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."