If~ou would like mow information on the "Healthy Children Ready to Learn" Initiative, the Conference on "Healthy Children Ready to Learn: The Critical Role of l'arents." or the six Sational Education Goals, please contact one of the following agellcies: Department of Health and Human Services 200 Indeprlldcllre ;\\r.. s.\\- Department of Education 400 M:II+II~ .k., S.W. Washington, DC 20202 (202) 401-3000 National Governors' Association 444 N. Capitol St., S.W. Suite 250 Washington. DC 20001 (202) 624.iJOO Department of Agriculture 14th St. & Independence Ave.. S.IV. \Vashington. DC: 20250 (202) 520-259 I spedc out for America's Children --- 1 -ea.rlT -- The Critical Role of Parents February g-12,1992 * Administration for Children and Families, U.S. Department of Health and Human Services * Food and Nutrition Service, U.S. Department of Agriculture * Office of Elementary and Secondary Education, U.S. Department of Education * Health Care Financing Administration, Department of Health and Human Services * Intergovernmental Affairs Office Ir U.S. Public Health Service, Department of Health and Human Services or Alcohol, Drug Abuse, and Mental Health Administration Office for Substance Abuse Prevention * Centers for Disease Control National Center-for Chronic Disease Prevention and Health Promotion National Center for Environmental Health and Injury Control National Center for Prevention Services * Health Resources and Services Administration Bureau of Health Care Delivery and Assistance Maternal and Child Health Bureau * Indian Health Service * National Institutes of Health National Institute of Child Health and Human Development National Institute of Dental Research * Office of Disease Prevention and Health Promotion * Office of Population Affairs * * * * * * * * * * * * * * * * * * * * * * * Alliance to End Childhood Lead Poisoning American Academy of Pediatric Dentistry American Academy of Pediatrics American Association of Public Health Dentistry American Association of School Health American Dental Association American Dietetic Association American Medical Association American Nurses' Association American Public Health Association American Public Welfare Association American Red Cross American School Food Service Association Association for the Care of Children's Health Association of Maternal and Child Health Programs Association of State and Territorial Dental Directors Association of State and Territorial Health Officials Child Welfare League of America, Inc. Children's Action Network Federation for Children with Special Needs General Federation of Women's Clubs Girl Scouts of the U.S.A. Healthy Mothers/Healthy Babies Coalition * * * * * * * * * * * * * * * * * * * * * * Home and School Institute Institute for Educational Leadership La Leche League International March of Dimes Birth Defects Foundation National Association of Community Health Centers, Inc. National Association of Elementary School Principals National Association of Pediatric Nurse Associates and Practitioners National Association of Social Workers N.ational Association of WIC Directors National Center for Clinical Infant Programs National Center for Educational Statistics National Commission to Prevent Infant Mortality National Congress of American Indians National Dental Association National Head Start Association National Health/Education Consortium National Mental Health Association National Parent Network on Disabilities National Parent-Teachers Association National SAFE KIDS Campaign National Urban League Parent Action * Parents as Teachers National Center + Society for Nutrition Education jl- United Way of America Dedication The Critical Role of Parents T here are 64 million children in this country. When I was appointed to be Surgeon General, I vowed to speak for all of them-whether rich or poor, healthy or sick, whatever their race or ethnic background. To this end, nearly 2 years ago, I established the Healthy Children Ready to Learn Initiative. This Initiative, which focuses on the health aspects of school readiness, was born out of the President's first National Education Goal, that "By the year 2000, all children in America will start school ready to learn." As part of this Initiative, the Conference on Healthy Children Ready to Learn: The Critical Role ofParents was held here in Washington, DC, in February 1992. More than `700 people attended- health professionals and administrators, teachers, Government officials, and others involved in the health and well-being of our Nation's young people-but our guests of honor for this Conference were the approximately 225 parents who attended from each of the 50 States, the District of Columbia, and the U.S. Territories. Over the course of those 3 days, our time was spent listening to and learning from one another. We learned what worked; we were told what didn't. The Conference was unique in that the parents spoke from their hearts. They raised a collective voice that said, in effect, "As parents, we must stand up for our children and our families and see that our needs are met. We must do so with dignity, and we must demand respect when others try to rob us of our dignity." Parents who never knew that they could speak for others eloquently articulated the needs of children and families. Although these parents came to our Conference from all parts of the country and from all walks of life, they came with the same mission: to improve the lives of the children and the families'of this country. This proceedings document is dedicated to those parents who attended our Conference. We are proud of them and inspired by them. It is our sincere hope that what we learned in those 3 days is reflected honestly in these pages. This document will serve as a "guide" for the rest of us and as an inspiration to do what was asked. As I stated at the close of our Conference, `This Conference may be ending, but what we have accomplished is the beginning of a way of acting and thinking with families in mind." iv Parents Speak Out for America's Children We must care for our children. That responsibility does not belong to only one individual or entity or Government agency. What we learned at this Conference is thatwe are all responsible for all of the children. We must become advocates for one another and share our strengths. When President Bush outlined his six National Education Goals, he envisioned an America where our children can compete on an international level. He knew that the children of today are the explorers, the writers, the teachers, and the inventors of tomorrow. If we invest in their future today, we can ensure their growth and advancement for tomorrow. As Surgeon General, I will speak for you, the families of America. My voice and my office are at your service. I thank you from the bottom of my heart for your thoughts, your energies, and your heartfelt spirit. Surgeon General Report of the Surgeon General's Conference v Contents Dedication iv Executive Summary Chapter 1 * Introduction 13 Chapter 2 It Charge to the Conference, Antonia C. Novello, M.D., M.P.H., Surgeon General 19 Chapter 3 * Parents Speak Out: Summary of Parent Work Groups 27 National Consensus 30 Findings at a Glance 30 Awareness of and Entry into Health, Education, and Social Service Systems 32 Participation in Health, Education, and Social Service Systems 36 Transitions Through Health, Education, and Social Service Systems 39 Programs That Parents Grade At 43 Regional Issues 44 Region 1 44 Region 2 46 Region 3 48 Region 4 50 Region 5 52 Region 6 54 Region 7 56 Region 8 58 Regions 9 and 10 60 Native American Families 62 Migrant Families 64 Chapter 4 jr Presentation of Findings Parent Representatives Awareness of and Entry into Health, Education, and Social Service Systems Sherlita Reeves, Parent Delegate from Arkansas Participation in Health, Education, and Social Service Systems Ellie Valdez-Honeyman, Parent Delegatefiom Colorado Transitions Through Health, Education, and Social Service Systems Larry Bell, Parent Delepte from Delaware Responder Panel James 0. Mason, M.D., Assistant Secretary fo1 Health, U.S. Department of Health and Human Services 67 68 68 70 73 78 78 vi Parents Speak Out for America's Children John T. MacDonald, Ph.D., Assistant Secretary for Elementary and SecondaT Education, U.S. Department of Education Catherine Bertini, Assistant Secretaly for Food and Consumer Services, U.S. Department of Agriculture Wade Horn, Ph.D., Commissioner, Administration for Children, Youth and Families, U.S. Department of Health and Human Services Christine Nye, Director, Medicaid Bureau, Health Care Financing Administration Lou Enoff, Principal Deputy Administrator, Social Security Administration 80 82 86 88 90 Chapter 5 * Commitment of Our Leaders 93 George H. Bush, President of the United States 94 Louis W. Sullivan, M.D., Secretary of Health and Human Services 97 Edward Mad&an, Secretary of Agriculture 100 Lamar Alexander, Secretary of Education 103 Roger B. Porter, Ph.D., Assistant to the President for Economic and Domestic Policy 108 Chapter 6 * Panel Presentations Panel 1A: Early Childhood Issues That Affect School Readiness and Health Panel 1B: Helping Families Get Services: Some New Approaches Panel 2A: Healthy Children Ready to Learn: What Are the Roles of Parents, Educators, Health Professionals, and the Community? Panel 2B: Special Issues That Impact Children and Families: Substance Abuse, HIV, and Violence Panel 3A: Disabilities Panel 3B: Exploring Comprehensive Health and Education Models for Young Children Panel 4A: Children with Special Health Care Needs: Lessons Learned Panel 4B: Parenting: The Critical Role Panel 5A: Childcare: Two Perspectives Panel 5B: Healthy Start, Head Start, Even Start, and WIC: Integrating Health, Education, and Social Service Programs 111 112 115 116 120 122 125 127 130 134 136 Chapter 7 * Closing Remarks, Antonia C. Novello, M.D., M.P.H., Suqem General 139 Appendix A: Conference Participants A-l Appendix B: Advisory Group B-l Appendix C: Planning Committee C-l Appendix D: Agenda at a Glance D-l Appendix E: Facilitators and Recorders E-l Appendix F: Workshops F-l Appendix G: Exhibits Gl Appendix H: Entertainment H-l Report of the Surgeon General's Conference vii Executive summary Executive Summary 0 n February g-12,1992, in Washington, DC, Surgeon General Antonia Novello hosted the `Healthy Children Ready to Learn: The Critical Role of Parents" Conference, sponsored jointly by the National Gover- nors' Association, the Department of Health and Human Services, the Depart- ment of Education, and the Department of Agriculture. The S-day Conference was part of the Surgeon General's Healthy Children Ready to Learn Initiative, developed in support of the first of six National Education Goals established by President George Bush and our Nation's Governors in February 1990. This goal states, "By the year 2000, all children in America will start school ready to learn." At the Conference, approximately 225 parents, representing the 50 States, the District of Columbia, and the U.S. Territories, joined with more than 500 government officials and representatives from public and private health, educa- tion, and social service agencies to search for new ways to advance the health and education of America's children. The parents were selected by their States and Territories to represent their area's economic, social, and cultural diversity. Parents from diverse backgrounds and other participants directed their efforts toward these challenging goals: * To identify the strengths of parents and families in their roles in preparing children to be healthy and ready to learn. * Tovoice parent and family needs to the health, education, and social service professionals responsible for programs that address the goal of preparing children to be healthy and ready to learn. * To highlight Federal, State, and community-based programs that effectively -_ address these needs. .- * To identify cross-cutting public/private/voluntary strategies that build a _, parent-and-family/professional partnership within the scope of existing ._ -:- ;- programs. -r j -- `= ;_ - -_ .- 1 - _ `2 _. -. -I;.~, ,~--- >v "By t&qear 2000, all childreh- in America%11 start school ready to learn." 2 Parents Speak Out for America's Children Executive Summary D uring the Conference, the State Parent Del- egates attended Parent Work Groups to dis- cuss three phases of involvement in health, education, and social service systems (the patchwork of health, education, and social service programs and activities throughout our Nation): awareness of and entry into the systems, participation in the systems, and transition as families move through the systems. The delegates were grouped into Parent Work Groups by regions, and special Work Groups were established for Native Americans and Migrant families to ensure that their issues were not lost. (The Native Americans and Migrant families were also represented in the Regional Work Groups.) At the close of the Conference, three representa- tives from the Parent Work Groups (one for each stage discussed, i.e., awareness and entry, participation, and transition) reported their findings to the Conference at large. The issues they raised were addressed by a panel of Government officials, directors of Federal programs that administer key health, education, and social service programs. As the State Parent Delegate Work Groups were meeting, other participants attended presentations by panels of professionals and parent advocates involved with health, education, and social service systems. The focusofthesepresentationswason howtomakeprograms fit families, instead of making families fit the programs. The following topics were covered in the panel presenta- tions: (1) Early Childhood Issues That Affect School Readiness and Health; (2) Helping Families Get Services: Some New Approaches; (3) Healthy Children Ready to Learn: What Are the Roles of Parents, Educators, Health Professionals, and the Community? (4) Special Issues That Impact Children and Families: Substance Abuse, Human Immunodeficiency Virus (HIV), and Violence; (5) Disabilities; (6) Exploring Comprehensive Health and Education Models for Young Children; (7) Children with Special Health Care Needs: Lessons Learned; (8) Parenting: The Critical Role; (9) Childcare: Two Perspec- tives; and (10) Healthy Start, Head Start, Even Start, and the Supplemental Food Program for Women, Inf%nt.s, and Children (WIG) : Integrating Health, Education, and Social Service Programs. Over the course of the 3 days, President George Bush and members of his Cabinet expressed their com- mitment to the Surgeon General's Healthy Children Ready to Learn Initiative by addressing the Conference participants. President Bush, Secretary of Health and Human Services Louis Sullivan, Secretary of Agriculture Edward Madigan, and Secretary of Education Lamar Alexander each described the efforts of the Administra- tion in meeting the first National Education Goal. The Conference also provided 28 workshops cov- ering a variety of health, education, and social topics from which the participants could choose. During the breaks, a special exhibition containing information about Federal, State, and community programs con- cerned with the health, education, and well-being of children was open to Conference participants. Also during the breaks and before the opening session, the Conference featured entertainment provided primarily by local children's groups. s Surgeon General, Dr. Novello is responsible for A the health of our Nation's people, and as a pediatrician,sheismostpassionatelyconcemed about her responsibility to our Nation's children. There- fore, Dr. Novello has made the health of our Nation's children the cornerstone of her agenda. In her Charge to the Conference, Dr. Novello stated that the first National Education Goal hoIds special importance for her. "Health and education go hand in hand; one cannot exist without the other," she said. "To believe any differently is to hamper progress." She cited the three specific objectives in the comprehensive goals statement for the first National Education Goal: Report of the Surgeon General's Conference 3 All disadvantaged and disabled children will have access to highquality and developmentally appro- priate preschool programs that help children pre- pare for school. Every parent in this country will be their child's first teacher and devote time each day helping his or her preschool child learn; that parentswill have access to the training and support they need. * Children will receive the nutrition and health care needed to arrive at school with healthy minds and bodies, and the number of low-birth weight babies will be significantly reduced through en- hanced prenatal health systems. Dr. Novello spoke about some of the barriers that our country faces in developing healthy children ready to learn: failure to immunize against childhood dis- eases, Acquired Immunodeficiency Syndrome (AIDS), childhood injuries, and violence. She stated that, al- though the statistics are staggering, she is hopeful that we can make a difference. She announced her commit- ment to the arduous task and challenged the Confer- ence participants: "I see our task as improving the health and welfare of our Nation's children in everyway we can." She urged the participants to work together, to teach and to learn from one another. `When it comes to health and education," she said, "we need total intuitive conviction to remove every barrier and reach every child." She urged the parents and professionals present to help make the Conference "a blueprint for bonding education and health-an essential task, ifour children are to succeed." I n their discussions of the stages of involvement with health, education, and social service systems (aware- ness and entry, participation, and transition), the parents examined three main questions related to the different stages: * What is my role as a parent? * What are the barriers and issues of concern? * What are some solutions and existing model pro- grams incorporating those solutions? Several issues and themes recurred in the parents' discussions, forming a kind of national consensus on the issues among the parents. The conclusions from this national consensus follow. Awareness of and Entry into Health, Education, and Social Service Systems Roles and Responsibilities of Parents First parents must identify their children's needs. Then, they must find the programs offering services that meet those needs. They should consider them- selves full partners with the professionals in making decisions for their children. Parents should be advo- cates and should network with other parents to share information and moral support. Barriers to Awareness and Entry Information about the full range of programs available to families is not readily accessible. In addition, the bureaucracy devoted to administering mostprograms is daunting to most parents. The paperwork is over- whelming, both in volume and in language. Eligibility criteria are inflexible. Social service workers, who often suffer from employee burnout or are culturally insensi- tive, can be patronizing and intimidating. Inflexible office hours and difficulties with transportation add to the problem. The systems seem to suffer from a lack of accountability. Parents feel frustrated and do not know where to turn for help. Solutions An easy-to-read, universal application form for all ser- vices was a major`proposal, along with consistent, flex- ible eligibility criteria. Agencies should operate during hours that are more convenient to working parents. Programs should be instituted in elementary schools to 4 Parents Speak Out for America's Children Executive Summary develop social competency and effective parenting skills. Funds should be made available for support groups. Parents need a way to talk back to the systems. A campaign should be conducted to increase public aware- ness of the importance of healthy children. Participation in Health, Education, and Social Service Systems Roles and Responsibilities of Parents The parents' primary role is to nurture their children. They should also serve as role models not only to their children but also to other families who need service, and they should enlist those families into programs. Parents need to be fully involved partners with the service providers-in making care decisions, communi- cating cultural sensitivities, and evaluating services. Barriers to Participation The same difficulties exist here as with gaining access to the system: paperwork, inflexible hours, transporta- tion problems, and gaps in service. These problems seem to stem principally from a lack of coordination among programs and the absence of a family-centered philosophy. Again, the parents saw a need for family support groups and funding to organize them. Solutions First, training in parent skills should begin early. Im- proved communications among agencies would solve many problems. "One-stop shopping" (i.e., receiving a multitude of services at a convenient location) with flexible hours and simplified paperwork would go a Iongway toward easing parents' burdens. Adirectory of services also would be helpful. Consistent funding for programs and parent involvement on the boards over- seeing programs would help provide quality service. A `national psychology" that supports families should be encouraged; i.e., our society must be encouraged to value the family and support the efforts of parents in raising their children, particularly for families who need'help. To that end, people should vote for candi- dates who espouse that view and who will work to further it when elected. Transitions ThmugJl Health, E&x&on, andSocial5krvi~System.s Roles and Responsibilities of Parents Parents need to be active participants in transitions from program to program because they are the best evaluators of their children's needs. They must be prepared for and remain involved in the transition process and, in turn, prepare their children. Again, they should be advocates for the child to ensure that the child is truly getting what he or she needs. Other important aspects of the parents' role are loving their children and helping develop self- esteemforthemselvesandfor theirchildren. Forsmoother transitions, parents must also be good recordkeepers and request written reports. Barriers to Smooth Transitions A lack of communication among agencies regarding available services complicates the transition process for families. Reports that are not written in the language of the parents make transitions confusing. Culturally Report of the Surgeon General's Conference 5 insensitive service workers isolate parents. Unstable funding makes it difficult to predict the availability of a particular program when a transition occurs. Solutions Improved communications was one of the most often- cited needs, along with information clearinghouses, hotlines, service directories, support groups, and com- munity outreach. Service providers should receive sensitivity training. Once again, the parents cited the need for a streamlined system for handling paperwork, one-stop shopping, and sensible hours. Characteristics of Programs Parents Grade A+ Parents said that programs must have the following characteristics: be child centered and family friendly, be easily accessible, have broad eligibility standards, be antidiscriminatory and multilingual, be well-promoted, provide individualized service, be staffed sufficiently, and be open at convenient hours. In addition to having these characteristics, programs must coordinate with one another to facilitate entry and participation in the systems and to avoid duplication or gaps in services. Above all, programs should empower families as they serve them. The parents strongly recommended pro- grams that involve parents directly as a way to empower them. Furthermore, they stressed that programs should involve the parents in making the decisions that affect their children, decisions ranging from policies to sta& ing and budgets. 0 n the final day of the conference, three repre- sentatives from the Parent Work Groups sum- marized their conclusions. One representa- tive focused on the discussions of awareness of and entry into health, education, and social service systems, an- other on participation, and the third on transitions. Awareness of and Entry into Health, Education, and Social Service Systems Sherlita Reeves Parent Delegate from Arkansas In summarizing the reports from the groups on aware- ness and entry, Ms. Reeves said that the parents' roles andresponsibilities should include becoming informed about their own child's needs, acting as an advocate for the child, meeting their own needs so that they can be equal partners with service providers and profession- als, and networking with other parents. The issues of concern were too much paperwork, difficulty in getting into the system, materials not writ- ten in parents' language, and providers who do not understand the culture of those that they serve. Inflex- ible hours of operation, lack of transportation, and environmental barriers for physically impaired people were noted as barriers. A significant problem is the lack of accountability in the systems. Solutions to these problems focused on establish- ing school-based programs that develop social compe- tencies, building support networks within the commu- nity, producing directories of resources with toll-free numbers, designing one-stop shopping for all man- dated programs, creating a universal application form, and giving parents a way to talk back to the system. Participation in Health, Education, and Social Service Systems Ellie Valdez-Honeyman Parent Delegatejkom Colorado Ms. Valdez-Honeyman stated that parents need to pro vide for the needs of their children. Food, clothing, safety, health care, and quality time are essential, but parents also need to instill a spirituality that encourages values, morals, and respect for themselves and for others. As families begin to participate in the systems, just as when they are entering the systems, parents need to continue to be advocates-for their own children, for other families, and for components of the systems that work for them. They should be involved in their communities. 6 Parents Speak Out for America's Children Executive Summary I Ms. Valdez-Honeyman related other areas of con- cern identified by the parents. They felt that a stigma is attached to receiving services, the stigma of being poor. Eligibility criteria can also be a problem because they are not flexible enough to include all who have need. Also, language not native to the parents and system jargon make dealingwith the systems confusing. Trans- portation is an issue in rural areas where services are limited and parents must travel long distances. Pro- grams often do not have convenient locations or hours for obtaining services. The solutions identified by the parents fell into two categories: local initiatives that deal with local service delivery, and Federal initiatives that reach across all levels to create a standard in which service systems welcome and embrace families. The principles would then be embodied in the design, delivery, and evalua- tion of services. Transitions Through Health, Education, and Social Service Systems Larry Bell Parent DebgateJLom Delaware Mr. Bell provided a laundry list of issues that the parents had discussed regarding transition. First, parents need to participate in the transition process so that they can help prepare their children for the transition. They can be better prepared for the transitions themselves if a resource manual or some form of information about new locations or programs, including contact names, were available to them before the transitions occur. The parents acknowledged their responsibility to maintain copies of their children's records to ensure that they are not lost during transitions. The parents also have asignificant responsibility in ensuring that the roles of parents and professionals in the transition process are clarified and that the family is treated with respect. Programs and staff must be culturally sensitive and relevant, and they must help develop self-esteem not only for the children but also for their parents, who then can be good role models. Parents should not be afraid to confront the systems if necessary to ease the transition process. The parents stressed that, to ease transitions, parental involvement in programs should be consis- tent: Furthermore, parental involvement should in- clude program design and policy-making decisions. Mr. Bell also presented concerns that were raised by the other representatives. The parents cited the need for improved communication among the various systems that serve them in the transition process. Im- proved communication would help avoid duplication of services and promote continuity of service as transi- tions occur. They recommended an interstate com- puter network to ease the application process as farni- lies move from State to State. They urged that school credits be accepted more readily from State to State. They repeated the plea for one-stop shopping, less paperwork, flexibility ofservice, and help with transpor- tation problems. They also promoted the use of school social workers who could act as advocates for parents and children in the transition process. Finally, Mr. Bell presented the parents' recom- mendation for legislative action to help improve the transition process and urged the parents to elect offi- cials who are family advocates. He summarized his remarks by reminding the participants of the three C's of successful transitions: consistency, continuity, and coordination of services. Report of the Surgeon General's Conference 7 James 0. Mason, M.D. Assistant Secretary for Health U.S. Department of Health and Human Seruices Assistant Secretary Mason, head of the U.S. Public Health Service, answered the parents' challenge for action by the officials by promising to meet with the State and territorial health departments and their com- missioners to discuss the issuesraised by the parents. He reinforced the parents' con tention that leadership must come from all levels. Dr. Mason stated that he agreedwith 98 percent of what the parents said and his agency is working toward creating a user friendly system of health care. As an example he offered a new Model Application Form, which is a simplified, unified, uniform application avail- able for use in the States. He stated that both the Federal Government and the parents want the same features in the systems, but that each must work from opposite ends to achieve them at the middle levels where the programs are implemented. He also outlined Healthy People 2000, a national program with 300 measurable health goals for the year 2000; 170 of these goals relate to mothers, infants, children, and adolescents. He closed by expressing the willingness to work together as partners. John T. MacDonald, Ph.D. Assistant Secretary for Eknmztaly and Secondary Education U.S. Department of Education Assistant Secretary MacDonald said that schools need to return to things that parents and children need. He sharedavision ofschools as the hub ofone-stop shopping, where education is the central mission but where children and families can use other family services as well. This facilitywould operate from early in the morning until late at night, including weekends and during summer and holidays. It would virtually never close. He also said we need a massive urban intervention program using Federal resources in conjunction with State and local resources to provide for communities. 8 Parents Speak Out for America's Children Assistant Secretary MacDonald explained that many current programs can help one another. He cited Even Start as an example. A program for children 0 through 7 years old that provides not only parenting and childcare butalsojob training and placement, Even Start can be used to buy or expand Head Start services or to create its own services. He emphasized that Federal agencies are working to integrate their services, and they will continue to do so with the support of America's families in persuading Congress to make needed changes. Catherine Bertini Assistant SecretaT forFood and Consumer Services U.S. Dqbartment of Agrkulture The Department of Agriculture spends more than half of its budget on food assistance programs for the poor and children. Ms. Bertini explained how the Depart- ment currently is working with directors around the country to promotejoint services for immunization and WIC. She also described direct certification of school lunch and breakfast programs through a computer marriage of the school lists with files from the Aid to Families with Dependent Children (AFDC) program in an effort to simplify eligibility factors and expand ac- cess. The two-signature policy for Food Stamps has been eliminated and the agency has launched a pilot program called Electronic Benefit Transfer (EBT) us- ing bank cards for the food stamp program. In closing, Ms. Bertini discussed the importance of school breakfast for children coming to school ready Executive Summary to learn. Half of the schools that have school lunch programs also have breakfast, but through expanded access the schools can feed more kids. She urged parents to work with and support the regional agencies that provide services and to help persuade Congress to support proposals for change in the systems. Wade Horn, Ph.D. Commissioner Administration for Children, Youth and Families (1.X Dqbartment of Health and Human Services Dr. Horn admitted that Head Start works because it is built upon parental involvement and community sup- port. Head Start also integrates health services and social services and is one of the largest delivery systems of health services to poor children in our country. However, Head Start still has much work to do. It is undertaking three new challenges: administering more money to serve more kids; increasing services to adults with children in Head Start, particularly adult literacy and substance abuse; and providing job training for Head Start parents. Dr. Horn also warned that Head Start is not an inoculation against everything that can possibly go wrong in a child's community. We must do a betterjob of creating a good environment for children when they leave Head Start. To that end, he has been working with Assistant Secretary MacDonald to establish better connections between Head Start and our Nation's public schools. Christine Nye Director Medicaid Bureau Health Care Financing Administration Ms. Nye described the massive effort that Medicaid makes to serve our people; it spends more than $100 billion for services to 30 million Americans, 17 million of whom are children. She continued that, although Medicaid is expanding services and eligibility, it still falls short in many areas. However, she cited some bright spots: expansion of eligibility for children to the maximum in as many as 20 States and increased flexibility in providing waivers to keep children with special health care needs at home rather than in institutions. One expanded program for children is the early Periodic Screening, Diagnostic and Treatment Program, the greatest child health reform since the enactment of Medicaid. Ms. Nye also described efforts to make access to Medicaid easier: streamlining application forms, increas- ing payments to community health centers, and working to overcome barriers between physicians and Medicaid. She expressed her commitment to continuing these ef- forts, but cautioned the participants that Medicaid is administered by the States and that the parents should workwith the State Medicaid staffand inform them of the findings of the Conference. In closing, she thanked the parents for rejuvenating her own commitment to imple- menting changes in the program. Lou Enoff Principal Deputy Administrator Social Security Administration Although most people think of Social Security as a retirement program, Mr. Enoff informed the partici- pants that it pays more than $1 billion to more than 3 million childrenunderitsprogramseverymonth. These children either have disabilities or they are the off- spring of retired or disabled workers or deceased par- ents. Social Security has expanded access with a nation- wide 800 number that operates 12 hours a day with bilingual help if the client needs it. In addition, Supple- mental Security Income (SSI) has an outreach program to find those people who are eligible. Social Security has begun integrating serviceswhere possible with other agencies. Also, Social Security has published standards of service for its offices, which will be modified as goals in providing services are met. For instance, Social Security cards are now issued within 10 days after the application is filed; the same process formerly took up to 4 weeks. Mr. Enoff urged the parents to call if they have a problem with or concern about Social Security. He reminded them of the 800 number and added that, if they received no satisfaction from the senice providers on the toll-free line, they could call him directly at 41@%%-9000. Report of the Surgeon General's Conference 9 George H. Bush President of the United States The President said that, in his administration, families come first. Pointing to the critical role of parents, he said that, as a child's first teachers, they offer the love and nourishment that no government program can ever hope to provide. Citing programs that promote the health and education of young children, President Bush stated that, since 1988, Federal dollars for immunization have more than tripled. In the last 3 years, funding for Head Start has almost doubled; this year's proposed increase of $600 million is the largest single increase in the program's history. President Bush also outlined the provisions of his health care reform plan providing a $3,750 tax credit for low- income families and an equal tax deduction for middle- income families; cutting costs to make health care more efficient; and cutting waste and abuse. The President called it a common-sense reform that will maintain high-quality care, cut costs, ensure maximum fi-eedom of choice, and give every Emily access to health care. Louis W. Sullivan, M.D. Secretary of Health and Human Services Secretary Sullivan said we must invest in children. To support that investment, the President's 1993 budget proposes to increase funding for programs serving children to $100 billion. Infant mortality is a national priority, and an expansion of the Healthy Start initia- tive will concentrate $143 million on 15 communities with stubbornly high infant mortality rates. We must also focus on prevention. The President has requested $52 million for immunization activities and $40 million for Centers for Disease Control (CDC) Lead Poisoning Prevention Grants to support 30 state- wide programs. Finally, we must empower parents. The President's $600 million increase in funding for Head Start will serve an estimated 157,000 additional children in I993 10 Parents Speak Out for America's Children and will involve their parents. In addition, the tax provisions of the President's health care reform pro- posal will help more than 90 million Americans and will cover 95 percent of the uninsured. Edward Madigan Secretaly of Agriculture Secretary Madigan outlined the many Department of Agriculture programs that have direct impact on chil- dren. He cited the following examples: WIC, a gateway to other government servicessuch asimmunization; the Child and Adult Care Food Program, which serves meals to preschool-aged daycare children (including Head Start meals), a service that is expanding; the National School Lunch and Breakfast Programs, which are being cross-matched with AFDC files to ensure that entitled children are reached; various summer food assistance programs; Food Stamps, the largest food assistance program; and various other programs for distribution of commodities. In addition to providing food, the Department of Agriculture also provides nutrition education through various programs. The Nutrition Education andTraining Executive Summary Program (NET) trains school food-service personnel, teachers, and students. The National Food Service Man- agement Institute, which operates at the University of hfississippi, trains school-lunch operators. Also, WIG provides nutrition education as an integral part of its program. Secretary Madigan urged the participants to work locally to ensure the success of these programs. Lamar Alexander Secretary of Education SecretaryAlexanderreiteratedtheAdministration'scom- mitment to Federal standards for quality education. He recounted the implementation of the Healthy Children Initiative in Tennessee during his term as Governor. That program sought to expand prenatal care, iden tifv doctors for newborns, and encourage employers to provide childcare opportunities for their employees. Secretary Alexander stated that, although na- tional policies and State programs are important be- cause they affect funding, the fundamental problem is a matter of parents, families, and communities taking care of children and putting a priority on them. He said the Department of Education now has 27 different Federal programs that are available for children under 5 or 6years old, but the challenge is to spend the money more wisely. As an example, Secretary Alexander pointed to the Decatur, Georgia, school district, which has turned the school community around by setting and enforcing tough standards and by using the school as the organiz- ing point to integrate community services for the chil- dren. In closing, Secretary Alexander encouraged the audience to assist their communities in becoming part of the America 2000 program. Roger 6. Porter, Ph.D. Assistant to the President @Economic and Domestic Policy Dr. Porter stated that the President's commitment to the goal that all children start school ready to learn permeates his administration. The President's Educa- tion Policy Advisory Committee, which is made up of educators, business and labor leaders, and media repre- sentatives, has spent much time discussing ways to enhance parental involvement in the health and educa- tion of our children. In addition, the President has established a partnership with the Nation's Governors in adopting the six National Education Goals. Dr. Porter stated three convictions that synthesize the spirit of the National Education Goals. One, fami- lies come first. Two, we must never allow things that matter most to be at the mercy of things that matter least. We, as a society, must honor those activities that involve one generation transmitting to the rising gen- eration a set of fundamental values and aspirations, which incIudes good health and a commitment to learning. Three, we are all in this together. I n her closing remarks, Dr. Novello observed that everyone came together at the Conference for only one purpose: to improve the lives of children and families. She said thatreforms in the health, education, and social service systems of this country will be ad- vanced through the families. It was her belief that the Conference did one thing beautifully: It vindicated parents. Parents will no longer be silent partners; they will be activists and advocates. Dr. Novello asked attendees tojoin her in sharing the responsibility for making their families and chil- dren well. She reiterated some of the concerns raised at the Conference: the importance of fathers in the family, the need for flexible services and cultural sensi- tivity, the needs of teenage parents, and the desire for self-esteem for all of our children and their parents. She urged the participants to become involved and share with those at the local and at the State levels, in the public and in the private sectors. Our children's well- being is no longer one person's responsibility, and we must "get real." There is too much at stake. This Conference, then, can be just the beginning of a coalition of parents trying to determine, through their collective actions, what this Government can do. In closing, Dr. Novello challenged the participants one last time. "I'm with you," she said. "Are you with me?" Report of the Surgeon General's Conference 11 1 htroducticm Chapter 1 Headytc~ i -earn- -- 0 n February 9-12, 1992, at the Ramada Renaissance Techworld in Washington, DC, the Surgeon General, Dr. Antonia Novello, hosted the "Healthy Children Ready to Learn: The Critical Role of Parents" Conference. This conference was jointly sponsored by the National Governors' Association, the Department of Health and Human Services, the Department of Education, and the Department ofAgriculture. The Conference was held as part of the Surgeon General's Healthy Children Ready to Learn Initiative, which in turn supports the first of six National Education Goals established by President George Bush and our Nation's Governors. This goal states, "By the year 2000, all children in America will start school ready to learn." Recognizing the crucial role of parents in ensuring their children's good health and preparing them for school, Dr. Novello invited them tojoin with Government officials and represen- tatives from public and private health, education, and social service agencies to open the channels of communication and to explore innovative steps to support the care and education of our Nation's children more effectively. Approximately 225 parents, representing the 50 States, the District of Columbia, and the U.S. Territories, gathered with more than 500 professionals concerned about the care of children to express the needs of families and explore ways that those needs can be addressed. Appendix Alists the more than 700 participants of the Conference. "Providing for health, nourishment, andz&k parenting are basi&k$s of providing a suitable foundation for normal growth and emotional well- being, a foundation that fosters the ability to learn and ensures school readiness. n 14 Parents Speak Out for America's Children Report of the Surgeon General's Conference 15 T he seeds for the Conference were planted in February 1990, when President Bush and the Nation's Governors made education a national priority and established the six National Education Goals. The first goal is an extremely important one because it focuses on the foundations of learning: physical, social, and emotional health and well-being, and cognitive development. Providing for health, nourishment, and active parenting are basic ways of providing a suitable founda- tion for normal growth and emotional well-being, a foundation that fosters the ability to learn and ensures school readiness. However, deficits in any of these areas during the critical early period in a child's development are difficult, if not impossible, to overcome. To achieve the first National Education Goal, our Nation must provide access to health care and proper nutrition, education for parents, and educational programs for all of our children. In August 1990, through the announce- ment of her Healthy Children Ready to Learn Initiative, the Surgeon General accepted the challenge to support achievement of this readiness goal. Dr. Novello's initia- tive focuses on the health component of the first Na- tional Education Goal because children's ability to learn is dependent on their health. To assist her in undertaking this challenge and to explore the best means to meet the goal, Dr. Novello formed an Advisory Group of highly qualified represen- tatives from the White House staff and the Departments of Education, Agriculture, and Health and Human Services. (The Advisory Group members are listed in Appendix B.) The role of the Advisory Group is to recommend steps to improve the health and well-being of children so that they are healthy and ready to learn when they begin school. This role encompasses the following tasks: (1) determining the health needs of preschoolers and their parents; (2) identifying Federal resources that can be used to meet those needs; (3) discovering gaps where resources to meet the needs are lacking; (4) clarifjing the relationship between the Federal Government and the States in meeting these needs and the responsibilities of each; (5) developing strategies to minimize barriers to cooperation among Federal, State, and local agencies and private organiza- tions involved in the health and education of young children: and (6) identi@ingways to expand the Nation's resources through cooperation and collaboration to meet the challenges of this readiness goal. Among other recommendations, the Advisory Group advised seeking parents' perceptions of needs that must be met if our Nation is to reach the readiness objective. The design of this Conference was based on the Advisov Group's recommendations. The Surgeon General set these challenginggoalsfor the Conference: To identi+ the strengths of parents and families in their roles in preparing children to be healthy and reads to learn. To voice parent and family needs to the health, education, and social service professionalsrespon- sible for programs that address the goal of prepar- ing children to be healthy and ready to learn. To highlight Federal, State, and community-based programs that effectively address these needs. To identi+ cross-cutting public/private/volun- tary strategies that build a parent-and-family/pro- fessional partnership within the scope of existing programs. In preparation for the Conference, the Surgeon Gen- eral requested that the States identify parents who would make up a State Parent Delegation at the Confer- ence. The term "parent" was broadly defined to include anyone who is guardian of a small child, i.e., parents, grandparents, adoptive parents, foster parents, etc. The individual State delegations were asked to hold pre- Conference meetings to discuss issues relating to health, education, and social service systems of importance to the parents. 16 Parents Speak Out for America's Children T he Conference, which was the result of 18 months of planning by the Surgeon General and her Advisory Group, assisted by the Planning Committee (listed in Appendix C), provided a unique c~pportuni~ for parents and families to meet with Fed- eral, State, community, and private professionals from health, education, and social service systems. The ;kgenda (Appendix D) was carefully planned to make tile Conference an effective forum for information eschange. The State Parent Delegates attended three Parent LVork Groups to discuss their needs and issues relating to three phases ofinvolvement in the health, education, and social service systems: awareness of and entry into the svstems, participation in the systems, and transitions as t&ilies move through the systems. The delegations were grouped according to geographical regions, and special work groups were established for Native American and Migrant families (who were also represented in the re- gional work groups) to ensure that their special concerns were not lost. The Facilitators and Recorders for these discussions are listed in Appendix E. In her Charge to the Participants, found in Chap- ter 2, the Surgeon General emphasized that these Par- ent Work Groups were the focus of the Conference. Chapter 3 of these proceedings summarizes the issues discussed in the Parent Work Groups. The summaries examine a broad national consensus from issues raised in several of the work groups and then explore the narrow focus of the individual work groups. Chapter 4 contains the findings as presented to the full Confer- ence at the closing session by three State Parent Del- egate representatives. It concludes with the remarks of the Responder Panel, directors of government pro- grams that provide services, who responded to the issues presented by the parents. During the Conference, President Bush and key members of his Administration expressed their personal commitment to Surgeon General Novello's initiative and emphasized its importance to our Nation's future by their attendance at the Conference and their remarks to the participants. The speeches delivered at the Conference by President Bush, Secretary of Health and Human Ser- vices Louis Sullivan, Secretary of Agriculture Edward Madigan, Secretary of Education Lamar Alexander, and Assistant to the President for Economic and Policy Devel- opment Roger Porter are found in Chapter 5. Concurrent with the Parent Work Groups, panel presentations that explored current services, both pub- lic and private, and parent support groups were con- ducted for General Participants (those who were not State Parent Delegates). These presentations, bypanel- ists who were experts in their respective fields, focused on ways to customize services to fit families instead of trying to fit the families into the services. Chapter 6 contains summaries of the Panel Presentations. All participants had a choice of 28 informative workshops covering a variety of topics from nutrition, health care, and injury prevention to violence and its impact on children. These workshops, led by profession- als in the fields, are described in Appendix F. Addition- ally, the Conference presented a special exhibition of Federal, State, and local programs dedicated to the health and education of children. Program representatives shared information about the programs and distributed materials. Appendix G contains a listing of the exhibitors. Participants were entertained during each of the breaks by an array of performers, most of whom were children. Appendix H recognizes each group who shared their talents with the participants. Report of the Surgeon General's Conference 17 2 Chapter 2 Antonia C. Novello, M.D., M.P.H. ootl Illot~tlitlLy I \\oltltl lil\c, to \\-t~lcotn~~ \ott 10 G the "Hcdtln (:ltildt.~t~ Kcwl\ to I.t~,tt-II: `l`ltt (:ritical Kale of f';tt.rttt\" (:oI~~~Ix~I~c~. Tlti\ (htifetw~cr is tlir crtltnitiatioi~ 01. IS tiioiitli~ of' pl;tt~- tiitig, otttlitiiti~, and tiit~~titi~~\itl~ tlit. Iw\~ xitl I~ri~litc~st itidi~~idttalscotict~l-tietl\\itli tlic lit~altli atid c~tlttc~;ttioti 01' our Salioti'~ chiltll-en. Pi-t~sitletit (kv)rgv Kttsti has tiiatlr tli~~tlttcxtioti of` 0ttrSation'~ cliiltlt~rti ;I tii;ijor piioi-it\ of Iii4 l'rc4idt~ti(.\~. Tltr Dtapat-ttncnt of I-It~tl~ll ;111tl I lt~tltatt Sc,t.\-ic (`4 atttl SectWar. Sttlliwti Ita\ t' tiixl~ c;ttiti~ fi)t. (.tiildt.cti ;I (`ol`tlt't`~toll~ ot tt1c Ik]`;tt`ttllt~tlt'4 a~tmd;t. `111(1 `I4 lIl(, Sltrgcon C;etlet-al, I Ita\x~tii;ttle tlir It~altli of ottt~S;ttiott'~ chiltIwti the ~ot~tit't~stoti~~ of`rninv. IIt3ltli ;itid cdiic ;I- lion go lutitl in l~atttl: otic cdittot ta\i\l witliottt 111~~ other. To twliwe ml\ diftim*tttl\ is 10 I~;Iw~~~I pt O~I~CY~. .Jttst ;ts ottt` chiltlt-ctl hx t' .t tiglit 10 t.c`(.c.i\t. tlic, lx.,1 educ;itioti xxilal~lc~, tlit7 lt;n(~ ;I right 10 lx% llc3ltlr\. \4 p;"`"lI\, le .. j:tal~itot 4. mid t~l~t~~,t~ot \. it i4 rip to 114 IO \I(`<' that this Ixm~tiit~s ;I i-t3lit\. Thwvfi)rr. \vv AI-C tnc~t~tittg to itttl)t.o\c. 11ttt tdt~t .I- tioti mid health of`oit~-S;ttioti`s( Iiiltlt t'ti :ititl to itnl)t~o\c~ these things tlit~t~ttgli ttith t'\t'$ of' lhtt~t~tttk tlrt-otigh tll~h collectkv pat~ticipatioti ot'tlic. titiiiih. Tlii\ i\ ottt~of'tli(~ most sci-iotts tasks for ai\ socic't\. ;ttttl it ~l~01t1~1 1101 Ix, ati\. less arriotth fot~ all ot II\ pthct-cd htw toth, i\s I \vrlcotiic ~`ott and ;tskx~,tt to gi1.v tlii\ t~i~l\~ottt- most wious attention. I xi1 going IO ash rwti 11i01.c 01' vott. (:;trl Jutig. tlic RI-v;il ps\-cliologist. said that "\\-t, \11011ld not pt"`t"tl'1 to tttl(l~`t-~t;ttld tt1c. \\01-It1 Ollh I,\ ititt~ll~~c~t: \vv ;tpptwlirt~d it jtt5t ;i\ tiittt~li In ftytlitig." I ;itti goitig to asli \ott IO ttst' \ottr t'\l>?iit~iicv ;itirl ititc.llcx.1. l,ltt al40 I ;tt11 goitlg to ;tb1\ \ott to rsl"v\4 \ottt' li.rlitip ;ilx)nt tlii4 cli;tllt~tigc. I ~wtil \ott to britlg ii01 otih \oiit. lo\x, ;ttitl rotit~t't~ti bill. if'tit'ct'\wn. <`\t'it \OIII' ;tttgc't` IO tiiis issttc. I atii ;tsil\itig \ott to g:c't iinol\etl. .Atltlitq I~~C~lili~ IO iIlI~~II~Y 1 \\ill l)I I,, ;g Ilit. Ix'41 iii (~;tcli oil< of.tt\ 0111 ,1ti(1 \\111 111 ill; in\ tltt. l)t.