By Garrett T. Pace on July 3, 2014 11:05 AM
The health of parents and children are closely intertwined,
yet the health-care system generally does not take an integrated approach to
family health treatment. For instance, pediatricians who treat children with
asthmatic symptoms often
do not ask about parents' smoking and rarely intervene to help change the
parents' smoking behavior. It's probably not considered within the scope of
their practice and they aren't able to bill the treatment to the child's
insurance. This situation is problematic since a primary cause of the symptoms
is likely the secondhand smoke in the child's environment. Pediatricians don't
necessarily need to abandon their specialization and start treating parents and
children in the same practice, but the solution likely lies in reforming the
health care system to be more holistic and interconnected.
Glied and Don Oellerich write in the Two-Generation
issue of Future of Children that
few programs aim to treat parents and children together due to structural barriers
in the U.S. health-care system. They argue that the Affordable Care Act, which
expands coverage to millions of lower-income parents, is a necessary step to
help establish a policy environment to allow for two-generation approaches to
Importantly, it's up to the states to take two further
steps. First, they need to ensure that parents and children can be treated in
the same programs despite Medicaid eligibility. Second, they should give
providers incentives to generate meaningful changes in their practices, such as
embracing the patient-centered
medical home model which makes additional payments to providers who
coordinate their services with other medical and social service providers.
Glied and Oellerich conclude that the rationale for
two-generation programs that target both children's and parents' health
problems is strong, and there are new opportunities ahead to develop and
implement these programs.
By Garrett T. Pace on May 23, 2014 10:39 AM
can make or break a child. Manageable stress is necessary to help a child
develop self-regulation and coping skills; yet, toxic stress can contribute to
long-term mental and physical health problems. With this in mind, what can be
done to help children in potentially stressful environments such as poverty or the
foster care system?
A. Thompson explains in the Future of
Children that the early plasticity (capacity to change) of the brain and
other biological systems offers hope to those who aspire to help at-risk
children. "We may be able to intervene early in children's lives with
experiences that help reorganize biological systems constructively." He advises,
however, that plasticity declines over time so early screening and intervention
is ideal. For instance, one study found that children who spent eight or more
months in a Romanian orphanage, while being profoundly deprived of normal human
relationships, before being adopted fared worse in terms of health consequences than similar children who only spent four months or less in the that
Thompson emphasizes that a key point of intervention to ease
the consequences of chronic stress is improving the quality of relationships
between children and adults. "Whether two-generation programs target parents,
preschool teachers, foster parents, or ... [grandparents], focusing on
relationships is likely to enhance their success." This shows promise in helping
strengthen families so children can experience a manageable amount of stress in
their lives that contribute to healthy development.
To learn more about this approach to combating stress, see
issue of the Future of Children.
By Wade C. Jacobsen on September 4, 2013 7:37 AM
To reduce children's exposure to the negative effects of having a
parent incarcerated (for example, family
financial strain, health
and social problems, housing
insecurity, etc.), Future of Children
Western and Christopher Wildeman urged policymakers to limit prison time
and provide effective drug treatment for nonviolent drug offenders. In line
with this call, Attorney General Eric Holder recently announced
that the Justice Department would stop perusing mandatory minimum
prison sentences for certain nonviolent offenders and promote drug-treatment
alternatives to incarceration. The changes, effective immediately, should help
the prison population and the number of children
exposed to incarceration.
With about half the
current prison population meeting the criteria for drug dependence or abuse,
effective drug treatment for prisoners and parolees is a serious concern. As the incarceration rate begins to decline, thousands of men and women will be sent back into their communities, and many will need substance abuse treatment. Western
and Wildeman report that prisoner reentry programs have been found to
reduce recidivism by connecting ex-prisoners to substance abuse treatment
services as well as education and employment opportunities.
