Road to the Future: Priorities for Child Health Services Research

Published:April 27, 2017DOI:



      Prior health services research (HSR) agendas for children have been published, but major ones are now over 15 years old and do not reflect augmented understanding of the drivers and determinants of children's health; recent changes in the organization, financing, and delivery of health care; a growing emphasis on population health; and major demographic shifts in the population. A policy-relevant research agenda that integrates knowledge gained over the past 2 decades is essential to guide future child HSR (CHSR). We sought to develop and disseminate a robust, domestically focused, policy-oriented CHSR agenda.


      The new CHSR agenda was developed through a series of consultations with leaders in CHSR and related fields. After each round of consultation, the authors synthesized the previous experts' guidance to help inform subsequent discussions. The multistep process in generation of the agenda included identification of major policy-relevant research domains and specification of high-value research questions for each domain. Stakeholders represented in the discussions included those with expertise in child and family advocacy, adult health, population health, community development, racial and ethnic disparities, women's health, health economics, and government research funders and programs.


      In total, 180 individuals were consulted in developing the research agenda. Six priority domains were identified for future research, including both enduring and emerging emphases: 1) framing children's health issues so that they are compelling to policy-makers; 2) addressing poverty and other social determinants of child health and wellbeing; 3) promoting equity in population health and health care; 4) preventing, diagnosing, and treating high priority health conditions in children; 5) strengthening performance of the health care system; and 6) enhancing the CHSR enterprise. Within these 6 domains, 40 specific topics were identified as the most pertinent for future research. Three overarching and crosscutting themes that affect research across the domains were also noted: the need for syntheses to build on the current, and sometimes extensive, evidence base to avoid duplication; the interrelated nature of the domains, which could lead to synergies in research; and the need for multidisciplinary collaborations in conducting research because research studies will look beyond the health sector.


      The priorities presented in the agenda are policy-oriented and include a greater emphasis on how findings are framed and communicated to support action. We expect that the agenda will be useful for immediate uptake by investigators and research funders.


