Tag Archives: Youth

Expanding Access to Preschool Could Improve Health and Equity in Cincinnati, August, 2016

One of my favorite things about doing HIAs and other projects at Human Impact Partners is the unexpected “Aha!” moments that occur, when we find something in the research that surprises us.

Today, Human Impact Partners and our partners from The AMOS Project are excited to release a report that examines the health and equity impacts of expanded access to preschool for children in Cincinnati. Our study concludes that expanding access to preschool would benefit the health and equity for children, families, and other residents of Cincinnati. That’s actually not an “Aha!” for me. I expected that improved education would have benefits to health and equity. But I didn’t exactly expect all of the connections we found.

To me, it makes sense that if children get a better chance at high-quality education earlier on in life, they will do better in school later on. What I didn’t expect was how far those ripple effects would reach. It makes sense that high-quality preschool education could improve reading and math scores in third grade. But interestingly, those impacts don’t always continue over time. By the fourth grade, children who had access to high-quality preschool don’t always show significantly different reading or math scores from those who didn’t. But, they are less likely to be held back to repeat a grade in school, and they are less likely to require special education services. Essentially, they are able to keep up. And this ability to keep up allows them to remain connected and engaged in the school system, which means that they stay in school. They graduate. And if they graduate, they have better job options with higher wages. Which means they are not as likely to become involved in the criminal justice system.

Higher wages and less crime because of preschool. Those are some far-reaching ripple effects!

Figure 1

And guess what else? I really didn’t expect this one, but it makes sense to me. Family relationships are better. Being a parent of a young child can be stressful. When parents don’t have resources to deal with that stress, a small proportion of the time it can unfortunately manifest in child abuse and neglect. But research suggests that high-quality preschool has some pretty impressive protective factors for this. High-quality preschools not only give parents a break from the stress of parenting, they give children an opportunity to learn social and emotional skills when interacting with other children, and they give parents structured and guided ways to interact with their children. In our study we predicted that nearly three out of ten children in Cincinnati who would have experienced abuse or neglect would not experience it if they were sent to preschool. And improved family relationships last over time as well. Forty-year-old adults who attended preschool as children are still more likely to say their family relationships are better than those who did not. Again – those are some far-reaching ripple effects!

Of course, increased education, improved wages, less crime, less stress, and better social relationships can all lead to improved health. And that’s a wonderful, amazing thing. But it turns out that preschool could also be a key factor in breaking the cycle of generational inequities. Due to multiple forms of structural discrimination, growing up in poverty, in a single-parent household, or with a parent who is incarcerated are all more common experiences for children of color. These experiences increase the odds of negative physical and mental health outcomes and lead to a vicious cycle that continues through multiple generations, further contributing to ongoing inequities. When preschools and the school systems that they feed into have a trauma-informed approach to discipline, focusing on the root causes of the problem behaviors, rather than zero-tolerance suspensions and expulsions, preschools could help break that cycle.

Figure 2

This is especially important for communities like Cincinnati, where many of these risk factors are nearly double the national rate.

Figure 3

Thus, based on our findings, our study recommends the following actions:
1. Expand access to high-quality preschool programs to all children
2. Prioritize to reach those most in need, such as children living in poverty
3. Assure high-quality preschools and teachers through adherence to preschool program and training features that research has proven to be successful
4. Utilize a trauma-informed approach to discipline that incorporates an understanding of the source of the behavior problem, in preschool and beyond, rather than zero tolerance policies such as suspensions and expulsions
5. Assure that high-quality preschools are geographically distributed throughout the city

This Health Impact Assessment was produced in partnership with our Advisory Committee members from Cincinnati Children’s Hospital, StrivePartnership, Interact for Health, Mercy Health, and United Way’s Success by 6.

Dismantling the Bars on the Birdcage

The recently released Coming of Age in the Other America by Stefanie DeLuca, Susan Clampet-Lundquist, and Kathryn Edin asks the question: why do some kids in the poorest neighborhoods thrive and meet their potential despite overwhelming odds when others don’t?

