Study Title: Child Status Index (CSI)

Context: In past, programs for orphaned and vulnerable children (OVC) have been evaluated by reporting the numbers of children and the services that they received (outputs.) To measure more appropriately the needs of OVC and the effectiveness of the support these programs provide (outcomes), the President’s Emergency Plan for AIDS Relief (PEPFAR) requested a tool to assess vulnerabilities, needs, and outcomes of OVC. To fill this gap, the Child Status Index was developed to provide a framework for identifying a child’s needs, creating service plans, and assessing intervention outcomes.

Study aims: As it is currently designed, the Child Status Index provides an assessment strategy that addresses the areas of a child’s life that are most indicative of the child’s relative well-being or vulnerability in low- and middle-income countries (LMIC). The CSI was developed based on twelve child centered factors, including food security, growth and nutrition, abuse and exploitation, legal protection, wellness, healthcare services, emotional health, social behavior, performance, and education. These factors are rated on a high inference scale following interviews and specific observations in a home/community visit. Each factor is rated as “good”, “fair,”, “bad”, and “very bad” relative to local norms by community volunteers who work for local organizations and who may have varying degrees of literacy.

Methods: The development of the CSI involved a community participatory process that included community workers, OVC caregivers, and village leaders in Kenya and Tanzania. To derive the domains and the factors that comprise the CSI, researchers conducted a series of informal discussions with community workers, guardians, and other service providers in Kenya and Tanzania. The CSI was then successfully tested to ensure its reliability and validity, and it has been utilized in trials in other countries, such as Ethiopia, Rwanda, India and Cambodia to raise ongoing feedback about its applicability.

Policy Implications:

• CSI results can be used for targeting children with needs and factors in which those needs appear, not by aggregating total scores, but rather by developing algorithms at a community level, such as: any score in the “very bad” range or more than a pre-specified number of scores in the “bad” range, and so forth. The targeting strategies are developed by community organizations depending on their funding priorities and resources.
• The CSI is often used in case management for child and households cared for by community based organizations.
• CSI information, when aggregated by factor, can inform program planning for identified organizations in a defined setting.
• The CSI can help identify benefits children receive from services, preferably used in conjunction with other outcome measures.

Principal Investigator: Karen O’Donnell (Duke University)

Contact: duke.ovcstudies@gmail.com