Last year, the Society for Social Work and Research Conference in Washington, DC, the American Academy of Social Work and Social Welfare (AASWSW) unveiled its 12 Grand Challenges for Social Work with a bold call to action to help solve the toughest problems facing our society today.
When we reflect and take inventory of our ever changing society, a path of progress towards justice and equality can be seen on the horizon. However, we must be diligent in identifying those challenges and barriers that may retard our progress and growth while increasing inequality for our most vulnerable citizens.
In September 2015, the United Nations unveiled 17 Global Goals for Sustained Development in an effort to end extreme poverty, fight inequality and injustice, and fix global climate change by 2030. The idea behind the global goals was to identify areas with the ability to affect the most change. Then, microtarget those areas through individual, organizational, and governmental action in order to maximize impact and improve outcomes.
However, the American Academy of Social Work and Social Welfare have narrowed down their target areas even further by identifying 12 Grand Challenges in which they believe social workers both domestic and international can directly impact to improve outcomes for those we serve.
“This critical effort identifies and seeks to address the full range of major challenges facing society, from ending homelessness and stopping family violence to promoting smart decarceration and reversing extreme income inequality.”
Twelve Grand Challenges for Social Work
1. Ensure Healthy Development for All Youth
“Each year, more than six million young people receive treatment for severe mental, emotional, or behavioral problems. Strong evidence shows us how to prevent many behavioral health problems before they emerge. By unleashing the power of prevention through widespread use of proven approaches, we can help all youth grow up to become healthy and productive adults.”
2. Close the Health Gap
“More than 60 million Americans experience devastating one-two punches to their health—they have inadequate access to basic health care while also enduring the effects of discrimination, poverty, and dangerous environments that accelerate higher rates of illness. Innovative and evidence-based social strategies can improve health care and lead to broad gains in the health of our entire society.”
3. Stop Family Violence
“Family violence is a common American tragedy. Assaults by parents, intimate partners, and adult children frequently result in serious injury and even death. Such violence costs billions of dollars annually in social and criminal justice spending. Proven interventions can prevent abuse, identify abuse sooner, and help families survive and thrive by breaking the cycle of violence or finding safe alternatives.”
4. Advance Long and Productive Lives
“Increased automation and longevity demand new thinking by employers and employees regarding productivity. Young people are increasingly disconnected from education or work and the labor force faces significant retirements in the next decades. Throughout the lifespan, fuller engagement in education and paid and unpaid productive activities can generate a wealth of benefits, including better health and well-being, greater financial security, and a more vital society.”
5. Eradicate Social Isolation
“Social isolation is a silent killer—as dangerous to health as smoking. National and global health organizations have underscored the hidden, deadly, and pervasive hazards stemming from feeling alone and abandoned. Our challenge is to educate the public on this health hazard, encourage health and human service professionals to address social isolation, and promote effective ways to deepen social connections and community for people of all ages.”
6. End Homeless
“During the course of a year, nearly 1.5 million Americans will experience homelessness for at least one night. Periods of homelessness often have serious and lasting effects on personal development, health, and well-being. Our challenge is to expand proven approaches that have worked in communities across the country, develop new service innovations and technologies, and adopt policies that promote affordable housing and basic income security.”
7. Create Social Response to a Changing Environment
“The environmental challenges reshaping contemporary societies pose profound risks to human well-being, particularly for marginalized communities. Climate change and urban development threaten health, undermine coping, and deepen existing social and environmental inequities. A changing global environment requires transformative social responses: new partnerships, deep engagement with local communities, and innovations to strengthen individual and collective assets.”
8. Harness Technology for Social Good
“Innovative applications of new digital technology present opportunities for social and human services to reach more people with greater impact on our most vexing social problems. These new technologies can be deployed to more strategically target social spending, speed up the development of effective programs, and bring a wider array of help to more individuals and communities.”
9. Promote Smart Decarceration
“The United States has the world’s largest proportion of people behind bars. Mass incarceration and failed rehabilitation have resulted in staggering economic and human costs. Our challenge is to develop a proactive, comprehensive, evidence-based “smart decarceration” strategy that will dramatically reduce the number of people who are imprisoned and enable the nation to embrace a more effective and just approach to public safety.”