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        • Bryant J.
        • Sanson-Fisher R.
        • Walsh J.
        • Stewart J.
        Health research priority setting in selected high income countries: a narrative review of methods used and recommendations for future practice.
        Cost Eff Resour Alloc. 2014; 12: 23
        • Hoagwood K.
        • Olin S.S.
        The NIMH blueprint for change report: research priorities in child and adolescent mental health.
        J Am Acad Child Adolesc Psychiatry. 2002; 41: 760-767
        • Flores G.
        • Fuentes-Afflick E.
        • Barbot O.
        • et al.
        The health of Latino children: urgent priorities, unanswered questions, and a research agenda.
        JAMA. 2002; 288: 82-90
        • Casamassimo P.S.
        • Lee J.Y.
        • Marazita M.L.
        • et al.
        Improving children's oral health: an interdisciplinary research framework.
        J Dent Res. 2014; 93: 938-942
        • Owens J.S.
        • Lyon A.R.
        • Brandt N.E.
        • et al.
        Implementation science in school mental health: key constructs in a developing research agenda.
        School Ment Health. 2014; 6: 99-111
        • Blum N.J.
        • Feldman H.M.
        • Barbaresi W.J.
        • et al.
        Research priorities for developmental–behavioral pediatrics: a DBPNet consensus study.
        J Dev Behav Pediatr. 2012; 33: 509-516
        • McPherson A.C.
        • Ball G.D.
        • Maltais D.B.
        • et al.
        A call to action: setting the research agenda for addressing obesity and weight-related topics in children with physical disabilities.
        Child Obes. 2016; 12: 59-69
        • Forrest C.B.
        • Simpson L.
        • Clancy C.
        Child health services research. Challenges and opportunities.
        JAMA. 1997; 277: 1787-1793
        • Halfon N.
        • Schuster M.
        • Valentine W.
        • McGlynn E.
        Improving the quality of healthcare for children: implementing the results of the AHSR research agenda conference.
        Health Serv Res. 1998; 33: 955-976
        • Stille C.
        • Turchi R.M.
        • Antonelli R.
        • et al.
        The family-centered medical home: specific considerations for child health research and policy.
        Acad Pediatr. 2010; 10: 211-217
        • Rothman R.L.
        • Yin H.S.
        • Mulvaney S.
        • et al.
        Health literacy and quality: focus on chronic illness care and patient safety.
        Pediatrics. 2009; 124: S315-S326
        • Burks M.L.
        • Brooks E.G.
        • Hill V.L.
        • et al.
        Assessing proxy reports: agreement between children with asthma and their caregivers on quality of life.
        Ann Allergy Asthma Immunol. 2013; 111: 14-19
        • Mangione-Smith R.
        • McGlynn E.A.
        Assessing the quality of healthcare provided to children.
        Health Serv Res. 1998; 33: 1059-1090
        • Dougherty D.
        • Simpson L.A.
        Measuring the quality of children’s health care: a prerequisite to action.
        Pediatrics. 2004; 113: 185-198
        • Lavizzo-Mourey R.
        Why we need to build a culture of health in the United States.
        Acad Med. 2015; 90: 846-848
        • Kindig D.A.
        • Asada Y.
        • Booske B.
        A population framework for setting national and state health goals.
        JAMA. 2008; 299: 2081-2083
        • Martin S.
        • Aston N.M.
        • Peters E.
        • et al.
        Mapping America’s Future, Brief 2. Evolving Patterns in Diversity.
        Urban Institute, Washington, DC2015
        • Department of Economic and Social Affairs
        • Population Division
        • United Nations
        World Population Ageing: 1950–2050. Changing Balance Between Age Groups.
        2001 (Available at:) (Accessed May 22, 2017)
        • Yoshida S.
        Approaches, tools and methods used for setting priorities in health research in the 21st century.
        J Glob Health. 2016; 6: 010507
        • Black R.E.
        The legacy of the Child Health and Nutrition Research Initiative (CHNRI).
        J Glob Health. 2016; 6: 010101
      1. Pooler J. Child Health and Nutrition Research Initiative (CHNRI) approach to research priority setting. Available at: Accessed January 12, 2017.

        • Green N.S.
        • Damus K.
        • Simpson J.L.
        • et al.
        Research agenda for preterm birth: recommendations from the March of Dimes.
        Am J Obstet Gynecol. 2005; 193: 626-635
      2. Strategic Plan 2000: From Cells to Selves. Eunice Kennedy Shriver National Institute of Child Health and Human Development, Washington, DC2000 (Available at:) (Accessed May 22, 2017)
        • Flores G.
        • Lesley B.
        Children and US federal policy on health and health care: seen but not heard.
        JAMA Pediatr. 2014; 168: 1155-1163
        • Isaacs J.
        • Lovell P.
        Priority or Afterthought? Children and the Federal Budget.
        First Focus, Alexandria, Va2016
        • Wietecha M.
        • Bethell C.
        The Case for Investing in Child Health as a Matter of Our Nation's Security, Economy, and Well-being.
        Children's Hospital Association, Washington, DC2016
        • Pascoe J.M.
        • Wood D.L.
        • Duffee J.H.
        • et al.
        Mediators and adverse effects of child poverty in the United States.
        Pediatrics. 2016; 137: e20160340
        • Edelstein S.
        • Hahn H.
        • Isaac J.
        • et al.
        Kids' SHARE 2016: Federal Expenditures on Children Through 2015 and Future Projections.
        Urban Institute, Washington, DC2016
        • Hay Jr., W.W.
        • Gitterman D.P.
        • Williams D.A.
        • et al.
        Child health research funding and policy: imperatives and investments for a healthier world.
        Pediatrics. 2010; 125: 1259-1265
        • Gitterman D.P.
        • Greenwood R.S.
        • Kocis K.C.
        • et al.
        Did a rising tide lift all boats? The NIH budget and pediatric research portfolio.
        Health Aff (Millwood). 2004; 23: 113-124
        • Shurin S.B.
        • Castle V.P.
        United States biomedical research impacting child health and the growth of the National Institutes of Health funding to pediatric departments and children's hospitals.
        J Pediatr. 2014; 164: 1248-1249.e1241
        • Forrest C.B.
        • Riley A.W.
        Childhood origins of adult health: a basis for life-course health policy.
        Health Aff (Millwood). 2004; 23: 155-164
        • Guttmacher A.E.
        • Raju T.N.
        The child is father of the man, and mother of the woman.
        Pediatrics. 2014; 134: e1411-e1412
      3. Building on a life-course perspective in maternal and child health.
        Matern Child Health J. 2003; 7: 5-11
        • Lu M.C.
        • Halfon N.
        Racial and ethnic disparities in birth outcomes: a life-course perspective.
        Matern Child Health J. 2003; 7: 13-30
        • National Research Council and Institute of Medicine
        Children’s Health, the Nation’s Wealth: Assessing and Improving Child Health. Committee on Evaluation of Children’s Health; Board on Children, Youth, and Families; Division of Behavioral and Social Sciences and Education.
        National Academies Press, Washington, DC2004
      4. Joslyn H. Words that change minds. Chronicle of Philanthropy, September 2016. Available at: Accessed May 22, 2017.

