Author Archives: Garrett Pace

A Holistic Approach to Healthcare

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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.

Sherry 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 health.

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.

Expanding the Two-Generation Approach to Combat Stress

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Stress 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?

Ross 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 environment.

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 the Two-Generation issue of the Future of Children.

The Implications of Parents’ Employment for their Children

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Parent’s (and especially mother’s) work is not always beneficial for their children.

In the Future of Children, Carolyn J. Heinrich explains that working parents can be positive role models for their children, and the income they earn can improve their children’s lives. However, work can impair the developing bond between parents and young children (especially when parents work long hours or evening and night shifts); and stress that parents bring home can have a negative effect on parenting and the quality of the home environment, and thereby induce stress into children’s lives.

It seems that the balance between work and family ought to be of utmost concern to policy makers, especially in relation to low-income parents who are most likely to work in stressful jobs with few or no benefits, but what is the solution?

Heinrich points to two-generation interventions as a possibility to maximize the benefits and minimize the detriments of parents’ work. She mentions the Career Advance program, which was recently highlighted by National Public Radio, as an example of a two-generation intervention that targets parents with children in Head Start for workforce development services. This and similar programs focus on high-quality childhood education, job training that helps parents upgrade their workforce skills as well as family and peer support services. She explains that if these programs help parents secure better jobs that improve how they feel about their work and the role models and encouragement they offer to their children, then their children may reap benefits beyond those from just the education and stronger financial supports families realize from program participation.

To learn more about how two-generation programs can help families, see the latest issue of Future of Children, Helping Parents, Helping Children: Two-Generation Mechanisms.

The Promise of Two-Generation Programs

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This week, the Future of Children released a new issue titled Helping Parents, Helping Children: Two-Generation Mechanisms. As the executive summary says, “because the home environment is so important for children’s development, many people think that ‘two-generation’ programs, which serve parents and children simultaneously with high-quality interventions, can be more effective (and perhaps more efficient) than programs that serve them individually.” These programs generally entail parents enrolling in education or job training at the same time they enroll their children in high-quality child care. The issue explores six mechanisms, or pathways, through which parents and the home environment may influence children’s development–stress, education, health, income, employment, and assets–to discover how we might best use these mechanisms to bolster two-generation programs.

A recent story in the Washington Post, which highlights findings from our issue, describes the two-generation approach, especially as it relates to alleviating poverty. It features Future of Children Senior Editor Ron Haskins, who remarks that although it is too early to tell whether the two-generation approach is effective in alleviating poverty, it certainly shows promise. P. Lindsay Chase-Lansdale, co-author of one paper in the issue, describes in the story how it is unreasonable for the child to be the only point of intervention when a family is going through difficult times: “Those gains [from childhood intervention alone] may not be enough if a child is coming home to a family with great hopes, but is stressed by making ends meet, working multiple jobs, looking for work or facing food insecurity.” To lift a child out of poverty, the family likely needs help as well.

The quality of the home environment and parent-child relationships are crucial for children’s development because they have lasting effects into adulthood and carry intergenerational implications. We invite you to explore the two-generation mechanisms and programs found in this issue of the Future of Children.

Higher Autism Rates: What Can Be done?

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The newest data on Autism Spectrum Disorder (ASD) from the Centers for Disease Control and Prevention (CDC) offer an alarming picture of childhood disability in America. Approximately 1 in 68 children who were 8 years old in the 11 participating states in 2010 were identified with ASD. This new estimate is more than twice as high as the earliest estimates from 2000 and 2002. The CDC states that “we don’t know what is causing this increase. Some of it may be due to the way children are identified, diagnosed, and served in their local communities, but exactly how much is unknown.”

People with ASD can have numerous strengths, but the challenges associated with ASD and other disabilities can be persistent and costly for individuals, families, and society. In the Future of Children issue on Children with Disabilities, Stabile and Allin calculated that the average annual cost (in 2011 dollars) to families of children with disabilities was approximately $10,800, and approximately $19,700 to social programs such as Medicaid and special education.

Even though there might be extra costs early on, Aron and Loprest note that early detection and intervention is crucial, and both sets of authors point out that early detection can provide long-term cost savings. However, some families are not screening their children due to barriers such as limited access and the belief that it’s unnecessary. Stabile and Allin emphasize that mental health problems, as opposed to physical disabilities, appear to be particularly associated with negative effects on future wellbeing in adulthood.

Having previously practiced social work in a treatment program for adults with ASD, ADHD, and learning disabilities, I’ve seen first-hand the difficulties that such adults can experience. These include difficulty developing and maintaining relationships (especially romantic relationships), finding and keeping gainful employment, and having healthy self-esteem after years of being bullied by peers.

