Research Policy Briefs

Shooting Without Bullets: Using Photovoice to Capture Cleveland Youth Perspectives to Inform Police and Other Criminal Justice Related Reform in Cleveland and Beyond.

This brief is a summary of a research paper authored by Amanda King, a third-year Case Western Reserve University law student, founder of “Shooting Without Bullets” and member of the Cleveland Community Police Commission. The paper was part of her “Shooting Without Bullets” Legal Policy research project, under the supervision of the Schubert Center for Child Studies. The views expressed and research conducted are solely those of Ms. King. Schubert Center Policy Research Assistant Keisha Matthews provided editing assistance. More information about Shooting Without Bullets.

Examining Resilience Among Maltreated Children.

Child maltreatment is a serious public health issue–an estimated 702,000 U.S. children were victims of maltreatment in 2014, a rate of 9.4 per 1,000 children. Childhood maltreatment puts children at risk for lifelong poor outcomes. However, emerging research examines the importance of protective factors and promoting resilience. Researchers at Case Western Reserve University recently completed a study examining how protective factors promote long-term resilience for maltreated children.

Questions about the research can be directed to Dr. Megan Holmes and Dr. Adam Perzynski.

Youth Suicide: Prevalence and Prevention.

Suicide is a major public health issue facing young people worldwide. Suicidal ideation (thoughts or wishes to end one’s life) and suicide affect youth from all cultures and socioeconomic groups. In the United States and in Ohio, suicide was the second leading cause of death for children ages 10-17 in 2014.2 In Ohio, suicide accounted for 23% of deaths (59 deaths total) in this age group. Locally in Cuyahoga County, Ohio, the Youth Risk Behavior Survey (YRBS) asks middle and high school students four questions about depression and suicide risk behaviors, including questions about self-harm, feeling sad or hopeless, thinking about suicide, and attempting suicide. Data from the 2014 middle school YRBS shows that 21.3% of students reported feeling sad or hopeless almost every day for two weeks or more. It also revealed that 14% of middle schoolers had seriously considered attempting suicide and 10% said they had attempted suicide in the past year. Data from the 2013 high school YRBS shows that high schoolers seriously considered suicide and attempted suicide at similar rates to the middle schoolers. The three leading methods of youth suicide include firearms, hanging and poisoning. In recent years there has been a growing body of research investigating the risk factors and protective factors contributing to youth suicide. Understanding the risk and protective factors that contribute to suicidal behavior can lead to better intervention and prevention programs.

African-American Children’s Literature: Examining the Genre in Childhood.

Books play a critical role in healthy child development.The role of multicultural literature is well established in developing children’s motivation to read and success in building literacy skills. Literacy is enhanced for children of color when there are culturally relevant characters and stories reflected in their books. Beyond gaining literacy skills, children can engage with difficult situations and learn about the perspectives of others.3 However much of children’s literature remains a reflection of a society with ongoing racial biases. In 1965, Nancy Larrick published “The All-White World of Children’s Books,” highlighting the lack of racial diversity in children’s literature, finding in a survey of over 5,200 children’s books, only 6.7% included a Black character.4 In a recent follow up study, a review of new books showed that only 10.5% of all new children’s books published in 2013 depicting human beings include a person of color.

Michelle Martin’s “Top Picks” in African-American Children’s Literature.

Transitions to Adulthood for Foster Care and Justice System-Involved Youth.

Adolescents, particularly those in urban areas, face many challenges in the transition to adulthood. More than half of youth in urban high schools fail to graduate high school, and many young adults are neither in school nor working during early adulthood. Researchers have proposed that the period from 18 to 25 is a particularly important time for developing personal identity, calling this time “emerging adulthood”. As youth transition to adulthood, they must shift somewhat from family life and develop maturity and key life skills, a time of opportunity but also of risk. 4 Those without higher education and those without a high school degree struggle to attain economic self sufficiency.

Play, Implicit Bias and Discrimination in Early Childhood: Implications for Child Development.

The years from birth to age five, when a child’s brain is developing most rapidly, are crucial for improving educational, health and social outcomes later in life. Access to quality early care with opportunities for imaginative play is increasingly understood as foundational for later school success, creativity and social and emotional skill-building as part of healthy child development. Research also shows that experiences of discrimination can negatively impact well-being, but little is understood about how bias may operate in an early education context and how discrimination may affect very young children. This issue brief investigates this new line of research and examines the implications of racial discrimination and implicit bias in early childhood education.

Children of Incarcerated Parents.

The experiences of and care for children who have one or both parents in jail or prison raise important issues for families, policymakers and the general public. In 2007, 1.7 million children in the United States had a parent in prison. Children of incarcerated parents experience challenges both unique to parental incarceration and similar to children with other life stressors. This brief provides an overview of issues related to children with incarcerated parents and a description of several evidence-based interventions targeted at children of incarcerated parents.

