The Child-Care Challenge

New York City (NYC) pediatricians are now caring for fewer HIV-infected infants and more school age children and adolescents than earlier in the epidemic. Clinical, laboratory and demographic data were abstracted from medical records at 10 NYC centers participating in the CDC Pediatric Spectrum of HIV Disease project. Pediatric AIDS cases and HIV-related deaths reported to the NYC Department of Health were examined. Median age of HIV-infected children in care increased from 3 years in 1989 to 1991 to 6 years in 1995 to 1998. The number of HIV-infected women giving birth in NYC declined 50% from 1990 to 1997 (1630 to 831); increasing numbers were identified prenatally (14% in 1989; 78% after 1995); and most received prenatal zidovudine prophylaxis (73% in 1997). Estimated perinatal transmission decreased to 10% by 1997. Improved identification of seropositive status in infants was associated with an increased proportion of infected infants receiving Pneumocystis carinii pneumonia (PCP) prophylaxis, 84% in 1997. AIDS free survival was longer for children born 1995 to 1998 than for those born before 1995, P = 0.004. In 1998 among children with advanced immunosuppression (CDC category 3), 66% were prescribed 3 or more antiretroviral medicines and 88% received PCP prophylaxis. Citywide AIDS cases and HIV-related deaths fell precipitously beginning in 1996. Based on the observations of this study, the cohort of NYC HIV-infected children in care is aging, associated with a decline in new HIV infections, high rates of PCP prophylaxis and increased time to AIDS. Falling HIV-related deaths citywide support these observations.

This qualitative study aimed to understand how community-level cultural beliefs affect families' and professionals' care for children with autism and developmental delays in immigrant communities, as a first step towards promoting early identification and access to early intervention services. The study was part of the larger New York City (NYC) Korean Community Autism Project, which was designed to identify strategies to increase awareness of autism and reduce delays in treatment seeking within the NYC Korean-American community. Our study elicited early childcare workers' and church leaders' beliefs about autism and developmental disorders and, in particular, early intervention. We also elicited responses to newly developed outreach materials targeting this community. An inductive approach was used to identify concepts and categories associated with autism. Our study confirmed that discomfort, stigma and discrimination are the prevailing community attitudes toward autism and developmental disorders in the Korean-American community. Families' and professionals' understanding of autism and their care for children are affected by these community beliefs. Approaching immigrant communities with general information about child development and education rather than directly talking about autism and developmental disorders is likely to engage more families and professionals in need for diagnostic evaluation and early intervention for autism.

A disproportionately large number of African American children are entering the public child welfare system, and many are in need of planning for adoptive placement. Although agencies specializing in adoption of minority children have been extremely successful in achieving same-race adoptive placements for African American children, funding and support for some of these initiatives have been withheld due to federal and state legislation designed to limit the consideration of race as a major factor in the selection of adoptive families. This article analyzes these issues, and describes successful placement practices used by a private agency in California and a public agency in Texas. Suggestions for culturally competent practice are elaborated. Recent statistics on out-of-home care reveal that a growing number of children are entering care and a disproportionately high number of these children are African American. The number of children in out-of-home care has increased from about 273,000 in the mid-1980s to almost 500,000 in 1992 [Children's Defense Fund 1994]. The proportion of all children of color in the out-of-home care system is three times their proportion in the nation's population [McKenzie 1993]. For example, in states such as New Jersey, Maryland, Louisiana, and Delaware, over 50% of the children in care are African American. Although accurate statistics on children in care needing adoptive placements are unavailable, experts estimate that between 30,000 and 50,000 U.S. children are legally free for adoption [North American Council on Adoptable Children 1995]. About 40% of these children are African American; in major urban areas like New York City and Detroit, about 80% of the children needing adoptive placement are African American [McKenzie 1993; Jones 1993]. Reasons for Out-of-Home Placements Several factors account for the growing number of placements in out-of home care and the increased need for adoptive families, including parental drug use, poverty, and increased reporting of abuse and neglect. Although the majority of the children in care are at least of school age, the out-of-home care population is beginning to include a larger number of infants, primarily due to parental substance abuse. According to the Children's Defense Fund [1992], more than 4.5 million women of childbearing age use illegal drugs and only 14% of those who need treatment receive it. African American children represent only 15% of the total U.S. child population, and almost 44% of all African American children live in poverty [Children's Defense Fund 1996]. A rise in reports of suspected and actual child abuse and/or neglect is a frequent concomitant of poverty. In fact, poverty is the greatest predictor of the removal of children of any age from their biological parents and placement in out-of-home care [Pelton 1989; Lindsey 1991]. As African American children are disproportionately poor, they are more likely to be removed from their homes and placed in out-of-home care. Other factors such as lack of understanding on the part of protective service workers of cultural differences and variations in child rearing have sometimes led to African American children being separated from their families and placed in out-ofhome care [Stehno 1982; Leashore et al. 1991]. In one state, one in 20 African American infants born in one year were placed in out-of-home care, compared with one in 100 Caucasian infants in the state [Morton 1993]. After entering the child welfare system, African American children are also more likely to remain in care longer than Caucasian children and receive fewer services, and their families may have fewer contacts with workers [Close 1983]. According to Stehno [1990], practitioners in New York were found to be less likely to arrange visits between African American families and their children than they were for their Caucasian counterparts. Once many of these African American children become legally free for adoption, traditional public and private agencies often find it difficult to recruit suitable adoptive families for them. …

