1. Thinking Beyond the Poverty Levels
It’s More than Income Eligibility & Benefits
Jessica Hoey, Outreach Director
Mary Bifulco, Poverty Simulation Manager
Brian Valentine, Program Director

2. Case Study Review case study in your small group
Group determined by the color of your paper
Discuss the questions presented on your paper with your group
Select one representative to share out in 10 minutes
Bring group back together, and allow one representative from each group to share out – ask the other groups w/ the same case study if they had anything to add.
Raise your hand if….
Have you interacted with children in the school that are combatting similar issues or backgrounds?
Raise your hand if…
You feel that you sufficiently recognize your own personal biases in most scenarios?
You have felt that you were able to provide adequate resources when working with low income students?
Today we are going to discuss many aspects of poverty. From definitions and statistics, to applicable resources that are available.

3. Training Objectives Define and describe poverty
Review statistics related to poverty
Correlate poverty with both health and educational outcomes
Explore resources available to low-income families

4. Supplemental Poverty Measure (SPM)
Poverty Defined
Official Poverty Rate
Supplemental Poverty Measure (SPM)
Developed in the early 1960s when President Lyndon Johnson declared war on poverty
Developed in 2010 by the Census Bureau
Uses three times the cost of a minimum diet to establish poverty rate
Estimates to cost of food, clothing, shelter, and utilities and then adds 20% for other expenses
Same in all regions
Adjusted for cost of living in different regions
Does not account for assistance provided by government programs
Does take into consideration the influence of government support
Audience engagement: Is it this easy to define poverty? Is the definition absolute or relative?
Sources and resources :

5. Poverty Realities
Could your survive at a minimum wage job?

6. The Parents

7. The Children

8. Hours a Week

9. Minimum Wage

10. Federal Poverty Line

12. Can you make it work? Could a family of four survive on minimum wage?
How much money do they bring home?
What are common expenses they have to consider?
Think-Pair-Share
Participants consider these questions, pair up with a person near them, and share their ideas/thoughts. This will then lead into a breakdown of a typical Missouri family.

13. Housing

24. Would any group like to give a reaction to this data?
Does anyone have a comment?

26. Poverty in Missouri
Our family who couldn’t meet all their basic needs, didn’t fall within this statistic.

27. Poverty in Missouri
What is contributing to poverty?

28. Five Key Elements of Poverty
Poverty: 5 Key Elements
Food
Health
Education
Energy & Housing
Family & Economic Security
These five elements contribute to poverty.

29. Food
Missouri has the seventh highest food insecurity rate in the country, with 16.8% of its population classified as food insecure. In addition, 7.9% of Missourians have very low food security, meaning there are “multiple indications of disrepute eating patterns and reduced food intake”.
Additional Notes/Knowledge:
The concept of food security, as the United States Department of Agriculture defines it, refers to "access by all people at all times to enough food for an active, healthy life." The USDA outlines food security as a continuum divided into four ranges:
High food security: Households had no problems consistently accessing adequate food. Marginal food security: Households had problems at times accessing adequate food, but the quality, variety and quantity of their food intake were not substantially reduced.  Low food security: Households reduced the quality, variety, desirability of their diets, but the quantity of food intake and normal eating patterns were not substantially disrupted.  Very low food security: At times during the year, eating patterns of one or more household members were disrupted and food intake reduced because the household lacked money and other resources for food. 

30. Energy & Housing
Recently, the National Low Income Housing Coalition released a report called "Healthy Homes," which found that substandard housing contributes significantly to the health issues faced by many low income children. Studies show that children who have secure, affordable housing are far more likely to stay in school and succeed socially, and their parents are far more likely to keep a job and maintain a family income.

31. Family & Economic Security
8.90% Missouri households with no bank account
$25,844 Average college graduate debt
59% of graduates have college debt
4.2% Average statewide unemployment rate
28.3% of jobs in Missouri pay below the federal poverty guideline for a family of four

32. Health
Low-income families are often uninsured or under insured leading to poor healthcare
Leads to a lack of treatment for both physical and mental illness
Food insecurity leads to increased health issues: diabetes, hypertension, weight gain
The Cycle Effect: Poverty is a factor contributing to teen pregnancy, and teen pregnancy contributes to poverty
Individuals living in counties with lower poverty rates can expect to live up to 7.5 years longer than those with higher poverty rates

