tems in their Title V maternal and child health programs (Gabor et al., 1997; Grason and Nachbar, 1997). In a pilot project involving seven states, sponsored by the MCHB in 1998, core performance measurements are monitored. These measurements include: needs assessments, percentage of Medicaid-eligible children enrolled, standards of care for women and children, health insurance coverage, and cooperative agreements among state Medicaid, WIC, and other human service agencies. An emphasis on information systems development is also part of these pilot programs and should be explored for linkage with welfare reform evaluation. In another example, the Institute for Child Health Policy at the University of Florida, Gainesville is currently evaluating enrollment in its Healthy Kids programs of outreach to uninsured children, as well as the quality of services in the program for children with special health care needs (Reiss, 1999; Shenkman, 1999).
Efforts to promote and monitor state health objectives should include indicators of children’s health according to welfare, employment, and/or income status. As state and local communities plan for future Healthy People 2010 objectives, the impact of continuing welfare reform should be part of future health objectives. Where monitoring systems exist or are planned, they should include either linkage to state and local welfare data sets or common data elements that would provide for evaluation. For example, child health status measures could be monitored regularly according to the following categories: employed families with private health coverage, employed families with Medicaid or CHIP coverage, employed families with no coverage, unemployed families with Medicaid or CHIP, unemployed families with no coverage. These categories could be applied across a range of child health measures: prenatal care, infant mortality, low birthweight, immunizations, hearing and vision screening, specialist care for children with special health care needs, injuries, or teen pregnancy.
The Aspen Roundtable on Comprehensive Community Based Initiatives has addressed the issue of using administrative data and identified several useful sources for conducting small-area analysis (Coulton and Hollister, 1999). These data include Head Start records, emergency medical service records, immunization registries, and hospital discharge records. Aggregate data at the neighborhood level, combined with comparable welfare data aggregated to the same level, can answer research questions about selected high-risk neighborhoods within a county, within major metropolitan areas, or across a state. Table 10–2 lists several Web sites of organizations conducting these types of neighborhood-level analyses using small-area analysis (Child Trends, 2000,b).
Examples of current research using administrative data on Medicaid use, health care access, and other health outcomes to evaluate the impact of welfare reform on children’s health are increasing. In spring 2000, a three-state study about children’s movement among AFDC, Medicaid, and foster care was released by the Assistant Secretary for Planning and Evaluation (ASPE) of the U.S. Department of Health and Human Services. The study was conducted by Chapin