Robert Kennedy traveled to Jackson, Mississippi in 1967, to hold hearings on the problems the poor in the South were having with a government food program that required them to purchase food stamps they could not afford. Kennedy’s actions offer us an important lesson about the capacity of a single politician to change the way people who are poor are viewed and assisted.
As Nicolaus Mills chronicled in 2006, Kennedy’s trip was overshadowed by an attack from Mississippi Senator John Stennis on the poverty program money being spent on Head Start in Mississippi. But, Kennedy’s second day in Mississippi changed his trip and the course of poverty in America. On that day Kennedy encountered a mother and her six children. She had no money to pay for food stamps and she was feeding her family rice and biscuits made from leftovers.
Kennedy was moved, but his deepest attention, as Nick Kotz, who was covering the trip for the Des Moines Register would write, went to the youngest of the children, a two-year-old baby sitting on the dirty floor. Kennedy tried tickling the baby, but he could not make the child respond. For Kennedy it was a life-changing moment. As Kotz would write, “the poor themselves made the best witnesses.”
Kennedy left the Delta with the desire to ask the heads of the major networks to produce a two-hour documentary about what it was like to live in the ghettos in poverty, to sit in a classroom that wasn’t stimulating, and to exist in conditions that most people believed didn’t exist in America. Most importantly, Kennedy wanted the rest of America and the politicians to see what it was like to live without hope. Kennedy knew that the lack of understanding of these difficulties allowed politicians and voters to stay numb to the conditions that existed.
Upon their return to the beltway, Kennedy and Clark went immediately to Agriculture Secretary Orville Freeman to seek emergency help for the hungry of Mississippi. But the Johnson administration, was focused on the war in Vietnam and worried about inflation, and was unwilling to increase its spending on the poor.
At the next hearing in Washington, the testimony on hunger in Mississippi was given by a Harvard physician; the Johnson administration and the Senate’s Democratic leadership finally felt enough pressure from the media to change their stance on what Kennedy wanted. Kennedy pushed through a program that would provide free food stamps for the neediest, and cheaper food stamps for all the poor, coupled with an investigation into how local officials distributed federal food.
The Senate Subcommittee on Poverty eventually reported out an emergency food and medical bill, which the Senate passed in ten days. The House approved the Senate bill, and in 1968, the emergency food aid Congress had mandated got distributed.
Sound familiar? We could substitute the name of a different war, and the name of a different national tragedy, and see that in some ways the challenges we face today aren’t so different from those that have come before for this great nation. But what has changed: Our dialogue about taking care of others, our willingness to make hard choices, our fondness for short articles and news pieces, and the inability of politicians to work together to solve our toughest problems.
If our economy and the effectiveness of our systems of care for those who are suffering are going to change then we need the sort of leadership that this story of Kennedy evokes. We need to create a dialogue about how to help others, and we need to elect politicians who talk about real ideas for solving real problems—for the long term.
What are we going to do to make that happen?
Overweight kids have more social problems; Well-child visits to screen for mental health last only minutes
Two studies last week in Pediatrics gave us more knowledge about mental health and wellness in young children.
The first study in Pediatrics found that the heavy kids were up to 20 percent more likely at age eight or nine to be described by their parents as having social difficulties and by teachers as having emotional problems.
The researchers surveyed the parents and teachers of 3,363 Australian children participating in a large national health study. At ages four and five, 222 boys (13 percent) and 264 girls (16 percent) were determined to be overweight, while 77 boys (4.5 percent) and 87 girls (5.2 percent) were obese.
Those kids with a body mass index (BMI — a measure of weight relative to height) at least 1.6 points greater than their normal-weight peers at a young age were more at risk of having social problems, including isolation or teasing, later on. The researchers also found out that the heavier kids were about 20 percent more likely, by the age of eight or nine, to experience social difficulties and emotional problems, as described by their parents and teachers, respectively.
The study points to the need to comprehensively screen more children earlier for all sorts of issues during well-child visits including eating and activity habits in addition to asking about developmental and mental health issues.
Unfortunately, a second study in the same issue of Pediatrics found that most well-child visits last less than 20 minutes and pediatricians are getting even more time-crunched as health care systems look to cut extra expenses any way they can.
In 2000, the researchers conducted a phone survey of about 1,700 parents across the U.S. with a child between four months and three years old. They asked parents how much time they had spent with a doctor at their last well-child visit and whether the doctor had talked with them about issues such as breastfeeding, the child’s sleeping position and sources of family support.
About one-third of parents said their most recent appointment lasted 10 minutes or less. Only one in five had a visit lasting more than 20 minutes. Interestingly, parents also reported how satisfied they had been with the visit.