33. Education
As evident, increased

34. Education

35. Poverty & Trauma Adverse Childhood Experiences (ACE) Toxic Stress
Traumatic events occurring in life before the age of 18
Toxic Stress
Profound, frequent, long-lasting, and uncontrollable adversity in the absence of stable, responsive adult support
Examples of ACEs: abuse, neglect, household dysfunction, exposure to violence
Explain map and talk about why poverty-stricken areas are at higer-risk (ie- unable to move out of dangerous neighborhoods, lack of affordable childcare, etc)
Toxic Stress- stressors such as the death of a loved one, divorce, or natural disaster shift from a tolerable stress to a toxic stress when a caretaker is not there to act as a buffer, creates a compounding effect. Poverty and economic hardship are stressors in and of themselves that can shift from tolerable to toxic stress.
Transition: Trauma and stress not only affect the social and emotional development of children and adolescents; they also have tremendous impact on the health and educational outcomes of the young people in schools you all serve everyday.

36. Childhood Poverty’s Risk Factors
Most significant risk factors affecting EACH child in poverty: E
EMOTIONAL & SOCIAL CHALLENGES
Early childhood development deficiencies
Emotional dysregulation A
ACUTE & CHRONIC STRESSORS
About 60% of children in poverty experience 3 or more major stressors vs. 15% of their non-poor peers C
COGNITIVE LAGS
Disrupted development of brain circuits; reduced brain cortex from trauma
Lack of formative cognitive stimulation in early years
Source for EACH: Teaching With Poverty In Mind, Chapter 2 “How Poverty Affects Behavior and Performance”
E: Children under the age of 3 need:
1-Ten to 20 hours each week of harmonious, reciprocal interactions. This process, known as attunement, is most crucial during the first 6–24 months of infants' lives and helps them develop a wider range of healthy emotions, including gratitude, forgiveness, and empathy.
2- Enrichment through personalized, increasingly complex activities.
Low-income parents often do not have the time, money, or resources to adequately meet these needs, which effects children even on a physiological and cognitive level for years to come.
Because of this children experiencing poverty, stress, and/or trauma may be more likely than their affluent counterparts to display:
-Acting-out” behaviors.
-Impatience and impulsivity.
-Gaps in politeness and social graces.
-A more limited range of behavioral responses.
-Inappropriate emotional responses.
A: Chronic stress..
-Is linked to over 50 percent of all absences (Johnston-Brooks, Lewis, Evans, & Whalen, 1998).
-Impairs attention and concentration (Erickson, Drevets, & Schulkin, 2003).
-Reduces cognition, creativity, and memory (Lupien, King, Meaney, & McEwen, 2001).
-Diminishes social skills and social judgment (Wommack & Delville, 2004).
-Reduces motivation, determination, and effort (Johnson, 1981).
-Increases the likelihood of depression (Hammack, Robinson, Crawford, & Li, 2004).
-Reduces neurogenesis (growth of new brain cells) (De Bellis et al., 2001) – which leads us to C!
C: The two points above- lack of proper early childhood development + repeated, lasting trauma- indelibly shape a young brain.
-Trauma can fundamentally alter brain chemistry, sending children’s nervous systems into states of constant hypo/hyper-arousal and hindering brain development in areas as crucial as the cortex which is responsible for memory, attention, language, consciousness, and more
-For example, one study found that by the age of 3 the children of professional parents were adding words to their vocabularies at about twice the rate of children in welfare families. As they continue to grow, low-income children have less access to books, computers, after-school enrichment activities that would give them opportunity to combat early deficiencies in education.
H: We will talk more about how and why poverty influences health outcomes for students in a minute, but for now take our word– children in poverty face greater risk of health complications which affects school performance in the following ways:
higher and longer school absences,
higher tardiness rates,
more undiagnosed problems or disabilities,
increases incidents of illness in class H
HEALTH & SAFETY ISSUES
Impacts on education
Hold that thought!

37. Poverty & Education Individual-Level
Average scores for math and reading proficiency were 21 to 27 points lower than students who were not eligible
Community-Level
St. Louis City high schools graduation was 71.81% in 2014 vs. Missouri’s overall graduation rate of 90.15%
Talk about free and reduced lunch qualifications as key indicators of which children are living in poverty, which is why they are present in every data map
How might the issues associated with EACH impact school proficiency because of individual student academics and behavior? How might school districts and the communities they are in impact the proficiency of the schools?
Transition: Communities play a vital role not just in the schooling and acculturation of our youth, but also in their health!

