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Methodology and Sources

The CBEM represents a comprehensive effort towards quantifying the prevalence of childhood bereavement in the U.S. Addressing limitations of past estimations, the model extends prior research by establishing a theory-based tool which incorporates inputs that are customizable geographically, temporally, and relationally. The model generates retrospective (current) and prospective (projected) estimations utilizing consistent and publicly accessible data sources. Rather than gathering new data, the model combines reputable, existing, population-level data sources to approximate the magnitude of childhood bereavement. The model is flexible, providing estimates over different areas with varying levels of detail (e.g., national, state, region). The CBEM introduces binomial distribution and life table methodologies to better estimate the phenomenon of childhood bereavement. The CBEM results presented in the 2019 reports reflect U.S. vital statistics from 2013-2017 (CBEM reports are updated annually as new data are available). The model estimates the number and percentage of youth who have already experienced a death loss in combination with the number and percentage of youth predicted to experience a death loss of a parent or sibling by the time they reach a defined age. The CBEM aims to characterize the phenomenon of childhood bereavement as a public health issue by including youth bereaved due to the death of a parent and/or sibling occurring at any time in their childhood.

The CBEM considers population statistics from the U.S. Census Bureau and mortality statistics from the U.S. Center for Disease Control (CDC). Specifically, data are drawn form the CDC Wide-ranging Online Data For for Epidemiologic Research (CDC WONDER). To protect privacy, data are often suppressed when there is a probability the individuals represented by the data could be uniquely identified. The threshold for data suppression in the CDC WONDER database is less than 10.  To circumvent data suppression in the CBEM, information in the reports combine mortality statistics across the most recently available 5-year period (e.g., 2013-2017). If there are 10–19 deaths per age range, the death rate is considered unreliable, however the CBEM can be run using this unreliable death rate. Any CBEM results provided with unreliable data are clearly noted and should be interpreted with caution.


Public Health Region Categorization

The 2019 CBEM State reports provide regional information on childhood bereavement due to parent death, and adult opioid-related deaths. To provide local CBEM estimates and avoid data suppression issues encountered at the county level, data for the CBEM State Reports were organized and analyzed by public health regions. Public health regions are defined at the state level and the defining entities vary from state to state. The table below provides links to the websites accessed for public health region information for each state. Six states did not have defined public health regions and are denoted with an asterisk (*), and three states have data reported at the county level.

For comparison purposes, these same public health regions were used to examine opioid-related deaths for adults ages 25 to 54 years old. This age range was selected to be consistent with the CBEM which considers the number of deaths among adults ages 25 to 54 when deriving childhood bereavement estimates.

STATE

SOURCE

LINK TO SOURCE

Alabama - AL

Alabama Public Health (2018). Regions and Coordinators. Accessed March 7, 2019.

https://www.alabamapublichealth.gov/perinatal/regions.html

Alaska - AK

Alaska Department of Health and Social Services (2019). Informed Alaskans, Alaska Health Profiles Geography: Public Health Regions. Accessed March 7, 2019.

http://dhss.alaska.gov/dph/InfoCenter/Pages/ia/geo_phr.aspx

Arizona - AZ

The University of Arizona Health Sciences (2019). Area Health Education Centers. Accessed March 6, 2019.

https://azahec.uahs.arizona.edu/

Arkansas - AR

Arkansas Department of Health (2019). Health Units. Accessed March 7, 2019.

https://www.healthy.arkansas.gov/health-units

California - CA

California Association of Local Behavioral Health (n.d.). Regions. Accessed March 7, 2019.

https://www.calbhbc.com/region-map-and-listing.html

Colorado - CO

Colorado Department of Public Health and Environment (2019). Health Care Coalitions. Accessed March 7, 2019.

https://www.colorado.gov/pacific/cdphe/health-care-coalitions

Connecticut - CT

Not Applicable

No Source - data were reported at the county level

Delaware - DE

Not Applicable

No Source - data were reported at the county level

Florida - FL

Top Dog Carts (2019). Florida Health Departments by County. Accessed March 7, 2019.