During longer visits, doctors gave a more thorough developmental assessment and discussed more health and safety issues with parents, and more parents said they’d had enough time to ask questions. Still, parents said they didn’t get any guidance about issues including child care, toilet training and emotional support at more than half of the longest visits.
Prior research has reported and practice guidelines have suggested for some time that enhanced screening efforts by pediatricians are necessary and will help us save health care costs long-term. But in spite of those calls the most recent statistics show that less than half of those pediatricians surveyed do so and this is in part at least theorized to be because of reimbursement issues; although many of those reimbursement issues appear to be solved.
I also think it is “behavior” and “habit”—it is difficult to get healthcare providers to change their practices voluntarily unless we as consumers start asking for changes or the federal government mandates those changes. It’s time for comprehensive change in our system of care for little kids. We know what works and that it will save money—what is keeping us from implementing those changes? Please visit www.projectskip.com for more information on screening.
- Obese Kids May Face Social, Emotional Woes (nlm.nih.gov)
- Well-Child Visits Suffer from Time Squeeze (nlm.nih.gov)
- Informed Patient: Making the Most of a Pediatrician Visit (blogs.wsj.com)
Last week a report from the Annie E. Casey Foundation found that “the official child poverty rate, which is a conservative measure of economic hardship, increased 18 percent between 2000 and 2009.” Similarly, according to the United States Department of Agriculture, the number of children facing food insecurity in 2009 skyrocketed to one-in-four. These facts are astounding, especially as the Children’s Defense Fund released a report that found “the U.S. spends almost two-and-half times as much per prisoner as per public school pupil.” Additionally, The Pew Charitable Trusts also released a report that found right here in California (along with other states across the country) we cannot track the effectiveness of our local First Five Commissions because we haven’t been collecting the data we need to convince tax payers that these program s are worthwhile (and to match and access federal funds). Poor nutrition in young children has been linked to lower intelligence, behavioral issues, and lower educational achievement. In turn, these childhood issues have been linked to delinquency and worse in adolescents and adults.
What are the Savings?
Several studies by the RAND Institute have found that: 1) targeted early interventions benefit children and their families, and 2) government funds invested early in the lives of some children result in compensating decreases in government expenditures. Well-designed programs for children age 4 and younger can produce economic benefits ranging from $1.26 to $17 for each $1 spent on the programs. More locally, it has been estimated to cost approximately $60 per day or $22,000 per year to house an adolescent in the juvenile detention facility.
The Hard Choices
Ten years ago, there was a renewed interest in the influence of early childhood—especially the first three years of life—on health and development. Governors and legislators directed budgetary surpluses to interventions for young children. New scientific studies revolutionized our understanding of the complex and dynamic ways in which both nature and nurture–genetics and the environment– shape the developing brain and the emotional, social, regulatory, moral, and intellectual capacities that emerge from early childhood. Last year, for the first time, recognizing the importance of delivering high quality services from trained providers to this age group, the state even created a preschool mental health endorsement process for those with specialized training in working with infants and children. But now that the budgets are tight these are the programs being cut—and it’s the basics that are disappearing—kids don’t even have enough food.
In my work both as an attorney and psychologist, I hear stories daily, of the positive effects of early interventions. There is the mother who was brought here from abroad only to find that her husband already had an entire family. With a little the help she has mastered new parenting strategies, and is now back in school and supporting her kids. There is the proud single father who has gone from being homeless to finding a new home with his son. How might life be different for so many, and the financial costs on society significantly smaller, if we just intervene early and invest in kids in their early years ?
There are difficult choices to be made with our budget in a time of soaring deficits. But short-term-thinking — profit now and pay later strategies – got us into this financial mess. As we try to fix it, we must choose solutions that focus on longer-term, lasting results for our most pressing societal problems. We cannot sacrifice the well-being of our children at any cost. Children shouldn’t have to go hungry—and in the long run it costs us much more for prisons.
Here is a great organization working to end childhood hunger. But also, get involved–and help our politicians invest in our future.
The first time I saw the video of Jessica Beagley I was shocked. But as an attorney and psychologist, I knew immediately there was a deeper story here. I watched several attorneys that morning on the talk show circuit, talking about what a “terrible” mom Beagley was and how “abusive” her behavior was towards the child. There weren’t any psychologists invited to speak. Now, don’t get me wrong, the behavior in the video is abusive. I would never recommend those sorts of tactics to parents and would have to report the sort of behavior in the video as abuse if confronted in my practice with such a tape. But to describe this simply as a “stunt” to get on Dr. Phil in a two-minute sound bite doesn’t do this story justice. It doesn’t do us justice.
