The Family First Act opens an opportunity for states to use Title IV-E foster care funds in ways that have not previously been available except through the IV-E waiver process. Well over 90 percent of the federal budget that the Administration on Children, Youth and Families (ACYF) is responsible for administering comes from Title IV-E foster care and adoption funds – that’s almost $9 billion of a $10 billion budget.
These funds offer very little flexibility beyond paying for foster care and adoption assistance payments for children removed from their parents’ care after bad things happen and the associated administrative, training and information systems costs.
In stark contrast, a miniscule percentage of ACYF funding is devoted to the primary prevention of child abuse and neglect, meaning the prevention of the initial occurrence of maltreatment through strengthening families, and not the prevention of re-occurrence of maltreatment after a child becomes involved with a state or local child welfare system. Under the Community Based Child Abuse Prevention provisions of the Child Abuse Prevention and Treatment Act (CAPTA), ACYF has close to $38 million to distribute among 50 states, the District of Columbia, and the territories designated for primary prevention activities. If we distributed the funds equally among states, which we do not, that would average about $670,000 per jurisdiction.
The Family First Act provides a very positive first step in changing a profoundly unbalanced and frankly illogical funding situation. The Act identifies a specific population that can benefit from the state option to use Title IV-E funds for prevention purposes, specifically, only children who are classified as “foster care candidates,” meaning they have already come to the attention of and are involved with the child protection system, and are deemed to be at imminent risk of entering foster care. Typically, that means they have already been determined to be victims of abuse or neglect and, with services, might be helped to avoid placement in foster care. Note that Family First also allows prevention services for pregnant or parenting youth in foster care who, by definition, are already involved in the system. The Act also specifies that federal Title IV-E funds to support those children and families can only be used for a few specific services that have a research-supported evidence base, and it limits the amount of time they can receive the services.
Again, let me emphasize that this is a positive step in the right direction. I commend Congress for taking this important first step. I, and my federal colleagues in child welfare, sincerely welcome the opportunity to use federal funds to help children who have been abused or neglected avoid unnecessary separation from their families and placement in foster care, along with the accompanying trauma that entails. But, I must emphasize that this is only the first step.
While it is critical to help children who become known to the child welfare system avoid unnecessary separation from their families when services can be offered to keep them together, it is even more important to help families and children avoid the situations that lead them to child welfare in the first place. When a report is made to a public child welfare system, it usually means that the harm has already occurred, a child has been abused or neglected, trauma has been inflicted, and any interventions from that point are remedial rather than preventative.
Add to that the fact that most parents who mistreat their children, intentionally or not, were mistreated themselves and their trauma was never resolved. When we choose, as a child welfare system, to intervene only after abuse or neglect has occurred, we are complicit in perpetuating that inter-generational cycle of trauma and maltreatment.
We can change that.
We must change that.
Imagine with me for a moment what the world would look like if the public health system’s major strategy to combat a serious disease such as polio was to invest in wheel chairs and crutches for patients after they fell ill, instead of investing in vaccines to prevent the illness; if car makers invested in jaws of life and ambulances to get victims out of mangled cars and to hospitals faster as their primary means for addressing automobile safety, rather than developing seat belts, air bags, warning systems and other safety features to prevent injuries in accidents; and if the primary way to deal with baseball or football injuries was to buy more icepacks, neck braces and slings as opposed to requiring players to wear helmets and shoulder pads.
Now, imagine this with me. Imagine that our country’s primary way of keeping children safe, protected and emotionally healthy was to invest nearly all of our money in placing children in homes other than their own, and in therapy to fix the trauma after they have been abused or seriously neglected, instead of investing in helping their parents to care for them safely before they are abused or neglected.
What would it look like if that were the case? It would look like 437,000 children in foster care – a 10 percent increase in the past five years. It would look like 4 million reports of child abuse per year, because that is the case. It would look exactly like what we have now; it’s what we do.
If we have any serious hope of stemming the ever-increasing demand for foster care; of committing ourselves to strengthening families’ capacity to care for their own children rather than committing to recruiting more and more foster homes; to reducing the numbers of children traumatized by abuse, neglect and family separation; and of breaking inter-generational cycles of trauma and maltreatment, we have to put our money and our efforts further up the river before families go over the first waterfall.
That requires a re-imagining of what public child welfare is all about, and this is the moment to do it.
The President’s proposed budget includes a provision that will allow states to opt into a flexible funding approach to use Title IV-E funds under a capped allocation, very similar to the existing IV-E waiver flexibilities that can be used to strengthen the protective capacities of families long before child welfare services are needed. In short, this will allow states to work with families earlier, to get them what they need and to prevent bad things from happening to children.
