Skip to main content

Advertisement

SpringerLink
Log in

The Full Picture: Incorporating Ecological Factors When Conducting Developmental Screening with Young Children Experiencing Homelessness

  • Published:
Child Indicators Research Aims and scope Submit manuscript

Abstract

Conducting a neurodevelopmental screening without considering ecological factors is insufficient and may underestimate the actual risk to development for children living in poverty. This article describes ecological risk factors among a nationwide sample (n = 231) of young children experiencing homelessness. Researchers examined rates of health care access and continuity, food insecurity, lead exposure, ACEs, and access to safe places to play using a new ecological screening tool developed for the population. Children in the sample experienced high rates of food insecurity, faced significant challenges to health care access, and significant exposure to adverse childhood events. Children experiencing homelessness and poverty experience more barriers to health care access and significantly more food insecurity and hunger. A third of caregivers reported that their child had some exposure to lead, primary due to substandard housing. And the majority were enduring long periods of homelessness with over half (56%) being between 1–6 months. Findings are discussed within a social determinants of health perspective.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Alaimo, K., Olson, C. M., & Frongillo, E. A., Jr. (2001). Food insufficiency and American school-aged children’s cognitive, academic, and psychosocial development. Pediatrics, 108(1), 44–53.

    Article  Google Scholar 

  • Alaimo, K., Olson, C. M., & Frongillo, E. A. (2002). Family food insufficiency, but not low family income, is positively associated with dysthymia and suicide symptoms in adolescents. Journal of Nutrition, 132(4), 719–725.

    Article  Google Scholar 

  • Alker, J., & Chester, A. (2016). Children’s health coverage rate now at historic high of 95 percent. Georgetown University Health Policy Institute: Center for Children and Families. https://ccf.georgetown.edu/wp-content/uploads/2016/11/Kids-ACS-update-11-02-1.pdf. Accessed 28 Sep 2022

  • Alker, J., & Roygardner, L. (2019). The number of uninsured children is on the rise. https://ccf.georgetown.edu/wp-content/uploads/2019/10/Uninsured-Kids-Report.pdf: Georgetown University Health Policy Institute: Center for Children and Families. Accessed 28 Sep 2022

  • Antonelli, R. C., McAllister, J. W., & Popp, J. (2009). Making care coordination a critical component of the pediatric health system: a multidisciplinary framework. https://pdfs.semanticscholar.org/84a7/32ca3928e2aac64981cf5fefc98a926deea1.pdf. Accessed 28 Sep 2022

  • Ashiabi, G. S. (2007). Play in the Preschool Classroom: Its Socioemotional Significance and the Teacher’s Role in Play. Early Childhood Education Journal., 35(2), 199–207.

    Article  Google Scholar 

  • Barnett, J. C., Berchick, E. R. (2017). Current population reports: health insurance coverage in the United States: 2016. (P60–260). US Census Bureau. https://www.census.gov/content/dam/Census/library/publications/2017/demo/p60-260.pdf. Accessed 28 Sep 2022

  • Barros, R. M., Silver, E. J., & Stein, R. E. K. (2009). School recess and group classroom behavior. Pediatrics, 123(2), 431–436.

    Article  Google Scholar 

  • Blair, C., & Raver, C. C. (2016). Poverty, stress, and brain development: New directions for prevention and intervention. Academic Pediatrics, 16(3 Suppl), S30–S36.

    Article  Google Scholar 

  • Blodgett, C. (2012). Adopting ACEs screening and assessment in child serving systems. Washington State University, Child and Family Research Unit. https://s3.wp.wsu.edu/uploads/sites/2101/2019/12/ACE-Screening-and-Assessment-in-Child-Serving-Systems-July-2012.pdf. Accessed 28 Sep 2022

  • Blumberg, S. J., Bialotosky, K., Hamilton, W. L., & Briefel, R. (1999). The effectiveness of a short form of the Household Food Security Scale. American Journal of Public Health., 89(8), 1231–1234.

    Article  Google Scholar 

  • Braveman, P. (2006). Health disparities and health equity: Concepts and measurement. Annual Review of Public Health., 27, 167–194.