      5. FrameWorks Academy. Available at: Accessed December 12, 2016.

      6. National Poll on Children’s Health. Available at: Accessed December 12, 2016.

        • Bales S.N.
        • Gilliam Jr., F.D.
        Lessons from the story of early child development: domain decisions and framing youth development.
        New Dir Youth Dev. 2009; 124: 119-134
        • Hein K.
        Framing and reframing.
        J Adolesc Health. 1997; 21: 215-217
        • Erard M.
        • Kendall-Taylor N.
        • Davey L.
        • Simon A.
        The Power of Levelness: Making Child Mental Health Visible and Concrete Through a Simplifying Model: A FrameWorks Research Report.
        FrameWorks Institute, Washington, DC2010
        • Feinberg M.
        • Willer R.
        From gulf to bridge: when do moral arguments facilitate political influence?.
        Pers Soc Psychol Bull. 2015; 41: 1665-1681
      7. Framing Child Poverty by Telling a Development Story: A FrameWorks Message Brief. FrameWorks Institute, Washington, DC2009 (Available at:) (Accessed May 22, 2017)
        • Wherry L.R.
        • Kenney G.M.
        • Sommers B.D.
        The role of public health insurance in reducing child poverty.
        Acad Pediatr. 2016; 16: S98-S104
      8. The Heckman Equation. Invest in early childhood development: reduce deficits, strengthen the economy. Available at: Accessed May 22, 2017.

        • Jutte D.P.
        • Miller J.L.
        • Erickson D.J.
        Neighborhood adversity, child health, and the role for community development.
        Pediatrics. 2015; 135: S48-S57
        • Chase-Lansdale P.L.
        • Brooks-Gunn J.
        Two-generation programs in the twenty-first century.
        Future Child. 2014; 24: 13-40
        • Haskins R.
        • Garfinkel I.
        • McLanahan S.
        Introduction: two-generation mechanism of child development.
        Future Child. 2014; 24: 3-12
        • Thompson R.A.
        Stress and child development.
        Future Child. 2014; 24: 41-60
      9. Kids Count Data Center. Available at: Accessed October 6, 2016.

        • National Research Council and the Institute of Medicine
        US health in international perspective: shorter lives, poorer health.
        in: Woolf S.H. Aron L. Panel on Understanding Cross-National Health Differences Among High-Income Countries. Committee on Population, Division of Behavioral and Social Sciences and Education, and Board on Population Health and Public Health Practice. National Academies Press, Washington, DC2013
        • Chen E.
        • Matthews K.A.
        • Boyce W.T.
        Socioeconomic differences in children’s health: how and why do these relationships change with age?.
        Psychol Bull. 2002; 128: 295-329
        • Wise P.H.
        • Kotelchuck M.
        • Wilson M.L.
        • Mills M.
        Racial and socioeconomic disparities in childhood mortality in Boston.
        N Engl J Med. 1985; 313: 360-366
        • Child Welfare Information Gateway
        Long-term consequences of child abuse and neglect.
        2013 (Available at:) (Accessed July 13, 2017)
      10. Brown DW, Kowlaski AE, Lurie IZ. Medicaid as an investment in children: what is the long-term impact on tax receipts? NBER Working Paper 20835. January 2015. Available at: Accessed May 22, 2017.