As summarized in an excellently in-depth Atlantic article, which I am leaning on until I get my hands on a copy of the book, two separate factors stand out for those who thrive: their neighborhood or having an “identity project”, meaning a strong passion such as music, art, or a dream job. But there are important caveats to underscore. Living in a safer neighborhood or having an identity project can help, but either of these alone is not a 100% guarantee that a person meets his or her potential. According to authors, other factors can simultaneously pull down and overwhelm even promising students – things like the absence of a parent, living in overcrowded homes, or living in blighted neighborhoods. As The Atlantic article powerfully notes, “A journey from poverty to the middle class or beyond is a birthright of many of these kids, their shot at the American dream. But the research indicates they can’t just get there themselves. Like anybody, they need a little help.”

But what can that help look like?

Help comes in different forms and at different levels – but what is central is putting the emphasis on supporting people. For example, it comes at a policy level by society enacting incarceration policies that focus on uniting adolescents and parents rather than separating them. It comes at a resource level by investing in housing and public services for neighborhoods deeply and historically overlooked. And it comes at a personal level by providing individual support. One example of the latter is a promising program profiled in a two-part series in The New York Times. Thread is a Baltimore-based program that brings together teams of volunteers to support at-risk teenagers, through unconditional support 24 hours a day for 10 years, and by providing increased access to community resources.

Thread Program Model 


(source: Thread.org)

But there’s a larger idea also at work here. A colleague of mine wisely suggested, “structural problems need structural solutions.” When we look at structural solutions, focusing separately on schools, family, policing – one of these alone is not enough. It’s too easy to fall through cracks if you focus on only one. This same concept came up at a staff meeting recently. Looking at an article on structural racism by Andrew Grant-Thomas and john a. powell, there is a metaphor borrowed from Iris M. Young who borrowed it from Marilyn Frye. (Still with me?) In talking about racism the article says the following – and I include the full excerpt because it’s important language:

“If we approach the problem of durable racial inequality one ‘bar’ at a time, it is hard to appreciate the fullness of the bird’s entrapment, much less formulate a suitable response to it. Explaining the bird’s inability to take flight requires that we recognize the connectedness of multiple bars, each reinforcing the rigidity of the others. In confronting racism we must similarly account for multiple, intersecting and often mutually reinforcing disadvantages, and develop corresponding response strategies.”

So in thinking about the work you do and the structural challenges you are working to confront, consider: how are you working on dismantling multiple bars on the birdcage, and not just one?


ACEs: A Hidden Epidemic

Today’s blog post is written by Christine Cissy White and is a re-post of one originally titled “Boston’s architect of community well-being: Pediatrician Renée Boynton-Jarrett”. The post was first published on February 22, 2016 by ACES Too High News

The Aces movement is filled with pioneers. There are physicians, professors and researchers who treat, teach and study. There are leaders of non-profits who partner with individuals, neighborhoods and organizations. Volunteers who give time. Experts who draw on wisdom gained in academia, clinical practice, community work and personal experience. But rarely does one person do all of these things while parenting three children under the age of thirteen. Read more… 

Dignified & Just Policing: Gang Injunctions and Other Policing Practices Have Uncertain Impacts on Community Safety and Health

Today, HIP and Santa Ana Building Healthy Communities (SABHC) released a report on the health and equity impacts of a gang injunction in the Townsend-Raitt neighborhood of Santa Ana, California.

A gang injunction is a controversial policing practice that essentially acts as a group restraining order against alleged gang members within a safety zone, a specific geographic area thought to be “controlled” by a gang. Since the 1980’s, over 60 gang injunctions have been imposed in California in an attempt to curtail a historic spike in violent crime in the state (and in the nation) during the late 1980’s and early 1990’s, a topic we tackled in a previous blog post.

The injunction in Santa Ana, the city’s second, would prevent alleged gang members from associating with each other or carrying out certain illegal and legal activities within the safety zone. The injunction has stirred up heated debate in Santa Ana since June 2014, when it was first implemented, and has been a flashpoint for controversy more recently amidst allegations of police brutality. Supporters of the injunction say it will lead to decreased crime and violence for all residents, while opponents say the injunction fails to address the root causes of crime and may lead to increased police mistreatment of local youth.

The HIA, which worked locally with SABHC, Chican@s Unidos de Orange County, KidWorks, Santa Ana Boys & Men of Color, Latino Health Access, UC Irvine’s Community Knowledge and Community & Labor projects, and the Urban Peace Institute, examined the impact the gang injunction would have on crime, safety, community-police relationships, education and employment, and collected data on community safety through surveys, interviews and focus groups. The HIA focused on populations that may be disproportionately affected by the gang injunction, including youth, undocumented immigrants, transgender or queer-identified people, the homeless, and those with physical and mental disabilities. Members of these groups fear that increased police presence in the neighborhood will exacerbate the potential for profiling and discrimination.