    Article  Google Scholar 

  • Braveman, P., & Gottlieb, L. (2014). The social determinants of health: It’s time to consider the causes of the causes. Public Health Reports, 129(Suppl 2), 19–31.

    Article  Google Scholar 

  • Braveman, P., Acker, J., Arkin, E., et al. (2018). Early childhood is critical to health equity. Robert Wood Johnson Foundation. https://www.rwjf.org/content/dam/farm/reports/reports/2018/rwjf445350. Accessed 28 Sep 2022

  • Bronfenbrenner, U. (1977). Toward an experimental ecology of human development. American Psychologist, 32(7), 513.

    Article  Google Scholar 

  • Bronfenbrenner, U. (1979). The ecology of human development: experiments by nature and design (pp. 3–7). Harvard University Press.

    Google Scholar 

  • Bruner, C. (2017). ACE, place, race, and poverty: Building hope for children. Academic Pediatrics, 17(7S), S123–S129.

    Article  Google Scholar 

  • Buckner, J. C., Mezzacappa, E., & Beardslee, W. R. (2009). Self-regulation and its relations to adaptive functioning in low income youths. The American Journal of Orthopsychiatry, 79(1), 19–30.

    Article  Google Scholar 

  • Center on the Developing Child at Harvard University. (n.d.). http://www.developingchild.harvard.edu. Accessed 28 Sep 2022

  • Centers for Disease Control & Prevention. (2020a). NCHHSTP Social Determinants of Health. www.cdc.gov/nchhstp/socialdeterminants/faq.html. Accessed 28 Sep 2022

  • Centers for Disease Control & Prevention. (2020b). https://www.cdc.gov/nceh/lead/prevention/blood-lead-levels.htm. Accessed 28 Sep 2022

  • Chatterjee, A., So, M., Dunleavy, S., et al. (2017). Quality health care for homeless children: Achieving the AAP recommendations for care of homeless children and youth. Journal of Health Care for the Poor and Underserved, 28(4), 1376–1392.

    Article  Google Scholar 

  • ChildTrends. (n.d.). Health care coverage for children: Key facts about health care coverage for children. https://www.childtrends.org/indicators/health-care-coverage. Accessed 28 Sep 2022

  • Chiu, S., Redelmeier, D. A., Tolomiczenko, G., et al. (2009). The health of homeless immigrants. Journal of Epidemiology and Community Health., 63(11), 943–948.

    Article  Google Scholar 

  • Chung, E. K., Siegel, B. S., Garg, A., et al. (2016). Screening for social determinants of health among children and families living in poverty: A guide for clinicians. Current Problems in Pediatric and Adolescent Care., 46(5), 135–153.

    Google Scholar 

  • Cicchetti, D., Rogosch, F. A., Lynch, M., et al. (1993). Resilience in maltreated children: Processes leading to adaptive outcome. Development and Psychopathology, 5(4), 629–647.

    Article  Google Scholar 

  • Clair, A. (2019). Housing: An under-explored influence on children’s well-being and becoming. Child Indicators Research, 12, 609–626. https://doi.org/10.1007/s12187-018-9550-7

    Article  Google Scholar 

  • Clark, R., Anderson, N. B., Clark, V. R., et al. (1999). Racism as a stressor for African Americans: A biopsychosocial model. American Psychologist, 54(10), 805–816.

    Article  Google Scholar 

  • Coleman-Jensen, A., Rabbitt, M. P., & Gregory, C. A., et al. (2017). Household food security in the United States in 2016—A report summary from the Economic Research Service of the United States Department of Agriculture. (ERR-237). U.S. Department of Agriculture, Economic Research Service. https://www.ers.usda.gov/webdocs/publications/84973/err-237.pdf. Accessed 28 Sep 2022

  • Coleman-Jensen, A., Rabbitt, M. P., & Gregory, C. A., et al. (2019). Household food security in the United States in 2018—A report summary from the Economic Research Service of the United States Department of Agriculture. (ERR-270). U.S. Department of Agriculture, Economic Research Service. https://www.ers.usda.gov/webdocs/publications/94849/err-270.pdf?v=963.1. Accessed 28 Sep 2022

  • Council on Community Pediatrics, Committee on Nutrition. (2015). Promoting food security for all children. Pediatrics, 136(5), e1431–e1438. https://doi.org/10.1542/peds.2015-3301

    Article  Google Scholar 

  • Council on Environmental Health. (2016). Prevention of childhood lead toxicity. Pediatrics, 138(1), e20161493.

