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Granite State Rumblings: Caregivers, Teachers, and Health Providers Are Vital To Childhood Development

Child_pushing_grandmother_on_plastic_tricycle

(Image by Wiki Common)

As we close the door on April this week and welcome in May, we are also leaving National Child Abuse Prevention Month. But this is an issue that must not be talked about for only one month each year. It must be part of the discussion of healthy child development all year long. Dr. Jack P. Shonkoff, Director of the Center for the Developing Child at Harvard University, explains in this video why we all have a stake in the healthy development of every child.

Dr. Nadine Burke Harris, founder and CEO of the Center for Youth Wellness in San Francisco, wrote a truly informative commentary on the effects of toxic stress on children that I would like to share with you.

Chances are, you know someone whose child has been diagnosed with Attention Deficit Hyperactivity Disorder. Perhaps your own child has received this diagnosis. In many cases, it’s a legitimate issue, and can require medication, therapy or both.

But in my experience, ADHD is one of the diagnoses that can be given – precipitously – to children whose behavior issues are not really about inattention.  Their behavior is just one outward sign of a much larger public health problem that we are still working to fully understand: toxic stress.

I observe its effects every day in the clinic where I practice as a pediatrician in Bayview, one of San Francisco’s poorest neighborhoods.

Babies have emotions, too

When we think of the emotional life of a baby, we often reduce the child’s feelings to the way he behaves around a few daily activities.  We hear an infant cry when he needs to eat, or sleep, or when he feels uncomfortable.  And most caretakers tune in and attend to those needs.

But an infant’s well-being is not just about food, rest and diapers. There’s a lot more going on inside a baby’s brain and heart that we can nurture and foster.

Babies and toddlers have a complex emotional life, just like adults. They are constantly observing their caregivers and the world around them to piece together their relationship to their environment.

During the critical developmental years, between birth and age four, some children experience high anxiety or fear because their home environment is unsafe.  They’re subject or witness to physical or emotional abuse, or even extreme poverty.  And this trauma can have a tremendous impact on their physical brain development, as well as their emotional development, at a stage when a child is forming the most important attachments in life.

“Toxic stress” is not typical stress

Every child experiences some stress growing up – and even some upsetting events.  That’s normal.  And learning to cope in those situations is actually necessary for the brain and the body, because it helps a child navigate a complex world and bounce back when trouble arises.  Even in a crisis, when a caretaker is there to help a child cope in a healthy way, it strengthens the child’s ability to trust.  Those kinds of experiences qualify as “positive” or “tolerable” stress.

But when a child endures something extremely stressful, especially if it is repeated or takes place over a long period of time– without adequate emotional support, this leads to prolonged activation of the body’s stress response system. That’s called “toxic” stress.  And it can affect the way the brain and body grow and develop.

Some examples of those painful experiences, also called “ACEs,” or “adverse childhood experiences,” include physical and emotional abuse, neglect, having a caregiver who is mentally ill or substance-dependent, or being exposed to violence without enough support from a loving adult.

Pain in childhood can lead to illness in adulthood

Prolonged or extreme adversity in childhood can cause damage emotionally, socially and physically.

Caregivers, teachers and health providers often see the impact of toxic stress most clearly in a young child’s behavior.  We’ll observe a child who is defiant, loses control a lot, has trouble paying attention or has developmental delays that we can’t attribute to an underlying physical problem.

And toxic stress affects more than outward behavior.  Below the surface, it manifests itself in actual physical changes in the brain and the body.

Like several other researchers, I have studied the link between ACEs and health.  The groundbreaking study in this area, published in 1998, found that a person with four or more adverse experiences in childhood had 2.6 times the risk of the lung disease COPD (chronic obstructive pulmonary disease) of someone with no adverse experiences.

ACEs can also heighten the chance of obesity, stroke, cancer, asthma and diabetes, as well as multiply the risk of hepatitis, depression and heart disease.

Stress sets off a chemical reaction

ACEs directly affect a child’s body by activating the same kind of “fight-or-flight” response you’d experience if, say, you came into contact with a bear.  The heart pounds, and the body releases hormones that cause chemical reactions.

Chronic stress can mean frequent triggering of this chemical response, and that can be harmful to a child’s development long-term.  It can lead to chronic inflammation, and affect the part of the brain that is implicated in addictive behavior.

The more adverse experiences a child has, the more likely s/he is to develop a host of risky behaviors and negative outcomes later in life, such as alcohol and drug abuse, teen pregnancy or even suicidal tendencies that can cause serious harm or greatly diminish the prospects of a healthy and successful adulthood.