\t 01 nItat tIii\ (.otift7vttct~ c `III xi\<, III tltc, ~tti.tllt~rl of \nicvic `i's t itiew4. I ;ttt~ ,t\l,ittg \ott. `1, `I lht~c'ttt. c)lfitill. lt~acllcT. or Irc~;~lrli , xix ljvn itlt,t-. to twiti~\ottt- lto11cq lwt~~~t~ptioti~ of \\lt,il c .~ti 11~,ll) I.ullilit3 .~ittl (.liikltx7t to lx, liealtli\- a~ttl t-txl\ to IC~.II II. If ~\~~tlo not f'kr tht~l~);t~t~it~t~~ot~;t~l~lt~~s4 thr t~olll (`1'114. rllt~tl \\C' IKY 0Illt';t pt`t of tl1t. plut'l~tll antI 1101 ;t Ihtt-1 01 tlit, ~oItttio~i. \\`c, I\tio\c\vt~ 1i:n.c pi~ot~letiis. hut ~VC' ;I140 ll`l\<, !$(`;I1 l't'~ottt'~`t'~ x1tl sttwlqtl~. not the lt.;t4t of` \\liicli i\ .biit.t~it ,t'r tl~\otioti to its cliiltltx~t1. \\`r nwd a t~otiitiiittitt~ttt Ii ont t~tcli p~t~v~ti lict~ locla~ xitl tiir org;ttii/,ttic~tts tlic3 tr~~ptxv~tit so tli;tt tlicr hill Ix-itig tlicit Ix~t ldio~\I~d~~~ :uitl tiicht pi-ofinttid Iitttiiat~ cotiitiiittiiwt to tliis iwtc'. l'~di;tl~~ ottr xi-(`;tttW cli;ill~tige i5 to join l1;1t1d~,1tt~l ICY ou't~;t trttc'.~tttt't-i(.;ttl +tit. This i\ tlw tnost (wity ~x~tt1t11~ iii 111~ \~oIM. mid totl:i\ \vt' bill Iwitig this (.otit't'ni to Ill:, Ii\<.\ ol'otti~ c~liiltltx7i. 20 I';it.t.nt\ Sf)c;t1, 0111 lot .-\tnvt-it-.I'\ (`llildtx~t~ \\.t, at-t foe ttsiiig oti tlit~ rolt. of lx11 t.tit\--,*I1 of its. !vlietlivi- the l't.csiclcitt. (::tl)itit~t offit t.1,. Frtlrt ,tI ofli- ci:tlk (k~\t~t~tioi~. ot'St;ttc of'fit~iktls. Sottit~of tis it1i~lit IN, pat-(`tits: 0tlivi.s ii1;t\ ttot. 15ttt to(l:t\. for tlic, tlttt ,ttiott 01 tlii\ (:t~tif~~t~~iic~. lvt'4 ta1\ts tltt* liottot~;tl~l~~ l)o\itioti tlt;tt c;ic~lt ~tdttlt i4 vacli child'\ l)di t'ttt. E:ac Ii \tttt.i i( ;tti c Ililtl I>(.l0ll~:4 to ~Nll of 11s. .Yo ollt' fXll (`III 01. ]""~I ;I111 t ;I*1 li~ll~~~tcli arid (`It'*.\ c.liiltl. Ixir togt~Ili~.t~ut~ ~.;i~t \(I i\t. for tlir cotiitiioti go21 of tti.thitig c,tt.lt c Itilcl ;I\ Iit~;tlllt\ attO t-c;ttl~ to Ic~tt~ti iis lx~44il~lc'. I \\ottltl :tIv) rctiiiti(l \ott 1101 to St.1 (livotti .txt.tl al~ottt tltt Ft.tlt,i,;tl (;o\t,i tttttt~ttt. -1.itis i\ \oitt. Cro\t,t ti- tiic'ttt. atttl it i\ ;I l~o\\~~i~fttl 01tts. \\`t. ;ttt' qoitiq 10 tt';t( II ~ott~cli;it ;t pouc't fit1 tool it (xii lx,. \\.t.,tI t~goiti~ IO t<`;t( Ii rott lip to tt\t' it. \\.c, lt,t\(. ct~~,tt~~tl. iiill)t o\c,tl. ,iiicI t~stcndd H~xl .Stat.t. \\`r Ita\t, (.ll;tttgt.(l ittttItttttt/,ttiott politic-\ to pt~ot(~cl c liildi t'ti ;I,-` 0 titist b;t\es aid that \\t` Itat. l)t.t.tt iti ;I Iutl lv;t\`e, bitt Irt tiic poitit ottt tli;tt Ilit' 1 ;ttt' of il1t.;tblt,\ Iia\ tll-tq~Ixd 6.5 ptTc"lt I,m\.c.t~tt l!Ehl ;ttttl l!NI. 1l~0111 L'T,iXticaaes iii IWO to 94x3 t';t\r\ iii l!Ml. \\`t, ll;i(l otll\ ahottt 1 ..WO c;tscs of'tit~;t~lt~s iii 1 IN:. \o \ ott t ati 4t.t' \\ t' still li;t\~ f.kit- to go to t-cdttcx~ ~iitwlc~~ cotiipl~~tt~h. l'lit~ public and thr pi-i\xtt. \t'cton ti;t\ t' tiictl~ili/t~tl: c'\t't.\otic' 11~s txyx)tldtd. Lh. Sttllhtt. Dr. Kopt.1.. lh. \l,tvltt. atltl I ;tt`tA finisliitig ;t sir-tit\ tottr ;tti(l li;i\v \i\itt*d clitiic 4 iii San Dirge. lkttx)it. 1'liil~ttlt~ll~lii.t. Kal)itl (:itl_ I'lioc~tii\. xntl Lhll;tb to c'ticotti~;tg:(` iittttttttii/;ttioi~. This lxt\t Ft-itlax. \\t' \-i\itt,tl ,111 it1tt11tttli/;ttiotI c litlit iii San Ikgo \vitlt l't~t~~itlt~ttt Ihid*. lloll~~~~~otl t t~lt~l)t itic,\ tool\011 iii~~islrs ititi~~ttt1i/.tti~~tt .I\ tltc,it c .ttt\t'atttl 101 i1tt.(l tliv (:ltildwii'~ .~c.tioti Srt\\ok. Tli~, I'ttldic l It~.tltl1 \(,I- \-kc h;ts txyx~iidtd aditiii ;thl\. l)tlt tlic.1 t' ir still itic )I (` tc) lx. (lotic. I.vt iii~`tit.t1\t' tliis l)oiiit. \\ll(.tt \\I' jolt1 tog:(~tli(.t - lxtt.t'ttt\. ~oit1ttiti~1itit~~. .ttitl 111,. qo\c't t1t1l~`tIl-\\lI~~t1 10. gvtltt~r \\t' tliitih ;tti(i c.kit'. \\c' t.tti ItI1 ii cltt\ c,l)irfl,ttric `ll,l1111d. \\L. ll.l\~~ 1,,l111 IIIC. 111~`.,11\ `Ill(l IllC. \\ Ill. "The influence of a parent is impos- sible to exaggerate. A child looks up to a parent; children trust their par- ents to help them make their dreams hecome realities." \IOI t' tlt.ttl L'.00(1 \tw\ ;I~o. l'hto said. "Thr dirrc- tioti iii \\Iiic Ii t,tli~t ;ttio1i st;tt'ts ;t tit;tti b.ill cl~tt.miitie his ftttt~i v lift*." I lx~lic~\c~ tli;tl. 11\iio\\ it to Ix, tt-tic in tiivmvti lift,. \I\ trrc~tl1c.t~ lids l)t.t.ti att cdttcatcw all lie*- lif'k. and ditb Ix,lic*\t3 ttt;tt ctlttc-.ttioti i\ tlit, gw;tte3t gift 0f`;tll. She \\;I\ tlit. ottt' \\I10 t~ttt~t~tti;t~:t.d *tit' to ttw tducatioti as ;I 1001 for \I,( ct.\\,. ,111 of it4 l~;irii tlir ditiietisit~tic of 2 l;tl~~t`l~ \\Ol~l(l f;~t)ttl 0111` l,at'cllt% Tlic inflttetice of ;t lxtt t'ttt i\ itttl~o4~il~lr' to ~u:,rj:eixtr. .-\ child lool\s tip to ;t pat t'tit: t~ltiltlt-t.11 tt~tt~t lIttAr Ixit~~tits to help tlietii make tltt~ir tlttwii~ Ixa~tii~ t-tditir's. It \\,I\ ;I Ioltgny fi)l- t11c f'rotn F;~jartlo, Puerto Rico. to tlit, Offic~t~ of (lit. Sttt~g~t~ti C;ctivi-al. bitt it \v;ts not ati it1il~o~rit~lt'\\;iI. Etlttcxtioti tiixle it poh5ihle. I\\uttldask \ott to t t'tiit~titlx~t~. too. that txq~tioiial tactic*. ~vlio tottchtd atltl itt\pit.cd Iott .tz ;I student. ThinI, uk;tt a tt~.tc~lt~t~ c;ltt (IO. .\\ p;tt~t'ttt\. cYltlc~ttol~~. and tl~;lltll l)t of~~~~iottal~. 1,~' t111tzt t~~~ii1t~tiil)t~t~ tlir iitfluetic~ 1l.t` can It,*\-v oti tltta fittttt~t. t~l'ottt~ cliil~lt~t'ti. \\.ht,ii I'ixGtlvtil htcti otttliiictl his cis Satiotwl Fdti~~ttion (;o;tI~ tot. Itic, vc';ii. L'OOO. Iir ~tni~iont-tl an \ittc*i-ic .t \\-lt~~t-c~ otti. c.ltil cl1il~livtt ol'totla\~;ii-v tlit v\I)lo~~`t \.\\I i1c.t ,. tc'.1( lt~.i\. :ttid iti~t.titot-~t~f'totiiot-t-o\\. \\ C' ii:ti\1 t~`.t( It tli<.tii ,111 llidt ur k~io\\ atid lmnide tlitmi \\ itI1 IIIII*C' tool4 111~7 i~c,c,tl to tii:rl\t~ tlic~ii- tli-taatttc cotlit' true. Our children are very smart; some of them are smarter than any of us ever were. They are eager to learn, and we must not fail them. M'e have some hard facts to face. Our educational system is unsurpassed at helping children excel at all levels, from diverse backgrounds, and often with En- glish as a second language. Our public schools and our concept of an educated society are the source of America's strength and its potential. Still, we must face the truth. Scholastic Aptitude Tests (SAT) scores con- tinue to remain low. M'e are not doing well in math and science. Many of our schools are overcrowded and overburdened, and many of our teachers are set up to fail by having too many children to teach. "We can't become discouraged. Our teachers, children, and future depend on our dedication to turn things around. Some will tell us that it can't be done or that it just might be be- yond hope. But I know in my heart that isn't true." We can't become discouraged. Our teachers, children, and future depend on our dedication to turn things around. Some will tell us that it can't be done or that itjust might be beyond hope. But I know in mv heart that isn't true. The President and the Kation's Governors are working to remedy these problems-to make our schools the institutions for learning that they were meant to be and are capable of being. Collectivel) we must work to make that a reali&. `1s Surgeon General, I am responsible for the health of the people of this great country. That means all cultures, races, mothers, and fathers. And to me, as a pediatrician, it especially means children. When I was appointed Surgeon General, I resolved that my agenda would focus on the needs of our Nation's children. It is an overwhelming task, but it is an altogether necessary one. When the President announced his six National Education Goals, there was, and continues to be, great enthusiasm for the promise of these goals. The first National Education Goal, that "By the year 2000, all children in America will start school ready to learn," holds special importance to me. This goal is realistic, and it is achievable. I believe those of us here in this room can be instrumental in implementing it in our own schools and communities. I know it is worth our best efforts. As part of this first National Education Goal, we must work to satisfy three o$jectil,es: * First, that all disadGmtaged and disabled children lvill have access to highqualivand developmentally appropriate preschool programs that help children prepare for school. + Second, that every parent in thiscountywill be their child's first teacher and devote time each day help irlg hi3 or her preschool child learn; that parentswill have access to the training and support they need. + And last. that children will receive the nutrition and health care needed to arrive at school with healthy minclsand bodies, and the number oflow- hir-thlveight babies will be significantly reduced through enhanced prenatal health systems. These three objectives are the keys to our children arriving at school healthy and ready to learn, and vour participation is crucial. This Conference has been structured to give each one of you the opportunity to participate and to listen to what the esteemed panelists, Government represen- tatives, and keynote speakers have to say. Most impor- tantly, this Conference has been structured to give you 22 Parents Speak Out for .-\merira's Children the opportunity to participate in these discussions and in the dialog that follows. Those ofyou here representing the .?O States and the Territories will be able to tell the rest of us what works andwhat doesn't work in your States and commu- nities. There is alwqs room for improvement, growth, and change. We are going to talk about the good and the bad. By doing so, lve Frill be able to avoid mistakes along the way and help, in turn, to highlight and applaud the success stories and use them as models as we move toward the vear 2000. Toda!,, there are 64 million children in this coun- tly. M'e have 19 million .&nerican children under .? years old and 4 million under 1 rrar. \IoI-e than 20,000 children a F'ear are killed bl. injuries. Some 1,6'ii have died from AIDS since its outbreak. Childhood diseases, due to a lack of vaccines, ha\,e disabled or killed thou- sands more. Although I am very hopeful, \ve must be honest. The statistics are staggering. What can we, as a Sation, do? M'hat can I, as Surgeon General, do? For one thing. I am always going to keep you informed. and I am going to tell you what you can do to help the Department [of Health and Human Services] and the Nation. To start, the goal of the Department of Health and Human Senices is to have 95 percent of children immunized by 1995 and, hopefully, all of our children immunized by the year 2000. If you are a parent, see that your children are immunized, and tell other parents, too. If you are an official, check out the situation in your own area and help make immunization for all children a reality. I believe that immunization is a right, and we must all get invol\-ed to make that right a reality. To be successful, all vaccines must be used if they are going to work; they do us no good by sitting in a clinic or a doctor's office somewhere. I must make one point perfectly clear: We do not suffer from lackofvaccine; we suffer from failure to immunize. The immunizations are available; we need to get them to all of our children. With regard to the terrible pandemic ofAIDS. it is here that we must increase our vigilance to stop its spread. We must educate about AIDS, help everyone involved in the care of those with HI\`disease, and send "It is my sincere hope . . . that: our true legacy will be evident in the children who will benefit from our collective efforts." the message that we must fight the disease, not the people with the disease. The number of pediatric AIDS cases continues to increase. Before 1985,58 percent of the children reported with AIDS were from New York City: Newark, or Miami. After 1985, however, only 36 percent of children with AIDS were from these cities. AIDS in women and children is spreading beyond the large cities to smaller towns and even rural settings. The greatest increases in numbers of cases reported to the CDC [Centers for Disease Control] were in rural areas and in metropolitan areas with populations of under 100,000. From 1988 to 1989, there was a 12 percent increase in the number of pediatric AIDS cases. From 1989 to 1990, there was a 37 percent increase. As of August 1991, 3,199 children under 13 with AIDS were reported to the CDC, more than half of them in the last 2 years alone. Of these cases, 84 percent were infected perinatally, and 52.4percent, or 1,677, have died. Based on the National Sur\ey of Childbearing Women, the CDC estimates that 5,000 to 6,000 HIV-infected women gave birth in the past year. Based on a 30 percent transmission rate, itis estimated that 1,800 to 2,000 HIV- infected infants were born. Children of minorit)- families have had mom than their share ofXIDS. For esampl~`. dth()t~~:h OIlI!' 1.3 percrnr of all cliiltlrcll ill lllv L`1litc.d Sl:ll(`~ ;I].(' The third point on \\-hich UY all nrtlst continue to fi)cur is thnt of'chilc~lioc~c~ injuries. .kcol-ding to ;I rt'cc'11t health report issued 1,) the Biir~;iii 01' Slatcmiai and (:hild Health. injuries aw the nlo\t +lific:unt hcxlth prohlein affecting our S`atioil's cllildi-(`ii mtl ;idoIcs- cents. lio\vt3~r \ve iiiwsiirc it-\vhctlici- lx ~iumlx~s of` deaths. dollal- coC5 for tre;itnimit, or rel;iti\c r;iiikiiig\ with othu health pix~hleiiis. 1iijtii-r. ncul not inaiiil ailtl kill 50 I~~;III\. of ow rhilclt-tw. Thv tick of illjwics is ;III epicternic~v~ cm control. (hilclhoorl injiii~~isoiic~oi~tlic~ principal public htdtli prot~lriiis iii .-\iiiri-ica today. causing inow deaths thaii all chiltlhootl diw;i\v\ coiii- biiiecl aiicl coiiti-ibiitiil g :4:-l-ratk to chiltlhootl clis;il,ilin. The Cllitetl Statrh i\ also ;I Satiotl pl~~gl~~tl tn \ioleiice. .Ainei-ican childi-en arc 10 tiiiic.5 mot-v liklx than Gmn~111 chikhell. 1 I ti1nes 11101~ likelv than FI-cI~cI~ chilcll-vii. and I.3 tinic5 iiiofc lil\cblv thm English chil- dren to Iw victims of` honiiciclc. \\-c COllld dcbatc whethrl- it is pmertl- or race that w inttwsifies patterns of~~~ot-t~idit~ alit1 mortalit\.. tliat 50 tlarkcns the picture fol- Colrncc. but 110w. 411ffic<. it to 4;q 1haL this 1121s to stop. .A5 Ah-ahm Lincoln 5aitl in 1X60, "lxt [I$ I1a.r faith that right tnaks might." linob~itig Eve are right. let's tlarr to do OIII- tltit! as jvr itndri-statid it. 24 1';11(~111\ st""`k 0111 for .\111rl~i(~`l" (:IliltlrcIl thaii ati\ SUI~Y)I~ (kmri-aI in liiston~. 11~ ~ctieclule- ad tin 4tdf if'\011 don't beliew ilir-goc~s off the rails 1vllc11 I \ isit ;I lwdiarl-ic clinic. an Indian Health Sri-\-ice Iiospital. ;I pdiatric AIDS unit. I have ulked in more high ~ctiool~~~i~cl iii nioremiall tmviis thaii I can i`enit'nl- bet-. The Black Foot Indian Nation gave me the mme "Pi-incus Fhiiig \2'oinan." I believe the\- hnw that I nwitetl to touch ~~II.~irieric~iiis. For the time that is iriilie to 4uve 3s Surgeon Ge~iei-al, I am absolutelv coinnnitted to inahc a clifklx2nce. I am making these conf~ssioiis to \V;II-II 1011. I did 1101 accept the I-esponsibilitv fi,~. this Iddtly (~hiltlrm Kradv to I~earn Initiative for re;~s011s of st;ttttj. 1 a111 a wriowi its VOII are. I see our tarli 2s itnproviiig thv health and b~lf:,\re of. our Satioil'.9 cliildrcti in e\x37' hw we can. B! ;rttc'litliiig ttii4 (i)iit~~t~~~~i(~~. \`()I1 ha\7 niadc 2111 escellrnt colllnlitn~c'tlt OII l~~~!~~~ll~ol~ other parents and children from your State, and for that I commend you. I urge !`ou to participate fully in the panel sessions and discussion groups. M'e are here to teach and to learn from one another. 1Ve are going to, as the kids sag. "get real." I know that any ofvou here ~vould jump f&m vour seat and take offin a dead run to grab a child from the path of a car. You ~vould shield a child about to be hurt. You would endanger yourself' to protect a child from a dangerous fall, L27ien it comes to health and education, we need a dead run; we need total intuitive cwnictioll to remove even- barrier and to reach even child. This Conference is geared to be that "dead run." When I \vas appointed I vo~erl to speak fiw all of the children. I vowed to be the Surgeon C&era1 fi)r all Americans. especially for all .%niericaii children, ivhrthei rich or poor, IV`]-icall-,~tneric~lll, lchite. Hispanic. Xsian Pacific Islander. or Satire ,~tnet-ican-~\.het~i~r docu- mented or not, from the President's grandchild to the child of a Migrant Marker. A%ll our childt-en need this attention. hut there are some ~vho especially need ml voice. One in five American children lives in po\.ertv: I speak for them. ThirF-eight percent of Hispanic chil- dren live below the poverty line; 43 percent of all L%frican-American children live in pavert!`. I speak for them, too. In the lvords of the Chilean poet, Gahriela Mistral: Mnn~ ofthe things WC need con zoclit; The rhikd cannot. Right mm is thP timr his bows m-e b~ingfkumcd, his blood is being made, and his smses are being developed. To him UP rnnnot answr `Tornon-ow I His name is `Todny. ' Today, as parents, you are hoth the expert and the student, and I ask all experts today to think also as parents. By all means, play both roles. By the year 2000. chances are that any one of' us may he onl!, a distant memory. It is mv sincere hope, however, that our true legacy will be evident in the children who will benefit from our collective effbrts. They will he children who started school healthy and reads to learn, children c\,ho learned and learned w;ell, children lvhose parents taltght them first and set the stage for the teachers who followed.childrenwho\\ere immunizedandwellnour- ished, children \vho have had all that America can give. The time has come for me to turn the focus hack on vou and ask all of you within this room to work together. M'e have a precious opportunity to spend 3 days at this Conference to think, argue, forge new initiatives, prioritize, and get involved. It is my fen.ent hope that the goals of this Conference will become a blueprint for honding education and health-an essen- tial task, if our children are to succeed. I wish \`ou the best in your endeavor. God bless I~OlI all. 3 Parents Speak Out: Summary of Parent Work Groups Chapter 3 SUMMARY OF PARENT WORK GROUPS D uring the Conference, the State Parent Delegates attended workgroups to which they were assigned according to the geographical regions in which they live. Native American and Migrant parents could choose to attend the regional work groups or separate work groups, which were established to ensure that their special needs or issues were not lost. In all the work groups, roundtable discussions were held to discuss three topics representing stages of families' imolvement with health, education, and social senice systems: aware- ness of and entry into the systems, participation in the systems, and transitions from one program to another as families move through the systems. In their discussions, the parents examined three main questions related to these stages: (1) N'hat is my role as a parent in this stage of working through and with the systems? (`L) Mhat are the barriers or other issues I face in this stage? (3) What are some solutions to these problems, and what are some existing model programs that incorporate some of these recommended solutions? This section details the issues raised by the parents. First, a summary of the national consensus, broken do\vn by topic, is given. The national consensus summa? contains issues raised by several of the lvork groups and upon which they were in agreement. Sext are summaries ofthe comments made by each workgroup (regional, Native American. and Nigrant). To avoid repetition, these descriptions may not include issues contained in the national consensus. Their purpose is to highlight the issues thatwere of particular concern to the specific workgroup rather than to provide an exhaustive list of issues discussed in each work group. 28 Parents Speak Out for America's Children National Consensus Awareness of and Entry into Health, Education, and Social Service Sys terns Roles and Responsibilities of Parents Solutions * Identify their children's needs * Interact and communicate with their children on a daily basis or Consider themselves equal partners with profes- sionals who also care for their children or Participate in networks and support groups Barriers and Issues of Concern Ir t * * * * sr * * Ir Confusion about the systems due to limited avail- able information or contradictor information Too much "red tape" Cultural insensitivi? and communication barriers Poor attitudes and intimidating behavior of ser- vice providers * * t Poor pa) and lack of incentives for providers to accept Medicaid * Inflexible hours of programs, clinics, etc. Transportation problems/inconvenient locations of senice facilities Inflexible criteria for eligibili? to receive senices Lack of accountabili& within the svstems Inadequate funding of needed senices Universal application form to apply for an array of serl-ices, such as M'IC, Head Start, Food Stamps, etc. One-stop shopping, with assigned resource coor- dinator for each family and provision of service directories, including toll-free hotlines Flexibility in criteria to establish eligibility to re- ceiye senices Convenient operating hours for programs and Facilities Elemental? school curricula in social compe- tent)- and parenting skills Funding for support groups for families Mechanisms within the systems for establishing accountability and for halting complaints Rotation of senice-provider staff to prevent em- plo~ee hut-nout An al\.areness campaign to promote the impor- tance of healthy children Development of a national health care policy Participation in Health, Education, and Social Service Systems Roles and Responsibilities of Parents t Become empowered and become role modelsfor their children and other parents * Serve as advocates for their children, for other parents in the systems. and for the programs that provide senices to them It Train ser\iceproviders in their culture and unique family characteristics * Be involved in program decisionmaking and in evaluating services * Be invohred in program activities and work with sel-\ice providers in meeting their children's needs 30 Parents Speak Out fol- .\lnerica's <:hildren Barriers and Issues of Concern t Bureaucraw. inflexible hours, and transporta- tion-problems * Gaps in senices * L.ack of coordination among sei3ices t Lack of a farnil!,-centered philosoph! * Insensitivity not only of sell-ice providers but of the public at large * Lack of incentives for families to become indr- pendent * Rigid eligibility requirement\ * Inequities in funding for education * Frustration with the systems * Hesitation in confronting the systems * Need for support groups Solutions * Training in parenting skills, beginning as early as elementarv school * Improved communications among service agen- cies and central community resource clearing- houses (one-stop shopping) or Paid positions for parents on boards that oversee programs * Emplovment policies that support families, such as farnil!, leave * Secure and increased funding for programs t Media campaign to improve public opinion of families receiving services t Election of go\-ernment officials who support families * Expansion or adaptation of mode1 programs to reach more communities and faivilies Transitions Through Health, Education, and Social Service Systems Roles and Responsibilities of Parents or Be active participants in the transition process t Be good recordkeepers it Demand respectand develop self-esteem for them- selves and their children Barriers Families Face During Transitions * Lack of communication among programs and the need for one-stop shopping + Failure to receive copies of children's records; records that contain technicaljargon or that are not translated into parent's native language * Lack of sensitivit) * Lackofconsistencvin parental involwmetit across programs * Need for support groups * Too much paperwork or Transportation problems or Inflexible programs and facilities * Lack ofempIo\ment policies that support L'Aiiilir~ t Xholishment of programs IKYXIIW of u~~st,tblc funding * Be a good role model for their children and for other parents t Define the role of parents for professionals in the s\stems Solutions or Toll-free hotlines and resource directories t SensitiCv training for service-provider staff * Mentoring of new parents in the programs b) svstem veterans + Guidance for parents provided by doctors. hospi- tals, and other service providers * One-stop shopping and assignment of one case- worker per family for all programs t Reform of eligibility requirements to consider net pa!-. examine hardship conditions, and provide a saf'en, net * Legislative action, such as farnil!, leave policies * Asscartit.cbncw training for children by tliril-parellr Awareness of and Entry into Health, Education, and Social &mice Systems The parents willingly accept their responsibility as the primanpro\ideroftheirchildren'sneeds. However, the! also acknowledged that every family needs help occasion- ally. Federal, State, and local programs can support informed parents who enroll their children into these progmms. Unfortunately, lack of information, bureau- cracy, and inflexibili? in service provision prevent man\ families from benefitting from these programs. The parents maintained that programs must be coordinated under the one-stop-shopping approach to supply flexible and accountable service. Roles and Responsibilities of Parents The delegates recognized that they must first identif! their children's needs. Children need to be immu- nized, given a proper diet, nurtured, taught self-respect and respect of others, taught learning skills, provided with a safe, stable home environment-the list is long, covering the full range of physical, emotional, and spiritual development. No system ofhealth, education. and social senice professionals can take the place of parents in the home. Parents must take the time and effort to know their children. Federal, State, and local programs can sen'e only a supporting role as parents struggle to raise healthy children. Daily interaction and communication with children is key. Good parents listen to their children, not onlywhen they complain or are sick but also at other times. Parents with special needs children must make an additional effort to maintain balance within the family and to devote attention to healthy siblings. All children, however. can benefit from existing Federal, State, and local programs, and parents must take the second step offinding out what the programs are and what they have to offer toward meeting their children's needs. There is no substitute for the well-informed parent. The delegates maintained that parents should consider themselves partners on equal footing with professionals and other care providers and be recog- nized as such. Parents who know their children's health needs and risks and the services available to support them make self-confident parents who can work effectively with care providers. U'hile respecting the judgments of professionals, parents should not surrender the decisionmaking to them; when profes- sionals give advice that seems questionable, parents should trust their own instincts enough to seek second opinions. As advocates for their children, parents should be assertive and persistent but should not forget to be diplomatic. The way they interact with care providers will influence how their own children behave toward others. Good partnerships are respect- ful partnerships. -5 .-. ----- ,: .----:;. ._ : _-..-- .._ / -z-.~ No system of health, educa+& -and social servic'c. profession&& can take the place of parents in the home. `L : Finally, the delegates agreed that networks and support groups are a tremendous asset. Parent networks can proride information, moral support, and hands-on care, and can make up for some-though certainly not all--of the failures of the present health care systems. Setworks can help parents at all stages of their children's health care, but most ofall in the entry stage, as the); make their first tentative and sometimes confused steps into the programs. N%en an individual family questions a profes- sional opinion, networks can supply alternative sources of information; when the family doesn't know where to turn 32 Parents Speak Out for Xmerica's Children or what step to take next, networks can point the way. Networks allow parents to draw from the shared experi- ences ofother parents and work together toward common goals. Not all parents entering the programs know their rights, and networks give them the opportunit\ to learn and exercise their rights in an unthreatening em-iron- ment. Networks are effective in this wa\- because theI. teach h>r example. Networks can also help parents learn their respon- sibilities. Not all parents are responsible parents. M1ile it is important that parents raise their children as thel see fit, some fail to recognize that their children have special needs. The children may be physically healthI, but have learning disabilitiesor behavioral or emotional disorders, and their needs ma!. pass unnoticed. The parents may have alcohol and other drug problems or problems that lead to child neglect or abuse. These parents may den!, that problems exist. The!, may be reluctant to seek help because they believe it is shameful to do so. Professional health care providers can inter- vene in such cases. However, professionals are often perceived as threatening and, as a rule, are less effecti1.e than parent networks in these especiallv difficult cases. Troubled parents are more likely to listen to other parents and to perceive them as partners rather than as authority figures. The other parents can, in turn, seek guidance from the rest of the network as it shepherds the family into the health care systems. Barriers and Issues of Concern The most often cited problem of parents being aware of and entering programs was confusion about the systems. To many parents, the systems seem designed to discour- age them from the start: To withhold information and frighten them away with paperwork. So single source of information on the man\- available resources exists. and information provided is often contradicton. III addition. many employees of the programs don't even know how the svstems work, nor do they how how to access the information that can help parents find their ~a~~. The amount of red tape is enormous: application forms are long and complicated. To make matte\ worse, different agencies have different application forms, and parents are forced to repeat the same com- plicated procedures as they try to move from one agency to another. As one parent stated, "The paperwork doesn't flow." In addition, application forms make no allowances for the diversi? of applicants. Parents who are not native English speakers often have great difficulty trying to make sense of the forms. Even fully fluent English speakers make this same complaint. No allowances are made for cultural differences or for the communication styles of minorities. Alternative sel\ices for the blind and the hearing impaired are also lacking. Many delegates complained that the attitudes and behavior of social senice workers and health care pro- viderscan be patronizing, unfriendly, intimidating, and sometimes even abusive. They believed that a great many social sell-ice lvorkers suffer from employee burn- out. 1Vorkers are not sensitized or properly trained, and they therefore bring their prejudices to the workplace. Parents entering the programs feel this most strongly, while those at later stages come to expect a certain degree of mistreatment as part of the price they must pay in eschange for senices. "It's hard to get into the system, and once you get in, you don't want to stay," stated one delegate. But their needs force the parents to stay, with the result that they come to feel as trapped by the systems as by the needs that brought them to seek help in the first place. As for health care providers, their attitudes and behavior tend to reflect their own unhappiness about how poorly they are paid for the services they provide. Medicaid, for example, pays providers so little that the)- have no incentive to take Medicaid patients. As a result, the patients often receive inferior care or are refused care outright. Cltimately, the patients are the ones who suffer from inadequately funded programs that fail to deliver on their promises. The health care centers themselves often present a\arietvof physical barriers to disabled children. who hold S-to-.5 office hours are making no allo~vances for working parents. The lvorking parent \\llo has to leave work-losing a morning. an afternoon, some'- times a whole da!, in the process-to mert these inflex- ible hours may be at risk of losing his or her job. This situation. in turn, ma!' put the child at risk of forgoing important preventive medical services such as immuni- zations and lvell-child checkups. Transportation is a related problem. Parents often have to take long hours a\vay from their ,johs because they have to travel long distances to their appomtments, and they often have to rely on either public transportation or help from friends. This prob- lem is particularly acute in remote, rural areas. The delegates expressed unanimous dissatisfaction with eligibility criteria. The criteria are artificial and inflexible. The\ do not reflect real income-net income, after taxes-and applicants can be denied entry into programs if their income exceeds the criteria by as little as a few dollars. A family mav meet the criteria one !`ear, onl!, to be disqualified the next because of a slight rise in income. M77ile the eligibili? criteria are meant to prel'ent abuses. the criteria themselves often foster dependency. In man\. cases, a famih, can benefit in the short run- quali@ for Food Stamps, for example-if one of the parents quits a job so as not to exceed the eligibilit) criteria. Quitting a job can actuallv mean more food on the table. L'nder some welfare programs, a family can quali@ onI!. if the father leaves home. `You learn to pla! the :game." one parent said. Parents take these steps, not because they are laz!. or cynical hut because they have immediate needs and feel they have no other choice. Ho~ve\,er, the choices they make often mean that depen- dence on welfare programs is handed down from genera- tion to generation. Parents who try to make this point with social selyice Ivorkers feel even more frustrated. Thev face a bureaucracy from the moment they enter a program, and the)- either adapt to the bureaucracy or go without selTices. If they feel they are mistreated, thev have no one to turn to within the systems. They see a general lack of accountability and are often afraid that if the!, protest, they will be denied services or subjected to further mistreatment. Inadequate funds are an underlying problem for all programs. Because there are simply not enough dollars to go around. programs sening the same com- munities are forced to compete for the same dollars. This competition createsdivisionswithin communities. and the rifts are often felt in the parents' netjvorks. Parents will natwall!, fight for the children, but lvhen they are forced to fight other parents, the real losers are the children. Solutions to Promote Awareness of and Entry into Systems First among the proposed solutions leas a universal or near-universal application form for all services. \vith consistent eligibility criteria. The form shoulcl be eas\' to read. .\lternate versions of the same form should he made available to parents who are not native English speakers. Special arraiigementssholltd be made fi,r the blind, the hearing impaired, and applicants Ivith low literacy levels. There should be a single point of entl?' for all senices, i.e., one-stop shopping. Mhen families enter the bureaucratic maze, the\ should be able to consult a single source for comprehensi1.e information on avail- able services and referrals. A resource coordinator should be assigned to each family, and the family should be provided with local, State, and national directories of available semices. Toll-free hotlines for resource information would be a useful supplement. Eligibility criteria need to be more flexible. The criteria should be based on real (net) income. Inflexible criteria often foster dependence on the systems, as par- ents quit jobs or avoid seeking emplo\ment and fathers leave households so that families can meet rligibili~ criteria. Greater flexibility will promote self-help. Agencies must also have flexible working hours- not just 9 to 5-in support of working parents. M:I~I~ parents risk losing thrirjobs if they have to take time off' from work to meet appointments with cart providers. Programsshorll[Ihe instittltedin element;~lv~choc,l~ to develop social cc~mpeteilc\~ancI part'llting skill< and 10 help train children to be effective parents and advocates for their own children someday. The characteristics taught should include self-esteem, problem-solving and decisionmaking skills, and respect for others. Funds should be made available to help create and maintain support groups. Support groups are popular: they encourage parents to take a more active role in raising their children; they develop parenting skills; and, because the). promote self-help, they can actually lighten the burden of social service systems. As one parent stated, "The best program is the program that doesn't cost anything," in other words, that encour- ages independence. Support groups are the closest kno\vn approximation to that ideal program. They can be developed at the neighborhood level, at the work- place, at schools, or within the tribe, and they can be tailored to any number of specific needs. Parrnts need a wa)- to talk back to the systems. Parents are partnerswith sewice providers, and the true beneficiaries are the children; when the partnership breaks down, the children pay the price. Parents should be treated compassionately and with respect. A mecha- nism should exist by which parents can submit evalua- tions ofthe services they receive and register complaints when necessar). Complaints should be addressed in a timely manner. The bureaucracy must be more ac- countable. and accountability must be on site to be effective. Parentswho have been recipientsofprograms should sel?e on agency advisory boards. Man!, delegates expressed the belief that em- ployee burnout is responsible for much of the rude treatment parents receive. The delegates suggested that rotating employees to different posts within agen- cies could help prevent burnout and would certainly result in better informed employees who can then pass their knowledge on to needy families. An all-out effort needs to be made to raise public awareness as to the importance of healthy children. Antismoking and AIDS a\vareness campaigns have proven rffectiw: children should be the next focus. Togerhel. j\ith a media campaign on children as ;m irl\rstnlellt in the ftltlu-r. thi\ count17~ shwAtl initiate ;I,, (`11(`1 gt.tic, dtJt,;t1v OII o,~I- 1iatiollal lir;llrh cart polic.\.. Is health care a right or a privilrgr? Is health illsurmce a right or a privilege? We cannot expect to move forward on particular solutions without defining our values and goals in specific, practical terms. Participation in Health, Education, and Social Service Systems As families participate in health, education, and social service systems, parents must seek education for them- selvesand become empowered, the delegates maintained, so that they can become role models for their children and for other parents whose families need senices. Fur- thermore, programs should offer incentives for parents to become empowered and for their families to become independent. Programs need to become family centered, and parents need to be involved in program decisionmaking to keep programs focused on providing quality service to meet families' needs. Roles and Responsibilities of Parents The delegates agreed unanimously that the parents' primary role ofnurturing their children does not change as their families participate in health, education. and social service systems. Parents of children who receive services do not relinquish their role as the prima? advocates for their children and as the parties respon- sible for ensuring that their children's needs are met. On the contrary, the delegates expressed that participa- tion in programs brings added responsibilities to the parents. The delegates contended that parents in families receiving senices have an even greater respon- sibility to become empowered themselves so that the1 can empower their families. They stressed that parents must seek education, when necessary, and good mental health; they stated emphatically that parents have the responsibility to be "emotionally and socially straight." As parents become empowered, they become role mod- els, not only for their children but for other parents in the community. 36 Parents Speak Out for America's Children An important function of parents whose children receive senices in serving as role models is to reach out to other families and enlist them into the programs. Mhen new families are enlisted, declared the delegates, these parents have a responsibility to help orient the new families in the programs by providing them with information and offering their support. In this way, parents sene a dual advocacy role-for new parents, by offering their support, and for the programs, by publi- cizing their senices and being committed to them. This commitment may involve lobbying for endangered pro- grams. As parents sene as advocates and network with other parents, they can build community support for families. As one delegate stated, "Empowerment of families happens as a result of education, support, and working together." LVorking together, the parents insisted, also means jvorking lvith the senice providers. Parents can sup- port the efforts of professionals working with their children by being involved with the programs' activi- ties and offering supplemental exercises at home. Parents should ask teachers or other care givers for actillties that the!, can use at home. LVorking together for the children's benefit can build trust among profes- sionals and parents. Ivith the result that service provid- ers ma!. begin to view parents in the manner that the) so fervently desire. i.e., as experts where their children "EmpAw-ment of families hq@ens as a resu It of education, s~pj&-t, and working together." -g-- C,~ `_ _ -- ~. r -.g. -.- ; -- . ._ -.. . . --y _ are concerned and as respected partners in providing for their health and education, Parents also haye a responsibility to train senice providers in the culture and unique characteristics of the families they sene. Only the parents can educate the community about the special problems ofminorit~ families. for instance. Programs must undrt-stand the cotntnmiities the!,set-\-e to adequately meet their needs. Repeatedly, the delegates insisted that. as respected partners, they should have a \-oice in the programs that seme their families. Thev contended that. because the\ have avested interest in the qualit\- of'senice. they-&ould be involved in all aspects of the programs. from program design to budgets and hiring decisions. The parents role should extend from planning and it~~l~lt~tnrt~tit~g pro- grams to e\,aluatitig them and their setGct3. Met- all. the quali? of senices affects the parents directly the!, arc the first to know when needs are not being met. Barriers to Participation and Issues of Concern On the topic of participation in health, education, and social senice systems, parents reiterated many of the complaints that the\ had expressed concerning alvare- ness of and entn into the svstems. The frustration with the y-sterns does not end Ivhen fatnilies become in- volved, the)- stated, citing the same difficultiesin obtain- ing information, inflexibiliv in hours and senices, transportation problems, and language barriers. Nor does the amount of "red tape" decrease once a family is participating in the programs. Stated one delegate, `*Bureaucracy often discourages participation." The delegates were also concerned about gaps in senices, which senice providers often do not address directly but instead "pass the buck," sending the farnil) from one provider to another in search of the needed senice. The supply of senices is often inadequate to meet the detnand, resulting in long waiting lists or the use of quotas. For instance, the lack of affordable daycare was a probletn cited by many delegates. The delegates attributed many ofthese problems to two principal factors: lack of coordination among pry* grams and the absence of a fatnilycrntered philosoplt\-. Coordination and collaboration among programswould facilitate the identification of gaps in senices, as well as duplication, so that resources could be used more efficiently to tneet the needs of clients. The implemen- tation of a family-centered philosophy would ensure that progratnswould provide parentswith the necessan information, would have flexible hours, would be con- veniently located. and would consider their families' cultural and language backgrounds, not only in their printed materials but also in their policies and proce- dures. The delegates also stated that leadership is lacking at the Federal and State levels, resulting in a resistance to such changes in the systems. The insensiti\-e attitudes ofsenice providersoften extend to the public, the delegates maintained, leading to a "national psychology" that looks down on parents receiving sellices. Delegates shared the embarrassment of themselves and friends created by comments that other customers in checkout lines make regarding their use of Food Stamps. The delegates want the general public to know that parents whose families receive senices care about their children and that their misfor- tulles can happen to anyone. "Our country is not segmented into welfare recipients and the rest of us," one parent insisted. In fact, most people in this country benefit from some kind of public funding, for example, fartn subsidies. As we improve our attitude toward families recei\r- ing senices, the parents countered, we must not let them become apathetic or complacent, with the result that they are dependent on the systems. The delegates repeatedly said that the systems need to offer incentives to parents to become independent. Often, they said, programs provide a quick fix for crisis situationswithout addressing the underlying causes. True healing cannot begin, they said, until the systems provide a holistic approach to treating fatnily problems. As one parent said, "There is a sense of futilin7 on the part of some families, a lost sense of what they could be reaching for and whar they might achiel.e." eligible for sen-ices: yet the parents cannot afford to provide for more than the child's basic needs. Health care, for instance, was a major concern; the delegates reiterated that every family has a right to adequate health care. Once again, the parents criticLed the rigid eligibility I-equirements. This situation also extends to education, the! maintained. They contended that inequities in fmiding in the local school districts automatically precludes "equal education for all," and middle-class children often are not eligible for special educational programs. They urged that these funding inequities should be addressed. Finally, the parents expressed again their frustra- tion in conhonting the systems to achieve positi1.e changes. Even parents who are activeI>. participating in y'stems hesitate to make waves. Said one parent, "If you act assertively,you are isolated." The!.reiterated the need for family support groups and ftmding to organize them. All of these problems can be o\,erwhelming for parents at times. One delegate summed LIP this senti- ment with the following remark: "The children are our future, and it's scaq." Solutions to Facilitate Participation Although the problems may seem o\envhelming. the\ are not insurmountable, the parents stated emphati- cally. They recommended taking steps in the follolving areas to begin to break down the barriers to producing healthy children ready to learn. First, the parentsadvocated that training in parenting skills should begin early, before a youngster becomes a parent herself or himself. They pointed out that our youiig people receive litnited training, at best, for their mostimportantrole. Mostofusfollowthe parenting styles of our own parents, but not e\eIyone is fortunate enough to have lo\ing and nurturing parents. Early training in parenting skills is imperative. The parents stressed that, for parents who need senrices. impro\,ed coinmLu~icationsamong senice agen- cies would solve many problems. Improved communi- cations would facilitate entry into and participation in programs because senice providers would be able to guide families to the most appropriate program to meet their needs. The delegates recommended cen- tral community resource clearinghouses. Such clear- inghouses should be staffed with culturally sensiti\:e employees, should provide the paperwork to apply for senices (preferably through the use of the universal application form), and offer flexible hours. Such a facility would lead to better coordinated services and a reduction of gaps and duplication in senices. It would ,,: "There is a sense of futility on the--part of some families, a lost sense of what they could be reaching for and what they might achieve." be a tint step toward implementing a one-stop shop- ping approach. In addition, the delegates recom- mended that resource hotlines be established, that directories of senices be published, and that each communit\.`s trlephone directov include a directory of local senices and resources. To move tolrard a family-centered philosophy in the systems, the delegates recommended that parents be elected or appointed to the boards that oversee programs. Through their positions on the boards, the parents could offer input, not only in planning but also in evaluating the programs that serve them. Parent input would keep the programs focused on the bottom line: providing quality sen-ice to meet the needs of 38 Parents Speak Out for i\tnerica's Chiltll-en families. The delegates added that parents should be compensated for theit- work and the expertise the\ would bring to the planning and evaluation processes. M'ithoutcompensation, the!,asserted, tl~eparentswould find it more difficult to gain the recognition they de- seiTe as respected partners. Etnplo!.ers also neecl to recognize the importance of families and develop policies accordingl!.. The del- egates expressed a need fin- flex-time so that the\- cm more easil!. attend to family matters. The work groups universally endorsed the passage of a famih. lea\~ act. The~alsorecomn~ended that etllplo~ei-ssLlpport da~~wc centers for their emplo\~es. Secure and increased funding for programs to ensure their continued esi~trnce \\~)uld also improve participation in the sYstcms. the delegates maintained. Funding is particularl! important Ii)]- p;went support groups. In addition, the delegates recommended that flmding mechanisms for education be changed. Fur- thermore, the!. recommended overall reform of the educational svstem. The delegates urged that a "national ps~cholo~~~" be developed acknowledging that all children and fami- lies have the right to certain basic supports for their health and well-being. This attitude can be achieved through the media. One group maintained that the Surgeon General's Office "has the pol\w-" to change public opinion through an advertising and public rela- tions campaign stressing this concept. Television spots could show a respectful approach to families applying for senices. Another aspect of changing the national attitude is to elect officials who actively support families. The delegates urged that Americans become involved politi- cally. Ifwe are to solve many of the problems facing our families, they said, we must have committed leaders. Finally, the delegates asserted that we have model programs that show us what works. We should adapt local model programs to other commutnities and expand model programs for special needs children to fit all children. Elements of the most cited model program, Head Start. could be incorpoI-ated in the pi-imaI-\-grades. fori~lsta~~cr. Transitions Through Health, Education, and Social Seruice Systems X11 parents and children experience transitions. The Parent \Vork Groups agreed that parents, agency offi- cials. and commmlity people all have roles and respon- sibilities in the successful transition ofchildren through health. education, and social senice programs. Being read!, to learn. they said, is more than making children rcad~~ for schools; it's also making schools ready for children. They concluded with what they called the "rule of the three C's," \\,hich the\. said drives successful transitions: (:onsistencv. continuity, and coordination of`srn-ices are all necessaq to promoting healthy chil- tlrr~v---a~~d families-ready to learn. Roles and Responsibilities of Parents During Transitions Xs they discussed parental roles and responsibilities in transition. the 12 work groups centered their thoughts on the following question: How do we, as parents, ensure a smooth transition from birth through infancy to earl!. childhood to being healthy and ready to learn for entering school? One response was sounded repeat- edly: Parents need to be active participants in the transition process because they are the best evaluators of their children's needs, including health and special equipment needs. To participate in transitions, parents must be prepared for the transition process. A transi- tion from one program to another requires adjust- ments for both parent and child. Therefore, a smooth transition begins with the transition of the parent. Examples of ways the delegates have participated in transitions and prepared their children for them in- cluded touring a new school or health facility with the child. introducing children to new people to acquaint them with new teachers or specialists, and learning a program's dail\,routine and talking to children about it betore ilnmersing them in it. The groups all agreed that m;lkiiiR these preparatioli\ for ati!. transition is impor- tant to ~.~cr\~)ne's \\rll-heii~g. The parent\ recom- n~~nctc~l rl~;ir lir2ltll pr~~~itl~*r~. 