Measures of Child Well-Being

The study team collected several types of data to measure outcomes associated with child well-being. For all focal children, parents reported on children’s school or childcare enrollment, attendance, grades, grade completion, experi-ences, behavior at school and childcare, and attitudes about school and childcare. Parents also reported on prosocial behaviors and emotional and behavioral problems of children with the Strengths and Difficulties Questionnaire (SDQ;

Goodman, 1997), along with children’s health, access to health care, and sleep disruptions, which are associated with a variety of emotional and behavioral disorders (Dahl and Harvey, 2007). Additional instruments were tuned to children’s developmental stage. Children 12 to 41 months of age were assessed with the Ages and Stages Questionnaire (ASQ-3) family of questionnaires to measure gross and fine motor skills, social development, communication, and problem solving, as observed by parents (Squires and Bricker, 2009).

The adult respondent completed the ASQ-3 form. Study

59 The statistic for PTSD is the national 12-month prevalence rate as measured in the National Comorbidity Survey Replication (NCS-R), which was fielded in 2001 and 2002. The NCSR used a different instrument to measure PTSD than the Family Options Study (NCS-R, 2005).

60 The statistic for national rate of serious psychological distress is from the 2011 National Health Interview Survey. This survey used the same measure of psychological distress as used in the Family Options Study (CDC, 2012b).

Short-Term Impacts of Housing and Services Interventions for Homeless Families 54 Chapter 5. Description of Usual Care (UC) and Outcomes Measured in the Study

staff assessed children from 3 years, 6 months to 7 years, 11 months of age with the Woodcock-Johnson III (WJ III) letter-word identification and applied problems scales (Wood - cock et al., 2001), which are early indicators of verbal and quantitative/analytic skills, respectively. Children in this age group also completed the Head Toes Knees Shoulders (HTKS) task. HTKS assesses self-regulation, in which chil-dren must remember rules and inhibit incorrect responses (for example, by following instructions to touch their head when the interviewer says “touch your toes”).

Finally, surveys were conducted with children from 8 years to 17 years, 11 months of age measuring anxiety, fears, and substance use. This array of measures, along with parental report, captured the most likely mental health consequences of homelessness and behavioral responses thereto. Parental reports of behavior for this age group included arrests or police involvement. Youth reported on school effort to supple - ment parental reports of functioning in the key developmental domain of school. Youth also completed the Children’s Hope Scale (Snyder et al., 1997), a measure of self-efficacy.

Child Well-Being Measures From Parent Report Across Age Groups

The research team used the parent-reported information on focal children to construct the following child well-being outcomes that are measured for children across age groups.

Child Education

• Preschool or Head Start enrollment (percent of focal children). This outcome measures enrollment in preschool or Head Start for children ages 1 year, 6 months to 5 years.

It measures the percentage of children ages 1 year, 6 months to 5 years who were enrolled in preschool or Head Start at the time of the followup survey.

• School enrollment (percent of focal children). This outcome is measured for children ages 6 to 17 years using the parent report. It measures the percentage of children ages 6 to 17 who were enrolled in school at the time of the followup survey.

• Childcare or school absences in past month. This outcome is measured from parent reports of the number of absences from childcare or school in the month prior to the survey.

The outcome is measured using a scale of 0 to 3, with 0 in - dicating no absences and 3 indicating 6 or more absences.

• Number of schools attended since random assignment.

This outcome is measured from parental reports and indicates the total number of schools a child attended since random assignment. (Change in school could be because of grade completion, residential move, or another reason.) The out-come is measured using a scale of 1 to 4. Number of schools is topcoded at 4 or more schools.

• Grade completion—not held back (percent of focal chil - dren). This outcome is measured from the parent survey for children ages 4 to 17 years who were not reported to be in childcare or preschool at the time of the survey. The outcome measures the percentage of these children who have not repeated a grade or been prevented from moving on to the next grade since random assignment.

• Positive childcare or school experiences. This outcome measures the parent’s assessment of the child’s childcare or school experiences, rating them as mostly positive, both positive and negative, or mostly negative.

• Positive childcare or school attitudes. This outcome meas-ures the parent’s assessment of the child’s attitude toward school or childcare. The parent was asked to rate how much the child likes school or childcare. The outcome uses a 5-point scale ranging from 1 (not at all) to 5 (very much).

• School grades. This outcome measures the parent’s assess-ment of the child’s grades for the most recently completed term. The outcome uses a 4-point scale ranging from 1 (mostly Ds and Fs) to 4 (mostly As).

• Childcare or school conduct problems. This outcome measures whether or not the parent reports having been contacted by the child’s school or childcare provider regarding the child’s conduct problems or if the child was suspended or expelled.

Health

• Poor or fair health (percent of focal children). This out - come measures the parent’s assessment of the child’s health at the time of the followup survey. The outcome measures the percentage of children with poor or fair health (rather than good or excellent health), based on the parent’s assessment.

