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From page 91... ...
Avai able data come from severe sources: vita statistics, surveys, and c inica and administrative datasets (U.S. Department of Hea th and Human Services, 1981)
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From page 92... ...
in 1981 md 1988 that focused on children's hea th. Na'donal Child Health Data Collection Efforts Many federa agencies are now mvolved m collectmg regular and periodic hea th information about children (see Box 4-1)
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· Early Childhood Longitudinal Study—Si th Cohort (ECLS-a) · NaDonal Housrehold EducaDon Survreys (NHES)
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, which uses the same design approach and sampling frame as the ongoing Nationa immunization Survey. SLAITS is a su vey platform designed to collect state- and loca -level hea th care data.
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From page 95... ...
These include the inevitability of some response bias (such as the inabi ity of the SLAITS platform to obtain information about fame ies without telephones in their homes or of household interviews to obtain data on the home ess) , issues about whether or not the interviews are conducted m multiple languages, and of culture va idation of questions across groups.
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The Nationa Household Education Su veys program provides descriptive data on the educations activities of the U.S. popu ation, both children and adults.
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It a so me udes trends and progress toward BOX 4-2 National Data Syntheses Amorica's Children and the Environment America's Children Key National indicators of Wellbeing Child Health USA KIDS COUNT Child Tronds Data aank NOTE: See Appendk c ~, web iinkri to, these sy thmeri a d r~ampieri ot the indiortors trr oked.
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From page 98... ...
Casey Foundation, uses census data to produce nations and state-leve mdicators of child well-being. KIDS COUNT produces an annua data book, makes data avai able on their web site, and funds a network of statelevel projects (see Box 4-3)
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From page 99... ...
Ths 10 mernnurss used to rank states on overall child well-being irrcludn · percentage of low-birlhwsight babies · infant mortality rate: · child death rate · rats of teenage deaths by accident, homicide, and suicide: · bi th rats to teenage mothers: · percentage of childrsn living with parents who do not have tull.tims, yearround employment · percentage of teens who are high school dropouts · percentage of teens not Standing school and not working · percentage of childrsn in poverty · percentage of families with childrsn headed by a singis parent Ths project ho also published a series of special reports, such as: · KIDS COUNT Data on Asian, Natvs Amencan, and Hispanic Children Findings from the 1990 Census: · City KIDS COUNT . success in School Education Idol That Count · Child Care You Can Count On Model Programs.
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From page 100... ...
Another limitation is that some sites or plans, especia Iy m maged care plans, do not collect data on patients but, rather, on visits. Other concerns relate to how issues of cu tura mistrust, perceived racism, or stereotyping may introduce measurement errors when providers and patients are from different cultural, ethnic, and racia backgrounds.
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From page 101... ...
Many of these community hea th reports focus on children and family hea th issues, and in many locations across the United States these reports have a so been based on new data collection or data synthesis projects. A network of children's preventive services tracking registries is now operating m six states and New York City as a result of a Robert Wood Johnson Foundation mitiative, All Kids Count' These data systems are developing the prototypes for a nationwide system of integrated population-based registries that cou d be inked with prima y care providers to ensure that a I chi dren have a "medico home" and that public hea th offcia s and other policy makers have populationbased data on all children.
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From page 102... ...
. Despite the knowledge, most data collection efforts do not describe or facilitate explanation of the c ustering of hea th conditions in specific individua s or population subgroups.
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From page 103... ...
and is compatible with the World Hea th Organization's Internationa Classification of Diseases. Functioning The second domain, which we call functionmg, is generally represented by single items or nested items in hea th su vets.
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. Bqond the creation of profiles, many favor the creation of integrative measures that would in effect sum the various components into single score or index
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integrative measures shou d characterize the specia aspects of children's he a th, such as develop m e nta cap acid e s. A good measure of heath would include a summary score of relevant strengths and deficits that are combined across severa components or constructs of deve opment, as is the case for attempts to measure school readiness, which aim to mclude a chi d's physica and neurodevelopmenta function, cognitive capacity, language function, and socia emotions deve opment A though such measures may not routinely assess hea th conditions or hea th impairments, they may provide a composite eva uation of a child's potentia to thrive in an educationa settnng and he p forecast that child's or group of children's hea th, emotiona, and socia needs (lanus and Offord, 2000)
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From page 106... ...
With the possible exception of overa I attempts to quantify a child's school readiness, few measures m current use provide actua profiles of different aspects of children's hea th, and there is a paucity of integrative measures that cover the age r mge from infancy through adolescence. Ana yses of extant nations surveys do not contarn profiles or integrative measures of children's hea th.
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From page 107... ...
Mapping trajectories through ongoing collection of data that adopts the same conceptua framework would enable rapid strides to be made m both measurmg and understanding children's hea th and would make it possible to identify md address the needs of subgroups with poorer hea th. Overcoming Methodological Gaps The contmuous changes in chi dren as they age can complicate the measurement of their hea th and require a tering the yardsticks used to assess hea th at various developments stages.
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From page 108... ...
Yet reducing complex issues to single items is problematic at best In the area of children's hea th, this process is further complicated by the paucity of we l-developed psychometrically sound instruments for measuring hea th that span the age range. As a resu I, with some occasions notable exceptions, primarily m the area of chi dren's menta hea th, NCHS and others have traditionally used sing e items preferentia Iy.
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From page 109... ...
, knowledge about what constitutes norma and abnorma is lacking and may vary by age of the chi d. Meaningtu measurements of hea th across regions and popu ations often require reliance on multiple informants, reconci iation of discrepant information across informants, combming different measures across informants and settings, demonstration that the measurements are not simply norma variations (e.g., extreme m terms of frequency, duration, or severity or in short- and long-term prognosis)
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From page 110... ...
by failure to use in-depth assessment approaches, failure to use most-va id informants, and failure to link influences with hea th conditions reflecting disease burden and policy import. Opporturd'des to improve tbe Conceptual Basis for Healtb Assessment The conceptua ization of children's hea th is challenging.
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From page 111... ...
In pa tic Jar, strategies shou d capture ch rages in particu arly sensitive periods of development and map how hea th during one period influences and predisposes to subsequent states of hea th. Mapping the hea th trajectories of individua children or entrre populations of children requrres consideration of what measures an a specific domarn can be linked across developments periods to create a conceptua IT consistent measurement trajectory, and a so what group of measures across domarns can be assembled to account for an aggregate trajectory.
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From page 112... ...
Chi dren in lower income families have more severe hea th problems and worse hea th prognoses than children m higher Income families. Except for most large nations surveys that collect data on family income and parenta education, few or no data are collected to provide a systematic understanding of differences m hea th m popuiahon subgroups based on socioeconomic status.
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From page 113... ...
, or school they experience, but there are few other assessments of their overa I functioning. Since many chi dren with even severe impairments are able to play, and most are able tn attend school, especially under current policies, this is only a gross estimate of their overall functioning.
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From page 114... ...
While many communities throughout the United States have engaged in the measurement of positive youth behaviors and deve opmenta assets as part of their own loca Interest or projects, it is important to consider how measurmg the developments assets of young people can be encouraged in a I communities md the data made available to public and private entities interested m fostering positive hea th development m their youth. In March 2003, Child Trends convened a nations conference of leading researchers to review the state of the art in measurement of positive development.
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From page 115... ...
Measures that assess hea th potentia and provide more comprehensive assessment of functioning, as well as for composite measurements of hea th, need to be .- chic aped. Deficiencies in the assessment of hea th and influences on hea th during midd e childhood and of specia popu alien subgroups a so need to be addressed.
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