Policymakers and practitioners should also focus on early contact with
the criminal justice system. Laurie
Chassin notes that substance abuse disorders are common among adolescents
in the juvenile justice system and underscores the need for effective screening
methods so that youth can be redirected away from the juvenile and criminal
justice systems as early as possible. She highlights the role of the youth's
social environment and mental health and finds evidence in favor of
family-based treatment models.
Limiting prison time, providing effective drug-treatment for offenders and
ex-prisoners, and identifying and addressing substance-use disorders early on
should help to lower the proportion of children exposed to parental
incarceration. For more on this topic, see the Future of Children issues on Fragile
Families and Juvenile
By Garrett T. Pace on August 12, 2013 9:29 AM
Rates of childhood obesity have risen for decades in the U.S.,
and there are many reasons
why its prevention and treatment ought to be a focus of public policy. For one,
preschoolers who are overweight or obese are five times more likely than normal-weight
preschoolers to have weight problems during adulthood. And one preschooler in
eight is obese, with higher rates among some racial minorities.
Recently, the Centers for Disease Control and Prevention (CDC)
found encouraging evidence that these trends might be improving. In a study of
11.6 million low-income preschoolers, the CDC found a
small decrease in childhood obesity rates in 19 U.S. states and territories
from 2008 to 2011. Experts
attribute the good news partially to programs that encourage child exercise, an
increase in breast-feeding, and improved nutrition in foods provided to
low-income families through federal programs. This research suggests that the
problem of childhood obesity can be ameliorated.
In the Future of
C. Lindsay, Katarina M. Sussner, Juhee Kim, and Steven Gortmaker argue that
successful interventions must involve parents from the earliest developmental
stages to promote healthful practices in and outside the home. Regarding the
racial and economic disparity in childhood obesity rates, Shiriki
Kumanyika and Sonya Grier observe that low-income and minority children
tend to watch more television than do white, non-poor children and are
potentially exposed to more commercials advertising unhealthy foods. One strategy
would be for Congress and the Federal Communications Commission to reduce or
eliminate advertising time for non-nutritious foods aimed at children. For more
recommendations on how to promote childhood health, see the Future of Children issue on Childhood
By Wade C. Jacobsen on April 3, 2013 9:08 AM
have more than doubled among children and tripled among teens in the past three
decades. Today, CDC estimates that 12.5 million kids
are obese - nearly 17 percent of children and adolescents in the US. Future of Children author Stephen
R. Daniels reports that obesity has serious consequences for children and
teens, including health conditions that were previously considered adult-only issues:
high blood pressure, nonalcoholic fatty liver disease, hardening of the
arteries, and type 2 diabetes, to name a few.
In the Future of Children,
Paxson and colleagues explain that that while researchers have proposed
many environmental and policy solutions to the obesity problem, such as
regulating the sale of soda in schools or building more sidewalks, several
strategies are more promising for the short term. These include in-school, after-school,
and child-care initiatives, as well as improving pediatric care. The most
effective strategies will involve parents, who play a significant role in
obesity prevention from gestation and infancy through adolescence.
Time Magazine recently highlighted
a five-month intervention program in which parents and children learned about
healthy eating and exercise, and parents learned how to set limits and teach
their children to monitor their own eating. In addition, these families met for
20 minutes with their physician every two weeks to be weighed and receive
advice and reading material. Results showed significant weight loss in the
treatment group, while the control group continued to gain weight.
Future of Children author Ana
C. Lindsay and colleagues explain, "By better understanding their own role
in influencing their child's dietary practices, physical activity, sedentary
behaviors, and ultimately weight status, parents can learn how to create a
healthful nutrition environment in their home, provide opportunities for
physical activity, discourage sedentary behaviors such as TV viewing, and serve
as role models themselves." For more information on research-based childhood
obesity intervention, see the Future of
Children issue on Childhood
By Regina M. Leidy on May 31, 2012 2:33 PM
Over the past fifty years, the number of reported childhood disabilities has steadily increased and the nature and consequences of disability have changed drastically. Prior to 1960, the poster child for childhood disabilities would have been a child with polio, wearing leg braces and using crutches for support. Today's poster child could be a child with autism.Where the pre-60s child wore his disability for the world to see, in many cases today's child experiences his disability internally. Over the past several decades, predominant childhood disabilities have shifted away from physical disorders toward mental health disorders. (Future of Children: Childhood Disabilities)
Much public attention and many resources are focused on medical research to identify risk factors and mitigate symptoms of disability for individual children.However, Stephen Rauch and Bruce Lanphear, in their chapter "Prevention of Disability in Children: Elevating the Role of the Environment," argue for a broader focus on environmental influences that put entire populations at risk. "Identifying and eliminating or controlling environmental risk factors that incrementally increase the prevalence of disability is the key to preventing many disorders," they write.
