County Profiles of Child Well-Being in Tennessee

Tennessee Index of Child Well-Being Methodology

As a trusted and consistent source for Tennessee data, the TCCY team chose 12 indicators, three in each domain, to make up its Index of Child Well-Being. They were chosen with consideration of important issues in Tennessee, and confined by what is available for all 95 counties. 

Indicators were chosen with a preference for measures of outcome rather than process. We tried to avoid using indicators that mostly measure the same thing (such as percent of children living in poverty and percent of children eligible for free and reduced-price lunch). We try to avoid using indicators for which a “better” rate was ambiguous (for instance, a low rate of children receiving SNAP benefits could reflect low poverty rates or poor outreach).

Over the past few years, we have made several changes in indicators as a result of the way the Centers for Disease Control—and, as a result, the Tennessee Department of Health—report data. Counties with small populations can have wide variations in rates in some data categories, especially when just children, or even just a subset of children, are the focus. Child and teen deaths provide a good example. For some counties, a single child death moves them from a rate of 0 per 100,000 to a rate of as high as 80 or 100 per 100,000. In this sense, their rates are not meaningful, and the CDC no longer reports single-year rates at the county level for some indicators when the population of the county is small. This is problematic when one is ranking counties.

For some indicators, we have been able to move to three-year averages and still get data for all counties. For others, we have chosen indicators available at the county level using 5-year American Community Survey Estimates. In both instances, the data reflect a longer period of time. This smooths year-to-year changes, making measures more stable over time, but it also creates more lag. Effects of outside events, such as the pandemic, take much longer to filter through, and it can be more difficult to track and name the changes they cause. Results of policy changes also take more time to show in the data and effects are smaller at first.

We moved away from our two indicators measured in dollars and toward those measured as percents. Still, some work with small rates of children overall and are reported per 1,000 children. Further, within those that are percents, some are high (high school graduation rates run from the mid-80s to the high 90s) and others are low (low birthweight is usually below 10 to 12 percent). With these different scales and magnitudes, they cannot simply be summed to reach an overall rate. To make them comparable, TCCY calculated the z-score for each indicator for each county, summed those for all twelve indicators and ranked the counties based on that total. Sums of the z-scores for the three indicators in each domain serve as the basis for each county’s domain ranks.

For each county, an indicator’s z-score represents the number of standard deviations the value of that indicator is from the average value for all counties. It is calculated as (the difference between a county’s percentage or rate on an indicator and the average value of all counties for that indicator) divided by (the standard deviation for that indicator). This is a common way to make variables or indicators that are measured in different units or have very different scales more comparable. For a full discussion of how to compute z-scores (aimed at non-mathematicians) see this WikiHow explanation.

 The indicators below make up this year’s county ranking.

Economic Well-Being

Percent of children living in poverty

Definition: Percent of children living in a household below the federal poverty line.

Source: US Census Bureau Small Area Income and Poverty Estimates (2022).

History in our county rankings: This has been in our county rankings from the beginning.

Severe housing cost burden

Definition: Percent of households that spend 50% or more of their household income on housing.

Source: American Community Survey, 5-year estimates (2018-2022). Table B25140. 

History in our county rankings: This is the second year we have used this indicator. 

Child care cost burden

Definition: Child care cost burden reflects the average estimate market-rate price for care for full-time care of an infant and 2+ year old but less than school age child as a percentage of the county’s estimated median household income. The market-rate is calculated by taking an average of the median market-rate fee for licensed providers in the county. When available, this includes Child Care Centers, Group Homes, and Family Homes. In instances where the county does not have all three, the providers existing in the county averaged. In instances where there are no licensed providers providing care to that age group in the county, the statewide average of Tier 2 market-rates are used. This average rate for infant
care and 2+ care is then combined to get the total cost of care.

Source: Determining Child Care Market Rates in the State of Tennessee (FY2022-23). Calcluations done by Tennessee Commission on Children and Youth's Data, Communication and Policy division. 