4~~1iool ~~tlrriinisti~;ltc~t~~. and senice providersdevelop transition resource manu- als concerning their programs and services for families. ;\greement \vas unanimous that parents must be good recordkeepers in order to make successful transi- tions; the parents must also ensure that records are transferred lvhen a child makes a transition out of one health, education, or social senice program or system and into another. These records, the delegates pointed out, include financial records for program eligibility, medical records for immunirations and tests taken, and school records for credits. During transitions, as well as in other stages of working with the systems, the delegates said parents must demand respect and develop self-esteem for them- selves and their children. To help ensure children's self-esteem during transitions, parents must make sure the children know their feelings about transition are important. Some parents have a special responsibilit) for developing the self-esteem of their children and making transitions smooth. Parents with children in special programs, for example, must make sure the! don't fall prey to the stigma that others often create when children need more than usual senices. The parents complained that practitioners do not ~llue parents as human beings. They were critical of people administering health, education, and social senice pro- grams who sometimes act as though they own the children. Phrases such as "parents are professionals, too" and "label cans, not kids" were voiced throughout the conference. The delegates agreed that parents need to be good role models, and becoming good models sometimes means finding good models for themselves first. It also means that parents need to watch out for other children in the community, and teach better parenting skills to parents who don't adequately fulfill the role of parent. As the conference was ending, one delegate com- mented, "I thought I was a pretty good parent when I came here. But with all I've heard and learned here, I know I'll be a better parent in the future." The other delegates agreed with this sentiment and added that the Conference has gi\,en them a new role: They have been charged with the responsibility of returning to their communities to meet with officials of programs that affect their children and to define the role ofparentsfor the professionals involved. Barriers Families Face During Transitions To open adialog on barriers to successful transition, the delegates focused on one question: What makes it difficult for my child and me to move from one program to another? One universal need for making transitions more successful was for parents, providers, and government officials to improve communications. The parents felt that better communication among agencies would de- crease turf wars, prevent duplication of senices, and promote the continuity of services. The delegates voiced concern that, too many times, they have found that professionals in officeXdon't knowwhat programs are a\-ailable through office B-even when A and B are under the 5ame umbrella agency. The parents pointed out that one-stop shopping is just as important for smooth transitions as it is forentp into programs. They also called for development of one universal applica- tion form for a \ariet!, of public assistance programs, such as \2'IC, .\FD(:, and Food Stamps. They insisted that transitions would be smoother if files were tracked through a computer svstem that is accessible to staff in all State programs. Parents said they need to receive the reports lvritten about their children so that they can assume the role of recot-dkeeper. But ifreports and other program materials al-e to be useful, thevcannot contain technical -jargon. Instead, they must be written in the language of the parents. That might mean having materials in foreign languages for parents who do not speak English or ha\ing them developed as picture books for parents who are illiterate. One delegate told of a Spanish- speaking mother of a mentally retarded girl who at- tended public school. For 4 years, the mother did not know about the child's educational progress, problems, or needs because evervthing she received from the 40 Parents Speah Out for .I\mer-ica's Children ,f school 1~1s l\.ritten in Etiglish. and tiotic' of thr ~c1ioo1 staff spoke Spanish. Parents repeated that. during transitions (as in other phases), program materials and staf`f'mnst be srnsi- tive to all diff'erent t\`pcs of cultures; they must br wnsitivr to social and financial status, too. The delegates com- plained that case workers tend to stereovpe and pigeon- hole people, too often ignoring clients backgrounds and histories. Successfitl transitions. the delegates said, de- pend on everyone ittyolved trusting each other: inappro- priate communications do not breed trust. Another universally noted need was for parents to be involved consistently during transition. Parent boards that are proportionately representative ofeth- nit, racial, and cultural differences give all parents an important voice in program design and polic~tnakini;. tvhich can help them prepare their child fc)r transition. After transition occurs, parents still need to he in- \.olved. The parents repeatedly cited Head Stat-t as a good example of a program that keeps parents itt- vol\.ed; but afier Head Stat-t, pxettts ~tertl to tnakc an extra effot-t to sta\ itt\ol\.etl in thrit- childtwt'~ orltv~. educational ol~pot-tiiiti~ir~. The delegates said that support groups are needed even more during trattsitions, and they advocated that programs work with support groups to make transitions more positive. But even if support groups are not available, delegates wict ptygrams should provide coun- selors to help get parents involved and to prepare them fot- transitions itito and out of programs. Once again. the vwt-k groups cited a need to decrease the time parents spend on paperwork b! de\~rlopitig It'45 complex fortns. In addition. delegates said agrncies must be directed to reduce the time the) take to decide ati applicaiit's eligibilitv. Implen~entiiig these clia~igcs ~\~oultl help families make more time11 trattsitiotis aiid provide more moti\.ation for families to ttio~~c' from otita progt-am to ailother. Delegates from ~~11 tou'ns ever)Jvhet-e pointed out that families in I-m-al .\merica often have no re- ~outx~s itt their hometo\vns to meet some children's ltcalth. t~drtcation, or social set-\ice needs; travel dis- tances to a\xilable pro\-iders can be long, and public transportation is seldom available. If transitions are to be successfL1. programs need to be as flexible as program adtninistrators expect the fami- lies to be. Flesibili? should begin with program eligibility criteria and then continue to the program structure and facilities. Many delegates remarked that family and indi- \idlral needs still exist lvhen income levels change, but eligibili& criteria at-e often too rigid to accotnmodate the transition. Too often. the parents noted, agencies oyer- look the need for their offices to be open when parents can gain access to them, after traditional business hours or on lverkends, for example. X stat-y from one delegate, the mother ofa child I\-ith physical disabilities, documents the need fix flesible facilities. The child's classroom contains a restroom. Howew- the delegate's son, who uses a \cheelchair. and his attendant were not allowed to use these f&ilities because he t-equires tnore time than the other childrrn. Tltev had to go across the school pm to a communal restroom because the tcachersdidn't~\-~tnt the other children uxiting in line for the ho\.. .Somr flesibilit\ in the pt-cjgi-atti \\.otlld liaw ttiatlc him feel tttort'~~-el~~otttt .md comli wt;tblt~. ;ttttl it ~~otiltl liaw m;idt. Iti\ tr~maitioti to tllc> t ~;I~WI~OIII nrt~c~lt IIIOI.C' lxAti\(,. Labor laws need to be enacted to make employs more considerate of the needs of people with children, particularly poor working parents. One parent del- egatesurprisedeven herunderstandingcolleagueswhen she told that her employer, a hospital, would not give her time off to come to the Surgeon General's Confer- ence; she had to deduct the Conference from sick and \acation leave, which she also uses when her child has a medical appointment or a day off from school. Parents reported that they and their children are constantly facing new transitions. They suggested that some of these transitions and their associated problems could be eliminated, if all levels of government would stop the frustrating practice of abolishing programs that families depend on without notice. Cnstable fund- ing from all levels of government is another frustrating barrier parents hurdle during transitions in health, education, and social service programs. The parents felt strongly that ftmding should not be based on grants or time limits. Solutions, Resources, and Partnerships for Improving Transitions As in the other stages, improved commmnication dur- ing transitions was one of the most often cited needs, and parents repeated their suggestions of using 800 numbers for information clearinghouses and hotlines, especially for State program information, and creating local phone directories for resources or computer data- bases that would be updated yearly with current infor- mation on various programs. Some delegates noted that hotlines need to have bilingual operators who are representative of the calling population. One delegate commented, "M%ere's l-BOO-MEDICAID? There's no trouble finding l-800-SEX." To address the need for culturally relevant pro- grams and culturally sensitive staff people, the del- egates suggested that professionals, particularly the first points of contact in a program or senice, be given sensitivity training so they know how to avoid offending people from various ethnic backgrounds, social classes, and financial means. Parents caid they could use guidance through the health, education, and social senice systems. One such guide they proposed was using system veterans as men- tors for new parents; these veterans could become personal mentors or could develop resource manuals that parents new to programs would receive for assis- tance and advice. They could also encourage new parents to seek out community-based groups, particu- larly support groups. Doctors and hospitals could provide guidance to parents through expanded prenatal and parenting train- ing. Thev could also distribute information and do outreach for State and community programs through packets that would be given to every parent of a new- born. Senice providers could assign a full-time staff person to help people with transitions into and out of the program or senice. X number of regions discussed total communi~ o\vnership of programs as another solution to promoting parental involvement. In other words, programr* have to be familiar to everyone in the community. not just parents. It is also important to involve parents in e\Auation teams for clinics, schools, and social senice agencies. The delegates fourld no shortage of solutions. either, for how to decrease paperwork and modernize programs. As was previously discussed, eve? work group adl,ocated one-stop shopping, sensible hours that fit parent schedules, and the use of a single form for several assistance programs. Likewise, many parents proposed that one case \vorker be assigned to work with a family fcjr all public assistance programs, rather than one worker for each program. This practice would allow families and case workers to develop a more trusting relationship and would reduce duplication of questioning and processing. The delegates also offered more solutions to the problem of rigid eligibility standards. The delegates suggested that assistance programs base theirdecisionson take-home pay, not gross income. One mother said, "If I brought home my gross pay, I wouldn't need the senices." 42 Parents Speak Out for America's Children The delegates also suggested that the Go\erntnent de- yelop hardship deductions that would be used in calculat- ing eligibilitv for senices and programs. Another call Ivas for a safe? net for families who don't a1wal.s fit within the parameters of assistance programs but are needful of help, even for a short time. An example of such a situation came from a southern delegate \vho told that she \vas liling in the north when her doctor said her child \\-a~ dying and needed to live in a warm climate. She and the child moved to Florida, but the father, Ivho couldn't find a comparable job in Florida, staved in Michigan. The woman applied for some assistance but 1~1s told she lvouldn't be eligible miless she first filed abandonment charges against her husband. All work groups discussed legislative solutions and regulator relief to some of the harriers to successful transitions. One remecl!~, the delegates agreed. is that parents have to support and elect family aclvocatrs at all governmental levels. ;\nother recommendation is for the Government to simpli& application and eligibiliv re- quirements. X third solution involves getting parental leave bills passed; they hal,e been proposed but now the! must be enacted so that parents, especially poor working parents. can have time away from theirjobs lvithout being penalized when a child needs to see a specialist or go to an interview for a new educational program. X number of delegates expressed concern that laws supporting families have been enacted but are not being enforced, at least not everywhere. Delegates from New York. New Jersey, and Puerto Rico, for instance, made a laundry list of needs that delegates from the Virgin Islands said their territorial govern- ment is addressing through the provisions and man- dates in the Education for All Handicapped Act (Pub- lic Law 99-457)) which targets children aged 0 to 2 who are at risk. The parents did not let themselves off the hook as far as developing solutions was concerned. The parent- directed solutions included acting assertively on the child's behalf. teaching children their rights so the\. can become their o\~n advocates, training them to be coop- erative (even when others are not), flelping them u11- derstand it's not their f:nult lvhen difficult teacher4 or caregivers can't be circumvented, and confronting teach- er-s who don't respect children or who belittle them, especially in front of other children. Programs Tha.t Parents Grade A+ r2hen the delegates were asked to make a wish list ofwhat a model program would be like, succinct descriptors were gi\-en quickly. In summar), the parents said programs must be child-centered and familv friendly, be easil! accessible, have broad eligibility standards, be antidiscriminatory and multilingual, be well promoted, provide individualized senice, be staffed sufficiently, and have hours of senice that are convenient to parents. Parents also cited a number of programs that they felt were exemplav in their administration or service. Public Law 99457, for children at risk aged 0 to 2 years, is a good example of a seamless and effective system. New parents need to be targeted for special attention. Public Law 994.57 should be expanded to benefit older children and children who do not have special needs, and should include family planning and prenatal and neonatal ser- \ices. More x-accines could also be delivered through this program. Other generic programs, or those based in man)- States, inchlded Head Start, school-based clinic programs, Home Instruction Program for Preschool Yomigsters (HIPPY), workshops on the development of Individual Education Plans (IEPs), United Way senices, Pathway to Understanding, and Family Resource Cen- ters. Local or regional programs are listed in the descrip tions of individual work groups, which follow. The delegates offered these recommendations with the hope that many of them will be implemented. One parent concluded, "We'ye said all this before; is anyone listening?" Region 1 delegates stressed the im- CONNECTICUT MAINE MASSACHUSETTS NEW HAMPSHIRE RHODE ISLAND Catalog of available services, explaining ehgihiliecriteriaand henefits,~\~ould help VERMONT parents as they enter the systems. The delegates rec- ommended that application processes be streamlined, beginning with a single application form, ifpossible, for all services. Apphcation forms should be adapted to linguistic and cultural differences. The blind, the hearing impaired, and those with low literacy le\.els need special attention. Social senice and health care providers nwd to adjust or stagger their offlice hours for wrking parents. The parents' transportation needs also should be addressed. To parkpate fully in `:Region `I "Recommendations at a Glance :; `Awareness and Entf'Y :" -)r Make information on health, education, and social services aVailable in public libraries 2: - * Streamline the procedures t0 LIpplY for services : : * Adapt app 1icaGon forms to kg&k and cultural differences j Sr Offer flexible hours for services ii Sr Address transportation needs c : ; i Participation I : * Encourage parent participation and. advoc;~;ram policies and 1 I * Inform parents of their rights; pubk~e p parents' options . * Make service providers accountable i * Understand he needs of parents, particularly smgle parents >\ "Transitions * Determine readiness for transition by abilities and developmental s%Fs rather than by age * Maintain consistent philosophies among programs * Train parents in the curriculum being used and demonstrate WV to social status j the health, education, and social 3el-rices systems, the delegates strongly advocat- td that pal-en ts vote in na- tional and local elections, join or form nehvorks ill tlreircorllmunities,andtake a more active role in thei school s\3terns. The\ \ieI\wl advocacl, for their children as a routine part of parenting in their rela- tionships wiith teachers, doctors, etc., and not .just in the realm of leg- islative activities. Thei. stressed that senice in- stitutions need to he more flexible philo- sophicallv so that they can be more tiparent driven"and that parents should participate lvith schools aiid wr\icr pro\idet-s as respected partners. For instance. patwit\ should be allolccd to attend in-ser\-ice training sessions fat- sei7ice providers. and they should se17e 011 boards that direct the activities of programs. Paretlts should be informed of their rights as thev participate in the vstems: i.e.. policies and options should he not onI!-\vritten but also puhlici~cd. Policies that rcsttlt in children beitig takrti from their parents should he scrrttitli/ed closeI\-. Pat-- cnrs should not he aft-aid to rspress thrit- t~txds. The delegatesalso complained that social set-vice and hralth cart sy\tctns at-v rigid. bttrvattcratic. alid cl\-rt-special- ired. lvith the result that parrtlta fwl lost It-ithitt thcsr svstems. The dclcgat~,si\.ct-~ co~lcertletl that the wt.\ icv providers m-e not accotttital~le fiti- the quality of'scr\ice they ptxnide. Pat-rnts need support from the s! \tcnt\ and from their cwiplo~ws (t'.,q., flrsihlc ltot~r4) to participate. Provider\ and emplo~~ct-\ must recognk that parrnts, particttlarl~~ single parents3 can't "do it all": the\ ha1.c ph!Gral and emotional litnitationc (wch as lack of time and an al~ttndanct~ of strt35). Parents ft-om the Se\\- England States ~vtw coot- cerned that children are stthjccted to transitions too often sitnply because their age dictates theI. move into a new program. These delegate\ felt that instead of chronological age, abilities and dv\~elopmental stages should be the factors that determine readiness to mo\.e on, up. or out. They noted that this cancerII is especialh important for childt-en with special needs. Another concern peculiar to this group ux that changes in philocophl. among programs impede successful transi- tions. As a solution, the!. suggested that schools host parent\\-ot-bishops that demottstrare the cttrriculttm and tell parents how they can complemenr it at home. Region 1 delrgatesechoecl the sentitnentsofmost othet groups concerning how pi-ograms and people must he sensitke to differences in ethnic. financial. and social status. Bttt this group added a unique parental role to the equation: Mothers and fathers must make sure that caregivers and setTice providrt-s understand and appre- ciate individual familv \alttes. as 1~~11. in Srw Hampshire. uhich coordinates nutrition educa- tion itt schools: the Yppet-\.alley Support Group in New Hatnpshit-r and \`ermont; G-owing Cp OK in Bristol. \.r.rmotlt: Eat&~ Childhood Group in Middlebury, Ver- tnottt: <:ollal,ot.atiotl for Children in Massachusetts: Eat-l!. Childhood Network in Aroostook, Maine; Devel- oping <:apahlc People Transition Task Force and Child Find, both in Rhode Island. entering nealtn, eciucatlon, and so- . cial senice systems should network with more experienced parents and -- -. play active roles in parents' organi- -~.~ zations. The delegates also advised 1-. --1 that resource coordinators be assigned -. to f;nnilies to help simplify the entry process and assist the parents as the\ learn about and access the programs they need. Application and enty' procedures are far too daunting; parents can feel lost tning to enter the s\`stem. One- NEW JERSEY NEW YORK PUERTO RICO VIRGIN ISLANDS Indicating their commitment to finding solutions to the prob- lems discussed, the Region 2 delegates held an impromptu meeting on their ow time to outline a proposal for establishing a model health, education, and social senice system. The proposal calls for a Federal initiative mandating a partnership across Federal agencies, the Office of Management and Bud- get, key Congressional committees, and families representing local areas. The initiative would establish a formal structure for implementing the following principles at all local levels: * A client- and family-centered program philosophy that emphasizes parent involvement in children's programs. and that is accountable to the individuals sen.ed. Ir A creative and flexible atmosphere Gthin the systems brought about by regulatory relief from bureaucracy and "red tape." * The standardization of eligibility requirements across all service programs and simplification of the process for establishing a client's eligibility. Ir Easier access to services provided by centralized directo- ries of senices, one-stop shopping, and flexible hours. * An integrated approach to senice deli!-et-y using unified case management and follolsup. t The rotation of senice personnel and continuous train- ing and cross-training to reduce burnout and promote sharing of information across programs \Gilthin the sys- terns. t Increased parental community involvement. Parents could make valuable contributions, especially for public relations, outreach to new families. and advertising of senices. To promote parent involvement, use a commu- nitybased approach and allow for flexible work sched- ules. Seek collaboration with businesses, churches. and other community organizations. stop shopping for senices w;1s strongh~recommended. Office hours must be built around the needs ofworking parents. In addition. agencies need to expand their public seiTice aiiiiOUilceillellts and make a greater o\,erall effort to keep parents informed about assailable resources. The delegates recommended a toll-free information hotline, along Ivith support groups and other programs designed to make parents, especialI> teenage parents, more a\vare of their responsibilities. The Region 2 delegates felt that the parents' role in nettvorking does not end with acti\-e participation in the svstems. l'arents should enlist other families into programs. Thy delegates also agreed that parents should hark a stronger role in de\.eloping agency pro- cedures and policy,. Parrnts neecl greater representa- tion on agencl' ad\-isor\- boards. Parents also should be in\ol\.ed in reforming health. rducation, and social senice systems to brnefit families. For instance, the delegates cited numerous problems lvith Medicaid, such as lack of phvsicians who accept Medicaid and long \vaiting fists for those \\.ho do. In addition to needecl reforms in sellices, the delegates cited a need to change our society's attitude tolvard families receiv- ing assistance from the systems. They are stigmatized in the public's perception as lazy and uncaring, and even the social senice lvorkers often behave rudely toward parents. This situation causes high frustration levels for families who participate in programs and prevents others from participating. The delegates felt that this behavior by senice providers is a ymptom of employee burnout, and recommended that employees be rotated to different positions Ivithin their agencies on a regular basis. This solution \vould also provide employees rzith a lvider range of experience and information about how their agencies r~ork-iIlforrnatic,11 that the!, can pass on to parents. Delegates from Region 2 considered the parent's role in rransi tions as acting assertiveI\. or aggressiveI\ and emphasized that it must begin as soon as a child's needs are diagnosed. It is the parent's responsibilit!,, the!. said, to demand access to and information about the prenatal and postpartum care their child \vith special needs might reqttire. Ho\vever. to encourage parents to act assertivel!.. the\. agreed, the Sation must de\-elop effective patent education. That education is linked to another need cited h!. Region 2 delegates. The!. Ivanted the Surgeon General to knor~ that the countm needs to establish an infra\tructttre to assist parents through their children's continuous transi- tions. Another important issue to this group \\`as the tack of quality control in senices. They remarked that unless quality control in health, education, and social senice systems is consistent, transitions IAll never he better than mediocre. Puerto Rico's Project ESPX (Es- cuela Pam Padres Ad- ultos, Project School for Adult Parents) KU singled out as a success ftil parents' support group. The New York Foundling Hospital teas also mentioned as a model program. In New .JerseY, the State Health Department's Catastrophic Illness in (:hildren Fund provides grants to families lvho Awaraness and Entw + sUDDOrt parent networks 3. ~._ A simoli& application and entry procedures . -:-- * R cruit parents to enlist other famifies atticipation * PFovide for parent involvement on agency advisory' boards * Se& parent input for needed reforms in the systems * Seek ways to change societal attitudes toward families who receive I \\ assistance : I * Rotate employees to avoid burnout 11 ~zould other\vise he nanciallv de\astatcd catastrophic illness. In addition, the Region 2 delegates recommended establishing a Federal initiative to institute a formal structure for implementing several principles in health, education, and social senice systems. In implementing this initiative, the Region 2 delegates recommended the fotloGng approach: (1) linking it to America 2000 or simi tar program; (2) involving the private sector; (3) borro\ving strategies that work from existing model programs and integrating them vertically and horirontalt~intocommuni~programs; (4) designating the Surgeon General to head the initiative and enlist the participation and cooperation of all relevant Federal agencies: and (.?r) recruiting parents who represent the diverse communities of the United States to be the liaison henceen government, communi?, and business representatives in the initiative. The delegates recommended recruiting and organizing these parents through a national clearinghouse and compensating them as experts for their work on the initiatiw. endah ms at a Glance L ? g ti ;. iTransitions zi * Educate parents t0 act asseruvely on behalf of their children : : ii sr Estdbfish con$tent qUali~-COntrol measures across `Ystems sr Establish an infrastructure to aSSiSt fadies in transition i. :. DELAWARE DISTRICT OF COLUMBIA MARYLAND importance of sprcial programs for ., teenage parents to help them cope I with theil.roleasparentsand tomake ,. them aware ofavailable senices. The\, alsoexpressed that entn'into programs JS~II~~ be facilitated by barrier-free health care centers and resource coordi- PENNSYLVANIA 1latoi.s for special needs children. lo inform parents ahotlt available senices, lists ofsemices VIRGINIA WEST VIRGINIA coUld accompany birth certificates; private doctors ~h(>t~ltl CIII~~+X ha1.e such lists on hand. The special needs of foster children demand greater attention; medical charts and equipment for foster children \vith special needs should follow the children in a timeI\ manner-. Family leave would allow parents time not onl!. to address their own infants' special health needs, htlt also to help other parents and their children. \4%ile all regions discussed legislati\re solutions and 1 latory relief to some llems families face, Re- 3 delegates were the ones who discussed x~rting the fetal alco- bill as part of the sohr- I to making health! Idren ready to learn. is bill \vould prohibit tallrants, bars, and li- or stores from selling Yohol to pregnant men. ~~lso, because pport groups are so iportant, funding lould be provided to ISrdin them and cover Isic operating costs. dditional fnnding is -quired to prevent turf ~attlesamongagencies nd within the com- nunities thev seme. a Glance j 1 Awareness and Entry "i j, Establish special programs for teenage parents \\ * Est&lish barrier-free health care centers and prO\ide resource coorsinators for special needs children * Distribute lists of services with birth certificates * pass a family leave bilk Sr pass the fetal alcohol bill f Provide funding for support groups * Expand program funding to prevent turf battles among EdUs programs ,ea elp administer services nnlirvmakin~ -.,, r- Jvide better training for resources, decrease bureaucracy+ `pLc' uJc u-ffectively _ __.-o p pn chil&t=n with special needs at ersons with speck-al needs or a case-by-case basis To enhance participation in the systems, the Re- gion ?J delegates stated that programs should he commw nit\' b&d whenever possible, administered by people who live in the communities. The delegates also recom- mended that the recipients or part-time recipients of senices be hired to administer the senices as ~~11. to help bridge the gap behveen bureaucracies and families. The!. liewed the role of parents participating in the systems as that ofdecisioninakei-s~\,ho helpeiiipo~\.ei-familiesi-ecei\-- ing senices. although the\. admitted that the swems do not allow for parental in\ol~ement ill policymaking. The\ were most concerned about the lack ofcultural wnsiti\-it\ displal,ed b>. the s\.stems. lack of training for scnice providers. and the negati\r stereo~ping of wcipirnth of senices. They also complained about thr s\.strms' bu- reaucrac\' and the poor use of resources. resulting in the lack of senices ii1 some areas. and the lack of.infol-lllatioll about senices. The delegates ft-om the mid-.\tlantic States advocated financial solutions to parents' needs. They suggested creating tax credits for parents ~410 keep children with special needs at home (rather than institu- tionaliring them at &wrnment expense), creating tax benefits for employers who hire individuals with special needs or their parents, and making funds a\-ailable for affordable daware. The Region 3 delegates maintained that transitions would be facilitated if programs focused on prevention of problems before crises occur. Although preventive ser- \ices may require a higher initial inrestment, these par- ents asserted, they would present significant cost savings to the Go\.ernment in the long term. The\, also commented that there is a lack of continuitv of senices as transitions are made Mithin the systems. Delegates told how some children with special needs were given assisti1.r tIeVices to hrlp them in school but that the equipment remained the school's property. In some cases. the equipment !\.a\ not c~en allowed to leave the buildingwhen the child went home for the evening; e\pn more often, a child was not allo\ved to take the devices to a new school-wan one in thr same system-as he or she matriculatrd. The delegates \varnrd that thcw policies do not promote smooth transitions fi)i- parents or childreli. .I fathrl. from Penns!%.ania was able to add some hope to this discusGon when he told how his State had bypassed the problem ivith a solution that benefitted evel?one. In his State. parents ofa child \vith special needs can spend up to Sl ,.X0 annually on assistive devices such as reading boards. The parents buy the device, but are reimbursed b\. the State. Their child can use the item until he or she outgrow it or leaves the State school system. Then the tyuipmellt is returned to the school, where it becomes a\nilabIc to another child. This regional group also advocated that solutions must he systemic: programs and services camlot con- tinue to respond to problems on a case-by-case basis. One parent said her child's school had rerouted a bus w it could transport a child \vith disabilities. But that change ill the route meant that some children rode the bu4 4 hows a da!.. The school responded to a particular case, not thy u~nclerl~ing problem that it did not have rnough buses accessible to children with disabilities. IChen another child \vith disabilities needed transpor- tation, the problem had to be readdressed. The parents maintained that the school svstem should have broad- ened its solution the first time by buying another bus and hiring another driver. a solution they felt would be cost effective in the long run. Model programs cited by the Region 3 delegates include Pennsylvania's Development Disability, which funds support groups, and the Communication Coun- cil, which involved parents as it rewrote the State-level standards for special education; the District of Columbia's Equipment Loan program, which funds equipment for special needs children, and the Parents and Friends of Children with Special Needs, a parent support group: MaFland's Special Mothers in Train- ing. a 5lveek training program for parents with disabili- ties, and New \`isions. a program that uses parents as case managers: M'est \`irginia's Public Health Screen- ing, designed to meet the needs of parents who do not qualify for hledicaid but cannot afford health insur- ance: corporate Xdopt-a-School programs: and\`irginia's Department of` Education /Division of Special Educa- tioll I~ro~1-;m~~. \\,liic.h pro~id~3 inf~~rniation on c.hiltl &~\~10I""~1". Region 4 delegates advocated that ALABAMA all Federal programs share a uni\.er- sal, easy-to-read application form to FLORIDA GEORGIA KENTUCKY MISSISSIPPI NORTH CAROLINA SOUTH CAROLINA TENNESSEE .: b : help simplify the entry process for .: -J parents. X central community re- source clearinahouse, or referral cen- ter, supplemented by a toll-free hotline, could also facilitate the process for enter- x2, `y mgparen ts. The eligibility criteria should be the same for all programs, but they should be more flexible. Presently, the systems encourage "staving poor" to meet these rigid criteria. They stressed that incentives are needed for families to move beyond assistance. The delegates also recommended that edu- cation in parenting skills begin in junior high school. OverAl, the systems would be more responsive to parents' needs as they participate in programs if the parents had greater involvement in policymaking and _ ecommendations at a tilance form and simpW the entry process learinghouses, supplemented bY a e eligibility criteria and incentives for families to move g and training of service providers attitudes, physical limitations, distances, professionals who know the cornmu*%`, its resources , and the * Provide issues facing famities * provide job stability and affordable housing jc E&dkh family leave POliCieS * Provide better daycare and respite care services nts in peer group visitation programs . . Y time to reassure children during transItions P' be 111 dig11 The wa, bar at 1011 ter- ho ire ati en to i-e as IT m tl M r f 1 `pecially in the training of ,ol*iders, many of whom shave as though they have :) sense of' the tvorth and lity of needy families. Se families hce lan- Te barriers, attitudinal riers, ph!,sical barriers health care centers, g distances to the cen- s, and inflexible office urs. M'orking parents ed special consider- on. As a rule, the par- Its have no choice but adapt to the systems aquirements, whereas, cone parent said, `The ionev should follow le child, not the other :ay arormd." The\ ex- lressed a need for pro- `essionals who knol\c he community, its re- sources. and the issues facing families. The delegates stressed that job stahilip and good housing are critical components of health. Parents need fatnih, sick leave policies and release time to obtain the senices thev need. Housing ordinances need to he enforced. Also needed are better clalcare set-rices and respite care srnices fix overburdened parents. Se\,eral regionsconsidered some untraditional~~a~s toitnpro~ecotntnLunications to facilitate transitions. Regiott 3 delegates made a umique t-ecoi~imcndatiot~: In\-olve parents in peer group lisitarioti programs. One mother told how her comtnunit~ solicits experienced parents to Gsit the homes of new parents and offer friendl!., nonthreatenitigad~ice about programs. set~ices. support groups, and ot-gani/;ations that are available to them. These Iisits, she added, are made to all ttew parents. not just parents of children with special health, education. or financial needs. The parentsfixn~l the southeastern States also pointed ottt the impot-tattce off;ttnilics' makittg timt for children hct\\ven trattsitions: e\w7`oLt(a needs ;I bt-wk. thevcaid, especiall\~~vhen a tt;tnGtion it1vol\x,sa cltxtge in marital \tatttb. li\ittg arrangc~nt~nt~. ot- hwltli caw. Some model programs cited by the Region 4 delegates ittclude Kentuck!,`s Family Resource and Youth Senice Centers. created as part of the Kentucky Educa- tion Reform Act and operated through the schools to benefit children and tamilies at risk; the Eastern Ken- tucky (:hild Care Coalition, a private resource develop- ment +genc\. that offers training and assistance to childcare pro\-idet-s and families; and Mississippi's Fatni- lies as Allies. a network of families with special needs children. The Florida delegation shared materials on several public and pri\ate progratns from their State: Infants & Toddlers; Florida's Interagencv Program for (Zhildwn and Their Families. which has established the Directol-\.ofEarl!-~~hildhoodSenices,accessihle through an 800 telephone number: Collaborative Adolescent Parenting Program (<:.\PP), an intergovernmental, in- tcragency. conlmttttit!,-based effort to support teenage parrnts: Faniil!.(:onnections, lvhich provides services to lowincome teenage ltarents, and Family Interaction Sow (FIS), a family support program for recovering pregnant and postpartum addicts, both sponsored b) the (Child Care (:onnection of Broward County, Inc., a prifittc, nonprofit organization that supplies Title XX childcare: Casa Madonna, an aftercare progratn for Hispanic substance-ahusing mothers, which is spon- sored by the Miami Mental Health Center, Inc.; The Bridge.sponsoredbVFalnilyHealthSe~ices,Inc.,which provides a mix of services to young mothers and their children; and Pro.ject MITCH (Model of Interdiscipli- nary Training for Children with Handicaps), which provides training to parents and other care givers, through fltnding from the Florida Department of Edu- cation to the Florida Diagnostic and Learning Resources System/South. In addition. the Department of Health and Rehabilitative Senices sponsors First Steps and the Community Resource Mother or Father Program. LMegates ft-otn Region 5 agreed that ILLINOIS INDIANA MICHIGAN MINNESOTA parenting skills should be part of -y every child's schooling and that re- i"<~, - r: 2. -$+: _ i sotwces should he available for the `/ ~~,L..~ c~ontitnting education of parents in j tht`se skills. Better parents will become a stronger and more effective presence in ; their communities. The?, will assUnte greater responsibilitiesin theirlocalschool OHIO s\`stems. both in policvmaking and in day-to-da, pat-ticipa- tion. to help counter the chaotic forces that act on WISCONSIN children as they enter adolescence. The Region .5 de]- egates complained that the middle class is excluded from set3ices. The!, stressed that e\.et-ytne needs access to adequate health care and that ottr Sation should protide "eqnal edttcation for all." Th e\ pointed OLIN that the goals of the Sttt-geon Genct-al's ittitiati1.e should go beyond the !`eat- 20(N). Other barriers to entq into the systems that / i%gion 5 ~`Jkconmxndations at a Glance :i~wareness and Entry *Provide training in 1 . * Don't exclude the middle class ~tot~t ~1 *IL.-J I i jr Continue the Healthy Children 7 to Learn Initiative beyond the Read) ' year 2000 : ' j, implement one-stop shopping i : jr produce a guidebook of services and include a director? of local services : in cOmmuniT telephone directories Participation i * A mparty services with education * pz$de m&hanisms for parents to get answers for questions or 10 voice L#i- complaints . --.-I....~~~+ in nob d~&onS * All04 greater parent tnvwvc3~~~zLG .-- r -- . ' *Forge stronger links amo ng s&x&, socia serwce systems. and local * prioritize needs before spending funds and make programs accoUntable for how funds are spent * provide for unbiased evaluation of programs * Address he causes of families' problems and prOvtde healw. not "band-aid fixes" fife skills, beginning at an early' age, t0 prepare children t0 orks and outreach programs `$ "A;p,~~~~ ~r~~~~e;~ as the Administration's advocate for families cited are long waiting ,)rsenicesandinflexibil- ' the swtems. They rec- lended a one-stop-shop approach to services providers \Vho are in- ted aboitt a\,ailahle re- `-c-es. The!, suggested during a gUidebook of ices and including a di- tOI of local senices in 17' cot~lt~~Ut~ih's tele- one director-. .is f&nilies partici- te in programs, the `eadtes asset-ted. edit- ion should accompam. : set-\-ices rendered. tey; complained that e programs are not Inil!, centered, and at parents j\.ho act isertivel!, to haye leir needs tneC 211-e iolated. The social service sI9em ~2s criticized for ha\ing no bllilt-it1 mechanism by ~\~hich parents can get ~I~SNW~~ to theit- manv questions and a sympathetic car for their complaints. The sytems are genrrall~~ pcwt'ijwl as bureaucratic. rigid, and inseiisiti\.e. Parents ucwl to playagreater role in polic~~clrcisions alit1 act a\ ad\-isors to programs. For instance, manf. of' the delegate\ fc'lt that parents should \vork jvith their schools to explore the possihili~ofdresscodes and establish otherpolicieh. M'hen this group discussed the parental role of being an advocate, they commented that pareuts rived to take this responsibilitv to the fullest. The\. must be involved in the school or program, know evenone from school board members to administrators to teachers, and become a presence in their child's education. Schools, in turn, need to forge strongel linkswith the social sen-ice systems aud local businesses. Another important issue to the Region 5 delegates \vas that needs must be prioritized before money is spent, that programs must be accountable for how the moue\ is spent, and that programs should he e\aluated hi, unbiased parties. The delegates expressed that programs must address the underlying causes of problems families face and that sellices should pro\ ide healing as families participate, not give them just a "band-aid fix." The Midwestern delegates repeatedly said that par- ents need to begin at childhood to prepare their children for the ultimate transition fi-om child to parent. The) advocated reaching out to children to show them how to be parentsand to explain the responsibilities thatgo along with the role. The\, recommended that schools teach basic life skills, beginning at an early age, so that children b'ill be prepared to parent the next generation. These parents also stressed that communication among parents and betw.een pare'uts aud programs is kr~ to successful transitions. They stated that strategies to improve communication should include outreach programs to draw new families and to trulv affect the communitv. Region .T, delegates looked to the Surgeon (General to be more than a partner with them in making health~~ children ready to learn. They agreed that she must be the atlillinistration's advocate for families. She must he among the ranks of people who hold health, education. and social sewice systems accountable for ensuring that children and parents can make transi- tions btT\\WW progran1s smoothl~~. .\lodel programs cited by the Region 5 delegates include the Illinois Governor's Education Initiative, r\-hich iurwl\.es parents in school policy decisions. Cn- der thih program, % communities discussed the reallo- cation of funds to allow State agencies to coordinate their efforts and develop stronger ties with the school system. Another Illinois program, Families With A Future, funds prenatal care, home visits, a children's clinic. nursing care, and certified advisers who coach mothers as they enter the social semice system; \-olun- teers provide transportation. In Minnesota, the Leave No Child Behiud program funds learning readiness. Other programs in Minnesota include Challenge 2000, Parent Involvement, and Learning Readiness. The Ohio delegates cited Family and Children First, and Iudiana parents praised the Indiana University Medical Center's James M'hitcornb Riley Children's Hospital as a model for caring for sick children and supporting the familie\ during times of crisis. Michigan programs in- clude the IAatino Outreach Program in Detroit and Pl+Tt l'ptow ARKANSAS families should be a nationlrride priority. They also strongly adyo- LOUISIANA x ; ;..- ,r .,- r cated regulation of the insurance c .5 .' c ; industry. Insurers can raise rates. NEW MEXICO : den!. coverage. aud cancel policies arbitrarily, M'ith the result that families OKLAHOMA either cannot afford health care or have to enter the social senice sr'stem and TEXAS sometimes give up jobs and income to meet rigid eligibility criteria. The delegates also pointed to loo keels of priiate participation in health care senices, saying that if pro\Gders lvere reimbursed at competitive rates. the senices M'ould improve across the board. The providers need to be better informed about available sell-ices and IXSKI~ to pass that information on to fami- lies. X resource directo?, and a toll-free information hothnt~ iri each State Ivere strongl!~ recommended. I commendations at a Glance o prevent arbitrary cancellation of in health care services by rrlmbursmg convenient locations `; J, ~~~~ parenw mOre crea&e input md pokv input and the opportuniy b7 i: : to evaluate programs ;! i lTransiti~~s !{ * Maintain effective communication between parents and careglvers, ii ;i -or Frovide mainstreaming for children with special needs in all a&ularIy for foster parents communities i: * ~~~~ partnerships among agencies that provide health and medical care ., 1 to better serve families In addition, health 1 providers should be ched and sensitized br, ents who are participat- in and have experience h the systems. ;\t fsent, families are not rceived as partners!vith otiders and do not feel spected. The delegates Irned thatparentsrvith gional accents ha1.e to ? careful that they are ot perceked as less in- rlligent merely be- ause their pronuncia- :OII is different or their peech patterns are lo\\er. The point of ontact for services both for parents en- ering the systems and -hose alreadv partici- pating) should be an individual who is representative of the local communit~~. Services are not oriented around family needs: families have to tral,cl long distances to appointments because of the limited number of providers in these States, and then they are forced to wait and waste time. Services should be located as near families' homes as possible. M'hy not set up on-site facilities so that parents can attend to other important family business. such as doing laundry? The delegates insisted that parents need more creative and poliq, input into the systems and should be gilwl the opportunity to submit evaluations of pro\-iders. There was national consensus that successful tran- sitions begin at home, but Region 6 delegates States added the advice that some situations demand special efforts. They commented that foster parents must be careful to validate their children's feelings at all times. Foster children have an extraordinary nevd to develop their self-esteem. Without this esteem. the parents said, children will not get the maximum benefit from transi- tions. Communications with children and caregivers has to be two-way. M'hile it is imperati1.e that parents be ~~0~11 acltocates for their families and rccogni/e thcif- ~ONW- as parents, thew dr~legates agreed. it is a1v1 critical that the\- listen to the children and the profes- sionals taking care of them. Parents in Region 6 also pointed out that mainstreaming is not available in all communities, but it is a w~iversal right ofchildren to be allou-ed to mainstream. Parents, thev said, need to demand this right for their families. The Region 6 delegates stressed that access issues must be addressed and that agreements are needed among agencies to form health and medical partnerships to better serve our Nation's families. The Children's Hospital in Arkansas, which al- ready has a hotline, was cited as a model program. Other Arkansas programs include Arkansas Better Chance, Child Find, Children's Medical Services, and Focus in Blytheville. Adult Learning Center in Shreve- port, Louisiana, combines infant care, literacy training, and a welfare office. Dallas, Texas, has a qualit!, infant care program for teenage mothers and helps them with the transition to Head Start. Another Texas program citedl1.a~ the Childcare Management System in El Paw. Oklahoma programs include the Illstilute fi)l (h&l .\~~()c;IcI. !%)~Jl~~l' bkll-1. ;Illcl oilSi% MISSOURI NEBRASKA among senices forces parents to make ; .- fi-equent Csits, compounding their dif- ficulties. Eligibility requirements are in- consistent from State to State, and par- ents \V~O relocate in neW communities have to repeat the lengthy application process. Because information on senices is tacking, in Missouri, some neighbors go door to door with flvers and other information. As families participate in pl-ograms, the Region 7 delegates recommended that parents seek an &who can be relied upon to supply accurate information. In turn, parents should share their knowledge of the programs J!ith othel-S. Parents also have a responsibilit\ to establish a positive interaction I\ith thecaser\-orker togive feedback L on the senices receilred. In deve ship: that first ha12 tier at a Glance areness and Entry duce distances that families nlUSt tTdVel fOr SerGceS %h *Improve consisteny Of ServicfzS from urban to rural areas -1 - r\y I * ImpTovc! cO0rchnanOn of services *Make eligibilit)r requirements consisW2lt from State t0 State loping these relation- s, however, theywxned parentsmustkeep their priority and maintain a mce between pdrticipa- 1 in program activities lfamilyiife. Theyfeared Itparentsmight fall in to ? tl-ap of trying to do elvthing and ydnled at pro\idersshould not .erwhelm parents with 10 much information td too manv activities the same time. Par- It involvement in pr* ram planning would lelp prevent these )roblems, they said, tnd parents also {ices is unet'en in urban and rural areas. The lack of coordination I 1 \\PmticiDation . -_--- I *Promote parent support groups I overwhelm parents with too manv activities 115 . . -.,, `Lx *Involve parents in program plannw *Provide more year-round prograr- *Provide f&&~ Head Start or locate Head Start together wm llue p or other childcare programs *Provide childcare for special needs children zation from parents about children's specific needs nest answers to parents' questions rather than "beating th, Of to a1 at er mod&d after the Nebraska Family Policy Act g h professional groups, cy-t-gew ~0UA-Q~~ . -7 F and State-to-State partnerships i ! The Region 7 delegates expressed a need for more year-round programs for their children. They also suggested full-day Head Start programs or collocating Head Start with providers ofTitle XX or other childcare programs. The\ would like to have childcare aLiilable for their special needs children so that they cm attend activitirs in lvhich their "normal"cl~iltlrc~~~ are imolvcd. They described ho\\, sprcial needs children are oftell denied acti\-ities simple. because the\ arc labeled as disabled, even though the parcllta think thrl are c;t pahleofparticipating..Foresample. 011c mother shared that her child leas not allo~~l to ride a horsr elan though her husbantl ~vas planning to ride \cith the child and take full responsibilit!. for the child's saf'et\.. The\- urged that MY "put label\ on cans. not o11 children." Like delegates from other rrgions, thcw parents said that, to ensure smooth transitions. they must be good recordkeepers and make s~tw their children's needs are communicated ~vhen records ;II-P transferred. Because those needs are not alw+-s pal-t of' a11 official record, parents must alert professionals to them. For example, health care professionals 111a. be proficient at doing C-tube-feedings. but a parent ma!`be the only one to know that his or her child needs to he fed for 10 minutes, then rested for 10 minutes, before finishing the feeding. Caregivers might know how to get a child ready for bed, but parents know which children won't go to sleep without their teddy bears in hand. At the same time, caregivers need to communicate fully with parents. These parents prefer honest answers to their questions. They insisted that caregivers should "tell it like it is" and not "beat around the bush," particularly when the information concerns their children. The delegates agreed that a model program would have a single point of entry even though a family might need a dozen or more senices. The model program would cover all needs and disabilities and be based on the philosophy that the systems should adjust to the needs of the farnil!,. There would be a single set of paperwork for all senices and a resource cowdinator assigned to each family to help the parents through the bureaucratic maye. Pt-escreenillg of infAnts and (Aild Find stwices should be made a\Glablc to all part'llt\. They cited the Nebraska Family Policy Act, which coor- dinatrsall set-\ices to need!-families, and recommended t1lat.a national policy modeled after this act be devel- oped. These delegates also expanded the idea ofparent support groups and partnerships to include parent-to- professional groups. professional-to-professional groups, agency-to-agellc~ partnerships, colllnlullit?i-t~commu- nit!. partnerships, and State-to-State partnerships. IGmsas model programs include Parents asTeach- ers, Healthy Start, the ParentTraining and Information (Ienter. and Keys for Networking, all in Topeka. In Omaha, Nebraska, the First Step Infant Health Care Prqject has prenatal programs and integrated services for low-income mothers living in public housing. t`n- der Missouri's First Steps program, resource coordina- tors come to the home and explain available senices to parents. In St. L>ouis, Missouri, the Human Develop- ment Corporation, Parents as First Teachers, and the Parent/Child Center were recommended. Missouri and Nebraska each have information hotlines: III ,Mis- souri the hotline is called Parent/Link. Kansas also has a Resource and Referral System hotline. The Nebraska Farnil!