The HIA concluded that the injunction is unlikely to bring about significant and lasting reduction of serious crime, based on the outcomes of other gang injunctions and input gathered from residents, city officials, community organizations and police. On the contrary, the injunction could have negative effects on public safety, public health and public trust.

The HIA found that:

  • The evidence is insufficient that a gang injunction will reduce violent crime, gang activity or gang membership, or that it will improve community-police relationships.
  • An injunction could make some in the community, particularly parents, feel more safe, but members of marginalized groups may, in contrast, feel more threatened by increased police presence.
  • An injunction could lead to significant disruptions to education and employment opportunities for those named in the gang injunction, with immediate harm to their health and well-being and long-term harm to their chances in life.
  • Young black and Latino men who experience repeated, unsubstantiated searches and other forms of suppression-based policing may experience higher levels of anxiety and depression than their peers.
  • An injunction could divert funding from community programs that address the economic and social problems that are the root causes of much crime and a detriment to public health and well-being. In contrast to the mixed evidence on the effects of policing strategies on crime, there is solid evidence that correlates reductions in crime with environmental, educational and economic factors.

Our findings led us to make specific recommendations for the police and other law enforcement and criminal justice agencies, city officials and community organizations. Our partners plan to use the data from the HIA in their campaigns on healthy policing practices and in upcoming court proceedings to determine whether the gang injunction will be upheld or reversed.

This report marks HIP’s third HIA on criminal justice policies, with a fourth HIA on policing in Ohio in the works (stay tuned!).

The efforts of groups such as those in Santa Ana to evaluate the public health impacts of policing practices, especially on communities of color, help to move us forward into rethinking how to best promote community safety for all.

Education: the Key to Health and Success for Foster Youth

carleneThis week’s post is written by HIP’s Social Media, Research, and Data Collection Summer Intern, Carlene Ervin. She is a sophomore at Yale University and a resident of Oakland, CA. 

Since I was five, my foster mom told me I would go to college. She never went to college herself but she wholeheartedly believed it was the only way to break the cycle of poverty, substance abuse, and violence. She did everything she could to get me there, including enrolling me in a college prep charter school. After a while, I had no doubt I was going to college and no one could stop me. It wasn’t until I was older that I realized my expectations were not common for most foster youth in California.

As an intern at Human Impact Partners, I was excited to see HIP has researched the educational experiences of foster youth. Last year, HIP completed a research project to inform California’s Local Control Funding Formula (LCFF), a 2013 bill that completely overhauled K-12 school funding. LCFF increases funding for all schools, but reserves the biggest funding increases for low-income children, English language learners, and foster youth. According to HIP’s analysis, one in 150 school-aged children in California are currently in foster care. Sixty-seven percent of foster youth are removed from their homes because of neglect, and another 18 percent because of abuse.

Both of my parents struggled with substance abuse and had disabilities that limited job opportunities. When I was placed in foster care at age five, I was old enough to know something was wrong but too young to understand what exactly happened. First, I was placed in two different foster homes within three months. My third foster home became my forever home, the place I still come back to for school breaks.

Once I was finally settled, I learned that I loved learning. School soon became a refuge because I could escape in the process of learning new things. While in school, I had some behavioral issues. And I wasn’t alone: according to HIP’s report, compared to the general population, foster children have more behavior problems, more anxiety/depression disorders, attention problems, and aggressive behaviors.

Foster youth also have higher levels of mental health problems. Early life and chronic stress can lead to mental health disorders and substance abuse. These issues make it harder for many foster youth to thrive in school. One study found that only about a third of teens in foster care graduate from public school, compared to almost 60 percent of their peers.

When I got accepted to Yale University, I couldn’t believe it. I didn’t know many people who attended an Ivy League school. Most foster youth don’t even make it to a four-year university. In general, only 1 in 10 of foster youth attend college and of those, fewer than a third graduate in 4 to 6 years. These statistics are especially troubling because of education’s long-term impacts. People with more education are likely to live longer, have healthier babies and children, have better social networks of support, and earn more money.