10. Reduce Extreme Economic inequality
“The top 1% owns nearly half of the total wealth in the U.S, while one in five children live in poverty. The consequences for health and well-being are immeasurable. We can correct the broad inequality of wealth and income through a variety of innovative means related to wages and tax benefits associated with capital gains, retirement accounts, and home ownership. Greater lifelong access to education will also provide broader economic opportunities.”
11. Build Financial Capability for All
“Nearly half of all American households are financially insecure, without adequate savings to meet basic living expenses for three months. We can significantly reduce economic hardship and the debilitating effects of poverty by adopting social policies that bolster lifelong income generation and safe retirement accounts; expand workforce training and re-training; and provide financial literacy and access to quality affordable financial services.”
12. Achieve Equal Opportunity and Justice
“In the United States, some groups of people have long been consigned to society’s margins. Historic and current prejudice and injustice bars access to success in education and employment. Addressing racial and social injustices, deconstructing stereotypes, dismantling inequality, exposing unfair practices, and accepting the super diversity of the population will advance this challenge. All of this work is critical to fostering a successful society.
How will academics, practitioners, schools of social work, governmental and NGO social welfare agencies respond to the call? As a practitioner, we have all seen grand action plans created only to sit on the shelf and never see implementation. Will they provide information to impact change, then wait for someone else to spring into action to implement, or will the experts in our profession lead the charge by engaging in public debate on the issues social workers have the most direct impact?
Together, the 12 Grand Challenges define a far-reaching, science-based social agenda that promotes individual and family well-being, a stronger social fabric, and a just society.
Smartphones Help UB Researcher Better Understand the Nature of Depression and Anxiety
Decades of research into anxiety and depression have resulted in the development of models that help explain the causes and dimensions of the two disorders.
For all of their well-established utility however, these models measure differences between individuals and are derived from studies designed using few assessments that can be months or even years apart.
In other words, the models are highly informative, but not optimal for examining what’s happening emotionally in a particular person from moment to moment.
Now, a University at Buffalo psychologist is extending that valuable research to repeatedly and frequently measure symptoms of specific individuals, in real time, to learn how immediate feelings relate to later symptoms.
The research casts anxiety and depression in a manner not previously studied and the results suggest that some emotions linger in a way that predicts feelings beyond what’s happening at specific times. This information could provide treatment benefits for patients struggling with the disorders, according to Kristin Gainey, an assistant professor in UB’s psychology department and the study’s author.
“Clinicians aren’t primarily interested in how one person’s symptoms compare to someone else, which is what most studies focus on. Rather, they’re most interested in how to shift the feelings of someone with anxiety or depression. In other words, they want to understand how to change the emotional experiences of a given individual over time and across different situations,” says Gainey, an expert on emotion and affect in mood and anxiety disorders and a recent recipient of one of the American Psychological Association’s Early Career Distinguished Scientific awards. “The only way to get at that directly is to measure these processes repeatedly within a person as they’re happening.”
To do that, Gainey conducted baseline assessments on 135 participants, each of whom were already seeking some kind of psychological treatment.
Three times a day for 10 weeks, the participants received surveys on their smartphones about their feelings and symptoms. They completed the survey within 20 minutes of its arrival.
“That generated enough reports to provide a good sense for each person’s fluctuations and trajectories of symptoms and affect (defined as the objective feeling state that’s part of an emotion),” says Gainey.
A smartphone provides a portrait of immediacy that questionnaires distributed in a lab that summarize feelings over extended periods are unable to achieve.
“We can’t always remember accurately how we felt days and weeks ago, especially if there were some days you felt really bad and other days you felt great,” she says. “That’s not easy to summarize in a single index.”
Anxiety and depression are each unique disorders, but they often appear together in a single patient. Both disorders share high levels of negative emotions, such as fear, sadness, and anger, while low levels of positive emotions, like excitement and interest, are unique to depression.
Gainey says it’s not surprising that particular affective states, like feeling happy or feeling sad, might be responsible for symptoms experienced soon afterward. What researchers don’t know much about is how long those effects tend to persist, and which specific symptoms they lead to hours or days later.
