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• To learn more about Dr. Bethell’s interests, work, and publications, click here.
• To connect with Dr. Bethell on LinkedIn, click here.
• Click here to learn about the CAHMI mission and work, and meet the CAHMI team.

About the DRC

• To find general FAQs about the DRC, click here.
• To learn about the National Survey of Children’s Health, click here.

Data in Action Resources

• To explore the Prioritizing Possibilities Data Query (PPDQ), click here.

   

About the MCH Measures Compendium and Measure Set Profiles

How were the 12 measure sets chosen for the measure set profiles and compendium?

The 12 measure initiatives/programs included in this portal were selected based on their use within a range of MCH programs across various settings, including state Medicaid/CHIP programs, community MCH health and social services programs, federal maternal, child, youth, and family-serving agencies, health systems, and health plans. Individual measures used by each of the 12 MCH programs/initiatives were included in this review and in the compendium as long as they were sufficiently developed to include a specific and clear measure numerator, denominator, and data source.

Why are some measures (for example, those included in Child Stats’ America’s Children chartbook) or frameworks (such as RWJF’s Culture of Health) not included in the compendium?

The focus of the compendium is on measures in existing measure sets and initiatives that are used to monitor health and well-being, guide needs assessments, implement and evaluate quality improvement processes, and build knowledge to advance policy, programmatic, and clinical work. The compendium is also focused on measures of health and well-being of children, adolescents, and families. There are many useful, valid measures and indicators in use that were outside the scope of this work; however, some may be included in the future.

Why are the Head Start measures included in the profiles but not in the compendium?

Individual measures used by each of the 12 MCH programs/initiatives were included in this review as long as they were sufficiently developed to include a specific and clear measure numerator and denominator and data source. Since the data collected through the Head Start Program Information Report’s 59-part child-health data collection instrument did not provide such information, we were unable to include Head Start measures in the MCH-MRN’s detailed measure characterization steps. However, in the future, it appears that it would be possible to construct measures with clear numerator and denominator specifications from the data collected.  

Will there be additional measures/measure sets added in the future?

We hope to include additional relevant measures/measure sets in the future as time and resources allow.

I still think there are additional, good measures in X measure set – who should I contact to get them included?

You may contact Dr Christina Bethell at info@cahmi.org with such inquiries. We will periodically review and add new measures to the compendium as time, resources, and appropriateness for the compendium allow.

Are these measures up-to-date?

These measures are up to date as of February 2016. We plan on updating this information semi-annually as capacity allows.

How was the measure classification framework created?

Individual measures were first anchored to the domains of measurement included in both the MCH-MRN conceptual framework and the Child Trends® Child Wellbeing Framework. This entailed categorizing measures into one of three domains:

(1) Individual and Population Health Outcomes (Conditions, Mortality, Overall Health and Well-being, etc.)

(2) Upstream Determinants/Risk and Protective Factors (Physical and Social Environment, Education, Health Behaviors, etc.)

(3) Health Care and Services Access (Access, Insurance, Hospitalization, etc.)

Based on similarities in measures across these three domains, all 821 measures were topically categorized at 3 levels:

Level 1:  All 821 measures were sorted into at least one of six high-level topics: (1) Health Care and Service Access; (2) Condition Prevalence and Health Status; (3) Mortality; (4) Social Determinants of Health; (5) Pregnancy, Birth, and Sexual Health and (6) Mental, Emotional, and Behavioral Health. (Note that some measures fell into more than one Level 1 category).

Level 2: Next, all measures were further categorized into 40 sub-topics, reflecting the depth of measures available within each Level 1 category. 

Level 3: Last, each measure was assigned to one of 205 sub-sub topics, meant to capture more specific aspects of health and well-being.  

For example, the AMCHP Life Course Indicator 9, the proportion of households experiencing food insecurity, is classified as:

Level 1: Social Determinants of Health
Level 2: Economic Factors
Level 3:Food Security  

Are these measures nationally endorsed?

Some measures are endorsed by the National Quality Forum (NQF); some measures are also included in the National Quality Measures Clearinghouse (NQMC) and/or the National Committee for Quality Assurance (NCQA). Endorsement simply means that a measure has been examined in a formal way by an organization containing measurement experts, and judged to be of high quality. However, this process can take a great deal of time and resources, and is usually not covered by grant funding. Lack of endorsement does not necessarily reflect the quality or validity of a given measure.

What are the advantages to using these measures?

Many of the measures included in the MCH-MRN’s electronic compendium are actively used to collect and report on data for a variety of purposes. Using these measures provides the benefit of improving the harmonization of a core set of measures across MCH agencies and programs and gives easy access to information and resources on existing measures. Standardizing measurement systems will provide evidence and guidance to support definitions of health that extend beyond the absence of disease. 