Now I see that given my history, I am lucky to value education, and how that benefits my health. Growing up, I always heard stories of former foster youth who ended up in jail or living on the street. Now I see the links between education, health, and quality of life.

Happily, the State of California seems to get this. In recent years California has taken steps to address the education deficits for some of the most vulnerable youth. In addition to the local control funding law, in 2012 California extended foster care to age 21.

Although the LCFF program has had a rocky start, I think it has great potential to help foster youth succeed in school if it provides services such as mentorship and/or counseling. Although these policies are still fairly new, with greater accountability on the state’s part, they can help foster youth have a chance to improve their education and ultimately their health.

What Happens to a Dream Deferred?

This week’s blog is a repost by Rachel Davis of Prevention Institute. She links efforts to prevent injury and death due to violence to many of the policy issues that we research at HIP, including incarceration, economic security, education, and housing policy. The article was originally published by “Nation of Change” on May 27, 2015.  

Earlier this month at the National Forum for Youth Violence Prevention’s fourth summit on preventing violence, Baltimore presented its city-wide blueprint, “B’More for Youth! Building Baltimore’s Cradle to Career Pipeline”. Read more …

Analysis: ‘Willful Defiance’ School Suspensions Have Health Impacts

We are re-posting an April 29, 2014 Reportingonhealth.org blog by Celia Harris.

In the 2012-13 school year, almost 260,000 student suspensions in California public schools — more than 40 percent of the total — were for “willful defiance” of authority. Willful defiance was the single most common reason for suspension and more students were suspended for willful defiance than for drugs, weapons and violence combined. Read more…


Reflections on the National HIA Meeting

Two weeks ago I took a trip to a fun city, reconnected with old friends and made some new ones, and came back rejuvenated, inspired, and ready to get back to work. But I wasn’t on vacation. I was at a conference, and definitely not the boring, stuffy event you might think of. This year’s National HIA Meeting, Sept. 26-28 in Washington, D.C., was the second time practitioners from all over the country have gathered to discuss our work. It was my first, and to me it felt like a lovefest. Here are three reasons why:

Keynote Address by Councilman Joe Cimperman of Cleveland. Cimperman’s moving and inspiring address made me want to jump out of my seat and move to Cleveland right then and there. He discussed the importance of health and equity in his city, and the success of HIA in bringing health into decision-making and generating recommendations for improving health. He also talked about HIA as a tool for creating grassroots support and building relationships. Here is a great interview with Cimperman.

As a participant, my favorite breakout session was “Achieving Health and Equity in Education HIAs.” To my knowledge, the HIAs discussed in this panel are the only education HIAs ever completed in the US. Panelists included Phyllis Hill from ISAIAH in Minnesota, Susana Morales-Konishi and youth researcher Asha Simpson from Youth UpRising in Oakland, and Maisie Chin from CADRE in Los Angeles. These inspiring women represent community-based organizations that prioritize health and equity in their work. Community organizations are a growing group of HIA practitioners, but were under-represented at the conference, so these women brought fresh voices. Asha Simpson and her young colleagues, who were also in the room during the session, are the first youth team to conduct an HIA.

In the final minute of this session, an audience member asked a provocative question: “What about the fact that qualitative, community-generated data is not legitimate?” We didn’t have time to tackle it from the podium, but later talked privately and decided the real question should be: “Has the community legitimized your data?” Many HIAs are conducted without taking into account community knowledge and lived experience, and panelists agreed that practicing HIAs like this raises the red flag of illegitimacy more than the opposite approach. This episode and subsequent discussion really illuminated for me the value that community organizations bring, not just to an HIA but also to conferences like this one. This conversation should definitely be continued at the next national meeting.

My very favorite highlight was the people who came together from around the country and the world to make the conference happen. I never stopped running into old friends I’ve gotten to know over the last five years of doing HIAs. Just as often, I met new people and heard new stories about fascinating HIA projects and other health and equity work. (I guess you call this networking, but that word is too boring for describing the passion people brought to these conversations.)

Now I’m back home and ready to apply my renewed enthusiasm to a couple of new projects. But also excited for the next opportunity to meet with the 450-strong (and counting) national HIA community. The 3rd National HIA meeting is tentatively scheduled for Spring 2015 in Washington, DC.