Access to Critical Services for Women and Children

Access to Critical Services for Women and Children Margie Findlay, Ph.D., R.N. Professor, Ida V. Moffett School of Nursing, Samford University Deborah Strevy, Ph.D. and Kay Emfinger, Ph.D. Assistant Professors of Early Childhood Education, University of Alabama at Birmingham Jill Cunningham, D.N.P(c), C.R.N.P., A.P.R.N., B.C., N.P.-C. Assistant Professor, Ida V. Moffett School of Nursing, Samford University Moderator: Joy Whatley, D.S.N., R.N. Associate Dean, Ida V. Moffett School of Nursing, Samford University March 11, 2008 Presented by: Margie Findlay, Ph.D., R.N. mpfindla@samford.edu Samford University What are Critical Services?  Essential services required to ensure optimum:  Health  Safety  Growth and development  Quality of life  Family well-being  Community well-being Concerns for Women and Children in Alabama  Pregnancy and Newborn Issues  Prenatal Care  Prematurity/Infant Mortality  Newborn Screening  Developmental, Social, and Educational Issues  Homeless Women and Children  Service Issues  Children with Special Health Care Needs and Developmental Disabilities Pregnancy and Newborn Issues in Alabama Access to prenatal care Early and regular prenatal care Insurance coverage High cost of neonatal intensive care services  High infant mortality rate  Early screening/treatment for inherited metabolic disorders     Bad news/Good news Percent of Births with Adequate Prenatal Care in Alabama between 1997-2006 78.5 78 77.5 77 76.5 76 75.5 75 74.5 74 73.5 Percent of All Live Births 78.2 77.8 77.2 76.6 76.2 76.8 77.7 78.1 76.7 75.3 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 Year Infant Mortality # of infant deaths under 1 year of age per 1000 live births  Alabama Department of Public Health data for 2006:  62,915 live births  571 fetal deaths  569 infants died before their first birthday  Infant mortality rate: 9.0/1000 live births   from 9.3/1000 in 2005  Twice as many African-American infants died (14.3/1000) than Caucasian infants (6.7/1000)  Hispanic infants—7.2/1000 http://www.adph.org/HealthStats/ Infant Mortality Rates Alabama and United States Rate per 1,000 Live Births 35 30 1965-2005 ALABAMA 25 20 15 UNITED STATES 10 5 0 1965 1970 1975 1980 1985 1990 1995 2000 9.0 6.6 2005 Year 8  Alabama continues to have one of the highest infant mortality rates in America  Major issues:  Prematurity  Poverty, access to care, lack of insurance  Infant mortality rates are  for women on Medicaid or without insurance:  No insurance—17.1/1000  Medicaid—10.6/1000  With insurance—6.1/1000 Alabama Department of Public Health ALABAMA NEWBORN SCREENING PROGRAM…… helping babies get started on the right foot  Expanded program initiated in 2004  Now screening for full panel of disorders that can be diagnosed using tandem mass spectrometry  Consistent with recommendations of AAP and March of Dimes  Lives have been saved and developmental disabilities avoided or minimized. Brochure and fact sheets available online: http://www.adph.org/newbornscreening/ Abnormal Newborn Screens and New Diagnoses by Year in Alabama 250 200 150 100 50 0 Prior to 2004 2004/2005 2006 2007 Abnormal Screens New Diagnoses Compiled by Deborah Strevy, Ph.D. dstrevy@uab.edu Presented by Kay Emfinger, Ph.D. emfinger@uab.edu University of Alabama at Birmingham Overview Who are the homeless? What are the causes? What are their concerns? What can be done to help? Voices of the children  Diamond, 13: “It sucks in the shelter because I can’t do the things I could do in a regular home. It’s just me and my mother here, and sometimes I cry and wonder why I’m here and when I’m going to get out” New York Amsterdam News, Dec. 17, 2003 Who are the homeless?  Definition: a person who “lacks a fixed, regular and adequate night-time residence”  Best estimates indicate 10% of those living in poverty are in shelter.  30%-41% of all homeless are women with children  Only 35% of homeless children and youth live in shelters  Almost half of the children in shelters are younger than 5 years old Voices of the children  Mickel 12, “Sometimes I feel sad, mad, angry and stuff. I feel mad because I don’t have my own room. I feel sad because I don’t like living here”. The New York Amsterdam News, December 11, 2003 What are the causes of homelessness?  