- Support Netlvork was cited as a model support program. Missouri's Parkway Ear-l!- Childhood Pro- grams and Earlv Childhood Organization (ECHO) arr successf1tl 1110drl p~-ogt~allls. Iowa has the Early (~hiltl- hood Special Edttcation p~-og~~~t~~~. the Pat-etlt Itthttt Surturitig (:cntcr. t]lts .\KP Respite (1;n.v Tl.;tining I't.c!jr.ct. ;tiicl I'p \\`ith F,niiilic\. Delegates from thesewestern States COLORADO were concerned about the availabil- \' --,--r-.7 -. it& quality, and cost of health care in `. .!-cm --" ,\- Am I yip-~!jyyz$ erica. MONTANA I They pointed out that get- ting families covered with health in- 1' . ".,r$$ _ -4 NORTH DAKOTA -. ~, ~--- surance is a need and a solution. They __--,- , 4~ ,, . : cautmned that health insurance should _ 5. Are 4 SOUTH DAKOTA `. . ,- .-, not be confused with Medicaid, which is a limited resource. In comparing .Medicaid UTAH with health insurance, they pointed out that health insur- ante allows access to health care; Medicaid does not WYOMING gm-antee that access. Health insurance covers preventive care; Medicaid does not. Going hand in hand bith the probhn of health care costs is the concern that liability has become a real problem in the United States. The doctor's fear of being sued for damages is increasing costs for parents and communities, These more sparsely populared States have sev- eral problems in making families aware ofservices and at a Glance enkxing their participa- tion. Families livirlg in ru- ral areas often have to relv on word-of-mouth for in- formation on available ser- vrces: ~4 toll-free hotline `muld be a useful solu- tion+ Each State should halk2 a free clinic system art from local businesses for programs such as chileare With an interagency co- t ~par-ticipatiotl \i * Encotirage supp :i * Extend programs su& as Girl Scouts and 4-H Clubs to a11 communities ordinator to provide and prhde funds for fa&ies who can't afford to Participate Parents with informa- ;\ 2 I * involve parents in program design and planning \I -k lndve prents in pg-qpms to visit new mothers and nerve a6 their hn and help line up State Semites. 3s mentors i\$r Expand hosp ital funding to provide followup care Region 8 dele- gates also ttrged ii 3% I greater invol\;ement .; 2 L B is Transitions at the community and : h c h hfarmahn from F~~ about mechm that migger certain 6-p local level, not only h+ors in children ide uaining in Parent@ skills and IlUk~On as part Of ee basic for individuals but -1 ...:,,;,.,l,,m to conduct Parenting training and help alsO for local busi- _ ._ dve Parenting vision , msses. They recom- -- &^ kllrrrmp 2 nation of learners mended that local that and local funds to supPo* P'ogrms * Run programs as businesses are run, with measures to ensure &j&yes are being carried out their business leaders support childcare centers, for instance. They suggested that community programs such as the Young Slen's Chris- tian Association (YMCA), the Girl Scouts, and -l-H Clubs be extended to all commuriities and that fLmds be pro- vided to families who cannot afford these programs. The) recommended that parents lobby within theircommuni- ties to sensitize leaders to the importance of the farnil>- as the basic building block of the communi?. They stressed that parents should be involved in program design and planning. An example of veteran parent involvement would be to visit new mothers in the hospital and serve as mentors. They also stated that hospitals need to allocate funds for followup care. Like the parents from Region 7, the Region 8 parents said that it is their role to inform programs about their children's particular behaviors and needs that might not be part of an official record. These delegates talked about the importance of informing new senice and care providers, before the transition takes place, about trigger mechanisms that evoke certain behaviors and ways the parent has found to control behavioral problems. Tran- sitions can be difficult and become a monumental hurdle to a family's development. When a transition is made, these delegates said, families need to celebrate their mutual or individual achievement. The Region 8 delegates advocated that training in parenting skills and proper nutrition should be pxt of' the basic school curriculum. Furthermore, they main- tained that parental edllcation is a role that religious bodies should assume. Part of that education, regard- less of its source, should be to help parents develop a positive parentingvision. Itwould bewiseforeducators to remember that not every parent's childhood lends itself to such positive experiences and that not everyone has an instinctive vision about parenting. This group looked at education in America and declared that we must become a nation of learners. Parents need to redevelop their onm enthusiasm for learning if they are going to create such an enthusiasm in their children. The Region 8 delegates cited a neecl for more mingling of Federal, State, and local funds to support programs. The!, also added that programs should be run in a manner similar to businesses, with measures to ensure that those who use the programs are receiving the value that they are intended to provide. Existing model programs they cited were Partners in Leadership, Family Resource Centers, Effective Parents Project, Parent Education and Assistance for Kids (PEAK) Parent Center, the Disability Information and Referral Senice (DIRS) Hotline, Connect, and El Groupa Vida in Colorado; Ask A Nurse and First Steps in Montana; Track- ing in North Dakota; and Baby Your Baby in Utah. Region 9 and 10 delegates argtted forcefully that health care and so- ALASKA AMERICAN SAMOA ARIZONA CALIFORNIA GUAM HAWAII IDAHO MARIANA ISLANDS NEVADA OREGON I WASHINGTON ,/,; is . -A.._ cial service systems should recog- ~ ._.. I, Y ,"J <:-;,;i -`__ &,t - -2 nize and \,alue native language dif- i ---"-y; ferences, local customs, and family _; .~r i L'dllles. %,foSt systems shobv a marked .~. ---., _ cultural insensitivitx. and fail to involve parents in decisions that affect their chil- dren. Social service workers need to be mot-e compassionate, and the)- need to encourage the growth ofcommunity-based programs. Eligibility crite- ria need major overhauling. The criteria are based 0:: artificial standards (income levels versus need) and lead to unfair labeling and inequities in services. Re- gional cost of living differences are not taken into account. They maintained that families rvho need the sen.ices most often cannot participate. Like parents in other reLgions, the.% delegates com- plained about the lackofcoordination offsenices; duplication of some senices co~h.Ses recipients and forces providers to compete forfitnding while gaps exist in the provision ofothet senices. Furthetmore, the)~n~aintined that the &shbtthon of.Xnices around he countn is ~llfAW1. Thev Aso voiced a desire t(~ paticipate i]l tile de `@* and planning for prcr gl~mts,itlclttdingi~~~o]vement `I1 cunictthtrn development, hi"lg.~ldbttdgetdecisiot,s. `At the same titne, parenh IllUS ensure tha&-nice pre \idersha~eafitllundentand- ingof~eirchildren'sneeds, They A0 tttaiIltiIled hat tO family problems such as divorce, substance or incarcet7ttiOn of a parent sibility to be advocates, not On&for tbeirchildren but ais0 for the pt-oograms in which they participate, and to lobby for these the Far \$`est and Pacific protectorates shared their concerns about the overwhelming responsibilities of being parents. The) said that parents need hope to get them through dail!. living and especially in situations when transitions are involved. To give families hope. Government agencies and other service providers need to help them fulfill basic needs, including those for housing. health rare. and nutrition. These parents also noted the lack of collaboration among agencies and the lack of consis- tency across agencies, both of jvhich make transitions more difficult. Thev cited a need for rtxferral pel-solar lvithill agencies to help families deal \vith transition issues. The Nation as a whole (especiall! all peoplr caring for its children) needs to comprehend the ef- fects of such family problems as broken honks and substance abuse: special concerns of parents 1vli0 art` incarcerated or unemploved need to be understood and taken into consideration when transitions are necessan.. Parents have a respoilsil~ilit~ to netrrork and to be team players in helping to provide senices, par- ticular-l!, during times of transition. Like the delegates from other regions, this group maintained that parents must maintain information about their children, and the\, must prepare their children for transitions. A model program would allocate funds for parent networks. especially among minority groups; involve local media, churches, and other community organiza- tions. including police, to disseminate information: involve greater parent participation; reduce paperwork for applicants: ensure that programs and senices are better coordinated; and respond to information re- quests in a timelv mamler. Examples of model pro- grams cited b!, these delegates include the Murphy School District in Phoenix,Arizona; California's Healthy Start Support Senices for Children; Even Start in Blackfoot, Idaho: the Slaternal and Child Health Pro- gram. Handicapped (:hildren's Resource Center, and Referral for Senices in the Mariana Islands; and the \\`ashoe Pregnanq Center in Reno, Sevada. Native American delegates iden- .- tified the search for information :," - &-ki , 2,` ~ . . - -.`1' . . , *. *+.:fg$y,-J;Y as their overriding issue. Parents I+(a[e s reguiations and policies, Federal programs also 1 f inj&ed workers benefits. 5 i * Provide controls over mistreatment oy `1 f Increase available health care and social se1 VKCJ ii * hcreae coordination of ser\`ke~ among State a $1 i $* provide resource materi& on each Stat{." nrnCT' I\ * Provide funding for support groups i bak-ticipation I e * Provide conveniently located facilities ! I* Address transportation problems H .I:,.,,.. 4 -. ' We, and I L.S. D epartments of Health and Human Ser- "migrallt" differently, 7 I! * Examine poli$=s and impkmentdon of food stamp aflomion leads to confLlsion i! * Make Food Stamps available for distribution through the Post Office \ ' * Address communication Problems by proG&mg more bhgd staff ;!, * Enforce child labor laws and keep children in school $I* Provide daycare services :a and causes denial ofben- for Lvigrant families jbransitions -J Actor ,,,h?mtcmc 70 h& ii * prov& improved access to pro@ :I $1 migrant families preparc r~ ~- &-^ 18 * Make tra&r of s&oO~ CredlB U~l~r*l ' Ii * Improve sensitivltJ I to migrant f;.-"ip" 1"`1"~.3 p robleGs and show respect 1 i * Hold a followup conference igrant lvorkers who do participate in programs find that the!; often must travel long distances to ob- tain sen-ices and miss lvhole days of work. Transportation is often hard to obtain. Crew leaders often do not allow parents time off to attend meetings. Migrants are often subjected to illegal treatment regarding Food Stamps allocation. One delegate recommended that Food Stamp distribu- tion be alphabetized for pickup at post offices, so that recipients do not have to spend hours lvaiting in line. Communication is often a problem for Migrants hc- cause senice providers lack enough bilingual staff` or have no one who can speak the client`s language. Keeping Migrant children in school is a pressing issue. Child labor laws are not enforced: children as voung as 10 or 11 years are hired to work in the fields. Parents often have no recourse but to havr their chil- dren work; their family's livelihood depends on theit halTesting as much as possible, and each pair of hands adds to their production. This problem is compounded by the lack of daycare for Al&ant families. The result isthat small children are brought to the fields along side working mothers, or they are left in the care of children who are too young to work, and It-ho are not much oldei than their charges. Migrant families, their conference representa- tives pointed out, face transitions that are a!most ahva1.s double-edged; they. are geographic as well as develop- mental. Migrant families are constantly making transi- tions and that means new rules and new ernironments for their children without any mechanisms to prepare for the adjustment. This continuolls movement means continually losing friends and family support.- This delegation commented that it is particularI> important for their parents to he guardians ofchildren's records. It is common for Migrant families to complete and file all the paperwork necessan to receive public assistance, only to have the growing season change and force a move to another State before the assistance starts. M'hen they get to the new State, they added, the paperwork has to be redone. But guarding the records does not always guarantee that they lvill be transferred easily or correctly. These delegates said school credits do not transfer from State to State Ve1-v easill- or un- formly, especially when students enroll in a nc'\v scl~ool in the middle ofa term. Migrant parents ~-c~co~~~nl~nd~~l that the U.S. Department of Education devise a system that allows classes and credits- to transfer from other States. These delegates also called for improved access to routine programsasaway tomake transitionssmooth. The!- said that bad health conditions and no daycare, after-school care, or social semices are the norm for communities lvhere Migrant workers live. They urged tha.t employers of Migrant tvorkers be closely moni- tored regarding their employment practices, facilities, and use of pesticides. For .\ligrant parents, developing children's self- esteem often entails demanding respect for Migrant families in general from teachers and other caregivers or sell-ice providers. They complimented the confer- ence cosponsors for including Migrant issues on the agenda. sa!ing that more of these opportunities are needed. They urged the continued participation of \Iigrant families so that they can be partners in raising healthy children ready to learn. The families agreed that a model program should include classes in prenatal care, dental care, and En- glish as a second language; make Head Start available for all Migrant children; involve parents in policy deci- sions; bring mobile health clinics to rural areas; fund senior centers for care for the elderly; and sensitize social sewice staffers to the special needs and cultural differences of Migrant workers. Migrant families are subjected to exceptional stresses and strains, and model programs should take care to address the needs of the family as a whole, to help maintain family integrity. Among existing model programs, Washington State has a Migrant Council that works with the whole family; the East Coast Migrant Head Start provides continuitv of sewices; and overall, Head Start is an effective program because it is designed to seme the family as a unit. 4 Presentation of Findings Chapter 4 0 ii the final tlw of the (:onf~rencc, the mort than iO0 participants came together to hear the findings of the Parrnr L2'w.k (;roups. Thr fincl- ings were presented I~\, three parelIt rcpresentati\~es, ant' for each of the topics discussed: a\varrness of and entn into health, education, and social srn-ice sytcms: partici- pation in the systems; and transitions fi-om one program to another within the systems. The parents prepared their presentations of the findings by working with the Ivork group facilitators, recorders, and rapporteurs to deter- mine a national consensus based upon the thorough it-ritten notes of the work group sessions. After the parent representatives presented the findings, the issues theI. raised were addressed 11~ the Responder Panel, composed of directors of key Go\.ernment agencies that pro\icle services to families. This dual panel composed of the Parent Representatives and the Rry~onder Panel ~vx moderated b~RearXclmiral~]ulia Plotnick. (:hirf`Surse of the U.S. Public Health %-\-ice. Awareness of cm02 EntrJ into He&h, Education, and Serial Service S\;stem Hi. She [Rear Admiral Plotnick] told \OII I`m from Clinton count?. I liw in a VCI>. rural part of Xl-kansas, and so that's the background I come f~rom. I have t\vo children. I have a l+.ear-old who is normal, hralth!-. and looks like she's 1X. and an X-year-old who has spina b&da, a neuralgenic bladder, severely dislocated hips, club feet, hydrocephalus, and growth hormone defi- cienc!. and tvho must take injections daih.. I'm a mllltidegreed individual, and I think I'm \\~a11 educatul. bllt I have to tell \oiI that rwtkiugin ni) lifl prepared my fix being the parent of a special needs child. But then. nothing prepared me for being the parwt of`;1 tanager. either. So,!x)u knoiv, youjust have to Iwrn as 1011 go. \I\- X-war-old daughter. \\ho has spina hifida, has txwl inwlvcd in programs like Head Start, \vhich \vas a blesillg to nn f':miil\,. I'rvxwtl~- she is on TEFRA,' \vhich. as m;un~ of \`OII ma\. knolv, is the Katie Beckett uai\x*r. and. again. that's been a Godsend to rnr. f:,lniilv. It can he \rl?' frustrating Iv-hen you are lvorking imtl ti3ing to do good for \vitr famih~, and just because 68 Parents Speak Out for America'~ Children you are lvorking and tying to do good, \-oil don't ha1.e any more ofan idea whew to go for sellices than people who aren't working and \vell educated. I mean. .just because ~OLI have a college degree. doesn't giw you an!- great insight into how to deal uith children. That's,just something u'e all ha1.e to learn. It's my task today to summarize to !VU the wports fl-om the groups on a\varene~~ and elltr\. and 1 \\-ish to let ~OLI knon- that I am speaking to !ou in a collaborati\~ wice, and not as a singlr illdi\iclual. The Parents' Roles and Responsibilities The groups felt that the parents sho~~ld first btw)mc inf'c~rmrd abotit their olvn cllildrc11'5 needs, ant1 that they need to he informrd about 1\4~at wr\-ict+ :IIN' available. It's ~el~ important to remember that I\noul- eclge is polver. A1nd \ve n~td to kncnv \vllat 0111 right4 a\ parents are. Parents should be thril- childrt3l's adw~catr~s;. and in order to do this, theI mllst first haw a belict in themseh~es. They've got to be ably to newt their ow11 needs in order to be equal partIlers with p~~olC~ssio~~al~ and sewice providers. Parents sliould nct\\.oi-k Gth other parents because there is great strength in num- bus, but NY have to keep in mind that net\~orking can be just one person Ivith allother l~~w~n. Issues of Concern There's just too much red tape and paperu,ork in systems that a;.e not people oriented. It's ye17 diflicult to get into the systems, and once IULI get in. VOII don't want to stay. An example of this is problems lvith the Medicaid program. Medicaid sa!`s that they will pa!' for senices for children who are indicated b!. screenings. hut they are un~villing to pay pro\idrrs eno~~gh mane! to make it worth their while. And the end result is the same: the child still gets no sellices. The system is not set up to meet thr needs of people whose first language is not English and who ha1.e a different culture. Their hours are inflexible fi)r working people. If \.ou'w got a <)-to-S.job, a lot of times You can't take off \\,ork to get VOLII' child's inimuni/a- tions \+.ithout rndangrrillg \.otII` 01~11 job. That's ;I problem. There are bat-l-iers for physically impaired people. There's a lack of transportation to providers, especially in remote rural areas. There is no account- abilit!. in the system, ancl if'you have a problem, there is often no one to ~vhoni ~011 can complain. Our s!.stem fosters dependency. Generations are growing alp on a lvelfare svstem. and it's becoming the oiih \~a\' of life that they know. In some cases, single parclits making minimum Irage cannot afford private llc.alth instu-anre to coyer their children. =\nd thus, in n1;u1~~ USC\. it's easier to he dependent on the system than it is to get a~job. 1l'elfAre programs, such as AFDC, cause f;unilies problems; families are unable to get a\sistancc* a lot of timrs unless the father is willing to lea\ e the honle. thus bre;Aing up the family. Thtw artw't rnough tas dollars to go around. T~~cw art.n't ~n0~1g1~ ri01lu1:~ to go around. I- ~~olunterr in the classrooiil. the\ spvlld timt'\vith ttlcnl. etc.Then,lvhen thr~~n~o\~eorentrrotl~r~~~~s;tt.m~ortl~t schoolsvstem, they're not that in!ol\etl. \Vc Itit*] Ihat \\c' need to keep the parents invohwl and kwp that in- votwme~it as the!- make tra~lsitions throtlghout the systems so that our children can be health\ and read\- to lear11. IVe also felt that parents should be in\ohwl in program design and the policl~inakillg decisions that L affect and impact upon their children. One suggestion is that NY form parent boards. which arc ven. pre\Aellt in Hcaci Start but do not exist in man\' other systems. Mter the transition occurs. parents need to continue to be involved. For example, parents that are involved in Head Start need to stay involved as their children grow and 111ove through other programs. Parents need to form their own support groups. M'hen they do, programs should work with them. In other words. Fvhen a parent group forms a support gro~~p to help themselves and to help other parents l\.ork through the transitional process, the programs and systems should be there for them. to support them, help thtw lea~-~l thr tl-ansitional process, and provide niatcrialsor \\,hatevrr thev need to make that transition a'r 5niooth as possible. Program c-ounwlors should be appointed to help ]xl1-cnta pw]x"- for tl1 e transition. Also, parents need to be ;ntare of'llot onlv the needs of their own children, lxlt the iiceds of others-to move away from, "me, ni! four. and no more." (:onsi\ttwc!. is the key to successful transitions. \\`r nrrd to he aware of the impact on children and parents of abolishing programs without notice, and man\ times Ivithout preparation to haIre those needs met through another area. M'e need stabilized funding so that programs can address the problems. instead of just looking at the symptoms. Someone suggested that the transitional process \\.c)r~ltl lx> easier ifIve de\,eloprd an interstate communi- cation \ystcwi. \l.e shol~ld crrate a national computer network so that the information on parents in one State could be readi]\. accewible to another State. \\`hen people st~ch as the Xligrant \cwkers move from one State to~ulothel.and the!.ha\,e toapplyforbenefits, the! haw to closr out theirtilr in the first State, reapply at the IleSt, go through that ~&olr process again, and reopen their tilrs. Of'trn it takes a long time before they get thr brnvfits. Sonit~tinies ttiev are ready to move on to the next grwving wason or the next location before the bellefits e\vn get started. So. if we had a national network. that information Icould be readily available, and that could hprecl up that recertification or reappli- cation process. .Yso, another thing that came up was to create a \~a!. that school credits could be acceptable from State to State. People move through different situations. They have things that are credited in one State, and when they go to the next State, the school says, "I'm sort. but this is not credited here." Then, the child has to go through that whole process again. Establish one-stop shopping-and I won't elabo- rate on that because it has already been stated. Decrease the time spent on paperwork. Make forms less complex. And make an effort to cut down on the duplication of information during the recertification process. hIan\ 76 Parents Speak Out for America'\ Children "Being ready to learn is more than making OUT children ready for the schools. We need to make the schools ready for our children." timec parents go ill to be recertified. alltl they gi1.c tht same information the!. ga1.e 3 month\ ago. Soinc.timt3 in Dela\\,are, I\hen you go to br rccertificd or to get scr\ices. they tell !YNI that you ha\.e to br at the social senice agency at 7:30 a.m. They see IOU at X:30 a.111. or Y:OO a.m., and then they give VOII papu7\wk to fill out that yotl,just filled out the last time. No information has changed, but the!- sa\ . "\Vell, !oii 1iaI.e to do it." LYc could cut down on that process and speed it up. M'orkers need to be sensitive to the needs of the parents \vho conw in and should be a\vare of the stereotvpes and not haw negati\c attitudes tov~cls them, becallse they wmldn't be there if the!. didn't need the help. The other area of concern \vas flexibility. TVe need to make the eligihilit), criteria tlcxiblr. For example. some people have incomes above the gt~itlrlines to receive Medicaid but alw have chiltlwn uith special needs. They can't get regtllar illsllrancc' brcause the child has a preexisting conditioll. so the insl1ranct compan~~does not want to cover them. So those pwplr grt lost in thecracks. \\`r nec~l topa\e tllr\\;l!-of4mooth transitions by rnakillg programs alltl f'Acilitit%s flcsiblc. Chr of 0111` tlrl'g"t'\ erprwcd tl1;tt ,just address the needsofone individual's problems. For example. one of the parents shared that they lvere in the process of suing the school system for some needs for their children and that when that fight is m'er, and that parent lvins. the next parent has to go through thr same process. I\`r think that systems need to Iearn from those fights with parents and those kinds of things that happen. They nerd to learn from the results so that other parents don't have to learn how to light tllr cvstcms better. \Vr 11red to lrlake slure that 0111` pl"`~l`allls are atlrquatd~ fililtlcd so tll;lt the llcwl~ that thc7 ;irt' tlv\ig:llcYl to ,t(ltll.t~cs call IX, ;1Cl(llX~~4 \Ve want the same things. You've got to startworking up from the bottom, and we've got to work harder from the top so that it gets all the way through. You've talked about flexible hours. You want flexible hours; you not only want them, you need them. And we want flexible hours. Last Friday, Secretaq [Louis] Sullivan [Health and Human Services], Sur- geon General Novello, CDC Director Bill Roper, and I were in San Diego to talk about an immunization initiative for infants. And what were we pounding the table about? Flexible hoIn-s, so that parents could bring their kids in the evening, on weekends. Let's make the systems user friendly. You want user-friendly systems; we want user-friendly systems. Let's work together to get it. We're not against each other. W'e're working for the same things, and some- how we have to get it into the middle. And I'm willing to work on that, and I know you ivill as well. I'm simpl! tl?ing to say that we are strijing for what you Tvant, what ~011 are talking about. Perhaps we can p11t 11101~~ ]X)\I.`l` iiito our grant applicati0n.s. Let nie.jitst end 1,:. talking about this doctm~en t. \\`e lta\,e Ivltat \ve call Healthy People 2000. This is not a Federal program; it'\ a national program. You helped develop the 22 p - t iority areas and the 300 specific, tneasur- able, realistic goals of'\\hcre this Nation could lx h! the vex 2000. l\`e'\~ pulled Health~~ Children 2000 out of a much thicker document. and of the 3,000 measurable ohjecti\es for the Nation forve'ar 2000, 1'70 of them t-elate to mothers. infants. children, and adolescents. M'e hope that~~,tt~villwork\\itli IISSO that c~en before thr~~earY?OW, as soon as possible, this Sation \vill lta~e arrived at 1vhet.e \`ott-as you helped us de\,elop these--said Ice ought to be. .Xtid we're \villiiig to work lvith you; 1t.e are partners. and we thank YOU for your input. John T. MacDonald, Ph.D. I ~vould like to thank our presenters for~\hat I cotisidet to be an extremely inspirational mewage. hut one that has a great deal of meaning to us. I h~~ild like to focus my comments in terms ofthe presentations 011 children and their families. I just rrturned last night front the Organization ofAmerican States mertingiti ~~tiatemala City on issues that affect the hemisphere in terms of the same kinds of things that lve are talking about toda\.- precisei\ the same kinds ofprohlems that IWI'W brought here. IV'e are dealittg uith a hemispheric prohlern that lve have to address ifIve are going to sutTive. not,jttst as a Sation. hut as a hemisphere. Il'hat I heard tocla!~. in sum, means involvement. flexibility, a role ofadvocacy, and finally. as Larry [Bell] shared with us, consistenc!~, continttit>-. and coordina- tion. I would like to talk a little bit about commitment, as the other C. to children and their families in an integratedwav. a much more integrated wan than M.e'\.e ever done before. In my trips at-oruld the countt? and 80 Parents Speak Out for America'\ Childrrn ;tl~) itt slwnding 34 \KII-s itt this business of children and f`alnilies. I fo~lncl that, on the awareness issue, it ttteatts \X)LI must not only he tnade aware hut you must have access. ,Jim rwd thr term "user friendlv." Our schools txtsicallv have never been user friendly because the scltools that 1%~ har,e todav are designed for a societ),, frankl\-, that doesn't exist today in tnost areas. I can remember, sotnemonthsago, [Secretat-yofEducation] I~mat- [Alexander] convened a group of us with an eminent sociologist, a guy I have a lot ofrespect for and who hasdonealot ofworkin thisareaforvears. Wewere kicking around the question, "M'hy don't our schools \vork any more?" And he said, "Heck, it's very basic. LVhat vou are trying to do with your schools is for a hunch of folks who don't exist any more." This gets to the access issue, what !ou need to do \I-ith folks. They can't get at you, and you can't get at them. So ~41~ don't YOU think about it? I think back to the txprt-icnces I had as a principal years ago, working in an area \vhere poor parents had many of the same prohtettts that ~UII have addressed in your presenta- tions. The\- worked. They had to jvot-k. They had to get tttcir w)ung\ter\ off early they couldn't get hack to " . . . you've got to join us in that message that. . . our schools must become user friendly, to provide a setting for one- stop shopping-places where education can go on and where mukibm3y senices can go on. . . ." cchonl to attend sessions orconf'errnces or this. that. or the other thing. At that time. xve had Title l-that \vas 27 years ago, when I came on board-and lye developed what we called extended school. This is very. similar to what Lamar mentioned that Decatur [Georgia] is doing 1101~. M'e ha1.e the Federal resources to open up the access issue. You can change the mindsets out there if you .join us in that attempt, working \vith our State commissioners, your State legislators, and your local school folks to "a)- that there is a system out there that will support your needs, if it is prop+. designed. LVe want access to it, and we want to use it. But !w~`ve got tojoin us in that message that we arr tqing to get across to people that our schools must become user friendlv, to prwide a setting for one-stop shopping-places where education can go on and where multif:nmil~ services can go on in terms of local agency semices, State agencv services. and. of course, the edrlcational srlvices that should go on on a continumn, places where a school operates from early in the morning until late at night and on weekends and is open during the school year, where it never closes, and it shouldn't. It's your largest real propert!' im.estment. It doesn't mean the teachers. as I.amar pointed oiit iii his remarks. haw to take on all thew other chores. .rhCV ;1l`P not tl.aillcd to do so-fine. But with that kind of setting, or a setting comparable to it in a community, we can reach and provide fi)r children and their families the kinds of needs that 1j.e need to meet today. It really bothers me terribly-to the point where I don't understand it-lvhen I think back to the late 19.3)~ and 1960s. LVhen we built elementam schools, we built little clinics in them, and dental centers, and so forth. TI?. to find a new elemental? school today that has that provision where lve can provide that kind of sellice to a child and his family. It doesn`t happen an! more. \Z'e have to return to some of the things we identified earlier on that parents need and children need and get back to it ancl make those provisions and open up those schools to do those things. Let me talk about transition for a minute. Ldrly [Bell] ux+ talking ahout transition. Let me throw out a bias of mine that we'w been tqing to work with- [<:on~missionr1-- of the ,Administration for Children, Youth and Families, Department of Health and Human Sel-\ices] \l'ade Horn and his folks. Transition. to me, means from conception to birth; it means from birth to school and community; and it means to the final thing that the President has also mentioned, and that is to making a life. Cnless Ive have the kind of system in place that provides for that and can deliver that, we're going to find ourselves generationally not making strides that we need to make to address the needs that we have toda!,. Looking at some of the things that I looked at for the past 3 days in a Third M'orld country-that can't happen here. L2'e have the ingenuity, resources, intel- lect, and experience that most people don't on how to approach this effort, and we can do it. Let me sa!`in closing thatifweusewhatwe know and use it creatively, lve can de\-elop support for what we are tl:ing to put through in I-ealltllorization ofall the elemen- tal-y and seconday programs-that's 57 programs and currend!. over $9 billioll. Mhat we are tn-ing to say is that \w need a massiw urban inten.ention program utilbing Federal IWOWC~Y ill conjunction \\ith State and local resources to prcnide for communities. an opportunitv to pl;ii~ fir \chatt~\w liiiinht7 of IXYII~ ir take5 to pull those w5iourct~\ lf)j:t~tl~tv. Iocatiqq the scl~ool ~~~~ainotlwr center as a hub to pi-wide an csrcwclctl set-\& or euttwdrd school concept so that children and their families can utilize. thevarious resourcesin collaboration to accommo- date the needs we have. \Vr have many programs out there currcii tly. for example, that can help each other. For example. \Vade's program [Head Start], even with the President's increasr, will still not se17.e all dir ~~oringsters Ivlio are currently eligible. But M'ade can use our program Even Start, which is for children 0 through 7 years old and their parents, to provide not only parenting and child care sel-\ices but also job training and placement ser- vices. That program can buy Head Start seiyices. can be used to expand Head Start sellices, or can create its own. Our Chapter I program, lvhich is basically age neutral. can also be used to by Hrad Start sellices. expand Head Start senices. or bur. their o~vn. In other words, what I am sa!+ng is that in terms of integrating what we haw currentl\~ on the books today, we can do a better job. M'ith our Department of Agriculture, with its LVomen. Infants. and (:hildrtw [MI'IC] programs, \ve've recenth signed a 1lemoran- dum of Understanding I\,ith them so that our \Ligrant programs can iitiliye \+I(: stwice5. \Ve \\aiit lo c~xpantl that to Even Start because (Congress. on our request. has now expanded the age range. Ilot for children from 1 through 7 years old. but from 0 to i: I Irish I could get it from prenatal to 7. But it's in this\va\.that \vv tie things together. and the Surgeon (;cnc~-al and hrr officr l\ith the Healthy Childrrn Read!, to Learn Task Fol-cc has been instrumental in pulling those of us together \vho have been wwrking on this so that, again. Eve are mart integrated than WE have been before. M'el~illcontinrle tostrive in thisdirection, butweare going to need your support lvith Congress to continue in this direction, lvhere we are pulling together and coordi- nating all the Federal efforts around the one focus-lvhat L\-e need to do for our children and our families who need them the most. Thank you VCIT much. Pwsident Bush has told those of us whom he appointed to jobs in his adininistl-atiotl that he wanted us "to work to t-rorient gor.ernmenT to better seme the needs of individuals." 1 rtmember that quote exactly because I thought that was so critical to defining our jobs; it is certainlv critical to defining why Dr. Novello has con- \,ened this Conference: to talk about one group of people-children and their parents-and hog., bywork- ing together with parents on behalf of healthy children, ~vc are helping children be ready to learn and to grow strong. Your confidence in Dr. Novello is vey well placed, and I know that she has been not only an outstanding spokesperson for these issues, but also, in convening all of us together, is making a constructive ef'fort to seeing this happen. I've learned a lot alread! today, and I'd like to share some thoughts in several areas: one-stop shopping, senice coordination, im- pro\iyg services. empowerment, and then finally some ideas about solutions. Before I start. though, first of all I wzit to explain \\-h!. I am here. r\s Secretay. Madigan said when he spoke !wterday. the Department ofAgriculture spends more' than half of its budget on food assistance pro- grams for the poor and for children throughout the country. So in m!. portfolio, I manage the Food Stamp program, school lunch and breakfast, MIC, summel f&d program. food program on Indian resen,ations, food for the elderly, food for childcare centers, Head Start centers, and others--there are 13 programs all together. with Food Stamps, school lunch, and 17C being the largest. Also, I come here as a colleague of the people at the table and as a colleague of Dr. Novello's and Dr. Mason's. Onr-stop shopping, as Dr. Mason said, is abso- lutely a must around the country. We agree totally on that issue in bringing all social services together, and as every speaker here said, that is a critical component. M'e have been sending a lot ofbooks to Delaware because 12 centers there have combined all social senices except forjob training-M'IC. Food Stamps, AFDC, Medicaid, 82 Pa-m\ Speak Out for America's Children \arious child development projects and programs-all together itI one office. I visited one of thaw offices: it was a pleasant place. One receptionist see\ the clients. and all of their information is on a computer. u9~ich sounds simple and makes sense. But it wx\ a Hugh undertaking for the State to cotxince the different Federal agencies ittvolwd to all participate in that project. It is a tnodcl. and \\v encouragt tnan~~ States- we sent many people there--to see how that works, hoping that UY can help them go more tolvard one-stop shopping in putting sewices together. The President mentioned the immunization pro- gram. M'e've been vev involved in that from the M'IC perspective because it isone ofthe fewplaceswherever) \uung children come within the sx-stem. If we can combine setTices and provide immunization services there at L1'IC clinics, it might he a \`et-) productive and helpful program to initiate. To that end, Dr. Mason and I ha1.e bcrn wn-king aggressively with health directors arottnd the countty~ to promotejoint senices for immu- ni/ation and I\?C. Secretar~~ Sladigan yestet-da!- mentioned direct certification fix-children in the school 1~1nch program. This is a ct-itical program. and I Icant to expand on it brieflv. It doew7~ make sense that a child may not be able to access a school lunch or breakfastjust because ofa hunch of papetxw-k that wxsn't turned in. Thewy the system uwrked before direct certification, as you knolv, was that at the beginning of the year, the school sent home a form, through the child, to the parent that said, "Please fill out this form. Your child may be eligible for a free or reduced-price meal; tell us your income." Many times those papers don't get returned; a lot of parents don't want to fill out that paper; sotne parents may never get it; some parents may not be able to read it. So children end up not being in the school lunch and breakfast program, under which they ma) be eligible for free meals, because of paperwork. What direct certification is doing-and in the counties that have started this already, we'\-e had great success. and it jusf began in September-is martying computer lists. The). mart-y the computer list of the kids enrolled in school with the families 1 hat are enrolled in AFDC and Food Stamps. The!, keep this confidential; it follo\vs all the confidentiality requirements. But instead of get- ting a letter stating that `kwtt- child may he eligible," \vhcn this \vorl;s-and it has Ivot-ked so fat- in the mast\ schools that lla1.e startr,d it-pat-ents get a leclc,l- 21 home that s;tu. "\i~~1t~~~ltil~Iis~~li~:il~lr~fi~i~~cil00l IIIll(~I1." .-\ll(]. in f':lcl. \\]lyrhc.t tilt' le.ll(.l c'\t`l gc'lS ll()l11(' (`1 Il"I ()I- []l(, p;,1(`,1, ,(.`,(I\ I]](, 1(.11(.1 i\ it 1~~1~~\;1111 i1t.t .ill'(' lII(. child grts the lt~itclt or the brwhtlt5t. 1 \\ot~ltl ~ttco~ii~- agt' people to go l10111~ ;tntl il4k their school districl if they ha\7 done this 1~1. On the Food Stamp and .\FD(: hide. I 1~1s at the Department of Health and IIttntan Senices managing the ,\FD<: program beforr I cants IO [the Deparnnen~ of`] Agriculture. One of` the I-casons I ~\`a\ ashed to cot~le is that the;\tltltinistt-atiott caresabout ttying to put these programs together. Alntoat e~~~~otte ~vho is att AFDC rrcipiettt receives Food Sta~ttps, :und tlir ttiajorit\. of Food Statnprecipi~ntrrecri\r,~FD(:. Itcertainl! makes sense to sinnplifi the rules and regulations. The people who determine eligibilit\. have thick books in ever) State for each ofXFDC, Food Stamps, and Medicaid. Atn~~ne having to learn the rules and how to ~vork through them takes OII a fairly remarkable chore. So Ivhat Eve are doing is \2-ot-king on the Federal level to identify eligihilit\ requirements. So far, lve've identified 32 eligihilit\ factors that at-e different in the t~vo programs. ancl \ve are lvot-king now to determine \vhich ones Eve can change to make them the same ot- similar, so it \vill he easier for eligibilit%. ~vorkera to manage. and ttltititatel~ easier for those \vlio at-e in need to access the sl3tettt itt both programs. M'e learned from this process. ho~ve\w, that MY have to idetitie- these [need4 chatige5]. bitt \\`e can'1 make all the changes otu-selves. .\lall\~ of thr ctlall~:es \\ill require congressional approL4. and we \\ill be looking at changes Iv. - can t~iakcc in the Federal (;o\-vrti- ment and idrntifving jvhcn NY nercl to go to (:ottgrew to request other changes. I found out one of thesr changrs lvhtm I first catttt~ to this,job. In Alahat~m I \vrttt to a Food Stamp office to apph for Foot1 Stamps because I wanted to we Ito\\ the system lvorked. I filled out lots of forms. and tltrtt the worker gave me one fortn that inclicated l had to take it home and have tny husband fill it out. I haid. "\I%!~? Yott'rr taking me at rn!. uwrd that I'm the head of the household, and all these other fin-ms are OK for tne to sign. LZ'h\- do I have to take this one home fc,t- him to sign! -** "\Vell, because that's the requirement. Evet-r adult in the housrhold has to siCgn this particular form." iVeIl, that didti't make an! sense to me, \\hatever; it \vas a tctrtn draliug \\ith ~vltrther or ttot \vc' \vere L'.S. citiLettr. So. 1 came back and asked questions about it, and a lot of'tlte cliCgihility workers laughed. M'e'd been telling you that this \+`as duplication fi)r a long time. LVe proposed in the Farm Bill to Congress that they change this and elintinatt: the t~vo signature requirement, and MY got it changed. Thar leas the good news. Then we fottttd out that .XFDC: and Meclicaid have the satne reqttirrtnetit. The final point on setTice coordination that I \vatlt to mention is what I think is the most exciting one we are working ott, and that is called Electronic Betteftt Transfer. M'e ha1.e now in the Food Stamp program a pilot prqject. and I lvant to explain what it is. This EBT, as it's called, is using the equivalent of bank hTAM [Xutomatic Teller Machine] technolog? for the pur- pose of pro\iding benefits for Food Statnps and, poten- Ml!., fat-.kFD(:. \\`I(:. and other programs as well. The \~a\. this ~vot-ks is. or would be, that there are no longer food cot~ponx in any cot~~tnut~ity that undertakes this project. People get a plastic card ancl have a private PIN [Pctvmal Identification Sut~~het-1. The State or the c01111t\ pl-ogl-"llls the atII0~1tIt of inone!. that \\ould otlieruist~ he food coupoti tiiotie\' into the a~~otmt. \Vheti a client takes the card to the grocery store. the t-ecipienr runs this card throttgh a titactiin~ at the checkout line. and it debits the appropriate Food Statnp accotttit for that titotitli. Shr cot~ltl also else it. if it's an .-\FD<: card. in a bank cash machine to take out hr~- .-\FD(: allortn~ttt, ttot ttrccwarily in one lump sum, altliough that is ccl-taittlv her option. hut alro in an\ ~~lllollllt\ that she nxnts for the lllolIttl \Vt- haw, itt the areas \vhet-e we are testing this [EBT]-Reading, PA-\: .-Ubttqttet-que. X51: Casper. L\1. (for \2`1(:): Ramsey- ( :outtt\., 11s; and Baltimore, \ID- onh praise front clients \vho have been using this and from the Governtnent and the pri\.ate sector ~vho ha\.r been using it as ~~211, with one exception that I \\ill mention in a minute. The people uho use Food Stamps in ,AFDC ha\.e hem thrilled with it, and the comments that we heat- and the research that we have Sal' that people like it. They like it because, first of all. it gives them security people don't have to wait at the mailbox 84 Parent\ Spsah Out for America's Children "Children are empowered by getting a good breakfast and lunch at school so that they can learn better." (as they must if' their food coupons or thrir .WD(: is mailed) to make sure they. get it. They dott't have to cash the .%FDC check in one lump ~111 and aomt.tin1t.s pay rnone)' to a check cashing plaw to get it cashed: it empowers them to be able to make decisiona about ho\\ much money the!, scant at each particular titnr.. \tllrn the): use this card in the grocety store. the\, dott't haw to deal with the coupons and counting out the coupons and dealing with it: the\, don't haw to deal with anvone else trving to steal and use their coupons before the!, get to thegrocet-ystore. It'saquicket-wa~toget through the system when they get to the grocety store. In M'yoming, one woman at a cash register told me that she had been a \7C client and now she was working, managing the cashiers in the store. One of the reasons that she liked working there MX that the card took the confrontation away in the tine. Because (this program was in MTC, she said, but it could \vork in M'I(: or Food Stamps) the machine says what's eligible and what's not eligible, there doesn't have to be a battle between two people for that purpose. It's a benefit for the stores; it helps them mo\`e people through the line faster. It's a benefit for the clients on L27(: because !-071 don't get otw~ouchet-, one time a month. MXenvou get one voucher once a month \`ou haw to ust' it all. atid that's tough if they don't have vow type of cereal that day. M'ith this new system, you can go back and use the card again; vou don't have to buy all of vow milk once a month and have it rot in the refrigerator, but you can go back o\et- and over again. It's a real plus. It'salsoa plusfor the taxpayers, I have to say, because it will ensure that all of the money that the taxpayers are spending on food-in out- budget this year is $34 billion- \\,ill be spent on food. and it ~511 be an overall plus. M%at ~vt' have to do is ensure that it's cost effective, and the wav that it's cost effecti\,e \ve hope, through our studies, is through combining set-\-ices. If \ve combine Food Statnps and AFDC and per- haps MI<:, and perhaps someday other programs that \vc can sa1.e on the administrative costs. which I think Eva\ t~~entiot~ed b\, a couple of speakers before, it wilt tl+ 11s ill th' hllg J-1111. That is the one problem: \ve haw not yet pt-owd that it will save administrative Monet-, but lve are determined to do that. States can implement this program for Food Stamps after April 1 of this !~at- without a ctetllotlstt-ation project. >-L5 far as imprwing set-\-ices, as Secretary [of@icul- ture] .\Iadigan said. President Bush for the last 2 years has iiicreased the 1\7<: program by proposing larger increases than any president ever-S223 million last year. $240 million this year. That combined total is going to help us set\`e more than 300,000 tnore people in the \?C pre gram. Improving senices in M'IC goes beyondjust putting more people in the program: it extends to improving the actual senices that we provide. One of the things that we've done in the NTC program is to look. for instance, at the issue of protnot- ing breast feeding, and the issue of helping to empolver mothers to make a choice between breast feeding and bottle feeding after they have given birth. Once when I visited a\$`I(: store in Mississippi and Ivent through the line looking at what I Mould buy, I told them I was a breast-feeding mom. I scanted to go through the line as a breast-feeding tnom attd pick up the food I would get. I picked up mv peanut butter. eggs. cereal, milk, and 111:' other products and thn they said. "Oh, rvell. if' \`()I1 \\c*-~JI'~ bt-t~astfecditlg. ltet-c. this i'i the ti~J~l1llI1~l tIl;ll IOIl \\y,(]ld MT'," \l'ell. thrl~c' I\;)\ \O 11111(.h fOJ~lJlll~~l f(,J rlJ(' month that I couldn't carry it out of the `store! It is no wonder to me that onlv 10 percent of M'I(: moms breastfeed, when people may he thinking that they ma! be giving up thislvondet-fit1 option of this great formula for their child. Not only would we like to empowet- women in making this choice. hut also provide mot-e nutrients for women who are breastfeeding. LVe filed a notice with the I;p~~tnl Register asking for comments. and we intend to file a proposed rule as soon as we can to offer a separate package for breastfeeding motns in the MIC program. In closing, school breakfast is critical for children coming to school read\- to learn-all of our studies show that. Half the schools that ha\-e lunch also have breakfast; we can have more. We've been going aroutid the country encouraging schools to offer school break- fasts, and it's realty critical for children to come to school ready to learn. The swmier food progratn is available-schools can offer it during the summer and pri\ate non-profit schools can offer it during the sum- mer to help children have tneats at school. ,-\I1 of these programs empower people. The M1(: program em- powers mothers to help make good decisions hv educa- tion and nutritional support. Childt-et1 at-r empo\vet-ed by getting a good breakfast and lunch at school so that the), can learn better. These programs are empowered by your comments and your direction to us. The solutions? How can we ivot-k together? EBT can start in States for Food Statnps aftet- Xpril of this year. You can tell \our State administrators and own county administrators that you think that thev ought to have EBT. You can work with our regional offices. M'e will work with you, and I will takeJim Mason's lead and work with the public welfare administrators and com- municate )`our comments specifically when I meet with the State Welfare Commissioners in 2 weeks. We can work together with changes that will simplify the appli- cation of AFDC and Food Stamps when we come up with proposals. We can work together becausewe need your help convincing our colleagues on the Agricul- tural, M'avs and Means, Finance, Education, and Labot Committees. It would be helpful if we had similar rules for att of these programs. You also can help by going to 86 Parents Speak Out for America's Children vow school, and ifvou don't have school breakfast, tell the school. school board, or someone else who is a decisionmaker in your community that you want school breakfast for the children in your school. It's an entitte- ment prog~xn; the Bush budget anticipates at least NO schools entering the program next year, but it takes cotntnunit~ leadership and community support to get that done through the schools. Every person in this room, those of us at this table, be they the parent presenters or the people in the Administration, can do a lot to work toget her so that we can take vour direction, the thoughts that we have, and implement. We can implement the President's direction to us to reorient government to better seme the needs of individuals. Thank you vet-y much. Wade Horn, Ph.D. Commissionu~ .-l[lminist,-ntio,,for Children, Youth andFmnilies I `. S. De~xwtm~nt o]`H~nlth nnd Human Sewices It is a pleasure to be here today at the closing day of this Conference and I want to thank the Surgeon General fhr the invitation to participate here, but particularly to thank her for her rzisdotn in acknowledging and t-ecogniAtig the importance of the role of parents in helping to get their kids to school health! atnd ready- to learn. If we needed any mhdation of how criticall\ important parents are, we'\.e heat-d that fi-om the three reprrsentatives here on the panel this mot-nitlg. I lrarn notjust from parents but also f'tx~ii my o\vti children,\vhich I think alI of'u~do. Xnd it'4 Ixxxus~ of.m\ 01vti experiences \vith iii\ olvti kids that I ha\.c t~~iiiaitietl committed to tnitig to help iI\ bc3t I cat1 in 1111 pf-rwtll position, help programs help parettts raiw their kitls. because kids are out-future. I could bc txxl brief`hew and 1 could ~a>`. "Guess \vhat. 1 t-t111 Htwl Stat-t. Head Start loot-ks; it's great." tit doubts, ;iiid cvmhod\ could applaud. Because Head Start i.c a great pt-ogram: Iwotrw it. in fAct. twbodics much of\vhat it is that thr patx*nfs tal!-.ctl about toda\~. It embodies parent inwl\t'm~nt and empowcl-- ment. HeadStart haslongrecogt~i/edth;tt pat-ettt4ar~ tJtt firstand niostitiipot-tatitedttcatot~softltrit~cltil~It~eti. .111tl NY'V~ embodied that etnpo~verment in thr Hcd Start parent policy councils. Also, Head Start integratccl health senices with social senices long ago. Do thou know that Head Start tnakes arrangctnenr.s for one of the largest delivery systems of health senices to poor childt-en in this cou11t1-G Last !