Technical Definitions in the MCH Measurement Portal

What is the difference between unit of analysis and target population?

The unit of analysis is the major entity being analyzed by a measure, which could be individuals, groups, or organizations (e.g. infants, caregivers, schools, clinics, or states). The target population is the demographic group of focus (e.g. infants, children, mothers, or pregnant women). For example, in a measure looking at the requirements for health education in high schools, the unit of analysis is high schools, but the target population is adolescents.

What does it mean for a measure to have technical specifications?

Technical specifications include numerator and denominator statements at the very least. Technical specifications can also include detailed information on the validation, development, and origin of many a measure. Measures were only included in the compendium if they had at least the minimum technical specifications of numerator and denominator statements. See the CAHMI’s 4-part Measure Review Strategy for more information on what defines a measure.

What are the numerator and denominator of a measure?

The denominator of a measure can be thought of as the greater overall population, for example “children age 0-5”.  The numerator of a measure can be thought of as the topic being measured among the population.  For, instance an example of a numerator would be “hospitalizations among children age 0-5”.

To illustrate this concept more specifically, when considering a measure that seeks to capture the proportion of adolescents ages 13-17 who received the HPV vaccine, the denominator would be the “total population of adolescents aged 13-17”, and the numerator would be “adolescents aged 13-17 who received a complete series of the HPV vaccine.”

What does it mean when a measure’s data source is “administrative data?”

When a measure’s data source is identified as “administrative data”, the data is typically pulled from sources such as insurance claims, birth and death certificates, and health records (both paper and electronic). 

About the MCH-MRN Project

What is the MCH-MRN project?

The goal of the MCH-MRN is to create a sustainable interdisciplinary network to ensure data-driven innovation and shared accountability to improve outcomes and systems performance on behalf of the nation's children, youth, and families. The CAHMI has contributed to this goal by identifying gaps and priority areas in MCH measurement and creating a dynamic electronic compendium of health and well-being measures of children, adolescents, and families to advance MCH research.

Who sponsors it?

The MCH-MRN is sponsored by the U.S. Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau (MCHB) (UA6MC26253). The collaborative network has been led by the CAHMI in collaboration with the UCLA Center for Healthier Children, Families, and Communities. Funding for the 2013-2016 cycle of this grant ended in August of 2016; the CAHMI will be leading the 2016-2019 cycle starting in September of 2016.

How can I join the MCH-MRN?

Thank you so much for your interest! Please e-mail Dr Christina Bethell at info@cahmi.org for more information.

Additional MCH Measurement Resources

What are some additional CAHMI/DRC-produced measurement resources?

Systems Improvement Portal (coming soon): Get information on valid and reliable measures to assess and monitor pediatric health care quality and on policy efforts around quality improvement

Data in Action Resource: includes links to data briefs, publications, and presentations on this topic

Data brief on Child Health Data for Quality Improvement Partnerships

Medical Home Measurement and Improvement Resources (coming soon): subpage of the Medical Home portal focusing on resources to help states, families, and medical practices understand, measure, and improve performance of medical homes

CAHMI’s Measuring Medical Home manual

Child Version of the CAHPS Survey, created in partnership with the CAHMI

Healthy People 2030 Portal (coming soon): See where DRC data aligns with Healthy People 2020 indicators

CSHCN Screener: This is a 5-item screening tool developed by the CAHMI to identify children with special health care needs. It operationalizes the MCHB definition of CSHCN by focusing on the health consequences a child experiences as a result of having an on-going health condition rather than on the presence of a specific diagnosis or type of disability. The screener is used as part of the National Survey of Children’s Health and the CAHPS Chronic Conditions Supplement. Resources include:

Using the Screener

Screener Items and Scoring Instructions (and Screener Items in Spanish)

CMS Manual on identifying children and adults with special health care needs

CAHMI publication in Academic Pediatrics on Taking Stock of the CSHCN Screener.

CAHMI publication on the new Title V performance measures in MCH Journal: A new performance measurement system for maternal and child health in the United States

CAHMI presentation on the MCH-MRN: Introducing the MCH Measurement Research Network [Power Point Slides, EnRich Webinar Series].

Where else can I go to find additional resources on measurement?

Below, users can find a series of reports, publications, presentations, and factsheets which provide additional information relevant to MCH measurement:

Last J, editor. A dictionary of public health. New York: Oxford University Press; 2007.

National Public Health Performance Standards Program. Acronyms, glossary, and reference terms. Atlanta, GA: Centers for Disease Control and Prevention; 2007.