    Article  Google Scholar 

  • Cronholm, P. F., Forke, C. M., Wade, R., et al. (2015). Adverse childhood experiences: Expanding the concept of adversity. American Journal of Preventive Medicine, 49(3), 354–361.

    Article  Google Scholar 

  • Cutts, D. B., Bovell-Ammon, A., de Cuba, S. E., et al. (2018). Homelessness during infancy: associations with infant and maternal health and hardship outcomes. Cityscape, 20(2), 119–32.

    Google Scholar 

  • Cutuli, J., & Herbers, J. (2014). Promoting resilience for children who experience family homelessness: Opportunities to encourage developmental competence. Cityscape, 16(1), 113–140.

    Google Scholar 

  • Daelmans, B., Gemmell, K., Manji, S., Schwethelm, B., & Tomlinson, M. (2021). Nurturing Care Handbook: Strategic Action 4 – Monitor Progress: How to Monitor Populations, Implementation, and Individual Children’s Development. World Health Organization (WHO). http://www.nurturing-care.org. Accessed 28 Sep 2022

  • Dammann, K. W., & Smith, C. (2009). Factors affecting low-income women’s food choices and the perceived impact of dietary intake and socioeconomic status on their health and weight. Journal of Nutrition Education and Behavior, 41(4), 242–253.

    Article  Google Scholar 

  • Dapul, H., & Laraque, D. (2014). Lead poisoning in children. Advances in Pediatrics, 61(1), 313–333.

    Article  Google Scholar 

  • DeCandia, C. J., Volk, K. T., Unick, G. J., & Donegan, L. R. (2020). Developing a screening tool for young children using an ecological perspective. Infants and Young Children, 33(4), 237–258.

    Article  Google Scholar 

  • DeCandia, C. J., Unick, G. J., Volk, K. T., & Donegan, L. R. (2021). Validating the neurodevelopmental domain of neurodevelopmental ecological screening tool: An ecological screener for use with 3–5 year-old children impacted by poverty and homelessness. Journal of Psychoeducational Assessment. https://doi.org/10.1177/07342829211005575

    Article  Google Scholar 

  • Dickman, J. (2017). Children at risk: gaps in state lead screening policies. Safer Chemicals, Healthy Families. https://saferchemicals.org/get-the-facts/children-at-risk/. Accessed 28 Sep 2022

  • Dietz, P. M., Spitz, A. M., Anda, R. F., et al. (1999). Unintended pregnancy among adult women exposed to abuse or household dysfunction during their childhood. JAMA, 282(14), 1359–64.

    Article  Google Scholar 

  • Dube, S. R., Anda, R. F., Felitti, V. J., et al. (2001a). Childhood abuse, household dysfunction, and the risk of attempted suicide throughout the life span: findings from the Adverse Childhood Experiences Study. JAMA, 286(24), 3089–96.

    Article  Google Scholar 

  • Dube, S. R., Anda, R. F., Felitti, V. J., et al. (2001b). Growing up with parental alcohol abuse: Exposure to childhood abuse, neglect, and household dysfunction. Child Abuse and Neglect, 25(12), 1627–1640.

    Article  Google Scholar 

  • Economic Research Service, U.S. Department of Agriculture. (2022). Food Security in the U.S.: Key Statistics and Graphics. https://www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-u-s/key-statistics-graphics/. Accessed 28 Sep 2022

  • Farah, M. J., Betancourt, L., Shera, D. M., Savage, J. H., Giannetta, J. M., Brodsky, N. L., & Hurt, H. (2008). Environmental stimulation, parental nurturance and cognitive development in humans. Developmental Science, 11, 793–801.

