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