Two major trends are responsible for the rise in homelessness over the past 20-25 years:  Poverty      Difficult choices must be made and housing is often let go 13% of the US population lives in poverty Real value of minimum wage is less than in 1970 More than minimum wage is required for one–two bedroom apartment 26% of homeless in the US are working Major trends continued…  Decline in public assistance  TANF (Temporary Assistance to Needy Families) and food stamps combined are below poverty level  Working poor earn wages below the poverty level  Fewer than one in four families receiving TANF have access to public housing  Between 1973 and 1993, 2.2 million low rent housing units disappeared from the market  In 2001 10.0 million people, 3.6 million of whom are children, had “worst case needs” for housing assistance Voices of the children  Cordell 13, “It’s embarrassing because you can’t invite your friends over to your house when you have to do projects in school. I can’t have any company in the shelter.” New York Amsterdam News. (2003). Homeless kids keep life in shelter a secret. December 11, 2003. What are the concerns of homeless women and children?  Domestic violence  Nationally, approximately half of all homeless women and children are fleeing domestic violence  Children grieve for their home, school, neighborhood, friends, pets and possibly family members  25% of women experience sexual or physical violence at the hands of an intimate partner in their lifetime  Residential instability contributes to the high risk of domestic violence for extremely poor women  Children who have witnessed violence may use violence to solve problems Concerns continued…  Health Care:  One third of families living in poverty have no health insurance of any kind  Illness and loss of work often leads the poor into the downward spiral of homelessness  Crowded shelter conditions exacerbate common illnesses such as colds, flu and asthma  Children in shelter may not have necessary immunizations, medical, dental care or eyeglasses Concerns continued…  Nutrition:  Diets of homeless women and children are high in fat, sodium and      cholesterol Homeless women rely heavily on fast food and food that does not have to be cooked, such as lunch meat Some shelters serve food that is inexpensive and high in fat, lacking the more expensive fresh fruits and vegetables Obesity and anemia are two common diet related problems of women and children living in shelter Women and children living in shelter fare better than those in motels Shelter life offers few opportunities for exercise Concerns continued:  Stress  Homeless mothers fear losing their children  Many mothers and children live with relatives and      friends before going into shelter Shelter life offers little privacy, parenting may be compromised Mothers develop guarding behaviors to protect their children from harm Lack of options for boys in shelter Sense of loss Restrictive rules Voices of the children  Mickel 12, “The shelter doesn’t affect me from my school life. You have to make up lies, saying that you live in such and such place, it’s just embarrassing. I can’t explain it. I have a fear that I’m not going to get a good apartment, that it’s gonna be a lot of rats and roaches, and drug and stuff around.” New York Amsterdam News. (2003). Homeless kids keep life in shelter a secret. December 11, 2003. Voices of the children  Shakweesha 10, “my friends started calling me shelter kid and they kept asking me why I lived in a shelter. It’s because my landlord kicked us out the building and we didn’t have anywhere to go. This girl told everyone in school that I lived in a shelter with her. It made me sad because I didn’t want anyone to know I lived in a shelter.” New York Amsterdam News. (2003). Homeless kids keep life in shelter a secret. December 11, 2003. Sources:          Bussuk, E. Dawson, R., & Huntington, N. (2006). Intimate partner violence in extremely poor women: longitudinal patterns and risk markers. Journal of Family Violence, 21, 387-399. Meadows-Oliver, M. (2002). Mothering in public: a meta-synthesis of homeless women with children living in shelters. Journal of Pediatric Nursing , 8(4), 130-136. National Coalition for the Homeless. (2007). Why are people homeless? NCH, Fact Sheet #1. National Coalition for the Homeless. (2007). How many people experience homelessness? NCH, Fact Sheet #2. National Coalition for the Homeless. (2007). Who is homeless? NCH, Fact Sheet #3. National Coalition for the Homeless. (2007). Homeless families with children. NCH, Fact Sheet #12. New York Amsterdam News. (2003). Homeless kids keep life in shelter a secret. December 11, 2003. Oliveira, N.L., Goldberg, J.P. (2002). The nutrition status of women and children who are homeless. Nutrition Today, 37(2), 70-77. Zugazaga, C. (2004). Stressful life events of homeless adults: a comparison of single men, single women, and women with children. Journal of Community Psychology, (32)6, 643-654. Presented by: Jill Cunningham, D.N.P(c), C.R.N.P., A.P.R.N., B.C., N.P.-C. jlcunni1@samford.edu Samford University Children with Disabilities – Who are they?  