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Child Welfare

Tending the Caregivers

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Mothers who work as healthcare professionals – physicians, physician assistants and nurse practitioners – can significantly reduce their stress levels and burnout by participating in close supportive groups at work, according to a new study by researchers at Arizona State University and the Mayo Clinic. The shared experiences in these support groups provide a wealth of nurturance for the women.

The study, “Fostering resilience among mothers under stress: ‘Authentic Connections Groups’ for medical professionals,” is published in the current issue of Women’s Health Issues.

Groups in the intervention provided “comfort, solace and advice as needed, building what some called a ‘secret sisterhood’ of shared experiences with genuineness and reciprocity in the relationship,” said Suniya Luthar, a Foundation professor of psychology at ASU and the lead author of the study. “These factors help build resilience for professional mothers who are under great daily stress, with substantial dual demands at work and at home.”

Senior co-author and collaborator on the project was Dr. Cynthia Stonnington, associate professor and chair of psychiatry at the Mayo Clinic College of Medicine, Arizona. Other authors of the paper are Alexandria Curlee, an ASU graduate student; Susannah Tye, Department of Psychiatry and Psychology at the Mayo Clinic, Minnesota; and Judith Engelman, a psychiatrist in private practice.

“Women medical professionals who are mothers often face the dual role of being the primary caregiver both for their patients and their children,” said Stonnington. “This puts them at higher risk for burnout than their male counterparts. Our study investigated how this supportive program might help mitigate stresses and promote their day-to-day health and well-being.”

The Authentic Connections Groups (ACG) intervention involved weekly sessions at work over a three-month period. The researchers randomly assigned 40 women at Mayo to one of two groups: either the 12 weekly one-hour sessions of the ACG’s or 12 weekly hours of protected time to be used as desired. The study was supported by a Seed fund from Arizona State University to Luthar, and the Mayo Clinic contributed release time to participate.

The study had several positive results.

It showed that those who participated in the ACGs had significantly greater reductions in depression and other global symptoms of stress than those given free time (the control group). Secondly, relative gains were still more pronounced three months after the program ended. Follow-up assessments showed significant between-group differences not only on depression and stress, but also on almost all other central variables, including parenting stress, self-compassion, feeling loved and physical affection. Participants in the ACGs also showed more reductions than control moms in cortisol levels (a biochemical indicator of stress) at both post intervention and three months follow up.

In explaining why this program worked, Luthar said that, in essence, the ACGs actively and continually fostered the development of close, mutually supportive relationships, and the resulting shared experiences and bonding helped to lower participants’ stress levels.

“Resilience research clearly shows the critical protective power of reliable close relationships,” Luthar said. “In this program, our focus was on developing and strengthening what we called ‘go-to’ committees for each woman. As topics were shared in the weekly group sessions over time, the moms each also shared them with their respective go-to’s. By the end of three months, each woman had developed great closeness not only with other moms in their work setting but also with at least two or three other women in their personal lives.”

A critical factor in enabling this effort was the institutional commitment to wellness. Stonnington reported that the ACG program was implemented as part of an initiative begun in 2015 at the Mayo Clinic in Arizona to address burnout and turnover among female physicians.

“Another major reason for the success of this program is that the groups were implemented in the women’s everyday settings, during their regular work-days,” said Luthar. “That the Mayo administration gave them the one hour per week free time to participate was a critical consideration, given how very packed these women’s schedules can be.”

The U.S. Surgeon General recently stated that efforts to promote the well being of medical professionals must become a major priority among health care organizations. This study demonstrates that facilitated colleague support groups can provide a viable, low-cost preventive way to mitigate burnout among women medical professionals who are also mothers.

More broadly, the authors note that the ACG program has the potential to be widely used in workplace wellness programs, given the high cost of worker stress and depression in contemporary America. Since completion of the Mayo project, Luthar and colleagues have successfully completed groups with military mothers, and are now offering it to women in the STEM (science, technology, engineering, and mathematics) disciplines, with both new projects implemented at ASU.

“It is our hope that over time, the ACG program will come to benefit women, mothers, and other adults in salient caregiving roles, as they routinely give so much of themselves to others while experiencing high everyday stress,” Luthar said. “It just makes common sense. Those who serve as first-responders, and who offer so much tending for many others, must themselves be tended – with this happening on a reliable and ongoing basis.”

