Many measurement systems to monitor the well-being of children and guide services are implemented across the community, state, and national levels in the United States. While great progress has been made in recent years in developing interventions that have been shown to improve the cognitive, affective, and behavioral health of children, many of these tested and effective interventions have yet to be widely implemented. One potential reason for this lag in implementation is a need to further develop and better utilize measures that gauge the success of evidence-based programs as part of a broad effort to prevent negative outcomes and foster children’s health and well-being.
To address this issue, the Forum on Promoting Children’s Cognitive, Affective, and Behavioral Health held a workshop in Washington, DC, on November 5–6, 2014, titled Innovations in Design and Utilization of Measurement Systems to Promote Children’s Cognitive, Affective, and Behavioral Health. The forum was established as an outgrowth of the 2009 National Research Council and Institute of Medicine report Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and Possibilities, which called on the nation to make the prevention of such disorders and the promotion of mental health of young people a high priority (NRC and IOM, 2009). The forum engages in dialogue and discussion to connect the prevention, treatment, and implementation sciences with settings where children are seen and cared for, including health care, schools, social service and child welfare agencies, and the juvenile justice system, and to create systems that are effective and affordable in addressing children’s needs.
The workshop on measurement systems was the third held by the forum. The first, on April 1–2, 2014, examined strategies for scaling tested and effective family-focused preventive interventions so they can have widespread economic and social benefits (IOM and NRC, 2014a). The second, on June 16–17, 2014, was on harvesting the scientific investment in prevention science to promote children’s cognitive, affective, and behavioral health (IOM and NRC, 2014b). Both workshops pointed to the key role of measurement systems in guiding program implementation, evaluation, and adaptation and in building support for preventive interventions, which heightened the forum’s interest in holding a workshop devoted specifically to measurement issues.
Many different measurement systems track the health and well-being of children in the United States. In part, these systems are designed to monitor and provide actionable feedback to improve the delivery of health care, social, and educational services for children at the local, regional, and national levels. They can provide information on such factors as:
- The selection of target communities;
- The targeting of risk and protective factors;
- Strategies to change health systems, policies, and practices; and
- Strategies to improve the overall delivery and quality of care.
However, many of these systems could be improved through such tools as data linkage and integration, quality improvement methods, and feedback mechanisms. For example, as forum co-chair Hendricks Brown emphasized in his introductory comments at the workshop, data generated and used in one system rarely cross over into other systems, so information from the health care system are rarely used in schools, and information from the juvenile justice or social welfare systems are rarely used in health.1 In addition, significant gaps exist in the ability to measure factors that have a significant effect on children’s health and well-being, Brown said. New measurement types and uses could provide innovative and efficient ways to assess, assemble, and integrate data to drive actions.
The workshop featured presentations on the use of data linkage and integration to inform research and practice related to children’s cognitive, affective, and behavioral health; the use of quality measures to facilitate system change in health care, classroom, and juvenile justice settings; and tools developed to measure implementation of evidence-based prevention programs at scale to support sustainable program delivery, among other topics. Workshop presenters and participants discussed examples of inno-
1 Please see Chapters 2, 4, and 6 for additional discussion of data usage and linkage across systems.
vative design and utilization of measurement systems, new approaches to build on existing data systems, and new data systems that could support the cognitive, affective, and behavioral health and well-being of children. As the other co-chair of the forum, William Beardslee, stated, the ability to improve the health of children through effective interventions “depends on the collection of data and the use of information for continuous quality improvement, so this is a crucially important forum.”
At the conclusion of both days of the workshop, the forum co-chairs, the moderators of the four panels that took place in the workshop (summarized in Chapters 2–5 of this report), and the leaders of the breakout discussions (summarized in Chapter 6) identified the major issues that emerged from the presentations and discussions. This section draws on those comments to introduce broad topics that emerged from speakers’ presentations at the workshop and should not be seen as the conclusions of the workshop as a whole. Each is relevant to the mission of the Forum on Promoting Children’s Cognitive, Affective, and Behavioral Health:
- Measurement of children’s cognitive, affective, and behavioral health and well-being can be a powerful force for accountability and for the promotion of preventive interventions.
- Measurement can improve understanding of the factors that influence children, including the broad systems that both establish context and affect their lives directly.
- Large gaps still exist in the kinds of data that are being gathered and the ways information is being linked to help improve children’s lives.
- A strong infrastructure can enable the collection, analysis, and dissemination of data that are accurate, timely, relevant, sustainable, and acceptable to providers and users of the information.
- Better and more accessible measures can contribute to better informed and more educated policy makers and members of the public, which can further the public health mission of detecting, responding to, and preventing threats to health.
- An increased emphasis on measures, better use of existing measures, and new kinds of measures could help encourage communities to adopt evidence-based programs.
- New technologies and platforms are enabling not just new and less expensive ways of gathering, linking, analyzing, and disseminating data but the collection and use of entirely new kinds of data.
- Data systems that are simultaneously embedded and transportable can grow to meet the needs that exist while providing useful information today.
- Communication and collaboration across sectors and across levels of government could greatly improve the development, implementation, and refinement of such measures.
- Short-term, medium-term, and long-term steps could be identified to make such improvements, which could help prioritize the actions of the public and private sectors.
The broad topics identified by the forum co-chairs, the panel moderators, and the breakout group leaders emerged both from the presentations at the workshop and from subsequent discussions. In this summary report, important points raised by workshop members during discussion sessions have been incorporated into the summaries of speakers’ presentations.
Chapter 2 describes several examples of the successful use of data integration to inform research and policy pertinent to children’s cognitive, affective, and behavioral health. It also discusses how these and other systems might be improved. Chapter 3 looks at innovations in the use of measurement systems to monitor changes in children’s health at the individual and population levels. Chapter 4 considers examples of how quality measures have been used to facilitate system change in early childhood, juvenile justice, and health care settings. Chapter 5 discusses tools developed to measure the implementation of evidence-based preventive programs at scale and offers suggestions about how such tools can be used to improve the sustainable delivery of programs. Finally, Chapter 6 summarizes the observations of the breakout groups and the comments of workshop participants on the major topics discussed at the workshop.
IOM (Institute of Medicine) and NRC (National Research Council). 2014a. Strategies for scaling effective family-focused preventive interventions to promote children’s cognitive, affective, and behavioral health: Workshop summary. Washington, DC: The National Academies Press.
IOM and NRC. 2014b. Harvesting the scientific investment in prevention science to promote children’s cognitive, affective, and behavioral health: Workshop summary. Washington, DC: The National Academies Press.
NRC and IOM. 2009. Preventing mental, emotional, and behavioral disorders among young people: Progress and possibilities. Washington, DC: The National Academies Press.