38. Social Determinants of Health (SDH)
Example:
ASTHMA
Rates in Children in 2015
Poor: 11%
Near Poor: 9%
2x Federal Poverty Level: 7%
Exposure to Triggers
Children in poverty have increased exposure to allergens, irritants, and pollution that aggravate asthma
Access to Treatment
Low-income families exhibit lower adherence to medications, unreliable transportation, and lack of access to resources for self-management
Definition
Conditions in which people live work, play, and age
Poverty is single most significant factor affecting quality access
Includes forces and systems that shape conditions
Political & Economic Systems
Social Norms & Policies
Development & Economic Agendas
Definition of SDH from World Health Organization
SDH of health evoke ideas of access to healthy foods, nature and recreational areas, and convenient transportation, but we must remember that underlying access (or lack thereof) to all of these is the most salient SDH of all: poverty
Asthma statistics from CDC National Health Survey in 2015 and Lung Association of Illinois
Chose asthma to highlight because it is the leading chronic condition in children under the age of 18 and also a leading cause of absenteeism with elementary school students. These numbers illustrate how social determinants of health account for many of the worse health outcomes kids in poverty face, as well as barriers to effective management and treatment following diagnosis.

39. Poverty & Health Health Effects of Toxic Stress Mental Health
Cells slow growth trajectory and contract in response
Neuroendocrine dysregulation
Immune system depression
Mental Health
Untreated mental health issues often co-morbid with chronic physical conditions
Access to Care
693,878 Missourians (11.7% of the state) do not have health insurance
Note that the data is aggregated by county, which is why there are only four distinct areas
Point out the discrepancies between the school proficiency map and the fair/poor health map– the rural IL counties have less students qualifying for free/reduced lunch and better school proficiency than STL city, but this map shows they have worse health. The blue squares on maps are hospitals- talk about how issues of healthcare access are different for urban/rural populations due to transportation, number of health clinics, etc.
Food Access- a families individual income is not the only determinant of food security. Food deserts are also a big barrier to reliable access to qualities food for families in both rural and urban settings. We know that access to fresh and adequate food is another key SDH that drives youth health outcomes. Several studies link food insecurity with higher rates of chronic disease. One study conducted by researchers at the National Institutes of Health found food insecurity status to be associated with higher rates of hypertension, hyperlipidemia, and other cardiovascular risk factors. (Food Insecurity Is Associated with Chronic Disease among Low-Income NHANES Participants
Hilary K. Seligman, Barbara A. Laraia, Margot B. Kushel
J Nutr. 2010 Feb; 140(2): 304–310. doi:  /jn )
Toxic Stress Effects-
-The body responds to stress with a primitive chemical emergency alarm system. When fight or flight is constantly firing, it hinders the development of many organ systems down to a cellular level
Shonkoff JP, Garner AS; Committee on Psychosocial Aspects of Child and Family Health; Committee on Early Childhood, Adoption, and Dependent Care; Section on Developmental and Behavioral Pediatrics. The lifelong effects of early childhood adversity and toxic stress. Pediatrics. 2012;129(1). Available at: www. pediatrics. org/ cgi/ content/ full/ 129/ 1/ e232
-Threat recognition triggers stress-response pathways to release adrenaline and other endocrine hormones into the bloodstream. When this plays out repeatedly over time, it takes a toll emotionally and physically.
-When the body is using so much of its energy and resources to respond to toxic stress, it depletes the immune system over time. This is intuitive to most of us- we all get sick more often when we are stressed out.
Mental Health-
-SDH play a big factor in mental health disorder prevalence as well. Low-income women and children are more likely to have psychological distress, anxiety, and depression.
Access to Care-
-This means that for many of the uninsured students at your school, your healthcare through the school is all they receive
-When people lack medical insurance, we know the first thing they lose is access to primary and preventative care. The Congressional Budget Office found that the current proposed Federal budget would cause 23 million currently insured people to lose their coverage. If this happens, your job as school nurses will become even more critical to ensure that students’ health needs are being addressed so they can thrive in school and beyond. How will you leverage this knowledge to better respond to the needs or your low-income students?

40. Resources
We can empower students and families by connecting them with resources.
Your local Community Action Agency
CAASTLC- Community Action Agency of St. Louis County, Inc.
PCAC- People’s Community Action Corporation (St. Louis City)
Casa de Salud- Health clinic serving un/underinsured and immigrant/refugee patients
Paraquad- Wide range of disability services following Independent Living Philosophy
Alive and Well STL- Work to reduce impact of stress/trauma on health outcomes
Teen Pregnancy and Prevention Partnership- promote adolescent sexual health and support for teenage mothers
NAMI (National Alliance on Mental Illness)- offer education and advocacy related to mental health
Safe Connections- Relationship and sexual violence prevention, advocacy, and services provider