Dr. Carol M. Trivette of North Carolina's Orelena Hawks Puckett Institute introduced herself and her organization. She stressed the Institute's dedication to family support and research-supported, evidence-based best practices. She described some of the background pieces that conference participants had received in their information packages and said that, in preparing for this meeting over the past few months, she pulled together more than fifty indicator frameworks. She found little commonality among these frameworks and, as a result, she started trying to understand the categories and dimensions of indicators. She also began compiling a running list of promotional indicators. She included indicators from Arizona and Iowa in the packet for meeting participants and recommended that participants look at the web sites of these two states. What follows is a summary of Dr. Trivette's presentation. Her framework and other materials from her presentation are found in appendix A.
Targets. These are children, families, or communities. It's important to think about the unit, the targets of the work. Thinking through targets helps to focus the rest of your work. Big initiatives may have many targets.
Categories. These are broad areas of application — such as physical health, education, and shelter — that relate to particular targets of interest.
Dimensions. Dimensions for a target category such as physical health might include nutrition or immunizations.
Trivette said that the values and culture of the state and the community will influence the choice of indicators. When asked about linking indicators to research, she said that, once dimensions are defined, states need to look at research to identify links between promotional indicators and long-term outcomes. An audience member observed that much of the research on relevant topics is done at the individual or program level and is not necessarily applicable to a population level. (Although the Healthy People 2010 objectives, that include data reported by income level and race, have been posted on the web by HHS.)
Other comments regarding research included the suggestion that the complexity of the human development process makes it advisable to bundle indicators rather than look at a single indicator.
Trivette identified three different types of indicators:
When asked to define these indicators, she provided these examples
Process. The number of times that social workers provide family support activities. (She warned states not to assume that activities happen as planned at the program level.)
Intervening. Intervening indicators might be, "mediating variables," for example, at the program level, the number of mothers and children spending significant amounts of time in interactive play
Outcome. Are children being able to engage in elaborated play?
Discussion ranged broadly across service delivery and social justice issues. Pat Seppanen of the University of Minnesota said, early in the session, that indicators of well-being might neglect social justice concerns and obscure a need for more aggressive income redistribution. Throughout the remaining discussion, she commented on how the relationship between the definition and development of indicators can be guided by existing power relationships. Another participant asked who decides on an appropriate outcome for a target population?
Other participants sought to explain how they addressed such challenges. Dee Gillespie of Georgia noted how that state struggled to define the target group that was as broad as possible (to avoid creating something for "those kids over there"). Another participant stressed the need to be guided by research in picking targets, pointing out that a range of attention needs to be devoted to healthy communities and a healthy state and that the development process should engage the targets in a discussion of what health means to them.
When Trivette presented examples of targets, categories, and dimensions, discussion turned to such issues as categorization. One participant cautioned against spending too much time on taxonomy, saying (paraphrase)
You can do it the age-graded way or using traditional departmental domains (e.g., health, education, etc.). It doesn't matter which road you take. The indicators have to have face validity. The unit of change is the community. There's a danger in developing elaborate systems and then not doing the work.
Others sought clearer definitions. David Diehl of FSA noted that the meeting originated in the desire of the four sponsoring states to come up with an indicator framework.
Margaret Gressens of the Healthy Anchorage Indicators project sought comment on their Success by Six indicators as represented in a pyramid diagram.
Near the end of the session, the four sponsoring states were asked to sketch their wishes for the shape of the afternoon session.