A caregiver is a child’s best buffer

Even in an atmosphere where stress is frequent and not controllable, a young child’s parent or caregiver is the number one shield against the effects of toxic stress.  Babies and toddlers are sponges.  They absorb many emotions – and tensions – in the atmosphere and people around them.  But when there’s a caregiver who can help the child manage these difficult feelings and develop resilience, it can prevent the development of toxic stress.

The quality of a caregiver’s interaction with a child is a key building block for healthy emotional, social and even physical development.  Research has shown that something as subtle as a parent’s facial expression and tone of voice will affect even a young infant.

Some of the best ways to support a child’s health and development involve simple things like smiling and laughing, taking time to play with a child one-on-one, and just slowing down to spend time together. Read more here.

 GROWING UP GRANITE 

Last week Spidey and I spent vacation week together. We had a blast playing games, reading stories, singing silly songs in the car as we ran errands, baking cookies, going to the Fisher Cats game and a play at the Opera House, and just being together.

I love the times we spend together. And I hope that when he looks back on his childhood, it will be with a special fondness for his Grandma Peanut Butter, as he calls me.

Playing with and spoiling our grandchildren is one of the special delights we have earned and they deserve. Right?

But did you know that grandparents also play a very functional role in today’s society? More than three million children in the United States are cared for every day by grandparents.

A number of factors are driving the increase in grandparents serving as the primary caregivers for grandchildren. Grandparents often step in to raise grandchildren when a parent is unavailable due to death, illness, incarceration, or abandonment. In other cases parents may have handed off children to grandparents when they went to serve in Iraq or Afghanistan.

Grandparents saddled with child-rearing responsibilities in these situations are faced with balancing the stress of the departure of their own child with the sudden shift in caretaking responsibilities at a time in life when retirement should around the corner. A Pew report last year found that more than a fifth of grandparents who care for grandchildren live under the poverty line, more than twice the overall poverty rate among Americans ages 50 and over. And the financial challenges appear especially stark for grandparents raising grandchildren alone.

Even in situations where a family is intact, the need for two income-earners in a family often motivates parents to turn to grandparents for childcare responsibilities. For many children, grandparents are a source of stability and increasingly perform routine activities traditionally assigned to parents, such as day-to-day decision-making and providing for the children’s needs.
Very young children can benefit greatly from spending quality time with their grandparents. For example, several studies have shown that children whose grandparents talk, read and sing often to them show better vocabulary and emotional development, and are better able to manage stress. Simple things like singing traditional lullabies, telling family histories or playing games can strengthen bonds with young grandchildren, and help them prepare to learn.

Here are some resources and good reads on the topic:

A Strong Safety Net Is Keeping People Out Of Poverty

Fifty years ago this week, in his first State of the Union speech, President Lyndon B. Johnson declared a “War On Poverty.” Johnson’s declaration came just weeks after succeeding to the White House upon the assassination of John F. Kennedy.

“This budget, and this year’s legislative program, are designed to help each and every American citizen fulfill his basic hopes — his hopes for a fair chance to make good; his hopes for fair play from the law; his hopes for a full-time job on full-time pay; his hopes for a decent home for his family in a decent community; his hopes for a good school for his children with good teachers; and his hopes for security when faced with sickness or unemployment or old age.

Unfortunately, many Americans live on the outskirts of hope — some because of their poverty, and some because of theft color, and all too many because of both. Our task is to help replace their despair with opportunity.”

This administration today, here and now, declares unconditional war on poverty in America. I urge this Congress and all Americans to join with me in that effort.

It will not be a short or easy struggle, no single weapon or strategy will suffice, but we shall not rest until that war is won. The richest Nation on earth can afford to win it. We cannot afford to lose it. One thousand dollars invested in salvaging an unemployable youth today can return $40,000 or more in his lifetime.”

Making poverty a national concern set in motion a series of bills and acts, creating programs such as Head Start, food stamps, work study, Medicare and Medicaid, which still exist today. The programs initiated under Johnson brought about real results, reducing rates of poverty and improved living standards for America’s poor.

As Shawn Fremstad writes in his blog on the Center for Economic and Policy Research, “there is a good historical case to be made that the “war on poverty era” continued at least through 1974 and arguably 1977 (and it was definitely over by Reagan’s election). As a practical matter, Nixon did much more to build on Johnson’s anti-poverty initiatives than to tear them down.

While Johnson may have initiated the War on Poverty, it was Nixon who institutionalized much of it.

For example, while the Food Stamp Program (now SNAP) was expanded from a pilot program to a permanent one in 1964, only about 1.5 percent of the U.S. population were receiving benefits the month after Johnson left office, and the decision to operate a food stamp program as well as the eligibility standards was still left to local areas. It was legislation adopted during the Nixon Administration (particularly in 1971 and 1973) that made food stamps a truly national program with uniform eligibility standards and availability nationwide. By October 1974, about 7 percent of Americans were receiving benefits. And it was the Food Stamp Act of 1977, which owes its existence in large part to the bipartisan efforts of Senator Bob Dole and George McGovern that established the modern program we have today.