Limited research has examined barriers to sexual and reproductive health (SRH) services for Mexican immigrant women, especially those living in the eastern United States. This mixed-method study describes SRH care utilization and barriers experienced by female Mexican immigrants living in New York City. One hundred and fifty-one women completed surveys, and twenty-three also participated in focus groups. Usage of SRH care was low apart from prenatal services. The highest barriers included cost, language differences, child care, and poor service quality. After adjusting for insurance status, barriers were associated with receipt of gynecological care from a clinic or private doctor. Greater SRH knowledge was associated with current contraceptive use and a recent PAP test. Women reported that promotoras could increase information about SRH and decrease barriers. Results suggest that in a context where services are geographically available, health care utilization is impacted by lack of knowledge and structural barriers such as language, cost, and child care. Implications for community outreach are discussed.

...about one-third of HIV-infected children in New York City... end up in foster care...It is ironic that the protections that were set up to protect disadvantaged and vulnerable groups like prisoners and children, particularly children in foster care, are actually limiting their options and their access to treatments [in clinical trials] that other people may be able to get. This is not just a problem in New York—this is a national problem. Most states do not have a policy that specifically permits children in foster care to participate in research.

Taking Back the Bible

Private practice physicians in New York City's poorest neighborhoods are typically foreign trained, have generally substandard clinical practices, and have been accused of rushing Medicaid patients through to turn a profit. However, they also represent a sizable share of physician capacity in medically underserved neighborhoods. This article documents the level of credentials, systems, and immunization-related procedures among these physicians. Furthermore, it assesses the relationship between such characteristics and childhood immunization rates. The analysis utilizes a cross-sectional comparison of immunization rates in 60 private practices that submitted 2,500 or more Medicaid claims for children. Immunization data were gathered from medical records for 2,948 randomly selected children under 3 years of age. Half of sampled physicians were board certified (55%), and half were accepted by the Medicaid Preferred Physicians and Children (PPAC) program (51.7%). Of physicians, 43% saw patients only on a walk-in basis, while only 17% scheduled the next appointment while the patient was still in the office. There were 75% of the physicians who reported usually immunizing at acute care visits. Immunization rates were higher among PPAC physicians compared to others (41% vs. 29% up to date for diphtheria and tetanus toxoids and pertussis [DTP]/Haemophilus influenzae type b [Hib], polio, and measles-mumps-rubella [MMR], P = .01), and board-certified physicians showed a trend toward better immunization rates (39% vs. 30%, P =.07). Physicians who reported usually immunizing at acute care visits also had higher rates than those who did not (38% vs. 27%, P = .05). Scheduling a date and time for the next immunization showed a trend toward association with immunization coverage (37% vs. 28%, P= .10). Private practice physicians who provide high volumes of care reimbursed by Medicaid have improved their credentials and affiliations over time, thereby expanding reimbursement options. Credentials and affiliations were at least as effective in distinguishing relatively high- and low-performing physicians, as were immunization-related practices, suggesting that they are useful markers for higher quality care. The relative success of the PPAC program should inform efforts to improve the capacity and quality of primary care for vulnerable children. Appointment and reminder systems that effectively manage the flow of children back into the office for immunizations and the vigilant use of acute care visits for immunizations go hand in hand. Opportunity exists for payers and plans to encourage and support these actions.