States, counties and communities know their families’ needs and their communities’ capacities, and we have to trust that they can take advantage of increased flexibilities that will benefit their citizens without restrictive laws that tell them which services they may or may not use to help a particular family or child.
We have marvelous examples of effective, well-conceptualized and implemented programs across the country where this kind of community-based, primary prevention, family-strengthening approach is working to keeping families strong and intact – notably, Live Well San Diego, the Harlem Children’s Zone, the Center for Family Life in Brooklyn, the Communities of Hope funded by Casey Family Programs across the country, in addition to specific county initiatives in places like Allegheny County, Pennsylvania; Jefferson County, Colorado; and Los Angeles County among many others. We would be remiss not to learn from these examples and do all we can to bring the primary prevention of maltreatment and family separation to scale as a major federal child welfare priority.
With the Family First Act we have reached one more step in the continuum of services to children and families in the United States. We now have prevention of foster care placement for those children brought to the attention of child welfare agencies, a limited population but a critical one in the continuum. That adds to the existing array of child welfare services that includes foster care and reunification support services, adoption services, and emancipation and transitional living services for youth exiting from foster care.
What remains missing is the ability to use substantial federal funds to strengthen families before maltreatment creates lasting, usually life-long trauma to children. We also lack the ability to provide strong community-based, universal family support services to families. Absent such services and support, many of those families will inevitably knock on the doors of public child welfare and cost us infinitely more in federal foster care dollars and in remediation efforts that could so clearly be avoided.
Failure to redefine the system to stem the tide of children entering care and keep families strong comes at great expense to everyone. Those costs are financial and societal. It’s an expense that is paid in inter-generational cycles of trauma that affect all sectors of our society. The family is the foundation of American society; we must treat it as such.
Terry Alves-Hunter, Foster Parent Advocate
Not in my womb, always in my heart
Learning & Emotional Assessment Program (LEAP) The Learning and Emotional Assessment Program (LEAP) at Massachusetts General Hospital assesses students and children ages 2 to 22 who have developmental difficulties and consults with their parents, teachers and care providers.
Our clinical professionals have devoted their training, research and clinical practice to acquiring the specialized skills needed to assess children with learning disabilities, psychological and developmental disorders. Our team loves working with children and has a natural ability to put them at ease.
The Department of Psychiatry offers a depth and breadth of resources available at few other hospitals or psychiatric centers, meaning your child receives comprehensive, state-of-the-art care without leaving our campus. Services available at the MassGeneral Hospital for Children include:
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Our clinical assessments are designed to be a comfortable and often fascinating experience, and we find that many children enjoy the warm, one-on-one attention they receive. In addition, our professionals excel at discussing the benefits of assessments with even the most skeptical of adolescents. Our Staff
Our experienced professional staff includes Child psychologists, Licensed clinical psychologists, Neuropsychologists, Certified school psychologists, clinical psychology interns and postgraduate fellows.
Research is an ongoing companion to treatment in the LEAP program, with clinical test data collected daily. This data is used to help participants in LEAP, as well as in other programs and departments. Conditions We Evaluate
LEAP treats a variety of conditions and disorders. With the trained resources of Mass General Hospital's Dept. of Psychiatry, we are able to evaluate and treat a variety of conditions and disorders.
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Boston Medical Center
Dr. Augustyn is the Director of the Division of Developmental and Behavioral Pediatrics at Boston Medical Center (BMC) and is a Professor at Boston University School of Medicine. She went to medical school at Loyola Stritch School of Medicine, completed her pediatric residency at UCLA and her Developmental and Behavioral Pediatric Fellowship at Boston University-Boston City Hospital. Her clinical work at BMC primarily involves the evaluation of children with various developmental delays including autism,speech and language delays, global developmental delay, learning disabilities, ADHD to mention a few.
Her research work has varied across her career and includes work on the effects of both in utero cocaine exposure and violence on early childhood and parenting and recently she has been a leader in developing the Center for Family Navigation at BU, a national leader in promoting and developing the use of navigators to support families of children with developmental disabilities.
Dr. Augustyn is co-editor of The Zuckerman Parker Handbook of Developmental and Behavioral Pediatrics for Primary Care and the section co-editor for Developmental and Behavioral Pediatrics for the online journal UpToDate. She currently sits on the sub board of Developmental and Behavioral Pediatrics at the American Board of Pediatrics and is on the Board of Directors of the Society of Developmental and Behavioral Pediatrics. She is also on the American Academy of Pediatrics planning committee for Practical Pediatrics, their national CME Program.
