice sectors (hea th, education, nutrition, chi d welfare)
From page 207...
... Substantia administrative data, collected primari y at the state level, could serve as the foundation for efforts to ana v, ze children's hea th in a community and the factors that might explain hea th problems. A though improved data integration is not m itse f sufficient to answer all questions re ated to children's hea th, enhanced efforts to use existing data could advance chi dren's hea th in many places.
From page 208...
... PROMOTING RESEARCH Recommendation 11: The U.S. Department of Health and Human Services and the Environmental Protection Agency should prioritize research and training on emerging methods for characterizing children's health and understanding i n ~ c en ces on it, including research on: · creation of improved measures of f~mctioning and health potentials · the r elative importance of and interactions among the ramge of influences; · biopsychosocial pathways of development; · assessment of cl lildren's exposures to envirommental towns amd other environmental health hazards; · reasons and remeddes for health disparPdesi · longitudinal methods that cam identity causal relationships between developmental and fimctional levels amd the health status of children; · development of profiles and integra'dve measures of children's health; and · construction of trajectories for each domadn of children's health.
From page 209...
... The committee determined that, despite general awareness of the scope and nature of chi dren's health disparities across population subgroups, the reasons for such disparities are barely understood. A growmg body of empirica literature indicates that many disparities begin early in life and increase or are compounded as a child grows.
From page 210...
... Fina Iy, there is a great need for research that can translate what are potentia Iy effective measures used primari y for research purposes into wider app ication for population hea th measurement and policy development. At present there is an enormous gap between what can be measured in controlled research environments and what is currentdy applicable for population md more genera hea th measurement uses.


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