https://topdogcarts.com/florida-health-department-county/

Georgia - GA

Carl Vinson Institute of Government, University of Georgia (n.d.). Mental Health Regions Map. Georgia Mental Health Districts. Accessed March 6, 2019.

https://georgiainfo.galileo.usg.edu/topics/maps/article/political/mental-health-regions-map

Hawaii - HI*

Community Collaborative Rain, Hail & Snow Network (n.d.). Hawaii Coordinators. Accessed March 7, 2019.

https://www.cocorahs.org/Content.aspx?page=coord_HI

Idaho - ID

Idaho Department of Health and Welfare (n.d.). Idaho Public Health Districts. Accessed March 7, 2019.

https://healthandwelfare.idaho.gov/Health/HealthDistricts/tabid/97/Default.aspx

Illinois - IL

Illinois Department of Public Health (n.d.). IDPH Health Regions. Accessed March 7, 2019.

http://app.idph.state.il.us/share/idphregions.htm

Indiana - IN

Indiana State Department of Health (2017). Indiana Public Health Preparedness Districts. Accessed March 7, 2019.

https://www.in.gov/isdh/17944.htm

Iowa - IA

Iowa Department of Public Health (2018). Bureau of Local Public Health Services. Accessed March 7, 2019.

https://idph.iowa.gov/Portals/1/Files/LPHS/Regional%20Map.pdf

Kansas - KS

North Central Kansas Healthcare Coalition (n.d.). Regional Healthcare Coordinators. Accessed March 7, 2019.

https://www.nckshcc.com/regional-healthcare-coordinators.html

Kentucky - KY

University of Kentucky College of Medicine (n.d.). AHEC Health Career Coordinators. Accessed March 7, 2019.

https://ahec.med.uky.edu/ahec-health-career-coordinators

Louisiana - LA

CLouisiana Department of Health and Hospitals (n.d.). Hospitals by Administrative Regions. Accessed March 7, 2019.

http://ldh.la.gov/index.cfm/page/2665

Maine - ME

Maine Department of Health and Human Services (2012). Maine Public Health Districts. Accessed March 7, 2019.

https://www.mainegeneral.org/Pages/Maine-Public-Health-Districts.aspx

Maryland - MD

Maryland Department of Health Developmental Disabilities Administration (n.d.). DDA Regional Map. Accessed March 7, 2019.

https://dda.health.maryland.gov/Pages/regional%20map.aspx

Massachusetts - MA

Massachusetts Executive Office of Health and Human Services (n.d.). Environmental Public Health Tracking Map. Accessed March 7, 2019.

https://matracking.ehs.state.ma.us/eohhs_regions/region_six.html

Michigan - MI

Michigan Association for Local Public Health (n.d.). State of Michigan Health Assessment. Accessed March 7, 2019.

https://www.malph.org/state-michigan-health-assessment

Minnesota - MN

Minnesota Department of Health (n.d.). Regional Trauma Advisory Committees. Accessed March 7, 2019.

https://www.health.state.mn.us/facilities/traumasystem/rtac/index.html

Mississippi - MS

Mississippi State Department of Health (n.d.). Public Health Regions. Accessed March 6, 2017.

https://msdh.ms.gov/msdhsite/_static/resources/7322.pdf

Missouri - MO

Missouri Department of Health and Senior Services (2017). Regional EMS Committees. Accessed March 7, 2019.

https://health.mo.gov/safety/ems/committees.php

Montana - MT

Montana Department of Public Health and Human Services (n.d.). Montana Health Planning Regions. Accessed March 7, 2019.

https://dphhs.mt.gov/qad/licensure/healthcarefacilitylicensure/ certificateofneed/healthplanningregions

Nebraska - NE

Region V Systems (n.d.). Nebraska Behavioral Health Regions (HHSS). Accessed June 14, 2019.

http://region5systems.net/who-we-are/nebraska-behavioral-health-regions-hhss/

Nevada - NV*

Nevada Governor's Office of Economic Development (n.d.). Regions. Accessed March 7, 2019.