    Article  Google Scholar 

  • Farrell, A. F., Dibble, K. E., Randall, K. G., & Britner, P. A. (2017). Screening for housing instability and homelessness among families undergoing child maltreatment investigation. American Journal of Community Psychology, 60(1–2), 25–32.

    Article  Google Scholar 

  • Felitti, V. J., Anda, R. F., Nordenberg, D., et al. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14(4), 245–58.

    Article  Google Scholar 

  • Finkelhor, D., & Turner, H. (2016). National Survey of Children’s Exposure to Violence II, 1993–2012 [United States]. Inter-university Consortium for Political and Social Research.

    Google Scholar 

  • Finkelhor, D., Turner, H., Ormrod, R., et al. (2009a). Violence, abuse, and crime exposure in a national sample of children and youth. Pediatrics, 124(5), 1411–1423.

    Article  Google Scholar 

  • Finkelhor, D., Ormrod, R. K., & Turner, H. A. (2009b). Lifetime assessment of poly-victimization in a national sample of children and youth. Child Abuse and Neglect, 33(7), 403–411.

    Article  Google Scholar 

  • Fowler, P. J., Taylor, J. J., & Rufa, A. S. (2011). Evaluation of housing support in child welfare: The impact on family preservation. Child Welfare, 90, 107–126.

    Google Scholar 

  • Fowler, P. J., McGrath, L. M., Henry, D. B., et al. (2015). Housing mobility and cognitive development: Change in verbal and nonverbal abilities. Child Abuse and Neglect, 48, 104–118.

    Article  Google Scholar 

  • Gallup. (2010). The state of play – Gallup principles and school recess. Robert Wood Johnson Foundation. http://www.playworks.org/files/StateOfPlayFeb2010.pdf. Accessed 28 Sep 2022

  • Gerhardt, S. (2004). Why love matters: How affection shapes the brain. Routledge & Tailor.

    Book  Google Scholar 

  • Ginsburg, K. R. (2007). The importance of play in promoting healthy child development and maintaining strong parent-child bonds. Pediatrics, 119(1), 182–191.

    Article  Google Scholar 

  • Gould, E. (2009). Childhood lead poisoning: Conservative estimates of the social and economic benefits of lead hazard control. Environ Health Perspectives., 117(7), 1162–1167.

    Article  Google Scholar 

  • Gulliford, M., Figueroa-Munoz, J., Morgan, M., et al. (2002). What does “access to health care” mean? Journal of Health Services Research & Policy, 7(3), 186–188.

    Article  Google Scholar 

  • Halfon, N., Larson, K., Son, J., et al. (2017). Income inequality and the differential effect of adverse childhood experiences in us children. Academic Pediatric, 17(7S), S70–S78.

    Article  Google Scholar 

  • Hambrick, E. P., Brawner, T. W., Perry, B. D., et al. (2019). Beyond the ACE score: Examining relationships between timing of developmental adversity, relational health and developmental outcomes in children. Archives of Psychiatric Nursing, 33(3), 238–247.

    Article  Google Scholar 

  • Harvey, K., Hevesi, R., & Downey, M. (2018). The impact of food insecurity on parents’ feeding strategies and goals. Appetite, 130, 306.

    Article  Google Scholar 

  • Haskett, M. E., Armstrong, J. M., & Tisdale, J. (2016). Developmental status and social–emotional functioning of young children experiencing homelessness. Early Childhood Education Journal, 44(2), 119–125.

    Article  Google Scholar 

  • Hauptman, M., Bruccoleri, R., & Woolf, A. D. (2017). An update on childhood lead poisoning. Clinical Pediatric Emergency Medicine, 18(3), 181–192.

    Article  Google Scholar 

  • Hayes, M., Zonneville, M., & Bassuk, E. L. (2013). The SHIFT Study: Final Report. American Institutes for Research & The National Center on Family Homelessness.