        • Komro K.A.
        • Livingston M.D.
        • Markowitz S.
        • Wagenaar A.C.
        The effect of an increased minimum wage on infant mortality and birth weight.
        Am J Public Health. 2016; 106: 1514-1516
      11. Internal Revenue Service. Earned Income Tax Credit (EITC). Available at: Accessed July 13, 2017.

        • Hartig S.
        • Skinner C.
        • Ekono M.
        Taxing the Poor: State Income Tax Policies Make a Big Difference to Working Families.
        National Center for Children in Poverty, Mailman School of Public Health, Columbia University, New York2014 (Available at:) (Accessed May 22, 2017)
        • Baltagi B.H.
        • Yen Y.F.
        Welfare reform and children’s health.
        Health Econ. 2016; 25: 277-291
        • Weisleder A.
        • Cates C.B.
        • Dreyer B.P.
        • et al.
        Promotion of positive parenting and prevention of socioemotional disparities.
        Pediatrics. 2016; 137: e20153239
      12. Waldfogel J. Tackling child poverty and improving child well-being: lessons from Britain. Available at: Accessed February 20, 2015.

        • Marmot M.
        • Bell R.
        Social inequalities in health: a proper concern of epidemiology.
        Ann Epidemiol. 2016; 26: 238-240
        • Fontanella C.A.
        • Hiance-Steelesmith D.L.
        • Phillips G.S.
        • et al.
        Widening rural–urban disparities in youth suicides, United States, 1996–2010.
        JAMA Pediatr. 2015; 169: 466-473
        • Mustanski B.S.
        • Garofalo R.
        • Emerson E.M.
        Mental health disorders, psychological distress, and suicidality in a diverse sample of lesbian, gay, bisexual, and transgender youths.
        Am J Public Health. 2010; 100: 2426-2432
        • Keller D.
        • Chamberlain L.J.
        Children and the Patient Protection and Affordable Care Act: opportunities and challenges in an evolving system.
        Acad Pediatr. 2014; 14: 225-233
        • Cheng T.L.
        • Goodman E.
        Committee on Pediatric Research. Race, ethnicity, and socioeconomic status in research on child health.
        Pediatrics. 2015; 135: e225-e237
        • Berdahl T.A.
        • Friedman B.S.
        • McCormick M.C.
        • Simpson L.
        Annual report on health care for children and youth in the United States: trends in racial/ethnic, income, and insurance disparities over time, 2002–2009.
        Acad Pediatr. 2013; 13: 191-203
        • Flores G.
        • Lin H.
        Factors predicting overweight in US kindergartners.
        Am J Clin Nutr. 2013; 97: 1178-1187
        • Lau M.
        • Lin H.
        • Flores G.
        Racial/ethnic disparities in health and health care among US adolescents.
        Health Serv Res. 2012; 47: 2031-2059
        • Chevarley F.M.
        • Owens P.L.
        • Zodet M.W.
        • et al.
        Health care for children and youth in the United States: annual report on patterns of coverage, utilization, quality, and expenditures by a county level of urban influence.
        Ambul Pediatr. 2006; 6: 241-264
        • Hill T.D.
        • Graham L.M.
        • Divgi V.
        Racial disparities in pediatric asthma: a review of the literature.
        Curr Allergy Asthma Rep. 2010; 11: 85-90
        • Popescu I.
        • Xu H.
        • Krivelyova A.
        • Ettner S.L.
        Disparities in receipt of specialty services among children with mental health need enrolled in the CMHI.
        Psychiatr Serv. 2015; 66: 242-248
        • Dougherty D.
        • Chen X.
        • Gray D.T.
        • Simon A.E.
        Child and adolescent health care quality and disparities: are we making progress?.
        Acad Pediatr. 2014; 14: 137-148
      13. Frey WH. Five charts that show why a post-white america is already here. Available at: Accessed December 30, 2015.