“This study let us see that some effects were short-lived, but for depression, if you were feeling high levels of negative affect, even if we control for how depressed a participant was at that time, it was still predictive of increased depression 24 hours later,” says Gainey.
That might suggest that clinicians could track peoples’ positive and negative affect in real time and plot trajectories that are indicative of increased risk.
“If we can identify specific risk factors for increased symptoms in real time, we could even use smartphones to send suggestions about helpful strategies or alert the person’s mental health care provider,” she says.
Climate Change Increases Potential for Conflict and Violence
Images of extensive flooding or fire-ravaged communities help us see how climate change is accelerating the severity of natural disasters. The devastation is obvious, but what is not as clear is the indirect effect of these disasters, or more generally of rapid climate change, on violence and aggression.
That is what Craig Anderson sees. The Iowa State University Distinguished Professor of psychology and Andreas Miles-Novelo, an ISU graduate student and lead author, identified three ways climate change will increase the likelihood of violence, based on established models of aggression and violence. Their research is published in the journal Current Climate Change Reports.
Anderson says the first route is the most direct: higher temperatures increase irritability and hostility, which can lead to violence. The other two are more indirect and stem from the effects of climate change on natural disasters, failing crops and economic instability. A natural disaster, such as a hurricane or wildfire, does not directly increase violence, but the economic disruption, displacement of families and strain on natural resources that result are what Anderson finds problematic.
One indirect way natural disasters increase violence is through the development of babies, children and adolescents into violence-prone adults, he said. For example, poor living conditions, disrupted families and inadequate prenatal and child nutrition are risk factors for creating violence-prone adults. Anderson and Miles-Novelo noted these risk factors will become more prevalent as a result of climate change-induced disasters, such as hurricanes, droughts, floods, water shortages and changing agricultural practices for efficient production of food.
Another indirect effect: Some natural disasters are so extensive and long term that large groups of people are forced to migrate from their homeland. Anderson says this “eco-migration” creates intergroup conflicts over resources, which may result in political violence, civil wars or wars between nations.
“This is a global issue with very serious consequences. We need to plan for ways to reduce the negative impacts,” Anderson said. “An inadequate food supply and economic disparity make it difficult to raise healthy and productive citizens, which is one way to reduce long-term violence. We also need to plan for and devote resources to aid eco-migrants in their relocation to new lands and countries.”
Which is worse?
There are no data and there is no method to estimate which of the three factors will be most damaging, Anderson said. The link between heat and aggression has the potential to affect the greatest number of people, and existing research, including Anderson’s, shows hotter regions have more violent crime, poverty, and unemployment.
However, Anderson fears the third effect he and Miles-Novelo identified – eco-migration and conflict – could be the most destructive. He says we are already seeing the migration of large groups in response to physical, economic or political instability resulting from ecological disasters. The conflict in Syria is one example.
Differences between migrants and the people living in areas where migrants are relocating can be a source of tension and violence, Anderson said. As the level of such conflicts escalates, combined with the availability of weapons of mass destruction, the results could be devastating.
“Although the most extreme events, such as all-out war, are relatively unlikely, the consequences are so severe that we cannot afford to ignore them,” Anderson said. “That is why the U.S. and other countries must make sure these regional conflicts and eco-migration problems don’t get out of hand. One way to do that is to provide appropriate aid to refugees and make it easier for them to migrate to regions where they can be productive, healthy and happy.”
Taking action now
Anderson and Miles-Novelo say the purpose of their research is to raise awareness among the scientific community to work on prevention efforts or ways to limit harmful consequences. The long-term goal is to educate the public on the potential for increased violence.
“From past experience with natural disasters, we should be able to prepare for future problems by setting aside emergency resources and funds,” Miles-Novelo said. “We should tear down negative stereotypes and prejudices about those who will need help and humanely assist refugees and others who are displaced. By doing all these things we can reduce conflict and hostility.”
Changing attitudes and policies about immigration also will lessen the potential for conflict, Anderson said. He points to the backlash against refugees in many European countries.
“The view that citizens of wealthy countries often have about refugees needs to change – from seeing them as a threat to a view that emphasizes humanitarian values and the benefits refugees bring when they are welcomed into the community,” Anderson said.
