Nov 07, 2018

The skills that children gain before kindergarten entry can greatly affect their ability to succeed in school and later in life. Consequently, communities have a vested interest in providing resources to support young children, setting them on a path toward success in school and life. A robust and reliable way to measure—at the national, state, or local level—whether children are on track to enter kindergarten can serve multiple purposes, including the following:

  • Describe children’s readiness for school in the years leading up to kindergarten entry.
  • Identify subgroups of children who are less likely to be on track for school readiness in order to inform program and policy decisions.
  • Form the basis for tracking trends over time to assess progress toward the goal of ensuring that all children are ready for school.

States and early childhood stakeholders have sought ways to capture such information about young children for years. However, until 2016, there was no single data source that provided a comprehensive, integrated assessment of multiple aspects of children’s health and development related to kindergarten preparedness.

The pilot Healthy and Ready to Learn Title V Maternal and Child Health Services Block Grant National Outcome Measure (NOM)[1] was developed by the Health Resources and Services Administration’s Maternal and Child Health Bureau (HRSA MCHB), in collaboration with Child Trends, to meet this need, and comes at a time of unprecedented investments in early childhood. It uses data from the 2016 National Survey of Children’s Health (NSCH), a nationally representative, annual household survey that includes 18 items to assess the health and development of children ages 3 to 5, across four domains, as well as in one cumulative summary measure. In 2017, a 19th item was added to the NSCH, and additional items continue to be considered for inclusion in the survey.

How the Measure Was Developed

The Healthy and Ready to Learn NOM reflects years of planning by HRSA MCHB. In 2016, HRSA MCHB added 22 items related to multiple domains of school readiness to the NSCH, after gathering input from experts in the field of early childhood and partner agencies. In 2017, Child Trends worked with HRSA MCHB to examine the data from the 2016 NSCH, a process that involved assessing the individual items, sorting the items into domains, and developing domain scales using a consistent, methodologically rigorous approach. This work culminated in the development of an overall index of Healthy and Ready to Learn, a pilot National Outcome Measure (NOM) for the Title V Program, in addition to four domain-specific indices.

The Current Healthy and Ready to Learn Measure

The Healthy and Ready to Learn NOM includes 18 survey items across four domains:

  1. Early Learning Skills
  2. Self-Regulation
  3. Social-Emotional Development
  4. Physical Well-Being and Motor Development

Individual item responses were coded and scored as “At-Risk” (0), “Needs Support” (1), and “On-Track” (2), accounting for age-specific abilities among 3- to 5-year-olds. These item scores were then summed to create a total domain score, and thresholds within each domain score were set, rendering domain measures of At-Risk, Needs Support, and On-Track.

The goal of the Healthy and Ready to Learn NOM is to assess readiness not only in each domain, but also across domains; for this purpose, a summary measure was developed. Analyses of the 2016 NSCH data using these domains found that 42 percent of children ages 3 to 5 were on track in all four domains; 34 percent were on track in three domains; 15 percent were on track in two domains; and 9 percent were on track in only one or in none of the domains.

The Future of the Healthy and Ready to Learn Measure

The Healthy and Ready to Learn NOM has the potential to become an accessible and useful way to assess children’s early learning, self-regulation, social-emotional development, health and motor skills, and overall school readiness. However, both HRSA MCHB and Child Trends recognize that the Healthy and Ready to Learn NOM is still a pilot measure, and additional steps must be taken to refine and validate it. As noted above, these validation efforts are currently being conducted jointly by MayaTech and Child Trends, in partnership with HRSA MCHB. To validate the measure, we will confirm that it uses the right items, encompasses the right domains, and reflects the right overall index. The steps in the validation process include the following:

  1. Gather expert input on the measure. Researchers, state policymakers, and state and national stakeholders have been asked to provide input on the measure. Their input will be used to refine existing items, identify potential new items, assess the response options, and explore how state-level stakeholders can use the measure.
  2. Assess whether the scales and index are appropriate and valid across subgroups. We are testing whether the measure is valid across subgroups of children, including subgroups based on age, race/ethnicity, and sex.
  3. Replicate the measure across years. We are re-estimating the measure using the 2017 NSCH data to confirm that the measure is consistent across 2016 and 2017. Re-estimating is important because changes were made to the measure in 2017; specifically, an item about color knowledge was added and the response options were changed for all items. When the 2018 NSCH data become available, we will re-estimate the measure again and also analyze new items (on language and communication) added to the survey, to see if they are appropriate for inclusion in the measure.

Related Documents:

Healthy and Ready to Learn: A New National Outcome Measure of Kindergarten Readiness Frequently Asked Questions

Webinar: Healthy and Ready to Learn – Developing a population-level measure of school readiness

Get an overview of the process of developing the Healthy and Ready to Learn National Outcome Measure and its importance to the early childhood field by watching this webinar.


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[1] National outcome measures (NOMs) cross all population domains and reflect maternal and child population health status. More than two dozen NOMs have been developed and are tracked and reported by HRSA MCHB.