History in our county rankings: This indictor was used in our 2023 profiles, however, the calcuation methodolgy and source has changed. Comparisons for this indicator should not be made to the published 2023 profiles. 

Education

Third to eighth grade reading proficiency

Definition: Percent of third- to eighth-grade students who scored “on-track” or “mastered” on the Tennessee Comprehensive Assessment Program (TCAP) reading and language test.

Source: Tennessee Department of Education (2023-24).

History in our county rankings: This has been in our county rankings from the beginning, though the tests became more rigorous, and the names of score categories changed, in 2017. The name of the test also briefly changed to TNReady, but the Department of Education is moving back to the TCAP name.

Third to eighth grade math proficiency

Definition: Percent of third- to eighth-grade students who scored “on-track” or “mastered” on the Tennessee Comprehensive Assessment program (TCAP) math test.

Source: Tennessee Department of Education (2023-24).

History in our county rankings: This has been in our county rankings from the beginning, though the tests became more rigorous, and the names of score categories changed, in 2017. The name of the test also briefly changed to TNReady, but the Department of Education is moving back to the TCAP name.

High school graduation rate

Definition: Percent of ninth-grade cohort that graduates in four years.

Source: Tennessee Department of Education (2022-23).

History in our county rankings: This has been in our county rankings from the beginning.

Health

Children who lack health insurance

Definition: Percent of children who lack health insurance.

Source: US Census Bureau Small Area Health Insurance Estimates (2021).

History in our county rankings: This has been in our county rankings from the beginning.

Low-birthweight babies

Definition: Percent of live births where baby weighs less than 2,500 grams (5.5 pounds), averaged over three years.

Source: Tennessee Department of Health (2020-22). 

History in our county rankings: This has been in our county rankings from the beginning, though it was previously just one year of data. The Department of Health has tightened its data suppression rules, and dozens of counties’ data were unavailable with one-year numbers. 

Kindergarten Immunization

Definition: Percent of public-school kindergarten students fully immunized for all required vaccine series at the time of survey completion. Required series includes: Diphtheria-Tetanus-Pertussis vaccine (DTaP), Measles, Mumps, Rubella vaccine (MMR), Hepatitis A Virus vaccine (HAV)2 Hepatitis B Virus vaccine (HBV), Poliomyelitis vaccine (IPV or
OPV), and Varicella (chickenpox) vaccine/credible history of disease.

Source: Tennessee Department of Health Vaccine-Preventable Diseases and Immunization Program. Kindergarten Immunization Compliance Assessment. (2022-23). 

History in our county rankings: This is new to the rankings.

 Family & Community

Youth Crime Rate Per 1,000

Definition: Rate of reported crimes alleged to have been committed by someone under 18 to county population
of youth 12 to 17.

Source: Tennessee Bureau of Investigation, Tennessee Incident Based Reporting System (2022). Accessed May
28, 2024. 

History in our county rankings: This is new to our county rankings this year. It replaces single parent families. 

Chronic Absenteeism

Definition: Children who are absent 10 percent or more of school days for any reason. Data include excused or unexcused absences and out-of-school suspensions.

Source: Tennessee Department of Education (2022-23).

History in our county rankings: This our second year using this indicator. 

Victims of child abuse or neglect

Definition: Children who are victims of a case of abuse or neglect. In cases with multiple children each child is counted individually. The total is the number of children associated with substantiated cases of severe abuse and of determinations of “Services Court Ordered“ or “Services Needed” in cases of non-severe abuse or neglect. The rate is per 1,000 children.

Source: Tennessee Department of Children’s Services (FY2022-23).

History in our county rankings: This has been in our county rankings since the beginning, but we have altered the way we count it. In previous years, we counted substantiated cases, regardless of the number of children involved in the case. Individual cases, even if they covered some or all the same people already attached to a different case, were counted if considered a new case. We have moved to counting children rather than cases. No matter how many children are associated with one case, they are all counted individually. Last year, we used this same calcuation method but it was reported on a calendar year versus a fiscal year.