MCH-MRN E-News Update: May 2019
Coordinated by CAHMI
Gaps in Child Flourishing Narrow with Family Resilience and Connection

Less than half of school-age children in the U.S. are flourishing, according to a new study led by researchers at the Johns Hopkins Bloomberg School of Public Health published May 6 in Health Affairs . “We found that family resilience and connection were important for flourishing in all children, regardless of their level of adversity,” says study leader Christina D. Bethell, PhD, director of the Child and Adolescent Health Measurement Initiative and professor at Johns Hopkins University Bloomberg School of Public Health.

The study found that only 40 percent of U.S.
school-age children were flourishing, ranging from 30 percent to 45 percent across U.S. states. Nearly half of children (48 percent) lived in families that reported the highest levels of resilience and connection. These children had more than three times greater odds of flourishing compared to the quarter of children living in families with the lowest levels of resilience and connection. A similarly strong association of resilience and connection with flourishing was found across all groups of children, regardless of their level of adversity—as assessed by the level of exposure to ACEs, exposure to poverty, and presence of a chronic condition and special health care need.

“With only four in ten US school-age children flourishing using these three basic criteria, we need population-wide approaches to promote child well-being,” Bethell says. “Based on our findings,  fostering safe, stable, and nurturing relationships through parent-child communication, particularly around issues that really matter, may be especially critical.”
The study suggests that more emphasis should be placed on programs to promote family resilience and parent-child connection, even as society works to lessen children’s adversities like poverty and child maltreatment. Promoting the factors associated with flourishing in the study could increase the level of engagement and success that children have in school and in their relationships and activities. Evidence-based programs and policies to increase family resilience and connection could increase flourishing in U.S. children, even as society addresses remediable causes of childhood adversity.
The authors further suggest that the success of such efforts depends on making families and children partners in the process which itself can promote flourishing among the providers of health care, social, or educational services.

The newly released study on child flourishing by Bethell and colleagues used data from the National Survey of Children’s Health (NSCH), an annual survey funded and directed by the Health Resources and Services Administration’s Maternal and Child Health Bureau and fielded by the Census Bureau. Findings were based on a nationally representative sample of over 51,000 US school-aged children between ages 6 and 17 years included in the combined 2016-17 NSCH data set. In this parent-reported survey, parents answered questions about child flourishing, family resilience and connection, the child’s exposure to adverse childhood experiences (ACEs), household income, and whether the child had a chronic condition and special health care need. ACEs include a range of experiences associated with trauma and toxic stress in children, such as exposure to household substance abuse, serious mental illness, family and neighborhood violence, and loss of a parent through death, incarceration or divorce.

Family Resilience and Connection Promotes Flourishing Among U.S. Children, Even Amid Adversity ” was written by Christina D. Bethell, Narangerel Gombojav (Johns Hopkins Bloomberg School of Public Health) and Robert C. Whitaker (Columbia-Bassett Program of the Columbia University Vagelos College of Physicians and Surgeons and the Bassett Medical Center). The study was supported by funding from the Robert Wood Johnson Foundation and the Health Resources and Service Administration of the Department of Health and Human Services.

Measuring Flourishing and Family Resilience in the National Survey of Children's Health  
In recent years, questions have been added to the National Survey of Children’s Health (NSCH) related to child flourishing and family resilience.

To understand more about the prevalence of “flourishing,” the NSCH asked parents a series of related questions. School-age children were considered to be flourishing if their parents reported that these three things were “definitely true” about their child: 1) they were curious and interested in learning new things, 2) they worked to complete tasks they start, and 3) they were able to stay calm and in control when faced with a challenge. These qualities contribute to flourishing in adulthood, which is most fundamentally characterized by having a sense of meaning and engagement in life and positive relationships. Parents also answered questions to assess family resilience and connection, including how families respond when facing problems, how well parents and children share ideas or talk about things that really matter, and how well parents cope with the day-to-day demands of raising children.   
For children age 6 months-5 years, four questions related to flourishing were asked that aim to capture curiosity and discovery about learning, resilience, attachment with parent, and contentment with life. The NSCH asked: "How true are each of the following statements about this child: (1) child is affectionate and tender, (2) child bounces back quickly when things don’t go his/her way, (3) child shows interest and curiosity in learning new things, and (4) child smiles and laughs a lot. The "definitely true" response to the question indicates the child meets the flourishing item criteria.

Beginning in 2016, the NSCH also began to ask questions related to family resilience . A composite was constructed based on parent/guardian responses to four survey items (possible score 0-4). These items ask how often the child’s family members do certain things when the family faces problems: “talk together about what to do,” “work together to solve problems,” “know they have strengths to draw on,” and “stay hopeful even in difficult times.” A positive response was “all or most of the time.”

Interactive queries yield more information on child flourishing and family resilience
MCH researchers, child and family advocates, and others can learn more about flourishing and family resilience measurement and findings through the resources provided on the CAHMI Data Resource Center for Child Adolescent Health (DRC). Queries about composite and individual items that compose these flourishing measures for both age groups 6 months-5 years and 6-17 years ) are possible. 

For example, data from the combined 2016-17 NSCH data set shows that:
  • 64.7 percent of young children, age 6 months to 5 years meet all four of the flourishing items; and 
  • 94.2 percent of parents responded that it was definitely true their child showed interest and curiosity in learning new things.

The NSCH questions related to flourishing and family resilience were developed based on a review of research-based models and measures of flourishing and family resilience. A Technical Expert Panel worked over the course of a year and included experts child well-being and family health, survey methodology, as well as interested organizations and family leaders. Additionally, there was a public comment period which yielded more input and ideas related to this concept and how it can best be measured. Finally, iterative and recursive rounds of testing were conducted to finalize items used in the NSCH.

Meet CAHMI at the AcademyHealth Annual Research Meeting (ARM)

Christina Bethell, will be presenting as part of the Child Health Services Research Interest Group Session to be held Saturday, June 1, 2019 from 8:30 am to 12:30 pm as part of the AcademyHealth Annual Research Meeting (ARM) at the Walter E. Washington Convention Center in Washington, DC.

The CAHMI staff and MCH-MRN research colleagues will also have presentations and poster sessions at the ARM. A list of titles and authors is below.  Click here to see details and abstracts.

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  • Download the most recent MCH-MRN Strategic Agenda.
  • Link to an article we’re reading this month: Forrest CB, Blackwell CK, Camargo CA Jr. Advancing the Science of Children's Positive Health in the National Institutes of Health Environmental Influences on Child Health Outcomes (ECHO) Research Program. Journal of Pediatrics. 2018;196:298-300. doi: 10.1016/j.jpeds.2018.02.004
The Child and Adolescent Health Measurement Initiative (CAHMI) is a center within the Department of Population, Family, and Reproductive Health at the Johns Hopkins Bloomberg School of Public Health