MCH-MRN E-News Update: July 2019
Coordinated by CAHMI
Just Released: Well-Being in the Nation (WIN) Measurement Framework

While many high school students graduated and families celebrated their accomplishment this past June, researchers in public health and other fields were taking note of differences in graduation rates across communities. Whether someone graduates from high school in the US is a strong predictor of one’s future health and life expectancy, as well as their community’s overall wealth and health. Because of this strong association, high school graduation rates are among nine core measures included in the newly developed Well-Being in the Nation (WIN) Measurement Framework: Measures for Improving Health, Well-Being, and Equity Across Sectors released June 3, 2019 by 100 Million Healthier Lives , convened by the Institute for Healthcare Improvement (IHI) , and in partnership with the National Committee on Vital and Health Statistics (NCVHS) , an advisory committee to the US Secretary of Health and Human Services.  

The WIN measures ( ) were developed to and can be used by anyone – from a federal agency to a heath care organization to a community coalition – to guide policy, compare results across initiatives, and drive improvement. In addition to high school graduation rates, measures like child poverty rates, community walkability, and how people feel about their own lives and their future are all important in creating health and well-being over the course of their lives. In total, the WIN Framework includes 3 sets of measures:
  •  9 core measures organized around the well-being of people, the well-being of places, and equity
  • Leading indicators based on domains such as community vitality, housing, transportation
  • A full flexible set of measures

“The degree to which people engage in civic life, good jobs are available, housing is affordable, the environment enables people to connect with one another, and the culture of the community is inclusive – all of these relate to whether a community might thrive,” said Somava Saha, MD, MS, Vice President of IHI, and Executive Lead for the 100 Million Healthier Lives initiative. “The WIN report recognizes that these elements – the well-being of people and the well-being of places – are interconnected and related to the systems and conditions that perpetuate health inequities.”
WIN Framework Collaborative Development Process and Ongoing Population-Specific Processes

The WIN measures were developed by over 100 organizations and communities working together across sectors to identify and try out measures that mattered to them. The CAHMI and MCH-MRN have participated from the onset of this effort. The current WIN indicators draw exclusively from existing data resources such as, County Health Rankings and Roadmaps , City Health Dashboard , US News & World Report’s Healthiest Communities , and the CAHMI’s Data Resource Center (DRC) on the National Survey of Children’s Health (NSCH) .

“As a whole, these measures help us to shift our understanding of what creates health and equity and what we should begin to track in terms of our nation’s well-being,” noted Saha. Together, stakeholder groups identified 500+ measures, which were narrowed down to nine core measures, as well as 54 leading indicators across 12 domains and 30 subdomains, such as food, health, housing, education, and transportation. In addition, groups identified a number of measures that specifically relate to the health, well-being and equity of certain populations, such as children and adolescents. The measures identified for children and adolescents are currently being considered for addition into the framework’s full flexible set of measures. Many recommended measures draw from those found in the NSCH, including child flourishing , supportive neighborhoods , school engagement , and safe schools

MCH Measurement Gaps Impacting Federal Policy, Programs, and Research
On July 11, 2019, the House Committee on Oversight and Reform held an unprecedented hearing titled, “ Identifying, Preventing, and Treating Childhood Trauma: A Pervasive Public Health Issue that Needs Greater Federal Attention .” This topic addresses many priority areas of measurement identified in the MCH-MRN Strategic Agenda. During the four-hour hearing, nine witnesses presented testimony in two panels. In the first panel, trauma survivors shared their personal stories. In the second, expert witnesses from academia and local, state, and federal government spoke on the subject. Dr. Bethell shared her testimony with recommendations for a response to needs for measurement and data drawing upon the gaps and priorities related to the social determinants of health, positive and relational health and family engagement focus areas of the MCH-MRN Strategic Agenda . These recommendations can be found in MCH-MRN Principal Investigator Dr. Bethell’s written testimony . Her short oral testimony can be viewed here , and the full hearing can be viewed here .