Beagley was desperate. And just like the mom who put her child on a plane back to Russia last year, Beagley’s son was also adopted from Russia along with his twin brother at 5 years old, and has since been diagnosed with Reactive Attachment Disorder (RAD). RAD is one of the most difficult issues to treat in children. Traditional methods of discipline typically don’t work for these children and they often have higher pain thresholds. Nearly every horror story you’ve ever heard about an adopted child is a result of poor attachment. With RAD the child doesn’t trust any adult, ever, and acts accordingly.
Since traditional therapies don’t work with these children, new and different ways of working with these kids pop up frequently all over the country promising a cure. For example, Law and Order did an episode a number of years ago on the death of a child during holding therapy—holding therapy in part, is designed to control and calm the child, and the situation. One of the tenants of most of these therapies is that the adult establish control of the situation with the child and establish rules and guidelines to be followed. What was very clear to me when I watched the video, is that Beagley was trying to break through to a kid who is resistant to nearly every form of discipline, and frequently disregards rules.
“Beagley,” according to the Associated Press, “made the video and went on the Dr. Phil show because she was desperate to find help for her son.” Imagine bringing home two 5-year-old boys because you want to shower them with love. You then find that one won’t respond to your affection, won’t follow basic rules of behavior, and lies, hits, and steals without regard for any consequences. And, your husband is a police officer who sees where these sorts of behaviors most frequently lead in adults. I have worked with families where one child with RAD has taken a knife to the throat of a younger child. I have also known couples who have chosen to abandon these children because the behavior was just beyond their capacities as parents to handle. What do you do as a parent?
The Beagleys couldn’t get help in this situation and that was the case in the several that I have described. Jessica Beagley’s son is finally getting the help he needs because he was finally properly diagnosed. It appears from reports that the Dr. Phil show facilitated the diagnosis and is paying for his treatment. Ms. Beagley has humiliated herself and put her child’s physical well-being at risk. But why are mothers often forced to go these lengths to get the help they need? And, why are we so quick to judge them?
An Anchorage jury decided Beagley’s unorthodox parenting was indeed a crime, finding the 36-year-old mother of six guilty of misdemeanor child abuse last Monday. Her sentencing will happen next week. Our justice system paints a very dichotomous picture of Ms. Beagley. Prosecutor Cynthia Franklin, who told the jury that Beagley abused the boy in an attempt to get on national TV, called the verdict a just one. “(The jury) concluded that it is child abuse to hurt your child as an audition for a television show,” she said. Defense lawyer Willam Ingaldson had argued Beagley struggled to correct the troubled boy’s bad behavior and was reaching out for help. That’s not a crime, he argued. Beagley “was trying, in the best interest of her child to do the “right” thing however misguided.
I would suggest a more compassionate story that can be told to the jury about Ms. Beagley. This mother trying to get on a reality show was merely a symptom of how our social services failed her and her son.
We need to have a larger discussion about this, outside of the limits of the courtroom and the two-minute sound bite. The real discussion we need to have includes what happened outside the video? What happened prior to the video? What happened after?’ Why was this mom, and why are so many others forced to take such drastic and misguided steps to help their children? We seem to have a new story every few months that points out the difficulties parents have in obtaining much needed mental health services for their children. That conversation is difficult and it will necessarily result in some systematic changes, but I challenge us all to have it. I don’t want to see more dramatic videos like the one Ms. Beagley made. Or worse yet, the results if all of these moms continue to go without help.
It happened the last week. I woke up and the sun was just “different” in the sky. I could feel a difference in the light and the coolness in the air as I went for my daily walk in the morning. The difference in light brought back memories of the transitions to fall: new school supplies, the first pair of shoes for the new school year, and the fun of seeing old friends. I loved school growing up but the transition from vacation to a structured school day can be difficult for many children and parents. Even children who are eager to return to the classroom must adjust to greater levels of structure and the demands associated with the school day. Getting a new school year off to a good start can influence a child’s attitude, confidence, and performance for the entire year, both socially and academically. With just a few adjustments you can make this transition easier. (You can remember these steps with the acronym: GO TEAM!)
- Get a Plan. Check out what you were supposed to have done over the summer and find out the logistics of going back to school. Schedule any needed check-ups or routine appointments now and try to make a schedule for the first few weeks that is predictable. Make copies of all your child’s emergency information for reference. For your children, designate and clear a place to do homework. (Older children should have the option of studying in their room or a quiet area of the house. Younger children usually need an area set aside in the family area to facilitate adult monitoring.)