`ear, more than 600,000 children in Head Start got free medical and dental screenings and follwup treatment, as well as itnmunilations, through the Head Start program. It has also been a leader in removing barriers to children with disabilities in terms of incorporating them and involving them in the program as well. Head Start has long recognized that children with disabilities need to be mainstreamed. M'e were doing that back in 196.3. I was in the 5th grade, but in 196.3, we \vere doing that. And we were a leader in that. In fact, today, almost 14 percent of all children enrolled in Head Start are children with disabilities. We even pay parents for their knowledge. Do you know that almost 40 percent of all paid staff in Head Stxt are parents of children either currentI\- enrolled in Head Start or formerlv enrolled? But I'm not satisfied. and we shouldn't be satisfied because there is still much to be done. I ani,just going to mention three titw challctigt3 and initiati\-e\ we are undertaking in Head Start. Fit \I of all, \ve need more money we need to serve more kids. The President, over the last 4 years, has increased our budget by $1.6 billion. That's an incredible achieve- mcnt--that's real money, even here in \%shington. The second thing we tteed to do is increase senices to adults of children enrolled in Head Start. In the old da\-s. \vc had this naive belief that we could save children 1~~ taking them out of`the home, working with them, and wnding rhrm back. Lye know that doesn't work. Ifwe are going to help children, UY have to help their parents. O\w the last 3 vears 1t.e have been improving the kinds attd quAiF. of senices to adults of children enrolled in Hcxl Stat-t. particularl!.in the area ofadult literacy. By the twd ol'this~~eat-, \ve lvill have an adult literacy program in e\w?. Head Start progt-atn in this county. M'e need to do a beuet-,job of' \\,ot-king lvith substance abuse problems \vhtw the\. exist in the families we serve. A recent stud! sho~~x that at least 20 percent of all adults who have children enrolled in Head Start have a serious substance abuw problem. \Ve need to do a better job, and we've hem workingwith Dr. Mason and his staff, particularly in the Office for Substance Abuse Prevention and also with the Office of Treatment Improvement, to tv to better coordinate senices around substance abuse issues in Head Stat-t. focused on the parents. The third thing we need to do is to use Head Start as a wedge to increase job skills of the parents who ha\ie their children enrolled in Head Start, and we've been doing that in active collaboration with the new Uob Opportunities and Basic Skills training] JOBS program, the 1988 Family M'elfare Act. and also with trying to merge or coordinate with the [Job Training Partnership Act] JTP.A prOgI-dlllS aS Well. M'e have to recognize that times have changed. We have a number of homes with no parents at home when Head Start is done at 12 noon. \Ve have to do a betterjob of coordinating with new childcare monies, and particu- larly childcare development block grant monies to etlsm-e that, for those Head Start children who have parents employd outside the home, NY can krrp thw ctmters optw so tliosr kid\ dotl't h;nc to be bttwY~ aCl~()~~ t,)\,.ttT();tll()tllt.t cc'ttI(`t.or.\\ot4(`\(`t ~~rt~tlittlot~~lt.t~~~~~~tt~. ,tallt IIOI~I~. \\itlr t11c. 1101x' tltitt \~~~I~c~~N~(I\ i\ tftc,tc'. Finall\-, in WI-ms of`tl-ansition. wv haw to do ;I better ,job of mo\ing kids from Head Start into the public schools. IAI-IT Bell talked about nuking our kids rcad\, fir school. but he also said that \VY ha1.e to do 3 better- job of makiligo~u-schoolar~ad~-fi,rolII-kids. \Vv do. Sonictimes people point to Hracl &II-t. a11t1 thev sin. "DOYOU think it's a success? It`s not ii stIccess. BCYXL~Y~~ kno~vnhat? LUteI vow kid gets a vear w tuv of Head Start. .5 wan doum the road, the gains start to dissipate." A~lcl I ~a!-, "Sure. If the child graduates into neighborhoods that are riddled \vith violence. ifthechildgraduate5into homes thatarr riddled with substance abuse, if the child graduates into 5cl1ools that are unresponsive to the needs of their children. rthat do you expect?" Head Start is not an inoculation against eveI?thing that can possibly go MIXES in that child's communitv. The fault is not Head Start's; \ve nerd to do a better job of jvhat happens to those childwn nllrn the\, leave Head Start. That's why it's been 50 grati+ing o\w the last 3 vears to work with Jack ~IacDonald in enawing that we make those connections het\veen Head Start and the public schools. Thankvou for the imitation to be hew. Christine Nye Diwcto~ .\lrclircd Hll ww 11 I want to thank [parent presentvr~] I .~I-I?' Bvll. Sliwlita Reeves, and Ellir \.alcle/-Ho~~e~111~111 li)r \our comments this morning. It's ahvays so crucial :ulcl important that \\c' hear the things that concern and intt'wst yu \luch of' what I heard this morning had to do Lvith the .\ledicaid pro`gram. The intereatiyg thing about this (Zonfcrence and\\.hat I've heard thismorningiis that it ctrncka rrle\wit chord for me not onh, as a parent but also a5 an adminis- trator of the Medicaid program. `1~ Dr. X4ason said, I reall!~ didn't know hou, to fl-ame 111~ remarks to YOU this morning, but it's absolutel~~ true that you lvant these things to happen. M'e IVdIlt these things to happen too, so \vhy don't the!. happen? Let's nuke them happen, and I think that is so important. Sot only are we all as parents sorneho~~,affected or infected b! the things that you said this morning; it goes deeper than that in other ways too. Forexample, I'm the parent oft~\,odaughters, one of ~vhom should ha\.c lxen 4 a month ago, hut who, despite all the efforts oftechnolofl, died. .&id I'm also the parent of a little girl l\ho lvill he ?J next week. So I ha\v, personall>-, lx~ause of that, a deep commitment to man>. of the things that you do. Sirriilarl!,, I can go through people i11 the Medicaid Bureau \vho are lvork- ing OII eligihilit\. pohc!., on home- and community- based 1vaiI.er.s. ul~o also have a commitment to making things better, not only ;IS professional people working in the Medicaid program, but who also are per$onall! inwh.etl in some of the things that VOLI are involved in as well. And that occurs not only at the Federal level- that WY as people \hare these things-but also at the State and local lt3.elr. 1 I\ nnted to make a few comments today, and there are man! things that I could say-so may'things thatwe arc toting to accomplish, so man\ areas \vhere \ve are still falling short, so man!` things that we have tolvork 011 togc-thrr. \fedicaid is a massive program. It senes almost :. cnsurt tnasinttm fi-cedom of choice, atid give e\.et7.fatttil~.-rich or poet`. 5icE, 01` healthy-access to IlPaltll cat-e. I kllO\\ how important thi5 is. patxicttlarl~ for parrnts !vho lta\v childreti with special needs. \I\- plan \vill cw4t1rc tltat wtt can change jobs \vithout etitlatt~c`riti~ the health insurance on which 10111 cltild d~.pettds. \\`c't.c brtiltl- ing on our sv\teni'\ \tt.etlglhs. \\.r't-c ;i\oidiiig tht pitfitlls of`tiatiottali~~tl care. tllc kind that propIt. fi.otn all over the I\-orltl cotiie to .\tiirt~ica to ~w;tpt'. .-Ul these appl-oat-lirs f'ot. Inec,titig oui- goal of healthy children wads- to 1t';irii must build 011 ;I Ix~aic truth, that, in thiscotIttti3. f';itiiilics COIIIC first. (;o\ct-tt- tllrllt l~"ogl-allls that cnxTtaLe tl1r I'l* `~rlitfitl tx~l~ of' l'attti- liesa~~tlcotniiiut~iti~s.tl~It~ tltvitt thr. fi-cctlotII of`c~ltoicx~. ot- hind tlivtii itp in t-cd tape ;II`C ~itirpl\~ ttttac~cept;tblc. Our tiio~x~nietit i\ about sttxwgth~iiitt~ f':ttttilitx O\YI- the next fc-\vdms. I'm tolrl\-oti~~illco~ttittt~t~;~~t-that national dialog. slim-e it~fotm~atiott. esplotx~ nc'xv i&a\. and then r~tiwti to u)t~r c.otntiiutiitit.~ to lead thv good fight. Your coniniittneut is an in+t-atiott. and I thattk T~LI for inviting nie to get a f'wlitig of` it fit-sthatid. May God bless all O~`\YNI. Thank you al1 and tna> God bless America. Thank you \-et-!. vu-\- mt~ch. Louis W. Sullivan, M.D. Secreta~r~ of Health and Hurnnn Services G ood morning. It is a sincere pleasttrr to b~elconte eveqm~te to the "Health!, ~~hildren Ready to Lxarn" Cotiferencr. I'd like to take a nmnent to commend m)- colleague, Dr. Antonia Novello. wtw has ken working diligvntl~~ during her tenttrt' at the Ikpartnwnt of Health and Humat~ Set~ices to improw the health and wzll- being of America's children. This vu?. timel! and itnporta~~t Conference is the culmination of' 18 niontl~s of planning among the Office of the Surgeon Gmetxl, the Departtn~nt.s c)f.Agricultttrr and Education. the Sadonal Go~xm~ors AwF ciation. and so tnanv others. I ant confident that this C:onfrr- encc' \\ill pIa\ ail cwtwtial role in 0111` dt'l~tt-ttltc'llt-\\idt, t%ftc )rt to itnpt-ow school waditi~ss. J'ou know it is not often that we policytnakers in \Vashington stop to conf&- with the real experts about the challenges fxing,1nwtican children. But todaywe arc. Today. 1t.e arc convening parents from evey State in our Sation. Together with educators and health pt-of'+ssionals ft-om the front lines, \ce can network, share promising progran~s. and strategire about holvlve c;ut tnt'et thr President'\ first Sational Education Goal tliat "b!. the x.eat- 2000 all children in America will start \c11001 1xYid\ to learIl." .-\s \ve all knojv, ;I good beginning is often the lie! to wcct'ss. This is v\pt,cially true tvhen we speak of cltiltlt~cn. .\s parettts. health cat-e professionals, psy- cltologict~. edttcators, and othet-s who u~~t-li with chil- dtwtt uill atteat. the rxpetiences of childhood shape the ~otirsi(~ of` ;I lifetime. This sentiment leas beautifull> c;tptrtrtd b\~,john \lilton, \vhow-ate: "Childhood sholvs thr. tttan as mot-nitlg sho\vs the day." M'hat determines whether a childhood is a beau- tiful sunrise in wartn tones of amber and crimson, or a grim, colorless dawn? First and foremost, a child needs to be secure in the love of his or her parents. h father who reads to his child each night before bed, or a mother who proudly displays crayon masterpieces on the refrigerator, is real])- laying the groundwork for a positive school experience. In addition, a warm, color- ful childhood is a healthv childhood. Children's health and their ability to learn are mutually dependent. Be- ing ready to learn depends upon a child haling enough to eat, being protected frotn preventable diseases, grow- ing up free from environmental pollutants, and having access to health care. Helping parents to provide a healthy childhood for their children is a central part of the mission of my Department. In his fiscal year 1993 budget, President Bush has provided us a blueprint for action. The President's budget proposal has three areas of emphasis: First, j\e must imrest in children; second, we must focus on preyen- tion; and third, programs must empower parents. Investing in Children Investing in children is sitnpl!, good health care polic!. The time and resources we devote to children now will pay continuous dividends in the future in the form of healthier and tnore productive citizens. In recognition .- _ : "I tr@j%&%zv~ &at th&amiIy is redly the fi&vd best department ofl<h and humAn.services. And:I"d like to say, as well, &at parents axe a child's first and -best .d-epartment of education,? _ __ r ofthis tact, the Pt-esidrnt's b@get proposes to increase im.estmettt progt-ams serving children to $100 billion, up from S60 billion in 1989. Healthy Start The first few years of life, beginning in the womb, are the most crucial period of child development. There- fore, if we truly desire to invest in the next generation, we must begin before the child is even born. We must begin bv making sure every mother receives early, quality prenatal care. Overall, nearly 25 percent of all women-and nearly 40 percent of Black and Hispanic women-do not receive prenatal care in their first trimester of pregnancy. Lack of prenatal care is a contributing factor to this Nation's disgraceful it&ant mortality t-ate. Despite spending tnore on health cat-e than an): other nation, the United States retnains 23th among nations in the rate ofsur~i~A of'infants. Each \`eat-, 40,000 American babies do not 1il.e to celebrate their first birthday. Black babies art' more than twice as likely as white babies to die. The President and I ha1.e made infant mortality a national priorit\ by developing a new infant health initiative, Health\ Start. Our strategy is to concentrate resourcw in 1 .i contn~ut~ities Ivith stubbornly high in- fant mortalit!. rates. Each community is given the flesibility to create a mix of setTices tailored to the tireds of their population. \Ve are requesting 5143 million to prwide these 1.5 communities with the re- sources necessary to full!, implement their detailed strategies for reducing infant mortality rates by at least 50 percent ovet- a .5-!,eat- period. We will use the kno\vledge gained from these demonstration prqjects as a model for other communities across the Nation. Focus on Prevention The President's budget also will focus resources and attention on pre\,entive health programs. Common sense argues that it is better to invest in prevention and screening programs than to Ivait until the advanced stages of disease. when treatment is more cotnplicated and more costly. 98 Parrnta Speak Out for America's Children "It is fto surprise that our most suc- cessful ~pfugrams for children-like Head Start-are built upon direct parental involvement." Immunizations Childhood immunizations are a~nong the most cost- effective prevention acti\,ities. Z\ Sl investment in measles-mumps-rubella Gwcine ma\- return S 11 in avoided medical care costs. M'e can be proud of the fact that 97 percent of American children entering school are immunized. Ho\\.ever, to be fully protected, chil- dren need to be properly immmlized by the time the! are 2 years old. Our rates among preschoolers are much lower, and in some inner-city areas, the immunization rate among 2 year olds is an abysmal 20 percent. That is whv the President has requested $.?2 mil- lion for our immunization activities-an increase of 138 percent since 1989. My Department will use this in- crease to target those children most at risk. These dollars will translate into 6.7 million polio vaccinations, 4.1 million measles-mumps-rubella vaccinations, and 2.6 million hepatitis B vaccinations. LeadPoisoning Lead poisoning, the most common environmental dis- ease ofyoung children, is another preventable disease. As many as 3 to 4 million American children under 6 years old may have lead levels in the blood high enough to cause developmental dclal.5. learning disabilities. heha\ioral problems, decreases in intelligence, and tA\.en death. Low-income, minority children growing up in ur- ban areasare most at risk ofhaving dangerously high levels of lead in their blood. The President's budget requests S40 million, a 90 percent increase, for CDC Lead Poison- ing Prevention Grants. These grantswill support about 30 statewide lead poisoning screening programs. Empower Parents The third emphasisofthe President's budget is thecritical role of parents and the need to support programs that empower pal-ents. I trul!. believe that the family is real]) the first and best department of health and human sel-\ices. LAnd I'd like to say, as well, that parents are a child's first and best department of education. Educators often speak of the "hidden curriculum of the home" to describe the important lessonswe learn during our first few years of life. We learn that our parents love us vel? much, and that gives us a sense of securitv. IZ'e learn how to share, and we learn right from left and right from wrong. These are not eas!' lessons to teach. And all too often this learning does not occur because parents cannot, or do not, attend to the needs of their children. It is no surprise that our most successful programs for children--like Head Start-are built upon direct pa- rental involvement. Head Start Head Start has won the confidence of the American people. It is known as a program that works and a program that is worthy of our tax dollars. Many of you in the audience are familiar with Head Start; some ma! even seme on parent councils, which guide the opera- tions of the individual centers. President Bush, a firm believer in the value of Head Start, has proposed the largest single-year funding in- crease in the histoy of Head Start. The $600 million he has requested will seme an estimated 157,000 additional children in 1993. These additions would mean that fUnding for Head Start has more than doubled since President Bush came to office. This unprecedented incrraae in He;ltl Start suppol-ts participation of`:ill vligit)lc ;uld iljtel.c4tc(l cti4;ld\;Itll`l~(.(l chiltllc'll 101' OII<' x(`;Il.. The President's Health Care Proposal In addition to targeted intet>.entions such as Head Start and Healthy Start, the President annout~ced last week his health care reform proposal. Under the President's plan, the middle class will get help to pa! for health care through a new income tax cleduction. For poor families, the plan guarantees access to health care through another new feature: a health insurance credit. In combination, these tax provisions Fuill help more than 90 million ;\mericans and covet- 93 percent of the uninsured. This morning I've outlined the tremendous ne\\ resources that the President wants to make available for children. But more money alone is not enough. The critical element of any initiative to help children is par- ents. Unfortunately. for reasons ranging from parental exhaustion to preoccupation with careers. children toda\ spend 40 percent less time rvith their parents than ther.did in 1963-an average of only 17 hours a \\,eek! To put that figure in perspective. Xmerican children spend an aver- age of 2.5 hours watching television each l\,eek. I'm encouraged to see so many parents alit1 child experts gathered for this Gmference. O\,er the next few days, you will have the opportunit!, to USC ~~~nr combined expertise to I~OIY this Sation to\vard the goal that all children lvill begin school read\- to learn. To borrow again f?om Milton, !-on jvill ha\.e the oppor- twnity to make childhood a \varm and radiant sunt-i$e. ushering in a day of golden hope. Thank you all. Godspeed to all of the Health!- Children Ready to Learn participants. Edward Madigan Secretary of Agm'culture N utrition is basic. hll things can be possible fol a child who is well fed: \er). little is possible to1 a child, or a pregnant mother, or anyone fat that matter, who doesn't get the nutritious foods \ve all need to grow, to learn, and to excel. It's ourjob to get that information to you and before the public and into e\,eryday practice. There are 64 million children in the United States t&a!,, and all of them share this need. That's why we're here this morning. The Prrsident recognized the importance of a strong nutrition foundation in his education initiative. The first of his six National Education Goals is that "B\ the \`ear %M~. all children in Xmerica will start school ready to learn." To achieve this, we have to ensure that they re- ceive the nutrition thev need for healthv minds and bodies. That responsibility begins before children are born. M'orking lvith mothers, we must ensure that the number of low-birthweight babies is significantly re- duced through good prenatal care. Xlthoughwe are investing large amounts ofmoney alld effort to help, it's the parents of children in these programs \vho have the primary role to play in their care and feeding. One of our best progratns for reaching both children and the parents of children at risk is the Supplemental Food Program for M'omen. Infants, and (:hilclren. or M'IC. This program provides suI~plrn~rntal food and nutrition education to low- incomr pregllant, postpartum. and hrrastfeeding \vomen: infants: ant1 voung children-all at nutritional risk. \\`I(: scr~.es OIIC in three babies born e\-etT' year. I That's about .!.?I million participants this month alone. ;\nd our highest priorit~~is 101\.-income pregnant \vomen and their infiints. LShat'.s more, \17C has become a gatr\\.a\.toothergo\.ei-ilmeiit ser\.iccs, especiallvhealth carr. Through \!I(:, pregnant women are learning about and obtaining health selyices they need. L.ocal 1VI(: agencies refer applicants to Sledicaid if it's like11 thw'rt` eligible. \2'1<: is an acljunct to health care that participants recei\.e at local health clinics. For example, M?C per- sonnel promote hreastfeeding among program partici- pants, coordinate with State and Federal immunization programs, and provide alcohol and drug abuse preven- tion education and referrals. \2'1<1 is cost-effective. X major study done in 1987-88 in five States shon-ed that Medicaid-eligible pregnant women who participate in MTC do indeed have healthier babies than low-income women who do 100 Parents Speak Out for America's Children not participate. EWIT dollar spent on prenatal \\`I(: care was associated uith a \ledicaid u\-ing\ of`bet~~reir S1.92 and S1.7.i for ne~vborn~ and their mothers. Last !`ear, the President highlighted \\`I(: a5 a major priority to ensure that chilclren enter scl~ooI health\, and ready to learn. He requested the largest budget illcrease for \47C of an!' president. An even larger increase, S210 million in 1993, will enable M'IC to reach .?.4 millioil women, infants, and children each mwth. \`irtuall\- al) lowincome pregi~arit\~onien and infnntsuho ;iw eligible are enrolled in the program. This 2-year effol-t w-ilill extend U?C benefits to nParl!- X0,000 more people. This )~ear, President Bush is requesting a SSOO million increase for the Head Start Program. Herr again, we at the Department of Agriculture \vork together \lith another Federal program. Head Start prokles education services under the Department of Health and Human Senices; the Department of .\gricnlture prw-ides the meals and snacks. Our counterpart program is the Child and ,\tlult Care Food PI~o~I-~I~. lvhich concentl-atcs on prtwhool children. ages three to five. in ilon-i-esitleiitial cliildcarc~ centers antI famih tlaw 211-c homrs. ~rod~t~, tht* p~~~~1~;1111 k operating iiationuide. iii 170.000 clriltlc;u-e c~`iltcw ;iiltl daycare homes. It's been a fast growing program, and many of your preschoolers participate. Next year, we propose to spend $1.17 billion on the Child and Adult Care Food Program. LVe expect to sene 100 million additional meals in 1993. due in part to the continued expansion of Head Start programs. Of course. the program hour children probably participate in \\,hen they enter kindergarten or first grade is thr Sational School Lunch Program. Through thi4 program. schools wr1.e almost 23 million lunches each school da!- in virtuallv all the public schools and in most of'thr priLite schools. Half of those are free or at ;I ~~edr~cetl price. Our efforts to change this program are aimed at fi)cusing 011r limited resources to those who ntwl them the most, without sacrificing the program beliefit\ to all of`oiii- Sdtion's chilclreii. Onw again this war, thr Bush .~dniinistration is proposing a rcwucturing of the reimbursement for the SCIIOOI I.unch Program. Our proposal would reduce the cost liw rrducecl-price lunches IX a quarter, so that a ~tutlent in that categol-\ could get a nutritious meal for no more than 13 cents. For reduced-price school breakfasts, the cost ~oulcl be reduced to a dime. ;2lore well-off children would find their per-meal costs increasing b! S.06. a small price for such an extended benefit to those truh in need. This proposal would enable us to reach ~~N.000 more children ~.ho are currently eligible to pur- chase meals at ;I reduced price but are not participating. This year, we`ve made it much simpler for schools to establish a child's eligibility for free school lunches and breakfasts. M'e'\e started a direct certification sv$tem under which schools now communicate direct11 lvith local welfarr offices. If a child comes from a farnil! receiving Food Stamps or benefits under the Aid to Families with Dependent Children Program (;\FDC), the child ~tlav receive free school lunches and break- fasts. Parents are not rtquired to submit an application. ;\s a result. schools report that the) `I-C sell-kg more free I~tnches to eligible children than ever before. We don't let kno\v how lnan\.morc are bencflting. but indications at`<' the number is substantial. the 1990 Federal Dietarv Guidelines for X1 .%nericans. L%mong other recommendations, these guidelines sug- gest that children and adults eat a diet in which 30 percent or less of the calories come from fat. U'e're working to achieve that goal in the school hmch and breakfast pro- grams, and we're making progress. To assist in this effort, we're conducting demonstrations in California, Colo- rado, Louisiana, Ohio, and Tennessee to test how schools can modi@ their menus to reduce fat, salt, and sugar and still keep students eating school lunches. M'e are testing or have tested four different types of low-fat hamburgers in six States last year, and the comments coming back from the schools were very' favorable. In a few months. we will issue a publication and instructional videos to give cafeteria workers additional information they need to offer meals that meet the dietary guidelines. The new dietal?, guidance Ivill be provided to more than 27.5,OOO child nutrition program operators-some of you are here today-in more than 90,000 school districts across the count?. I have prom- ised to provide schools with the tools they need to comply with the dietary guidelines by 1994. Our goal is to have at least 90 percent of all lunch and breakf%+t menus in line with the dietan guidelines 131 the vear 2000. I'd like to do a little hettcl- than that, and sooner. Some of you are parents of children ~&o Ivill be participating in the School Lunch Program. and IYHI need to be involved with vour school and its l~u~cl~ program. Just as Head Start o\veh much of its success to parent involvement, the same holds true for school lunch. Our most successful school lunch programs are those where parents are involved. Besides school lunch, the School Breakfast Pro- gram senes almost five million children daily. Xnd about 80 percent of school breakfasts are served free. The largest of our food assistance programs is Food Stamps. Eighty percent of those benefits go to families with children and about half of all Food Stamp partici- pants are children. More than 12 million children receive Food Stamps each month. Beyond that, three out of four households with children also receive benefits from at least one other food assistance program. In 1993, the Department of .Agriculture expects to spend almost $23 billion on the Food Stamp Program alone. Food Stamps are available for eve7 needy person who meets the quali- fications and enrolls in the program. anyone for #&at matter, F&O doesn't There are, of course, other food assistance pro- grams. During thv summer months, the Department of ,\griculture provides meals for children in low-income neighborhoods. In 1993. this program will provide about 100 million meals. M'e also distribute food pack- ages and commodities. Food packages are distributed on Indian resell.ations and to the homeless. 1Ve also have programs that distribute bulk commodities to orphanages, hospitals, soup kitchens, food banks, and meals on lvheels. The food assistance programs do a vey good job of providing needy people with food. But they need to do mol-e than that. MTe must make use of these pro- grams to teach people about the critical relationship between diet and health. M'e need to do more than provide good food. `IZ'e need to provide food that is good for them in the right mix. We need to help them understand the difference. The Nutrition Education and Training Program, known as NET, supports nutrition education for school food senice personnel, teachers, and students. NET has done a good.job in the Nation's schools. But some areas deserve more attention-such as educating 102 Parents Speak Out for America's Children preschoolers in the Child and r\dult Care Food Pro- gram. The President's 1993 budget requests a 3) percent increase in SET fmnds next year. These new funds will be used to expand nutrition education and training to childcare providers 1~110 seI1.e vex?- young children. \.lre will develop preschool curricula as \vell as materials that show care provide,-s how to ,etTe saCe and nutritious meals and snacks. 1 want to mention the Sational Food Sellice Management Institute. sponsored by the Department of Agriculture. The Institute began operation\ at the University of Mississippi in 1990. It helps ~hool lunch operators impro1.e both the qualin. of meals and thy operation of child ntltt-itioll progr;uns. \Vr cqwct the Institute to be a \aluable source of con5istwt training and research-based information. From the beginning, MIC has ~natle nuts-ition edu- cation an integral part of the program. In 1993. 1t.t' \\ill spend $1 1.5 million on nutrition education to help par- ents learn about the right foods to ~17~ their children. To further improve the nutritional status of the neediest MT<: participants, NY have requested S 12.3 million for our Extension Senice to provide intensive nutrition training for the most need\,. \\`r lvill use these funds to serve 30,000 new WIG participants, in addition to the 9 1,000 now sewed through the Expanded Food and Nutrition Education Program. The President's budget also proposes S4.5 million in State grants to develop and distribute training and nutrition education materials for hard-to-reach adults. The objective here is a nutrition message sensitive to income, educational levels, and cultural preferences. The breadth of our food assistance efforts affects many people. In total, this month, we'll reach over 50 million Americans. This effort begins with informed, engaged parents who are taking an active role in the programs that affect their children. I urge you to work locally to see that these programs succeed. Evenone who can and should be enrolled in these programs needs to be enrolled. Thev are among the most success- ful and helpful in government. In many cases, it takes you to make them work. Keep at it. Thc~-e arc 63 million children depending on YOU and on mc. 11'~ can ndv a difference in their future. It's our future as well. The stakes are too high for us not to succeed. 1 thank !ULI, and God bless you. Lamar Alexander Secretary of Ed,ucation C an yw imagine a more irrepressible Surgeon General than Antonia Novello? She called me a few months ago, and then she came by to see me. I said, "SON., I Ivill be glad to come see you," and she said, "Oh. no. I Ivant to come see you." So she came over to see rue, and she told me about her ideas for this Conference and ho~v she {canted to focus the idea of healths children Tvith the first Sational Education Goal-chilclren ready to learn-and how she wanted the \-arious Departments, those of us in the Federal Government who \vork in these areas, to join in and to work Jvith the Governors. But more than anything else, we wanted to invite and bring together people from arourlcl the country, not all of whom were experts in working with the Government every day, but people who were ad\,ocates. Some are experts in working with the Government even- day, but many are not, and I'm sure it's been a vet-y free-flowing, spontaneous, useful 2 or 3 days. I got the sense of thatjust this morning in the few moments I talked with you. 1 think it's good to have conferences when you don't know exactly what the result will be; when you have people who aren't programmed necessarily; when ~OLI have an opportunity to heat- a lot of different people and learn some things you might not have known before and consider some things that might be different than things you considered before. 1 think in an opportmnit\ like that you can make more of a contribution than you can in something that is staged. I know that many of`you worked late last night with ~YNII- thinking and vow ideas. and you will probably be ~vondel-ing, "Nowlvhat? Mhat about all of that work. all of that enthusiasnl. all of that talk-%\iIl it make an\ (liff~l.yllc.~~" \j-rll. t)lt. ;I,~SIVC*' is, t)f~(`t)t~rse it \\ill IllahC' ;I diffcrelicr. \i)uought tog:et asrnscof that fi-on] thvcroud that ~OLI'\Y attracted hrre in the last fev cla)~ The President's beeii here: lots of people ha\v been here. They're pa!ing attention, I think, to your presence. So your ideaswill make their \\a! back into Government. into the States that !`ou come from, and hopefully, and ma\be most importantl!., which islvhat I'd like to talk about, back to the communities in lvhich yo11 live. M'e like to call them the America `LO00 communi- ties. You ma\` call them Ivhatevel- !-ou \vould like, but in the end, that's lvhere the results really make a differ- ence. I get a lot of letter\ from children. since \ve'rr talking about children, and teachers encourage them to write me. I like to see that, because so often OUI children today end up sittin, u around ~\.atching: televi- sion. which is sort of a one-\\-a! thing, and they're not communicating and talking and having conversations as much as they should. The President talked about .\merica 2000 and a national examination system. This is a \.ollultal?-s!.stelrl. Yo'ou may be in my hometown in MeryTille, TS, and JOLI really wonder, "M'ell, I read all this stuff in the paper. Are our kids here learning math in the fourth grade to a world-class standard? I'd like to know\-." \\hat the President u'ants to do is to make sure lvc' create wmc standards in math, sciencr. English. histon.. and grog- raphy. then a series of\vhat he calls ;\merican ;Ichieve- ment tests that 11-e can use in ill\. hometo\\ 11 to ans\ver that question. Then if some kids are and some kids aren't, at least \vv'll have ail honest atls\ver about it and \ve can go to \vork on it. Of course. lvhat the President is suggesting is not more tests, just clifferrnt tests-tests that might give us a clearer indication. M'e want Ameri- can schools with Xmerican values for our children, but we also want them to be able to learn enough and do enough-all children-to live, work. and compete with children gro\vingup in Seoul andTai\van and all around the world. 1 was the Governor of Tennessee for 8 years, and after I had been there a~.hile, I figured, ifwejust sort of get up eveIT day and do our job, we may end tip going arollnd in circles. \V'e have a philosopher in Tennessee uamed (:het Atkins \vho pla\s the guitar, and he says somrthiiig veil' profound: "In this litk !uu have to he might\- careful where vou aim because you are likely to get there." LVe talked about it tvith our cabinet in the State go\.ernment and came up lvith a very short sen- tence about lvhat we were tying to help our State do. Soticc- I didn't say "what we were going to do for our State" because that's not the \vay it ~vorks. That's the "a) some peoplr thinhit\~~orks, and sometimesyo~l read the ncv.spapers aiicl people sax-. "I'm going to do this, and I'm going to do that." That's not the way it works. `Cl'hat 1t.e Ivei-e Ming to do lvas use o~ir positions in golrern- ment to help people do things for themselves, commu- uit\. by community. And our goal for our State was to ha\y healthy children lvho lived in safe and clean communities and who could go to good schools that uuuld help them ha1.e a better life and a goodjob. It was that simple. and\w al\raysstarteclwith healthy children. 104 Parents Speak Out for America'\ Children MLI\ wife \vas one of mv educators on this. Gover- nors real]\- educate themselves in public, if the!.`re smart. They don't arrive knowing e\-ety.thing: the!, reallv don't arrive knowing much. So. I learned a lot. and I thought that one of m\ roles as Gwcrnor Eva\ to help others learn as I \fls learning. \I\. \vifv f'ormrd a Health\, <~hilclren 1nitiatix.e and Ivent to ROI-k ovc`i` ;I period of 6 to 8 years on a number of'thiuga. One ofthose things had to do\\ith a\~nhigh infimt mortality rate lve had in the State and a \wv low level of prenatal health care. \Ve found that for a relativeh~ small amount of money lve could take prenatal hralth care senices, which were available in onlv about 30 of OLW 9.5 counties, and expand them \irtuall\ to ejvn couii~`. It real]>- took placing priorit\, on it and \kw-king on it and talking to a lot of people about it and 5pendillg some monel.. In the ~vtiole State budget, holvever, it \vasn't much mane\`. 1Ve saw results from that. I ran into indkiduals, women in Tennessee tolvns, lvho Ivould cotne up to me and say. "I think your wife ttrlpcd 111:. t,ab!. be born health!,," because the\, knew that sheers involvtd. It gave the mothers some awareness of Ichat come of their- responsibilities might be during the period ofpregnancv, and it made some difference. We found some other things that could be done. The Healthy Children 1nitiatk.e revealed that may babies were being born without a pediatrician available on the first day. They also found it was entire]!. possible to have one available on the first day, and that it didn't necessarily cost money. The pediatricians in our Stat? and our Healthy Children Taskforce got together and simply agreed that, if a child was born who didn't ha\,e a pediatrician identified. the hospital, doctors, and Healthy Children Initiative would designate one so that babies being born in Tennessee had a doctor. So,just those two things made a difference. I also recall that toward the end of the time 1 was Governor, the head of the Healthy Children Initiative and my wife came in and said, "M'e need to do more in childcare." I said, "`Well, the budget is ah-eady made up and we don't have anv more monev for thisveal-." I MX always twing to thiiik of the practical things, 1011 kncnv. I The\, said. "Oh. tllat`s not a problem. \vv'll,ju, because it's part of mp job to help .%merica 2000 communities do what the President has asked them to do: adopt those six Sational Education Goals; develop a strateg? in theil hometown to move toward those goals; and develop a report card to measure progress toward those goals and to think about creating a new. break-the-mold .\meri- can school that really meets the needs of children the wa\`they are growing up toda!,. Then. I go to California. and the Governor reminds me that 1 out of 10 hahies horn in California even; year is a drug baby-hahies born with some poison in them. They're not all crack babies, but they are drug habies. There are 250,000 children horn in California even-year. That's a lot of babies, and that's an obstacle to learning. Those children have one strike against them from the day they are born in terms of their ability to grow up, live and work, and compete in a world with children from all over the world. One of my perceptions is that more money will help, but there is alot ofFederal money out there, much of which could be better spent if we could find ways to organize it better. For example, Jule Sugerman came in to see us the other day. Man)- of you may know him. He got buy in the 1960s and really, with some others, im.ented Head Start-just a little pilot program and zoom, here it goes, o\rer the last several years. Everyone is awfully proud of Head Start. He pointed out to us in the Department of Education that there are now 27 different Federal programs that were available for chil- drenwho are less than 5 or 6years old and that the major challenge right now-while he's an advocate for more money-is spending that money wisely. I think of Decatur, Georgia, as a wonderful ex- ample. There's a school district that, in the early SOS, had people trying to get out-parents seeking to get their children in schools in other districts. Today they are trying to get in. There are two reasons for that: One reason has to dowith whatgoes on inside the school and the second reason has to do with what goes on in the community outside the school, hoth involving children. Inside, it's a tough school with high standards, teachers who are responsible for the progress of the children, and a very strict superintendent. This is a school that \\,ould have a profile for low achievement scores-it's a minority district, SO-9.5 percent, rvhere most of the kids have a chance to have free lunches or free breakfasts. But in this school they ha\.e among the highest achieve- ment scores in the school districts in the State. Mllat makes the difference? I think it's what goes on inside the school. The superintendent in this rela- tivel!~small school district-one high school, one middle school, and a few, three or four, elementary schools- has gathered more than $1 million of support from the communit\. to help the children. He uses the school as the organizing point to help those children, so the! don't just turn kids loose in the afternoon at 3:30 p.m. to go home to an empty house with no support. The) have everyone from the Boy Scouts to the Girl Scouts to the local foundation, to the Department of Health and Human Senices and Department of Education offices. They've just rounded them all up, and they've taken that money, energy, and interest, and they are fitting it with the real needs of those children. They don't interfere with the school's function of teaching and learning. I don't think we should; we shouldn't dump problems on the school that the school is not capable of 106 Parents Speak Out for America's Children handling. But they do use the school as a center for the organization of community efforts, which helps the children become ready for school and stay ready for school as they grow up. "Every chilrc@, a fragile, mirxuTous op portunity for &ccess and phtential." ;_ ~.. r_ I am sure the President has told you that the Head Start increase that he's recommended is the largest one- time increase in history. The Federal budget has gone up 25 percent over the last 4 years, overall. Head Start funding from the Federal Government has gone up 127 percent. I suppose it could be more as compared to the rest of the budget, but nothing I can think of has had a higher priority than the Head Start increase. Then there's Even Start, the WIG program, and many others which I'm sure you've already discussed in the last 3 days. The point I would like to leave with you is that when you go home, I hope you will seriously think about becoming deeply involved in creating an America 2000 community, because that will put you in the midst ofwhat is going to be happening in America in this decade to help our children reach this goal. That's the first thingwe have to do. We have to get interested, and we have to mobilize the community. They have to pay attention to mothers who have no prenatal health care, to babies who have no doctors, to children who have no one to love them or read to them, to disabled kids who need a little extra help and an opportunity to be included. All of these take time, and we can't make progress if what we lead the Nation in is watching television. We have to get unconnected from the television and more connected with real people in our own hometowns. So if, in Derry, New Hampshire, or anywhere, they decide to respond to the President's challenge to become an America 2000 community as they have in Las Cruces, New Mexico, in Billings, Montana, in Omaha, Ne- braska, in Richmond, l'irginia, America will benefit. There are already 1,000 such communities; there will be 2,000 by the end of this !fear and several thousand as we move on through the 1990s. In all of those communi- ties, goal number one is the children. What I would hope is that while you're spending some of your time advising LB how to change the Federal spending patterns, the State commissions, and the various advocacy groups, don't forget to advocate where you live, because that's where you'll make the most difference. In Decatur, tvhen they take the children in one high school, one middle school and three elementary schools, and they mobilize everything there to help those children, they can do it, because there are that many children and there's plenty of help and they can fit it together. When we think about the whole world, sometimes it's so incom- prehensible that we can't seem to find a way to make a difference. Butwhen we think aboutwhere we live andwe go outside and we spend that time with our children, which is hard to do, as so many ofyou do as advocates, then we can make a real difference. The schools can be changed to fit the needs of working families and can be made more convenient. They can be made better places for children who need special help, gifted children, children who need help catching up, and children who would like to go ahead. For example, there's no reason schools should reall) ever be closed. That's the first conclusion reached h> Derry, New Hampshire. They can open the schools in the afternoon to be convenient to working families and in the summer for kidswho need special education, and eveTone involved in special education knows ho\v much a child loses betlveen Ma\- and September. There'4 110 lieed for that to I~appm. The school?, C~lll OlX'll Ill). ;111(1 f';llnilie\ th;it C;+II afti)rct it <.a11 tlctll l);l\ f()I rfl`l+--il c~oe511't cost rlltlcll-mtl the <~o\el-lll1lcm1 (`;111 pi\ lot. f'atnilies Iv110 can't afford it. It's JNst 2 llliltt~l~ ofcomittg to the conclusion to do it. I thank !uu f'ot- coming:. xicl I thank most ot`\xnt fix staying ttp 50 late. 1'1~ alwad!- had ;I glimpw at tht thoughts that are I,ehiII(l\otu-report just thih morning. I know that the Surgeon General with her irrcpressibil- itv \vill makr sure that all of`us pa!' attention to \i%at wu say. \Ve'll tt-v to do our best here in funding and the organization ofprograms in NXVS that make a difference for !`ou. I hope 1ou'll keep in mind that thet-e is a lot there toIvot-kwith and that thereare childt-en\vho need help. Still. the most effecti1.e place to make a difference is in the faniilv, in the con~n~ut~it~, and in the places closest to the children. Thank you vet?. much. Roger B. Porter, Ph.D. Assistant to the Pwsiden~t forEconomic nnti Domestic Poliq t's a great pleasure for mc to be \vith \ou to&t\ in I, the final hours of this \.et-! impot-tattt (:onftit-ence as You prepare to lea\-e behind a series of' finditlgs that those of 11s in the Federal -our cldic;ttion and commitment, and I Irish you, and all of 115x4 ;I Sation. ~~11 asue tttitlertake this important task. -rIl;illk \OlI \.el`\ lllllcll. ._ - -_ "My third apd final convict&n is that we are all in this together;" 6 Panel Presentations Chapter 6 W hilt, thr State Pal-etit Dclcgates ww at- tending the Parrnt LVoi-k (;roups. the Gen- txrt Participants attended panel presenta- tions dealittg with a nu~nbc~- of issues wlatcd to the health aud education of children. The group of more than .300 General Participants coii5isted of pareiitsI\,ho wet-e not appoitttecl as State Parent Delegates (several of whom represettted parent adwcacy groups and parent networks): government officials; representa- tives of Federal, State. and local government health, education, and social senicc programs: representa- tives of other public (iioiigo\et-iittietit~~~) prograins; and reprecentati\.es of private programs. Each panelist leas chosen based on his or her estettsi\.r experience in the specific sub-jcct area to be presettt~d. T\\w concur- rent panel presentations Ivet-e given in fi1.e diffet-cnt time periods. Summaries of the pi-raentatiotis follo!v. EARLY CHILDHOOD ISSUES THAT AFFECT SCHOOL READINESS AND HEALTH Moderator Xlarilyn H. Gaston. 11.D.. holcls the ranh of &sistant Surgeon General itt the Public Health Srt-\ice and is currently the clirector of the Bureau of Health Ewe Delivery and .-lssistance at the Health Rtxnu-ces and SenicesAdministration. Shedesct-ihedfi)m-cot-net-stones that affect school readiness and health: adequate nutri- tion, proper immunization, injut?. pre\.ention, and access to primal? and pre\,enti\.e health care. The panel discits- sion fitcused on building pre\etttive measures. providing quali? services on tinte, and overcoming the barriers to adequate health cat-e and nutrition. Dr. Orenstein manages the Federal Immunization &alit Pi-ogt-am, ~\hich supports the States' immunization pro- gr;mts and provides neat-k one-fourth of all the vaccines rotttittcl'r. used to l)revcnt disease itt children. He said that L.S. immunization levels are the highest in the ~vorlcl: State law proricle for immunization of children rrgardless oftheir socioeconotnic status. race, ethnicity, etc. Orensteitt etnphasized that these immunization requirements provide effective protection against dis- txrs, not only for individuals hut also for communities, because high levels of itnmunization in a commurtit! calt stop the chain of trat~smtssion. Hwvever. Dr. Orenstein reportecl that recent sta- tistics reveal some problems in OIII- immunization pro- gratns. For example, ittner cities tttay have large con- centrations of umxcinated people. Also, the recent measles epidemic ~vas caused b>, the t`ailure to \,accinate children at an appropriate earI!, age. To combat the problem, Dr. Orettstein urged health professionals and other ttwmbers of societx to talk to each other and parents about thr need to wccittatc on time and the implicatiotts of not cloitig so. He also Liked about the itttportaiict- of a c~ommuiiit~~ iiift-~tstt-ltctitt-e to pi-oxide vaccinations (~.g.. an adequate number of clinics avail- able. appt-opt-iatv staff. and flexible hours for vaccina- tiotts). Hr r~co~~tme~~d~d promoting immunization through all health care contacts. such as early infant! carr+vers. earl!, childhoocl health care providers, and ducatol-s. He \tt-essed thr importance of ftguring out the bar&t-s to prc~xwtion. "The bottom line," he said, "is that ttiew is ii0 I-easoii for people to suffer from ptwwitahle diseases." Deborah Jones, B.S., M.S. l>iWt/J,; .\`f'Zil,jfVSf~ .%NtP \\T<,' P,TJ~WflVl Sm~,jmry Stntv Ik~mmw t of Hwlth 11s. Jottes discttssed the role of nutrition with respect to the health ancl IveIl-being of children. Sating that nutrition has physiological, psychological, biochetni- cal. and social itttplications, she relayed its role in 112 Parent\ Speak Out for America's Children providing enerR, digestion, and a host of`other meta- bolic functions. She suggested \va!.s to ensure adeqttate nutrition and talked about the recommended dail! allowancesof\,at-ious nutrientsand how they help fostet proper growth and development of the \-en' votung. Ms. Jones then focused on the symptoms and treatment of tnalrtutrition and hunger. Both have a ttegative impact on learning abilities and behavior. Numerous studies of malnourished children sho\v that they perform poorly on probletnsolving and psycho- logical, cognitive, verbal, and visual tests. Other signs of undernutrition are apath!-, inattentivettess. problems interacting with others. and other learning problems. Ms. Jones noted that nutrition progratn~ such as \$I(: provide several benefits, including food supplements, information on nutrition. and social setTires. L1l(: is sometimes t-eferred to as "the gattww" to health care, imtt~tmizatiot~. Food Statttps, XIrdicaitl, Aid to Fatnilivc with Dependent Children. and .\Iigt-ant Education. 111 the lot~grtttt. \\I(: cat1 s;\\Y' \Ietlicaid c'ost\ for tt(,\\-bot II\ and mothers. M'hen mothers participate in the pro- gram at the prenatal stage, both baby and mother become healthier. Ms.Jones affirmed that at-risk babies whose mothers participate in the \2'IC program are born healier than those u,hose mothers lacked that advantage. In closing. Lls.Jones urged the eradication of malnutri- tion and hunger and the promotion of social sen-ices to addt-e\h the needs of.ttndersetTed and targeted popula- tions. To achieve these objectives, she advised (1) edu- cating the .\ntrrican population 011 the importance of nutt-itiott. (2) expanding the \$`IC program to sene a lat-gtar portion of its eligible population. and (3) protnot- ittg programs that pt-oxide nutritious school lunches. According to Dr. l\`ilson, preventing injuries to chil- dren ma!. he the most significant challenge to health caregiwt-s for children. One in five children is serioush ittjwed ewt? year. One-half of childhood deaths are due to injuty . and the nrtmher is grooving. Howe\,et-, prrwnti\.r measures have been slow to develop. noted Dr. \Vilson. Injuries to children result frotn a variety of inci- dents: accidental shootings, poisoning, falls, motor vehicle accidents (both occupant and nonoccupant), drolvtting, and burns ft-om fit-e or other sources. The injurv problem visits different populations in different ways. Statistics show that bo!,s are tnore likely to have all npes of injuries than girls and that children ofcolor are at greater risk than uhites. Because many types of injut? require home treatment. parents need to kno\v and apply first aid skills. However, not all parents are equipped to handle injtttT. The lasting effects of injuries vat? greatI!,, and the! can he significant. Injuries ma\' interfet-r with the ahilit\ to move or tttanipulale object5 for the rest of the child's lift. Head injttries interfere with ph\.sical and/or mental ftmctionitlg-\\.hrthel- or not the child beconte> cotn- plete11 disabl4. B~~tttre itt,jtu-its nta\' afflict ho\\- :t child IOO~S. thw oftt3i 1tc~lp Io\\tar his 01` hrr 4~Hi5t~c~lll. III :I11 of th<,\y (a,~`\. iltjttl\ ;~f'fix II (.ltil(lt-<.lt'4 i.(7l(lill(.\s 10 IC'~tl~lt. How do children get into situations that cause injuries? Dr. Wilson believes accidents occur in part because children live in an environment designed by and for adults. First, childrens' small size is a problem because they can easily slip through spaces. (Seatbelts and grocen carts, for example, are not designed for children.) Sec- ond, children lack thejudgment and experience that this environment requires. For example, they ask questions such as "Is this gun a toy? Can I fly like Superman?" To combat the childhood injury problem, Dr. Wilson noted that supenision of parents cannot always be relied upon as a solution. Instead, she advocated, we need to build a " . . . while three out of four elderly citizens receive financial assistance, a large number of children-one out of five -lives in poverty, and one child out of four is born into poverty." better environment for children. Myron Allukian, Jr., D.D.S., M.P.H. Director, Personal Health Se-ruices Boston Department of Health and Hospitals Dr. Alhtkian spoke about the importance and the diff- culty of getting primary health care and preventive health care for children. Quoting MarkTwain, he said, "Even if you're on the right track, you'll get rut1 over if you just sit still." He urged taking an aggressive ap- proach to solving children's health care problems. because the Nation has not emphasized that Ivorking together to produce the healthiest children is a prioriK. He noted that, while three out of four elderl! citizen> receive financial assistance, a large number of chil- dren-one out of five-lives in poverty, and otte child out of four is born into poverR. Yet cash payments to needs families with children have decreased sigttifi- candy. This situation broadens the gap between the haves and the have-nots and atnplifies the social prob- lems that stem from poverty-atnong thetn: ( 1) inad- equate health care and food supply; (2) poor academic performance; (3) teenage pregnancy; and (4) [tide- spread drug and substance abuse. To address this situation in which many people lack health and dental insurance and an increasing amount of care is given to fewer and fewer people, Dt-. Alhtkian offered the following guidance. First, health care priorities tnust he reversed so that the health care system promotes health care for everyone. To accom- plish this reversal, the national budget for health care must he increased. Parents, educators, health profes- sionals, and legislators need to become more account- able. "Currently," he warned the audience, "we are using hand-aid approaches." Head Start semes only a small portion of the people l\ho need it. Community health centers reach only one-fifth of the children eligible for senicrs. He noted progress in lowering infant mortalit\- rate% for the Sation; however, he said, the black population still experiences tlvo to three times greater rates of infant mortalin. Second, national leadership must promote preventive health care for evctT man, \~wtnan, and child. Communi~-based pre- vention set-r-ices and a national health plan, including a preventi\.e health program for kindergarten through grade 12. must he provided. The plan would include national programs in fatnily planning to promote the concept of having children Jvho are wanted. Third, medical schools neecl to be encouraged to cooperate- rather than to compete-for private sector grants. Fi- nally. Dr. Nlukian talked about the importance of sensitivity to the needs of the commtmity and private citizens when dealing with health matters because, he said in closing, "children are 100 percent ofourfuture." 