When seeking to prevent disability, there are three levels that need to be considered. Primary prevention seeks to keep disabilities from developing.Secondary prevention utilizes methods of screening and early detection to identify problems before they can do "too much damage." Tertiary prevention focuses on restoring health and function to people who have already developed a disability. Tertiary and secondary prevention are the primary efforts of the clinical community. But in order to reduce the prevalence of disability in the population, primary prevention is essential.
The causes of many disabilities in childhood are complex and result from the interplay of environmental risk factors and genetic susceptibility. Purely genetic and purely environmental disabilities exist, but they are rare. Children are particularly vulnerable to environmental stressors; they pass through several delicate developmental stages and, pound for pound, they eat and breathe more environmental contaminants than adults. An exposure that is harmless in adults can have a dramatic effect when it occurs during fetal development or early childhood.
One example of an environmental risk for disabilities in children is lead in house paint. Lower IQ and ADHD in children have both been linked back to lead as has criminal behavior in adulthood.A cost-benefit analysis of requiring lead based paint to be removed concludes that every $1 spent to reduce lead hazards in housing would produce between seventeen and two hundred twenty one dollars in benefits by reducing screening and treatment for lead toxicity, ADHD treatment, and special education.
In a long awaited move, the CDC recently cut the threshold for lead poisoning.This new lower threshold "means public health agencies have a bigger job to screen children for lead and to prevent exposure in the first place," said Lanphear in an interview with John Ryan of Seattle station KUOW "The new standard from the Centers for Disease Control and Prevention nearly doubles the number of children considered to have lead poisoning. Now, one out of 40 American kids has what's deemed a dangerous level of lead in their blood, reported Northwest public radio."(http://www.nwpr.org/post/cdc-cuts-lead-poisoning-threshold)
This change in lead level standards is just one example of how our regulations and knowledge about environmental risk factors changes over time.In the face of such changes, it makes sense to consider a preventive approach that shifts the entire population's health curve in a positive direction. As Issue Editors Janet Currie and Robert Kahn summarize in the introduction to Children with Disabilities, "the heart of [Rauch/Lanphear's] argument is that societal choices can shift the curve of child health outcomes to increase the probability that some children will be moved from a nondisabled to a disabled state. Exposure to chemicals in the environment, for example, may decrease the attentiveness of all children, but in a subset of more vulnerable children, the exposure may lead to symptoms and impairment that warrant an ADHD diagnosis. The implication is that society should pay attention to shifting the entire distribution of health outcomes in a positive direction and that doing so will reduce the toll of childhood disability. Such a public health focus on prevention is a useful complement to the usual medical focus on improving technology or the quality of medical care for children who already have disabilities."
By Wade C. Jacobsen on May 25, 2012 9:36 AM
Future of Children research
underlines the challenges faced by youth approaching adulthood, particularly
among those from disadvantaged backgrounds with no postsecondary education on
the horizon. Even thornier is the pathway to adulthood for youth from more
vulnerable populations such as those challenged with a chronic illness, mental
health issues, or physical disabilities. A recent study highlighted by CBS News
indicates that one in three young adults with autism has completed no college
or technical schooling and has no paid work experience seven years after
graduating high school. This is urgent news considering that roughly half a
million autistic children will be reaching adulthood in the next ten years.