• Well-child checkup in past year (percent of focal children).

This outcome measures the percentage of focal children who received a physical examination or well-child checkup in the year prior to the survey, based on the parent’s report.

• Child has a regular source of health care (percent of focal children). This outcome measures the percentage of focal children who had a regular provider of health care at the time of the followup survey, based on the parent’s report.

• Sleep problems. This outcome measures the parent’s report on the frequency of two indicators of sleep problems—

tiredness on waking and tiredness during the day. The out - come is measured using a score of 1 to 5, with higher values indicating greater frequency of these sleep problems.

Behavioral Strengths and Challenges

• Behavior problems. This outcome is measured as the nation - ally standardized score from the SDQ. The SDQ is a behavioral and personality assessment. The total problem score measures emotional symptoms, conduct problems, hyperactivity, and peer problems.

• Prosocial behavior. Prosocial behavior refers to positive actions that benefit others. Prosocial behavior is measured for the study using the SDQ prosocial domain and is a nation - ally standardized score.

Characteristics of Focal Children in the UC Group Exhibit 5-11 displays the values of the outcomes described previously for focal children in the UC group.

School and Childcare

Among children ages 1 year, 6 months to 5 years in the UC group, 35 percent were enrolled in center-based care, pre-school, or Head Start. For 4- to 17-year-olds, 93 percent were enrolled in school. The percentage of school-age youth

(ages 6 through 17) enrolled (98.3 percent) is comparable with the percentage nationally (98.0 to 98.6 percent), although this study’s sample includes more children at the lower end of the age range. At younger and older ages, fewer children in the UC group were enrolled in school than their peers nationally; for 5- to 6-year-olds no longer in childcare, 86.7 percent compared with 95.1 percent nationally; for 16- to 17-year-olds, 91.1 percent compared with 95.7 percent nationally (Snyder and Dillow, 2013: Table 6).

Children in the UC group scored 0.95 on average for absences from school or childcare in the past month, wherein 0 indi - cates no absences and 3 indicates 6 or more absences. (During the summer, parents reported on the most recent month of enrollment.) National data suggest somewhat lower rates of absenteeism. Translating data from the National Assessment of Educational Progress to our scale, average numbers of absences for fourth graders in 2011 were 0.71 (for all children) and 0.82 (for children eligible for free and reduced-price lunch). For eighth graders, the comparable numbers were 0.82 and 0.89 (Snyder and Dillow, 2013: Table 187).

Exhibit 5-11. Family Options Study: Child Well-Being Outcomes Measured for Children Across Age Groups

Outcome Usual Care Group

Mean Value (Standard Deviation) Child education

Preschool or Head Start enrollment^a (%) 35.2 (60.0)

School enrollment^b (%) 93.0 (33.0)

Childcare or school absences in past month^c 0.95 (1.28)

Number of schools attended since random assignment^d 1.96 (1.15)

Grade completion—not held back (%) 90.4 (38.1)

Positive childcare or school experiences^e 0.58 (0.72)

Positive childcare or school attitudes^f 4.30 (1.28)

School grades^g 2.93 (1.26)

Childcare or school conduct problems^h 0.24 (0.55)

Child physical health

Poor or fair health (%) 4.6 (26.8)

Well-child checkup in past year (%) 90.2 (38.1)

Child has regular source of health care (%) 92.8 (33.0)

Sleep problemsⁱ 2.08 (1.44)

Child behavioral strengths and challenges

Behavior problems^j 0.58 (1.61)

Prosocial behavior^k – 0.16 (1.41)

a Base for preschool or Head Start enrollment is children ages 1 year, 6 months to 5 years.

b Base for school enrollment is children ages 4 to 17 years.

c Absences outcome is defined as 0 = No absences in past month, 1 = 1 to 2 absences, 2 = 3 to 5 absences, and 3 = 6 or more absences.

d Number of schools outcome is topcoded at 4 or more schools.

e Positive childcare or school experiences outcome is defined as – 1 = mostly negative experiences, 0 = both positive and negative experiences, and 1 = mostly positive experiences.

f Positive childcare or school attitudes outcome is parent report of how much child likes school and ranges from 1 to 5, with higher values indicating greater like of school.

g School grades outcome is defined as 1 = mostly Ds or Fs, 2 = mostly Cs, 3 = mostly Bs, and 4 = mostly As.

h Childcare or school conduct problems outcome is defined as 0 = no problems reported or 1 = parent contacted about behavior or suspension or expulsion from school or child-care center.

i Sleep problems outcome ranges from 1 to 5, with higher values indicating more frequent tiredness on waking and during the day.

j Behavior problems outcome is measured as the standardized Total Difficulties score from the Strengths and Difficulties Questionnaire (SDQ).

k Prosocial behavior is measured as the standardized prosocial domain score from the Strengths and Difficulties Questionnaire (SDQ).