Violence in Childhood: Understanding Prevalence, Risk and Prevention Strategies.

The experience of violence among children and adolescents raises significant concerns for individuals, families and the general public. Despite a declining trend in violence committed by youth, media accounts of school shootings and bullying incidents have stimulated public and professional awareness about this issue. Effective strategies exist to prevent and respond to violence and victimization; however, challenges remain in broadly implementing best practices. This brief reviews some of the recent U.S. violence data, describes some of the potential consequences of children and young people witnessing or experiencing violence and some of the policy and practice initiatives focused on youth violence, both nationally and in Ohio.

School Climate, Social and Emotional Learning and Student Success: A Look at Safety, Bullying, Positive Behavior Interventions and Supports.

Healthy schools and educational environments are essential for healthy child and adolescent development. A positive school climate is one that “includes norms, values and expectations that support people feeling socially, emotionally and physically safe.” A positive school climate is associated with academic achievement, school success, effective violence prevention, healthy student development and teacher retention. Evidenced-based behavior interventions and disciplinary practices contribute to a positive school climate. Conversely, research has found that schools with harsh disciplinary practices typically have lower achievement scores and other poor outcomes. Providing students with a safe school environment is a key component of fostering a positive school climate. This brief highlights current research on bullying and student safety as well as Ohio school safety and climate policies.

Lessons from the Playing Field: Addressing Youth Sports-Related Concussions — Susannah Briskin, MD, Amanda Weiss-Kelly, MD, & Mary Solomon, DO.

Consistent with the national picture of increasing sports-related pediatric traumatic brain injuries (TBIs), Ohio has seen dramatic rises in these types of injuries. Ohio emergency room visits for pediatric TBIs increased from 2,970 visits in 2002 to 5,167 visits in 2010 (Ohio Department of Health, 2012). As a result of increased awareness and concern for Ohio’s children, legislation was introduced to improve safety precautions for student athletes. This legislation, House Bill 143 (HB 143), was passed in December 2012 (H.B. 143, 2012). This policy brief highlights some recent TBI data, discusses best practices for preventing and treating child and adolescent sports-related concussions, and reviews HB 143 and related policy efforts, including implications for parents, coaches and other key stakeholders.

Civic Engagement and the Youth Vote.

In 2008 an estimated 22 million young people (ages 18-29) voted in the national election. This was one of the highest turnouts of young people ever recorded. Two million more people under the age of 30 voted in 2008 than in 2004. While young voters typically represent the smallest percentage of votes in an election, they are a major subset of the electorate. Young people represent 24% of the eligible voting population. As a result, their voting power is significant in terms of its potential impact on an election. The increased youth turnout in the 2008 election has inspired many researchers and advocates to explore the reasons for this increase and ways to further youth voting and engagement in future elections. A confluence of factors such as extensive voter outreach measures, civic education and increased public interest are important contributors to increasing voter turnout. This issue brief reviews the current research on youth civic engagement and discusses policy and practice implications for the youth vote.

Adolescent Transitions, Developmental Assets and Parental Monitoring: Lessons from the Cuyahoga County Youth Risk Survey — Jean Frank, MPH and Erika Trapl, PhD.

Adolescence is a time of social and developmental transition. Risk taking and reward seeking is a normal part of healthy adolescent development, but these behaviors can raise concerns when sensation-seeking leads to immediate or future harm. National data from the 2011 Youth Risk Behavior Survey (YRBS), a school-based public health survey conducted by the U.S. Centers for Disease Control and Prevention (CDC), indicate that many high school students engage in priority health-risk behaviors. Understanding the prevalence of risk behaviors, developmental assets and parental monitoring among youth is a crucial first step toward promoting behaviors and environments that are conducive to adolescent well-being. Moreover, collecting local data allows for comparison between local, state and national trends. This research and policy brief summarizes key findings from the Cuyahoga County YRBS, with a focus on the middle to high school transition, and discusses some of the practice and policy implications.

Parental Job Loss and the Implications for Children — Mark Votruba, PhD.

Jobs are currently at the forefront of both public policy discussions and the everyday lives of families in the United States. Although two years of consistent job creation and an 8.3% unemployment rate for January 2012 indicate national progress since the lowest point of the recession in April 2009, recovery remains elusive in Ohio generally and Cuyahoga County specifically. Studies have shown than job loss has a negative impact on future employment, income, and economic security, as well as the affected worker’s physical and mental health. Job loss has also been associated with strained marital relationships and a higher likelihood of divorce. While these disruptions to financial security and relationships can be expected to impact the wellbeing of displaced workers’ children, very little empirical data is available on the subject. This research and policy brief discusses the work of Dr. Mark Votruba and colleagues to estimate the causal effect of parental job loss on children’s school performance in Norway. Commentary is also provided on the policy and practice implications here in the United States.