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Child Welfare

Exposure to Domestic Violence Costs U.S. Government $55 Billion Each Year

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The federal government spends an estimated $55 billion annually on dealing with the effects of childhood exposure to domestic violence, according to new research by social scientists at Case Western Reserve University.

The results of a study on the national economic impact of exposure to domestic violence—published in The Journal of Family Violence—showed higher health-care costs, higher crime rates and lower productivity in children as they aged.

“This is a significant public-health problem that not only means long-term consequences for these children, but also imposes a substantial financial burden to society,” said Megan R. Holmes, assistant professor and founding director of the Center on Trauma and Adversity at the Jack, Joseph and Morton Mandel School of Applied Social Sciences.

The Centers for Disease Control (CDC) defines intimate partner violence—more commonly known as domestic violence—as any physical violence, sexual violence, stalking and/or psychological aggression perpetrated by a current or former intimate partner.

In the United States, an estimated 15.5 million children each year are exposed to at least one episode of intimate partner violence, with more than 25 percent of children exposed to domestic violence in their lifetime.

The CDC’s National Intimate Partner and Sexual Violence Survey reports that 27.3 percent of women and more than one in 10 men (11.5 percent) have experienced physical violence, sexual violence or stalking by intimate partners at least once in their lives.

Married or cohabiting couples who have children are reported to experience the highest likelihood of domestic violence.

By the time a child exposed to domestic violence reaches age 64, the average cost to the national economy over their lifetime will reach nearly $50,000 across the following main categories, according to the research.

  • Health care: Estimated effects of domestic violence exposure on the use of hospital care and physician and clinical services.
  • Crime: The estimated effect of domestic violence exposure on the lifetime likelihood of violent crime: murder, rape/sexual assault, aggravated assault, robbery.
  • Productivity: The productivity effects of domestic violence exposure stem from a connection to lower educational attainment. Using estimates for the age-specific effects of education on worker earnings, the study calculated the expected earnings detriment associated with exposure to domestic violence.

That includes at least $11,042 in increased medical costs, $13,922 in costs associated with violent crimes and $25,531 in productivity losses.

“And that’s just for one person,” Holmes said. “If we consider Ohio’s young adults, for example, the 172,500 Ohioans who are 20 years old, the cumulative lifetime cost for the estimated 25 percent who were exposed to domestic violence as children will be nearly $2.18 billion. Applied to the entire nation, the economic burden becomes substantial—over $55 billion.”

She said the effects of children’s exposure to domestic violence carry long-lasting consequences—and society picks up the tab.

While much research has been conducted on the effect of domestic violence exposure on short- and long-term outcomes, this is the first study to add a price tag to this public health problem.

“Although we researchers often use words like ‘ground-breaking’ to describe our work, few studies really meet that bar,” said Rebecca J. Macy, editor-in-chief of The Journal of Family Violence and associate dean for academic affairs in the University of North Carolina School of Social Work.

“With their study on the economic burden of children’s exposure to partner violence however, Prof. Holmes and her colleagues have really produced a groundbreaking study.”

By understanding the extent of the costs incurred, policymakers can now reference the economics to push for more effective preventive and therapeutic interventions, Holmes added.

The study was done in coordination with Francisca García-Cobián Richter, research assistant professor; Kristen Berg and Anna Bender, both doctoral candidates, at the Mandel School; and Mark Votruba, associate professor of economics, at the Weatherhead School of Management.

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Child Welfare

Getting Care Right for All Children – Free Online Course

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Join over 5,000 learners from across 172 countries who now understand just how important the UN Guidelines for the Alternative Care of Children are when caring and protecting vulnerable children.

Now is your chance to register to be part of this FREE global online course. Starting on 19 February, it is open to everyone who is interested in or responsible for children’s care and protection.

It only takes a maximum of 4 hours a week to take part in this six-week truly interactive course. Allowing you to learn wherever and whenever it suits you.

By the end of it, you’ll better understand the key principals, pillars and implications of the UN Guidelines. You’ll also connect and learn from people throughout the world.

What to expect?

During this course, you’ll have access to a mixture of learning materials including:

  • A film following a family moving through the care system.
  • Filmed lectures, articles and reports from world leading experts.
  • Online discussions to debate, ask questions and share opinions.
  • Quizzes.