Recognizing the importance of education for
children with disabilities before and throughout the transition to adulthood, the
United States has made many advances in special education over the past few
decades. The special education system gives children with disabilities greater
access to public education and provides an infrastructure for their schooling. Moreover,
some services even extend through early adulthood, which is more than can be
said for other
vulnerable populations. The federal Individuals with Disabilities
Education Act (IDEA) requires that secondary schools develop individualized
transition plans including long-term education goals, vocational training, and
general life skills.
these advancements in special education, Laudan Aron and Pamela Loprest
indicate in their chapter Disability
and the Education System, that many problems remain, including the
over- and under-identification of some subgroups of students, delays in
providing service to students, as well as bureaucratic and financial barriers that
often complicate effective service provision. In addition, some needed services
may not be available when children have reached adulthood. A recent article in US News
and World Report indicates that families of children with autism
often describe leaving high school as "falling off a cliff" because of the lack
of services for adults on the autism spectrum.
Providing these children with needed support before
and after the transition to adulthood has substantial immediate and long-term
economic costs and benefits. A recent article in CNN Health
reports that out-of-pocket medical expenses are growing fastest among Americans
18 years old and younger. The Future of
Children volume, Children with Disabilities indicates that these
expenses are higher among families caring for a child with a special health
care need. In their chapter, The Economic Costs of Childhood Disability, Mark Stabile and
Sara Allin suggest that due to these high costs to children and families, the
benefits of effective interventions to prevent and reduce childhood disability
might well outweigh the societal costs of such programs.
May 23, 2012, the Anderson Center for Autism hosted an event for more than 350
practitioners and parents, which featured research from the Future of Children's Children with
Disabilities volume, and discussed effective early interventions for children
with disabilities. For more discussion on evidence-based policies
and intervention programs for special needs children and those making the
transition to adulthood, see the Future
of Children volumes Children with Disabilitiesand Transition to Adulthood. Add your voice by commenting on the Future of Childrenblog.
By Wade C. Jacobsen on December 5, 2011 3:54 PM
week's news provides one example of the political kinks between research and
New York Times reports that federal funding for six new evidence-based
initiatives will be significantly cut or eliminated under a new House proposal.
of Children researchers show that one program funded by the
initiatives, the Nurse-Family Partnership discussed in the previous blog,
delays second births and reduces child maltreatment among teenage mothers.
no decisions have been finalized yet, experts are concerned about the future of
such programs. Brookings scholar and Senior Editor for the Future of Children Ron Haskins asks
in the Times article, "Why, in a constrained budget environment, do you cut the
programs that have to show they're working? It makes no sense." For more
comments by Ron Haskins, see the Brookings Institution blog
on this topic. Also see policy suggestions in the Future of Children.
By Wade C. Jacobsen on December 2, 2011 1:48 PM
estimates for counties and school districts indicate that a third of all
counties in 2010 had school-age poverty rates that were significantly higher
than the national poverty rate. This is one of many statistics about the
welfare of U.S. children that compels us to review the supports we currently
provide and in the future might provide to children and their families.
But in challenging fiscal times, how
do we make decisions about what programs to support?
A major objective of The Future of
Children is to translate evidence-based research for policy
makers, practitioners, and others working in the field. Although no social
science research is perfect, quality research can help policy makers and
practitioners better understand what works best for children, and allocate
finite resources to meet their needs.
The Obama administration embraces
evidence-based programming. But interpreting evidence is often as important as
the evidence itself, particularly when the views of policymakers and interest
groups may influence interpretations of research outcomes. According to a Future
of Childrenpolicy brief, the views of policymakers and those
in office often outweigh the evidence, and influential interest groups may be
more concerned with the people and organizations they serve than with
In a recent presentation for the University-Based
Child and Family Policy Consortium, Jon Baron, President of the The
Coalition for Evidence-Based Policy and Woodrow Wilson School
alumnus, spoke about the benefits and challenges of using evidence to inform
policy and program development. It is tempting for programs to want to show
success and for politicians to want to quickly dismiss what does not work, but
is better to create an environment that supports accurate research and allows
for program growth over time. Working closely with the Office of Management and
Budget, the Coalition uses a two-tiered approach: providing support for
programs with the strongest positive evidence from randomized trials, while
rigorously evaluating programs with less evidence.