New Release – ReMoved 3: Love is Never Wasted
Kevi’s story, though fictional, allowed me to paint for you a visual picture of how much it hurts to have a mother leave you all alone. It invites you to yearn with him—to share his longing to capture a woman that you know you probably never will. It shows how wildly untameably beautiful such an enigma is to her son, with her hair dancing in the wind and the scent of her teasing in and out of his existence.
Mostly, it helps you understand that there’s more to the story than just her. For kids like me, who were raised by many parents, it’s not just about our bio moms, you see. Sometimes, it isn’t even mostly about that mom. It’s also about this foster mamma who feels warm and soft and safe. It’s about how you never want to live without those feelings or her arms around you again.
Maybe it’s about that foster daddy that you just aren’t sure about. He might hurt you like all the other daddies you’ve ever known. But, maybe he won’t…
Through the Author’s Pen & Own Experience of Foster Care
My mother’s purse was her survival kit. She never forgot it.
She often forgot us. But she never forgot it.
Inside that purse, she carried an envelope. The envelope held all the things one would normally file away in the safety of their home. Instead, she carried those things—the few markers of our meager existence—in a manila in her handbag.
I suppose this was the only way for her to hold onto anything in a life where change usually happened in a moment’s notice. It wasn’t uncommon for us to ditch all of our possessions when the police discovered us living in a condemned or abandoned building. Also, as a battered woman, Mamma always had to be prepared to run on the days it seemed Daddy might actually kill her.
The purse and the envelope may have been an insignificant thing to anyone else, but for a kid like me, it proved that everything outside of it could be taken in an instant. It signified my mother, how she’d come to be, and the struggles of her life.
That’s why I made the biological mother’s purse a significant part of the story in ReMoved 3. As I wrote “Love Is Never Wasted,” I tried to infuse it with those things that would make it feel real to others who had walked a similar journey. I sought to put in specific feelings and moments that kids in foster care would really connect to.
As a foster kid, you often find yourself torn between families because each one holds a piece of what you need. You long to understand your biological parents and to know what it was like when you were budding in your mother’s womb. You have to know because, on some level, your body still remembers. The body can’t forget the place it was first fed.
Let’s not overlook, though, that you need more than roots to grow. Our bodies instinctually know this as well. We must also feel that we are safe, that nourishment is always available, and that the sun can shine most every day.
Ideally, our kiddos would get all these needs met from the same person. Sadly, that is not always the case. For the 400,000 plus kids in the U.S. foster care system a solitary caretaker will not be found to meet all their needs. Our best hope for these kids is that love can be absorbed from multiple sources. We hope that, collectively, they get enough of what they need from the world around them to grow healthy and strong.
Like Kevi’s story, my own life was changed by having multiple temporary parent figures. Though not ideal, this piecemeal parenting experience is what taught me how to love.
There were the moments that my birth mom snuggled me in bed. In the submission of sleep, she would occasionally relax and offer some warmth. These memories of cuddling my mom inspired the scenes of Kevi snuggling his birth mom in the film. Even the direst situations usually have some moments of bonding.
When my mother didn’t have any affection to give, my big brother stood in the gap. He frequently acted as a caretaker, comforting me, protecting me, and feeding me on the days everyone else forgot to. Because of my big brother, when my new little brother entered the world and cried out for protection, I knew how to answer that call.
Unfortunately, I could only answer it slightly better than our mom did. You see, I was only six. Then seven. By eight, I felt like I was dying. My enchantment with my mother began to wither, along with my body and soul. I called out to the universe for something to take me from the daily pain that she and my father put me in.
Foster care was the answer I received.
Sadly, foster care brought more pain. It’s difficult to describe the feelings that come from being ripped from one’s life source, especially when that life source is also robbing you of life. Regardless of her failures, though, she was still the first person who had held me. Now, I found myself miles from her familiarity. I frequently asked myself if anyone could love me in this strange new place, where nobody looked or acted like me and Mamma.
Some of them couldn’t love me, it seems.
Yet, some of them could and did. Some of them even did without any expectation of return. Most of them who loved me were only able to hold me for a moment in time. No matter how fleeting my time with them was or how heartbroken I was upon leaving, these people became the beautiful springtime of my memory. From each moment I got with them, I would continue to flourish and grow; although, I wouldn’t necessarily see that at the time.