- Organize. Help kids organize materials and study schedules. Fill backpacks early and check out needed supplies. Make a note of important dates, especially back-to-school nights. Visit the school if possible if you are in a new area or classroom. Select a spot to keep backpacks and lunch boxes at home. Designate a spot for your children to place their school belongings as well as a place to put important notices and information sent home for you to see.
- Transition to the New Schedule. If you have time, start sliding into an earlier bed time and a more structured schedule of activities, especially in the morning. Buy only the essential school clothes to start. Summer clothes are usually fine during the early fall, but be sure to have at least one pair of sturdy shoes. Check with your school to confirm dress code guidelines.
- Establish Good Communication with Your Teacher. Offer to help out in whatever way you can. Establish a means of communication for the year, and especially if you co-parent with a former spouse, talk about how to maintain a good sense of what is going on in the classroom. Volunteer or offer some sort of classroom supplies if you can, or explain if you can’t, but ask what other ways you can support the teacher.
- Activities after School Should be Selected Carefully. Don’t overschedule. Leave time for children to be creative and to play in an unstructured way. Make certain there is family time built into the new schedule.
- Model Empathy and Compassion. Have a discussion with your child about talking with other children who don’t seem to know anyone or aren’t wearing the latest styles. (If you are screaming at another parent in the parking lot that isn’t a good start!) Give your child a few strategies to manage a difficult situation with another child on his or her own, and encourage your child to tell you or another adult if a problem situation persists. Let your children know you care. If your child is anxious about school, send a personal note in the lunch box or book bag. Reinforce their ability to cope. Try to arrange get-togethers with some of your child’s classmates before school starts and during the first weeks of school to help your child re-establish positive social relationships with peers.
Most of all, have a sense of humor and remember that transitions to a new routine are tough on everyone—there are bound to be missteps, and how you handle those “problem moments” is important for your child to watch as a way for them to learn good coping skills. Make your schedule as easy as possible the first week so you can be there for extra support if necessary—transitions are tough on us too.
Have a great first few months and enjoy the Fall!
A new study last week found that prescriptions for antidepressants for patients without a psychiatric diagnosis increased from 2.5 percent of all visits to nonpsychiatrists to 6.4 percent between 1996 and 2007. For visits to primary care providers, antidepressant prescriptions without a psychiatric diagnosis grew from 3.1 percent of all visits to 7.1 percent over this period; for other nonpsychiatric providers, the increase was from 1.9 percent of visits to 5.8 percent.
The study also reported that patients who received antidepressants from nonpsychiatrists without a psychiatric diagnosis were:
- most likely to be fifty years old or more,
- less likely to be paying for the visit out-of-pocket, and
- more like to suffer from another medical condition like diabetes and to have excessive fatigue or non-specific pain.
So what does this mean? I suspect the take home message is that non-psychiatrists (primary care physicians and other non-psychiatrist prescribers) are so comfortable with the newer antidepressants (which have fewer side effects) that they often use these medications to alleviate overall discomfort and vague symptoms in their patients. But I also think we have responsibility here. I suspect this increase also reflects our broader wish to “take a pill” to fix things—as opposed to looking at the underlying causes of our problem, or to engage in longer term types of “talk” therapy treatments to address longer term issues, or other factors that give rise to illness in our lives.
Usually the most effective treatment for depression, anxiety and most mental health issues is a combination of medication and psychotherapy. Similarly, if you have a heart ailment, along with medications, you will need to make changes in your diet, stress levels, and other areas of your life. With most diseases—getting well often involves major lifestyle changes across many aspects of your life. It is these less-tangible, more difficult changes that often interfere with our recovery from any disease.
So, how can we get this message out to the public more effectively? We need to shift our emphasis from mental illness to mental health and shift away from the notion that a “pill” will give us that quick cure to the notion that treatment of all diseases requires lifestyle changes. We also need to remove the “stigma” associated with talking cures.
One by one—start talking about prevention and start talking about wellness in your conversations with friends. Get a mental health check-up and encourage others to do the same. At the heart of the effort to transform the mental health system is the need for a change in everyone’s thinking – from believing that depression or anxiety represent some sort of moral weakness, to an understanding that recovery from a mental illness happens all the time, if you get help in the form of good treatment, just like any other disease. Rarely does that treatment come in the form of one simple “pill.”
“Between what one wishes to become and what one has become there is a momentous gap, which will now never be closed.”
Quote from the dissertation of Thomas Fuchs the father in the most recent murder-suicide in San Diego.
San Diego has had a string of murder-suicides over the last few months. We struggle as a community to understand these events, especially when we see the pictures of lives that seemed filled with happiness. In the latest of these incidents the father and children are described as having the perfect relationship. So what do we know about these sorts of crimes?