        • Perrin J.M.
        • Anderson L.E.
        • Van Cleave J.
        The rise in chronic conditions among infants, children, and youth can be met with continued health system innovations.
        Health Aff (Millwood). 2014; 33: 2099-2105
        • Cherkasky M.
        New York City medical care—some problems and prospects.
        Bull N Y Acad Med. 1963; 39: 343-348
        • Gavin K.
        How “love” and a landmark paper improved health care.
        2016 (Available at:) (Accessed December 12, 2016)
        • Leininger L.
        • Levy H.
        Child health and access to medical care.
        Future Child. 2015; 25: 65-90
        • Dick A.W.
        • Brach C.
        • Allison R.A.
        • et al.
        SCHIP’s impact in three states: how do the most vulnerable children fare?.
        Health Aff (Millwood). 2004; 23: 63-75
        • Dougherty D.
        • Schiff J.
        • Mangione-Smith R.
        The Children’s Health Insurance Program Reauthorization Act quality measures initiatives: moving forward to improve measurement, care, and child and adolescent outcomes.
        Acad Pediatr. 2011; 11: S1-S10
        • Devers K.J.
        • Foster L.
        • Brach C.
        Nine states’ use of collaboratives to improve children’s health care quality in Medicaid and CHIP.
        Acad Pediatr. 2013; 13: S95-S102
        • Ireys H.
        • Zickafoose J.
        • Brach C.
        Key Lessons from the National Evaluation of the CHIPRA Quality Demonstration Grant Program. Final Summary.
        Agency for Healthcare Research Quality, Rockville, Md2015 (AHRQ Publication No. 15–0071)
        • Tebb K.P.
        • Sedlander E.
        • Bausch S.
        • Brindis C.D.
        Opportunities and challenges for adolescent health under the Affordable Care Act.
        Matern Child Health J. 2015; 19: 2089-2093
        • Cheng T.L.
        • Wise P.H.
        • Halfon N.
        Quality health care for children and the Affordable Care Act: a voltage drop checklist.
        Pediatrics. 2014; 134: 794-802
        • RTI International
        State Innovation Models (SIM) Initiative Evaluation: Model Design and Model Pre-test Evaluation Report.
        RTI International, Research Triangle Park, NC2014 (Available at:) (Accessed May 22, 2017)
        • Gates A.
        • Rudowitz R.
        • Guyer J.
        An overview of delivery system reform incentive payment (DSRIP) waivers.
        2014 (Available at:) (Accessed March 13, 2015)
        • Kelleher K.J.
        • Cooper J.
        • Deans K.
        • et al.
        Cost saving and quality of care in a pediatric accountable care organization.
        Pediatrics. 2015; 135: e582-e589
      14. HCIA Disease-Specific Evaluation: Third Annual Report. NORC at the University of Chicago, Chicago, Ill2016 (Available at:) (Accessed May 22, 2017)
        • Mays G.P.
        • Mamaril C.B.
        • Timsina L.R.
        Preventable death rates fell where communities expanded population health activities through multisector networks.
        Health Aff (Millwood). 2016; 35: 2005-2013
        • Donnelly L.
        • McLanahan S.
        • Brooks-Gunn J.
        • et al.
        Cohesive neighborhoods where social expectations are shared may have positive impact on adolescent mental health.
        Health Aff (Millwood). 2016; 35: 2083-2091
        • Newman S.
        • Holupka C.S.
        Housing affordability and children’s cognitive achievement.
        Health Aff (Millwood). 2016; 35: 2092-2099
        • Simpson L.
        The adolescence of child health services research.
        JAMA Pediatr. 2013; 167: 509-510
        • Committee on Pediatric Research
        Promoting education, mentorship, and support for pediatric research.
        Pediatrics. 2014; 133: 943-949
        • Chambers D.A.
        • Norton W.E.
        The adaptome: advancing the science of intervention adaptation.
        Am J Prev Med. 2016; 51: S124-S131