Thousands of uncertain days would pass under the gloomy cloud that we call foster care. Though I acted it out differently than our character Kevi, I was a mess during most of those days.
But a new day would eventually come!
I would grow up. Slowly, I would discover that my life had been changing. As an adult, I would finally find that it was all my own. With my newfound sense of freedom and control, I would choose to become the wife to a husband who loved me selflessly.
Of all the guys I could have chosen, including the kind who may have felt more familiar, how did I know to settle on one like him? The faces of several good foster fathers smiled distantly behind the man I had chosen to spend my life with.
After years of being loved in a way I’d never felt loved before (by my husband Doug), I would become a mother. Despite the years of worry that I’d be a parent like him or her, I found that I was actually more like her and her and him. Tortured childhood and all, I was brimming with love to give, thanks to those who had poured love into me.
This forced me to ask an important question: How could a girl, who had been miserably failed by the people who gave her life, find herself building a completely different world than the one she grew up in?
The answer was clear. I had gotten to this place because an alternate reality had blown into my childhood. It had changed me. Its name was foster care. For me, foster care wound up carrying the faces of seven different homes over seven years. When I was 15, its name became adoption.
Ironically, this system of child protection that had starved me is also the very thing that helped me thrive. Foster care brought so much internal destitution, but it also brought moments of witnessing healthy, selfless, loving, human interactions.
I hope “Love is Never Wasted” reveals that even small moments with a child can show him he has a choice in how he lives his life. Because of my time in care, I now knew that there was not just one possible way to be. Throughout my foster care experiences, I had, here and there, tasted the essence of something sweeter and more fulfilling than my past life. I became hungry for more of it.
I now exist as living proof (hidden behind my stories) that love always offers nourishment and that a little bit of it can go a very long way.
A lot of it can make miracles.
A little bit of love carried me out of my tortured childhood. A lot of it led me to the place I am today and a little boy named Kevi.
The More the Merrier? Children with Multiple Siblings More Susceptible to Bullying
A child with more than one brother or sister is more likely to be the victim of sibling bullying than those with only one sibling, and firstborn children and older brothers tend to be the perpetrators, according to research published by the American Psychological Association.
“Sibling bullying is the most frequent form of family violence and it is often seen as a normal part of growing up by parents and health professionals, but there is increasing evidence that it can have long-term consequences, like increased loneliness, delinquency and mental health problems,” said Dieter Wolke, PhD, of the University of Warwick and lead author of the study. It was published in the journal Developmental Psychology.
Wolke and his co-author, Slava Dantchev, B.Sc., also of the University of Warwick, wanted to understand the underlying causes of sibling bullying and examined the possible impact of family structure, parenting behaviors, early social experiences and a child’s temperament.
The researchers analyzed data from a longitudinal study of 6,838 British children born in either 1991 or 1992 and their mothers. They defined sibling bullying as psychological abuse (e.g., saying nasty or hurtful things), physical abuse (e.g., hitting, kicking or pushing) or emotional abuse (e.g., ignoring one’s sibling, telling lies or spreading false rumors). The kids were put into four categories: victims, bully victims (defined as being both a perpetrator and victim of bullying), bullies or uninvolved.
When the children were 5 years old, their mothers reported how often the children were victims or perpetrators of bullying in the household. Sibling relations were analyzed two years later when the mothers were asked how much time the children spent engaging with their siblings on various activities, such as crafts or drawing. Several years later, at age 12, the children reported if they had been bullied by a sibling or if they had bullied a sibling within the previous six months. The boys and girls were also asked their ages when they first experienced sibling bullying and when they first bullied a sibling.
Researchers also collected family statistics from the mothers, including the number of children living in the household, the mother’s marital status, the family’s socioeconomic background, maternal mental health during and after pregnancy, parental conflicts, domestic violence and child abuse and the mother-child relations. They also assessed each child’s temperament, mental health, IQ and social/emotional intelligence at various points during their early years.
Approximately 28 percent of the children in the study were involved in sibling bullying and psychological abuse was the most common form. The majority of those children were found to be bully victims, meaning they bullied and were bullied, according to the study.