Developmental delay / Mental retardation  Autism (1:150)  Chromosome disorders  Down Syndrome most common  Cerebral Palsy  Spina Bifida  Metabolic / Errors of metabolism  ADHD  Epilepsy Statistics Children with Disabilities  United States –  5.5 million children (8%) have disabilities  Male > Female  South –  Almost 2 of every 5 people with a disability lives in the South (38%)  Alabama –  23% of the population with a disability  53,000 – children ages 5-15 with a disability Statistics  Jefferson County  5,801 children with disabilities (ages 5-15)  Male / Female ratio – 3:1  Birmingham Alabama – in the top 10 of places of 100,000 or more with the highest percentage of people age 5 and older with disabilities  61,421  27.6% of the population Data indicate that finding quality child care for children with disabilities and special health care needs is almost impossible Parent Survey Summary – Families with a child with a disability  83% report difficulties finding, obtaining or keeping child care  76% report being unemployed due to the lack of child care  21% report working less skilled positions, part-time or seasonal Poverty / Costs  The families of children with disabilities tend to be among the poorest  Poverty statistics – 28%  It costs on average three times as much to raise a child with disabilities as compared with typical children More Barriers  Attitudes of providers  Lack of knowledge  Physical barriers  Behavioral issues  Staffing ratios  Age issues  Medication administration  Liability / Insurance  Toileting issues Best Practices and the Law  Inclusion  American with Disabilities Act  Individuals with Disabilities Education Act Lack of Comprehensive Medical Services for children with disabilities  Access Barriers  Unequal access to screening and services  Complex systems of care (eligibility and policies)  Community and system capacity issues  Low income / Transportation  Uninsured / Underinsured  Insufficient support  Lack of partnerships between agencies  Lack of awareness and understanding Lack of Comprehensive Medical Services for children with disabilities  About 700,000 children with disabilities lack health insurance coverage  40.3 % of those are from the South Lack of access to:  Health promotion services  Medical home / Care coordination  Specialist health services  Dental care Healthy People 2010 Goals for children with special health care needs  Families partner in decision-making and planning  Coordinated, on-going comprehensive care in a medical home  Adequate private and public insurance  Early and continuous screening  Organized community-based service system  Necessary services for transition to adulthood My roles in improving access  Alabama Council for Developmental Disabilities - Inclusive Out-of-School Care Project  Governor's Office of Faith-based Initiatives  Inclusion in the faith community  United Cerebral Palsy – Health and Wellness Center  Care coordination clinic What Can We Do to Improve Outcomes in Alabama? For Pregnancy and Newborn Issues:  Simple solution -- Abolition of Poverty  But, there are no simple solutions to complex problems  Healthy Alabama 2010 Goals  Reduce infant mortality rate to 7.9/1000  Pregnancy planning --  to 60%  Adequate prenatal care --  to 90%  Education  Preconception care/pregnancy planning  Access to care  Family support services NEED TO BE PROACTIVE RATHER THAN REACTIVE! What can be done to help? For Homeless Women and Children:  In the classroom:  Be sensitive to the needs and restrictions of shelter life when making assignments  Be aware that shelter children may not reveal their living conditions  In the community:  Volunteer to tutor shelter children at the YWCA  Volunteer to prepare and serve a nutritious meal at First Light Shelter for Women and Children  Volunteer for Habitat for Humanity  In Alabama:  Be an informed voter, research candidates positions on poverty and health care and vote your conscience  “Shop till it Stops”, purchase gifts that give back a portion of their proceeds to the homeless Favorite sources for gifts that give back:  www.realsimple.com (Life and Soul tab)  www.habitat.org (Habitat Store tab)  www.globalgirlfriend.com (catalog tab)  www.nothingbutnets.net (buy a net tab)  Or Google, “gifts that give back” for an extensive list. For Children with Disabilities: Improve access to child care  Awareness  Public support / Local leadership  Policy support  Training / technical support  Quality assurance  Research  After-school and summer care Improve access to health care  Assurance of services  Training  Care guidelines  Parent involvement  Agency partnering  Access to specialty care  Policy changes  Collaboration between agencies  Appropriate and comprehensive coverage  Cost sharing  Program and access standards that comply with ADA  Screening and Early Intervention Alabama Women Shaping Public Policy Second Annual BACHE Women's Conference A copy of this presentation will be available at: www.samford.edu/alabamawomen