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.
How to Support Foster Children
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.
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.
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.
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,
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.
Systems Perspective and the Myth of the Self-Made Man
As a social worker, we spend a good deal of time looking at systems, and systems work means we can’t only focus on what’s “wrong” with the individual in our office. Our focus can’t simply be what can this person do to move toward more emotional happiness? We need to always be considering how living in the world and engaging in relationships with other systems and other people play a large role in what this client does, how they think, and how they feel.
My job isn’t to just locate the unhelpful belief my client has about their self-esteem or retrain how they respond to a negative thought. When doing systemic work—even with just one person—I need to look at how race, ethnicity, age, sexuality, and gender play a role in my client’s life. I need to look at how that client’s family system, school system, government system, community systems, and more played a role in shaping my client.
As basic as this is, it’s important to note that It’s a fairly un-American way of going about things.
The Big Lie of Individualism
We’re taught that we should hold up the self-made man. We celebrate that guy to no end in movies, plays, songs, and stories. It’s our enduring myth.
We, social workers, see the monstrosity in that idea—pleasant and attractive though it is. We know that human beings can only grow and thrive within relationships, not apart from them. We know that nothing is self-made. We know that we are working from day one of life to attach to others.
We need to push back on the “self-made man” myth because it’s racist. It’s sexist. It’s heteronormative.
And it’s killing us.
And since I work mostly with men I want to be very direct because it’s literally killing us as the suicide rate for men is incredibly high: five times greater than for women. And we apply words like “strong” and “hard” when we’re describing masculinity? Something is missing. The weaker sex, the special snowflakes, are the ones who are supposed to need help. Not us.
Social workers disagree about many things and we have lots of ways we think are the best way to help any given client, but one thing we can all agree on when it comes to healing is that the relationship does a great deal of the work. It can begin to heal trauma, mental illness, and the “worried well.” It’s the way in, it’s the way through, and it’s the way out of suffering. It’s not the only thing, but it’s part of everything. Death is in the separateness, the lack of relationship.
And name your –ism because that’s about separateness too. We can’t fully heal a white person without moving through white supremacy together and we can’t help men without addressing the patriarchy. We may not call it out or by these names, but to connect with someone in their suffering is to refuse white supremacy and masculinity.
We need to keep doing what we’re doing, but we need to go further. We’re healing the people without healing the system and we can only thrive so much within a sick system.
Moving Ourselves Toward an Ego Dystonic State With the World
In a mental health session, our work is often to connect our client with other people. Often this happens through the therapeutic relationship with us first, but ultimately, it’s done so they can connect with the other people in their life. Doing this on an individual level is important, and as difficult as it is (and it is difficult), it’s really the bare bones of our work. Because what we’re doing, if we stop there, is helping people build up coping strategies to survive in a broken system.
So we have to stop and ask ourselves if in our work we are challenging the system that our clients live in and, not for nothing, that we’re living in too. Now, this can be a controversial stance for some people. It sounds “agenda-driven” and done unskillfully it is just that. But for those who feel they are thriving in this patriarchal, white supremacist world, do we have any choice, ethically, but to aid them in shifting their lens?
For too many of us, we have come to see this world as ego syntonic and we need to push toward discomfort in ourselves to see the world as it is. And that will move us toward change.
A Child Welfare Example
Let me take my work in child welfare as an example. Most of the parents I’ve worked with over the years are well-meaning and loving people. Many of them are involved in child welfare because they had hit their children in order to discipline them. Many of them feel this is ok. Many of the child welfare workers think it’s ok to physically discipline a child. We even have different words so we separate “abuse” from “physical discipline” and we jump through hoops to try to define “excessive corporal punishment” as separate from “physical discipline”. Many parents have no hesitation telling me that when their child gets out of line they need a slap, a spanking, a something that lets them understand limits, but that this is discipline and not abuse.
And in the course of this conversation, I usually hear the inevitable, “It happened to me and I turned out ok.”
And right there is the thing that I’m talking about with these systems. You “turned out” in such a way that you think it’s ok to hit a child, your child. And this is the proof that you didn’t turn out as “ok” as you think. You grew up with something violent being normalized.
But that’s our society. That’s the society that collectively calls sexual assault “locker room talk” and elects a president. That’s the society where powerful, talented men are allowed to produce and direct movies for years without consequence for their sexually abusive behavior.