“Bullying occurs in situations where we cannot choose our peers, like in families,” said Wolke. “Siblings live in close quarters and the familiarity allows them to know what buttons to press to upset their brothers or sisters. This can go both ways and allows a child to be both a victim and a perpetrator of bullying.”
Family structure and gender were the strongest predictors of sibling bullying by middle childhood, according to the authors.
“Bullying was more likely to occur in families with three or more children and the eldest child or older brothers were more often the bullies,” said Dantchev. “Female children and younger children were more often targeted.”
Wolke and Dantchev believe bullying can happen in larger families because resources such as parental affection or attention and material goods are more limited.
“Despite our cultural differences, humans are still very biologically driven. A firstborn child will have their resources halved with the birth of a sibling, and even more so as more siblings are added to the family,” said Wolke. “This causes siblings to fight for those limited resources through dominance.”
Although the researchers investigated whether marital and socioeconomic status would be associated with more or less bullying, they did not find any evidence.
“Sibling bullying does not discriminate. It occurs in wealthy families just as much as lower-income families and it occurs in single-parent households just as much as two-parent households,” said Wolke.
These findings may be helpful to parents as they welcome new additions to their families, Wolke said.
“It will be important for parents to realize and understand that resource loss can affect an older child,” he said. “It is a good idea for parents to manage this from the beginning by spending quality time with their firstborn or older children and by involving them in caring for younger siblings.”
Article: “Trouble in the Nest: Antecedents of Sibling Bullying Victimization and Perpetration” by Slava Dantchev, B.Sc., and Dieter Wolke, PhD, University of Warwick. Developmental Psychology. Published online Feb. 14, 2019.
What Drives Racial and Ethnic Disparities in Prenatal Care for Expectant Mothers?
Prenatal care — health care for pregnant mothers — is one of the most commonly used forms of preventive health care among women of reproductive age. Prenatal care represents an important opportunity to detect, monitor, and address risky health conditions and behaviors among expectant mothers that can impact birth outcomes.
Both delayed prenatal care (i.e., care initiated after the first trimester of pregnancy) and inadequate prenatal care are associated with poor infant health outcomes such as low birth weight. Although researchers continue to debate precise causal effects, studies suggest that prenatal care brings important benefits — including reductions in maternal smoking, lower rates of preventable pregnancy complications like high blood pressure, and better management of the mother’s weight after giving birth. Furthermore, mothers who initiate care earlier are more likely to take their infants to well-baby visits after their babies are born.
As with other forms of healthcare, we see significant racial/ethnic disparities in access to and use of prenatal care. Although researchers have explored overall disparities in health outcomes rooted in differences in health insurance coverage, education, family income, and county-level poverty, more remains to be learned about how such factors affect various racial/ethnic inequalities.
Such knowledge is critical for achieving national public health goals and for addressing gaps in health outcomes for pregnant women. My research explores this area and can point to solutions that can improve and equalize health care for various groups of women and their children.
Disparities in First Trimester Initiation and Adequacy of Prenatal Care
My research quantifies how various factors contribute to gaps in prenatal care among non-Hispanic white, non-Hispanic black, and Hispanic women. By combining county-level U.S. Census data with rich data on children born in 2001 from the Early Childhood Longitudinal Study, I am able to pinpoint factors that typically cannot be considered simultaneously. For example, I can explore the effects of both maternal access to transportation and the availability of physicians in various counties.
My results reveal significant disparities among black, Hispanic, and white mothers in terms of the start of prenatal care in the first trimester of pregnancy. Although approximately 89 percent of whites initiate care during the first trimester, only 75 percent of black mothers and 79 percent of Hispanic mothers do so. Mothers from these groups also experience disparities in the adequacy of prenatal care they receive. Approximately 79 percent of non-Hispanic whites experience at least adequate prenatal care, while only 68 percent of Hispanic mothers and 69 percent of black mothers receive adequate care. What explains these differences? Here are the key findings from my research:
Socioeconomic characteristics like education, family income, and participation in the Special Supplemental Nutrition Program for Women, Infants, and Children explain far more of the racial/ethnic gaps in prenatal care than any other factors. These factors explain over half of black–white disparities and nearly half of Hispanic–white disparities in first trimester prenatal care initiation. Socioeconomic characteristics also explain far more of the racial/ethnic gaps in prenatal care adequacy than any other group of factors (although these factors account for considerably more of the black-white gap than the Hispanic-white gap).