With the increased prevalence of ASD among children, policy makers should remember that this is not simply a childhood disability, but a lifelong disorder with potentially significant long-term costs and challenges. Clearly, we need more research to understand the causes of ASD, but the funding and evaluation of expensive interventions to prevent and reduce the negative aspects associated with ASD, and other disabilities, during childhood and early adulthood might be justified given the research found in this Future of Children issue.

Examining For-Profit Colleges

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My graduate school curriculum, in clinical social work, consistently emphasized “self-awareness,” or being conscious of one’s feelings, beliefs, biases, and overall state of being. I suppose a benefit of this training is that I’ve developed a habit of trying to recognize and challenge my own biases.

One bias I’ve had since childhood concerns the role of for-profit colleges. It likely originates from peers who made fun of certain teachers at our elementary school because they had attended for-profit universities. Back then, I thought they were institutions where students bought an easy low-quality degree. More recently, I’ve considered them overpriced, insufficiently regulated, and limited in educational effectiveness. Now an article by David J. Deming, Claudia Goldin and Lawrence F. Katz in the Postsecondary Education issue of the Future of Children that has given me a more nuanced view.

They explain that for-profit colleges have seen a large increase in enrollment during the past fifteen years. Possible explanations for this include overcrowding at community colleges, aggressive marketing strategies, a more career-oriented curriculum, and the ability to quickly expand program capacity for high-demand occupations. Importantly, they enroll a disproportionately high share of disadvantaged and minority students, and those who are less prepared for college.

To me, this doesn’t sound too bad. It seems that they help meet the demand for higher education, especially among the disadvantaged, and might even be considered innovative. But there’s more to the story.

Graduates of for-profit schools tend to have higher loan balances and default rates than comparable students at nonprofit schools, have lower earnings on average, are less likely to be employed six years after initial enrollment, and are less likely to believe their education was worth the cost. Additionally, a very high portion of for-profit revenue (sometimes close to 90%) is drawn from students’ federal financial aid. Partially due to the high cost to taxpayers and students, the federal government recently proposed stricter “gainful employment” regulations that could put schools with poor outcomes at risk of losing federal aid eligibility. If the regulations are implemented, some schools will likely need to restructure their programing to stay in business.

Deming and colleagues come to several conclusions. First, for-profits schools seem necessary to help meet the growing demand for higher education. Second, for-profit colleges generally work best with short, well-defined programs that are occupation-oriented. Finally, since longer programs have the potential to amount to great costs to students, they need to be well regulated. The authors recommend requiring counseling by an independent third party to ensure that prospective students understand financial aid packages and accompanying obligations, and to restrain aggressive and misleading recruitment practices.

Bias confirmed? Partially, since for-profit colleges tend to be more expensive and seem to need more regulation to help prevent negative outcomes. However, it was unfair of me to believe these were all low-quality degrees, especially given the strengths of for-profit education.

Who Needs Fathers?

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With many children being raised by single mothers today, are fathers becoming dispensable or non-essential? Is child rearing more about the quality of parenting than who provides it?

Not necessarily. In a systematic review of published research on the effects of fathers’ absence on children, Future of Children Editor-in-Chief Sara McLanahan and colleagues found that the most rigorously designed studies find negative effects on child wellbeing. The strongest evidence relates to outcomes such as high school graduation, children’s social-emotional adjustment, and mental health in adulthood.

But an important consideration is the nature of the parents’ relationship. In the Fragile Families issue of Future of Children, Robert I. Lerman describes how the capacities and contributions of unwed fathers fall short of those of married fathers, but this varies by the kind of relationship the father has with the child’s mother. Clearly, father-child relationships are crucial, but the quality and stability of these relationships are at risk in fragile families.

Phillip A. Cowan, Carolyn Pape Cowan, and Virginia Knox consider how to tailor existing couple-relationship and father-involvement interventions, which are traditionally intended for married couples, to the needs of unwed parents in fragile families. The authors emphasize that improving the parental relationship, regardless of whether the parents live together, will in turn have a positive effect on fathers’ involvement. Ultimately, improving the parental relationship might also be among the most promising mechanisms of promoting marriage, which in turn could be an important component of reducing family poverty and improving child wellbeing in fragile families. Fathers are needed, and some fathers could use a little help.

Future of Children will return to the topic of parental relationships and the science of marriage with a full issue dedicated to the subject in Fall 2015.

A Counterintuitive Approach to Reducing Poverty

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Can government successfully intervene to raise incomes and reduce poverty? It’s a heated but critical question. While social welfare programs, such as SNAP (food stamps) and Medicaid, help lift low-income families out of poverty, in some cases they can produce a disincentive to make more money–known as the “cliff effect“–in which a modest increase in income could mean an equal or greater decrease in welfare benefit. In other words, some families could be worse off financially if they accept a small raise at work.

This is obviously problematic, but what is the solution?

