Abstract
Social determinants of health (SDOH)—conditions in which children live, learn, and play—affect child health and well-being. Publicly funded services in education and child welfare systems are important resources to support child well-being, but cross-system coordination is rare. Leveraging integrated administrative data from 60,287 6th graders enrolled in public schools in Minnesota, we used latent class analysis (LCA) to examine patterns of cross-system SDOH, including educational services and involvement in child welfare. Five classes emerged. The largest class was characterized by a few multi-system SDOH and had low service needs. Two classes had differing patterns of school service use, one with a greater likelihood of special education service use alone and the other characterized by the use of multiple school services. Two classes were characterized by cross-system SDOH/service use (e.g., homelessness, child protection, placement in care, mental health, and special education services). We then assessed whether race/ethnicity predicted class membership and tested educational distal outcomes. American Indian, Black, and Latinx children had higher odds of exposure to both cross-system SDOH classes. Students facing any SDOH, particularly those with greater multi-system SDOH exposure, had worse attendance and academic achievement. Our study indicates that children are navigating complex experiences of SDOH and service needs, with a disproportional likelihood that Black children, Indigenous children, and other children of color (BIPOC) experience SDOH. Identifying patterns of SDOH provides an opportunity for policymakers and practitioners to intervene to promote health equity. By understanding facilitators and barriers to child well-being, the results inform how child-serving systems can strive toward health equity.
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Data Availability
This study used data housed in the Minnesota Linking Information for Kids (Minn-LInK) project at the Center for Advanced Studies in Child Welfare (CASCW) at the University of Minnesota. Data are not publicly available, but arrangements to access data may be made by contacting the CASCW Director of Research and Evaluation at cascw@umn.edu.
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This study was approved by the University of Minnesota Institutional Review Board (IRB). The study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments. The University of Minnesota IRB approved a waiver of consent for this study using data obtained for administrative purposes.
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Data for the current study were provided by the Minnesota Departments of Education and Human Services for the purposes of evaluating service provision and improving student instruction, pursuant to the Minnesota Government Data Practices Act and the Family Educational Rights and Privacy Act (FERPA). The University of Minnesota IRB approved a waiver of consent for the current study.
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Maura Shramko is now at the American Institutes for Research.
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Shramko, M., Lucke, C. & Piescher, K. Patterns of Social Determinants of Health and Publicly-Funded Service Access among Children Involved in Educational, Child Welfare, and Social Service Systems. Prev Sci 25, 521–531 (2024). https://doi.org/10.1007/s11121-023-01638-7
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DOI: https://doi.org/10.1007/s11121-023-01638-7