As a second predominant type of administrative data, vital statistics systems also can be linked to welfare data sets to provide a range of child health data. Issues of interest in using birth and death certificate files are described as follows:
Although obtaining access to birth records varies in difficulty depending on many state characteristics, birth records carry information of at least three kinds: the timing and nature of the birth (e.g., family size, birth spacing); services and the payment source for the birth (e.g., prenatal care used and whether the birth was covered by private pay, Medicaid, or medically indigent funds); the family (e.g., marital status); and the well-being of the child at the time of birth (e.g., birthweight, length of hospital stay, 5- and 10-minute scores, and the presence of congenital abnormalities).
Birth and death records increasingly are being maintained in electronic form, with greatly improved systems for updating this information in a more timely manner and linking these data for research purposes.
Child death is another indicator that can show differences as a result of services received (Earth and Blackwell, 1998). Although preventing child death is not the primary or sole responsibility of public assistance programs alone, child death rates are sensitive to conditions affected by public assistance, including poverty and lack of supervision. For example, if TANF programs increase the likelihood of home visits by caseworkers who also look for dangerous conditions in the home, if they result in changes in parental substance abuse, if they change access to health care, if they lead to longer spells in which a child is not supervised, changes in death rates from accidents, illnesses, and overdoses could result. Thus, death rates and types of deaths that comprise that rate can change for program users, nonusers, and former users.
A variety of relevant outcomes can be captured using death records, including adolescent suicide, adolescent homicide, many kinds of accidental deaths, deaths caused by injuries, deaths from abuse and neglect, and deaths caused by substance abuse (if overdose is the cause of death).
Death records are in the public domain and are available at the state level as well as from the National Death Index (NDI)—a central computerized index of death record information on file in state vital statistics offices. Investigators also can obtain data at the state level and make arrangements with the appropriate state offices to obtain copies of death certificates or specific statistical information such as cause of death.
Several public welfare agencies have matched child deaths against their welfare caseloads to better understand the vulnerability of their populations. Children who participate in AFDC, Medicaid, or Food Stamp Programs may experience an overall death rate greater than or different than that for other children (Maine Department of Human Services, 1983). Parents on welfare in