Survey Results

Survey Items: Over 60 survey items are used to construct this measure.

Denominator: Children age 0-17 years

Numerator: 0 domains, 1 domain, 2 domains, 3 domains

Revisions and Changes: This measure was added to the 2022-2023 NSCH Data Query for the first time. There have been changes to some survey items used to construct this measure since 2016. Changes could be in the way the item was worded, in the response options provided, or in other areas such as a skip pattern change, question placement changes, etc. For more information about the changes, click here.

Additional Notes: The Whole Child Risk Index (WCRI) assesses the complexity of children's health risks across medical, social and relational domains. This composite measure was developed from 12 health risk measures which were grouped into three domains of risks that children may experience. Some health risk measures were constructed based on multiple survey items asked in the NSCH. This version of the WCRI counts the number of domains (0-3) for which the child qualifies as having risk(s).

- The Medical Health Risk (MHR) domain includes 4 measures that identify children experiencing: 1) a more complex special health care need based on responses to the validated CSHCN Screener; 2) two or more of the chronic or life-long diagnosed conditions; 3) one or more of 12 frequent, chronic and/or serious functional difficulties aligned with domains included in the International Classification of Functioning for Children and Youth; and/or 4) fair or poor overall health status.
- The Social Health Risk (SHR) domain includes 4 measures that identify children whose caregivers reported that they: 1) sometimes or often could not afford enough food to eat; 2) somewhat or very often found it hard to cover the basics, like food or housing on their family’s income and/or family was not able to pay the mortgage or rent on time; 3) lived in an unsafe neighborhood and/or the child was a victim of or witnessed violence in their neighborhood; and/or 4) witnessed their child being treated or judged unfairly due to their race or ethnic group, health condition/disability, and/or sexual orientation/gender identity (6-17 years).
- The Relational Health Risk (RHR) domain includes 4 measures that identify children based on risks to the safety, stability and nurturing qualities of their relationships in the home. The RHR domain identifies children who: 1) experienced two or more of six household level adverse childhood experiences; 2) had one or both caregivers with fair/poor mental health; 3) had a caregiver report frequent aggravation with their child; and/or 4) had a caregiver who lacked emotional support or was not coping well.

Individual domains were set to missing if the child had 3 or more missing health risk measures for that domain. Children with any missing domains were coded as missing.
The construct and predictive validity of the measure were done through confirmatory factor analysis and logistic regression analysis. Psychometric properties and validity of the measure showed that the WCRI is a robust, holistic assessment tool. For more information about the development and validity of the measure, see Bethell C, et al. Toward Measurement for a Whole Child Health Policy: Validity and National and State Prevalence of the Integrated Child Risk Index. Acad Pediatr. 2022 Aug;22(6):952-964 and Bethell CD, et al. Social and Relational Health Risks and Common Mental Health Problems Among US Children: The Mitigating Role of Family Resilience and Connection to Promote Positive Socioemotional and School-Related Outcomes. Child Adolesc Psychiatr Clin N Am. 2022 Jan;31(1):45-70. doi: 10.1016/j.chc.2021.08.001. PMID: 34801155.
Please note that the measure was validated and presented in the previous publications as the “Integrated Child Risk Index”.

Treatment of Unknown Values: Missing values may be due to non-response (i.e. a skipped item) or a “don’t know” response. The way these items are handled can vary by measure. For Title V Maternal and Child Health Services Block Grant Measures, having missing values for all items in an indicator will lead to the case being given a missing value on the overall measure. For some other measures, if there is a missing value on any of the items, the case will be set to missing. How missing values are handled is documented in the "Additional notes" field above when required. Missing values are not included in the denominator when calculating prevalence estimates and weighted population counts displayed in the Interactive Data Query results table. In the majority of cases, the proportion of missing values is less than 5%. Exceptions are noted in the form of a Data Alert at the bottom of a results table. The exclusion of these values does not change the prevalence estimates (%) and only marginally affects the weighted population counts (Pop. Est.). To learn about the impact of the missing values on the population count estimates, click here.

History and Development:
About NSCH
The National Survey of Children’s Health (NSCH), funded and directed by the Health Resources and Services Administration’s (HRSA) Maternal and Child Health Bureau (MCHB), is designed to provide annual national and state-level information on the health and well-being of children ages 0-17 years in the United States. The U.S. Census Bureau administers the survey, oversees the sampling, and produces a final data set of survey results. HRSA’s Maternal and Child Health Bureau (MCHB) develops survey content in collaboration with the U.S. Census Bureau and a Technical Expert Panel. The Technical Expert Panel consists of experts in survey methodology and children’s health, federal and state stakeholders, clinicians and researchers. In 2016, the NSCH underwent a significant redesign which combined content from both the NSCH and the National Survey of Children with Special Health Care Needs (NS-CSHCN). Further information on that redesign can be found in “The Design and Implementation of the 2016 National Survey of Children’s Health”.
The NSCH is conducted as a household survey, and one child per household is selected to be the subject for the detailed age-specific questionnaire. The respondent to this questionnaire is a parent or guardian who is living in the home and has knowledge of the sampled child. Survey participants complete either web-based or self-administered paper-and-pencil questionnaires. Data from the NSCH is used for scientific research, federal policy and program development, and state-level planning and performance reporting. Information is collected on factors related to the health and well-being of children, including access to and utilization of health care, receipt of care in a medical home, systems of care for CSHCN, family interactions, parental health, school and after-school experiences, and neighborhood characteristics.
More information about the survey can be found in the “About the National Survey of Children's Health” section of this website and HRSA’s MCHB website.