Commissioned by leading international agencies, the course is run by CELCIS and delivered through FutureLearn, the digital education platform.

Course materials delivered in English, with some course materials available in French and Spanish. Don’t miss your chance to take part!

This course is designed for practitioners and policymakers from both state and non-state bodies (such as NGOs, CBOs and private service providers) and anyone working in providing services around children’s care.

This might include social workers, para-social workers, community support workers, lawyers, psychologists, child protection professionals, teachers, medical workers and care workers, including those in family-based and residential settings.

The course will also be accessible for people not working directly in this field and others with an interest or responsibility in the field of child protection and child care.

The course will be conducted in English with some course materials (including text and videos) also accessible in Spanish and French, reflecting the truly global nature of this issue.

What previous participants said:

‘I really enjoyed this course and gained a lot from what has been shared in articles, videos and other learners’ posts. This has already impacted my work.’ – Participant from Togo

‘I have learned so much about what happens in other countries around the world. I will continue to reflect on my current practice.’ – Participant from Swaziland

To get access to this free resources, sign up here.

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Child Welfare

Tracking the Impact of Early Abuse and Neglect

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Children who experience abuse and neglect early in life are more likely to have problems in social relationships and underachieve academically as adults.

Maltreatment experienced before age 5 can have negative effects that continue to be seen nearly three decades later, according to a new study led by Lee Raby, an assistant professor of psychology at the University of Utah.

“It is not a controversial statement to say abuse and neglect can have harmful consequences,” Raby said. “This study adds to that by showing that these effects are long term and don’t weaken with time. They persist from childhood across adolescence and into adulthood.”

The journal Child Development published the study. Co-authors are: Glenn I. Roisman and Madelyn H. Labella, Institute of Child Development, University of Minnesota; Jodi Martin, Department of Psychology, York University; R. Chris Fraley, Department of Psychology, University of Illinois at Urbana-Champaign; and Jeffry A. Simpson, Department of Psychology, University of Minnesota.

Raby said his team wanted to know two things: Does maltreatment early in life have long-term associations that extend into adulthood and do those effects remain stable or weaken over time?

The researchers used data from the Minnesota Longitudinal Study of Risk and Adaptation, which has followed participants since their births in the mid-1970s. The U study looked at data on 267 individuals who had reached ages between 32 and 34.

Information about the participants’ exposure to physical abuse, sexual abuse and neglect was gathered from multiple sources during two age periods: 0-5 years and 6-17.5 years. Throughout childhood and adolescence, teachers reported on the children’s functioning with peers. The children also completed standardized tests on academic achievement. The participants were interviewed again during their 20s and 30s, during which they discussed romantic experiences and educational attainment.

Unlike studies based on adults’ retrospective accounts of their childhood experiences, the data used here were collected in real-time. In addition, because data on the participants has been collected throughout their lifetimes, the researchers were able to disentangle the effects of maltreatment that occurred in their early years from experiences of abuse and neglect during later childhood.

“The design allows us to ask our two questions in a way no other study has before,” Raby said.

Raby said the findings showed those who experienced abuse or neglect early in life consistently were less successful in their social relationships and academic performance during childhood, adolescence and even during adulthood. The effects of maltreatment did not weaken as the participants got older.

“The harmful effect of early abuse and neglect was just as important when we were looking at outcomes at age 32 years as when we looked at outcomes at age 5,” he said.

The researchers found abuse and neglect in later childhood also impacted these competencies in adulthood, but that later maltreatment did not fully account for persistent and long-term influences attributed to abuse and neglect experienced in early childhood. They also found long-term difficulties with social functioning — but not academic achievement — occurred independent of such factors as gender, ethnicity and early socioeconomic status.

“These findings add more evidence for the importance of identifying high-risk families and attempting to intervene before experiences of abuse and neglect occur,” Raby said.

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Child Welfare

Bipartisan Task Force Hosts Discussion on Effects of the Opioid Epidemic on the Child Welfare System

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The Congressional Caucus on Foster Youth and the Bipartisan Heroin Task Force teamed up to host a dinner highlighting the effects that the opioid epidemic has had on the country’s child welfare system. This epidemic has impacted countless lives throughout the country and has already had a specifically insidious impact on children.

