Expert consensus on assessment items for identifying health and social needs of children in public assistance households: a modified Delphi study

Child poverty is a major public health concern and a central driver of health inequities. Children residing in households receiving public assistance remain vulnerable to unmet health and social needs, despite financial support. Routine welfare practice lacks standardized, feasible items for comprehensive assessment of these children’s health and living conditions. This study aimed to establish expert consensus on assessment items for identifying the health and social needs of children living in public assistance households in Japan. A modified Delphi study was conducted among professionals engaged in supporting children and families receiving public assistance, including caseworkers and public health nurses. An initial pool of assessment items was developed based on a literature review and expert input and organized into three domains: daily life patterns, child-reported information, and caregiver-reported information. Items were iteratively refined through three Delphi rounds conducted between July and December 2025. Item appropriateness was rated using a five-point Likert scale. Consensus was defined as ≥ 70% agreement in rounds 1 and 2 and ≥ 80% in round 3. A total of 49 participants completed the first round, with 43 and 47 participants completing rounds 2 and 3, respectively. Across rounds, the number of items was progressively reduced, resulting in a concise set of 17 items for daily life patterns, 24 for child-reported information, and 10 for caregiver-reported information (predominantly from caregivers of preschool children under 6 years of age). Core domains related to daily routines, subjective health, healthcare access, and the caregiving environment were consistently retained. Item reduction was primarily driven by considerations of feasibility, response burden, and practical applicability. This study established expert consensus on assessment items for identifying the health and social needs of children living in public assistance households. The resulting assessment items prioritize relevance, feasibility, and applicability in routine welfare practice. These assessment items may provide a more systematic approach to identifying children’s health and social needs in welfare settings. Further research is needed to evaluate their validity, implementation, and potential effects on service delivery and child outcomes.