This blog covers advances in child health research and in mapping techniques. We apply these stories to central Texas.

School-based mental health clinic locations based on DCMC/COH study


Check out the following article in the Austin American Statesman:

The Austin school district has received $4.5 million to open mental health centers in 22 elementary schools in the eastern part of the city during next semester.

The one-year pilot program could be extended, depending on the program’s efficacy and need, among other factors.

Mental health centers currently operate in 18 middle and high schools in an effort to help students who have experienced trauma.

The latest grant comes from federal money administered by Gov. Greg Abbott’s office and will pay for two staff members at each of 22 elementary schools to provide therapy services. The grant also will pay for identifying victims, teacher development and other social services for students.

“This grant will help ensure that these young students’ lives are not defined by the crimes they have experienced but with the right help move on to be happy and productive,” Abbott said in a news release.

The district chose the 22 schools — all of which feed into Akins, LBJ and Lanier high schools — because they’re located in a part of the city that a 2012 study by Dell Children’s Medical Center of Central Texas and Children’s Optimal Health identified as having a high incidence of child abuse and neglect. The area includes high-crime neighborhoods and a lack of transportation and social services for children.

Without mental health services, children with trauma often fail to develop social and emotional behaviors on par with their peers, and are less likely to properly cope with stress, manifesting in behaviors like aggression and avoidance, according to school district officials.

“By providing mental health services on campus, we are able to identify, support, and efficiently provide clinical treatment for our students experiencing a variety of mental health issues,” Tracy Spinner, assistant director of comprehensive health services for the district, said in a news release.

Austin was the only school district chosen for the pilot program.

The Austin school board on Monday approved contracting with Vida Clinic to provide the mental health services in the pilot. The clinic has operated at Anderson, Bowie and Crockett high schools.


TACC Teams Up with Children’s Optimal Health to Improve Child Welfare

The Texas Advanced Computing Center (TACC) at The University of Texas at Austin has teamed up with Austin, Texas-based non-profit Children’s Optimal Health (COH) to provide the technical infrastructure needed to help solve issues in children’s health and education throughout Central Texas, including disease, mental health and adverse childhood experiences.

“COH is an amazing organization focused on the admirable goal of enabling communities to better protect and promote the health of children through data,” said Dan Stanzione, executive director of TACC. “We increasingly see where advanced computing technologies can play a huge role in helping address problems of immediate societal need.”

“In this case, COH is combining disparate sources of data with geospatial mapping technologies – and facing technical challenges around scale, capacity, and sustainable infrastructure – exactly where we can help. We are very proud that we can use our expertise and systems to support the mission of COH, and help them in their important work,” Stanzione said.

Geographic Information Systems, or GIS, is a method used to capture, analyze and present spatial or geographic data in a map format. COH uses this method, along with related spatial analysis methods, to understand changes in a community’s landscape, including the delivery and use of health care and educational services.

“COH partners across government, health care, education, and business to provide a neutral look at the realities in Central Texas and identify potential solutions,” said Maureen Britton, COH president and executive director. “As visual images, maps overcome language barriers and offer a powerful communication tool. By working with local data providers, the methods used by Children’s Optimal Health have taken this tool to a new and exciting level of granularity that brings value to our community. The more we bring this data to life through the maps, the more we get data driven information to the right people.”

TACC is providing COH with HIPAA and FERPA secure general cloud computing and storage, and a virtual machine environment. “It’s everything they need to perform their preferred visual and statistical analyses,” said Chris Jordan, manager of data management and collections at TACC. “And it’s set up in a way that’s secure and can be accessed from anywhere.”

Collaborating with TACC has tremendous potential for Children’s Optimal Health, according to Susan Millea, community systems and population health analyst. “Not only does TACC provide an analysis platform and a place to have our data securely stored, but TACC has many other advantages, including staff expertise, and new forms of visualization. In addition, TACC is affiliated with the Dell Medical School—that’s the most exciting part.”

COH formed in 2008 after several organizations began observing that rapid growth in Central Texas was outpacing the capacity to provide needed services where people were residing. Texas leads the nation in the growth of the child population, and central Texas is leading the state. New neighborhoods are forming and growth is occurring in areas that have been traditionally rural. The infrastructure to provide services such as education, access to health care, social services, and public transportation is not well developed in these areas of rapid growth.

Over the last four to five years, the medical industry has realized that the single biggest factor in predicting a person’s health is their zip code—it’s even more important than their genetic code. “This epiphany that place matters speaks to the importance of population health,” Millea said.