Systems work is helping people see that things they take for granted could be wrong. Knowing
- That there are not simply two genders.
- That race is not encoded in our DNA.
- That women are not genetically more nurturing.
- That there are no such things as boy and girl toys.
Knowing all that means we have to fundamentally shift our way of thinking, our way of feeling, our way of living—day to day—in this world. And we may need to fundamentally, though not radically, change the way we approach therapy.
Merging the Therapist and the Advocate
Great things can come from our work with individuals, couples, and families. We can support people in relieving a lot of pain and finding healthier ways to interact. We move people through trauma, out of depression and anxiety, and to better navigate relationships. We help people live within our broken world—which is no small feat. Part of our happiness can only come by becoming more open to uncertainty which is all we really can be certain about.
But can we do more or does our job end there?
I believe we can. Not by “pushing an agenda” or preaching, but by becoming grounded in a strong analysis of the patriarchy, in racism, and in anti-oppressive work. With this analysis, we understand ourselves differently and we understand others in a new way. We see more easily how reactive our clients can be while not realizing they’re being reactive. We are so skilled at reaching for feelings or for picking out the latent content. We see through all of the mental healthy stuff, and we bring it into our work. But, we can see through the racism, the gender norms, the patriarchy, the homophobia and bring that into the work as well? The stronger we are in our own analysis the more able we are to help clients see when they’re reacting to a system instead of their own desires or someone else’s needs.
Most of us just aren’t so good at doing it yet. So many of us separate this work: “I’m a therapist in the office, and I’m an activist when I’m outside.”
That’s great. It is. But we need to find a way to merge the two. To make them inseparable.
Can we repair an airplane while we’re flying it? Can we change our systems while living in them?
Well, first off, we have no choice. We can’t step outside of it because it’s the air we breathe.
With everyone we meet, whether client, friend, lover, or family we need to be grounded in our awareness. We need to support the people we care about, our clients or otherwise, and do all the great engagement and interventions we learned in social work school and beyond—but we have to have an eye on the system. The system they’re in. The one we’re in. The whole shebang.
We need to not preach. We need not be so agenda driven that we miss the humanity of the client or clients sitting in our offices and their suffering. Our need to end the patriarchy cannot be at an individual client’s expense, of course!
But in session and out, we need to be on the lookout for moments to open our own and others’ eyes to the sickness that we are living in. The sickness that lies and says this is the only way to be.
Head Start May Protect Against Foster Care Placement
Participating in Head Start may help prevent young children from being placed in foster care, finds a national study led by a Michigan State University researcher.
Kids up to age 5 in the federal government’s preschool program were 93 percent less likely to end up in foster care than kids in the child welfare system who had no type of early care and education, said Sacha Klein, MSU assistant professor of social work.
Klein and colleagues examined multiple forms of early care and education – from daycare with a family member to more structured programs – and found Head Start was the only one to guard against foster care placement.
“The findings seem to add to what we already know about the benefits of Head Start,” Klein said. “This new evidence suggests Head Start not only helps kids develop and allows parents to go to work, but it may also help at-risk kids from ending up in the foster care system.”
Klein and colleagues studied the national survey data of nearly 2,000 families in which a child had entered the child welfare system for suspicion of abuse or neglect. Those children were either pulled from the home or were being overseen by a caseworker.
Klein said Head Start may protect against foster care because of its focus on the entire family. Services go beyond providing preschool education to include supporting parental goals such as housing stability, continued education and financial security.
There are more than 400,000 children in foster care in the United States, about a third of them under the age of 5, according to the most recent report from the U.S. Department of Health and Human Services. All children in foster care automatically qualify for free Head Start services, regardless of income level.
Klein said the findings suggest policymakers should consider making all children in the child welfare system, including those living at home, automatically eligible for Head Start. That could help prevent more kids from ending up in foster care.
While foster care can be a vital resource for protecting children from abusive and neglectful parents, it is rarely a panacea for young kids, the study notes.
“Indeed, young children who are placed in foster care often have compromised socio-emotional, language and cognitive development and poor early academic and health outcomes,” the authors write. “Trauma and deprivation experienced before removal may largely drive these developmental deficits, but foster care often fails to alleviate them and sometimes can worsen them.”
Klein’s co-authors are Lauren Fries of MSU and Mary Emmons of Children’s Institute Inc. in Los Angeles.
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