The cultural and political currents that shaped American society during the early decades of the twentieth century had a decided effect on the configuration of the American welfare system as it appeared in the 1930s. Social workers, politicians, and reformers carried those currents into the maelstrom of the Great Depression to influence New Deal policy. New York city took the lead in many of the movements that influenced the way Franklin Roosevelt's administration addressed problems arising out of economic crises during the Great Depression—the city's innovative approach to unemployment became a prototype for work-relief programs; the charities controversy conditioned much of the later policy surrounding public subsidies and child care; the city's widows' pension program laid the foundation for ADC. There were, of course, many social and political leaders from New York who brought their ideas and attitudes to Washington in 1933, including Frances Perkins, Homer Folks, and Jane Hoey. Harry Hopkins was unique among them because he seemed to combine all of the experiences that contributed to America's emergent welfare system. His proposed job assurance program was neither ameliorative nor preventive. Rather, it was meant to place economic agency in the hand of the worker because Roosevelt's federal relief administrator believed that relief did not improve status of the worker; only the security of an assured wage could do this.KeywordsWelfare SystemGreat DepressionUnemployment InsurancePension ProgramRelief SystemThese keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

In the 1980s and 1990s, the transformation of the United States toward a global and information‐oriented economy has precipitated changing expectations and opportunities for working class men and women. Men have lost work, poor women have lost welfare benefits and many working class people no longer have access to adequate housing. The overall impact of these changes, including the uneven destruction of poor communities and the shifting, unstable gender hierarchies they have produced, has been to generate intense conflict reflected in increased violence in the community and in the household. The research described below, based on fieldwork in New York City in the 1990s among women and their families who have been relocated from family shelters into permanent housing, begins to outline some of the intervening processes that foster violence towards poor women. For many women violence is the immediate event that precipitates them into homelessness. But, when women leave the shelter system and have to create their lives anew, they are often alone and in need of help. Their isolation puts them, once again, at risk of finding men who help in some ways but also abuse them. The analysis examines the areas, such as child care, that social services are able to address and other areas in which such services fail. Overall, the paper suggests that the global city which New York has become in the 1990s has generated an increase in inequality, which in turn increases violence in shifting poor communities and relocated households.

This article focuses on child care arrangements, mothering attitudes, and family support systems as they affect the labor force participation of urban Puerto Rican mothers. In general, for women in the United States, paid work outside the home has become a normal part of life and, for most women, a necessary aspect of existence. Puerto Rican women, particularly those in the New York City area, however, have declining, not rising, rates of labor force participation. Our study looked to child care factors for a partial explanation for this work pattern. The study method used in-depth interviews with a sample of 40 Puerto Rican mothers stratified by occupational status. All these mothers have worked outside the home, but not all are currently working. Cultural values toward family care were strongly expressed by the mothers and were found to significantly affect work patterns, particularly for women with erratic work histories. The social policy implications of this study relate to the need to recognize and act on the connection between participation in the labor market and cultural attitudes toward child care for a significant low-income urban minority population.

The extent of availability and utilization of private pediatric care, for well and sick children under six years of age in New York City, was investigated by means of a questionnaire (10% sample of all practicing physicians). Ninety-three per cent of the physicians responded. It was found that the pediatrician spent more time for well care than for sick care, whereas the general practitioner devoted the greatest share of his time to the care of sick children. The general practitioner provided 61% of the total volume of private pediatric. care. The average child was seen by a physician eight times annually. The study indicates that in New York City private pediatric care is available and fairly well utilized.

