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Toward Measurement for a Whole Child Health Policy: Validity and National and State Prevalence of the Integrated
Christina Bethell1, Courtney K Blackwell2, Narangerel Gombojav1
1Johns Hopkins Bloomberg School of Public Health, Department of Population, Family and Reproductive Health, Child and Adolescent Health Measurement Initiative (C Bethell and N Gombojav), Baltimore, Md.
Insights
A new index, the Integrated Child Risk Index (ICRI), assesses children's medical, social, and relational health risks. It reveals significant prevalence of multiple risks, especially among publicly insured children, highlighting disparities across demographics and states.
Area of Science:
- Pediatric health services research
- Child development and well-being
- Public health policy
Background:
- Assessing comprehensive child health risks is crucial for effective interventions.
- Existing indices may not fully capture the interplay of medical, social, and relational factors.
- Understanding national and state-level prevalence of child risk is essential for policy development.
Purpose of the Study:
- To develop and validate the Integrated Child Risk Index (ICRI).
- To estimate national and state-level prevalence of multidimensional child health risks.
- To assess the association of the ICRI with child flourishing, school engagement, and healthcare utilization.
Main Methods:
- Utilized data from the National Survey of Children's Health.
- Constructed the ICRI with medical (MHR), social (SHR), and relational (RHR) health risk domains.
- Employed confirmatory factor analysis and logistic regression for validity assessment.
Main Results:
- The ICRI demonstrated a robust 3-domain structure and strong predictive validity.
- 64.3% of children with medical risks also experienced social and/or relational risks.
- Nearly one-third of US children faced risks across two or more ICRI domains, with significant state-level variations.
Conclusions:
- The ICRI is a valid tool for assessing child risks at national and state levels.
- Findings underscore the need to incorporate relational health risks alongside social and medical factors in child health policies and Medicaid models.
- Integrated systems of care are recommended to address the multifaceted risks impacting child well-being.
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.
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