    Google Scholar 

  • Healthy People. (2020). Social Determinants of Health. U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health. Accessed 28 Sep 2022

  • Herbers, J. E., Cutuli, J. J., Keane, J. N., & Leonard, J. A. (2019). Childhood homelessness, resilience, and adolescent mental health: A prospective, person‐centered approach. Psychology in the Schools.

  • Hoffman, J., & Russ, S. (2013). Pretend play, creativity, and emotional regulation in children. Psychology of Aesthetics, Creativity, and the Arts, 6(2), 175–184.

    Article  Google Scholar 

  • Jelleyman, T., & Spencer, N. (2008). Residential mobility in childhood and health outcomes: A systematic review. Journal of Epidemiology and Community Health, 62(7), 584–592.

    Article  Google Scholar 

  • Jones, D. E., Greenberg, M., & Crowley, M. (2015). Early social-emotional functioning and public health: The relationship between kindergarten social competence and future wellness. American Journal of Public Health, 105(11), 2283–2290.

    Article  Google Scholar 

  • Jyoti, D. F., Frongillo, E. A., & Jones, S. J. (2005). Food insecurity affects school children’s academic performance, weight gain, and social skills. Journal of Nutrition, 135(12), 2831–2839.

    Article  Google Scholar 

  • Kaboom. (n.d.). REPORT: Play matters: Giving children the chance they deserve. Kaboom. https://media.kaboom.org/app/assets/resources/000/003/066/original/kaboom-publication-play-matters.pdf. Accessed 28 Sep 2022

  • Kleinman, R. E., Murphy, J. M., Little, M., et al. (1998). Hunger in children in the United States: Potential behavioral and emotional correlates. Pediatrics, 101(1), E3.

    Article  Google Scholar 

  • Kull, M. A., & Coley, R. L. (2014). Housing costs and child functioning: Processes through investments and financial strains. Children and Youth Services Review, 39, 25–38.

    Article  Google Scholar 

  • Kursmark, M., & Weitzman, M. (2009). Recent findings concerning childhood food insecurity. Current Opinion in Clinical Nutrition and Metabolic Care, 12(3), 310–6.

    Article  Google Scholar 

  • Larson, K., Russ, S. A., Nelson, B. B., et al. (2015). Cognitive ability at kindergarten entry and socioeconomic status. Pediatrics, 135(2), e440–e448.

    Article  Google Scholar 

  • Lee, P., & Paxman, D. (1997). Reinventing public health. Annual Review of Public Health, 18, 1–35.

    Article  Google Scholar 

  • Leriou, E., Kazani, A., Kollias, A., & Paraskevopoulou, C. (2020). Understanding and measuring child well-being in the Region of Attica, Greece: Round one. Child Indicators Research, 14, 1–51. https://doi.org/10.1007/s12187-020-09770-4

    Article  Google Scholar 

  • Lê-Scherban, F., Wang, X., Boyle-Steed, K. H., et al. (2018). Intergenerational associations of parent adverse childhood experiences and child health outcomes. Pediatrics., 141(6), e20174274.

    Article  Google Scholar 

  • Leventhal, Y., & Newman, S. (2010). Housing and child development. Children and Youth Services Review, 32(9), 1165–74.

    Article  Google Scholar 

  • Lou, D., & Taylor, W. (2011). Do all children have places to be active? Disparities in access to physical activity environments in racial and ethnic minority and lower-income communities. Active Living Research.

  • Luthar, S. S. (2003). Resilience and vulnerability: Adaptation in the context of childhood adversities. Cambridge University Press.

    Book  Google Scholar 

  • Maggi, S., Irwin, L. J., Siddiqi, A., et al. (2010). The social determinants of early child development: An overview. Journal of Pediatric Child Health., 46(11), 627–635.

    Article  Google Scholar 

  • Massachusetts Office of Health and Human Services. (2017). Early intervention partnerships program comprehensive health assessment guide. Commonwealth of Massachusetts Department of Public Health. http://www.mass.gov/eohhs/docs/dph/com-health/prego-newborn/cha-guide.pdf. Accessed 28 Sep 2022

  • Masten, A. S. (2011). Resilience in children threatened by extreme adversity: Frameworks for research, practice, and translational synergy. Development and Psychopathology, 23(2), 493–506.

