Existing programs could increase thriving, even for children facing adversity, large study finds
Less than half of school-aged children in the U.S. are flourishing, according to a new study led by researchers at the Johns Hopkins Bloomberg School of Public Health. However, children living in families with higher levels of resilience and connection are much more likely to flourish. This is true for children across levels of household income, health status and exposure to adverse childhood experiences.
The findings, published in the May issue of Health Affairs, suggest that more emphasis should be placed on programs to promote family resilience and parent-child connection, even as society works to lessen children’s adversities like poverty and child maltreatment.
“Family resilience and connection were important for flourishing in all children, regardless of their level of adversity,” says study leader Christina D. Bethell, PhD, director of the Child and Adolescent Health Measurement Initiative and professor in the Department of Population, Family and Reproductive Health at the Bloomberg School. “Parent-child connection had a particularly strong association with child flourishing.”
For their study, Bethell and colleagues used data from the National Survey of Children’s Health, an annual survey funded and directed by the Health Resources and Services Administration’s Maternal and Child Health Bureau and fielded by the Census Bureau. Findings were based on a nationally representative sample of over 51,000 school-age children between ages 6-17 included in the 2016 and 2017 combined NSCH. Children’s parents or guardians answered a series of questions about child flourishing, family resilience and connection, the child’s exposure to adverse childhood experiences (ACEs), household income (using federal poverty-level guidelines) and whether the child had a chronic condition and special health care needs.
ACEs include a range of experiences associated with trauma and toxic stress in children, like exposure to household substance abuse, serious mental illness, family and neighborhood violence and loss of a parent through death, incarceration or divorce.
School-age children were considered to be flourishing if their parents reported that three things were “definitely true” about their children—they were curious and interested in learning new things, work to complete tasks they start and were able to stay calm and in control when faced with a challenge. These qualities contribute to flourishing in adulthood, which is most fundamentally characterized by having a sense of meaning and engagement in life and positive relationships. Parents also answered questions to assess family resilience and connection, including how families respond when facing problems, how well parents and children share ideas or talk about things that really matter and how well parents cope with the day-to-day demands of raising children.
The study found that only 40 percent of U.S. school-age children were flourishing. This ranged from 29.9 percent to 45.0 percent across U.S. states. Nearly half of children (48 percent) lived in families that reported the highest levels of resilience and connection. These children had over three times greater odds of flourishing compared to the 25.5 percent of children living in families reporting the lowest levels of resilience and connection. A similarly strong association of resilience and connection with flourishing was found across all groups of children, regardless of their level of adversity as assessed by their level of ACEs exposure, exposure to poverty and presence of a chronic condition and special health care needs.
“With only four in ten U.S. school-age children flourishing, we need population-wide approaches to promoting child flourishing,” Bethell says. “Especially critical are efforts to foster safe, stable and nurturing family relationships by encouraging parents to communicate with their children about things that really matter to the child and family.”
Promoting the qualities of flourishing assessed in the study could increase the level of meaning and engagement that children have in school and in their relationships and activities. Evidence-based programs and policies to increase family resilience and connection could increase flourishing in U.S. children, even as society addresses remediable causes of childhood adversity. The authors further suggest that the success of such efforts depends on making families and children partners in the process,which itself may promote much needed improvements in the flourishing of our nation’s practitioners of children’s health care, social or educational services.
“Family Resilience and Connection Promotes Flourishing Among U.S. Children, Even Amid Adversity” was written by Christina D. Bethell, Narangerel Gombojav (Johns Hopkins Bloomberg School of Public Health) and Robert C. Whitaker (Columbia-Bassett Program of the Columbia University Vagelos College of Physicians and Surgeons and the Bassett Medical Center).
This study was supported by funding from the Robert Wood Johnson Foundation and the Health Resources and Service Administration of the Department of Health and Human Services.
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