Date of Award

Winter 2010

Document Type


Degree Name

Doctor of Philosophy (PhD)


Health Services Research

Committee Director

James Alan Neff

Committee Member

Qi Harry Zhang

Committee Member

Martha L. Walker


This study examines the usefulness of the New Model of Children's Health and its Influences for the identification of predictors for health service effectiveness. Health service effectiveness is measured by probability estimations of whether young children receive formal or informal developmental screenings. Screenings lead to prevention of communication delays in later childhood. Formal screenings with standardized questions are preferred over informal screenings, which are knowledgeable observations. The theoretical framework is a child-centered socio-ecological theory that is untested for use in health service effectiveness studies until the present one. Four developmental concepts of the theoretical framework, social environment, physical environment, biological history, and child behavioral history, are tested through secondary analysis of longitudinal data.

Multivariate analysis by Cox regression is used to determine whether predictor variables from any of the four conceptual areas of the framework explain young children's receipt of formal or informal screenings. Cox regression is also used to examine the magnitude of differences on probability estimates generated by the predictor variables for the time of formal or informal screening receipt.

The results show that the social environment predictors, maternal depression, maternal race, and maternal age and the child behavioral predictor, infant fussiness and irritability are significantly related to formal screening receipt and the model as a whole is significant. The social environment predictor, maternal depression, and the biological history predictor, birth weight, are significantly related to informal screenings and were the sole contributors to the informal model significance as a predictor of screenings. For both models, maternal depression consistently is associated with early screening receipt. Multiple correlation squared (R2) strength of association measures between the models and survival were weak.

The implication of these findings is that the New Model of Children's Health and its Influences is useful in identifying predictors of health service effectiveness and may improve in predictive value under different conditions. Another implication is that when children are very young, maternal depression is a prevalent condition which may create the need for increased health services for children. Alternatively, health policymakers may increase support for new mothers with the aim of decreasing a lengthy need of services for children as they grow and develop.