    Article  Google Scholar 

  • Masten, A. S., & Coatsworth, D. (1995). Competence, resilience, and psychopathology. In D. Cicchetti & D. J. Cohen (Eds.), Developmental psychopathology vol. 2: risk, disorder, and adaptation. John Wiley.

    Google Scholar 

  • Masten, A. S., Miliotis, D., Graham-Bermann, S. A., et al. (1993). Children in homeless families: Risks to mental health and development. Journal of Consulting and Clinical Psychology, 61(2), 33–343.

    Article  Google Scholar 

  • McIntyre, L., Glanville, N. T., Raine, K. D., Dayle, J. B., Anderson, B., & Battaglia, N. (2003). Do low-income lone mothers compromise their nutrition to feed their children? CMAJ, 168(6), 686–691.

    Google Scholar 

  • McMenamin, S. B., Hiller, S. P., Shigekawa, E., et al. (2018). Universal lead screening requirement: A California case study. American Journal of Public Health, 108(3), 355–357.

    Article  Google Scholar 

  • Metzler, M., Merrick, M. T., Klevens, J., et al. (2017). Adverse childhood experiences and life opportunities: Shifting the narrative. Children and Youth Services Review, 72, 141–149.

    Article  Google Scholar 

  • Milburn, N. G., Iribarren, F. J., Rice, E., et al. (2012). A family intervention to reduce sexual risk behavior, substance use, and delinquency among newly homeless youth. Journal of Adolescent Health, 50(4), 358–364.

    Article  Google Scholar 

  • Moffitt, T. E., Arseneault, L., Belsky, D., et al. (2011). A gradient of childhood self-control predicts health, wealth, and public safety. Proceedings of the National Academy of Sciences of the United States of America, 108(7), 2693–8.

    Article  Google Scholar 

  • Monnat, S. M., & Chandler, R. F. (2015). Long term physical health consequences of adverse childhood experiences. The Sociological Quarterly, 56(4), 723–752.

    Article  Google Scholar 

  • Moore, T. G., McDonald, M., Carlon, L., et al. (2015). Early childhood development and the social determinants of health inequities. Health Promotion International., 30 Suppl 2, ii102-15.

    Article  Google Scholar 

  • National Academy for State Health Policy. (2020). About ABCD. https://nashp.org/identifying-children-and-families-at-risk. Accessed 28 Sep 2022

  • National Health Information Survey. (2018). Centers for Disease Control & Prevention. https://www.cdc.gov/nchs/nhis/nhis_questionnaires.htm. Accessed 28 Sep 2022

  • New York State Department of Public Health. (2009). Lead exposure risk questionnaire for children. New York Dept. of Health, 2009. https://www.bcbswny.com/content/dam/BCBSWNY/Provider/public/forms/patient-care/patient-care-forms-logic-gate/lead-risk-assessment.pdf. Accessed 28 Sep 2022

  • Non, A. L., Rewak, M., Kawachi, I., et al. (2014). Childhood social disadvantage, cardiometabolic risk, and chronic disease in adulthood. American Journal of Epidemiology, 180(3), 263–71.

    Article  Google Scholar 

  • Norman, D., Kennedy, B., & Kawachi, I. (1999). Why justice is good for our health: The social determinants of health inequalities. Daedalus, 128, 215–251.

    Google Scholar 

  • O’Connell, M. W., Boat T, Warner, K. E, eds. (2009). Preventing mental, emotional, and behavioral disorders among young people: progress and possibilities. National Research Council and Institute of Medicine Committee on the Prevention of Mental Disorders and Substance Abuse Among Children, Youth, and Young Adults: Research Advances and Promising Interventions. National Academies Press.

  • Oregon Health Authority. (2018). Lead screening protocols for children. Oregon Health Authority, Public Health Division. https://www.oregon.gov/oha/ph/healthyenvironments/healthyneighborhoods/leadpoisoning/medicalproviderslaboratories/documents/lead-screening-protocol-2016.pdf. Accessed 28 Sep 2022

  • Orgcode Consulting, Inc. (2015). Service Prioritization Decision Assistance Tool. http://www.orgcode.com/products. Accessed 28 Sep 2022

  • Ossiander, E. M. (2013). A systematic review of screening questionnaires for childhood lead poisoning. Journal of Public Health Management and Practice, 19(1), E21–E29.