“The opioid crisis is devastating families and our already over-burdened child welfare system,” said Rep. Karen Bass, Co-chair of the Congressional Caucus on Foster Youth. “We have learned so much from the crack cocaine epidemic and how it affected those in the child welfare system. Now, we have to apply those lessons to the epidemic at hand. Last night’s bipartisan dinner was a step in that direction and I look forward to working with my colleagues in both caucuses that participated tonight on this incredibly important issue.”

More than 20 Members of Congress from the two caucuses came together Tuesday night to work with experts — individuals who grew up in the child welfare system and individuals who have dedicated their life’s work to children in the child welfare system — to identify tangible ways Congress could assist the overflowing child welfare system and also take meaningful action in bringing this epidemic to an end.

“I was pleased to join my colleagues last night at a bipartisan dinner that addressed our country’s opioid epidemic,” said Rep. Marino, Co-chair of the Congressional Caucus on Foster Youth. “This epidemic has affected countless children in the foster care system and it is up to Congress to come together to find a solution to end this horrible tragedy in our nation. I look forward to having more productive discussions on this issue and will continue to work tirelessly with Congress to ensure that our children are protected from this crisis.”

Ideas presented ranged from reforming law enforcement’s ability to respond to on-scene overdoses, to overhauling relapse protocol in court orders, to creating an entire cabinet position to address the issue of drug epidemics in our country. Experts and Members were quick to caution that there will be no one quick fix to this expansive issue, but agreed that conversations like the one held last night will bring us closer to a better future for these communities affected by this epidemic.

“The opioid epidemic has had a devastating impact on communities in New Hampshire and across the country,” said Congresswoman Kuster, the founder and co-chair of the Bipartisan Heroin Task Force. “That impact has been acutely felt by families and children who so often bear the brunt of substance use disorder. I’m pleased that the Bipartisan Heroin Task Force and the Congressional Caucus on Foster Youth have come together for this constructive conversation about how we can better support children as we take on the opioid crisis.”

“The opioid epidemic continues to destroy communities and families across my home state of New Jersey and throughout our nation,” said Republican Chairman of the Bipartisan Heroin Task Force, Congressman MacArthur. “More and more children are ending up in foster care because of this crisis and straining our already burdened child welfare system.  I’ll continue to work with my colleagues on the Bipartisan Heroin Task Force and the Congressional Caucus on Foster Youth to combat the opioid crisis and help children impacted by it.”

The dinner featured three panelists, all of whom have been directly impacted by the child welfare system, addiction or both. Linda Watts serves as the Acting Commissioner for the West Virginia Department of Health and Human Resources and provided detailed analysis regarding her work at both an administrative level as well as in the field.

Angelique Salizan is a former foster youth who is currently serving as a legislative correspondent in United States Senator Sherrod Brown’s D.C. office and a part-time consultant for the Capacity Building Center for States, an initiative of the Children’s Bureau. China Krys Darrington has been a trainer for the Ohio Child Welfare Training Program since 2010 and a provider of Recovery Support Services through XIX Recovery Support Services since 2007.

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Child Welfare

How to Support Foster Children

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When you choose to become a foster carer the rewards can be great. Supporting a child through a difficult period in their life, watching them grow and develop into a well-rounded individual; it’s understandable why so many choose to pursue this worthwhile vocation.

However, as with any profession, it does come with some downsides. Primarily helping some children to cope with the trauma and stress that being in foster care can evoke.

So, how can you best support a foster child in a meaningful way? One that will be beneficial to the both of you.

Listen

Feeling like the most overlooked member of society can have a damaging and long-lasting effect on foster children. Meaning that the simple act of offering them an ear to vent their worries, experiences or anything at all can be extremely positive. It establishes you as a point of reason in their life.

You can’t always solve the issues that are brought up during these moments. Nor should you try, but it is worthwhile simply being there to hear. Because, at the end of the day, your foster children deserve to be listened to.

Celebrate

Birthdays. Christmas. Halloween. Important events can often go overlooked as a foster child. So, taking the chance as a foster parent to celebrate these milestones – no matter how little or big – can be the change that a child needs. Simple things such as helping put up a Christmas tree could be a moment they will remember for a long time to come.

And at the end of the day events like Halloween and Birthdays are fun – something every child needs a little more of in their lives.