114 Parents Speak Out for America's Children Deborah Clendaniel, MS. Diwrtor, Maternal and Child Health Services Lklawaw Division of Public Health Ms. Clendaniel's presentation introduced the concept of one-stop shopping, or colocation, for health and social senices deliver),. This type of system has been working in Delaware for more than 20 years. Having a single point of entry into the system makes obtaining senices and enrolling in appropriate programs easier for clients, thereby increasing the number of people \vho receive the senices they and their children need. The staff of the Delaware Sewice Centers see them- selves as a "funnel," helping to direct clients to the senices the\. need and to cvhich they are entitled, all during a single visit. Each center houses a variety of health and social services, including senior centers, health clinics, parole/probation offices, daycare facili- tirs. and migrant health offices. Most are open from i:OO a.m. until 900 p.m. While clients' convenience is the main concern, colocation also benefits program administrators. Information can be shared among agencies, and the certification and income verification process is greatly simplified. Referrals (e.g., for speech/ language/hearing evaluations) can be made in house. Automated data management makes client informa- tion more accessible, keeps it up to date, and lets the staff members closest to the client access the data they need to make decisions. Ms. Clendaniel said that the guiding philosophy is that delivery systems must begin toaccommodate, rather than merely tolerate, the needs of the population they serve. HELPING FAMILIES GET SERVICES: SOME NEW APPROACHES This panel, moderated by Ronald \.ogel of the Depart- ment of Agriculture's Food and Sutrition Senice, pre- sented several innovative ways of eliminating the diffi- culties many parents encounter in tning to negotiate the bureaucratic maze that surrounds the senices the\ need for their children. Making the s!xtem more comprehensible, more user friendly. and simpler to access was the common theme. Juanita C. Evans, M.S.W. Ch$ Child and Adolmmt Hmlth Rw~~ch Lkparfmfv f of ,Ilnffvn0l, Zvfknt, Child. ON! Ms. Evans presented the new Model Application Form whose development was mandated by the Omnibus Bud- get Reconciliation Act of 1989. The Xlodel Application Form is designed to simplify the application process for individuals and families eligible to apply for any or all of the seven aid programs offered through the Maternal and Child Health Bureau. In keeping with the congressional mandate, work was completed within 1 year's time and manv agencies (including the Department of Health and Human Services, the Office of the Assistant Secretary of Health, WC, Medicaid, Head Start, and others) were represented on the interagency work group. Ms. Evans said that including representatives from the Office of the General Counsel and otherre\iewing bodiesgreatly helped the process, because their input was obtained during the development phase rather than after the fact. The Model Application Form is available for use from the Maternal and Child Health Bureau or from Governors' offices. State agencies are free to use the form in whole or in part, to adapt it as necessary, or to not use it. Mary Jean Duckett Chief; Home and Comrn unity-Bad ?t:nirter- Branch illedicaid Buwnu Helrlth Carp Finnnring Administration MS. Duckett explained the Targeted Case Management benefit available for some Medicaid recipients. Selecting Targeted Case Management allows Medicaid clients to choose a certified case manager to assess their needs and guide them to appropriate senices and agencies. Case managers not only refer clients to ~lrdic;~id-co~~rl~ctl agencies 21id provitl<~rs. but ;llso help clietits ilttc.1.ilc.l \t.itll 1;111dl~)1-d4 01. hou~ittg ;igc.nc it,\. 4cl1o~~lc. ,llltl :lll\ other arcas i\herc ;issixt;iilw i\ nrtdtd. SItdic;~id is ;i Ft*deral ag:enc!. that is State adininis~rwcl. 2nd Statm wt inoht of`thc regulations Ihat gowri1 ~4~0 is t~ligiblt~. rvhat senices art'covel-ed. and \vhicii pr-ovitltm ;irt~;~uthori/etl to reqttrst reimbut-sernrtit for sei7ices rendered. States tnav make Targeted (:ase Slat~agetnet~t a\xilable to Lleclicaid clientson the basis ofiticomr. cet-rain medical orps\.cliolo~ical conditionx, qeograptiic region. aqr. ot- c other criteria as deemed appropriate. Authorked case managers can be schools, social u~xkers, or othet- agencies. and case managers need not work for public agencies. States tnav not resrrictcase tiiati~tget~eligil~ilit~ to a particular provider; rather. general qualifications must he written to allow a nt-ietv of provider3 to he eligible. The 1Vyotning Health Passport. prcwntetl to the audi- ence by Dr. MYhams, uses smart card technoloq~ to record and store cotnprchensi\~r medical and eligibil- ity data for \VIC clients in ;I format that is pot-table. itiespetisi\.c, cay. to itpclate. and cottfidcntiai. The passport itself, wliicli looks like a credit card. i5 ;I 16 kilobyte tnicrocotnputer. The cards cost about SIO each and have an estimated life of` .j \twx .I twd`~ tnemot~ capacit\. ciiii be doubled foi- ;it)oiit SO.40. Because M'IC information take\ up ottk about one- third of the card's metnor\., thr rt'tnainitlg memory k open for other agencies to IIW. X client \vho visit\ a senice provider presents his or hct- cai-cl: the client'\ history is al-ailable to the ptxxider, and thtz card is autotnaticall~-~tpclated each time set-vice!, are rrndered. Clients control access to the itiformatioti throttgh the use of PINS. Clients can obtain paper copies of thcit entire record at MI<: offices. Dr. \Villiam\ said that the Health Passport has hrrn especiall~~\.aluablc in sparsely populated r\ivtnitig. because it eliminates both the delay and the cost of mailiiig. tt~lq~hotiitig, or faxing information among agencies. Other Statrs that arr preparing to pilot similar programs are .\lontana. Sorth Daliota. and Idaho. \I\. French closed rhe session uith a discussion of priKrc>, x~tl cotifidt~titialit~ of client information. A- thottgh integratittg setTices and sharing data have ben- efits. wch rscliatigc~s tnay sotnetitnes threaten patient cotlfidentialit~. \Z;tn!. Federal and State regulations govern thr exchange or disclosut-e ofpersonal informa- tion. Special regttlatiotis , apph. to certain sensitive infot-mation. such 25 program record5 concerning sub- 3tatnc.e ahusc, .UDS status, sesual histot?, and actual OI ~usprcted child abuse. In integrated data systems, confidentialit!. ma! bc maintained by the use of pass- uxwds. wad-ottlv set-eens, cscluG\~e or restricted access files. and othermetltods. In searching for the appropri- ate lx~lancr bct\vecn data sharing and client privacy, Ms. Frrnch asserted, atltiiitiistt-ators should solicit clients' opinions about \\kat information ma\- be shared and lvhat ititi)t-matioti ma\ not. .~dtnitiistratot-s must review and bccomt~ tatniliar \\itli the txyuiretnetits of all appli- cahlc lrgislati\v, regulatot7~. ot-p"lic\-t-rstrictiotison the release oJ'inti)t-m;tti~~n. Fit+., 11s. French urged con- titiwd coopt*t~atioti ;iinotig agencies and progl-ani\ as tlir\- x01.1\ to bala~ice thew t\co ittiportant concerns. HEALTHY CHILDREN READY TO LEARN: WHAT ARE THE ROLES OF PARENTS, EDUCATORS, HEALTH PROFESSIONALS, AND THE COMMUNITY? The theme of' this pmcl, tnodrt-atecl by Josie Thomas, Prqject Coordinator for the Fatnil!- and Community Set- ~~orliitlgPt-ojectattherlLssociationfor theCareofChildren's Health, ~~ascoopelationatnongparents,educators, health professionals, and the comtnunit\ in raising healthy chil- dren. Each speaker stressed the need for true collabora- tion, interdependent partnerships, and empowerment. 116 Parrnts Sped Out for America's Childrm ;Ils. Streett iwgcd the audi~i~c~ to plkt fatnil\-i\weat tllc top of'tlre national +qwtla and to im1mn.c the clIialit\-of lifk f'or.-\nl~lic-an l;mliliv\. Highlightillg tile pi\c)t;tl roits of` parents in meetiiig tllt3t goals. slit- said lwoplt should tui-li to parc'i~ts fil,\t \\.hcii looking t'or infi)nna- tion pux~ining to childi-vii'\ I\-elklwiiig. "The onI\ peopk \\ho can iiiaLc ;I change fill- pai-c*l~t\." \liv uid. "arc parcnts." She citcbd adoptioti statistics to illtl5tratc~ lio\v rapidI!. the ~vorld ha\ cliangrtl. Fifrvcti \ cw3 ago, the proctw to adopt ;I child tool\ an a~uag~ of'o~ih 9 months. Solv. the situatioli ha5 w~~iwd. Gtli onh I of X.7 tt'enagei-s prcwiitiii;g her balx Ii)r atloptioli. tIllI\ cl-wting a shortage of'atlopt;~l~l~ lxibir4 and long \\.ait- ilig lists fiw prospu~ti\r atlopli\t~ pawiits. llou~\w.. JIs. Streett empliasi/ed that. in thv faw of' ;I changilig sobet!., thr needs of'childreii and tlic ncwl fix stl-ong families haw not chaiiyed and ii~\w bill change. Ln- fortunately, tocla!-`s demands on propl~`s li\w ma!- cause them to forget about thr support that children neecl. .\lthough the support children nwd is commoii knoukdge. not e\w?ulir recognixs that parents are the largest untapped political constituenc.~.. AIs. Strrett offered the fi)llowing guidance. ( 1 ) Ensure that uxy political candidate-loc~~l. State. and national-sup- ports the needs of parents. (2) Encourage parents to voice their nerds. For example, children's needs can be supported h!.creatiiig a better~~orliplace. Some offices. she said. are leading in this direction 1)~. allwing: chil- dren to come to Ivork with their parent lvhtw the childcare pro\kIer is sick. Noting that the Cnittd States is possihh the onh \I-estern countn` that does not ha\.c a family and medical leave policy, Streett told the group that it's time to get motivated. (3) Encourage childrtw to be creative and interactive. She directed parc`nts to turu off the video games and television. In closing, she urged the audiencr not to "take tl1e .?`;1s\ \\`a\' ollt because we're tired, I~ecausc~ none of IIS iii-t' as tired 2s our grandmothers w7e." Dr. Epps spoke about the integral role of educators in the partnership with parents and families, health pr~~f`cssional2, and commuiiit~~ resource people. ~~ollal~or~~tioii. he said. rnables educators to interact rffecti\-el! l\ith individuals, f'amilies, groups, and communities to enhance a\`iareness of problems, promote appl-opriate action, and advocate solutions. HC talktd ;tholIt the lieed to establish goals. Ivhich he definul ;I\ simpl!. drcwnr \vith a timefl-ame, such as l'rrsid~nt I~r~~h'~goala fi>r thy \var X00. The educator's goal\ must maxinli/e thr ph\-sical. emotional. and social ~\.vll-being of`chiltlre~~. .-1 compromise in an!. of' these ;wc`;is might af'kt childrrn's ahilit!- and willingness to Icarn. Kcali/ation 01` goals. said Dr. Epps. requires educator-s to NW I\~~o~vlrdge and skills effectiveI! in these thaw roles: ( i I assessor. (2) advocate, and (3) promoter. Dr. Eppselaborated that, although formal mecha- nisms such as screening activities and programs help educators assess children's needs, these mechanisms shouldn't replace the daily monitoring of children's behaGor and actions. By obseming behavior, attitude, and/or symptoms in daily interaction with children, educators can begin to understand the physical, emo- tional, and social risk factors that have a negative impact on children's health. The), then can address actual or potential needs by communicating their knowledge about children's patterns of growth and development to other members of the partnership-families, com- munity resource people, health professionals-to rein- force behavior (if healthy) or intenrene (if unhealthy). In the role of assessor, educators must negotiate, con- sult, and refer. They must work with outside health professionals to gain knowledge and skills so that fami- lies and schools can replace unhealthy lifestyles with healthy ones. As advocates, educators influence the way the community Gews and responds to the goal of making children healthy. In this role also, Dr. Epps noted that strong collaboration with other partners-legislators, civic leaders, corporate officers, and community lead- ers-iscrucial. For example, noting that Head Start can "The message needs to ring clear that (1) society is in danger when children's health is at stake, (2) children's health and learning go hand in hand, and (3) proper resources must be allocated to ensure the health of children." be replicated anywhere and that Head Start makes children ready to learn, Dr. Epps stressed the fact that public schools are not yet ready to receive Head Start graduates. Public schools need to collaborate with the local Head Start programs. The message needs to ring clear that ( 1) society is in danger when children's health is at stake, (2) children's health and learning go hand in hand, and (3) proper resources must be allocated to ensure the health of children. As positive role models, educators must promote a healthy lifestyle by showing nutritious eating patterns, participating in exercise and fitness, practicing stress management techniques, and eliminating substance abuse. Finally, educators must promote comprehen- sive school-based health programs as feasible and cost- effective. In closing, Dr. Epps reminded the audience that healthy children are the product of instituted and sustained change. "Only through health," he said, "can children learn." Robert G. Harmon, M.D., M.P.H. Administrator, Hrnlth Resourws and Seruiws It is important to get children healthy and ready to learn each year, in 2nd grade as well as 12th grade, began Dr. Harmon. His presentation focused on the role of health care professionals in making children healthy, the problelns they face, and characteristics of successful collaborations. He noted the multitude of problems that concern health care professionals: low birth lveights, infant mortality rates, immunization, and ernironmental contaminants. To address these problems, he said, communities need partnerships of all kinds: between the public and private sectors; between various professionals such as psychiatrists, social sellice workers, and family physicians, etc.; and between parents and all others in the partnership. The family environment is the most significant factor in prodding for children's health, said Mr. Harmon, because, "while social senice systems fluctuate, the family is constant." The family profits from successful collaboration. Among the criteria for evaluating 118 Parents Speak Out for America's Children "The family environment is the most significant factor in providing for children's health . . . because, `while social service systems fluctuate, the family is constant.`" programs is the ability of health professionals to ( 1 ) understand the de\~elopment needs of infants, children, teenagers, and families, (2) provide family- centered care, (3) provide emotional support to families, (4) understand and appreciate that families have different methods of coping, (5) access a deliver) system that is responsive to parents, (6) be culturall) competent, (7) understand and honor racial, ethnic, and cultural differences among families, and (8) respect beliefs, attitudes, and talents of family members. Charles P. LaVallee Executive Director Caring Program for Children Western Pennsylvania CaringFoundation, Inc. The Caring Program for Children is a Blue Cross and Blue Shield program that acts in partnership with the community to provide free primary health care to children living in poverty. The program operates on the premise that children won't be ready to learn if they are not healthy, and the program's overall goal is to empower parents. Therefore, a key feature of this program is that each participant receives a medical card so that no one knows he or she is in need, and confidentiality and family dignity is thereby protected. The program works because the burden is shared between the physician who provides care in the hospital and Blue Cross and Blue Shield, which matchesexpenses. Empowerment of people in this way and building of partnerships are key to the success of this type of program. One of the problems society faces, said Mr. LaVallee, relates to the "knowledge gap"about the large number of people M.ho lack health care insurance. A strategy for combatting the problem of the uninsured is to promote communityfundraisingprograms that keep funds in that particular community. The strategyworks with the help of community leaders and mobilization of power bases, because people are attracted to projects designed to keep money at home. Mr. LaVallee stressed the need to form partnershipswith hospitals, legislative staff, and community leaders, among others. He also emphasized the need to work with both the media and members of these partnerships to find people in need in the community. He cited some examples. In one case, M'IC workers. school nurses, and hospitals discovered people in need. In another case, the media used an identifiable figure-television's Mr. Rogers-to iden- ti$ thousands of needy children. Poverq health care needs are an important priority. To underscore this importance, Mr. LaVallee posed a situation in which chronically ill children of deceased parents lose their eligibility for medical assistance once their social security income runs out. Mr. LaVallee recom- mended dramatizing such situations through the media. and trauma centers are forced to fold under the pres- sttre of`providitig fi.ee medical care to indigent patients \vho have been shot or stabbed, the resttlt is fewer hospitals and trauma centers available to all. Dr. (:oletiian-~lillei~ closed the session with an invitation to her l\w-kshop sessiott. I\&vt-e she would discuss inter- vention strategies. SPECIAL ISSUES THAT IMPACT CHILDREN AND FAMILIES: SUBSTANCE ABUSE, HIV, AND VIOLENCE Moderator Bill Xlodzeleski of the Department of Education's Office of Drttg Plantling and Outreach called this panel one of the most important at the Conference. He stressed the relevance of the issws that would be discussed by the panelists, noting that these issttes will touch the o\-etvhelming majoritv of Ameri- can children and adolescents before they gradnate from high school. Substance (drug, alcohol, and to- bacco) abuse, HIV and .-UDS. and violence affect onr families and commnnities \\ithottt regard to race. re- gion, or income level. Beverly Coleman-Miller, M.D. I?-QSidQtl t Tfw BC.11 Groups, Inc. Dr. Coleman-Miller spoke about the impact of\iolence on children. which she has ohsen-ed in more than 2.5 years experience in the medical field. She cited the horrendons statistics for deaths. shootings. and stab- bings, then pointed ant that these figttres accomit onI!- for reported incidents. The graving acceptance of violence in the streets as a part of life is. according to Dr. Coleman-1liller, the single biggest problem that must be overcome in putting an end to violence. "The United States nnderstands that children lvho rvitness violence are different from children T\-ho clon't," she said, citing the special educational and cotmseling programs that were lamlched for children dnring last year's Gulf War. No such programs exist for children whowitness streetviolence on a daily basis. Dr. Coleman- Miller expressed her belief that the titne for studying the effects ofviolence on children is past; now we must work to eliminate violence. She retninded the andience that violence affects all of US. Children who witness violence at an early age grow up believing that violence is an acceptable way to deal with conflict. and the c!,cle Dr. Wendy Baldwin Uqbit~ Diwtor Dr. Baldwin discussed the social effects of pediatric and adolescent ;UDS cases. Dr. Baldwin emphasized that in pediatric.AIDScases,~ve must consider familieswith;UDS, not jttct children Ivitlt .VDS. 1lore than 3,300 children in the United States are kno\vn to have AIDS, and because Ml-blo\vn AIDS is the vntl stage ofthe disease, the number of children l\ho are HR'-infected is assnmed to be much largrr. <~ttrrent estimates place the nnmber of infected childrctt benveen 10,000 and W.000. ,UDS is the ninth katling canse oftleatlt for childrrn in the general popu- lation ancl the Gsth leading cause of death for ,Urican- .~tn~rican childt-en. .-\IDS aftccts minorities and the poor "AIDS is the ninth leading cause of death for children in the general population and the sixth leading cause of death for African-American children." 120 Parents Speak Out for America's Children disproportionately, often striking individuals and families least equipped to deal with the resulting pressures. Children contract AIDS in one of two ways: they at-e born to an infected mother or they receive a contami- nated blood transfusion. In most cases, at least one parent already has the disease. Often, the familv has a 1listot-r. of substance abuse, ancl manv children with ;UDS are mcm- bers of unstable or single-parent f`amilirs. PaverF' is another problem that frequent]\. affects .UDS families. Man)- HR'-positive children are wards of the Statr and at-e therefore denied access to the state-of-the-art treatments that are available onlv in clinical trials. The stigma attached to ;UDS because of its t-outes of transmission (intra\.enous drug use or unprotected inter- course) can lead to gra\`e consequences for cltildrrn \vho are diagnosed with the disease. In some cases, parents have hidden the child's condition and haw refttsed to seek medical treatment for the child. .%I Hn'-positi\-e diagnosis has in some cases led parenti to abandon their children. Oxen children becotne infected through con- taminated blood transfttsions, the stigma, emotional pain, and financial strain of this new disease often compound the w,orries of the medical condition that required the transfusion in the first place. Adolescents constitute a significant risk group, especially those who lack the supervision and guidance that a strong family provides. C'nprotected sex atih drug use remain the two biggest risks for HIV transmis- sion among teenagers. Dr. Baldwin said that, while parenting skills did not require extra work in quieter times, parents must devote added attention and effort to rearing children in this turbulent era. "Families are the basic socializing unit for children," she said, as she underscored the importance of teaching children self- esteem and discipline early in life. Millie Waterman Interim Chairman National Phrent/Teacher Association `(p7:b HQa!lh nnd Welfare Commission Ms. Waterman presented the PTA's approach to addrcss- ing the critical problems of substance abuse. AIDS, and violence. At the heart of all its policies is the PT;\`s 95year- old tradition of support for parent involvetncnt. Tht National PTA is working to achieve three major goals itt conjunction with the President's six National Education Goals: (1) to design and implement compr~ltcnsivr parent involvement progratns in schools across the coun- tt?, (2) to identic and eliminate the risks to children, and (3) to use the schools as a de1iyet-y point for coutlseling, nutrition. and health programs. On the topic of substance abuse, PTA advocates ;I "110 us?" policv designecl to eliminate the mixed messages children recrive about drugs, alcohol, and tobacco. .Uthough the use of illicit drugs (such as cocaine and marijuana) has declined over the past drcadc. tltc use of alcohol and tobacco has increased. To he cuccessful. 11s. M'aterman said, drug use prevention programs must discourage the use of all drugs and must be supported bv the entire communitv. Sot only children but also parents must be educated about drug use. PTA is the recipient of a grant from General Telephone and Electronics, Inc. (GTE), for a program called "Common Sense," which targets children benveen the ages of 8 and 12. This p&gram is based on three components: (1) building strong bonds betv-een children and families, (2) setting limits and rules for children. and (3) serving as good role models for children. PTA also calls for an end to "At the heart of all its policies is the PTA's 95-year-old tradition of support for parent involvement. " televisiol~ ad\,ertising for beer: this ad\-ertising is nlost often aired dtu3ng sporting cyents, lvhich are lvatched b!, thousands of children who get the impression that, in Ms. M'aterman's words, "beer time is party time." On the subject ofAIDS, PTA has begun a program called "AIDS Education in the Home and at School" with a grant from the CDC. PTA urges all hoards of education to establish policies on the school placement of children with AIDS and on AIDS education in health and hygiene classes. PTA advocates sexual abstinence as the bestway to prevent the spread of;UDS among the teenage population. PTA also recognizes the m~any forms violence takes in our sociep. Corporal punishment, or beating children as a means of discipline, is legal in 28 States. The National PTA promotes banning corporal punishment across the country. Television violence is another area of concern. The National PTA also \\.orks to reduce the violence that gangs and child abuse inflict upon our children. Mark L. Rosenberg, M.D., M.P.P. Director, Division OJ Inju ty Co~ttrol ,%tionnl CtwterJor Enz~irontnentnl HeulUl und lnjtq Control CenfrrsJor Dkrmr Con~ml This presentation on the public health approach to violence prevention closed the session. Like Dr. Coleman-Miller, the opening speaker. Dr. Rosenberg stressed that the time for action has come. The solu- tion to violence in America isn't buying guns, installing home alarm systems, or putting metal detectors in the schools; rather, it is preventing violence in the first place. Although the popular conception of CDC has to dowithdiseasessuch as AIDS and toxic shocksyndrome, CDC's prevention philosophy is no less applicable to violence. According to Dr. Rosenberg, "accident" is a word that has heen removed from the CDC \-ocabulan because it implies that injury is unal-oidahle. On the contra?, he said, violence is preventable using the same steps that researchersfollowin epidemiological (disease control) studies. First, the reports of violence and intentional injuries are studied to determine recurrent patterns. Next, researchers work to design possible intenentions that would prevent such incidents. These interventions are then tested to determine which are most effective. Dr. Rosenberg emphasized the prevention aspect of CDC's approach. Unlike police officers and other law enforcement professionals, public health profes- sionals can get involved before the harm is done. Public health officials also ha\ie access to a broader range of incidents, because unlike police, they can work on cases where no criminal activity is involved. As part of CDC's prevention efforts, Director Bill Roper recently an- nounced his intent to begin a National Center for Violence and Injury Prevention at CDC. DISABILITIES Moderator Vernon N. Houck, M.D., Director of the Na- tional Center fi)r Emironmental Health and Injury Con- trol at the Centers for Disease Control, began this discus- sion h!- contrasting recent progress in eliminating dis- eases, such as polio paralysis, rubella, and cerebral pal?, \\ith the need to reduce the causes of developmental disabilities in children. Prevention of the diseases was successf~~l, he stated, because the cause in each case was identified. However, learning disabilities such as those related to childhood lead exposure are not yet prevent- able because lead poisoning and its sources often cannot be pinpointed. In their discussion of lead poisoning, mental retardation, fetal alcohol syndrome (FM) and fetal alcohol effects (FM). Dr. Houck and the panel speakers delivered a common message: although it is costly to remove pollutants and take preventive measures to combat other disabilities, "the cost of doing nothing is far more than the cost of finding intenTentions and apply- ing them." The speakers emphasized education and prevention, wherever possible. When pre\Tention is not possible, quick intemention and diagnosis are needed. Equally important is research to determine the causes of disabilities if they are not completely understood. 122 Parents Speak Out for America's Children Sue Binder, M.D. Clt iPJ; I.fwl Poisoning Prtwn tiott Urn nclt Cm tmr Jh I~iwtrw C'otttrol According to Dr. Binder. childhood lead poisoning is an ancient problem. TheRomans discovered the weet- nessoflead saltsand used them in alcohol. Today,water and soil hall more lead in them than we think, and lead is still found in paint. .As a result, children ingest lead as part of their normal hand-to-mouth actkit\-. Although lead-based paint I$YIS federalh~ ballned in the 19ZOs and 193Os, it is still used from time to time. In the 1940s. several cases of lead poisoning manift,sted s\mptoms like iilflamiiiatioIi of'the brain, itiabilitv to\\Xlk and talk, and-in the wnw cases-death. The Byers mtl 1.01-d study follor~ed 10 6- to 1 I-lear-old\ Icith problems sns- petted to be caused by lead poisoning. The researchers found that the children'5 intelligence quotient (IQ) ~~average. but they did poor-l!-in school. The children appeared to be smart, but they did not learn. In the 1970s the Seedleman study examined lead exposure in children who did not display symptoms b!, measttring lead levels in their teeth. The findings revealed a positive correlation between high lead levels in teeth and teachers' evaluation of distractibilic, and other academic performance characteristics. Children with high lead levels had lower IQs (by 4 points) and did not perform as well as those with lower lead levels. The Seedleman study follo\\,ed these children for 11 years (through high school). The followup findings shelved that. although these children displayed basicallv nor- mat IQ, they performed below normal and had high dropout rates and absenteeism. The tragedy is that these problems of lead exptr sure are pre\.entable. Howe\,er, according to Dr. Binder. "Cntit the 1970s. people were not concerned with lead esposure unless they displayed svmptoms." At that time, 40 micrograms of lead per deciliter was consid- ered to be a problem. In 1991. the Surgeon General considered 10 micrograms per deciliter to be a prob- lem. "The bad ne\\s." said Dr. Binder, "is that we wom'about lead levels that are lower and lower, but the good news is that we are finding the average blood lead level to be dramatically declining." The reason for this deciine can be attributed to tower lead in gasoline and stricter laws by the Environmental Protection Agency that result in reduced lead levels in blood. We have reduced these environmental sources. However, the major sources of lead stilt are lead- based paint, paint-contaminated dust, and debris from window wells that children ingest in normal hand-to- mouth actkit)-. Older homes that have undergone renovation are a particular problem. The Department of Housing and Urban Development estimated that, in 1980, 74 percent of homes still contained some lead- based paints. In November 1990, Herbert Needleman spearheaded a plan with a program agenda that called for an increase in the number of prevention actkities and programs, an increase in the abatement of paints and lead poisoning, and an increase in the surveillance of elevated blood levels in children. This agenda has resulted in increased ft~rlding dollars and increased efforts to promote partnerships in the pri&jte wctot and fottttdatioti sitpport. .tmong othrt-s. Report of the Surpwn General's Cont'errncr 123 Craig T. Ramey, Ph.D. Iliwc-tar Dr. Ramey described the `*rapidI!. changing landscape" for children jvith disabilities, particularly mental retar- dation, x society stands on the threshold to mount new research for programs to treat and prevent these dis- abilities. Mental retardation, he said. represents 7.3 percent of all disabilities and is predictable: it is not randomly distributed. The poor are at a 11lucll greater risk for mental retardation than other populations. Pet-hap5 23 percent of individuals that fall below the poverty line are at an elevated risk for ~nental retarda- tion that lasts over more than one generation. Mothers with an IQlower than 70 are also at greatel- riskofhaving mentalk retarded children. Mental retardation is cauqed 1,:. factors such as poor health care and wstemic mild insults. Se\-ent!.-fi1.r percent of mental retardation Ml in the mid-raligt (IQ of .j.? to `70). "The notion that mental retardation i> a permanent characteristic of a perwn." said Rarn~~ . "ha\ been challenged h!- longitudinal mltl ethnographic~ research. . Treatment of mild mental retardation ha\ been 5~1101nmons Ivith education and the pro%on of I rehabilitative ell\.ii-oliilieiits," Recent research in mental retat-dation ha:, 4101\11 that low-birth\\-eight ant1 premature infallt\ ;IIT 1m1-11 into a "double jcopardv" situation htacause thr\ ~\we IXH-I~ not only with lo\\ birth \\&ght and prcmaturr. hut in dkpro- portionate percentages to tlisad\alltagecl tanlilies. These children did relatk~eh. ~~11 w11e11 the\- receivecl intensi\.e home treatment \c?th indkidual care and a wcational cui-riculum with a Y~I) good teacher-to-child ratio. This treatment and development program, which is affiliated with several universities, was implemented in eight pro- gram sites across the county. 111 most cases. significant improvements occurred when key components were fo- lowed: inte~ention, followup, sufleillance, referrals. and home Jisits. III this study. followup wxs more extensive than in many other similar intervention studies. Xcross the board, those in the more intensive intenvntion group were at an adGwtage. The frequency of mental retarda- tion decreased in direct proportion to the amount of inten-ention received. Thefollowupofchildren (through age 12) showed high risk children had, an IQ of below 85 (borderline intelligence). For those mentally retarded children who recei\,ed early intemention, only 28 percent repeated at least one grade bv age 12. M'ithout early inte1yention. .i:i percent repeated at least one grade by age 12. Ann Streissguth, Ph.D. Children afflicted \vith F.kE and FAS are unable to reach their full potential due to prenatal alcohol exposure, according to Dr. Streissguth. These youngsters have nor~nal intelligence but can't "get it together." They often suffer from distractibihtT; attention deficit disorder, and the lack of abilic to focus on important issues. Hobvever. F.G. she emphasized. is totally preventable. "It's one thing to pl-spare children for school," she said, "but it's a bier respollsibilitv to ensure that each child begins life in an :, alcollol-frer ~Il\il.oIlIll~Ilt." F.-\S depr-ives children ofreaching their potential ,jtlst a5 su~-el~~ as birth clefects do. Holvever, birth defects arc ohseI-\~able. For example, children exposed to tl~alidomidc hark, noticeable ph!.sicat defects. F.VS, h! "FM deprives children of reaching their potential just as surely as birth defects do." 124 Parents Speak Out for America's Children contrast, is a hidden disabilitl,. Because ethanol c~.orws the placenta free]!,, in minutes the blood lewl of the fetus is the same as that of the mother. Sw~ptom~ ot FAS include (1 ) prenatal and postnatal growth defi- ciency, (2) a pattern of n~alforniation in terms of facial features (large distance &tIvren eyes, thin upper lip. and flat midface) and brain composition. and (3) cc'n- tral ne~~~)u)r s~.atem d\-sfIulction. The tuixollcq)tion is that all childrrn I\ith F.\S iwc nleiltall\- rrtarded. III realit\.. olil1.3) ptwwit ai-c wrai-tM: man\ \cith FAS xc borderline intelligent. l-loUr\-cr. all children \\itli F.-\S are dysfunctional. `.lQi\ iiot tlir fiictor tliat tl(~tvriiiilirs hov~I\ell a person f~~nctioii~." affirni~d Dr. Streiqyith. "unclerl\-in,g brain damage i\." Ljr. Strvissgutli \tatctl that \ ic-tini\ of F.IS arc at high risk (mail\. are in\-oI\vd in crinlv). ai1d thy loiig- tt'r111 col14cqllellcrc of'tll~ pldAm ucY.d to t,c ulltlcT- \tood. She brought attention to tlith w~\erit\. a~itl magnitude of F.IS and F.IE and \trvwd the. ~lr-cd ii)]- education and earl\- intt77wition. Shv has rrcri\x-d mailI. letters fi-oni parents-oiic 01' \vliicli +lic rv;id aloud--stating, in effect. that 0111' h\\t~`iii tail5 tlit'4t children. Dr. Strcixyguth adwcatcd ( I ) p~iblic rtluc;~- tion, (2) professional training, and (3) profe5sioiial senices. People need education about tht. riA\ associ- ated r*-ith social drinki+g during pregnaiicl (i.e.. there is no knolvn safe lel.el of' alcohol esposur~ tllu-ing pregnant!,). Specifically, Streissguth recotn~neildrd (1) impro\,ed diagnosis of F;\S and FAE and (2) design of special programs for children with these problems so that the)- can find producti\.e places in societ). and are not failed by society. She acknowledged that rnm~ people simply don't recognize the difference between brain damage (an effect of FXS and F.AE) and retarda- tion. She emphasized the need to diagnose !-outlg children, adolescents, and young adults. M7thout a successful diagnosis, she said, these children remain in an environment that offers no help for them. EXPLORING COMPREHENSIVE HEALTH AND EDUCATION MODELS FOR YOUNG CHILDREN .\loderator S1ai-1. Brecht Carpenter of the Commission to Pre\wlt Infant IIortalitv introduced the panel members. The nwspdw-son thi\ppanel presentedconcretr recom- Inentlation~ fi)r inno\xtive 1ra1.s to improve health, rcluca- Con. and wcial selyicvs d&w-\- b- wnng children. Edward Zigler, Ph.D. Ih. Ziglvr. a selMesc~-ihrd "( :ongrcssional gadfl!.." pre- \txtetl his view on the future of childcare in this couiitil' and outlined hi\ plan for the School of the T\\-ent!--Fir\1 (:cntul~.. As long ago as 19X. Congress recognized the ilwtl fi)r a natiolial childcare y3tem. In 1971, Congress paswd legislation that \vould have mandated a national Iletlvork of childcxc~ wntcw, but the bill Ivas vetoed b) then presidrnt Sison. Dr. Zigler stressed thatchildcare is now an cl'en more iinportant national priority due to tvo particular demographic shifts: (1 ) the dramatic "We cannot treat children the way we are currently treating them in the childcare setting in America and expect this to be a great nation." increase in the number of mothers working outside the home and (2) the increase in the number of single-parent families. Today, 65 percent of mothers with school age children work outside the home. The figure for moth- ers ofpreschool children is 60 percent. Amongwomen with children less than 1 year old, 54 percent work outside the home. Moreover, the Department of Labor estimates that, by the year 2010, labor shortages will draw even more mothers into the work force. Today more than 25 percent of all American children and 50 per- cent ofblackchildren grow up in single-parent families. Research 011 the impact of daycare on children, Dr. Zigler noted, has shown that good dayare is good for children and bad daycare is bad for children. M'e know how to provide good care, but we don't want to pay what it costs. "The general state of childcare as experienced by children in this counts is abysmal," he stated. "This country is getting what it pays for." The average annual turnover in childcare facilities is about 40 percent. As many as 90 percent of daycare centers in the U.S. are completely unregulated. No national standards exist, and there is wide variation among States. Even where standards exist, they are too lax to be of much use. Based on studies recently completed in California, Dr. Zigler estimated that about one-third of centers in this counts are so poorlv managed and the qualit) ofcare is so low that children are being "serioush compromised." He went on to say, "We cannot treat children the way we are currently treating them in the childcare setting in America and expect this to be a great nation." &Uthough the 1990 Childcare Block Grant has been hailed by many as a victon for childcare reform, Dr. Zigler expressed doubt that it will have any signifi- cant positive effect. Seventy-five percent of the funds allocated to the Block Grant are earmarked for poor or nearly poor families. The middle class, which is equall) in need of good childcare, will see almost no benefit, and Dr. Zigler expressed his fear that this situation ma) lead to backlash against the grant and against childcare reforms in general. He stressed the relationship of good daycare to achieving the President's six National Education Goals. "Five lousy years of childcare will 126 Parents Speak Out for America's Children guarantee that the\- [children] tvill show up at school guarantee that the\- [children] tvill show up at school not ready to learn." not ready to learn." In Dr. Zigler's opinion, the system as it currently In Dr. Zigler's opinion, the system as it currently esists does not lvork and cannot he made to work. esists does not lvork and cannot he made to work. Instead of tt7ing to retrofit the current system, he Instead of tt7ing to retrofit the current system, he proposes a whole new system that he calls the School of proposes a whole new system that he calls the School of the Tlventy-First (:entur\.. The program, as Dr. Zigler the Tlventy-First (:entur\.. The program, as Dr. Zigler envisions it, will incorporate the following key features: envisions it, will incorporate the following key features: * * * Two systems will exist: first, the formal, Y-month, 8:00 am to 300 pm school, and second, the 12- month. 7:OO am to 9:00 pm school. Children will enter the system at the age of three for full-day. developmentally appropriate school. In commmlities that already have Head Start programs, Head Start could simply be blended into the system; parents with earnings above the poverty line will pay an enrollment fee. Before- and after-school childcare will be pro- vided for children aged 6 to 12. Each family will be assigned a home visitor who lvill conduct developmental screening. offer sup- port to parents, etc. All family daycare programs will be tied in to the school, which will offer support and periodic training sessions for childcare providers. The school will contain a comprehensive informa- tion and refer-al system that can direct families to appropriate health and social senices agencies (such as immunization clinics or night care providers). Successful pilot programs to build Schools of the T\vent\-First Centun. alreadr. exist in several States, including Missouri, C:onnecticut. Colorado. \l'\oming, Texas, Kansas. Idaho, Arkansas. and Mississippi. .-\nother proposal Dr. Zigler is attempting to present to Congress is the "(:hildren's Allowance for America." This plan would allow a new parent to \\-ithdraw up to S.?,OOO from his or her o\vn Social Security account to allow the parcwt to stay home or to help pay for good childcare. Nancy Van Doren President, Tmveh:r Companies Fouwlntion Director, ~V~tionnl and Community .-lffir~ LXvisio,7 Thp Trcwe1cr.r Cornponies Ms. Van Doren spoke on behalf of the Travelers Com- panies Foundation about the role that businesses and private organizations can play in securing good care for children and pregnant women. The Travelers are headquartered in Hartford, Connecticut-one of the poorest cities in the country, located in one of the richest states. Disproportionately large numbers of children in Hartford are born to teenage mothers, are underimmunized, and have asthma, attention deficit disorders, or learning disabilities. All of these condi- tions are usually preventable. As one of the organization's social responsibility commitments, the Travelers are working to improve the health ofchildren and the prenatal care of mothers in the greater Hart- ford area. M71en a new children's hospital was proposed for Hartford, the Travelers commissioned an independent analyst to conduct an evaluation of Harti&-d's health cart delivevneeds. The consultant found that,while Harttijrd would indeed benefit from haling another- hospital, it was even more important to increase availabilip of priman and preventive health care for children and expectant mothers. Ms. \`an Doren said that it has been a challenge to persuade contributors and decisionmakers to redirect their limited resources fi-om "glamorous." high-lisibilih projects such as new hospitals to more mundane (but effectivy) applications such as prenatal and perinatal health clinics for low-income mothers. 11s. \7an Doren said that she is motivated in her efforts b!. a mixture of rage and shame that people in her communit\. are unable to have even their most basic needs met. She urged the audience to let their rage and shame move them to act and to search for opportunities to push for the redirection of resources to the places \vhere theI. can do the most good. Hartford has been successful $0 far in its drive to reallocate resources from prisons to scl~oola, and from neonatal intensive care units to preventive care. Ms. \`an Doren emphasized the importance of prel,enting health crises rather than remedving them. CHILDREN WITH SPECIAL HEALTH CARE NEEDS: LESSONS LEARNED This panel offered wluable insights about setting up systems that address the problems of children with special health care needs. The speakers offer three perspectives-all key to successful programs: (1) par- ent empowerment, (2) program-level development, and (3) State-lel,el involvement. The panel uxs moder- ated by Rear Admiral~Julia R. Plotnick, M.P.H., R.S.(:., who holds the rank ofAssistant Surgeon General and is the Associate Director. Division of Senices for (:hildren with Special Health (;arr Needs. at the \f;irtTIld a11d (1hiltl Health Kureau. Ms. Robinson se17w as a parent/child advocate at the Robert Ta!4or (:otni-ntulit!.-kno~vn to he the largest public housing divisiott in the I_`nited States-w+et-e she has resided for more than 20 >`ears. Her video presentation highlighted the dail!. struggles of a com- munity with high& concentrated and severe povert) and its associated problems: extreme overcrowding, extremely high infant mortality and morbidity rates, high incidents of low birth iveight, high percentage of teenage tnothers, and high rates of violence. The commrmi~ is further crippled b!, threatened famih unity; psychological and phvsical absence of fathers; anger, depression, and despair: and social isolation. 11s. Robinson`s determination to help herself and fellow community members led to her advocacy work on the Beethoven Project at the Center for Successful Clhild De\,elopment. The (:entet- protides cot~irntuni~.-based senices that address the health, education, and social needs of the coniniuni~. The (;entet-`4 philosoph\. is based on two beliefs: that each individual has the abilip. toachie~-eandbrindepende~ttanctin controlofhisot.ht,l- life, and that strong fLnily relationships are important. Set-r-ices are tailored to the needs ofindi\idual titmilies. in a n.pe of holistic set3icr plan. Instead of' focusing on the barriers to itnprwing communin. life. said 11s. Rohittson. the <:rnter builds on community strengths to deal lvith the problems. From her experience at the CIenter, 11s. Robinson shared t~vo basic problems and approaches to sohing them. ( 1 ) Economic entrapment and iwlation leads to a nlolltll-ttr~llo~ltll sttxtggle to meet basic needs. To address this problem. the (23iter offers ongoing employment training, coutwling. and I-efcr-t-als. The Center also provides other tools to make lift- rasirr and help people to help themselves. Project staff at-e empathetic rather than y-mpathetic, and support groups abound. (2) Educational opportuni?. is lacking in the communit\: Project staff help parents to become better persons as well as better parents. The Center recognizes that parents who feel powerless and/or inadequate as parents don't read to children. Staff tn~nnhet-s stress the importance of reading to their children and other approaches parents can use to foster school success. The staff encourage strong parent-child relationships and emphasize taking pride in the child's academic achievement. Finally, parents are taught to become accountable and take an active role in their children's lives and in their community. Said Ms. Robinson, "Healthy parents read\, to learn will provide LB with healthy children ready to learn." Polly Arango Ms. .It-ango introduced her audience to Sew Mexico from the \-ielvpoint of Sew .\lexico's parents of children \vith special health care needs lvho have been working to impt-o\e the State's medical and educational systems. \Vhilc Sew Llvsico i\ a State ofgreat physical beau? and diwrGt~-. it also faws many challenges: It Ont'of'sc\en Sew Slesicochildt-en lil,esin paver?. Ir Stv Slesico ranks .`ilst in the Sation in the per- ccntagr of \vomen rect%ing prenatal care. + The State's tern suicide t-ate is dismal. Thet-rfot-c. Sew Mexico's families have arranged to makt~ the lives 01.1 heir children better, one famil!,and oiie issne at a time. 11s. .\rango became involved as an advocate j\hen she and her family learned that their youngest son, Sick. has cerebral palsy and developmental delays. As Ivith many middle-class families, the .-\rangos discov- ered that fe\j- avenues existed to assist them as thev stt-uggled to pay Sick's medical and preschool bills. For example, although Nick was adopted, his adoption occurred before the emergence of adoption subsidies. Sick is an LXnierican Indian, but his birth parents chose not to enroll hitn in the tribe, a decision honored by Nick's adoptive farnil!,. & a result, Nick is not eligible for services through Indian Health Service or the Bu- reau of Indian Mfairs. Because they were decided]) 128 Parents Speak Out for America's Children middle class, the Xrangos could not meet income guide- lines for the State's crippled children program. To deal with her frustration. Ms. Arango joined with other parents to found a statewide organization called Parents Reaching Out (PRO) for any and all families with children who have chronic conditions. disabilities, or illnesses of any kind. Twelw years later. PRO has 500 members ~vho at-e from e\w?. pat-t of the State and every ethnic background and ~vho have chil- dren with many challenges. Man!. of' PRO's membet-r are the professionals, friends. and relations of families \vho ha\,e children with special health needs. PRO began as an organization to provide peer support and information to families. and this fitnction continues to he the heart and SOLII of its ef'fot-t5 to&t\. Holye\-et-. PRO's parent\ soott tackled Ijiggct. ihsttca such as \\riting rhc lcgi&ttiott that created a (;omptx- hensive High Risk Insut-ancc Pool for Sew Nrsico. The list of issues they have addressed goes on and on. The following elements have contributed to their success in changing the s\xtem: * Ordinal parents have united to form a common bond. * They have forged strong partnerships\vith health. education, and other professionals. * One parent usualI!- has risen to the forefront as a symbol of the movement. * Public and private agencies have supported the 2 campaigns Mith technical assistance and in-kind contributionsasawayofenlighteningandeducat- ing the public. + At least one policymaker who is willing to "bleed and die" for the issue has become involved. * The highly visible work and people are supported by a broad-based grass-roots community of fami- lies and professionals who voluntec~r at hotne. Sr Evenone remembers the bottom line: improving the health of children and ensuring that their fami- lies can raise them with dignin., rrspwt. and lo\r. \Ihen 11s. McConnell's child required an osygtw tank. she had to learn about health cat-e svstems and ho~v IO make thetn\vork. Because ofherexperience, ILlc(~ot~ttcll ~vas hired b\. the Michigan Department of Public Hwltlt to work on a peer level lvith "weigh?," issues for a ttrwl\ creatrd parent participation program. The program, horn out of` decentralization at the State level, nccdtd more parent involvement at the local level. Ms. \lc(Ionnell dexribed the initial ambivalence of` one sup~r~~iso~~ who did not understand the need for parent in\ oh t' mrnt at the State le\.el. Holvever, as the program gained \vide acceptance, she gained this pet-son's full wppo1-t. \Is. \lc(:onnell's job was to build relationships; create task forces; make appro\.als: and set policies for hospitals. physicians, L md home health senices. She is proud of the f:nct that all hospitals in her State now tired pal-en t ad\-isot-y committees and parent staff. She stressed the benefits gained from building relationships among parents, communi~. and Cgoverntnent: the establishment of enormous power bases that took action when funding cuts 1vet.e threatened. They influenced senators so that "Families have both an immediate vested interest to get things changed and the freedom to act. . . ." l);trcttt~ receij-ed needed appropriations. The!, helped est;thlish boilerplate in law that required that t`atnilies and conseqttences to them be considered before pt-OgtTttllS are changed or funds are Gthdt-awl. In effect. the legislsladon mandated State government to work with bnilies. Ms. McConnell noted that parents are willing to take t-i&s to support the continuance of needed sen-ices. "Even if they are not sure the steps at-e right," she said, "[parents] are \%illing to follow their instincts." Ms. McConnell introduced four strategies to help families meet children's special health care needs. (1) Support. State agencies should nurture and facilitate the develop tnent of statelzide coalitions of and support groups for persons with disabled children. State agencies should encourage refer]-dls to these groups. Financial sttpport is also vet-y important. Parent consultants must get reim- bursed for their time and expenses. ,~wther t\pe of support involves helping parents acquit-e a \vealth of knokvledge. They need information, for example, about who in the communi~ has had a bad experience lvith clinics, etc. (2) Dissemination of Infi)rmation. State agencies must establish effective, routine mechanisms for receiving information from parents and parent support groups and for disseminating information to them (Ltm- il! support nenvorks). .%gencies must pt-o\idc families with clear written information describing programs. ser- \-ices. and mechanisms foracces\ittg those senicrs. .+tt- ties must prwide read\ access fi)r parents to unhiaaed attd complete information from their child's records. (3) (:ollabordtion. Fatnilies that participate across the State must represent the culn~ral and economic di\.et-sit\. of the State. They must participate fully Ivith professionals in polic! development, program itnplementatiott. coot-di- nation of senices. and e\.aluation of programs. State agencies must financially support parents involved in these activities. (4) Integration (the ultitnate goal of senicrs). State agencies must have a written poliq that reflects the pivotal role offamilies. Integration recognizes the concept of fdmil>,vol\-ed in the program. Thirteen states. ittctuding l\lissouri, have Parents ;is Teachers p~-og~x~~is in place. .