Serious Mental Illness in Childhood: What Longitudinal Data on Manic Symptoms Can Tell Us — Robert Findling, MD, MBA.

Elevated symptoms of mania (ESM) are increasingly prevalent among children seeking care for psychiatric distress. Characterized as marked extremes in mood accompanied by intense irritability, ESM is the hallmark feature of bipolar disorder, which is also being diagnosed in children at increasingly high rates. However, ESM does not on its own indicate a bipolar diagnosis, and there is currently no reliable means of predicting whether a child with ESM will ultimately develop bipolar disorder. Given the rising prevalence of Bipolar spectrum disorders in clinical settings, the lasting consequences that accompany such a diagnosis, and the implications for providing treatment, accurately identifying bipolarity in children with ESM presents a critical challenge. This research and policy brief summarizes the ongoing work of CWRU scholars and collaborators to gather and analyze longitudinal data addressing this need and discusses some of the practice and policy implications.

Children Exposed to Violence & the Defending Childhood Initiative — Daniel Flannery, PhD.

Children and adolescents who are chronically exposed to violence are at increased risk for psychological distress, with associated symptoms ranging from depression, anger, and anxiety, to poor physical health outcomes, dissociation, post traumatic stress, and thoughts of suicide. Furthermore, there is a clear link between childhood violence exposure and perpetration of violence, with children displaying exposure-related aggression as early as the preschool years. Cuyahoga County is challenged with staggeringly high rates of childhood exposure to violence and associated risk factors. Cuyahoga County is also one of eight sites that received funding through the U.S. Attorney General Eric Holder’s Defending Childhood Initiative. The goals of the Defending Childhood Initiative are to prevent exposure to violence, mitigate the negative impacts of exposure when it does occur, and develop knowledge and spread awareness about the issue. Researchers at the Begun Center for Violence Prevention and Education at Case Western Reserve University are part of this collaborative effort, providing ongoing planning, data and evaluation support.

Toward an Understanding of Girls with Eating Disorders.

Many girls and women develop harmful eating patterns during adolescence and early adulthood, with most cases of anorexia nervosa developing between ages 15 and 19 and most cases of bulimia nervosa developing between ages 20 and 24. Younger girls are also at risk for developing patterns of disordered eating. A recent population-based study of U.S. adolescents found that 0.3% of teens suffer from anorexia nervosa, 0.9% suffer from bulimia nervosa, and 1.6% suffer from binge eating disorder. This issue brief covers the current clinical understanding of eating disorders as well as best practices for treatment. In addition the brief highlights current research on eating disorders being conducted by CWRU faculty.

Children’s Development of Mathematical Skills — Lee Thompson, PhD.

National and international assessments of quantitative literacy demonstrate that U.S. students are not performing as well on measures of mathematic abilities as their peers in other countries. Given the importance of mathematics for school, employment and other aspects of daily life, policymakers, practitioners and parents have incentives to improve children’s mathematic proficiency. However, less is known about which interventions can best improve quantitative literacy. In order to develop strategies to improve children’s math skills, we first must understand the underlying skills necessary for mathematic competence and the factors that influence the development of these skills. Researchers at Case Western Reserve University are working to address this gap in knowledge. This policy brief covers the ongoing research by Dr. Lee Thompson and colleagues to address a gap in our understanding of how children develop math skills.

Early School Progress in Children with Extreme Prematurity — H. Gerry Taylor, PhD.

Improvements in neonatal intensive care have led to the increasing survival of children born with extreme prematurity. These children typically suffer from a range of neurodevelopmental and health problems that affect a variety of aspects of their lives, including their academic abilities. Early recognition of academic issues and timely educational interventions are necessary to facilitate success for these children. By the time they enter kindergarten, children with extreme prematurity have begun to demonstrate educational and cognitive deficits. However, research has often focused on early outcomes as opposed to studying children at the time of school entry. In addition, few studies focus specifically on extremely premature children, who are at higher risk for negative outcomes. Research conducted by scholars at CWRU and colleagues seeks to bridge these gaps by identifying and addressing early academic consequences of extreme prematurity.

Lessons in Child Welfare Reform from Cuyahoga County and Beyond: The Annie E. Casey Foundation’s Family to Family Initiative — David Crampton, PhD.

Child welfare agencies are often caught between criticism that they do not intervene enough to protect children and criticism that they are ‘baby snatchers’ who disrupt family and community life. Federal child welfare funding can reinforce these dynamics by limiting service options and emphasizing out-of-home care. These challenges have contributed to a system in which child welfare workers can be disconnected from the communities they serve. The Annie E. Casey Foundation’s Family to Family Initiative is one of several broad efforts to move the debate away from a false choice about whether CPS should intervene more or less in families’ lives, and instead develop strategies for engaging families and communities in the care and protection of children. Results from a recent evaluation of Family to Family suggest how communities and child welfare agencies can work together to reduce child maltreatment. From 2006- 2009, Dr. Crampton was a member of a national research team evaluating the Annie E. Casey Foundation’s Family to Family Initiative.

