Our Community Health Needs Assessment: The Impact of Neighborhood Conditions on Child Opportunity
November 9, 2022 by Chaya Merrill, DrPH
November 9, 2022 by Chaya Merrill, DrPH
The neighborhoods that children call home make a big difference in their opportunity to develop to their full potential. Neighborhood features – such as the quality of schools, access to healthy food, and employment rates – shape a child’s future. I came across a tool recently, the Child Opportunity Index, that measures the level of child opportunity in every census tract (i.e., neighborhood) across the United States on a scale of 1 to 100.
Neighborhoods that score closer to a 100 have ample opportunity for children to thrive whereas those that were closer to 1 do not provide neighborhood conditions or resources that helped children reach their potential. I was intrigued by the COI and thrilled when Children’s National Hospital and HSC Pediatric Center decided to use the COI in our latest community health needs assessment (CHNA).
A Few Words on Community Health Needs Assessments
You may know that all non-profit hospitals, including Children’s National and our partner site, HSC Pediatric Center, must conduct a CHNA every three years per federal legislation that was passed a decade ago. There are many ways that hospitals conduct these assessments from relying on interviews, surveys, secondary data sources, hospital data and/or any combination of the former. I’ve been involved in this work for Children’s National Hospital since our first CHNA that was released in 2013. For our latest CHNA (released in June 2022), we applied a data-driven and community engaged approach that used the COI to assess opportunity levels in our hospitals’ primary service area (PSA) while engaging with community stakeholders to learn about their perspectives on opportunity. Take a look at our report here.
A Bit More about the Child Opportunity Index
The COI is a tool that was developed in 2014 in collaboration with the Kirwan Institute for the Study of Race and Ethnicity at Ohio State University with funding from the Robert Wood Johnson Foundation and The Kellogg Foundation. It’s a phenomenal tool that you can read much more about on the diversitydatakids.org site. On a high level, the COI looks across 29 different neighborhood-level indicators to score every single neighborhood in the United States on how well they are performing across these different indicators. There’s some mathematical magic that results in a composite score for each neighborhood. For the data-lovers, you can learn more about the technical aspects of the tool here and you can dig really deep into a neighborhood’s score to see exactly what indicators impacted that neighborhood’s score at this interactive COI website. For example, for a neighborhood that scored low, you can figure out exactly which of the 29 indicators pulled the score down. Was it early childhood education, lack of access to healthy food, a lack of space for the children to play, poor employment rate…or some combination of all of these factors? With the COI’s interactive tool, you can take a look at any neighborhoods of interest to you. I recently overheard a colleague say that she consulted the COI when she was looking to move to a new neighborhood. What parent doesn’t want to live in a neighborhood that gives children the best shot at success?
Our 2022 CHNA
For our 2022 CHNA, we applied the COI to our hospitals’ primary service area (PSA) which includes all of DC and parts of Maryland (Prince George’s County and Montgomery County) – check out the map. Darker is better. The darker areas indicate neighborhoods of highest opportunity while the light blue/white areas are neighborhoods of lowest opportunity. It’s quite apparent that opportunity is not equitably distributed in our community. Northwest DC and Montgomery County, MD are areas of high opportunity while Southeast DC and parts of Prince George’s County have many areas of low opportunity. For our CHNA, we then identified neighborhoods in our PSA with the lowest COI scores and at least 1,000 children – this amounted to 16 neighborhoods in DC (concentrated in Wards 7 and 8) and across Prince George’s County (“red” neighborhoods below).
Numbers – or opportunity scores – don’t mean much without understanding community context. We engaged with many stakeholders who have a vested interest in these communities to learn about their perspectives on opportunity: community residents, employees at local organizations, government leaders, hospital staff and other stakeholders. Our engagement efforts included community conversations, interviews, surveys, and town halls. We also hosted a pilot youth Photovoice program for more than 20 high school students from the region. Youth met with facilitators and guest speakers to engage in an open dialogue about health equity and neighborhood conditions that impact health. The students were asked to use their cell phones to capture images that showed the assets and challenges that impact health in their communities. They worked with the facilitators to learn how to use their voices to promote positive change in their neighborhoods. We learned quite a bit from engaging with our community. We’ll be posting another blog post highlighting this project soon!
Using the insight we gained from the COI and our understanding of our community perspectives, we pared down the 29 COI indicators to four indicators that will be our hospital’s focus for the next three years: Early Childhood Education, Healthy Food, Health Insurance Coverage and Employment Rates. Please take a look at our 2022 CHNA Report for more details.
Everything we learned is helping shape the second phase of this work: our Community Health Improvement Plan (CHIP)! The CHIP details how Children’s National Hospital and HSC Pediatric Center, in partnership with our community, will address the four priority indicators. We’ll write a blog post about the CHIP soon and we’ll publish our CHIP report on November 15. We are looking forward to spending the next three years working on initiatives that improve opportunity levels for children in our community.
Child Opportunity Index: diversitydatakids.org
Director of Child Health Data Lab within the Child Health Advocacy Institute at Children's National Hospital