    Article  Google Scholar 

  • Priest, N., Paradies, Y., Trenerry, B., et al. (2013). A systematic review of studies examining the relationship between reported racism and health and wellbeing for children and young people. Social Science and Medicine, 95, 115–127.

    Article  Google Scholar 

  • Racine, E. F., Jemison, K., Huber, L. R., et al. (2009). The well-being of children in food-insecure households: Results from The Eastern Caribbean Child Vulnerability Study 2005. Public Health Nutrition, 12(9), 1443–1450.

    Article  Google Scholar 

  • Redlener, I., Gracy, D., & Walto, D. (2016). Unfinished business: More than 20 million children in U.S. still lack sufficient access to essential health care. Children’s Health Fund. https://www.childrenshealthfund.org/wp-content/uploads/2016/11/Unfinished-Business-Final_.pdf. Accessed 28 Sep 2022

  • Reyes, J. W. (2007). Environmental policy as social policy? The impact of childhood lead exposure on crime. The BE Journal of Economic Analysis & Policy, 7(1).

  • Rose, D., & Bodor, J. N. (2006). Household food insecurity and overweight status in young school children: Results from the Early Childhood Longitudinal Study. Pediatrics, 117(2), 464–473.

    Article  Google Scholar 

  • Sacks, V., Murphey, D., Moore, K. (2014). Adverse childhood experiences: National and state-level prevalence. (Publication #2014–28). Child Trends. https://childtrends-ciw49tixgw5lbab.stackpathdns.com/wp-content/uploads/2014/07/Brief-adverse-childhood-experiences_FINAL.pdf. Accessed 28 Sep 2022

  • Saegert, S., & Evans, G. W. (2003). Poverty, housing niches, and health in the United States. Journal of Social Issues, 59(3), 569–589.

    Article  Google Scholar 

  • Shonkoff, J. P., & Phillips, D. A., eds. (2000). From neurons to neighborhoods: the science of early childhood development. National Research Council and Institute of Medicine Committee on Integrating the Science of Early Childhood Development. National Academies Press.

  • Shonkoff, J. P., & Garner, A. S. (2012). The lifelong effects of early childhood adversity and toxic stress. Pediatrics, 129(1), e232–e246.

    Article  Google Scholar 

  • State of Illinois Department of Public Health. (2015). Childhood lead risk questionnaire: guidelines for Illinois physicians and health care providers. Illinois Department of Public Health, Illinois Lead Program. http://www.dph.illinois.gov/sites/default/files/publications/preventing-and-testingfor-childhood-lead-poisoning-areference-guidefor-physicians-and-healthcare.pdf. Accessed 28 Sep 2022

  • Tanner, J. L., Stein, M. T., Olson, L. M., et al. (2009). Reflections on well-child care practice: A national study of pediatric clinicians. Pediatrics, 124(3), 849–857.

    Article  Google Scholar 

  • Taylor, L. A., Coyle, C. E., Ndumele, C., Rogan, E., Canavan, M., Currey, L., & Bradley, E. H. (2015). Leveraging the Social Determinants of Health: What Works? Blue Cross Blue Shield of Massachusetts Foundation and Yale Global Health Leadership Institute.

    Google Scholar 

  • Thompson,. (2016). What more has been learned? The science of early childhood development 15 years after neurons to neighborhoods. Zero to Three, 36(3), 18–24.