Maternal health and characteristics of pregnancies (such as maternal age and number of previous pregnancies) explain 8.8 percent of black-white differences and 8.7 – 9.7 percent of Hispanic–white differences in the timing of the start of care in the first trimester. But differences in the adequacy of care are not related to maternal health or pregnancy characteristics.
Types of insurance coverage – whether women are covered by Medicaid, private insurance, or have no coverage — explain similar small percentages of differences in the timing of first trimester care, but again do not account for gaps in the adequacy of care.
The location of prenatal care facilities – in physicians’ offices and public health clinics — explained 4.7-6 percent of black–white gaps in timing of the start of care and 2.9-4.9 percent of Hispanic–white disparities. Location of care explained about 8.3 percent of black–white gaps in the adequacy of care but did not explain Hispanic-white gaps.
Maternal behaviors like smoking and state of residence and count-level conditions did not significantly contribute to racial and ethnic disparities in the initiation of prenatal care. But the availability of local gynecologists and state of residence did help to narrow black–white gaps in the adequacy of prenatal care, although these factors did not influence gaps in the adequacy of care between Hispanics and whites.
Addressing Socioeconomic Factors to Improve Prenatal Health
My research suggests that large and persistent socioeconomic disparities are primary contributors to racial/ethnic gaps in the timing and adequacy of prenatal care. This finding is not surprising — pregnant women with lower incomes and levels of formal education often do not have the resources necessary to obtain care early and often. However, participation in the Special Supplemental Nutrition Program for Women, Infants, and Children made a difference for pregnant women, suggesting that this public program can help meet the financial needs that remain an important barrier to timely and adequate prenatal care.
My findings suggest that policymakers should endeavor to help disadvantaged populations gain expanded access to healthcare. Medicaid expansions through the 2010 Affordable Care Act provide one promising intervention. Although such expansions target childless poor and near-poor adults, women who receive coverage prior to pregnancy can end up enrolling earlier in prenatal care; and they can obtain continuing help with the management of chronic health problems, potentially improving outcomes when their babies are born.
Ultimately, as my research shows, reducing economic inequality may help to close racial and ethnic disparities in prenatal care. Read more in Tiffany L. Green, “Unpacking Racial/Ethnic Disparities in Prenatal Care Use: The Role of Individual-, Household-, and Area-Level Characteristics,” Journal of Women’s Health 27, no.9 (2018).
Dilemmas and Solutions for Americans Raising Children While Caring for Elderly Family Members
Approximately half of middle-aged people in American provide financial, health, or emotional support for adult parents and minor or adult children. The term “sandwich generation caregiver” emerged in the 1980’s to describe middle-aged people who support minor children while providing physical, emotional, financial, or legal assistance to adults. Of course, doing so much exacts personal costs. Sandwich generation caregivers often experience stress-related illnesses, lost income, and decreased work productivity. They also find it harder to provide prolonged assistance to adult children.
Historically, caregiving could be shared by extended family members who lived in close proximity. Now more people relocate for career opportunities. Younger people may do senior care at a long-distance, or aging parents may move closer to one of their adult children and increase the burden on that family.
Caregivers who are employed full-time and taking care of multiple family members must adjust their work schedule and often take unpaid leave to fulfill obligations. They may lose Social Security and pension benefits or experience stressful financial strains that can cause them to become ill. Very often, sandwich generation caregivers choose to attend to the health of a child or parent and neglect their own health. Poor caregiver health is becoming a public health issue.
Sandwich generation caregivers also face barriers in the workplace and increase the cost of health care for employers. Health care costs for caregivers are approximately $13.4 billion greater than for employees that do not have caregiving responsibilities. Working caregivers may have a hard time juggling the crushing time demands of work and caregiving; and they may pass up promotions, decrease work hours, and take unpaid leave because they have depleted paid vacation and sick days.
Caregiver absences cost the U.S. economy $25.2 billion annually in productivity; and workers often quit jobs, lose lifetime wages, retirement savings, and pension benefits. Less than half of U.S. employers offer flexible schedules or the opportunity to telecommute to accommodate caregiving tasks.