Playdates

Your support is vital, but often the support of peers can also be invaluable for the wellbeing of those children in foster care. Setting up playdates – even for older children – can be a great way to help them interact and enjoy time with children their own age.

Older children or teens may be unreceptive to you making playdates for them. But, arranging ‘coincidences’ of kids their age coming over can always be an alternative solution. What they don’t know…

This can also be beneficial for any of your own children that may also be in the house. A disgruntled foster child can be a distressing presence in the home, so balancing this out with a familiar friend and playmate is often needed to offset this. All of the children in your home can benefit from socialising with others both in and outside your own home at times,

Getaway

Sometimes life can get a little too much when you are forced to come and go through a number of foster homes, which is a reality for many foster children. A day out – not even an expensive day out or holiday – can be a bright spot in an otherwise overcast moment in their lives. The zoo, beach, museum and even the park can be an adventure.

It’s not always clear what a child is going through, nor will they always express their emotions in healthy ways. Removing them from the environment which creates these feelings can be a relief in many cases.

Help with School

On average, foster children tend to do worse academically and behaviour wise in school than other children. The reasons are often self-explanatory, but it is something which you can positively influence whilst they are under your care.

Helping with homework, actively engaging with teachers over what you can do further to help and encouraging after-school activities are some ways to do this. Goals should be set, but ensure they are realistic and rewarded when surpassed.

Overall, being a foster parent is a big task but one that can bring so much enrichment to a child’s life. As a solid figure in their life, you can help ensure the rest of their life is more positive than the start. Supporting a foster child can be a challenge, but that makes it all the more rewarding when you see a positive effect on the life of a child.

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Child Welfare

Parental Medicaid Expansion Translates into Preventive Care for their Children

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When low-income parents enroll in Medicaid through the Affordable Care Act (ACA) state expansion program, their children have considerably better odds of receiving annual preventive care pediatrician visits, according to a new analysis by the University of Pittsburgh Graduate School of Public Health and Johns Hopkins University.

This “spillover effect,” explained in a study published online today and scheduled for the December issue of the journal Pediatrics, demonstrates that the potential benefits of Medicaid expansion extend beyond the newly covered adults.

“These findings are of great significance given the current uncertainty surrounding the future of the ACA and Medicaid expansions authorized by the law,” said senior author Eric T. Roberts, Ph.D., assistant professor in Pitt Public Health’s Department of Health Policy and Management. “Lawmakers crafting policy proposals that could curtail Medicaid benefits or eligibility should recognize that such efforts would not just limit the receipt of health care services by low-income adults, but also by their children.”

The ACA provided states the opportunity to expand Medicaid coverage to all low-income people at or below 138 percent of the federal poverty level. So far, 31 states and the District of Columbia have expanded Medicaid coverage.

Roberts and his colleagues identified 50,622 parent-child pairs from data collected in the 2001 through 2013 Medical Expenditure Panel Surveys, a nationally representative survey administered by the U.S. Department of Health & Human Services that includes detailed information on family structure and demographics, including health insurance status and health care use.

They discovered that children of parents who had recently enrolled in Medicaid had a 29 percent higher probability than children of unenrolled parents of receiving their well child visit, which is recommended annually for children age 3 and older, and more frequently for infants and toddlers.

During the visits, the children are examined for growth and development and given immunizations, and their caregivers are guided on proper nutrition and child behaviors. Studies have shown that children who get well child visits are more likely to receive all their immunizations and less likely to have avoidable hospitalizations. The U.S. has persistently low rates of well child visits, particularly in low-income families.

“There are many reasons that parental Medicaid coverage increases the likelihood of well child visits for their children,” said Roberts. “It could be that insurance enhances the parents’ ability to navigate the health care system for themselves and their children, increasing their comfort in scheduling well child visits. Medicaid enrollment could be a sort of ‘welcome mat,’ in which eligible but previously uninsured children are enrolled after their parents gain coverage. It also could be that parental Medicaid coverage frees up more money to provide preventive services to their children, because even copays can be a deterrent to medical care among low-income people.”

Maya Venkataramani, M.D., is lead author on this research, and Craig Evan Pollack, M.D., M.H.S., is a coauthor. Both are from the Johns Hopkins University School of Medicine.

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