Maine did not have mortality that was significantly higher than other children in poverty, although some types of mortality were high among welfare recipients; for example, the risk ratio for children whose parents were on welfare had a five times greater risk of experiencing a death from nonmotor vehicle accidents than other children in poverty. In a more recent study (Philips et al., 1999), mortality related to homicide, suicide, and automobile accidents (when substance abuse was mentioned on the death certificates) was shown to be substantially higher in the first week of the month—probably related to the greater availability of discretionary income following the arrival of government assistance checks and pay checks.

  • Evaluations of the relationship between deaths and welfare changes need to assess the type and timing of the deaths. Because child mortality is relatively rare—even among high-risk populations—studies of welfare populations may need to combine these mortality data with injury data and incarceration data (discussed later in this paper) to obtain an overall assessment of significant threats to well-being.

Other data sets may not be as easily linked to welfare data sets, yet they should be considered. Twenty-one states have comprehensive databases on hospital discharges (Pappas, 1998). These data can provide information about a wide variety of health concerns, such as child injuries, acute illnesses, and emergency room visits. These data sets may include measures of income, payment authorization, or actual welfare status. Injury data can be linked to welfare participation for individual-level analyses if they can be obtained from local hospital organizations.

Data from school-based health centers are available in fewer places, but could be expected to become more useful as school-based health clinics expand their reach. Although not yet widely available, school-based health centers are growing in coverage and in some states now blanket the state. Some states, such as Massachusetts, have initiated statewide systems of maintaining school health data. School-based clinics often are under the umbrella of a local hospital, and can serve as Medicaid providers under managed care contracts. These data will be most useful when they cover a large proportion of all youth in the area under study and when they provide additional information not available in the Medicaid data. This is the case in Colorado and Connecticut, which have extensive school-based health center networks (Koppelman and Lear, 1998).

Another source of data is programs funded under Title V, the Maternal and Child Health Block Grant (MCHB), which requires performance measurement for contracting and evaluation. State welfare reform evaluators should collaborate with Title V program staff to explore data linkage, inclusion of common data elements of welfare status and health across data sets, and other ways to share data and evaluate child health in the era of reform. For example, several states, including Kansas and Arizona, are implementing performance measurement sys-



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