\Iatty use fundsfion~ Even Start, (:hapter I. <:hapter II. childt-en's ttw+t hinds. private cotp~~t- Con\ ;u~l fi~tuntlations. and public set~ice gwups such its the Ki\\;utis Club. 111 closing. Ms. \$inters said that while the Parents it\ Teachers proqtm does not solve all of the prob lems that f&e chilclren ant1 their families today, she and her organi/ation are proud to be part of the solution. Following Sk. Lj?nter's presentation, a member of the audience [Sandra McElhany of the National Mental Health Association] urged attendees to write their representatives in (Congress to ask them to support an amendment to the Bill for Educational Reseu-ch and Education thatwill be proposed b> Senator Kitt Bond of Mssouri. The amendment, which has the support of Senators Kennedy (Massachusetts), Dodd (Connecticut), and Pell (Rhode Island), would grant States fitnding-$20 million per year for .3 years-to start or expand Parents as Teacher programs. Mary Louise Alving, M.Ed. Project Diwrtor, Pormt Ltmhhip Training Citizms Educnfion Gnfpr Ms. Aking presented a set of proven guidelines fot setting up parent involvement programs. Although it is widelv known that parent involvement improves children's self-esteem and school performance. 73 percent of parents still do not get involved. Ms. Xlviug offered wa\`s to increase parent itnvlvemen~ in school programs. The Parent Leadership Training Project at the (:iti/etts EdItcation (:enter begat1 in Seattle in 1986 " . . .parent involvement improves children's self-esteem and school performance. . . ." to address the needs of !&grant f'nmilies. Since then, it has expanded to include families and schools of all backgrounds. Ms. Ahing first talked about the four myths that people use to sal'that parent involvement is not practical. The first was that "parellt involvement" means volunteer- illg for school activities. .\ls. .-\l\ing disap-eed, ca!ing that a parent who helps his child with her home~\w-k. or who takes an active role at school hoard meetings. is iit lea5t a4 involved as the volunteer. The second mvth is that pawllts don't have time to participate in scl~ool activities. Sht pointed out that parents do COIW to school \~Ix~n the\ have lvhat they think is a good reason (for example. debates about cc?ndom distribution in high sc11oo1~). "Parents are hard to reach"~vas the third nn.th. Yls. .\l\illg asserted that it is the schools, not the parents. lvho are m~welcoming. The fourth m\-th she confronted \vas the "at risk" classification of families from certain csthliic groups or economic levels. She said that all famil.ies are at risk at some time. and that these kinds of classifications promote division within the communiE. Ms. Alving presented eight "do`s" for successful par(;nt involvement programs. These were repeated in the video that \sas shown at the end of the session. + All activities and programs should be based on the idea that all families have something to shark. * Parent im~olvement programs should include members of other programs--such as Chapter I and Head Start-and should collaborate with other programs. Ir Slost successful programs focus on the child's teacher. Parents want to meet and get to know their children's teachers. Teachers are often the best way to reach parents. Ir The program should he coordinated by a team; a ~oocl program lvill rapidf expand to a size where it simple cannot be administered by only one person. Teams should consist of the school prin- cipal, two parents, tlvo teachers, a school district represrntati\,e. a business/comlnulli~ represen- tative, a social ser\-ices professional, and a cul- ture/language specialist (as- required). Before the team begins planning, they should attend a 5 day training session. Ir * * * Succtwful prograrns ahvays allow room for adjust- ment. Evcrv scl~ool is different. and programs must be adapted to lit thrir audiences. Teacher training is an important part of parent iliwhwiicnt programs. Teachers often have no training on ho\\- to pork \vitli parents. Ongoing fiinding for parent involvement pro- ~T;lIll~ 410~11d be olmiJlrd. .7 Too often, when funding rt111s out. the parent invol\.enient pro- g:1-an1 goes with it. Begill to lvork for permanent funding earl!-. . Buiiding a developmental e\-aluatioli process into the program means that staff can evaluate their progress at an!. point and can make any necesy acljustm&ts. Letitia Rennings, M.S. Evrn $0 ft Coodiru7tor Last to speak in this session was Ms. Rennings, who discussed the Even Start program. This family literac) program has ir?creased in Federal funding from 132 Parents Speak Out for America's Children $14,820,000 in 1989 to $70 million in 1992. President Bush is recommending that funding for the 1993 fiscal vear be $90 million. There are c7trrrntl\- 240 f71nded programs, including 9 Migrant progratns. Even Stat-t is open to children front birth thro77gh agv wven living itt a Chapter I elementat:, attendance area and a parent who is eligible for adult basic education. Even Start is composed of three cow cotnpo- nents-parenting education. early- cltildl7ood etl71ca- tion, and adult education. The projtacts build OII tG;l- ittg progratns in the cotntnltnit~.. i;71cl1 a Head Start, Chapter I, Ch;7ptet- II, ad77lt education. progratn\ fot children u-ith disabilities, .JTP.L and .JOBS. Thy progtwn's goal is to break the c\.cle of illiteracy tliar plague5 so tnati~. .-\tiwt-icati fattiilirs. The brnefits of E\wi Start's foc714 on litety at-e inativ. Parents \vho Icarn to read dcwlop att ititrrest in school, and sonic of theni choow to go back to scl~ool ac a result of their involvement. In additiott. cItiIdtx*tt feel pro7tcl of their parents and \\orl\ to cw~ttlatc tItc.ir parents acadeniic success. In somr projects, p;~tx~tIs lrve f in-med their 0~11 support networks ;III(\ 11;1\x~ learned the importance of proper health c;w and n7ttrition. talking and reading to their childrw. att(1 scning as good role nwdels. The self-estccwt ;71td cotifidcttceofpxticipants-adults andchildt-rti alike- is great]! increased. The results of first !-eat- ( 1989) pt-ograttt r~xl~~a- tions sh01\ that `70 pet-cent of fxmilies set~td ltavc ann71al ittcome\ of. less than 510,000. Evtv .St:ur ha\ rcacli~d 13.000 adults ant1 48.X)0 children acros4 tht co7tntt-v. The nlajorit~-ofad7tlt participantsaw brt\vcac.tt the ;lcrC% of 2 1 and 29. h To cloce her presentation. Ms. Reriningsoff~t-ctl rhr a77dietice sonic specific ill7tstrations ofthr good Even Start can do fix- fiumilies and for Ivhole conitn7tnities. She llt-iefl\- drsctii~ed three stlcccssfitl pt-ogratns-one itt a tt.;tiiet- park in Fort (Zoiiitls. (kAorado. one it1 a \.etT poot- cotntnuttitv in Snt~arl~iile, Tennessee. and one in the town of'Hidaigo, Texas. on the Mesican border. Each of thrse prograni\ has tailored its set-\ices to fit the specific needs of the cotntnttnit_\ and lamilies it sexes. Recognizing that fanlilies' basic needs initst be nlet before the! can begin to ;tpph, thetnseives to stttd$lg, thr (Colorado progtxn &et-s not oni!. (kneral Eqtti\-alettr!- Diploma (GEL)) trainingfot~patw~ts. btlt also teachesl);tt.etltitlg skills, basic nutrition, and h@xie, anti coordinates a food donation progratn. In Sneachiiie, where nxttn people hale never been inside a school bttiiclit~g, 1.50 f:,\tniiies--ainlc)st t7xy- otle in the count--is inwived it1 Even Start. 1lot-e than .X0 people attended the progratn's spring picnic. rvith rvenxme in the coti~tii7ttiitx participating. The tmvn sheriff cooked. and the staff of the bat-bershop gave free haircuts-wine to 1vottttw \vho had tte\w had their hair cut bv sotneotle outside their imtnediatc farnil!. .-\t the end of the )`ear. -lH ~vottwn twroiied in Evm Start had passed the GED and IO of them recei\wl drivers` licenses. In Hidaigo. Tesas. the Ewn Start progranl setTes ;I cotnttt7ttlity that is nlo\ti!- Hispanic and poor: the faniiiies participatiti, 0 in Earn Start had no pitttmhin~o~ server svstetns. Their hotttrs t-esetnhlrd small toc~isi~ed~. Seat+ 1'10 pat-etttsand 130 children atx~etiroilecl iii the progratn. Before E\wl Start catne to Hidalgo. tnan!. \vomrn. who had had evett less rdttcatiott than thrit husbands. lvere completely illiterate. 51atl!, families \\`ere entitled to food assistance, but could not negotiate the system because they could not read. The Hidalgo Even Stat-t home visit has proved the most effective titeatis of`itiipro\~ing families ' iiterac\. skills iii ;I cttitrtr- ally srnsiti\.e tnannt`r attd of'assistitlg families in dealing uith social set-i-ice agencies. CHILDCARE: TWO PERSPECTIVES (:hiidcarr C;III be \ie\veci frotn two perspectives: that of the parents and that of childcare providers. This panel. tuodet-ated by Barbara A. M'iller, Ph.D., Public Affairs Director for the National Xssociation for the Education of Young Children (NXEYC), pt-esentrd the results of t\vo national childcare s7113ty, one from each perspec- tive. Dr. L\`iiier noted that these projects, which u'ere separatei~ funded and designed, are ttttiqtte because the!- highlight partnerships (collaborations). The first stud\- \vas the National Childcare survey sponsored 1~1. S.kE\rY: and the Xdtllittistlatiotl ott <~hiidt-en, Youth, and Fanlilies. U.S. Departmrttt of Health and Human Setlices. The stud!. ttwcl a tviephone sutTey of parettts cleGgtted atttl anaivzeci 1~1. the Urbatl Institute. It ex- piotwl gvnetxi clttrstionsahottt childcare at-rangetnents 134 Parents Speab Out for America'\ Children and included substudies of low-income families and militay families. The secottd stud!-. the Profile of Childcare Settings, was sponsored by the Department of Education. \ The study dealt with the supple of childcare services, use by low-income families. range of senices, and qualit!,. Patricia Divine-Hawkins Publir .4@iry Co-Dimtw .Ycttionnl .-issociatio~~ ,Jor the Educntion cf kbuug CXiltiw,l Ms. Divine-Hawkins reported imtnense change Gth respect to childcare in this cotmtt-~ in this generatiott. In the 1990s. man!' mothers are lvorking. resulting in a large proportion of' children in preschool and ;I large number of children caring for thernsel\~r~. She also reported a shift from informal toTGtt-d formal childc~art centers and homes. (ivi5us studies of part~nts and national studies h>. the hdtttinistratiott on (:ttildrett, Youth, attd Familirs point touwtl these conclusion\. She noted that the cot~st~met- studie5 of 19% through 1976were prototvpesofour understandingofchildcare. but the! did not include f:ntnily daycare providers. r\ccording to Ms. Divittc-Hawkins, social policies of the 1990s are oriented more toward children and the family. Childcare is a central component of etnplo!ve benefits in many companies. Head Stat-t created nrv partnerships between Federal, State. and local govern- ments. The continuitv between earlv childhood educa- tion programs and elementary school has enhanced and eased the transition between early cltildhood and kindergarten. However, these social factors create a complex situation and thus a need to look at childcare issues more holistically. Ms. Hawkins-Divine related that N;\EYC's research examines how the supply of and demand for childcare work together. It is the first research that (1) studies the range ofoptions for different families in different types of situations, (2) explores characteristics of individual families, (3) develops a comprehensive database with individual data tailored to individual circumstances. and (4) examines socioeconometrics. NXEYC also emphasizes the importance of partnerships in addrew- ing childcare issues. Dt-. Hofferth was the principal investigator of. the ~a- tional Childcare Sunny. which explored sttpplemettt;tl caw for children (center care, family daycare, in-hotttc cat-e. care b\. a relative. or no supplemental care). The components of the sttt~e\. included the n~~tntbet- of households l\ith children under certain ages, ttumbet- of children enrolled itt da\care, a parent suney, and ;t provider WIVV. The sttt~-c~ revealed a high pet-centagt ofsttpplrttletttal c;w and a major shift in the provider\ of ~llpplelllental cat-(`: more and more children ~vho receive care out of' the home are enrolled at centers AS opposed to wcei~iiig care at ltotiws of relatives. The sunr! examined primat? care for the )wungest pre- school child by income, for employed mothers. Enroll- ment in center-based prograttts has increased particu- larly among lolvest income families whose childrett are placed in subsidized programs and who receive direct financial assistance. etc. The \vorking poor and low- to middle-income families, by contrast, are participating at a louver rate in center-based programs. Dr. Hofferth said it is noteworthv that the cost of care has not increased significantl!. relative to the cost of living. But, she affirmed. 35 the high-income familiesget tax credits and low-income families get assistance, the middle class gets squeezed out. Dr. Hofferth's research shows that parenti learn about childcare arrangements for the youngest child through relatives. friends, and neighbors (informal nrt- works) and ft-om referrals. The most important factors fi)t- measuring daycare are quality (above all else), reliability. teacher training, and student-ttrteacher ratios. The SIN- veyfottnd thatparentsweregenet-allysatisfirdwith daycarr arrangements. One-fourth oftheparentssrtrveyedwanted to change arrangements. Of those, one-half wanted to switch to childcare centers. Childcare centers are the preferred alternative. Intel\iews wi\ith SII~TV\~OI~S S~OISXY~ that some centers were regulated, and others were ttot. Sottrrgttlatrd cetttet-4 ottt~trtmberetl regulated centus. S0ttre@ated ccntet-\ differed flrottt regulated one4 itt that the!, lvere smaller. had shorter operating hours, charged less. and bvt`re not run bv professionals. The major findings were that, during the preschool years, more and more children are in childcare centers and some, especially the poor, mav be suffering. Elizabeth Farquhar, Ph.D. Ptyqwl tt1 `4 tz n!yst lkf,ntfttifwt of Educntiott Dr. Farquhar talked briefly about the Department of' Education's role in creating policies and studies concerning earl>- childhood education, childcare, and family education. The Department of Education supports Chapter I creation of Even Start for adults in need of literacy skills. Preparing Young Children fat Success is a Department of Education program that prepares children for schools. The Department also sponsors the Profilr of Childcare Settings Studs. The Department also collaborates efforts with the Department of the Health and Hunlan SelTices. Since the 198Os, the Department has lvorked \vith the States. who became active in de\.eloping preschool programs. "(:ollaboration." Dr. Farquhar stated. "is \`er\' effective in these studies." Ellen Eiiason Kisker, Ph.D. .%tliot~ I&wc1rchrt .\ln thma t im Poliry Knrcrt~rh, It1 c. Dr. Kisker, who directed the Profile of (~hiltlcart~ Settiilg.\ Study, described her extensive research on the supply of` childcare for preschool and school-age children and on childcare utilization bv low-income mothers in terms of two aspects: availability and qualiv. Dr. Kisker discussed availabilit\ in trrms of formal earlI, education and care at centers and at regulated farnil!. daycare progmms. She found that the number of programs has tripled and enrollments have quadrupled since the 1970s. She con- firms that utilization rates are high and that most \-acan- ties are concentrated in fewer than one-half of da\,care facilities. Ho\ve\-er. more infornratioll is needed from parents to determine if shortages exist in specific areas for certain tl\-pes of children. Dr. Kisker noted that not all programs provide all services. As a starting point, one can l(,ok at adlnissions policies and determine whether the f'ncility accepts infants, children who need futl-time ser- tices. and handicapped and/or sick children. In terms of quality, Dr. Kisker noted, daycare centers can take manv forms. "A davcare center that is considered quality," said Dr. Kisker, "promotes child development. . You can't assess childhood develop- ment by individual child, but there are certain indica- tors of qualit!,." These indicators include (1) average group size, by various ages (look at the various laws pertinent to the regulations); (2) average child-staff ratios, bv various ages; (3) teacher qualifications, b\ type of degree; (4) teacher turnover (profit versus nonprofit), and (-5) parental fees (not changed since 1970s if adjusted for inflation). The Childcare Settings s&d? led to new childcare policies. The 1990 baseline data lvere used to assess what has happened since the early education initiatives \vere developed, and programs have since been implemrntrd. To illustrate Dr. Kisker's statement, Ms. Divine-Halvkini; shared that 32 projects in 32 States have e\.aluatcd the transition of Head Start graduates over the nest three grades, assessed their progress, and tlet~rmined under Ivhat conditions they progress. HEALTHY START, HEAD START, EVEN START, AND WIC: INTEGRATING HEALTH, EDUCATION, AND SOCIAL SERVICE PROGRAMS L\`ade Horn, (Commissioner of the Administration for (Children, Youth and Families. sewed as moderator for this session on collaboration among various health and social senice agencies. A. Kenton Williams, Ed.d .-\ssociate Cornrnissionn HPCMI Stcu-t Bu,ucc u "Head Start is alive and kicking because itworks." So Dr. M'illiams, the newly appointed Associate Commissioner for the Head Start Bureau, opened his discussion of the 136 Parrnts Speak Out for America's Children Head Start program. Head Start is a comprehensive child development program that works lvith the whole child to promote self-esteem, education and literac!-. and health through four channels: education, health services (including medical, dental, psychological, and nutrition), social semices, and parent involvement. President Bush has recommended that Head Start he allocated $600 million for the coming fiscal \~ar. Head Start is proud of its cooperative I-elationshipc\~ith other programs and agencies. including the Health (:are Financing Xdministration. the Public Health %I-\-ice. and the Department of Edlwation. Dr. M'illiams said that he is happv to be tvorking with cuch a successful p~-og~-am and nanwd the fi,llo\v- in? priorities for Head Start in the coming yw * To better se17.e prrgnant uw1ne11 and to provide optimal prenatal care to keep mothers health!. and to help them bear healthy children. * To maintain continuing relationships with pri- ma? care physicians. * To improve clients' access to secondary care. Ir To provide referrals to appropriate psychological counseling, substance abuse treatment, etc. * To reduce the number of low-birthweight babies and to reduce the infant mortalitv rate. * To improve clients' understanding of wellness and increase personal responsibility for health, including cessation of cigarette smoking, alcohol or substance abuse, etc. Donna F. LaVallee, M.S. Nutrition Coorclinator ,Yew I'isions for.Vezuport County Dividing her work week between M'IC and Head Start in her job as nutrition coordinator for this program in Sewport County, Rhode Island, Ms. LaVallee had man!- insights about how to integrate efforts between these programs. Because N'IC and Head Start seme the same popu- lation, both proaVallee offered many simple wggrs- tions to help foster collaboration behveen local M7C and Head Start offices, such as open houses, cross-referrals, membership on each other's policy committees, guest speaker exchanges, and assistance in program evaluation. Because M7C and Head Start have so much in common, they can share many things, including resources, cospon- sored clinics and health fairs, joint newsletters, all-in-one application forms, community needs assessment data, and more. Ms. L.a\`allee urged program staff to "commu- Ilicate, cooperate, and coordinate." Thurma McCann, M.D., M.P.H. Acting lAmfor, (?ffp of HecclthJ Stnrt He<~lth Ke..tourre., nnd Swuires .-idminist,ntion Dr. hIc(h~n described the Healthy Start program, \vhich is based on recommendations from the President's Commission on Infant Mortality. Nowin its early stages. Healthy Start is being implemented in 13 communities lvith the aim of reducing infant mortalit) in those communities by 30 percent. Program applicants were required to meet five basic criteria to have their proposals considered: ( 1) innovation in deliverv svstems (e.g., user friendli- ness, etc.), (2) community commitment to Health>- Start's goals, (3) the ability to offer increased access to health care to reduce low birth weight and other causes of infant mortality. (4) integration of medical and social seIT.ices. and (.5) multiagency participation. As a \vhole, the Healthy Start program is unique in that it allocates unprecedented resources to prenatal and perinatal care, mandates community choice and flex- ibility. and empowers communities to build the kinds of programs that will work best for them. Although Healthy Start funding lasts for only .5 years. Dr. McCann stressed that a community that has "`bought into" the program can find a way to keep it in place even after Fedeml funding is withdrawn. Healthy Start encourages communi?, involvement and has won support fi-om \zrious churches, civic k~oups. tribal councils, schools, and business orgmizatkms. Such agenciesas thePublic Health Senice, the Health (Zare Financing .\dministration% the Department of E~luc;~tio~~, ad tlw Department of Health and Human Sri-\icc\ ;II*` also dcthv pmtm-rs in the national prygmm. Patricia A. McKee Now in its third year, the Even Start program is proud of its cooperatit.e relationships with other agencies and within the commux~ities it selves. W. WKee presented a briefoveniew of what Even Start is doing in this area. Mrhen Even Start was mandated by (Congress 3 years ago, part of that mandate required that Even Start work with other agencies to achieve their common goals. The 76 programs established to date contain a total of 869 collaborative arrangements for prima? (or "core") ser- \rices and 1,600 collaborative arrangements for support senices. More than 67 percent of all Even Start programs work with their local Head Start programs. Howard T. Miller Coordinator Even Start Family Literq Procgrum Ptinc~ George's Conrn~~ Publir Schools Mr. Miller opened his presentation \vith a brief o\-eniew of the statistics on illiteracy in America rued what it costs. More than 40 percent of all milita? sellice enlistetls are functionally illiterate. More than nvo-thiI-cls of all L.5;. colleges must offer remedial English classes. SIore than one-half of all prison inmates are functionally illiterate. He stated that these and other data show that the deleterious effects of illiteracy lead to financial losses, crime, Liolence, poverty, and depression. Even Start's approach in Prince George's Comnty is based on t\vo important assumptions: (1) parents' level of educa- tional achie\rement affects their children's success in school and (2) a child raised in a literate home lvill naturally learn to read,just as he will learn to talk and to feed himself, through learning "reading behaviors." The second assumption is called "emergent literacy." Mr. Miller stressed the importance of educators' getting to know the families of the children they teach, to form a cooperative partnership between the school and the parent. Parents who are enrolled in the Even Start program along with their children are able to go to classwhen it is convenient for them, and transportation is provided. Parents learn new skills in preparing for the "If we can help the parent become literate, these families can succeed." GED, and they also learn parenting skills that help them teach their children. General health and nutrition sen-ices also play an important part in helping families to learn and grow together; recognizing this importance. Even Start coordinates closely with Head Start, M?C, the Cooperative Extension, and schools. "If we can help the parent become literate, "Mr. lfillersaid, "these families can succeed." 138 Parents Speak Out for America's Children a closing Remark chapter 7 Antonia C. Novello, M.D., M.P.H. Su,rgeo,n General I have onl)- a few comments. I think that toda!, you have seen that when people get together, things work. But I can also tell you I am proud of your three capable I-epresentatives who communicated your wisdom about what this counts needs and what this administration can do to sohe our problems. This wz unrehearsed; it was collectiveI\ put together; and I think it probabl) represents us better than anyone talking from their own pain. This is what makes this Conference unique. Moreover, it's even more difficult for me to speak after haying heard people like this. I also can tell you that. when this Conference is done and Ivhen 1t.e all go our separate ways back to the States and commmnities, rn\ impression will be that we ha\-e come together for onl\- one purpose, and that's the purpose of taking care of children and families. The President said his vision is that. in the !~ar 2000, this countn' and these children are going to mo~c` forward. The children of tody will he the explorers. lvriters, teachers, doctors, and imentors of tomorro\v. President Bush said that, in America, families come first, and that's what makes this conference unique. You are here from 50 States and from Territories asfarawayasGuam. You are here from PuertoRico, and VOLI are here from eveqlvhere. ContraIT to \\hat the only reporter that has come aboard asked yesterday. yowl are not all Republicans. In this Conference, I have taken great pain to make sure that we are not labeled b! ethnicity, language, or gender. N'e are here with only one mission, no matter where we come from and who we are. That mission is to care for the children and families of this count?. You have articulated what ~0~1 need, and I have never heard it so well expressed. This Conference is focused on our children, and we're working tolvard the benefits of every child. I have been much more im- pressed than ever by people who perhaps neyer knew the\. col11d speak for others and be taken seriouslv. M'e said this is about respect, respect across the board. I think in these 3 days, we have shared the commonality that, e\-en if !.oL~ don't speak the same language, it doesn't mean that you are not intelligent. Most impor- tantl!., \ve recognize that "poop " is a transient state of mind: todal. it is ~011; tomorrow, it can be me. So let's not only be culturallv sensitive, let's also be culturall! responsive. I think this Conference has concentrated on that. Whatever personal circumstances we brought here-and I can assure you that some ofyour faces said, "Show me," and some of your faces said, "One more conference; don't bother me with trivia"-1 can assure you that b\. having come here for whatelrer was the message VOLL thought you \\.anted to bring, you have adI,anced the field of every child, and you will perhaps be as responsible for having made one more child part of these Cnited States byjust having been here. For that ~OLI should be complimented. \Ve came here to deal with awareness, transition, and participation. .-\fter ha\ing listened to the parents, VOLI realize that parents do all three at once, and some- times one parent does it all. I hope now that you realize parents are crucial fol-\vhate\er\~e're going to do in this countll. for the f:nnnilies. If I.011 don't believe me, then I \\`ant to know where \-ou'\e been for the last 3 days. i\hen I charged !.ou on Monday, I told J.OLI I lt'as going to ask the best ofyu. But I warn you. I'm going to ask even more of you, even when you think you're going to go home and forget about this Conference. I can tell J-ou that \\-e'\,e heard the parents and the groups. I've felt the pain, and I've talked to you. I've talked to every one of 1~1 indi\iduall~ or coltectivelv. M'hen we leave this place, we will have everything that's been said included in a proceedings compendium. We will complete the docu- ment as quickly as possible, but remember we must go through the General Services Administration and Gen- eral Accormting Office to have it printed. We're going to make sure that this goes to eve? Governor, every one of you, and el-er) legislatorwho asks for it; right now the Hill is also clamoring for it. So this is going to be a public cloculllent for all of those who need it. 140 Parents Speak Out for America's Children But the document Lvill bc-just a docttmettt if`ytt do not work with us to make it a reality. ji)ti \\w-t' able to see that out- officials at-e committed. but don't evet put the rights and the benefits of !uur famil!, only- on some other people's shoulders. You have IO sl1at-e the t-esponsihility: otherwise, it will not become a rtAit\-. The reforms of this countt?- uill come fixwat-d through the families; the parents spoke today, and the\ no longer Irant to be silent partners. They want to he activists and advocates, and to do that YOU also have to speak for vowself. Othenvise, w.e't-e ttot going to get amwhere. I also heard that parents, especiallv f:nthers. have to be part of e\-et?,thing that NY do. I think. as I'vv said beforr, we have to find \sax-s hv \\,hich \se bt-in' \vhere your mouth is." $Z'e must make sure that we write in the language that proplc understand. Yesterday, I ~YBS in a transplan- tation meeting, and the\- told me 1 need bilingual pet-mits todonate m\.ot-gatts..&ld thel-salminoritiesdo not donate. \Vould you donate your organs b>. signing a docttttirtit gi\wt to ~wii hv a pet-son who is not culttir- all\- settGtivc. itt ;I lanp~age that \Y)U do not understand? 1fu~1 sign. I hi117 a bridge I want to talk to x'oit about. This I~c~partntcnt is making sure that evet?thing is put itt the latlgu;igc that people \\A1 understand. hlost itttportantl\.. some of our groups have no tnore than an 8th grads education. So again YOU said it, "Put it in wxds that people understand." In medicine, we't-e ah\~~i~~s talkittg about EKG [electrocardiogram] and EEG [el~ctroencepl~~tlogr~~t~~] . and I asked a doctor, "Mhat is an EC;<;?" He didn't ktto~v, so I told him, "an egg." It's aIs;0 important to remember that the cottntt~ is ft~ll of' childt-rtt ha\.ing children. Lye have to wort-~ about them. too. The] do not love their children less because the\ arc children themselves. The), at-e going to tteed m~d~t~~tattdittg. and they are going to need us to help them, too. Self-esteem \vas another issue raised here. Self- estt'em is no longer just for the child. It also has to come from the parents, and that is something that we cannot by.. ;2Iedicare. Medicaid, not-Social Security can bu!,it. That has to come from within. But \ve cannot only think of self-rsteem for the children. 14-e have to give it for the parents. Occasionalh., tak;t. vow time to tell us \vhen Eve d<) good, and. occasionally-.just forget that xve did bad. 1 think positive is part of \vhere \\`e have to go. One \I-omati said wr have to help people to help themsrlves. rather than offer programs that foster de- pendrnc~~. I ~gwe. I h;nx~ the feeling that that should be au+ \ve should mo\~ to1vat.d our goal. LZ'e might use diffewttt \\oi-d\. \Ve might sa\ "ad\ ocac~" or "enipowcr- mc3it." Eithczt- \~a!, \vv tit4 ;I little more positi\istii itt ;gcittittg togvthct-. The title of the Conference has been "Healthy Children Ready to Learn: The Critical Role ofparents." I do believe-and I hope you do, too-that this Conference has done one thing beautifully: It has vindicated the parents. It has helped people realize that they can no longer be silent. No single program in this country should be done in the absence of the parents' participation; otherwise, it will be one more useless piece of paper. I said in my opening remarks that this Conference was the result of 18 months of planning. I believe that is totally obsolete at the end of these 3 days. This is just the beginning, not the end of 18 months. I have seen all my Assistant Secretaries involved in this with me, and we're going to make sure that whatever we plan will be with families, parents, and children in mind. For that reason, this is a success story. I know I told you not to ever get discouraged with the Federal Government. It's a powerful one, and you have to learn how to use it as a tool. Today you had everyone at the top discussing how they see it. As I told you, perception versus reality is the problem here. You might perceive one thing, and the reality might not be so bad, but I think it worked on both sides of the table. You have heard from all of us-from the Secretary of Health and Human Services, the Secretary of Agriculture, the Secretary of Education, six Assistant Secretaries, and the President of the United States. But most importantly, we heard from you. That's what makes this Conference unique. I think we should never underestimate the power of a coalition. Alone, we are not going to do anything, including the President himself. We all have to be able to tell the Government we're here. We're part of the solution. Please, let's not be part of the problem. I want all of us to get together, regardless of what we felt when we came here, because united we can do a lot ofwork. I know that you probably have thought, "She's going to repeat herself again." No one alone can work. We have to unite. But I also told you to use anger if necessary. I can tell you that I feel good that you did, because when you used anger, you were collectively expressing something that I hope the Conference has alleviated. Perhaps now you at least know a place where you can find a solution for your problem. I know that I have told you that we have to be creative. Part of this world is discourage- ment, but I'm not going to let anyone use it to take care of you or me. Discouragement is a state of mind. I ask you to join me to share the responsibility for making your family and your children well. Share with us at the local and at the State and at the National levels and in the public and the private sectors. It's no longer one person's responsibility. There is too much at stake! So look at everything that works, and look at everything you think needs to be replaced. Then call and cajole and make sure that you get involved. I know that we are "conferenced out," but I know also that we are accelerated to the "max." You have to use that momentum when you get back to work and to your communities and say, `You know when the Surgeon General, the Secretaries, and the President speak, they are committed to make the family top priority." Let's get real. Let's get real! I can tell you that when the experts go home, they are not going to be devoid of work because I am not going to be devoid of work. I have your telephone numbers, your fax numbers, and even your grandfather's numbers. So, rest assured that this is not just the ending of 3 days, but it's the begin- ning of a coalition of parents taken seriously, trying to 142 Parents Speak Out for America's Children determine, through their collective actions, what this government can do for you. I'm with you. Are you with me? I want to bring six people to the podium because without them I don't think we could have done this. They are the three parents' representatives and the three parents' alternates. I think we should give an applause to our panel. We had six parents, three to come forward and three to be available in case they fainted. Obviously, we didn't need the other three, but they were there and ready to go. So, I would like to do something. There's not much I can do for you all, but I can certainly give what I call the Surgeon General's Certificate of Appreciation, and believe me, I do not give that too freely. But, when people give of them- selves, as they did to represent you, I think a Certificate ofAppreciation from me isjust the first step. I think that you should be able to thank these six people who represented you so well. Because without them, and you, this Conference would have never happened. So how about if we applaud for all of us. Ellie Valdez- Honeyman, Larry Bell-I am eating squash all my life- Sandy Slavet, Rosa Palacious, and Jesus Sada. Sherlita [Reeves] had to go and pick up her little child, so we'll keep Sherlita's and mail it to her. We might be "conferenced out," but I think we are motivated to go out there and do a lot for what we have tried to accomplish. Most important, is that, collec- tively, we will be able to do it. This document will not stay on anybody's shelves; I guarantee you that. So today's the beginning, but I need you. Remember, united we will succeed. Separated, we will not get anywhere. Today's the first day. Thank you for coming, and God bless you. le program in this c Report of the Surgeon General's Conference 143 8 Conference v Participants CD The Surgeon General's Conference The Critical Role of Parents Washington, DC February g-12,1992 `To potect their privacy, addresses of the State Parent Delegates have been omitted. However, the parents had the opportunity to exchange addresses and phone numbers at the Conference. 2Attended the Native Amerkan Parent Wmk Group. 3Atte-nded the Migrant Parent worh Group. A-2 Parents Speak Out for America's Children Alabama Susan Colburn Montgomery Letitia Hendricks Montgomery Susan Watt Childersburg Alaska Esther Johnson* Augoou Danielle Mad&an Elmendorf Sue Wilken Fairbanks American Samoa Karen Ho Ching Pago Pago Iutita Savali Pago Pago Fa+etai Seumany Pago Pago Lui Tuitele Pago Pago Arizona Pamela Jones Phoenix Ernest0 Meza Phoenix Pamela Morrison Phoenix Jerry Pearson Phoenix Arkansas Pamela Ashcraft Little Rock Mary Blanchard Blytheville Deborah Frazier Little Rock Barbara Gilkey Little Rock Angela Lee Little Rock Nancy Lovette Blevins Hazel Murray Pocahontas Mary Ann Pickard Searcy Sherlita Reeves Paragould Linda Spence Blytheville Dinah Wells Manila California Anna Cortez Norwalk Ann Kinkor Ranch0 Palos Verdes Colorado Diane Reeves Denver Ellie Valdez-Honeymau Arvado Connecticut Judy O'Leary Trumbull State Parent Delegates Delaware Laurence Bell Laurel Laura Ivansons Newark District of Columbia Goldie Anthony-Henry Washington Dona Brawner Washington Brenda Calloway Washington Joan Christopher Washington Rosalind Coleman Washington Connie Dudley Washington Cristina Espinel Washington Lisa Holland Washington Susie Ring Washington Tawana Kinney Washington Maria Meehan Washington Kurt Stand Washington Lorraine Street Washington Florida Kenneth Chambers Tallahassee Romero Cisneros3 Wauchula Shirley Herbert Kendall Lauderdale Lakes Georgia Pappas Jarpon Spring Wendell Rollason3 Immokalee Jesus Sadas Ruskin Lisa Spikes Tallahassee Anuette Townsend Tallahassee Felix Valle3 Immokalee Connie Wells3 Wauchula Verdule Youyoutes Zolfo Springs Georgia Anne Butts Atlanta Tma Doucett Columbus Louise Harris Clarkesville Porter Harris Clarkesville Gen Hunter Atlanta Glenda Welch Gainesville Sarita Welch Clayton Guam Mae Ada Agatia Margaret Artero Agatia Hawaii Susan Rocco Aiea Lanette Teixeira Honolulu Helen Usuvale Honolulu Idaho Marcia Hallett Boise Carolyn Ropke Boise Illinois Marion Cooper Chicago Pat Doherty-Wddner Chicago Rosemarie Frey Wheaton Mitzi Montgomery Sauk Village Catherine Raack Wheaton Debra Zurkamer Springfield Indiana Carol Burkes Martinsville Mary Snyder Martinsville Iowa Gloria Rlinefelter Dubuque Jean Linder Johnston Report of the Surgeon General's Conference A-3 State Parent Delegates Kansas Judy Moler Topeka Josie Torrez Topeka Kentucky Rhonda Henning Louisville Gleason Wheadey Frankfort Louisiana Joan Caloway Shreveport Tammy Rodgers Baton Rouge Lab Schwartzman Baton Rouge Charles Tyler New Orleans Maine Annette Cohen-Hyman Kennebunkport Jenifer Van Deusen Augusta Mariana Islands Victoria Mendiola Tinian Severina Ogo Rotas Rosa Palacious-Power Saipan Rita Sablan Saipan Catalino Sanchez Saipan Elizabeth Torres-Untalan Saipan Maryland Kathy Cooper Be1 Air Mona Freedman Baltimore Shawn Fritz Frederick Barbara Mallonee Annapolis Gordon Mallonee Annapolis Valarie Phillips Baltimore Massachusetts Deirdre Ahneida Amherst Rosalie Edes Concord Sandy Slavet Randolph Michigan Charlotte Boatmon Quincy Myra Charleston Detroit L. Bryn Fortune Farmington Hills Celia Garza Detroit Luz Teresa Hemandez Detroit Minnesota David Becker St. Paul Roxanna Lee Foster St. Paul Mississippi Patty Appleton Jackson Gwendolyn Fortson Jackson RobertFortson Jackson Patricia Hych Tupelo Missouri AlanKilhgsworth Springfield Stephanie Mason St. Louis Deborah McDannold Columbia Carol Mertensmeyer Columbia Ellen Moses Creve Coeur Donna Snead Kansas City Montana Lea Bear Cub Brockton Ellen Bourgeau Missoula Marilyn Femelius Missoula Julie Flynn4 Wolf Point Doreen J. Fowler Wolf Point Karen Moses Helena Sue Phelan Helena A-4 Parents Speak Out for America's Children State Parent Delegates Nebraska Susan Christensen Omaha Cyndia Eckhardt Lincoln Nevada Patti Miller Reno Robert Miller Las Vegas New Hampshire Carol Barleon Bow Brenda Copp Manchester New Jersey Joan Applebaum West Trenton James Brown East Orange Camelia Leach Newark Rhonda Nichols Newark Ciro Scalera Newark New Mexico Kathryn Brown* Taos Pueblo Shirley Chaves Espanola Yvonne Gomez* Taos Pueblo Patricia Solomon-Thomas Lagona New York Marvina Heywood Utica Bob Shannon Buffalo Notih Carolina Gail Dunton At-den Gwendolyn Parker Chinquapin Meg Sawicki Charlotte North Dakota Mary Ann Anderson Bismarck Nanci Cooley Grand Forks Ohio Sandy Barber Wauseon Judy Minatodani Solon Peter Somani Columbus April Thoms Reynoldsburg Oklahoma Pamela Htmt* Skiatook Marcia Lemons Oklahoma City Mary Littles Midwest City Linda Terrell Oklahoma City Susan Webb Norman James Wilson Cushing Oregon Paula Bender-Baird Enterprise Jean Josephson Portland Katherine Weit Portland Pennsylvania Risha Henley-Davis Harrisburg Loaiza Manzo Harrisburg Frank Meredick Plymouth Ralph Warner East Greenville Mary Wood Hadley Puerto Rico Sonia Benitez Cataiio Maria Burgos Canovanas Abigail Muiioz Alverio Caguas Rafael Sanabria Santurce Ahna Socorro De Leon Caguas Rhode Island Linda Dee Bryan Providence William Bryan West Greenwich Cindy Flores Coventry Patrice Richardson Barrington Janet Samos Warwick Report of the Surgeon General's Conference A-5 State Parent Delegates South Carolina Betty Baker Davidson Columbia Debra Derr Columbia South Dakota Julie Darger Pierre Glenda VanderPol Academy Tennessee Michael Allen Monterey Sherry Allen Monterey Linda Lemons Memphis Phyllis Medlin Cookville Texas Holly Craig Grand Prairie Darlene Dubicki Austin Norma Heredia Arlington Priscilla Ring Georgetown Leslie La&am Austin Candy Sheehan Coppell MariaVargas El Paso Utah Brent Briggs Sandy Becky Hatfield West Jordan Vermont Cathy Crow South Burlington Susan Rump Thetford Center Clark Sutton Middlebury Megan Sutton Middlebury Karen Witkin Essex Junction Virgin Islands Mark Benoit St. Croix Verona Charlemagne St. Thomas Joyce Lebron St. Thomas Patricia Nobbie St. Croix Catherine Rogers St. Croix MaryAnn Weston-Livisay St. Thomas Virginia Loretta Byrd Richmond Peggy Singleton Oakton Cherie Takemoto Alexandria Marilyn West Richmond Washington Rail ArambuP Oralia Garza Wapato Kathy Johnson Zillah Felix Monte8 Sunnyside West Virginia LornaAdkhxs South Charleston Bob Craig Farmington Kathy McCullough Charleston Barbara Merrill Charleston Jane Vance South Charleston Wisconsin Ody Fiih Hartland Patty Peterson Cashton Patty Skenandore De Pere Wyoming Des&e Lopez Rawlins Carole Palmer Cheyenne A-6 Parents Speak Out for America's Children Carolyn AbduIlah Center to Prevent Handgun Violence Washington, DC Steve Abrams U.S. Department of Agriculture Food and Consumer Services Washington, DC Shellie Abramson U.S. Public Health Service Washington, DC Irene Adderley Washington, DC Public Schools Washington, DC Jeanette E. Akhter, M.D. National Perinatal Association Bowie, MD Katrina Alaman-Murray National Association of Social Workers Washington, DC Lamar Alexander Secretary of Education Washington, DC Robert E. Alexander U.S. Department of Education Office of Migrant Education Washington, DC Barbara Aliza Association of Maternal and Child Health Programs Washington, DC Dorothy J. Allbritten National Association of Children's Hospitals and Related Institutions Alexandria, VA Myron Alltian, Jr., D.D.S., M.P.H. Boston Department of Health and Hospitals Boston, MA Mary Louise Alving, M.Ed. Citizens Education Center Seattle, WA Rita L. Amadeo, M.D. Easter Seals Gwaynabo, PR Maureen Ambrose Pennsylvania Department of Education Harrisburg, PA Robert W.Amler, M.D., M.S. U.S. Public Health Service Atlanta, GA Kim J. Amos National Center for Clinical Infants Program Arlington, VA Polly Arango Algodones Associates Algodones, NM Ann Armstrong-Dailey Children's Hospice International Alexandria, VA Susan Austin National Association of Federal Education Program Administrators Philadelphia, PA Corime Axelrod U.S. Public Health Service Rockville, .MD Laura Diaz Baker Puerto Rico Federal Affairs Administration Washington, DC Wendy Baldwin, Ph.D. National Institutes of Health Bethesda, MD Linda V. Barnett U.S. Department of Agriculture Food and Nutrition Service Alexandria, VA Rosemary Ramirez Barbour U.S. Department of Education Washington, DC Sandy Bastone U.S. Department of Agriculture Food and Nutrition Service Alexandria, VA Pat Bayer American School Food Service Association Alexandria, VA Mae Beck Black Coalition of Concerned Citizens for Child Care Dallas, TX Juliane Becket University of Iowa Cedar Rapids, IA Julie Beckett Federation for Children with Special Needs Boston, MA Arlene Bennett National Association for the Advancement of Colored People Legal Defense and Educational Fund, Inc. Philadelphia, PA Report of the Surgeon General's Conference A-7 General Participants Vii Berg U.S. Department of Education Office of Migrant Education Washington, DC Catherine Bertini Assistant Secretary for Food and Consumer Services U.S. Department of Agriculture Washington, DC Lea D. Beshii District of Columbia Commission of Public Health Washington, DC Susan Binder, M.D. Centers for Disease Control Atlanta, GA Patrice Birman U.S. General Accounting Office Washington, DC Kathleen Kirk Bishop, D.S.W. Vermont Department of Social Work Burlington, VT Lorine P. Bizzell U.S. Department of Agriculture Food and Nutrition Service Atlanta, GA Tara Blackcoon Wisconsin Winnebago Health Authority Mauston, WI Vi&i Blackcoon Wisconsin Winnebago Health Authority Mauston, WI Randall Blackdeer Wisconsin Winnebago Health Authority Mauston, WI Heather Block U.S. Department of Agriculture Child Nutrition Service Alexandria, VA Joy E. Blotmt Georgia Department of Education Atlanta, GA Donna Blum National Institutes of Health Bethesda, MD Stephanie Bordenick National Institutes of Health Rockville, MD Mary Ellen Bradshaw, M.D. Bureau of School Health Service Washington, DC Charlotte Brantley Texas Department of Human Services Austin, TX George Brenneman U.S. Public Health Service Rockville, MD Patrick Bresette Center for Public Policy Priorities Austin, TX Adrienne Brigmon Head Start Bureau Washington, DC Robin Brocato, M.H.S. Head Start Bureau Washington, DC Leigh Brown Oklahoma State Department of Health Oklahoma City, OK Linda Brown Health Care Financing Administration Washington, DC Scott Brown U.S. Department of Education Office of Special Education Programs Washington, DC MarshaE. Butler, D.D.S., M.P.H. Colgate-Palmolive Company New York, NY John A. Butterfield President's Council on Physical Fitness and Sports Washington, DC Ann G. Cagigas, R.N., IBCLC Guaynabo, PR Suzanne Camp Greater Southeast Healthcare System Washington, DC Mary M. Campbell American Psychological Association Washington, DC Rose Cardinal Asthma and Allergy Foundation Washington, DC Mary Brecht Carpenter, R.N., M.P.H. National Commission to Prevent Infant Mortality Washington, DC Lorraine Carrimon Wisconsin Winnebago Health Authority Mauston, WI A-6 Parents Speak Out for America's Children General Participants Sylvia Carter Head Start Bureau College Park, MD Sandra Carton Head Start Bureau Washington, DC DonnaRae Castillo National Research Service Award Training Program Rockville, MD Jennifer M. Cernoch, Ph.D. Santa Rosa Children's Hospital San Antonio, TX Gwen D. Chance Texas Head Start Collaboration Austin, TX Barbara E. Chandler, M.O.T., O.T.R. American Occupational Therapy Association Rockville, MD Bruce R. Chelikowsky Indian Health Service Rockville, MD Ann Chen Nurses Association of the College of Obstetricians and Gynecologists Washington, DC Deborah Clark National Immunization Campaign Washington, DC Valencia Clarke Association for the Care of Children's Health Bethesda, MD Deborah Clendaniel, M.S. Delaware Maternal and Child Health Services Dover, DE Helen T. Closson Elliot Health System Manchester, NH Beverly Coleman-Miier, M.D. The BCM Group, Inc. Washington, DC Robert J. Collins Indian Health Service Rockville, MD Donna L. Conforti U.S. Department of Education Washington, DC Mary Ann Cooney Manchester Health Department Manchester, NH L4x-i Cooper Healthy Mothers, Healthy Babies Washington, DC Genevive W. Cornelius U.S. Department of Education Office of Elementary and Secondary Education Washington, DC i&ma Critz U.S. Department of Education Washington, DC Nancy Cude Arlington Early Intervention Coordinating Council Arlington, VA Ronald Daly U.S. Department of Agriculture Extension Service Washington, DC Diane D'Angelo RMC Research Corporation Portsmouth, NH Suzanne Danielson Department of Health and Hospitals Baton Rouge, LA Margaret (Peg) M. Davis Governor's Planning Office Harrisburg, PA Robert E. Dawson U.S. Public Health Service Rockville, MD Alberta Day Wisconsin Winnebago Health Authority Mauston, WI Mary Dale DeBore Bethesda, MD Chris DeGraw, M.D., M.P.H. U.S. Department of Health and Human Services Office of the Assistant Secretary of Health Washington, DC Debra Delgado School Based Adolescent Health Care Program Washington, DC Diana Denboba U.S. Public Health Service Rockville, MD Sara Reed DePersio Oklahoma Department of Health Oklahoma City, OK Julie DeSeyn The Home and School Institute Washington, DC Report of the Surgeon General's Conference A-9 General Participants Leslie Dunne Healthy Mothers, Healthy Babies Washington, DC Bob Erbetta U.S. Naval Reserve-Campaign Drug Free America Marblehead, MA Dee Dickehnan Child Protection Program Falls Church, VA Eden Fisher Durbin Y.M.C.A. of the U.S.A. Washington, DC Patricia Divine-Hawkins Head Start Bureau Washington, DC Alyson Escobar U.S. Department of Agriculture Hyattsville, MD Melanie Earl Santa Rosa Children's Hospital San Antonio, TX Clare M. Dome&i U.S. Department of Health and Human Services Washington, DC Juanita C. Evans, M.S.W. U.S. Public Health Service Rockville, MD Larry Edehnan The Kennedy Institute Baltimore, MD Nancy Evans Manchester School District Manchester, NH Dana M. Dorf U.S. Department of Agriculture Food and Nutrition Service Boston, MA Maurice J. Elias, Ph.D. Rutgers University New Brunswick, NJ Elizabeth Farquhar, Ph.D. U.S. Department of Education Office of the Undersecretary Washington, DC Laura Drake Barbara Bush Foundation for Family Literacy New York, NY Gail Johnston Ellis Epilepsy Foundation of America Landover. MD Herta B. Feely National SAFE KIDS Campaign Washington, DC M. Ann Drum, D.D.S., M.P.H. Office of the Surgeon General Washington, DC AM Ellwood Minnesota Early Learning Design Minneapolis, MN Janice Feld Legislative Affairs Specialist Alexandria, VA Mary Jean Duckett Health Care Financing Administration Baltimore, MD Martha Emerling Schwartz Foundation Mt. Laurel, NJ Karen S. Fennell American College of Nurse- Midwives Washington, DC B. Richmond Dudley, Jr. General Services Administration Washington, DC LaRue Emmell Montgomery County Health Department Norristown, PA Sister Isolina Fen+ Easter Seals Ponce, PR John C. Duffy U.S. Public Health Service Rockville, MD Lou Enoff Social Security Administration Baltimore, MD M. J. Fmgland Office of the Surgeon General Washington, DC Janet Dumont U.S. Public Health Service Rockville, MD Willie L. Epps, Ph.D. St. Clair County Head Start Program East St. Louis, IL Marilyn J. Flood Child Care Action Campaign New York, NY DennisDunn Growing Child Lafayette, IN A-10 Parents Speak Out for America's Children Tony Fowler U.S. Department of Education Washington, DC Amy Fox American Academy of Pediatric Dentistry Chicago, IL Harriette Fox Fox Health Policy Consultants, Inc. Washington, DC Clara L. French U.S. Department of Agriculture Food and Nutrition Service Alexandria, VA Amy Friedlander U.S. General Accounting Office Washington, DC Robert G. Froehlke, M.D. Office of the Surgeon General Washington, DC Robin S. Funston U.S. Department of Health and Human Services Offke of the Secretary Washington, DC Margaret Garikes Office of the Surgeon General Washington, DC Constance Gamer, R.N.C., MAN., Ed.S. U.S. Department of Education Office of Special Education Programs Washington, DC Preston J. Garrison United Way of America Alexandria, VA Karen T. Garthright U.S. Department of Health and Human Services Food and Drug Administration Rockville, MD Kay Ghahremani U.S. Department of Agriculture Food and Nutrition Service Alexandria, VA Frankie Gibson Head Start Bureau Washington, DC Barbara Gleason America 2000 Washington, DC Miie Golden Maryland Department of Health and Mental Hygiene Baltimore, MD Gloria Gonzalez Office of the Surgeon General Washington, DC Nilda M. Gonzalez Puerto Rico Easter Seals San Juan, PR Bill Gould National Network of Self Help Clearinghouses Los Angeles, CA Linda Graham Children's Rehabilitation Service Montgomery, AL Holly Grason Association of Maternal and Child Health Programs Washington, DC General Participants Pamela Greenberg National Association of Pediatric Nurses and Practitioners Washington, DC Joan Greene National Association of Pediatric Nurses and Practitioners Arnold, MD Sarah M. Greene Administration for Children, Youth and Families Alexandria, VA Aido G. Gregory Puerto Rico Department of Health Puerto Rico Sue Greig, M.S., R.D. American School Food Service Association Manhattan, KS Jerry Griepentrog Carson City, NV Mark Grimes American Academy of Pediatrics Elk Grove Village, IL Lucy Gritzmacher Candlelighters Childhood Cancer Foundation Washington, DC Virgil Gulker Love, Inc. Holland, MI Lynn F. Gurkhx Department of Environment, Health, and Natural Resources Raleigh, NC William H.J. Haffner, M.D. Indian Health Service Bethesda, MD Report of the Surgeon General's Conference A-l 1 General Participants Cynthia Haileselassie U.S. Department of Health and Human Services Washington, DC Barbara Halhnan U.S. Department of Agriculture Food and Nutrition Service Alexandria, VA Janice Hamilton JMH Communications New York, NY Anne L. Hansen Michigan Department of Education Lansing, Ml Connie Hansen Council of Community Services of Roanoke Roanoke, VA Kirsten Hansen, M.Ed. Georgetown University Child Development Center Washington, DC Robert G. Harmon, M.D., M.P.H. Health Resources and Services Administration Rockville, MD Jackie Harrison, R.N. Children's Hospital New Orleans, LA Max Harrison American School Food Service Association Alexandria, VA Edith Harvey U.S. Department of Education Office of Migrant Education Washington, DC William Haskins National Urban League New York, NY Laura Havens March of Dimes Washington, DC Ethel Hawkins District of Columbia General Hospital Washington, DC BarbaraHeiser, R.N., B.S.N., IBCLC La