An early look at what can happen when a pediatric health system begins to treat

August 3, 2018, Nationwide Children's Hospital
In a recent publication in the journal Pediatrics, researchers from Nationwide Children's Hospital present a case study for treating a neighborhood as a patient. Credit: Nationwide Children's Hospital

In a recent publication in the journal Pediatrics, researchers from Nationwide Children's Hospital present a case study for treating a neighborhood as a patient.

Neighborhood effect syndrome, characterized by symptoms of extreme poverty including blight, housing insecurity, racial segregation, trauma, violence, poorly performing schools, low social cohesion and support and environmental toxins, has debilitating consequences on child health. Health care providers frequently encounter challenges to caring for children from affected neighborhoods, and these children often experience poorer outcomes compared to peers in unaffected . Historically, institutions have been largely ineffective in changing these outcomes with one-child-at-a-time tactics.

In a novel approach to improving outcomes for these children, Nationwide Children's leaders with community partners decided to address neighborhood effect syndrome as a target for pediatric health care—treating the neighborhood as a patient. In 2008, Nationwide Children's began collaborating with residents, government entities and social services agencies to develop the Healthy Neighborhoods Healthy Families (HNHF) initiative.

The hospital's first patient neighborhood was the Southern Orchards neighborhood of Columbus, Ohio, located adjacent to the Nationwide Children's main campus. Before the intervention, the neighborhood experienced high rates of poverty and violent crime.

"The Southern Orchards neighborhood, right by the hospital, was one with gun violence, high infant mortality rates and high asthma rates in children," says Kelly J. Kelleher, MD, director of the Center for Innovation in Pediatric Practice at Nationwide Children's and lead author of the publication. "Houses were boarded up and vacant. You didn't see kids playing outside much."

The target area includes all of Census Tract 56.10 and Census Tract 56.20. In 2009, the neighborhood was characterized by the following:

  • Home to 4,300 persons, 23 percent of whom were children
  • 50 percent of children in the neighborhood were living in poverty
  • 50 percent of the children in the neighborhood were African American
  • 25 percent of children in Livingston Elementary School and 33 percent in South High School were regularly changing schools
  • 1 in 3 residents over the age of 16 were employed full time

The chief concern uncovered through multiple sources of data and information was neighborhood safety associated with population loss and surge in vacant and abandoned property.

"Residents were deeply concerned about blight and gang/drug activity, including on vacant properties in proximity to the school," says Dr. Kelleher. "Our primary target for intervention became housing. Our collaboration committed to renovating, building and developing mixed income housing to reduce crime, improve the vacancy rate and better family outcomes."

According to Dr. Kelleher, the publication describes $23 million invested in upgrading more than 300 homes through the HNHF Realty Collaborative, which was formed with not-for-profit development corporation, Community Development For All People. The entity is owned by Community Development For All People with a board of directors selected by the two groups. To date, the investment has grown to more than $40 million.

The partnership, with collaboration from the Columbus Mayor's Office, accessed Neighborhood Stabilization Program funds from the city, acquired properties from the city's Land Bank program and gathered support from contractors and realty agents.

The multifaceted intervention launched by the collaborative included a home repair program, rehabilitation and home ownership program, home construction program, workforce development program and rental housing development.

The community development efforts by the HNHF Realty Collaborative are still in early phases, considering Southern Orchards has experienced neighborhood effects syndrome for 80 years. Still, some measurable outcomes are observed:

  • Investments have transformed housing stock in the area and reduced blight.
  • The vacancy rate declined from more than 25 percent to 6 percent.
  • Youth who have participated in area development programs have shown progress in emotional health and academic performance.
  • The high school graduation rate has risen from 64 percent in 2013 to 79 percent in 2017.
  • For owner-occupied homes, the market has seen a 50 percent increase in sales volumes and a 22 percent increase in sales prices.
  • Homicides have declined, and while homicide rates in Columbus overall have risen, none were reported in the immediate Southern Orchards neighborhood in the last year.

"By taking both short- and long-term views of community development, Nationwide Children's and our partners have ambitious goals across many domains," says Dr. Kelleher. "The community-level approach allows the integration of epidemiology approaches, business resources and neighborhood development to support a mixed income community. Our next challenges will be to continue growth with new partners and to measure outcomes on children's health in the neighborhood."

Explore further: Living in better neighborhood may protect health of kids in poverty

More information: Pediatrics (2018). DOI: 10.1542/peds.2018-0261

Related Stories

Living in better neighborhood may protect health of kids in poverty

May 8, 2018
While poverty has long been linked with poor health, a study from UC San Francisco has found that simply living in a more desirable neighborhood may act as a health booster for low-income children.

Walkable neighborhoods might lower kids' asthma risk

June 11, 2018
(HealthDay)—Children may be more likely to develop asthma if they live in neighborhoods where it's difficult to get around on foot, a new study suggests.

Low neighborhood walkability increases risk of asthma in kids

May 5, 2018
(HealthDay)—Children living in neighborhoods with low walkability are at increased risk of asthma, according to a study published online April 17 in the Annals of the American Thoracic Society.

Kids in tough neighborhoods head to ER more often

April 6, 2018
(HealthDay)—Growing up in a disadvantaged neighborhood may mean more visits to the emergency room, a new study suggests.

Kids from low-income areas fare worse after heart surgery, finds study

February 23, 2018
Children from low-income neighborhoods had a higher mortality rate and higher hospital costs after heart surgery compared with those from higher-income neighborhoods, found a national study of more than 86,000 kids with congenital ...

Recommended for you

Breastfeeding protects infants from antibiotic-resistant bacteria

October 18, 2018
A recent study completed at the University of Helsinki investigated the amount and quality of antibiotic-resistant bacteria in breast milk and gut of mother-infant pairs. The findings have been published in the journal Nature ...

Inflammation in the womb may explain why some babies are more prone to sepsis after birth

October 9, 2018
Each year 15 million infants are born preterm and face high risks of short- and long-term complications, including sepsis, severe inflammation of the gut, and neurodevelopmental disorders. A new report in the American Journal ...

Dummies not to blame for common speech disorder in kids

October 9, 2018
New University of Sydney research shows bottles, dummies, and thumb sucking in the early years of life do not cause or worsen phonological impairment, the most common type of speech disorder in children.

'Genes are not destiny' when it comes to weight

October 9, 2018
A healthy home environment could help offset children's genetic susceptibilities to obesity, according to new research led by UCL.

Old drug could have new use helping sick premature babies

October 8, 2018
Researchers from The University of Western Australia, King Edward Memorial Hospital and Curtin University are investigating whether an old drug could be used to help very sick premature babies.

Insufficient sleep associated with risky behavior in teens

October 1, 2018
Adolescents require 8-10 hours of sleep at night for optimal health, according to sleep experts, yet more than 70 percent of high school students get less than that. Previous studies have demonstrated that insufficient sleep ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.