Deborah Frank, MD
Dr. Frank is the Director of the Grow Clinic for Children and a board-certified Developmental and Behavioral Pediatrician at Boston Medical Center (BMC). She is also a Professor of Pediatrics at Boston University School of Medicine. Dr. Frank attended Harvard Medical School and completed her residency at Children's Hospital Seattle. After her residency, she went on to complete a fellowship in Child Development at Children's Hospital Boston. Dr. Frank specializes in issues of growth and nutrition and the impact of hunger on child development.
Dr. Frank has written numerous scientific articles and papers. Her work has focused on breastfeeding promotion, women and children affected by substance use, nutrition among homeless pregnant women and children, Failure to Thrive, food insecurity, and the “heat or eat” phenomenon, the dilemma that many low-income families face in the winter when they have to make the critical choice between heating their homes and feeding their children. She is especially proud of successfully mentoring many pre-professional and professional colleagues.
Cited as a respected authority in her fields, Dr. Frank has frequently given testimony to state and federal legislative committees on the growing problem of hunger and associated hardships in the United States and its effects on our youngest children. She has recently been nominated by Congresswoman Nancy Pelosi to the newly established National Commission on Hunger. She is also an invited member of the Aspen’s Dialogue on Food Insecurity and Health Care Costs.
L. Kari Hironaka MD, MPH
Dr. Hironaka is a board-certified Developmental and Behavioral Pediatrician at Boston Medical Center. She completed her fellowship at Boston Medical Center. Dr. Hironaka specializes in health services research, health literacy and ADHD, as well as residency training.
John Maypole, MD
Dr. Maypole completed Pediatric Residency in 1999, and Pediatric Chief Residency in 2000 following his training at Yale University School of Medicine. Dr. Maypole has consistently included primary care, medical education, and in participating in and developing innovative clinical programs for complex children and their families. Dr. Maypole served as Associate Director of the Pediatric Integrative Medicine Education Project and performing Holistic Medicine consults and medical education at Children’s Hospital from 2003-2005. In 2005, Dr. Maypole became Director of the Department of Pediatrics at the South End Community Health Center while serving as an attending physician for the Comprehensive Care Program (CCP) in the Department of Pediatrics at Boston Medical Center. CCP is a multi-disciplinary team of providers who provide enhanced and coordinated primary care to the most medically complex patients and higher risk families in the Pediatric Department, including ex-premature infants, children with special health needs and neurodevelopmental disabilities. In February of 2013, Dr. Maypole came to Boston University/Boston Medical Center to work full time to develop approaches and programs to address this fast-growing segment of the pediatric population. In September of 2014, Dr. Maypole received an award from the Center for Medicare Medicaid Innovation, supporting a 3 year effort for the Massachusetts Alliance for Complex Care/4C program--a consultative, multidisciplinary care support model of care for PCPs and families of medically complex children, of which he is co-principal investigator. He is an associate professor of Pediatrics at BUSM. Dr. Maypole writes child health-related articles for a lay audience, for mainstream media and online publications.
Jenny Radesky, MD
Dr. Radesky is a board-eligible Developmental Behavioral Pediatrician and a board-certified general pediatrician who recently joined the faculty at Boston Medical Center after completing her fellowship training here. She attended Harvard Medical School and completed her pediatrics training at Seattle Children’s Hospital. Dr. Radesky is a clinician-investigator whose clinical interests include early childhood adversity, attachment relationships, and child self-regulation, as well as teaching trainees methods of observing parent-child interaction. Her research examines mobile/interactive media use by parents and young children and how this effects parent-child interaction and child social-emotional development. She is an active member of the AAP Council on Communications and Media.
Arathi Reddy, DO
Dr. Reddy is a board-certified Developmental and Behavioral Pediatrician at Boston Medical Center. She attended medical school at Western University of Allied Health Sciences in Pomona, CA and completed her residency at Morristown Memorial Hospital/ University of Medicine and Dentistry of New Jersey in Morristown, NJ. She completed her fellowship at Einstein Montefiore and worked in NYC prior to joining the faculty in March 2011.