“To be effective, services need to be culturally sensitive, requiring us to better understand our community at the neighborhood level,” she said. “This applies everywhere, but rapid growth within Latino and Spanish language-dominant neighborhoods emphasized the need for culturally competent services in those communities. Neighborhood level maps help us understand assets and needs within the local cultural context, and provide insight to guide decisions to effectively and efficiently target resources.”

COH gathers data from organizations such as school districts, hospitals, insurance companies, police departments, businesses, public transit and housing authorities. The organization combines disparate data about individuals and the community and analyzes it in a broad way. They use GIS analysis to visualize the data so that it is understandable for communities to help solve issues, support policy decisions and monitor change over time.

Recently, COH completed a project with Dell Children’s Medical Center addressing patterns of child maltreatment before and after the recession. For this project, the non-profit used GIS tools to understand population migration to areas beyond of the city of Austin, the related reduced access to services in those outlying areas, and changes in patterns of substantiated child maltreatment. “Understanding these geographic patterns and ensuring access to essential services close to where people live can reduce family isolation and stressors, and help prevent child abuse and neglect,” Millea said.

COH also partners with the E3 Alliance, a regional, data-driven education collaborative focused on building the strongest educational pipeline in the country, and area school districts to complete studies on issues such as early child development, obesity, physical fitness, child vehicular safety, and school readiness.

See full article here:


The Suburbanization of Poverty: The Geography of Childhood Poverty in and around Austin
By Sam Tedford
In recent years, Austin has settled in near the top of the list of fastest growing cities in the United States. And though we know that the city is rapidly growing, there is still much to understand about the changing demographics of Austin. Historically, racist urban planning led Austin to develop into an intensely segregated city both economically and racially with large concentrations of urban poor communities and communities of color forced into certain neighborhoods on the east side. However, in the changing social and economic environment of Austin today, the geography of poverty and race is unlike anything this city has seen before. A quickly growing city means a growing demand for housing, which has led to a major affordability crisis in the Austin housing market, and the displacement of many low income residents due to gentrification. For my study I focused on one of the most vulnerable populations directly affected by poverty and displacement: children. The study analyzes the geographic distribution of economically disadvantaged children in Austin and the surrounding areas across ten years from 2005 to 2015.

Mapping Disadvantaged Populations

Using data from Texas Education Agency performance reports from the 2004-2005 school year and the 2014-2015 school year, I initially mapped both district level and campus level economically disadvantaged rates, defined as the percentage of the student population on free and reduced lunch, while denoting Title I qualifying schools in each time period.
In the 2004-2005 school year, 12 out of 27 of the school districts surrounding Austin had over 40% of their student population on free or reduced lunch. By the 2014-2015 school year, 20 out of the 27 districts had a population comprised of over 40% economically disadvantaged kids.

School Districts

Economic disadvantage rate by ISD 2005

Economic disadvantage rate by ISD 2015

In the 2004-2005 school year, 117 out of 200 campuses in the study area qualified as Title I. In the 2014-2015 school year, 164 out of 266 campuses qualified as Title I.

School Campuses

Economic disadvantage rate by campus 2005

Economic disadvantage rate by campus 2015


Mapping Change over Time


Economic disadvantage rate change over time by ISD


Mapping Hotspots


In an attempt to find patterns in the rise of economically disadvantaged student populations, I first looked for spatial auto-correlation, or clustering, of economically disadvantaged populations in the district-level data. By calculating Moran’s I, a spatial statistic which compares each target feature to its neighbors as well as to the mean of all features, the district-level data showed statistically significant clustering with a 95% confidence interval. This initial calculation compelled me to continue exploring patterns in geographic proximity of economically disadvantaged districts and calculate the Getis-Ord Gi* statistic for the district-level data, another spatial statistic which identifies hot and cold spots, for economically disadvantaged student populations.

The results of the hot spot analysis reveals hotspots in Elgin, Bastrop, Manor, and Del Valle, meaning those school districts had a statistically significant concentration of economically disadvantaged populations. This method of analysis also reveals coldspots, here meaning statistically significant concentrations of low economically disadvantaged percentages, in five school districts: Dripping Springs, Lake Travis, Lago Vista, Eanes, and Leander.