    Google Scholar 

  • U.S. Centers for Disease Control and Prevention. (2012). Low level lead exposure harms children: a renewed call for primary prevention. Report of Advisory Committee on Childhood Lead Poisoning Prevention. U.S. Centers for Disease Control. https://www.cdc.gov/nceh/lead/acclpp/final_document_030712.pdf. Accessed 28 Sep 2022

  • U.S. Department of Housing and Urban Development. (2015). Family Options Study—Short-Term Impacts of Housing and Services Interventions for Homeless Families. http://www.huduser.gov/portal/portal/sites/default/files/pdf/FamilyOptionsStudy_final.pdf. Accessed 28 Sep 2022

  • Ugwi, P., Lyu, W., & Wehby, G. L. (2019). The effects of the patient protection and affordable care act on children’s health coverage. Medical Care, 57(2), 115–122.

    Article  Google Scholar 

  • Wade, R., Jr., Cronholm, P. F., Fein, J. A., et al. (2016). Household and community-level adverse childhood experiences and adult health outcomes in a diverse urban population. Child Abuse and Neglect, 52, 135–145.

    Article  Google Scholar 

  • Weinreb, L., Wehler, C., Perloff, J., et al. (2002). Hunger: Its impact on children’s health and mental health. Pediatrics, 110(4), e41.

    Article  Google Scholar 

  • Weiss, M. J., & Wagner, S. H. (1998). What explains the negative consequences of adverse childhood experiences on adult health? Insights from cognitive and neuroscience research. American Journal of Preventive Medicine, 14(4), 356–360.

    Google Scholar 

  • Wilkey, C., Donegan, L. R., Yampolskaya, S., & Cannon, R. (2019). Coordinated entry systems: Racial equity analysis of assessment data. C4 Innovations.

    Google Scholar 

  • World Health Organization Commission on Social Determinants of Health. (2008). Closing the gap in a generation: health equity through action on the social determinants of health. WHO Press. https://www.who.int/social_determinants/thecommission/finalreport/en/. Accessed 28 Sep 2022

  • Zeanah, C. H. (2019). Handbook of Infant Mental Health (4th ed.). The Guilford Press.

    Google Scholar 

  • Ziegler, T. (2012). Keeping homeless children safe from lead poisoning. National Health Care for the Homeless Council. https://nhchc.org/webinars/keeping-homeless-children-safe-from-lead-poisoning. Accessed 28 Sep 2022

Download references

Acknowledgements

We wish to acknowledge all programs and families who participated in this study and provided feedback on the appropriateness, usefulness, and feasibility of the NEST. They provided valuable insight on item development and user experience that informed the development of the tool.

Funding

This study was funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) (Grant #1 R44 HD088291-01). The NICHD approved the study design during the grant review process but was not involved in the decision to submit this paper for publication.

Author information

Authors and Affiliations

  1. C4 Innovations, 117 Kendrick Street, Suite 300, Needham, MA, 02494, USA

    Katherine T. Volk

  2. Artemis Associates, 15 Main Street, Suite 224, Watertown, MA, 02472, USA

    Carmela J. DeCandia

  3. Department of Social Work, University of Maryland, Baltimore, MD, 21201, USA

    George J. Unick

Authors
  1. Katherine T. Volk
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Carmela J. DeCandia
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. George J. Unick
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Katherine T. Volk.

Ethics declarations

Ethical Approval

This research was approved by the Heartland Institutional Review Board.

Informed Consent

All participants included in the research consented to being involved.

Conflicts of Interest

The authors have no conflicts of interest to declare.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Public Policy and Relevance Statement

Conducting developmental screening for preschool age children experiencing homelessness and housing instability must include more than just questions about traditional developmental milestones. It must also take into consideration the wellbeing of the child’s caregiver(s) and the environment in which the child is living. For children already facing socioeconomic disadvantage, routine, ecologically-oriented, developmental screening can help identify and thwart developmental challenges during early childhood, possibly preventing myriad health problems from emerging later in life. This information is vital to helping the child thrive and is also essential to forming sound public policy in which to support their wellbeing.

Rights and permissions

Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Volk, K.T., DeCandia, C.J. & Unick, G.J. The Full Picture: Incorporating Ecological Factors When Conducting Developmental Screening with Young Children Experiencing Homelessness. Child Ind Res 16, 87–108 (2023). https://doi.org/10.1007/s12187-022-09978-6

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12187-022-09978-6

Keywords

Search

Navigation