Jodi Santosuosso, NP, MSN
Jodi is a certified nurse practitioner in the Developmental and Behavioral Pediatrics Division at Boston Medical Center. She attended University of Massachusetts College of Nursing and Health Sciences and completed her residency at University of Massachusetts, Boston. She joined the Boston Medical Center and Boston University School of Medicine faculty in April 2007. Jodi has had extensive training in developmental and behavioral pediatrics, gastrointestinal (GI) diseases and ear, nose and throat (ENT) disorders.
Laura Sices, MD, MSDr. Sices is a board-certified Developmental and Behavioral Pediatrician at Boston Medical Center (BMC). She attended medical school at University of Pennsylvania in Philadelphia, PA, completed her residency at The Children's Hospital of Philadelphia and completed her fellowship at University of Washington in Seattle, WA. Dr. Sices was on the faculty at Rainbow Babies and Children’s Hospital in Cleveland, OH before joining BMC in 2007. Dr. Sices’ clinical work focuses on assessment and management of children with a variety of different concerns, including developmental delays, speech and language delays and conditions, ADHD, learning disabilities and differences, and autism spectrum conditions. Her academic focus is on developmental screening and the early identification of developmental delays.
Naomi Steiner, MD
Dr. Steiner is the Director of Training at the Division of Developmental and Behavioral Pediatrics. Dr. Steiner studies how computers train the brain, which is an area of great interest in overlapping fields of ADHD, psychology, neuroscience and education, and closely followed by many as a complimentary or alternative approach to the traditional psychopharmacological treatment of ADHD. She is specifically interested in implementing neurofeedback attention training in schools. She is also interested in teaching self-regulation skills and relaxation breathing in schools. Dr. Steiner is multicultural and multilingual. In 2030 more than 50% of children will be raised bilingual in the United States! Dr. Steiner has written a book on how to successfully raise children bilingual (7 Steps to Raising a Bilingual Child), and instructs medical professional, teachers and parents on how children learn two languages, and how English Language Learners can be successful at school.
Mary Ellen Stolecki, NP, MSN
Mary Ellen is a board certified pediatric nurse practitioner in the Developmental and Behavioral Pediatrics Division at Boston Medical Center and an Instructor of Pediatrics at Boston University School of Medicine.
She specializes in primary care of the Child with Special Health Care Needs (CSHCN) in the Comprehensive Care Program. She also practices in the Pediatric Gastroenterology Division providing specialty care for gastrointestinal (GI) conditions.
Her clinical interests are primary care for medically complex children (as well as GI issues) of CSHCN including: care of the premature infant, autism, cerebral palsy, seizures, Down syndrome, Williams syndrome, Turner syndrome,achrondroplasia,and multiple congenital anomalies.
Jodi Wenger, MD
Jodi Wenger, MD is a graduate of Dartmouth Medical School who completed her pediatric residency at Boston Medical Center. She spent several years on the Navajo Reservation in northeastern Arizona before transitioning back to Dartmouth Hitchcock Medical Center in Lebanon, NH. She served as a pediatric hospitalist, outpatient provider and educator at Dartmouth Medical School.
She has always had an interest in children with special health care needs. She worked in the Comprehensive Care Program at BMC as a resident and is thrilled to return. She was the general pediatrician at the multidisciplinary spina bifida clinic at Dartmouth Hitchcock and cared for children with neurologic challenges while on the Navajo Reservation.
Dr. Wenger has also had an interest in resident work hour reform and continues to support the software she and her husband created during her chief resident year. Amion, continues to allow one to make fair physician call schedules that can be easily accessed online.
Barry Zuckerman, MD
Dr. Zuckerman is Professor and Chair Emeritus of Pediatrics at Boston University School of Medicine/Boston Medical Center. He is a national and international leader in child health and development. His research focuses on the interplay among biological, social and psychological factors as they contribute to children's health and development. Dr. Zuckerman and colleagues have developed four programs that transformed health care to better meet the needs of low income and minority children. The success of these efforts is that they are now all national programs; Reach Out and Read, Medical-Legal Partnership, Health Leads and Healthy Steps. In addition to more than 250 scientific publications, he has edited nine books, including three editions of Behavioral and Developmental Pediatrics: Handbook for Primary Care. He has served on prestigious national committees; National Commission on Children, Carnegie Commission on Young Children, Bright Futures, and has received numerous national and international awards including the C. Anderson Aldrich for Child Development and the Joseph St Geme Award for Leadership from AAP, and the Policy and Advocacy award and Health Care Delivery Award from the APA. He has consulted in Turkey, Bangladesh, and Thailand regarding child development.
- See more at: http://www.bmc.org/pediatrics-developmentalbehavioral/team.htm#sthash.UrLgPWRv.dpuf
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