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Treating Entire Neighborhood as a Patient Can Make Good Things Happen

“Neighborhood effect syndrome” is a term referring to an entire community condition characterized by symptoms of extreme poverty including poor health, housing insecurity, racial segregation, trauma, violence, poorly performing schools, low social cohesion and support and environmental toxins.

Health care providers frequently encounter challenges in caring for children from affected neighborhoods, and these children often experience poorer outcomes compared to peers in unaffected neighborhoods. Historically, institutions have been largely ineffective in changing these outcomes with one-child-at-a-time approaches.

In a novel approach to improving outcomes for children in struggling neighborhoods, researchers from Nationwide Children’s Hospital in Ohio present a case study for treating the entire neighborhood as a patient in the journal Pediatrics.

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 next to the hospital’s main campus. Prior to 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,” said Kelly J. Kelleher, M.D., 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.”

In 2009, the neighborhood was characterized by the following: 4,300 residents, 23 percent of whom were children; 50 percent of neighborhood children were living in poverty; 50 percent of children were African American; 25 percent of children in Livingston Elementary School and 33 percent in South High School changed schools regularly; 1 in 3 residents over the age of 16 were employed full time.

The chief concern 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,” said 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 the publication, $23 million was invested in upgrading more than 300 homes through the HNHF Realty Collaborative, which was formed with the 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 intervention included a home repair program, rehabilitation and home ownership program, home construction program, workforce development program and rental housing development.

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

  • The vacancy rate declined from more than 25 percent to 6 percent.
  • 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.
  • Youth who have participated in area development programs have shown progress in emotional health and academic performance.
  • Investments have transformed housing stock in the area and reduced blight.

“By taking both short- and long-term views of community development, Nationwide Children’s and our partners have ambitious goals across many domains,” Kelleher said.

“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.”

Source: Nationwide Children’s Hospital

 

 



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