Making the case for lead safe housing: Downstream effects of lead exposure on outcomes for children and youth.

Lead based paint is a predominate source of lead exposure in children, which has a documented negative effect on their health and development. Despite public health efforts, the housing stock in disinvested neighborhoods in many cities continues to present significant risk of childhood lead exposure. In this article, we describe how a multi-agency integrated data system was used to document the impact of lead exposure on indicators of child and youth development as recorded in educational and human service systems. By tracking administrative data for two cohorts of Cleveland, Ohio children from birth to early adulthood and using rigorous matching methods to reduce confounders when comparing those with and without elevated blood lead levels, we document negative effects on developmental, behavioral and socio-economic outcomes due to early childhood lead exposure. The magnitude of disparities between individuals who had elevated blood lead levels (≥5 µg/dL) in early childhood, compared to their matched counterparts, is in the ranges of 20-40%. The analysis is framed by clarifying the context, assumptions and limitations associated with the use of administrative data. This type of information has been useful in illuminating the burden of lead exposure for children, families and youth serving agencies and engaging public officials, landlords and residents in initiatives to bring housing up to lead safe standards.

Why Does Child Maltreatment Occur? Caregiver Perspectives and Analyses of Neighborhood Structural Factors Across Twenty Years.

Research on caregivers' views of factors that contribute to child maltreatment and analyses of neighborhood structural factors offer opportunities for enhancing prevention and intervention efforts. This study compared explanations of the factors that contribute to child maltreatment in a neighborhood-based sample of adult caregivers at two-time points: 1995-1996 and 2014-2015 along with analyses of neighborhood structural conditions during the same period. The study sample consisted of two cross-sectional subsamples: 400 adult caregivers in 20 census tracts in Cleveland, Ohio from a 1995-1996 study, and 400 adult caregivers of the same 20 census tracts surveyed in 2014-2015. At each time point, residents were asked to rate how much each of 13 factors contributes to child abuse and neglect. Median regression analyses adjusted for individual and neighborhood characteristics showed that "lack of religion" decreased somewhat in importance over time, while that of "single parents" increased slightly. Otherwise, there was substantial consistency in caregivers' perceptions of factors contributing to maltreatment over the two study points. In terms of overall ranking, at each time point the most important contributors to child maltreatment were "drugs," "alcohol," and "psychological or emotional problems," while the least important were "divorce," "single parents," and "lack of religion." Differences in ratings of contributing factors were associated with individual and neighborhood characteristics, most consistently by participant race and age and by neighborhood maltreatment investigation rate. Despite these differences, for any maltreatment prevention or intervention effort using or planning to use maltreatment etiology in some way in its activities, etiology seems to represent a fairly stable platform for programming.

Two sides of the same neighborhood? Multilevel analysis of residents' and child-welfare workers' perspectives on neighborhood social disorder and collective efficacy.

Neighborhood processes have been shown to influence child maltreatment rates, and accordingly neighborhood-based strategies have been suggested as helpful in intervening in and preventing child maltreatment. Although child-welfare workers are at the forefront of child maltreatment work, little is known about the extent to which their perspectives on neighborhood processes related to child maltreatment align with those of neighborhood residents. The current study examined the views of neighborhood residents (n = 400) and neighborhood-based child-welfare workers (n = 260) on 2 neighborhood process measures: social disorder and collective efficacy. Because social disorder is viewed as a risk factor for child maltreatment and collective efficacy is viewed as a protective factor, child-welfare workers and residents of neighborhoods need to reach a common understanding of these factors in order to reach agreement on the safety of children in these neighborhoods. The samples of neighborhood residents and child-welfare workers were nested within 20 neighborhoods in Cleveland, Ohio. Multilevel modeling taking into account individual and neighborhood characteristics indicated that child-welfare workers consistently tended to perceive higher social disorder and lower collective efficacy compared to residents. Neighborhood characteristics were associated with residents' and child-welfare workers' perspectives on social disorder in different ways. Differences between residents and child-welfare workers concerning perceptions of neighborhood processes have implications for better understanding the context and improving the effectiveness of neighborhood-based interventions to prevent child maltreatment. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Understanding trends in neighborhood child maltreatment rates: A three-wave panel study 1990-2010.

This study examines how changes in the social and economic structure of neighborhoods relate to changes in child maltreatment report rates over an extended period. The panel study design allows us to partition the changes in child maltreatment report rates into a portion associated with how the levels of socio-economic risk factors have changed over time, and a portion related to how the relative importance of those factors in explaining maltreatment report rates has changed over time. Through the application of fixed effects panel models, the analysis is also able to control for unmeasured time-invariant characteristics of neighborhoods that may be a source of bias in cross-sectional studies. The study finds that increases in vacant housing, single parent families and unemployment rates are strongly associated with increases in child maltreatment report rates. Changes in racial/ethnic composition did not produce changes in maltreatment report rates except when they reached extreme levels of segregation. Although poverty rates were predictive of cross-sectional variation in child maltreatment, increases in neighborhood poverty became less associated with increases in child maltreatment report rates over time.

Change and consistency in descriptions of child maltreatment: A comparison of caregivers' perspectives 20 years apart.

Although approximately one-fifth of child maltreatment reports originate with family members, friends, neighbors, or community members, their efforts to identify and report child maltreatment are still not well understood. Nor is it well understood how these individuals' perceptions of what constitutes maltreatment may change over time. This study examined descriptions of behavior perceived as maltreatment by caregivers of minors in Cleveland, Ohio, USA neighborhoods. Data were obtained from two neighborhood-based cross-sectional surveys of caregivers of minors: one conducted in 1995-1996 and the other in 2014-2015. The sample consisted of 400 caregivers living in 20 census tracts with varying profiles of maltreatment risk in the 1995-1996 study, and 400 caregivers living in the same 20 census tracts surveyed in 2014-2015. Each time point, participants were asked to provide three examples of behaviors they considered to be child abuse and neglect. All responses were categorized using the 1995-1996 coding scheme. Logistic regression analyses including all 800 participants, adjusted for individual and neighborhood characteristics, and accounting for residential clustering in neighborhoods, showed that participating in the 2014-2015 survey was associated with 51% increased odds of mentioning an act of neglect and a 39% decreased odds of mentioning an act of physical abuse. No significant temporal changes were observed for inadequate supervision, emotional or verbal abuse, sexual abuse, and parental misbehavior. Associations between specific types of maltreatment and individual and neighborhood characteristics were observed. Potential practice implications and future research directions include seeking greater familiarity with caregivers' perceptions of maltreating behaviors to better understand how these perceptions might "translate" into child maltreatment reports and investigations.

SROI in the pay for success context: Are they at odds?

The Pay For Success (PFS) and Social Impact Bond (SIB) movements to date have focused heavily on shorter-term outcomes that can be monetized and show clear savings to government entities. In part, this focus derives from the need to specify contract payments based on a narrow set of well measured outcomes (e.g., avoided days in jail and foster care, decreased use of behavioral health services). Meanwhile efforts to measure the social return on investment (SROI) of interventions have sought to expand the view of relevant outcomes to include domains that lend themselves less clearly to monetization. This paper explores the intersection between these two movements with illustrations from a SIB initiative underway focused on homeless families with children in foster care. Challenges and potential for SROI in a third-party payor environment will be discussed as well as opportunities to better leverage the strengths of both types of initiative.