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Survey Items: Survey instrument item numbers for children ages 6-11: G11a-c; for children ages 12-17: G11a-c Variables in public use data file: K6Q71_R; K7Q84_R; K7Q85_R
Denominator: Children ages 6-17
Numerator: Meet flourishing measure criteria; Do not meet flourishing measure criteria
Revisions and Changes: There have been changes in 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: For children ages 6-17, three questions were asked that aimed to capture curiosity and discovery about learning, resilience, and self-regulation. The survey question asked, "How often does this child: 1) Show interest and curiosity in learning new things (K6Q71_R); 2) Work to finish tasks they start (K7Q84_R); and 3) Stay calm and in control when faced with a challenge (K7Q85_R). To qualify as “Child is flourishing", a child must have a response of “Always” or “Usually” on every individual item for which they have a valid response. The composite measure is only considered missing if all component items are missing. Questions were developed based on a review of positive health indicators by a Technical Expert Panel (TEP). This TEP included a representative group of experts in the field of survey methodology, children's health, community organizations, and family leaders. Additionally, there was a public comment period which yielded more interest in this concept. To learn more about the development of flourishing measures, see the "Flourishing From the Start: What Is It and How Can It Be Measured?" issue brief. For more information on the Title V MCH Block Grant measures, review this document.
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 NPMs and NOMs, 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: Overview of the Title V Block Grant The Title V Maternal and Child Health (MCH) Services Block Grant Program is a federal-state partnership to improve the health and well-being of mothers, children--including children with special health care needs--and their families in all 59 states and jurisdictions. The Title V MCH Services Block Grant Performance Measure Framework enables states to demonstrate the impacts of Title V within a state. The performance measurement system utilizes national data sources, including the NSCH, to track the ultimate outcomes of the program -- National Outcome Measures (NOMs) – and the key metrics of health behavior or health care access and quality -- National Performance Measures (NPMs) -- that influence NOMs. In 2024, the Title V NPMs and NOMs were updated. Some measures have new denominators (subsets of children), and some new measures have been added. Some measures are no longer NPMs and NOMs and are now classified as Standardized Measures. In 2024, MCHB expanded the definition of children with special health care needs (CSHCN). In addition to the CSHCN Screener, the denominator now includes children with at least one health condition and one functional difficulty asked in the NSCH. More information about the Title V MCH Services Block Grant and performance measurement system can be obtained at the MCHB website. Learn more about the NPM and NOM content changes at the MCHB website and DRC website. About the 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 in the United States. The U.S. Census Bureau administers the survey, oversees the sampling, and produces a final dataset. 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). Combining or comparing data from before and after the redesign is not recommended. 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.
Overview of the Title V Block Grant
The Title V Maternal and Child Health (MCH) Services Block Grant Program is a federal-state partnership to improve the health and well-being of mothers, children--including children with special health care needs--and their families in all 59 states and jurisdictions. The Title V MCH Services Block Grant Performance Measure Framework enables states to demonstrate the impacts of Title V within a state. The performance measurement system utilizes national data sources, including the NSCH, to track the ultimate outcomes of the program -- National Outcome Measures (NOMs) – and the key metrics of health behavior or health care access and quality -- National Performance Measures (NPMs) -- that influence NOMs. In 2024, the Title V NPMs and NOMs were updated. Some measures have new denominators (subsets of children), and some new measures have been added. Some measures are no longer NPMs and NOMs and are now classified as Standardized Measures. In 2024, MCHB expanded the definition of children with special health care needs (CSHCN). In addition to the CSHCN Screener, the denominator now includes children with at least one health condition and one functional difficulty asked in the NSCH.
More information about the Title V MCH Services Block Grant and performance measurement system can be obtained at the MCHB website. Learn more about the NPM and NOM content changes at the MCHB website and DRC website.
About the 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 in the United States. The U.S. Census Bureau administers the survey, oversees the sampling, and produces a final dataset. 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). Combining or comparing data from before and after the redesign is not recommended. 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.
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C.I. = 95% Confidence Interval. Percentages and population estimates (Pop.Est.) are weighted to represent child population in US.
DATA ALERT: This "Family Resilience" subgroup is based on the responses to 4 survey items: When your family faces problems, how often are you likely to do each of the following: 1) talk together about what to do; 2) work together to solve our problems; 3) know we have strengths to draw on; 4) stay hopeful even in difficult times. For a family to qualify as demonstrating resilience, a response of either "all of the time" or "most of the time" on all four items is required. To qualify as “Child is flourishing", a child must have a response of “Always” or “Usually” on every individual item for which they have a valid response.
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