http://www.diversifynevada.com/why-nevada/regions/

New Hampshire - NH*

U.S. Department of Agriculture (2013). Rural-Urban Continuum Codes. Accessed February 26, 2019.

https://www.ers.usda.gov/data-products/rural-urban-continuum-codes.aspx

New Jersey -NJ

New Jersey Hospital Association (2019). New Jersey Hospitals by County. Accessed March 7, 2019.

http://www.njha.com/media/543112/NJ-Hospitals-by-County-Map.pdf

New Mexico - NM

New Mexico Department of Health (n.d.). Public Health Regions. Accessed March 7, 2017.

https://nmhealth.org/about/phd/region/

New York - NY

New York Department of Health (2015). Interactive Map: Regional, District and County Environmental Health Programs. Accessed March 6, 2019.

https://www.health.ny.gov/environmental/water/drinking/doh_pub_contacts_map.htm

North Carolina - NC

North Carolina Department of Health and Human Services (2018). Public Health Preparedness & Response Regions. Accessed March 7, 2019.

https://epi.publichealth.nc.gov/phpr/regions.html

North Dakota - ND

North Dakota Department of Human Services (n.d.). Regional Human Service Centers. Accessed March 7, 2019.

https://www.nd.gov/dhs/locations/regionalhsc/

Ohio - OH*

Ohio Emergency Medical Services (2015). Medical Direction. Accessed March 7, 2019.

Dept of Public Safety Regions - https://www.ems.ohio.gov/medicaldirection-rpab.aspx

Oklahoma - OK

Oklahoma State Department of Health (n.d.). Trauma Continuous Quality Improvement. Accessed March 7, 2019.

https://www.ok.gov/health/Protective_Health/Emergency_Systems/Trauma_Division/CQI_-_Continuous_Quality_Improvement/index.html

Oregon - OR

Oregon Health and Science University (n.d.). Area Health Education Centers. Accessed March 7, 2019.

https://www.ohsu.edu/area-health-education-centers/ahec-centers

Pennsylvania - PA

Pennsylvania Department of Health (n.d.). Pennsylvania Health Districts and Counties. Accessed March 7, 2019.

http://www.health.state.pa.us/pdf/hpa/stats/hsi2001/pamap.pdf

Rhode Island - RI

Not Applicable

No Source - data were reported at the county level

South Carolina - SC

South Carolina Area Health Education Consortium (n.d.). South Carolina AHEC System Map. Accessed March 7, 2019.

https://www.scahec.net/regions.html

South Dakota - SD

South Dakota Department of Health (n.d.). Public Health Preparedness and Response. Accessed March 7, 2019.

https://doh.sd.gov/providers/preparedness/contact.aspx

Tennessee - TN

Tennessee Department of Health (n.d.). Local and Regional Health Departments. Accessed March 7, 2019.

https://www.tn.gov/health/health-program-areas/localdepartments.html

Texas - TX

Texas Health and Human Services (2019). Department of State Health Services Public Health Regions. Accessed March 7, 2019.

https://www.dshs.texas.gov/regions/

Utah - UT*

Utah Department of Public Safety (n.d.). Community Support Liasons. Accessed March 7, 2019.

https://dem.utah.gov/resources-for-ems/community-support-liaisons/

Vermont - VT

University of Vermont Larner College of Medicine (n.d.). Office of Primary Care and Area Health Education Centers Program. Accessed March 7, 2019.

https://www.med.uvm.edu/ahec/opc-ahec/overview

Virginia - VA*

Virginia Department of Social Services (n.d.). Find Your Local Department. Accessed March 7, 2019.

http://www.dss.virginia.gov/localagency/index.cgi

Washington - WA

Washington State Department of Health (2010). Public Health Emergency Planning Regions. Accessed March 7, 2019.

https://www.doh.wa.gov/Portals/1/Documents/1200/phsd-PHEPR.pdf

West Virginia - WV

West Virginia Healthcare Coalition (2019). Hospitals by Regions. Accessed March 6, 2019.