Columbia University, Glossary of Epidemiology Terms, https://epiville.ccnmtl.columbia.edu/glossary.html

National Quality Forum, The ABCs of Measurement, http://www.qualityforum.org/Measuring_Performance/ABCs_of_Measurement.aspx

Mangione-Smith, R., Schiff, J., & Dougherty, D. (2011). Identifying Children’s Health Care Quality Measures for Medicaid and CHIP: An Evidence-Informed, Publicly Transparent Expert Process. Academic Pediatrics, 11(3). doi:10.1016/j.acap.2010.11.003

Robert Wood Johnson Foundation (2016). From Vision to Action: Measures to Mobilize A Culture of Health

For the Public’s Health: The Role of Measurement in Action and Accountability. https://www.nap.edu/catalog/13005/for-the-publics-health-the-role-of-measurement-in-action

National Quality Forum. (2015). Pediatric Measures. http://www.qualityforum.org/Pediatric_Measures.aspx

Agency for Healthcare Research and Quality. (2015). Pediatric Quality Measures Program; Available Measures Developed by PQMP Grantees. 

http://www.ahrq.gov/policymakers/chipra/factsheets/index.html

The Cycle of Engagement

• To learn about the Cycle of Engagement Model and Early Childhood Cycle of Engagement Tools, click here.
• Click here to read our 2-pager for families about the Cycle of Engagement.
• Click here to read our 2-pager for providers about the Cycle of Engagement.

The Well Visit Planner

• To learn about the Well Visit Planner, click here.

The Promoting Healthy Development Survey

• To learn about the Promoting Healthy Development Survey, click here.

• To learn about our work to promote outcomes for CSHCN, click here.
• To learn about the CAHMI's CARE_PATH for Kids, click here. 

• What are Adverse Childhood Experiences (ACEs)?

  The term Adverse Childhood Experiences (ACEs) refers to a range of events that a child can experience, which leads to stress and can result in trauma and chronic stress responses. Multiple, chronic or persistent stress can impact a child’s developing brain and has been linked in numerous studies to a variety of high-risk behaviors, chronic diseases and negative health outcomes in adulthood such as smoking, diabetes and heart disease.

   

• What is trauma-informed care?

  Trauma-informed care encompasses three levels of focus from a systems level: addressing policy and procedures, creating approaches for organizing and delivering services and providing specific programs or interventions for families.

   

• What is the neurobiology of trauma and stress?

  Stress is a normal response to challenging life events. However, when stress reaches excessive levels, it can affect how a child’s brain develops. The Center for the Developing Child at Harvard University has outlined three different types of responses to stress:

   

  • Positive stress response is a normal part of healthy development in response to challenges such as attending a new school or a taking a test. It is characterized by brief increases in heart rate and mild elevations in stress hormones, which quickly return to normal.
  • Tolerable stress response results from more serious events such as a car accident and results in a greater activation of the body’s alert system. When a child has sufficient support with trusted adults, the body can recover from these effects.
  • Toxic stress response can occur when a child is exposed to severe, frequent or prolonged trauma without the adequate support needed from trusted adults. Toxic stress can result in changes in the brain’s architecture and function, can affect learning and development processes and can impact long-term health outcomes.

   

  Evidence from the field of neuroscience clearly demonstrates that ongoing exposure to traumatic events in childhood (also commonly referred to as ACEs) -- such as physical or emotional abuse or neglect, witnessing or experiencing violence in the home or community, substance abuse or mental illness in the home, the absence of a parent due to divorce or incarceration, severe economic hardship, or discrimination -- disrupts brain development, leads to functional differences in learning, behaviors and health and is associated with both immediate and long-term impacts on health.

   

• What is the role of resilience?

  People can be extremely resilient in the face of adversity when provided with protective relationships, skills and experiences. Research has shown that resilience – which can be learned - can mitigate the impact of ACEs and produce better health and educational outcomes. At the heart of resiliency is the need to cultivate healthy social- emotional development in children and families. This includes both intrapersonal skills – self- regulation, self-reflection, creating and nurturing sense of self and confidence – and interpersonal skills – establishing safe, stable and nurturing relationships.

   

• How was the National Prioritizing Possibilities Agenda developed?

  Over a four-year period, the Child and Adolescent Health Measurement Initiative (CAHMI) and Academy Health engaged more than 500 people across multiple sectors in a rigorous process to establish a national agenda to address ACEs. It began with the first-ever available national and state level data on ACEs, resilience, and family functioning from the 2011–12 National Survey of Children’s Health. To develop the agenda, a series of in-person meetings and listening forums were conducted along with several rounds of online crowdsourcing to identify goals and priorities across 10 stakeholder groups; educational sessions with stakeholders; and a range of research-in-action; coupled with community efforts.

• To read the Prioritizing Possibilities National Agenda, click here.

• To read a special issue of Academic Pediatrics addressing Child Well-being and Adverse Childhood Experiences in the United States, click here.