The Child Status Index: A Paradigm Shift in Assessing Highly Vulnerable Children in LMIC

• Collaboration among Duke University, Measure Evaluation, & USAID O’Donnell K, Nyangara F, Murphy, R, & Nyberg B

• Designed to improve on the “one size fits all” program planning and M& E tools for PEPFAR programs

• To develop a child centered tool for assessing vulnerable children and theirhouseholds

Approaches to OVC assessment #1One size fits all Individualization

Child and household “outcomes”Improvements related to outputsIncreased risk (other factors)Program plans: “Outputs”:•Care plans: child and household level•Available resources

Outputs•Care plans: child and household level•Determined by needs and/or resources

Assessment of child and household status•Well being•Vulnerabilities•Needs

Desired outcomesBenefits to child and householdNew risks/needs

Approaches to OVC assessment #2• Objective indicators, e.g., clean water source

• Subjective reporting, e.g., self report “I am as happy as most children.” “He fights with other children.”

• High inference ratingsDerived from interviews and observations of specific markers that can be objective or subjectiveReference can be local, national, or international norms

RECOMMENDED: MULTIPLE APPROACHES

CSI development: To determine what are the important factors to assess about a vulnerable

child’s life?A community participatory approach to factor development

(Kenya, Tanzania, Ethiopia, Cambodia) with families, guardians of orphans, village leaders.

We asked, and they told us what we needed to know.

Nutrition, shelter, abuse and protection, health, psychosocial, learning and education…

• Resulting in 12 factors– Child centered– Could be responsive to intervention– Would detect an emergency situation

• To be rated using a high inference approach suitable for use by community volunteers– Interview multiple household members and others– Observations and inference

• Each rated from good to fair to bad to very bad (4, 3, 2, and 1)

CSI: Uses and cautions

1. Targeting vulnerable children+ within a community, selecting

specific factors or # of “very bad”

-scores are not addtititive

2. Case management+what does the child and

household need-if it is better, doesn’t mean it

can be withdrawn

3. Monitoring and evaluation+can be used for outcomes not

outputs-not as a stand alone given

variability/bias in responses

4. Program planning+what are the priorities in this

community?-based on local norms, so cannot

compare across communities/countries

Approaches to OVC assessment #1One size fits all Individualization

Child and household “outcomes”Improvements related to outputsIncreased risk (other factors)Program plans: “Outputs”:•Care plans: child and household level•Available resources

Outputs•Care plans: child and household level•Determined by needs and/or resources

Assessment of child and household status•Well being•Vulnerabilities•Needs

Desired outcomesBenefits to child and householdNew risks/needs

Adaptations

• To local context• To users (pictorial)• To inform with multiple approaches• To usage, e.g., Child Support Matrix for

determining care plans, driving “outputs”• Universal access through the web: The

Durham Group

This (CSI) has completely changed our approach.  Previously, we thought that all poor children had the same needs but now we find that each one is different...

We also see how the activities we plan work together, sometimes affecting just one child and sometimes the whole family."

Community volunteer, West Oromia village, Ethiopia