http://www.wvha.org/getmedia/4df46ee3-8b25-444d-b582-a5a2fdef8491/WV-Healthcare-Coalition.pdf.aspx

Wisconsin - WI

Wisconsin Department of Health Services (2018). DHS Regions by County. Accessed March 7, 2019.

https://www.dhs.wisconsin.gov/aboutdhs/regions.htm

Wyoming - WY

Wyoming Department of Health (n.d.). Emergency Medical Services Healthcare Preparedness Program. Accessed March 7, 2019.

https://health.wyo.gov/publichealth/ems/hospital-preparedness-program/


Sources

  1. Pynoos, R. S., Steinberg, A. M., Layne, C. M., Liang, L.-J., Vivrette, R. L., Briggs, E. C., . . . Fairbank, J. A. (2014). Modeling constellations of trauma exposure in the National Child Traumatic Stress Network Core Data Set. Psychological Trauma: Theory, Research, Practice, and Policy, 6(Suppl 1), S9-S17. http://dx.doi.org/10.1037/a0037767

  2. Nickerson, A., Bryant, R. A., Aderka, I. M., Hinton, D. E., & Hofmann, S. G. (2013). The impacts of parental loss and adverse parenting on mental health: Findings from the National Comorbidity Survey-Replication. Psychological Trauma: Theory, Research, Practice, and Policy, 5(2), 119-127. http://dx.doi.org/10.1037/a0025695

  3. Brent, D. A., Melhem, N. M., Masten, A. S., Porta, G., & Payne, M. W. (2012). Longitudinal effects of parental bereavement on adolescent developmental competence. Journal of Clinical Child & Adolescent Psychology, 41, 778-791. https://doi.org/10.1080/15374416.2012.717871

  4. Yu, Y., Liew, Z., Cnattingius, S., Olsen, J., Vestergaard, M., Fu, B., … Li, J. (2017). Association of mortality with the death of a sibling in childhood. JAMA Pediatrics, 171: 538–545. https://doi.org/10.1001/jamapediatrics.2017.0197

  5. Oosterhoff, B., Kaplow, J. B., & Layne, C. M. (2018). Links between bereavement due to sudden death and academic functioning: Results from a nationally representative sample of adolescents. School Psychology Quarterly, 33(3), 372-380. http://dx.doi.org/10.1037/spq0000254

  6. Griese et al. (2018). American Journal of Orthopsychiatry, 87(5), 540-548. http://dx.doi.org/10.1037/ort0000265 

  7. Centers for Disease Control and Prevention, National Center for Health Statistics, CDC WONDER Online Database. http://wonder.cdc.gov/

  8. Centers for Disease Control and Prevention, National Center for Health Statistics. Underlying Cause of Death 1999-2017 on CDC WONDER Online Database, released December, 2018. Data are from the Multiple Cause of Death Files, 1999-2017, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. http://wonder.cdc.gov/ucd-icd10.html

  9. SAMHSA, Center for Behavioral Health Statistics and Quality (2018). 2017 National survey on drug use and health. https://www.samhsa.gov/data/sites/default/files/cbhsq-reports/NSDUHDetailedTabs2017/NSDUHDetailedTabs2017.pdf

  10. Child Trends (2019). State level data for understanding child welfare in the United States: Foster care. https://www.childtrends.org/publications/state-level-data-for-understanding-child-welfare-in-the-united-states

  11. Centers for Disease Control and Prevention (2017). U.S. state prescribing rates, 2017.  https://www.cdc.gov/drugoverdose/maps/rxstate2017.html

  12. SAMHSA (2018). Treatment Episode Data Set (TEDS): 2015-2016.  https://www.datafiles.samhsa.gov/study-dataset/treatment-episode-data-set-admissions-2016-teds-2016-ds0001-nid18447


Judi’s House/JAG Institute partnered with the New York Life Foundation to help support grieving children and families by creating the Childhood Bereavement Estimation Model (CBEM).