Similarly, Supplemental Security Income was established in 1972 to replace state programs for the elderly and disabled (funded under the Social Security Act) with a federal program with uniform eligibility criteria throughout the nation. And the EITC was first established in the Tax Reduction Act of 1975, signed by President Ford. Both SSI and the EITC had their beginnings in Congressional debates in the early 1970s over President Nixon’s otherwise ill-fated Family Assistance Plan proposal.

And, in 1969, Nixon called for adding an automatic COLA to Social Security as well as an across-the-board benefit increase); he signed both into law in 1972.”

President Nixon also signed legislation enacting the Women, Infants, and Children program (WIC). The program provides nutritious foods, nutrition education, and referrals to free health and social services to pregnant, postpartum and lactating women and their infants and children up to age five.

(To see what other Presidents have done to increase the well-being of America’s children watch our video Presidents Helping Children.)

We have been hearing, and I am sure will continue to hear, legislators declare that the war on poverty has been a failure. But I beg to differ. That assumption is incorrect. The truth is that the percentage of poor Americans went down substantially in the sixties, from 22.2 percent to 12.6 percent, a 43 percent reduction in six years. These programs were also adequately funded during that time, a critical component to ensuring success.

We also know that without many of the programs established in the sixties, the poverty rate would be much higher today. What has failed is our legislators’ determination to continue the war on poverty in a meaningful way. Cuts to funding, changes in the structure of some of the programs, and shifting political ideologies have all impacted progress. But legislation aimed at strengthening instead of shredding the safety net here in the State can put us back on the right course.

There is legislation being proposed at the State level that will have a direct impact on poverty in our state. In the next few weeks and months we will update you on the bills and action that you can take to continue the war on poverty here at home.

As President Johnson said in his State of the Union address, “Poverty is a national problem, requiring improved national organization and support. But this attack, to be effective, must also be organized at the State and the local level and must be supported and directed by State and local efforts.”

Low Income Families Are Suffering From Federal Budget Cuts (From Every Child Matters Education Fund NH)

By Mary Lou Beaver,
New Hampshire Campaign Director, 

Every Child Matters Education Fund

 

Mary Lou Beaver

MaryLou Beaver

NHLogo

Each year, to track the progress toward the goal of cutting poverty in half in 10 years, Half in Ten publishes an annual report that examines 21 different indicators of economic security and opportunity. On Tuesday, Half In Ten released their new report, Resetting the Poverty Debate: State of the States 2013.

Here are some excerpts from the report:

Poverty Rate

The percentage of people in poverty—defined as having an annual income below $23,492 for a family of four—did not change nationally from 2011 to 2012, remaining at 15 percent, or 46.5 million Americans. Similarly, the percentage of people with incomes of less than half the poverty line—sometimes referred to as deep poverty—remained at 6.6 percent in 2012. These measures do not account for the impacts of the Earned Income Tax Credit, nutrition assistance, and other noncash benefits on income.

To substantially reduce the share of Americans living below the poverty line, policymakers first need to immediately shift their focus from austerity to job creation and investment in people. The poverty rate remains high today due in large part to an excess of poorly compensated jobs. We need to turn bad jobs into good ones by increasing the minimum wage, supporting poorly compensated workers’ efforts to join unions, and ensuring that all workers have basic benefits such as paid sick leave.

Child Poverty Rate

Nationally, 21.8 percent of children ages 18 and younger were living below the poverty line in 2012. But children end up in poverty because their families are in poverty. When the incomes of the adults who reside with children—mainly parents—are not sufficient to meet the basic needs of the family, child poverty rates get worse. One considerable factor contributing to these high rates is family employment. Over the past several years, the rate of family unemployment has remained very high. While the family unemployment rate fell from 12.1 percent in 2011 to 10.1 percent in 2012, the share of families with at least one unemployed parent looking for work was still higher than the national average unemployment rate of 8.1 percent in 2012.

High School Graduation Rate

One of the national indicators that has shown improvement over the past several years is the on-time graduation rate for high school students, which measures the percentage of students that enter high school as freshmen and graduate within four years. The on-time high school graduation rate increased from 75.5 percent in the 2008-09 school year to 78.2 percent in the 2009-10 school year, its highest level since 1974.

Children who participate in state-funded prekindergarten programs are more likely to graduate from high school on time. Nationwide, total state funding for pre-K programs decreased by nearly $60 million in the 2010-11 school year. This is the second year in a row for which inflation-adjusted spending dropped, following a $30 million decrease in the 2009-10 school year. By contrast, Vermont had the best on-time graduation rate in the country and also maintains one of the best pre-K programs, increasing its enrollment by 25 percent in 2011.

