Study Hypothesis
Children’s HealthWatch interview data are used to continually monitor the following hypothesis:
Changes in public policies (e.g. public assistance programs) and fluctuations of the economy impact the nutrition, health, and development of young children and the health and economic well-being of their families.
Children’s HealthWatch monitors, among other key indicators:
Child health:
- Health status
- Developmental risk (Parents’ Evaluation of Developmental Status – PEDS)
- Growth (weight and height measurements)
- Health care utilization history: admission from the emergency department and lifetime hospitalizations
- Other measures
Caregiver health:
- Health status
- Mental health risk
Household economic hardships:
- Food insecurity (lack of access to food due to financial constraints)
- Housing instability (history of homelessness, behind on rent/mortgage, multiple moves)
- Energy insecurity (inability to pay utility bill, unheated/uncooled days)
- Health care hardships (forgone care due to cost, difficulty paying for other needs as a result)
- Child care constraints (difficulty obtaining child care influencing caregiver ability to work or study as desired)
Other measurements:
- Early education and care
- Access to programs and services
- Immigration experience
- Financial hardships, employment, financial well-being
- Experiences of discrimination (EOD)
- Adverse Childhood Experiences (ACEs)
- Positive Relationship Experiences & Community (PACEs)
Children’s HealthWatch is uniquely positioned to demonstrate the effects on children’s and families’ health of changes to public policy and the economy, given our long history of data collection during economic booms and recessions. Monitoring data since 1998, the Children’s HealthWatch dataset currently includes over 90,000 interviews with caregiver-child dyads.
Caregiver Interview
Children’s HealthWatch data consists of repeated cross-sectional sentinel sampling of English- and Spanish-speaking caregivers (and previously, in Minneapolis only, Somali-speaking caregivers) of children under four years of age accessing emergency departments (ED) and primary and acute care clinics in Children’s HealthWatch medical centers. The survey instrument is administered during waiting periods in exam rooms in the ED or clinic or by phone follow up after an ED or primary care visit. During the survey, research assistants collect information about demographics, child health and development, caregiver health, housing, household food security, federal assistance program utilization and access, employment, income, financial literacy, oral health and health care access, utilities, and child care, Adverse Childhood Experiences (ACEs) and Experiences of Discrimination.
Procedures:
Caregivers of children under 48 months of age seeking medical care for their children are interviewed during their medical visit or via phone follow up after a visit.
Study research assistants:
- Obtain consent and determine eligibility
- Caregiver eligibility requirements include:
- English or Spanish speaking
- Index child has not participated in Children’s HealthWatch interview in the past 6 months
- Primary caregiver of child
- Lives in same household as child
- Lives in the state where the interview is conducted
- Caregiver eligibility requirements include:
- Ask caregivers all questions in the Children’s HealthWatch interview, with the exception of any the caregiver declines to answer.
- Provide families, at the conclusion of the survey, with information about local services, especially those in their neighborhood or refer, as appropriate, to on-site resources.
- Compensate families with a gift card or other approved incentive after completing the interview.
Data collection and storage
- All interviews are conducted using password protected and encrypted laptops or tablets in REDCap (Research Electronic Data Capture).
- Site Managers code and clean interviews on a regular basis.
- After interview. data are cleaned and reviewed.
- Data are added in 6 month batches to the analytic dataset managed and maintained by the Children’s HealthWatch team at Biostatistics and Epidemiology Data Analytics Center (BEDAC).
- Across all four research sites, we collect approximately 3,300 records per year.
To learn more about our COVID-19 Follow-Up Study, click here.
Medical Record Review
Children’s HealthWatch collects medical and sociodemographic data through medical record review.
Procedures – Core Survey:
- Data obtained from medical records include: admission to the hospital on the day of the survey, child’s weight and height, birthweight. Data are entered directly into the electronic interview at each site and sent securely to BEDAC.
Electronic Health Record Repository
In three of our four sites we have additionally developed an electronic health record (EHR) repository, which allows us to follow children’s health and health care utilization longitudinally over time. The repository contains linked records (survey and EHR data) from children from our Boston, Minneapolis, and Little Rock sites. We hope to add Philadelphia in the future. The records have also been geocoded, which allows examination of geospatial and exposure data, such as pollution and noise exposure or green-space and food access, as well as Census data at the parcel level, like income.
Data Collection Location
Why monitor children in acute/primary care clinics and emergency departments?
Children’s HealthWatch collects data on children under four years and their families in emergency departments and clinics at Boston Medical Center in Boston; Arkansas Children’s Hospital in Little Rock; Hennepin County Medical Center in Minneapolis; and St. Christopher’s Hospital for Children in Philadelphia.
Why monitor children in primary care clinics and emergency departments?
The Children’s HealthWatch sample comprises a vulnerable sentinel group who will show effects of a given situation before the wider population (like “canaries in a coal mine”). Emergency departments and acute care clinics serve a disproportionate share of medically uninsured and underinsured young children. Additionally, working poor caregivers are likely to have less work flexibility to take children for routine health care visits, making greater use of off-hour acute care centers and emergency departments instead. Health and social problems come to the attention of acute care and emergency department medical providers that otherwise would be missed.
Follow the links below to learn more about our research findings published in peer reviewed journals and policy reports/briefs. We also present our work in national scientific meetings and policy conferences, testimony at hearings, policy briefings, webinars and other virtual events, and in the media.
To read our peer-reviewed articles, click here.
To read our research and policy briefs, click here.
To read our testimonies, statements, and letters, click here.
To read our blog posts, click here.
Electronic Health Record Repository & Geocoded Data
In three out of four sites (Boston, Minneapolis, Little Rock), Children’s HealthWatch survey has been linked to the electronic health record (EHR), creating a longitudinal data repository with children’s health and health care utilization. Philadelphia site is working to have surveys linked in the near future. The survey/EHR data have also been geocoded, which allows examination of geospatial and exposure data, such as pollution, noise, and heat exposure or green-space and food access, as well as Census data at the parcel level, like income.