Improving Oral Health and Access to Dental Care for Children — James Lalumandier, DDS, MPH.

The Surgeon General’s Report on Oral Health refers to oral diseases as a “silent epidemic,” and tooth decay is the most common chronic disease among children. This policy brief highlights Dr. Lalumandier’s research interests, which focus primarily on the preventive aspects of dentistry, including fluoridation, fluorides and sealants. He is the founder of the Healthy Smiles Sealant Program, an innovative clinical outreach program that seeks to prevent dental disease in children, while educating dental students about the importance of community service. The Healthy Smiles Sealant Program is a public-private partnership funded primarily by the Saint Luke’s Foundation. It is also made possible by donations from Case Western Reserve University and the efforts of dental students, hygiene students and volunteer dentists.

Teen Dating Violence and Girls.

In the United States, as many as 1 in 5 teens reported experiencing physical or sexual abuse in a dating relationship and the prevalence of emotional or verbal abuse may be even higher. While particularly tragic cases are often highlighted in the media, these are merely examples of a more widespread problem of violence and abuse in adolescent relationships. This abuse has serious immediate consequences for teens and has also been linked to a pattern of violence which may lead to intimate partner violence in adulthood. Less attention has been given to the amount and nature of all forms of violence both experienced and committed by teen girls compared to adult domestic violence; however, research and practice have begun to focus more on this important social problem. This issue brief highlight current research on teen dating violence and reviews the implications for policy and practice.

Obesity & Hypertension in Elementary-Age Children — Marilyn Lotas, PhD, RN.

The problems of obesity and being overweight in U.S. children and adolescents, along with co-occurring conditions such as hypertension and diabetes, are a major concern. The 2007-2008 National Health and Nutrition Examination Survey found that 17% of children and adolescents ages 2-19 years are obese based on measurements of their height and weight. In Ohio, approximately 14.8% of children are overweight according to the U.S. Department of Health and Human Services, while the numbers seem much more serious for Cuyahoga County. This policy brief highlights the findings from a 2005 research study conducted as part of a comprehensive partnership between Cleveland Metropolitan School District (CMSD), the Francis Payne Bolton School of Nursing at Case Western Reserve University and the American Heart Association. Approximately 200 children in the 7th and 9th grades received routine state mandated health screenings measuring the students’ height, weight, and blood pressure.

Girls in the Juvenile Justice System: A Profile of Ohio.

Juvenile delinquency among girls is a unique research, practice and policy challenge that requires a comprehensive understanding of the problem, including scope, causes and risk factors, and opportunities for effective prevention and intervention. Various child-serving systems, including education, child welfare and mental health services are connected to the juvenile justice system and the young people in its care. The following information and data have been compiled to develop a common source of reference for the experiences and needs of girls in Ohio who have either entered or are at-risk of entering the juvenile justice system. Data collection, maintenance and reporting are not consistent across the state or across child-serving agencies, and ease of data accessibility varies considerably as well. Thus, while significant gaps in data exist, this summary serves as a starting point for background on vulnerable girls.

Managing Mental Illness on Campus: The Student Experience Transitioning to College — Eileen Anderson-Fye, EdD.

A mental health crisis is taking place on college campuses around the country. There is growing concern about the serious mental health issues of college students and the mounting need for professional resources to mitigate and treat them. The college transition from late adolescence to emerging adulthood can be especially challenging for young people managing mental illness while transitioning to a peer-based college environment and juggling campus life. This research and policy brief highlights the initial findings from the Transitions in Medication Experience (TIME) study. The goal of this study is to better understand college student experiences with managing their own psychiatric medications and mental health services in the transitions to and through college. This two year pilot addresses the existing gap in knowledge about the practices and experiences of late adolescents taking psychiatric medications in college contexts.

Advancing Children’s Health & Development: The National Children’s Study in Northeast Ohio — Dorr Dearborn, MD, PhD.

This research and policy brief highlights the National Children’s Study, which has a study center in Northeast Ohio. The study will follow the environmental (using pre- and post-natal natural and man-made environmental, biological, genetic, and psychosocial factors) influences on the health and development of approximately 100,000 children from 105 locations across the United States from birth to age 21. As the largest longitudinal study of U.S. children, their families and their environments, the National Children’s Study will be a collaborative effort involving children of diverse ethnicities and socioeconomic backgrounds. The goal of the study is ultimately to improve the health and well-being of children. The study’s key scientific questions address some of the most pressing health and development concerns for today’s children, including: diabetes, injuries, asthma, obesity, autism, and learning and behavioral problems.