Gender Wage Gap

Even though our economy has been growing slowly and steadily, women are among the groups that are still not sharing in its gains. In 2012, median annual earnings for women working full time and year round were $37,791, 76.5 percent of the median annual earnings—$49,398—of men working full time and year round.  The gender wage gap did not change significantly from 2011 to 2012, and there has been little progress in closing the gender wage gap since 2001.

Unequal pay means lower earnings for women and higher poverty rates for both married couples and female-headed households. In the 1990s, the Institute for Women’s Policy Research estimated that boosting women’s pay to men’s levels would cut the poverty rate in half for both single mothers and married couples and by even more for single women without children. Passing the Paycheck Fairness Act would reduce the gender wage gap. Policies such as increasing the minimum wage, expanding investments in child care, and improving pay for workers in female-dominated occupations such as care work would help narrow the gender wage gap.

Besides pay disparities, other work challenges also hold women back, such as paid sick leave.

Lack of Health Insurance Coverage

One of the biggest expenses that pushes families into poverty is out-of-pocket spending on medical expenses, usually due to a lack of health insurance. In 2012, 10.6 million people fell into poverty due to out-of-pocket medical expenses, according to the U.S. Census Bureau. Nationally, our recent investments in this indicator have shown improvement. The percentage of people without health insurance has gone down, falling from 15.7 percent in 2011 to 15.4 percent in 2012.  Since 2010, the number of people without health insurance has decreased by 2 million, in part due to provisions in the Affordable Care Act, or ACA, that have increased coverage among young people. As the full law goes into effect in 2014, further improvements in this indicator are expected.

In too many states, however, low-income nonelderly adults are not able to benefit from part of the ACA that was designed to help them—Medicaid expansion. They are much more likely than higher-income adults to be uninsured. They also fail to receive needed medical care and have problems paying medical bills. However, 24 states are refusing to implement the ACA’s option to expand Medicaid cover- age to most uninsured people with incomes of less than 138 percent of the federal poverty line.

Massachusetts has the lowest rate of residents earning 138 percent of the federal poverty line without health insurance. Only 7.6 percent of the state’s residents lack any kind of health care coverage due to its health insurance program. The state has also chosen to expand Medicaid.

Hunger and Food Insecurity

The food-insecurity indicator measures the share of total households that experienced difficulty providing enough food for all their members due to a lack of money or resources. In 2012, 14.5 percent of households—17.6 million households, to be exact—were food insecure. The change in food insecurity from 2011 to 2012 was not statistically significant.

Although food insecurity increased during the first year of the recession, it has essentially remained stable since then. This is likely due in large part to the effectiveness of the Supplemental Nutrition Assistance Program, or SNAP, formerly known as food stamps. Recent research found that in 2011 and 2012, SNAP contributed to reductions in food insecurity among families who obtained program benefits. Yet SNAP funding has suffered recently. In November 2013, a temporary boost to SNAP funding made available through the American Recovery and Reinvestment Act expired, cutting the average SNAP benefit for a family of three by $29. This expiration took effect in November 2013; those relying on the program now have, on average, $1.40 per person per meal.

On top of that, many lawmakers in Congress have demanded further draconian cuts—as much as $39 billion over 10 years—in a recent House proposal. Policymakers should reject proposals that would damage SNAP’s responsiveness to economic conditions by radically altering its structure, as well as moves to further cut benefits.

Affordable and Available Housing

Nationally, there were only 57 affordable and available units per 100 renter house-holds with very low incomes in 2011, the most recent year for which data are available, compared to 58 units in 2010. The number of renters with “worst-case needs” continued to increase in 2011.

Left alone, sequestration could cut housing vouchers for as many as 185,000 families by the end of 2014. These cuts are already seriously impacting the states. Congress should reverse the across-the-board cuts in housing that are part of sequestration and increase investments in rental-housing assistance and development.

The bottom line is this: Low-income families in states across the country are suffering from too many years of reckless efforts to reduce the federal deficit. Although many states need to improve local policies—especially those that hinder the ability of low-income families to access federally funded programs—the state- by-state results from our indicators show that the budget choices we make at the national level have consequences. The effects of sequestration will continue into next year and for many years thereafter. “It is like a slowly growing cancer,” says Steven Warren, vice chancellor of research and graduate studies at the University of Kansas. In 2014, sequestration will only get worse. The cuts will be deeper.

Many of this year’s cuts simply have not been implemented yet. And the one-time fixes that agencies made this year to mitigate sequestration’s impacts are no longer an option moving forward.

 

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