Economic disadvantage hot- and cold-spots by district 2015


Mapping Directional Distribution


Standard deviation ellipses showing distribution of economically disadvantaged students
Next, I tested for similar patterns in the campus-level data. I first calculated standard deviational ellipses (SDE) for the 2004-2005 data and for the 2014-2015 data. SDEs were calculated in order to measure directional trends in the distribution of elementary school campuses with high economically disadvantaged student populations by weighting campuses by the raw count of economically disadvantaged students. The results show an increase of 77.53 square miles in area from 2005-2015 with directional shifts to the Northeast and the South.
Again, this prompted me to continue to explore patterns in the geographic distribution of economically disadvantaged students over time, and so I again calculated statistically significant hot and cold spots using the GetisOrd
Gi* statistic. The results reveal strong hotspots in the southeastern parts of Austin with developing hotspots in the far south, San Marcos ISD. This map shows a distinct coldspot to the west of Austin and a neutral line of campuses that are likely statistically insignificant due to their extreme neighbors on either side.

Campus ED GI 2015 web


Mapping Distance from Austin City Center

Finally, in an attempt to visualize the relationship between schools with high economically disadvantaged populations and the city center, I created a simple graph with the campus’s distance from the city center on the X axis and the campus’s economically disadvantaged rate on the Y axis. This graph displays the line for both 2004-2005 and 2014-2015 and reveals that the highest average percentage of economically disadvantaged students increased from 5 to 10 miles in 2004-2005 to over 30 miles away in 2014-2015.

Rates of student economic disadvantage by distance from center of Austin



What this data shows is that:

  1. The percentage of children living in poverty rose in the majority of the school districts in the Austin area from 2005 to 2015.
  2. The largest percentage point increases in economically disadvantaged populations from 2005 to 2015 happened in districts increasingly distant from center of Austin.
  3. The major directional shifts in childhood poverty since 2005 have been to the Northeast and to the South with a distinctive majority of childhood poverty situated in the eastern half of Austin and surrounding districts, namely Austin, Del Valle, Manor, and Bastrop.
  4. Childhood poverty in the Austin area is not randomly distributed and is distinctly clustered.

These changes in the geography of childhood poverty are important because they have an impact on how (and where) we aim to fight poverty. The methods and systems we have developed over the years to combat the effects of dense, urban poverty may not translate well to the sprawling suburbs. Austin is not alone among cities experiencing the suburbanization of poverty and shares many challenges with other cities nationwide. And though the trend is recent enough that we know little about its long-term effects, there are a some key areas that we know will be directly affected by the shifting geography of poverty. The suburbanization of poverty will have a direct impact on where we locate and how we implement health and human services, how we plan transportation systems, and who has access to job opportunities. The rise in suburban childhood poverty will have an effect on schools that have not historically supported large populations of economically disadvantaged students. And even as we seek to understand and meet the growing needs of these communities in real time, we must also be thinking upstream and questioning, what caused this?
Sam was an intern for Children’s Optimal Health and recently graduated from The University of Texas at Austin from the Department of Geography and the Environment. She is currently working as a Planner for the City of Austin Comprehensive Planning Division of the Planning and Zoning Department and keeps a weather eye on the shifting demographics of Austin and the modern and historic social injustices driving them.

COH welcomes Dr. Anjum Khurshid
The health care delivery and health planning landscape in the Austin MSA is changing rapidly. COH desires for itself and for the benefit of its community partners to add value to the strategic initiatives being established at the Dell Medical School (DMS) and by other governmental, nonprofit, and health-focused entities in Central Texas. COH enjoys a strong reputation as a trusted data steward, provider of high-quality geospatial analysis, and convener of action-oriented health summits.

In order to build on that reputation and enhance value to Central Texas, Children’s Optimal Health (COH) is very pleased to have contracted for the consulting services of Dr. Anjum Khurshid, MD, PhD, MPAff.

Dr. Khurshid will provide insight into better positioning COH to interface with the multiplicity of groups at DMS and elsewhere that are pursuing health-related innovations in Austin. Dr. Khurshid has the background and experience to help COH develop relationships with new and existing partners that more effectively match its capacity to emerging needs. Dr. Khurshid can also help COH access funding and technical assistance from national programs (both governmental and philanthropic) that support community-oriented, data-sharing activities.

Anjum Khurshid
How do Austin’s children fare under the 10-1 plan?
Children’s Optimal Health (COH) has prepared this series of maps in which the Austin City Council districts under the 10-1 system are overlaid on maps previously produced by COH. This was done to spark discussion on how the changes to Council could impact, and be impacted by, child health needs. The districts are delineated by color except in the map of “Medicaid-eligible children by ZIP Code” in which the districts are bordered in red. Please contact us regarding any questions you may have about these maps.

Transportation-Related Child Injury




Child Oral Health



Child Obesity