Criminologists have coined the phrase “family annihilators” to describe these attacks. Most of them are either men who want revenge or who act out of a misplaced sense of altruism. For example, in the case of a bitter custody battle these men will commit the final act of domestic violence by taking the children away from the mother. Or, in a perverse desire to spare the children from the hurt and pain caused by the hard realities of being broke, they will shield the children by taking their lives in addition to their own. What we know about family annihilators is somewhat limited because most of them aren’t around to talk to but there are some things we can learn from looking at the research:
According to the Violence Policy Center:
- In the United States in 2007, 1108 murder-suicides occurred; 95% were committed by men; 75% involved an intimate partner; and 75% were committed in the home and most with a handgun.
- The men involved are typically “perfect citizens” and they see no other way out of a current dilemma or difficulty. The events are planned and allow them to feel control over their destiny and their children’s.
- Societal factors contributing to these acts include the economy, social isolation, and shame. These aren’t simple acts but involve a number of factors.
What can we do as a community to prevent this? Reaching out to our neighbors is key. Help reduce the stigma around asking for help in your community. In San Diego the County Crisis Line number is 1(800) 479-3339.
I will be discussing this more on KUSI (channel 9) in a half hour show on Sunday June 26 at 10 am. For those of you not in the San Diego viewing area I will post the video next week.
Summer is a time to reconnect with your kids. Spend time having fun, talking and being outside. But research also shows that kids can lose skills over the summer if they don’t spend a little time keeping their minds sharp. So here is my list of fun summer activities that can also prevent “brain drain”.
- Consider a special summer program in a new subject. Check out a summer camp in science or a special career path.
- Get a library card. Encourage your child to read and make it a family activity. Read together.
- Make a neighborhood production. This is my favorite. Let the kids plan a “show” and produce it over the summer months. Help them to plan it, manage it, and create a fun production that is inclusive.
- Explore the internet together; Encourage interests and strengths naturally. Check out a particular subject and learn more about it together. For example, learn about your family history through genealogy.
- Work on something that is difficult in a new and fun way. Times tables causing angst? Create a funny song together to encourage practice or make it a fun game.
- Excursions to parks, museums, or an aquarium. Head to the local exhibits to learn about animal habitats or historical issues in your area.
- Get outside and limit TV and the internet. Go for walks together and visit local recreation areas.
- Learn to take public transportation. An important skill for older kids, make this into a fun treasure hunt to teach them to navigate the bus or trolley system.
- Opportunities to write. Ask for a story, or create a running story where everyone in the family adds a paragraph and see what the result is!
- Pick a fun recipe and teach kids to cook (and slip in lessons in math and measurement) the basics.
So there you have it. Please feel free to share your fun ideas. Check out my segment on Fox 5 San Diego discussing some of these tips. Prevent Brain Drain.
June 9, 2011 For Immediate Release
Contact Person: Anya Moberly (firstname.lastname@example.org)
San Diego, California — Parents and teachers concerned about a child’s mental health and development can now get immediate answers from an online screening with Project SKIP (Screening Kids for Intervention and Prevention) (www.projectskip.com). Project SKIP was developed by Dr. Bonny Forrest, a psychologist and attorney, who has more than a decade of experience working with children with mental health issues and development disabilities, including autism.
“Project SKIP has been my passion for more than 10 years,” said Dr. Forrest. “We have developed the program to effectively and efficiently screen children for social-emotional, cognitive, and developmental delays (including autism) through the use of gold standard on-line instruments.” Project SKIP is for kids from the ages of two through 18.
“In May” noted Forrest, “a U.S. Government study found that 1 in 7 children have a developmental disability. Yet sadly, only about 50 percent of children with developmental problems are identified before they enter school. The parents and teachers of these children deserve to have a reliable screening tool at their disposal.” With SKIP, any parent or teacher can log on, any time, and for a $20 fee, get immediate feedback about a child’s behavior in relation to other children of the same age. Dr. Forrest emphasized that the screening does not provide a diagnosis, but begins the process of understanding a child’s mental health and developmental needs to access supports at home and in school. In addition to the online screening, Dr. Forrest will provide parents and teachers with a 15 minute consult if their child is found to be “at risk” for a mental health issue or development delay. The consultation will focus on helping the parent find any necessary follow-up services.
“We need to take mental health and developmental screening to the level of prevention in this country” said Forrest, “We brush our teeth every day, why aren’t we screening for these issues regularly.
About Dr. Bonny Forrest
After practicing law for more than a decade, Dr. Forrest received her Ph.D. from Columbia University with fellowships at Yale University, Columbia University and the National Institute of Mental Health.
Log on at www.projectskip.com