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 Vandivere
Child Trends
Bill O’Hare
Annie E. Casey Foundation
Funded by the Annie E. Casey Foundation
Research Questions
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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?
2
Purposes
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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.
3
Data Base
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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
4
Method

The index is comprised of 7 domains:
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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.
5
Index Domains and Subdomains
CHILD WELL-BEING
CONTEXTUAL WELL-BEING
PHYSICAL HEALTH
FAMILY CONTEXT
1.
2.
3.
4.
Health Status
Limiting Conditions
Health Risk Behaviors
Health Promoting Behaviors
PSYCHOLOGICAL HEALTH
1.
2.
3.
4.
Internalizing Problems
Externalizing Problems
Self-Esteem
Coping Skills
SOCIAL HEALTH
1.
2.
3.
4.
Parent-Child Relationship
Activity Engagement
Positive Social Behaviors
Negative Social Behaviors
1.
2.
3.
4.
Parental Engagement
Guardian Functioning
Home Environment
Health Coverage
COMMUNITY CONTEXT
1.
2.
3.
4.
Neighborhood: Supportive Environment
Neighborhood: Support for Parenting
Safe Neighborhood
Safe School
SOCIODEMOGRAPHIC CONTEXT
1.
2.
3.
4.
Socioeconomic Well-Being
Human Capital
Family Structure
Family Size
EDUCATIONAL ACHIEVEMENT &
COGNITIVE DEVELOPMENT
1.
2.
3.
4.
School Problems
Learning Difficulties
Cognitive Development
Achievement
6
Note: For a complete list of the 69 indicators please see the authors.
Method, continued
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Summary scores calculated for child well-being
and contextual well-being separately for each
child.
Indices developed separately for 6-11 and 1217 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).
7
Micro vs. Macro Indices
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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.
8
Micro data present a picture of the
actual circumstances experienced by
individual children
Cumulative Child Well-Being Across Domains
100%
90%
31
80%
23
# of Domains
in which
Children are
Faring Well*
4
70%
25
60%
25
3
2
50%
21
40%
19
30%
20%
16
10%
19
9
12
Ages1 6-11
2
Ages12-17
0%
1
0
9
*Score of 75+ in a domain
Understanding the Mean Scores
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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
10
Child Well-Being is Lower for Teens
Mean Scores on Child Well-Being Index by Age
100.00
90.00
Mean Score
80.00
70.00
71
65
71
66
68
72
70
73
Ages
6-11
67
Ages
12-17
56
60.00
50.00
40.00
30.00
20.00
10.00
0.00
OVERALL CHILD
WELL-BEING
INDEX SCORE
PHYSICAL
HEALTH
DOMAIN
PSYCHOLOGICAL
HEALTH
DOMAIN
SOCIAL
HEALTH
DOMAIN
EDUCATIONAL
ACHIEVEMENT &
COGNITIVE
DEVELOPMENT
DOMAIN
11
Contextual Well-Being Varies Less
by Child Age Than Child Well-Being
Mean Scores on Child Well-Being Index and Contextual WellBeing Index by Age
100.00
90.00
Mean Score
80.00
70.00
71
Ages
6-11
65
56
60.00
52
Ages
12-17
50.00
40.00
30.00
20.00
10.00
0.00
OVERALL CHILD
WELL-BEING
INDEX SCORE
OVERALL CONTEXTUAL
WELL-BEING
INDEX SCORE
12
Child Well-Being is Higher for Girls
Mean Scores on Child Well-Being Index by Gender:
Children Ages 12-17
100.00
90.00
Mean Score
80.00
70.00
67
67
63
60.00
69
69
72
72
63
57
MALE
55
FEMALE
50.00
40.00
30.00
20.00
10.00
0.00
OVERALL CHILD
WELL-BEING
INDEX SCORE
PHYSICAL
HEALTH
DOMAIN
PSYCHOLOGICAL
HEALTH
DOMAIN
SOCIAL
HEALTH
DOMAIN
EDUCATIONAL
ACHIEVEMENT &
COGNITIVE
DEVELOPMENT
DOMAIN
13
Child Well-Being Varies by Race/Ethnicity
and is Lowest for Black Children
Mean Scores on Child Well-Being Index by Race/Ethnicity:
Children Ages 12-17
100.00
90.00
WHITE (NON
HISP A NIC)
80.00
Mean Score
70.00
60.00
68
68
70
65
57
61
60
67
73
70
66
62
57
71
74
64
65
64
56
48
50.00
71
70
63
56
B LA CK (NON
HISP A NIC)
49
M ULTIRA CIA L
40.00
30.00
OTHER
20.00
HISP A NIC
10.00
0.00
OVERALL CHILD
WELL-BEING
INDEX SCORE
PHYSICAL
HEALTH
DOMAIN
PSYCHOLOGICAL
HEALTH
DOMAIN
SOCIAL
HEALTH
DOMAIN
EDUCATIONAL
ACHIEVEMENT &
COGNITIVE
DEVELOPMENT
DOMAIN
14
Note: ‘Other’ Race includes Asian, Native American, Alaska Native, Native Hawaiian and Pacific Islanders
Child Well-Being Varies by State
WA
MT
ME
ND
ID
OR
MN
MI
WI
SD
VTNH
NY
WY
IL
CO
KS
IN
WV
VA
MO
KY
NC
TN
AZ
OK
NM
AR
SC
MS
HI
TX
NJ
MDDE
DC
OH
UT
NV
CA
PA
IA
NE
MA
CT RI
AL
GA
LA
FL
AK
Mean Child
Well-Being Score
70 to 75
65 to 70
60 to 65
55 to 60
50 to 55
15
Child Well-Being for Low-Income
Children Also Varies by State
WA
MT
ME
ND
ID
OR
MN
VTNH
MI
WI
SD
NY
MA
CT RI
WY
OH
UT
NV
CA
PA
IA
NE
IL
CO
KS
IN
OK
NM
VA
MO
KY
NC
AR
SC
MS
HI
TX
DE
MD
DC
WV
TN
AZ
NJ
AL
GA
LA
FL
AK
Mean Child
Well-Being Score
70
65
60
55
50
to
to
to
to
to
75
70
65
60
55
16
Contextual Well-Being Varies by State
WA
MT
ME
ND
ID
OR
MN
VTNH
MI
WI
SD
NY
MA
CT RI
WY
OH
UT
NV
CA
PA
IA
NE
IL
CO
KS
IN
OK
NM
VA
MO
KY
NC
AR
SC
MS
HI
TX
DE
MD
DC
WV
TN
AZ
NJ
AL
GA
LA
FL
AK
*Note the ranges of contextual well-being mean scores differ from child well-being mean scores.
Mean Contextual
Well-Being Score
60
55
50
45
40
to
to
to
to
to
65
60
55
50
45
17
Summary of Results Based on the
NSCH Micro Data
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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.
18
Limitations
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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.
19
Conclusions

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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.
20
For more information please contact
Laura Lippman at:
llippman@childtrends.org
www.childtrends.org
www.aecf.org/kidscount