Notes: Sample sizes vary by outcome. See Appendix B for details on outcome specifications and values. Means and standard deviations are weighted to adjust for survey nonre-sponse.

Source: Family Options Study 18-month followup survey

Short-Term Impacts of Housing and Services Interventions for Homeless Families 56 Chapter 5. Description of Usual Care (UC) and Outcomes Measured in the Study

Children had attended 1.96 schools, on average, since ran - dom assignment, which means one school change on aver-age in less than 2 years. As described in Chapter 3, school mobility is associated with lower levels of academic achieve-ment. Only 90.4 percent of children had completed all the grades in which they were enrolled; that is, 9.6 percent had been held back since random assignment.

Parents reported that children had mostly positive experi-ences in school (0.58 on a 3-point scale wherein 0 indicates both positive and negative experiences and 1 indicates mostly positive experiences). Parents also reported that children liked school, averaging 4.3 on a scale wherein 4 is pretty much and 5 is very much. Children’s grades, as reported by parents, averaged 2.93 on a scale wherein 2 is mostly Cs and 3 is mostly Bs.

Most children in the UC group (76 percent) had no conduct problems at school, but 24 percent had problems, some of them quite serious; 12.48 percent had been suspended or expelled from school and an additional 11.81 percent had problems that led the school to contact the parent. These problems, especially suspension and expulsion, varied by age. Older children were more likely to be suspended or expelled (0.6 percent of 1- to 4-year-old children, 8.0 percent of 5- to 12-year-old children, and 20.9 percent of 13- to 17- year-old children). These proportions for school-age children are far higher than the national averages of 6.9 percent sus - pended and 0.21 percent expelled (Snyder and Dillow, 2013:

Table 193).

Health

Parents reported that 5 percent of children in the UC group were in fair or poor health, comparable to 5 percent of poor children, but higher than the 1 percent of nonpoor children younger than age 18 in the National Health Interview Sur-vey in 2012. Family Options Study children were somewhat less likely to have a regular source of medical care than poor children generally (93 versus 95 percent), however (Bloom, Jones, and Freeman, 2013). Only 90.2 percent of UC children had received a well-child checkup in the past year. Parents reported that children rarely had trouble waking up or were tired during the day (2.08 on a 5-point scale wherein 2 indi - cates rarely).

Behavioral Strengths and Challenges

Parents rated their children on the SDQ, a standardized meas - ure of behavioral strengths and challenges. The reported scores are standardized by age and gender, so that children can be compared to their peers in a national sample. Children in the UC group scored markedly higher than national norms

on behavioral problems (0.58 standard deviations in the national data) and somewhat lower (0.16 standard deviations) on prosocial behavior.

Child Well-Being Outcomes for Specific Age Groups The study team constructed the following child well-being outcomes measured only for specific age groups.

Ages 1 Year to 3 Years, 6 Months

• Met developmental milestones (percent of focal children).

This outcome is defined as the percentage of focal children who scored above the typical developmental thresholds on the five domains measured in the ASQ-3.

• Low birth weight (percent of focal children born since random assignment and at least 1 year of age at the time of the survey). This outcome is measured for focal children born since random assignment who were 1 year old or older at the time of the followup survey. It measures the percentage of these children whose birth weight was below 5 pounds, 8 ounces, the threshold for low birth weight (CDC, 2014).

The outcome uses parent reports of the birth weight for these children.

Ages 3 Years, 6 Months to 7 Years

• Verbal ability. This outcome is measured as the nationally standardized score from the WJ III letter-word identification test.

• Math ability. This outcome is measured as the nationally standardized score from the WJ III applied problems test.

• Executive functioning (self-regulation). This outcome is measured using the HTKS developmental assessment meas-uring inhibitory control, attention, and working memory.

Ages 8 to 17 Years

For focal children between the ages of 8 and 17, the study team measured five outcomes from the child survey and one from the parent report.

• Anxiety. This outcome is measured using the A-Trait scale from the State-Trait Anxiety Inventory for Children, or STAIC (Spielberger et al., 1973). Scores range from 20 to 60, with higher scores indicating greater anxiety.

• Fears. This outcome is measured using the Fears Scale (Ramirez, Masten, and Samsa, 1991). Scores range from 33 to 99, with higher scores indicating more fear. Children were asked to indicate the extent to which they had 33 different fears.

• Substance use. This outcome, which combines data using 23 items from the Centers for Disease Control and Prevention (CDC) 2011 Youth Risk Behavior Survey, measures whether

the child had used tobacco, alcohol, or marijuana in the past 30 days or had ever used other substances—cocaine, inhalants, or steroids (ages 8 to 17) or ecstasy, meth, heroin, controlled prescription drugs, or injected drugs (ages 13 to 17 only).