Leche League International Franklin Park, IL Michael H. Henrichs, Ph.D. Rids Adjusting Through Support, Inc. Rochester, NY 0. Marie Henry, R.N., DNSC, FAAN Office of the Surgeon General Washington, DC Victoria Hertel American School Health Association Littleton, CO Catherine A. Hess, MSW American Public Health Association Washington, DC Laurie Hicherson U.S. Department of Agriculture Food and Nutrition Service Alexandria, VA Grant Higginson, M.D., M.P.H. Office of Health Services Portland, OR Donna Hines U.S. Department of Agriculture Food and Nutrition Service Alexandria, VA Sandra L. Hofferth, Ph.D. The Urban Institute Washington, DC Patrick F. Hogan U.S. Department of Education Office of Migrant Education Washington, DC Joan Holloway Division of Special Populations Program Development Rockville, MD Silvia Holschneider National Health Education Consortium Washington, DC Jerry K. Hood U.S. Public Health Service Rockville, MD Beverly J. Hoover American Red Cross Washington, DC Wade F. Horn, Ph.D. Administration for Children, Youth and Families Washington, DC Karen Home South Carolina Governor's Office Columbia, SC Alice M. Horowitz National Institutes of Health Bethesda, MD Vernon N. Houk, M.D. Centers for Disease Control Atlanta, GA A-12 Parents Speak Out for America's Children Frances Howard National Library of Medicine Rockville, MD Judy Hudgius Virginia Department of Education Richmond, VA Louise Hunt, R.N., B.S.N. U.S. Public Health Service Rockville, MD Vince L. Hutchins U.S. Public Health Service Rockville, MD Michael T. Hymn, Ph.D. University of Wisconsin- Milwaukee Milwaukee, WI Darla ldeus Center on Budget and Policy Priority Washington, DC Roger Iron Cloud Head Start Bureau Washington, DC Angeles Lopez Isales Departamento de Education de Puerto Rico Hato Rey, PR Brenda James-Pitt Montgomery County Health Department Norristown, PA Mary A. Jansen, Ph.D. U.S. Department of Health and Human Services Alcohol, Drug Abuse and Mental Health Administration Rockville, MD David Johnsen Case Western Reserve University Cleveland, OH Beverly H. Johnson Association for the Care of Children's Health Bethesda, MD Dr. Jerry M. Johnson U.S. Coast Guard Washington, DC Richard H. Johnson, ACSW Head Start Bureau Washington, DC Susan Johnson Texas - Office of the Governor Austin, TX Dennis Jolley Office of the Surgeon General Washington, DC Bertha Jones U.S. Department of Housing and Urban Development Washington, DC Cami Jones Texas Education Agency Austin, TX Deborah Jones New Jersey State WIG Program Trenton, NJ Linda Jupin U.S. Department of Agriculture Food and Nutrition Service Washington, DC Marta Kealey U.S. Department of Agriculture Food and Nutrition Service Alexandria, VA General Participants Woodie Kessel U.S. Public Health Service Washington, DC Arlene Kiely Association for the Care of Children's Health Bethesda, MD Stephen King Agency for Health Care Policy and Research Rockville, MD Randy Kingsley U.S. Department of Education Washington, DC Regina L. Kinnard U.S. Department of Education Washington, DC Kllen Kliason Kisker, Ph.D. Mathematics Policy Research, Inc. Princeton, NJ Nancy Kleckner Growing Child, Growing Parent Lafayette, IN Jean Klinge U.S. Department of Education Washington, DC Jane Kratovil Council of Chief State School Officers Washington, DC Stephen H. Kreimer National School Health Education Coalition Washington, DC Mary A. Krickus American School Food Service Association Alexandria, VA Report of the Surgeon General's Conference A-13 General Participants Heidi Kurtz American Federation of Teachers Washington, DC Harms Kuttner Office of Policy Development The White House Washington, DC Leslie Lanham Children's Defense Fund-Texas Austin, TX Cheryl LaPointe U.S. Public Health Service Rockville, MD Georgianna Larson Pathfinder Resources, Inc. St. Paul, MN K&ten Larson U.S. Department of Health and Human Services Washington, DC Dora L. Lasanta Departamento de Education de Puerto Rico Bayamou, PR Bill Latimer North Carolina Governor's Office Washington, DC Charles LaVallee Western Pennsylvania Caring Foundation, Inc. Pittsburgh, PA Donna F. LaVallee New Visions for Newport County Newport, RI Jean E. Lazar U.S. Public Health Service Rockville, MD Rice C. Leach, M.D. Office of the Surgeon General Rockville, MD Brenda Leath National Health/Education Consortium Washington, DC Meg Leavy University of Maryland College Park, MD Alice Lenihan, R.D. North Carolina State Department of Environment, Health and Natural Resources Raleigh, NC Donna Len0 Indian Health Service Rockville, MD Susan Lenox Goldman State of New Jersey Trenton, NJ AmlW.Lewin The National Learning Center Washington, DC Helen D. Lilly, Ph.D. U.S. Department of Agriculture Food and Nutrition Serivce Alexandria, VA Lauren Long Columbia, MD Thomas J. Long, Ph.D. Long and Associates Bethesda, MD John T. MacDonald, Ph.D. U.S. Department of Education Assistant Secretary of Education for Elementary and Secondary Education Washington, DC Thomas C. MacMichael Comprehensive Health Investment Project (CHIP) Replication - Total Action Against Poverty (TAP) Roanoke, VA Edward Madigan Secretary of Agriculture Washington, DC Patricia Mail U.S. Public Health Service Rockville, MD Lani Smith Majer Anne Arundel County Health Department Annapolis, MD Pamela Mangu Georgetown University Washington, DC Howard Manly Deputy Commissioner of Public Health Washington, DC James Manning U.S. Department of Education Washington, DC Carolyn Marsh Arkansas Children's Hospital Little Rock, AR Judy Martiu East Kentucky Child Care Coalition Annville, KY Jo& Martinez Puerto Rico Department of Health Puerto Rico A-14 Parents Speak Out for America's Children Julian Martinez U.S. Department of Education Washington DC James 0. Mason, M.D. Assistant Secretary for Health U.S. Department of Health and Human Services Washington, DC Jiiy Mason Office of the Surgeon General Washington, DC Debbie Massey U.S. Department of Agriculture Food and Nutrition Service McLean, VA Bijoy Mathew Association of Maternal and Child Health Programs Washington, DC Lisa Matras Office of the Surgeon General Washington, DC William P. Matson Commonwealth of the Northern Mariana Islands Public School System Saipan, MP ThurmaMcCaun, M.D., M.P.H. Office of Healthy Start Rockville, MD Mark C. McClary National Association of WIC Directors Washington, DC Phyllis McClure National Association for the Advancement of Colored People Legal Defense and Educational Fund, Inc. Washington, DC Beverly McConnell Michigan Department of Public Health Detroit, MI Pat McCulla Children's Hospice International Alexandria, VA Sandra J. McElhauey, MA. National Mental Health Association Alexandria, VA Dr. Alice M&ii U.S. Navy Personal Excellence Partnership Program Washington, DC Mary McGonigel Association for the Care of Children's Health Bethesda, MD Dennis D. McUbeuny Charles Webb Easter Seals Center Parent Association Mt. Pleasant, SC Patricia A. McKee, ED U.S. Department of Education Office of Elementary and Secondary Education Washington, DC Connie McLendon Texas Association for the Gifted and Talented Round Rock, TX Elizabeth McMauis Barbara Bush Foundation for Family Literacy Washington, DC Michelle H. Metts Cabinet for Human Resources Frankfort, l?3' General Participants Angela D. Mickalide National SAFE RIDS Campaign Washington, DC Elizabeth Milder-Beh Pennsylvania Governor's Office Harrisburg, PA Cbristiue Miller US. Department of Education Washington, DC Howard T. Miller Glenn Dale Early Childhood Center Glendale, MD Robert C. Miier Todd County Schools Mission, SD June Million National Association of Elementary School Principals Alexandria, VA Claudette Mitchell, M.BA U.S. Public Health Service Rockville, MD W&e Mitchell Office of the Surgeon General Washington, DC Evelyn Moth D.O.T. Day Care, Inc. Washington, DC William Modzeleski U.S. Department of Education Washington, DC Eileen L. Moe, CSW-ACP Texas Health Department Austin, TX Linda G. Morra U.S. General Accounting Offtce Washington, DC Report of the Surgeon General's Conference A-15 General Participants Claudia Morris Healthy Mothers, Healthy Babies Washington, DC Jo& Murioz National Coalition of Hispanic Health and Human Services Organizations Washington, DC Martha Naismith Johnson &Johnson HMI W'ashington, DC Carol Naswortby Texas Work and Family Clearinghouse Austin, TX Pam Navarro National Institutes of Health Germantown, MD Richard P. Nelson, M.D. Child Health Specialty Clinics Iowa City, IA Liz Newhouse Texas Respite Resource Network San Antonio, TX Mary Nichols Sigma Theta Tau Clifton, VA Erik Nielsen American Occupational Therapy Association Rockville, MD Lulu Mae Nix, J&AD. National Institute for Integrated Family Services Camden, NJ Julie M. Novak Alabama Department of Public Health Montgomery, AL Jackie Noyes American Academy of Pediatrics Washington, DC Christine Nye Health Care Financing Administration Baltimore, MD Diane O'Conor Governor's Office for Children, Youth, and Families Baltimore, MD Godfrey P. Oakley, Jr., M.D. Centers for Disease Control Atlanta, GA William Oliver PRIDE Parent Training Marietta, GA Sally Olsen Santa Rosa Children's Hospital San Antonio, TX Walter A. Orenstein, M.D. Centers for Disease Control Atlanta, GA Belinda Ortega Ysleta Del Sur Pueblo El Paso, TX JoAnne Owens-Nauslar Nebraska Department of Education Lincoln, NE Miriam Padilla, M.D. Rockville, MD Deborah Parham Special Initiative, Policy and Evaluation Branch Rockville, MD Barbara Park American Dental Association Chicago, IL Steven Parker, M.D. Boston City Hospital Boston, MA Sandra Parks-Trusz, Ph.D. Epilepsy Foundation of America Landover, MD John Patrick Pa&no U.S. Department of Agriculture Food and Nutrition Service Alexandria, VA Lori Pastro U.S. Department of Health and Human Services Washington, DC Anne L. Pavlich, R.N. U.S. Consumer Product Safety Commission Bethesda, MD Robym J. Payne Girl Scouts of the U.S.A. New York, NY Gloria Pereira Frederick County Head Start Frederick, MD Steve Perxnison, M.D. Indian Health Service Washington, DC Hihna M. Persson Woodbridge, VA Alwin K. Peterson Michigan Department of Public Health Lansing, MI A-16 Parents Speak Out for America's Children General Participants Sharon L. Philip Alexandria City Health Department Alexandria, VA Patricia Pbipps Institute for Child Care Professionals Houston, TX Patricia Place Natural Academy of Sciences Washington, DC Deborah Fells Pleasants Washington DC Public Schools Washington, DC Julia Plotnick, R.N.C., M.P.H. U.S. Public Health Service Rockville, MD Michele A. Plutro, Ed.D. Head Start Bureau Washington, DC Betty S. Poehhnan National School Boards Association Alexandria, VA Susan Poisson, M.A. Reginald S. Lourie Center for Infants and Young Children of Maryland and Virginia Rockville, MD Florene Stewart Poyadue Parents Helping Parents San Jose, CA E. Ann Prendergast U.S. Public Health Service Rockville, MD Theressa Price, R.N. Jackson-Hinds Comprehensive Health Center Jackson, MS Daniel Puntillo, Jr. Middle Earth Somerville, NJ Kathryn F. Purnell South Carolina Department of Health and Environmental Control Columbia, SC James F. Quilty, Jr., M.D. Ohio Department of Health Columbus, OH Craig T. Ramey, Ph.D. University of AIabama- Birmingham Birmingham, AL Arnold D. Ramirez Phoenix Human Services Head Start Phoenix, AZ MariaRapuano Alliance To End Childhood Lead Poisoning Washington, DC Karl A. Reis U.S. Department of Agriculture Food and Nutrition Service Alexandria, VA Letitia Rennings, M.S. U.S. Department of Education Washington, DC Judith Ressallat National Association of School Nurses, Inc. Washington, DC Christopher Rigaux National Center for Education in Maternal and Child Health Washington, DC Suzanne Ripley National Information Center for Children and Youth with Disabilities McLean, VA Lourdes A. Rivera Children's Defense Fund Washington, DC Latricia Robertson U.S. Public Health Service Rockville, MD Diana Robinson Center for Successful Child Development Chicago, IL Cindy Rojas Rodriguez Southwest Educational Development Laboratory Austin, TX Mark L. Rosenberg, M.D., M.P.P. Centers for Disease Control Atlanta, GA Judith Rosenburg, LCSW Support Group Training Project Berkeley, CA John P. Rossetti U.S. Public Health Service Rockville, MD Paula Russell Texas Health Department Austin, TX Jesus Saavedra, M.D. U.S. Public Health Service Washington, DC Patricia A. Salomon, M.D., C.M.O. U.S. Department of Health and Human Services Rockville, MD Report of the Surgeon General's Conference A-17 General Participants Helen Scheirbeck Head Start Bureau Washington, DC Diane Schilder U.S. General Accounting O&e Washington, DC Elizabeth Schmidt Of&e of the Surgeon General Washington, DC George A. Schmidt, Ph.D. Florida State Interagency Office of Disability Prevention Tallahassee, FL William Sciarillo Maryland State Health Department Baltimore, MD Mary A. Scoblic, R.N., M.N. Michigan Department of Public Health Lansing, MI Elaine L. Scott Capitol Children's Museum Washington, DC Maureen Seller National Center for Education in Maternal and Child Health Washington, DC Fadrienne Sessions Jackson Hines Comprehensive Health Center Jackson, MS Paula M. Sheahan National Center for Education in Maternal and Child Health Washington, DC Steven P. Shelov, M.D. Albert Einstein College of Medicine Bronx, NY Joy Shelton Delta College University Center, MI Bill Shepardson Council of Chief State School Officers Washington, DC Phyllis J. Siderits Institute for Child Health Policy Gainesville, FL Tom Slatton, Ph.D. Texas Department of Human Resources Amarillo, TX Elizabeth Sloan Elliot Health Systems/Elliot Hospital Manchester, NH Allen N. Smith Head Start Bureau Washington, DC Becky J. Smith, Ph.D. Association for the Advancement of Health Education Reston, VA Marnie Smith Peyser Associates Washington, DC Joanne Smogor Manchester School District Manchester, NH John A. Snowden Capitol Children's Museum Washington, DC Carolyn Snyder U.S. Department of Education Washington, DC ShenieSocha Governor's Development Disability Council Omaha, NE Denise Sofka U.S. Public Health Service Rockville, MD Marian Sokol, Ph.D The Children's Hospital Ambulatory Care Center San Antonio, TX Benita Somerfield Barbara Bush Foundation for Family Literacy New York, NY Lydia Soto-Torres, M.D., M.P.H. Office of the Surgeon General Washington, DC Georgeline Sparks Indian Health Service Rockville, MD Lynn Spector U.S. Public Health Service Rockville, MD Leslie Stablein Arlington County Department of Human Services Arlington, VA Irene Steibii Maryland Department of Human Resources Baltimore, MD Walter Steidle, Ph.D. U.S. Department of Education Washington, DC A-18 Parents Speak Out for America's Children General Participants Lisa M. Tate American Academy of Pediatrics Washington, DC John Steindorf Wisconsin Winnebago Health Authority Mauston, WI Elizabeth Tuckermanty U.S. Department of Agriculture Nutrition Extension Service Washington, DC Stephen B. Thacker, M.D., M.Sc. Centers for Disease Control Atlanta, GA Delores Stewart U.S. Department of Agriculture Food and Nutrition Service Trenton, NJ Leticia Ubinas, M.D. U.S. Public Health Service Alexandria, VA Carolyn Thiel U.S. Department of Agriculture Food and Nutrition Service Alexandria, VA Jenifer Van Deusen Maine Department of Education Augusta, ME Dianne Stewart Center for Public Policy Priorities Austin. TX Josie Thomas Association for the Care of Children's Health Bethesda, MD Nancy Van Doren The Travelers Companies Foundation Hartford, CT Joyce P. Stines Appalachian State University Boone, NC Lucy A. Thompson District of Columbia General Hospital Washington, DC Kaye Vander Ven U.S. Public Health Service Alexandria, VA Rosalie Streett Parent Action Baltimore, MD Ann P. Streissguth, Ph.D. University of Washington School of Medicine Seattle, WA Karen VanIandeghem National School Health Education Coalition Washington, DC Claudia Thorne Greater Southeast Healthcare System Washington, DC Nancy &riffler Georgetown University Child Development Center Washington, DC Peter K. Vaslow Institute for the Enhancement of Family Development Bethesda, MD Janet Tognetti U.S. Department of Agriculture Food and Nutrition Service Alexandria, VA Dr. Draga Vesselinovitch University of Chicago Chicago, IL Phyllis Stubbs U.S. Public Health Service Rockville, MD Geraldine Tompkins WIC State Agency Washington, DC Candace Sullivan National Association of State Boards of Education Alexandria, VA Viia View National Center for Clinical Infants Program Arlington, VA Debra Jean Torrez Ysleta Del Sur Pueblo El Paso, TX Carol Treen Manchester School District Manchester, NH Amin Wahab Community Development Institute Lakewood, CO Louis Sullivan, M.D. Secretary of Health and Human Services Washington, DC Lori Tremmel American Public Health Association Washington, DC Sherlie Svestka U.S. General Accounting Office Washington, DC Report of the Surgeon General's Conference A-19 General Participants Elayne Walker National Association of Community Health Centers Washington, DC Mary C. Wallace U.S. Department of Health and Human Services Food and Drug Administration Rockville, MD Janet Wallinder Multnomah County Health Department Portland, OR Megan Walline Department of Justice Washington, DC Sharon Walsh Burke, VA Gailya P. Walter Centers for Disease Control Washington, DC Millie Waterman National Parent-Teacher Association Mentor, OH Mary Jo Waters Love, Inc. Holland, MI C. J. Wellington, M.D. Children with Special Health Care Needs Washington, DC Valerie Ahn Welsh U.S. Public Health Service Washington, DC Jerry West National Center for Educational statistics Washington, DC Beth Wetherbee Delaware Division of Public Health Dover, DE Debra Whitford U.S. Department of Agriculture Food and Nutrition Service Alexandria, VA Clarissa Whittenberg National Institutes of Health Washington, DC Steve Wickizer, R.Ph. Office of the Surgeon General Washington, DC I.0l-i wicks Fox Health Policy Consultants, Inc. Washington, DC Sally Wilberding National Institute for Dental Research Bethesda, MD Barbara A. Wtier, Ph.D. National Association for the Education of Young Children Washington, DC A. Kenton Williams, Ed.D. Head Start Bureau Washington, DC J. Terry Williams, R.D., M.P.H. Wyoming Department of Health Cheyenne, WY Kim Williams Arkansas Children's Hospital Little Rock, AR Barbara Wells Willis: U.S. Department of Agriculture Washington, DC Loma Wilson, R.N., M.S.P.H. Missouri Department of Health Jefferson City, MO Modena E.H. Wilson, M.P.H., M.D. Johns Hopkins University Baltimore, MD Shirley I. Wilson Commission on Public Health Silver Spring, MD Susan winillgar U.S. Department of Education Washington, DC Mildred M. Winter, M.Ed. Parents as Teachers National Center St. Louis, MO Bonnie Wise United Planning Organization Washington, DC Frances 0. Witt Maryland State Department of Education Baltimore, MD KeIIy woods JMH Communications New York, NY Beverly Wright U.S. Public Health Service Rockville, MD Sharon E. Yandian Head Start Bureau Washington, DC Dorothy M. Yonemitsu San Diego Imperial Developmental Services, Inc. and the Union of Pan Asian Communities San Diego, CA A-20 Parents Speak Out for America's Children General Participants Lenore Zedosky West Virginia Department of Education Charleston, WV Edward Zigler, Ph.D. Yale University New Haven, CT Report of the Surgeon General's Conference A-21 Advisory Group The Surgeon General's Conference am -- The Critical Role of Parents Washington, DC February g-12,1992 William R. Archer III, M.D. Deputy Assistant Secretary for Population Affairs U.S. Department of Health and Human Services Hubert H. Humphrey Building Room 736E 200 Independence Avenue, SW Washington, DC 20201 Jane Baird Deputy Assistant Secretary for Planning and Evaluation U.S. Department of Health and Human Services Hubert H. Humphrey Building Room 410E 200 Independence Avenue, SW Washington, DC 20201 Daniel Bonner Deputy Assistant Secretary for Elementary and Secondary Education U.S. Department of Education Room 2181, FOB 6, Mailstop 6100 400 Maryland Avenue, SW Washington, DC 20202 Richard Chambers Director, Intergovernmental Affairs Office Health Care Financing Administration U.S. Department of Health and Human Services Hubert H. Humphrey Building Room 410B 200 Independence Avenue, SW Washington, DC 20201 Chris DeGraw, M.D., M.P.H. Coordinator for the Children and Schools Program Office of Disease Prevention and Health Promotion U.S. Public Health Service U.S. Department of Health and Human Services Switzer Building, Room 2132 330 C Street, SW Washington, DC 20201 Marilyn H. Gaston, M.D. Director, Bureau of Health Care Delivery and Assistance U.S. Public Health Service U.S. Department of Health and Human Services Parklawn Building, Room 7-05 5600 Fishers Lane Rockville, MD 20857 B-2 Parents Speak Out for America's Children AlanHinman, M.D., M.P.H. Director, Center for Prevention Services Centers for Disease Control U.S. Public Health Service U.S. Department of Health and Human Services 1600 Clifton Road, Mail Stop E07 Atlanta, GA 30333 Wade Horn, Ph.D. Commissioner, Administration for Children, Youth and Families Administration for Children and Families U.S. Department of Health and Human Services Switzer Building, Room 2026 330 C Street, SW Washington, DC 20201 Vince L. Hutchins, Ph.D. Acting Director, Maternal and Child Health Bureau Health Resources and Services Administration U.S. Public Health Service U.S. Department of Health and Human Services Parklawn Building, Room 9-03 5600 Fishers Lane Rockville, MD 20857 Elaine Johnson, Ph.D. Director, Office for Substance Abuse Prevention Alcohol, Drug Abuse and Mental Health Administration Rockwall II, Room 9D-10 5600 Fishers Lane Rockville, MD 20857 Paul Johnson, Ph.D. Office of Health Planning and Evaluation Office of the Assistant Secretary for Health U.S. Public Health Service U.S. Department of Health and Human Services Hubert H. Humphrey Building Room 740G 200 Independence Avenue, SW Washington, DC 20201 Hanns Kuttner Associate Director for Health and Social Services Policy Old Executive Office Building, Room 219 Washington, DC 20500 John T. MacDonald, Ph.D. Assistant Secretary for Elementary and Secondary Education U.S. Department of Education 400 Maryland Avenue, SW Room 2189 Washington, DC 20202 Rae Nelson Deputy Associite Director for Education and Drug Policy Old Executive Office Building, Room 218 Washington, DC 20500 Jeffrey Rosenburg Special Assistant to the Commissioner Administration on Children, Youth, and Families Administration for Children and Families Hubert H. Humphrey Building 200 Independence Avenue, SW Washington, DC 20201 David Rostetter Coordinator, School Readiness Initiative Office of the Assistant Secretary for Planning and Evaluation U.S. Department of Health and Human Services Hubert H. Humphrey Building Room 415F 200 Independence Avenue, SW Washington, DC 20201 Stephen J. Sepe, Ph.D., M.P.H. National Vaccine Program Coordinator Division of Immunization National Center for Prevention Services Centers for Disease Control U.S. Department of Health and Human Services 1600 Clifton Road, Mail Stop E-07 Atlanta, GA 30333 Carolyn Snyder Confidential Assistant to the Assistant Secretary for Elementary and Secondary Education U.S. Department of Education Room 2181, FOB 6, Mailstop 6100 400 Maryland Avenue, SW Washington, DC 20202 Report of the Surgeon General's Conference B-3 W. Craig Vandexwagen, M.D. Acting Associate Director, Office of Health Programs Indian Health Service U.S. Public Health Service U.S. Department of Health and Human Services Parklawn Building, Room 6A-55 5600 Fishers Lane Rockville, MD 20857 Ronald J. Vogel Director, Supplemental Food Programs Food and Nutrition Service U.S. Department of Agriculture 3101 Park Center Drive, Room 1017 Alexandria, VA 22302 Gailya Walters Program Officer Office on Smoking and Health U.S. Department of Health and Human Services Switzer Building, Room 1229 330 C Street, SW Washington, DC 20201 Valerie Ahn Welsh Office of Health Planning and Evaluation U.S. Department of Health and Human Services Hubert H. Humphrey Building Room 740G 200 Independence Avenue, SW Washington, DC 20201 Paul Wise, M.D., M.P.H. Maternal and Child Care Health Expert Joint Program in Neonatality 221 Longwood Avenue, 5th Floor Boston, MA 02115 Sumner Yaffe, M.D. Director, Center for Research for Mothers and Children National Institute for Child Health and Human Development National Institutes of Health U.S. Public Health Service U.S. Department of Health and Human Services Executive Plaza North, Room 643 9000 Rockville Pike Bethesda, MD 20892 Office of the Surgeon General U.S. Public Health Service U.S. Department of Health and Human Services Hubert H. Humphrey Building 200 Independence Avenue, SW Washington, DC 20201 M. Ann Drum, D.D.S., M.P.H. Special Assistant for Program Activities M.J. Fiigland Director of Public Affairs Margaret Garikes Executive Assistant Louise Hunt, R.N., B.S.N. Assistant to the Chief of Staff Rice C. Leach, M.D. Chief of Staff Lisa Matras Special Assistant Winnie Mitchell Policy Coordinator for AIDS and Underage Drinking Elizabeth Schmidt Director of Communications Lydia Soto-Ton-es, M.D., M.P.H. Policy Coordinator for Women's Health B-4 Parents Speak Out for America's Children 8 Planning 0 v c ommittee CD 3 Q mm x The Surgeon General's Conference The Critical Role of Parents Washington, DC February g-12,1992 Robin Brocato, M.H.S. Health Specialist Head Start Bureau U.S. Department of Health and Human Services P.O. Box 1182 Washington, DC 20513 Chris DeGraw, M.D., M.P.H. Coordinator of Children and Schools Program Office of Disease Prevention and Health Promotion Office of the Assistant Secretary of Health U.S. Department of Health and Human Services 2132 Switzer Building 330 C Street, SW Washington, DC 20201 Diana Denboba Public Health Analyst Habilitative Services Branch Maternal and Child Health Bureau U.S. Public Health Service U.S. Department of Health and Human Services Parklawn Building, Room 18A-18 5600 Fishers Lane Rockville, MD 20857 M. Ann Drum, D.D.S., M.P.H. Special Assistant for Program Activities Office of the Surgeon General U.S. Public Health Service U.S. Department of Health and Human Services Hubert H. Humphrey Building Room 718E 200 Independence Avenue, SW Washington, DC 20201 Robert G. Froehlke, M.D. Special Assistant to the Surgeon General Office of the Surgeon General U.S. Public Health Service U.S. Department of Health and Human Services Hubert H. Humphrey Building Room 718E 200 Independence Avenue, SW Washington, DC 20201 Louise Hunt, R.N., B.S.N. Assistant to the Chief of Staff Office of the Surgeon General U.S. Public Health Service U.S. Department of Health and Human Services Parklawn Building, Room 18-67 5600 Fishers Lane Rockville, MD 20857 Liuda Jupin Food Program Specialist Food and Nutrition Service U.S. Department of Agriculture 3101 Park Center Drive, Room 540 Alexandria, VA 22302 Marta Kealy Food Program Specialist Food and Nutrition Service U.S. Department of Agriculture 3101 Park Center Drive, Room 540 Alexandria, VA 22302 C-2 Parents Speak Out for America's Children Miriam A. Kelly, Ph.D. Project Officer Center for Medical Effectiveness Research Agency for Health Care Policy and Research U.S. Public Health Service U.S. Department of Health and Human Services 6001 Montrose Road, Suite 704 Rockville, MD 20852 Dushanka V. Kleimnan, D.D.S., M.Sc.D. Deputy Director National Institute of Dental Research National Institutes of Health U.S. Public Health Service U.S. Department of Health and Human Services Building 31, Room 2C39 9000 Rockville Pike Bethesda, MD 20892 Jean Klinge Special Assistant to the Director of Compensatory Education Programs US. Department of Education 400 Maryland Avenue, SW, Room 2043 Washington, DC 20202 Rice C. Leach, M.D. Chief of Staff Office of the Surgeon General U.S. Public Health Service U.S. Department of Health and Human Services Parklawn Building, Room 18-67 5600 Fishers Lane Rockville, MD 20857 Patricia Mail Public Health Analyst Faculty Development Program National Institute on Alcohol Abuse and Alcoholism U.S. Public Health Service U.S. Department of Health and Human Services Parklawn Building, Room 14C-20 5600 Fishers Lane Rockville, MD 20857 Pamela B. Mangu, MA. Early Childhood Specialist National Center for Education and Maternal and Child Health Georgetown University 38th and R Streets, NW Washington, DC 20057 Lisa Matras Special Assistant Offtce of Surgeon General U.S. Department of Health and Human Services Hubert H. Humphrey Building Room 718E 200 Independence Ave., SW Washington, DC 20201 Julia Plotnick, R.N.C., M.P.H. Chief Nurse U.S. Public Health Service Maternal and Child Health Bureau U.S. Department of Health and Human Services Parklawn Building, Room 18A-19 5600 Fishers Lane Rockville, MD 20857 Carolyn' Snyder Confidential Assistant to the Assistant Secretary for Elementary and Secondary Education U.S. Department of Education 400 Maryland Avenue, SW FOB 6, Room 2189 Washington, DC 20202 Josie Thomas Family Networking Coordinator Association for the Care of Children's Health 7910 Woodmont Avenue, Suite 300 Bethesda, MD 20814 Valerie Ahn Welsh Senior Program Analyst Office of Health Planning and Evaluation U.S. Public Health Service U.S. Department of Health and Human Services Hubert H. Humphrey Building Room 740G 200 Independence Avenue, SW Washington, DC 20201 Report of the Surgeon General's Conference c-3 Agenda at `0 aGlance Agenda at a Glance 2:oo - 530 Registration (Registration 8:00 - 5:30 each day of the Conference) 8:00 - 900 Opening Ceremonies Joint Senice Color Guard and Singers West Invocation Reverend Jeffrey Jerimah Pastor of Fourth Presbyterian Church Bethesda, Maqland Welcome Dr. Louis W. Sullivan Secretary of Health and Human Services Charge to Participants Dr. Antonia C. Novello Surgeon General 900 - 930 Break 9:30 - lo:40 Concurrent Panel Sessions Panel ZA-Healthy Children Ready to Learn: What Are the Roles of Parents, Educators, Health Professionals, and the Community? Panel ZB-Special Issues that Impact Children and Families: Substance Abuse, HIV, and Violence 1045 - 1:15 Parent Work Groups lo:45 - 12:w Concurrent Panel Sessions Panel IA-Early Childhood Issues That Affect School Readiness and Health Lunch During Work Group Panel IB-Helphtg Families Get Services: Some New-Approaches 2:00 - 2:30 Keynote Address George H. Bush President of the United States of America r] Everyone m State Parent Delegates I] General Participants D-2 Parents Speak Out for America's Children 8:30 - 9:00 Keynote Speech Edward Madigan Secretay of Apkulture 9:00 - 9: I5 Break 9:15 - 12:15 Parent Work Groups Lunch During Work Group 12:30 - 3:30 Parent Work Groups 3:30 Break ZOO-3z3O ZOO-3z30 Concurrent Panel Sessions Concurrent Panel Sessions Panel W-Child Cam Two Panel W-Child Cam Two Perspectives Perspectives Panel 5&-Healthy Start, Head Panel 5&-Healthy Start, Head Start, EY~II Start and WIG: Start, EY~II Start and WIG: Integrating Health Education and Integrating Health Education and Social Swvica Programs Social Swvica Programs 12~30 - ZOO tunch I 1 3:30 - 5:30 Exhibits Open 4:oo - 5:oo Workshops 15-28 300 - 9: IO Speech Roger B. Porter Assistant to the President for Economic and Domestic Policy 9:10 - IO:30 Findings of Parent Work Groups IO:30 - 1 I:45 Responder Panel I 1 I:45 - 12:15 Meeting Summary Dr. Antonia C. Novello Surgeon General Monday, February 10 I Tuesday, February 11 4:oo - 5:oo We invite the parents to attend an open forum to share your views on a variety of topics related to raising drug- free children. A panel of representatives from the Department of Education and the Department of Health and Human Services will be present to hear your comments and answer questions about topics such as: J What do children from birth to age seven need to know about drug prevention? J How does drug use affect the lives of young children? J How can parents prepare children to lead drug-free lives? J How can schools and communities help? J What preschool and early elementary programs include drug prevention? J How important are drug education curricula for preschool and early elementary school children7 Report of the Surgeon General's Conference D-3 Fad&on and Recorders The Surgeon General's Conference ptcr 1 -earn -- The Critical Role of Parents Washington, DC February g-12,1992 Robert E. Alexander Migrant Education U.S. Department of Education 400 Maryland Avenue, SW FOB 6, Room 2025 Washington, DC 20202 Robert W. Amler, M.D., MS. Agency for Toxic Substances and Disease Registry Centers for Disease Control U.S. Public Health Service U.S. Department of Health and Human Services 1600 Clifton Road, NE Mailstop E31 Atlanta, GA 30333 Sandy Bastone Office of Analysis and Education Food and Nutrition Service U.S. Department of Agriculture 3101 Park Center Drive, Room 214 Alexandria, VA 22302 Viia Berg Migrant Education U.S. Department of Education 400 Maryland Avenue, SW FOB 6, Room 2025 Washington, DC 20202 Sylvia Carter Head Start, Region 3, Resource Center University of Maryland University College University Boulevard at Aldephi Road College Park, MD 20742 Larry Edelman Project Coordinator, The Kennedy Institute Project Copernicus Department of Family Support Services 2911 E. Biddle Street Baltimore, MD 21213 Sam Fii Walcoff & Associates 635 Slaters Lane, Suite 400 Alexandria, VA 22314 E-2 Parents Speak Out for America's Children &~y Ghahremani Supplemental Food Programs Division Food and Nutrition Service U.S. Department of Agriculture 3101 Park Center Drive, Room 530 ,Uexandria, VA 22302 Frankie Gibson Head Start Bureau P.O. Box 1182 Washington, DC 20013 Donna Hines Supplemental Food Programs Division Food and Nutrition Service U.S. Department of Agriculture 3101 Park Center Drive, Room 540 Alexandria, VA 22302 Roger Iron Cloud Head Start Bureau P.O. Box 1182 Washington, DC 20013 Arlene Kiely Association for the Care of Children's Health National Center for Family-Centered Care 7910 Woodmont Avenue, Suite 300 Bethesda, MD 20814 Jean Klinge U.S. Department of Education FOB 6, Room 2043 400 Maryland Avenue, SW Washington, DC 20202 Donna Leno Indian Health Service Health Education Section Parklawn Building, Room 6A-20 Rockville, MD 20857 Andrea Wargo, Ph.D. U.S. Public Health Service Hubert H. Humphrey Building Room 727E 200 Independence Avenue, SW Washington, DC 20201 Juliane Becket University of Iowa 4555 Westchester Drive, NE Cedar Rapids, IA 52402 Heather Block Child Nutrition Service U.S. Department of Agriculture 3101 Park Center Drive, Room 1007 Food Program Specialist Alexandria, VA 22302 Adrienne Brigmon Head Start Bureau P.O. Box 1182 Washington, DC 20013 Sandra Carton Head Start Bureau P.O. Box 1182 Washington, DC 20013 Donna Rae Castillo National Resources and Services Administration Training Program Division of Education, Evaluation, and Demonstration U.S. Public Health Service U.S. Department of Health and Human Services Parklawn Building, Room 18A-10 Rockville, MD 20857 Tony Fowler U.S. Department of Education FOB 6, Room 2155 Washington, DC 20202 Linda Jupin Supplemental Food Programs Division Food and Nutrition Service U.S. Department of Agriculture 3101 Park Center Drive, Room 540 Alexandria, VA 22302 Report of the Surgeon General's Conference E-3 Marta Kealey Supplemental Food Programs Division Food and Nutrition Service U.S. Department of Agriculture 3101 Park Center Drive, Room 540 Alexandria, VA 22302 Randy Kingsley U.S. Department of Education 400 Maryland Avenue, SW FOB 6, Room 2030 Washington, DC 20202 Patricia D. Mail National Institute on Alcohol Abuse and Alcoholism Faculty Development Program Parklawn Building, Room 14G20 5600 Fishers Lane Rockville, MD 20857 Mary McGonigel Associate Director, Association for the Care of Children's Health National Center for Family-Centered Care 7910 Woodmont Avenue, Suite 300 Bethesda, MD 20814 Latricia Robertson U.S. Public Health Service U.S. Department of Health and Human Services Parklawn Building, Room 18A-55 5600 Fishers Lane Rockville, MD 20857 Helen Scheirbeck Head Start Bureau P.O. Box 1182 Washington, DC 20013 Susan Wininger U.S. Department of Education 400 Maryland Avenue, SW FOB 6, Room 2033 Washington, DC 20202 Sharon E. Yandian Head Start Bureau P.O. Box 1182 Washington, DC 20013 E-4 Parents Speak Out for America's Children Workshops v CD s CL mm x 11 Workshop 1 Eight Fatal Parent Paradigms and What You Can Do About Them The Surgeon General's Conference The Critical Role of Parents Washington, DC February g-12,1992 Bill Oliver Executive Director PRIDE Parent Training Drugs are not new. However, parents' perspectives no\, about drugs are new. This workshop explored eig]rt parental viewpoints that lead to adolescent involvement with the drug culture and described a model that can bt used to shift these viewpoints. Workshop 2 Caring for Your Infant and Young Child, AAP Publication Steven P. Shelov, M.D. Professor and Vice Chairman Albert Einstein College of Medicine Montefiore Medical Center With the AAp's childcare book as an example, this workshop demonstrated to parents how to use th( childcare information found in a parent guide to prc )- mote the health and well-being of their children. Workshop 3 Department of Education Resource Room The Education Resource Room allowed Conferenct' participants to obtain more information on releKmt programs administered by the U.S. Department of Education. Printed materials were available, and pt'[`- gram officers were on hand to explain how each pro- gram works, how to applyforfunding, and other impor.- tant information. F-2 Parents Speak Out for America's Children Workshop 4 Migrant Education: Integration of Services Patrick F. Hogan Education Program Specialist Office of Migrant Education U.S. Department of Education This workshop shared information about the Office of Migrant Education's coordination efforts among vari- ous programs and with other identified agencies that offer services to the Migrant population. Workshop 5 An Introduction to the Head Start-Public School Transition Demonstration: The Importance of Parents Michele Ann Plutro, Ed.D. Education Specialist Head Start Bureau The workshop briefly outlined the Head Start transition demonstration and the key components required for its implementation in 1992,1993, and 1994. The involve- mentofparentsandfamilieswithin thetransitionproject was discussed. Workshop 6 Head Start Initiatives for Parents: The National Parent and Child Centers' Program and the Comprehensive Child Development Program Richard H. Johnson Chief, Social Services, Parent Involvement, Parent- Child Centers' Branch Head Start Bureau AUen N. Smith Special Assistant, Associate Commissioner Head Start Bureau This workshop presented two national special demon- stration programs that are administered by the Head Start Bureau and focused on providing services to income-eligible families with children younger than Head Start age. Both programs emphasize ap.proaches and strategies that support the role of parents. Workshop 7 Preventing Injuries to Children: What, Why, and How Modena E. H. Wilson, M.D., M.P.H. Associate Professor of Pediatrics Johns Hopkins University In this workshop, the most important causes of injury in early childhood were outlined. High risk groups were identified, and developmental issues were discussed. Prevention strategies and their implementation were presented. Supporting materials were provided. Workshop 8 Public Health Issues in Child Daycare Stephen B. Thacker, M.D., M.Sc. Director Epidemiology Program Offtce Centers for Disease Control This workshop focused on the public health issues related to children in daycare. Issues included the prevention of infectious diseases and injuries, the po- tential benefits of child daycare (especially with regard to child development), issues regarding children with special needs, and occupational health issues. Report of the Surgeon General's Conference F-3 Workshop 9 Violence in Childhood: Where Does It Come From and What Can We Do About It? Mark L. Rosenberg, M.D., M.P.P. Director, Division of Injury Control National Center for Environmental Health and Injury Control Centers for Disease Control This workshop examined the problem of violence in America and focused on (1) the magnitude of the prob lem, (2) the impact ofviolence on children, (3) the pub lit health approach to violence prevention, and (4) potential interventions and strategies for prevention. Workshop 10 Immunization Coalitions: Mobilizing Communities to Increase Access to Care Deborah Clark National Field Director National Immunization Campaign parents can get involved. Discussions centered on family issues and ways to help parents empower themselves to support our country's goal of strong, nurturing families. Workshop 12 Enhancing Readiness to Learn: Mental Health and Social Competence in Early Childhood Sandra J. McElhaney, MA. Director of Prevention National Mental Health Association Maurice J. Elias, Ph.D. Associate Professor of Psychology Rutgers University The National Mental Health Association has long recognized the role of social competence in enhancing children'sreadiness to learn and to prepare for their roles as productive citizens. This workshop reviewed National MentalHealthAssociationeffortsintbisareaandoutlincd the best practices in early childhood programs. This workshop related the experiences of the National Immunization Campaign that united the efforts of more than 25 national organizations and 75 community-based coalitions to demonstrate ways that diverse coalitions can broaden public access immunization and other primary Workshop 13 New Information for Parents about Nutrition for Young Children care services. Helen D. Lilly, Ph.D. Food and Nutrition Service U.S. Department of Agriculture Workshop 11 Parent Action: Finally! An Organization for ALL Parents This workshop addressed what parents need to kiio\v about good mealtime experiences for the toddler arid how to implement the new U.S. Dietary Guidelines ill the diets of children older than two. Rosalie Streett, M.S. Executive Director Parent Action This workshop focused on why Parent Action, the only national membership organization for all parents, was established, what its goals are, what it does, and how F-4 Parents Speak Out for America's Children Workshop 14 Health Care for Children Living in Poverty Charles P. LaVallee Executive Director Western Pennsylvania Caring Foundation, Inc. Caring Program for Children The Caring Program for Children provides free pri- mary health care coverage to children who live in poverty but are ineligible for Medicaid. The workshop examined the impact of this innovative public-private partnership, which is now operational in 15 States. The Caring Program's new initiative, care coordination for children with special health care needs, was also pre- sented. Plans for national replication were highlighted. Workshop 15 Our Children Are Dying-What Are You Gonna Do? Beverly Coleman-Miller, M.D. President The BCM Group, Inc. This interactive workshop offered parents and others ways to control an apparently uncontrollable prob- lem-violence and its impact on our children. Specific, proven initiativeswere presented, along with the newest ideas from the leaders in the field. The roles of the community and the schools were discussed. Workshop 16 Improving Access to Care: Peer Support Groups for Low-Income Pregnant Women and New Parents Judith Rosenberg, L.C.S.W. Director Support Group Training Project Both service providers and policymakers now acknowl- edge the need to address nonmedical social and psycho- logical barriers that block access to care and preclude improvement in the health of low-income populations and promotion of positive health practices. The Sup- port Group Training Project organizes and facilitates peer support groups that are an effective way of deliver- ing health education to low-income and minority preg- nant women and new mothers. Workshop 17 Poverty, Illness, and Child Development: A Pediatrician's Perspective Steven Parker, M.D. Director, Developmental Assessment Clinic Boston City Hospital This workshop focused on the double jeopardy of children growing up in poverty: (1) the increased risks for exposure to medical illnesses, substance abuse, and family disorganization and (2) the deleterious effects of these risks on children's ability to learn. Strategies about how to meet these children's needs were dis- cussed. Workshop 18 U.S. Department of Education Resource Room The Education Resource Room was available for Con- ference participants to obtain more information on relevant programs that are administered by the Depart- ment of Education. Printed materials were available, and program offtcers were on hand to explain how each program works, how to apply for funding, and other important information. Report of the Surgeon General's Conference F-5 Workshop 19 Parent/School Partnerships: A Chapter I Strategy for Improving Student Achievement Workshop 22 Childhood Lead Poisoning Prevention in the 1990s Diane D'Angelo Research Associate RMC Research Corporation Chapter I programs have long advocated the involve- ment of parents in their children's education. This workshop provided participants with an overview of Chapter I programs, requirements for parent involve- ment, strategies to involve parents, and suggestions for home-based activities parents can use to support their children's education. Workshop 20 "As I Am": An Early Childhood Mental Health Curriculum Kirsten Hansen, M.Ed. Director, Head Start Mental Health Project Georgetown University Child Development Center Promoting good mental health practices is important for all children. This workshop introduce,d the con- cepts of mental health, related methods of incorporat- ing the curriculum into daily life, and presented lesson plans. Workshop 21 Preventable Developmental Disabilities Godfrey Oakley, M.D. Division of Birth Defects and Developmental Disabilities Centers for Disease Control This workshop focused on major opportunities to pre- vent poverty-associated disabilities including mental retardation, spina bifida, and fetal alcohol syndrome. Susan Binder, M.D. Chief, Lead Poisoning Prevention Branch Centers for Disease Control This workshop focused on the Centers for Disease Control statement Preventing Lead Poisoning in Young Children. It presented simple ways to reduce lead exposure, and the shift to primary prevention of lead poisoning was discussed. The workshop also examined the roles of the following groups in preventing lead poisoning: Federal, State, and local agencies; legislative bodies; advocacy groups; private foundations; and indi- viduals. Workshop 23 Bright Smiles, Bright Futures: A Multicultural Approach to Oral Health Education Alice M. Horowitz, MA. (Moderator) National Institute of Dental Research National Institutes of Health Marsha E. Butler, D.D.S. Colgate-Palmolive Company Robert S. Gold, Dr.P.H., Ph.D. University of Maryland Janice M. Hamilton, M.S. JMH Communications Through a partnership with national Head Start and the University of Maryland, Colgate has developed ;* multicultural oral health education curriculum \\itlr interactive activities and support materials for PI.<`- school and first grade children. Its specific aims arc' 1" (1) improve children's oral health knowledge. (2' improve children's attitudes toward preventive Old health care, (3) positively influence children's ol-nl health behavior, and (4) encourage family invOlvc'- ment in children's oral health. F-6 Parents Speak Out for America's Children Workshop 24 Parents as Teachers: Ensuring Good Beginnings for Children Mildred M. Winter, M.Ed. Executive Director Parents as Teachers National Center Thisworkshop centered on parents' role as the first and most influential teachers of their children and on a home-school partnership that supports parents of chil- dren from birth to age three in this role. Results from evaluations of the program's effectiveness were pre- sented. Adaptations for teen parents, the childcare center, the workplace, and other program settings were described. Workshop 25 Feeding Hungry Children Barbara Hallman Chief, Policy Branch, WIC Division Food and Nutrition Service U.S. Department of Agriculture This workshop provided a description of the range and scope of food assistance programs available to Ameri- cans, with special focus on those serving very young (preschool) children. Workshop 26 Tackling Children's Health in an Urban Center: One Corporation's Model Initiative Nancy Van Doren President The Travelers Companies Foundation This workshop detailed the involvement of The Travel- ers in community-wide efforts to improve children's health in Hartford, Connecticut. The model focuses on collaboration and coordination ofcommunityresources and services. This model may be replicable in other communities. Workshop 27 National SAFE KIDS Campaign-Preventing the Number One Killer of Kids: Childhood Injury Herta B. Feely, B.A. Executive Director National SAFE KIDS Campaign Childhood injury is the leading threat to the health of America's children. The National SAFE KIDS Cam- paign illustrates how community-based childhood in- jury prevention activities (in the areas of traffic injury, burns, falls, poisonings, chokings, and drownings) can be effective in reducing this threat. The workshop informed participants about the Campaign's resources and how to become involved in local SAFE KIDS initia- tives such as Project GET ALARMED, SAFE KIDS BUCKLE UP, and the SAFE KIDS Bicycle Helmet Campaign. Workshop 28 Capacity Building Through Early Intervention Connie Gamer, RNC, MSN, Ed.S. Senior Program and Policy Specialist Office of Special Education Programs U.S. Department of Education This workshop examined strategies for capacity-building for families with children with disabilities using the Part H conceptual framework. Links between health and education served as a fundamental building block of this discussion. Report of the Surgeon General's Conference F-7 The Surgeon General's Conference 1 -earn- -- The Critical Role of Parents Washington, DC February g-12,1992 Alliance To End Childhood Lead Poisoning 600 Pennsylvania Avenue, SE Suite 100 Washington, DC 20003 America 2000 400 Maryland Avenue, SW FOB 6 Washington, DC 20202 American Academy of Pediatric Dentistry 211 East Chicago Avenue, #lo36 Chicago, IL 60611 American Academy of Pediatrics 141 Northwest Point Blvd. P.O. Box 927 Elk Grove Village, IL 60009-0927 American Dental Association 211 E. Chicago Avenue Chicago, IL 6061 l-2678 American Red Cross 431 18th Street Washington, DC 20006 American School Food Service Association 1600 Duke Street, 7th Floor Alexandria, VA 22314 Arkansas Department of Health 4815 West Markham Street Slot 17 Little Rock, AR 72205-3867 Association for the Care of Children's Health 7910 Woodmont Avenue, Suite 300 Bethesda, MD 20814 Barbara Bush Foundation for Family Literacy c/o Simon Schuster 15 Columbus Circle, 34th Floor New York, NY 10023 Centers for Disease Control 1500 Clifton Road Atlanta, GA 30333 Cbild Care Action Campaign 330 7th Avenue, 17th Floor New York, NY 10001 G-2 Parents Speak Out for America's Children Children's Hospice International 901 North Washington Street, #700 Alexandria, VA 22314 Department of Agriculture Supplemental Food Programs Division 3101 Park Center Drive, Room 540 Alexandria, VA 22302 Elliot Health Systems/Elliot Hospital 80 Tarrytown Road Manchester, NH 03103 Florida HRS State Health Office 1317 Winewood Boulevard Tallahassee, FL 32399-0700 Health Care Financing Admiitration 200 Independence Avenue, SW Washington, DC 20201 JMH Communications c/o Colgate-Palmolive Company 300 Park Avenue New York, NY 10011 Kids Adjusting Through Support, Inc. 600 East Avenue Rochester, NY 14607 Maryland Department of Health and Mental Hygiene 201 W. Preston Street Baltimore, MD 21201 MELD (formerly Minnesota Early Learning Design) 123 North Third Street Suite 507 Minneapolis, MN 55401 National Information Center for Children and Youth with Disabilities 7926 Jones Branch Drive, Suite 1100 McLean. VA 22102 National Association of Community Health Centers, Inc. 1330 New Hampshire Avenue, NW Washington, DC 20036 National Association of Elementary School Principals 1615 Duke Street Alexandria, VA 22314 National Association of WIG Directors P.O. Box 53405 Washington, DC 20009-3405 National Center for Clinical Infants Program 2000 14th Street, North Suite 380 Arlington, VA 22201-2500 Report of the Surgeon General's Conference G-3 National Center for Education in Maternal & Child Health 38th 8c R Streets, NW Washington, DC 20057 National Head Start Association 201 N. Union Street, Suite 320 Alexandria, VA 22314 National Health Education Consortium Switzer Building, Room 2014 330 C Street, SW Washington, DC 20201 National Institute for Dental Research 9000 Rockville Pike Building 31, Room 2C35 Bethesda, MD 20892 National Mental Health Association 1021 Prince Street Alexandria, VA 223142971 National SAFE RIDS Campaign 111 Michigan Avenue, NW M'ashington, DC 20010 National Urban League 500 East 62nd Street New York, NY 10021 Pathfinder Resources, Inc. 2324 University Avenue West Suite 105 St. Paul, MN 55114 Reginald S. Lourie Center for Infants and Young Children of Maryland and Virginia 11710 Hunters Lane Rockville, MD 20852 South Carolina Governor's Office 1205 Pendleton Street Columbia, SC 29201 State of New Jersey CN 364 Trenton, NJ 086250364 Texas Office of tbe Governor Capitol Station P.O. Box 12428 Austin, TX 78711 Texas Respite Resource Network Santa Rosa Children's Hospital P.O. Box 7330 San Antonio, TX 78207-3198 The Home and School Institute 1201 16th Street, NW Washington, DC 20036 United Way of America 701 N. Fairfax Street Alexandria, VA 22314 University of Vermont Department of Social Work Burlington, VT 05405 U.S. Naval Reserve-Campaign Drug Free America P.O. Box 44 Marblehead, MA 01945 G-4 Parents Speak Out for America's Children m Entertainment The Surgeon General's Conference The Critical Role of Parents Washington, DC February g-12,1992 W e extend our thanks to the individuals and groupswho provided entertainment during the Conference sessions and breaks. The performances reminded us, in many cases, of our country'svaried cultural heritage. More importantly, the spark and vitality displayed by the children underscored the importance of the Healthy Children Ready To Learn Initiative and inspired us to work diligently to achieve our goal. Thank you to all who entertained and inspired US. Antonia C. Novello, M.D., M.P.H. Surgeon General Arlington County Head Start Children Singers Arlington Community Action Program Arlington, VA Cathi Brown, Comedienne Washington, DC The Chicitas Langley Park/McCormick Elementary School Hyattsville, MD The Fabulous Flying Fingers (c-h-=) Barnsley Elementary School Rockville, MD Glenallan Chorus Glenallan Elementary School Silver Spring, MD Joint Service Color Guard Washington, DC Keith Norris, Magician Bowie, MD North Springfield Handbell Ringers North Springfield Elementary School Springfield, VA Rapping Cheerleaders The Amidon School Washington, DC Singers West West Potomac High School Alexandria, VA Town 8c Country Singers and Ringers The Newport School Kensington, MD Young Traditional Indian Singers and Dancers Indian Health Service Baltimore-Washington Area Kids on the Block Columbia, MD H-2 Parents Speak Out for America's Children Report of the Surgeon General's Conference H-3