Mr. Baron presented two examples
of programs that have yielded positive results among disadvantaged groups, one
in the field of education and the other in child health and wellbeing, both of
which were featured in Future of Children volumes:
In education, the H&R Block FAFSA
Project yielded strong positive effects, according to Mr. Baron. As described
in the Future of Children issue Transition to Adulthood and highlighted in a past
blog, the goal of the intervention project is to
inform low-income families of the financial aid that could be available to them
and to help them make informed decisions about whether or not to apply and
enroll in college. Findings from randomized experiments show that the program
increased college enrollment for low- and moderate-income students by about 26%
when compared to the control group.
In child wellbeing, rigorous social
science evaluations of home-visiting programs designed to improve parenting and
reduce child maltreatment convinced President Barack Obama's
administration to initiate a multi-billion-dollar federal program to expand a
particular model of home visiting, the Nurse Family Partnership (NFP). As
summarized in The Future of Children's issue on Preventing Child Maltreatment, in this program,
specially trained registered nurses conduct regular home visits to low-income
first-time mothers to promote healthy behavior during pregnancy and positive
Key to the success of
these and future initiatives is working with policy makers and practitioners to
better understand the problems they are trying to solve, their social networks,
and the ways by which they acquire, interpret, and use research. The next step
is then to effectively translate unbiased research that addresses their
questions into information that they can use.
The Future of Children
publishes two volumes and policy briefs each year to bring research on various
topics about child wellbeing to those working on the frontline. To read our
volumes and policy briefs, click here. To view webcasts from some of our outreach
events, click here.
By Melanie E. Wright on December 16, 2009 1:35 PM
On November 19, an international coalition of NGOs used World Day for Prevention of Child Abuse to host events about and bring attention to a threat faced by children all over the world. While most child abuse and neglect prevention strategies focus on parents – by educating them on parenting methods or treating underlying risk factors such as alcohol abuse – this coalition instead addresses the wider culture. This strategy holds that a supportive community can lead parents to make better parenting choices and can help them overcome challenges, whereas negative societal influence can overwhelm even well-intentioned parents.
In the latest The Future of Children volume, Preventing Child Maltreatment, one article looked at the community’s role in preventing child abuse from taking place. The authors found that social environment affects norms about appropriate child-raising behaviors and the acceptability of parents seeking external support when encountering challenges. In addition, positive interactions between neighbors increase the likelihood that parents will feel responsible for and act to protect all children in the neighborhood, whereas isolating and unfriendly neighborhoods may increase parental stress and their tendencies to neglect or mistreat their children. Formal community services can improve parents’ mental health and parenting capabilities and provide temporary relief from parental responsibilities.
The article highlights some innovative community programs that are designed to change a community’s atmosphere and norms to reduce child maltreatment. For instance, Triple-P in South Carolina has offered community-level information campaigns and parenting advice sessions through existing institutions such as child care centers and preschools. The Durham Family Initiative in North Carolina expands the availability of community services and uses outreach workers to build relationships in at-risk communities, address neighborhood needs, and build human capital through leadership and mentoring programs. Both these and other programs have shown promising results in reducing child abuse and neglect cases -- suggesting that well-informed, well-equipped, and socially cohesive neighborhoods aid child wellbeing.
These programs face major challenges, however; costs can be significant, and changing behavior and investing in social networks can be difficult. In addition, more work needs to focus on which communities are most in need of such programs and most likely to benefit from them. Of course, individual factors play a major role in child maltreatment cases, so a community approach alone cannot solve problems of child abuse and neglect. Still, building up a supportive community is an important step toward protecting children.