Guilt and Exhaustion
Sandwich generation caregivers at the same time express guilt that they are not doing enough – and say they feel exhausted from doing too much. Guilt and exhaustion about how caregiving affects their children is a perpetual undercurrent of stress that affects their own health. In one of my research interviews, Sophie said “I was a single mom at the time…[my kids] really needed me here and then it would be my night to go shower mom and put her to bed… I’d cry sometimes all the way there and then I’d get there and Mom would be sitting there, facing the wall …and then on the way home you’d cry because…how could I think that I didn’t need to be there.” And in another interview, Ellie explained that she felt “…sometimes it’s almost like a ball and chain and then I think, “What am I teaching my kids… I want them to have the freedom to live their life without feeling obligated to take care of me someday. And sometimes I wonder how strong a message I’m sending in that regard.”
Self-Care Helps Caregivers Cope – and Jobs Can Too
Parenting and caregiving are both consuming roles – yet many caregivers understand that they still need to take care of themselves because otherwise the pressure or anxiety can be overwhelming. Self-care takes many different forms for sandwich generation caregivers: leisure, exercise, and socializing.
Abby, for instance, told me that even during the hardest part of her caregiving experience she still did Friday night dinner and cards with her husband and friends, took her Tuesday golf outing and walked her dog daily. Abby realized that carving out time for herself helped her stay healthy and not resent taking care of her dad. Similarly, at the beginning of our interview, Zach, said he “was not the type of person to feel guilty” about taking time for himself. He incorporated his kids into his coping strategies by going for long walks with them.
Not only do most sandwich generation caregivers need the wages and benefits that work provides, they also need a break from caregiving. Work sometimes offers a “guilt-free” break, allowing them to feel productive and serving as either a social outlet or a place for solitude, as two interviewees explained:
- Chloe stated that caregiving was mentally and physically exhausting. She admitted that it was hard to not feel guilty about taking time for herself but she had a “wake up call” during a physical when her cholesterol and blood sugar were elevated. She allowed herself to relax and socialize during her quarterly conference for work.
- Leah believed the hardest part of being a parent, caregiver, and professor was that she was “always surrounded.” Leah said that she didn’t take any time for herself. She felt she had to work to make up for the “hole” she put her family in to earn her degree but then she revealed that being in her office at work was like a “retreat”. She could play music and work at the computer and just be by herself while she graded papers and worked on her research.
What Employers Can Do
Employee assistance programs, flexible schedules, and telecommuting options can reduce some of the stress sandwich generation caregivers experience. Such employees often miss work due to caregiving tasks and their own poor health as a result of stress. They may not have the time to practice preventative health habits and coping strategies, and some develop cardiac, psychological, and chronic illnesses. Employee assistance programs can reduce such problems, to the benefit of all concerned. Employers can, for starters, create a supportive environment for caregivers and help them to seek and utilize institutional and community resources.
In some cases, flexible schedules and telecommuting may allow caregiver workers to maintain their job productivity and prevent valued employees from having to reduce work hours or quit altogether. Employers and fellow employees should also realize that for some caregiver workers time at the office can also act as a coping strategy because it offers a physical and emotional break. This should not be seen as a problem. When caregivers practice self-care, they are healthier – and can be more productive even as they balance the complex demands of their work and family responsibilities.
Smartphones Help UB Researcher Better Understand the Nature of Depression and Anxiety
Decades of research into anxiety and depression have resulted in the development of models that help explain the causes and...
Enhancing Education with Digital Tools in the Classroom
Especially now, with the rise of technology in the classroom, teachers have practically unlimited methods for teaching, assigning, and grading...
Brick and Mortar Stores and Their Potential Demise
Earlier this year, Business Insider reported almost 4,000 stores in the United States will close. Among those were giant corporate...
How the Internet and Social Media Is Impacting Social Work
Social media and the Internet, in general, have had an immense effect on social work. It enables communication between people...
Virtual Crisis Intervention: Wave of the Future?
Crisis intervention, once primarily delivered over the phone is increasingly being delivered through the computer and via text. Social Workers...