• Goal-oriented thinking. This outcome is measured with a modified version of the Children’s Hope Scale (Snyder et al., 1997) which measures positive, goal-oriented thinking.

Scores range from 6 to 30, with higher scores indicating greater hope.

• School effort in past month. On the child survey, respon-dents were asked to report on how hard they worked in the month before the survey during the school day and on homework. The outcome measure ranges from 1 to 4, with higher scores indicating greater effort at school and on homework.

• Arrests or police involvement in past 6 months (percent of focal children). This outcome is measured using the parent report about whether the child had any problems that involved the police contacting the parent and whether the child had been arrested in the 6 months before the adult survey.

Characteristics of Focal Children by Age-Specific Outcomes in the UC Group

Exhibit 5-12 displays the values of the outcomes described previously for focal children in the UC group.

Ages 1 Year to 3 Years, 6 Months

By parent report, only 77 percent of children passed the developmental cutoff score in all five domains of ASQ-3.

Children were least likely to meet age standards for fine motor development and most likely to meet standards for gross motor development, with performance in the com-munication, problem-solving, and personal-social domains falling in between.

Parents reported that 9 percent of babies born since random assignment had low birth weight compared to a national figure in 2012 of 7.99 percent (CDC, 2014).

Ages 3 Years, 6 Months to 7 Years

Children ages 3 years, 6 months to 7 years were assessed directly with two subscales of the WJ III test of cognitive abilities, with scores compared to national age norms. Given the large association of family income with reading and

Exhibit 5-12. Family Options Study: Child Well-Being Developmental Outcomes for Children in Specific Age Groups

Outcome Usual Care Group

Mean Value (Standard Deviation) Ages 1 year to 3 years, 6 months

Met developmental milestones^a (%) 77.2 (54.6)

Low birth weight^b (%) 9.2 (36.3)

Ages 3 years, 6 months to 7 years

Verbal ability^c – 0.21 (1.38)

Math ability^d – 0.22 (1.24)

Executive functioning (self-regulation)^e 16.74 (22.87)

Ages 8 to 17 years

Anxiety^f 34.63 (10.64)

Fears^g 64.75 (21.63)

Substance use^h (%) 7.71 (38.55)

Goal-oriented thinkingⁱ 22.61 (6.97)

School effort in past month^j 2.81 (1.07)

Arrests or police involvement in past 6 months^k (%) 12.01 (41.34)

a Met developmental milestones outcome is defined as scoring above the typical development cutoffs in all domains of the Ages and Stages Questionnaire (ASQ-3).

b Base for low birthweight outcome (parent report) is children born since random assignment who are at least 1 year old at followup.

c Verbal ability outcome is the nationally standardized score from the Woodcock-Johnson III (WJ III) letter-word Identification test.

d Math ability outcome is the nationally standardized score from the WJ III applied problems test.

e Executive functioning outcome is the Head Toes Knees Shoulders (HTKS) score and ranges from 0 to 40, with higher scores indicating greater executive functioning.

f Anxiety (child report) is measured using the A-Trait scale from the State-Trait Anxiety Inventory for Children (STAIC). Scores range from 20 to 60, with higher scores indicating greater anxiety.

g Fears outcome (child report) is the score from the Fears Scale and ranges from 33 to 99, with higher scores indicating more fear.

h Substance use (child report) is measured with 23 items from the Centers for Disease Control and Prevention (CDC) 2011 Youth Risk Behavior Survey.

i Goal-oriented thinking (child report) is measured with a modified version of the Children’s Hope Scale and ranges from 6 to 30, with higher scores indicating higher levels of posi-tive, goal-oriented thinking.

j School effort outcome (child report) ranges from 1 to 4, with higher scores indicating greater effort during school day and on homework.

k Arrests or police involvement in past 6 months is from parent report.

Notes: Sample sizes vary by outcome. See Appendix B for details on outcome specifications and values. Means and standard deviations are weighted to adjust for survey and assessment nonresponse.

Sources: Family Options Study 18-month followup survey; ASQ-3; WJ III; HTKS assessment; Family Options Study 18-month child survey

Short-Term Impacts of Housing and Services Interventions for Homeless Families 58 Chapter 5. Description of Usual Care (UC) and Outcomes Measured in the Study

math ability (for example, Miller, Votruba-Drzal, and Setod-ji, 2013), it is not surprising that UC children scored about one-fifth of a standard deviation below national norms on both letter-word identification (a measure of verbal ability) and applied problems (an early measure of math ability).

math ability (for example, Miller, Votruba-Drzal, and Setod-ji, 2013), it is not surprising that UC children scored about one-fifth of a standard deviation below national norms on both letter-word identification (a measure of verbal ability) and applied problems (an early measure of math ability).

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