Given the current public need for more information on childhood adversity, trauma and resilience, the CAHMI created for all states (including District of Columbia) and the nation new Fact Sheets, Strong Roots Grow a Strong Nation . These fact sheets include prevalence data for adverse childhood experience (ACEs) for both adults and children as well as key outcomes for children (such as bullying, school engagement, resilience and flourishing). These fact sheets feature combined 2016/2017 NSCH data and data from the Behavioral Risk Factor Surveillance Survey (BRFSS) and aim to generate local awareness and action to advance policies that catalyze well-being across the nation. 
Requests for Feedback on Data, Measurement, and Research Plans
In addition to this hearing, other federal agencies have requested input on data, measurement and research plans, including the Federal Data Strategy Action Plan and the NIH Research Domain Criteria best practices for incorporating development and environment into research. The CAHMI has submitted feedback and input for these requests, highlighting the key priorities and gaps stated in the MCH-MRN Strategic Agenda. While efforts are being made to align measurement and data to promote well-being across the country, key measurement gaps must be prioritized. These include conceptual gaps, gaps in data available across relevant units of analysis, gaps for key populations, gaps in access to and support for the effective use of data for research, policy, or practice, and gaps in platforms allowing routine and personalized data collection and sharing at local and service settings. 

The recommendations set forth by the CAHMI and in Dr. Bethell’s testimony reflect the MCH-MRN agenda, for which gaps in positive childhood experiences, social-emotional development and functioning, positive and relational health and family engagement have been assessed and documented. In order to leverage possibilities to promote child well-being, we need to further expedite and expand the use of existing measures on child adversity, positive health, resilience, and related data for research, policy, and practice; and to remove barriers to using available data at the local, state and national levels.
Survey word cloud. Adobe Stock
Continue to Provide Input on the National Survey of Children’s Health (NSCH)

The  NSCH is funded and directed by HRSA MCHB  and is a powerful national and state resource. The CAHMI expedites and supports effective use of data from the NSCH to improve child, youth, family and community health and well-being in the US through its HRSA supported Data Resource Center.

The CAHMI is assembling ideas and input from our network related to future iterations of the NSCH.
  • Click here to provide input on what you wish to see prioritized and maintained in the NSCH, what you may recommend editing or adding, and your other ideas for optimizing this essential national resource.  
Engage with the MCH-MRN
The MCH-MRN provides a platform to: inspire, support, coordinate, and advance efforts related to MCH measurement, promote measurement innovation and shared accountability, and improve outcomes and systems performance on behalf of the nation’s children, youth, and families. 

MCH-MRN members contribute to setting a strategic agenda, collaborate to address MCH measurement gaps and needs, and receive resources and information relevant to MCH measurement. Here are some further ways to get involved with the MCH-MRN:
  • Engage in the network. Please fill out our engagement tool to help us understand how you would like to be engaged in the MCH-MRN and how best to keep you informed about network activities.
  • Use our website and interactive compendium to quickly browse through over 1000 MCH measures by measure set, data source category, or three levels of topical categories.
  • Download the most recent MCH-MRN Strategic Agenda.
What We're Reading This Month:

  • Freed GL. A Missed Opportunity to Address a National Shame: The Case of Sickle Cell Disease in the United States. JAMA Pediatr. Published online June 17, 2019. doi:10.1001/jamapediatrics.2019.1536

  •  Leslie LK, Mehus CJ, Hawkins JD, Boat T, McCabe MA, Barkin S et al. Primary health care: potential home for family-focused preventive interventions. Am J Prev Med. 2016;51(4, Suppl 2):S106–18.

  •  Marie-Mitchell A, Kostolansky R. A Systematic Review of Trials to Improve Child Outcomes Associated with Adverse Childhood Experiences. Am J Prev Med. 2019;56(5): 756-64.
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