Future of Children author Gordon L. Berlin suggests expanding the Earned Income Tax Credit (EITC), which was created to increase work incentives among the poor by reducing the federal taxes they owe and refunding any leftover tax credit through yearly tax returns. For those filing taxes this year, the maximum EITC for a family with three children is approximately $6,000, while those without children can receive a maximum of approximately $500. As President Obama acknowledged in his 2014 State of the Union Address, “few [policies] are more effective at reducing inequality and helping families pull themselves up through hard work … but it doesn’t do enough for single workers who don’t have kids.”

Berlin’s policy recommendation addresses this concern. He argues for increasing the credit for all low-wage workers aged 21 to 54 who work full time–regardless of whether they have children or whether they are married, though the largest benefits would accrue to two-parent households in which both adults can work full-time. This policy would reduce poverty without distorting work incentives, as the earning supplement would progressively decrease with higher income. In effect, it could help transform a “cliff” into a steady slope of opportunity.

To learn more about this proposed policy, including how it could be paid for, see the Future of Children issue on The Next Generation of Anti-Poverty Strategies. We will return the topic of EITC expansion and how it can help children in our Spring 2014 Future of Children issue, “Helping Parents, Helping Children: Two-Generation Mechanisms.”

Preventing Childhood Sexual Abuse

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Chances are that you or someone you know has been sexually abused. David Finkelhor, director of the Crimes Against Children Research Center, writes in the Future of Children that approximately 3% of children are likely victimized in a single year, and 25-40% of women and 8-13% of men report a history of sexual abuse. Many potentially negative consequences can result from this type of abuse; thus, prevention and treatment should be a matter of public policy.

What type of person sexually abuses a child? The answer might not be what you think. Finkelhor explains that only 14% of sexual abuse victims who come to law enforcement attention are victimized by a stranger, while 26% are victimized by a family member and 60% are abused by someone in the family’s social network. And it’s not just adults who perpetrate–about a third of abusers are juveniles. Also, only a small percentage of new offenders have a prior record. Luckily, many abusers are relatively low-risk for re-offending once caught.

Some of these figures might seem frightening to parents who feel a lack of control over their children’s safety. However, parents can use proactive strategies to protect their children, and if abuse happens, it should be reported promptly (regardless of who the perpetrator is) and followed immediately by professional treatment for victims. Having practiced social work with youth offenders and victims and their families, I understand it can sometimes be difficult to take the matter outside the family, but it really is in everyone’s best interest.

Policy makers have tried to alleviate the problem by focusing primarily on offender management (for example, registering sex offenders, conducting background employment checks, controlling where offenders can live, and imposing longer prison sentences) and school-based educational programs (for example, teaching children how to identify dangerous situations, refuse an abuser’s approach, and summon help). Surprisingly, there is little evidence to suggest that offender management prevents sexual abuse, despite its popularity. In addition to more research into these practices, Finkelhor recommends using law enforcement resources to catch more undetected offenders and concentrating intensive management efforts on those at highest risk to re-offend. School-based programs, on the other hand, have been shown to achieve some of their goals, but studies are inconclusive about whether these programs actually reduce victimization. For more information on how to prevent child abuse, see the Future of Children issue on Preventing Child Maltreatment.

How Parents Can Reduce Children’s Indirect Trauma from the News

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The Boston Marathon bombing, the Sandy Hook School shootings, the September 11 terrorist attacks. What thoughts and feelings come to mind at the mention of these events? That might depend on whether you were there, your personal connection to them, your age at the time, and your news media consumption during the tragedy.

I still remember my school day as an adolescent on September 11, watching non-stop news coverage, feeling despair, confusion, and deep concern for people I didn’t even know. Later, these feelings were coupled with hope and inspiration as I heard of profound heroism, all coming together to instill a deeper sense of patriotism and humanity. Yet it was a difficult time that we all had difficulty processing.

News reports of research describe how media exposure during times like these can be linked to acute stress, and sometimes has long-term effects. As Barbara J. Wilson explains in the Future of Children, children might be especially vulnerable to this effect. Continuous coverage of child abductions, war, terrorism, and even natural disasters make it difficult to protect children from disturbing news stories. Children may experience fear, anxiety, and trauma. And parents may not recognize that the symptoms their children manifest–such as physical aches, loss of appetite, nightmares, or clingy or aggressive behavior–are connected to media exposure.

What can parents do?

It depends on the child’s age, but all children benefit from limited media exposure and constructive conversations with a calm parent about what’s going on. Parents can promote coping strategies, such as exercise, emotional expression, or special play to help deal with frightening images in the media. Older children can be taught that the news overemphasizes crime and violence, and many terrible events, such as child kidnappings, occur infrequently in the real world. For younger children, it might be best to provide physical comfort and turn off the device. Permitting children under the age of eight to see graphic images in the news, even when the TV is on in the background, may present challenges, since it’s more difficult to explain these things to younger children. For more information, see the Future of Children issue on Children and Electronic Media.