Introduction

Independent foundations' primary focus is grant making.In general, their assets come from the gift of an individual or family.Community foundations' assets usually come from many donors rather than a single source, and grant making is limited to a particular region.Community foundations are usually classified as private charities under the tax law and are subject to different rules and regulations than are other private foundations. Access To CareAccording to 1988 Census Bureau estimates, over thirty-one million Americans are without health insurance.The demographics of these people are diverse, and their ranks continue to grow as the service industry burgeons and as competition in health care increases.Regional disparities in access also exist.Foundation funding in this area ranges from economic analyses of the problem to direct provision of care.

BACKGROUND AND AIM: Emerging data suggests that during the Coronavirus Disease-19 (COVID-19) pandemic care for chronic health conditions, such as asthma, decreased. Nationally, children were 84% less likely to seek care for asthma in emergency departments during the initial stages of the pandemic compared to the same period in 2019; little is known about the various barriers to asthma-related care for children during this time. Here, we aim to understand the impact of COVID-19 on two adjacent neighborhoods with historic differences in social determinants of health by evaluating their access and need for acute and chronic healthcare in New York City (NYC) during the pandemic. METHODS: We will conduct a community-based participatory survey of families in each neighborhood: 25 families from East Harlem (EH) and 25 families from the Upper East Side (UES). There are documented disparities in asthma-related health outcomes between these neighborhoods, where the prevalence of asthma is 3.5 times greater in school-aged children in EH compared to the UES. We will include families with children who have active asthma between 5 and 17 years of age. This survey will evaluate differences in environmental conditions, including the built environment, social determinants of health and health care utilization during the first 6 months of the pandemic (March 1st through August 31st 2020). RESULTS:We will present survey responses and analyze the differences in environmental exposures, social determinants of health and healthcare utilization during the pandemic in each respective neighborhood. CONCLUSIONS:Our community-based survey results will identify differences regarding environmental exposures as well as barriers and facilitators to healthcare during the initial stages of the COVID-19 pandemic in two distinct neighborhoods in NYC. These data provide an initial step in identifying potential areas of concern to inform future public health interventions and clinical responses to optimize care in vulnerable communities. KEYWORDS: Asthma, Respiratory outcomes, Children's environmental health, Environmental disparities, Socio-economic factors (non-chemical stressors),COVID-19

Back to table of contents Previous article Next article Members in the NewsFull AccessCancer-Stricken Psychiatrist Crafts Unique LegacyJoan Arehart-TreichelJoan Arehart-TreichelSearch for more papers by this authorPublished Online:20 May 2005https://doi.org/10.1176/pn.40.10.00400022Suppose you were 35 years old and had everything to live for—a burgeoning psychiatric career, a loving partner, a child, and colleagues and friends who described you in glowing terms.But suppose you were told that you didn't have long to live. What would you do with the time remaining to you?Would you continue your practice? Take a big trip? Or would you do something that would help other people in a similar situation? That's what Joelle Pauporte, M.D., a psychiatrist in West Hartford, Conn., chose to do: she launched a novel project that will touch many other dying parents and bring them closer to their children.In the summer of 2003—shortly before her 34th birthday—Pauporte learned that she had breast cancer. Although she had a modified radical mastectomy followed by chemotherapy and radiation, she was told last summer that the cancer had spread to her bones and that she would probably have only another year or two to live.She decided that she would devote much of that time to bonding with her 3-year-old daughter, Halle. One of the things she was especially determined to do was read books to Halle.“When you are feeling so ill that you can't get on the floor and color with crayons, when you are too tired to do anything, you can still pick up a book, sit and snuggle with your child, and read,” Pauporte said in an interview.Pauporte also resolved to start collecting good books for Halle to read as she grows older, both to encourage Halle's love of reading and to have her daughter feel “comforted by reading, to feel this warmth, almost as if I were there.”To select appropriate books for Halle, Pauporte sought the assistance of Jane Breen, the children's librarian at the West Hartford Public Library. In one conversation with Breen, Pauporte said: “You know, we could do something similar for other parents” with cancer by helping them use reading to bond with their children.Thus, with the help of Breen, family, and friends, Pauporte's Light One Little Candle Book Drive came into being in February. The concept is very simple, Pauporte explained. People donate new books to a hospital. Each parent with cancer at the hospital can choose one of these books to bring home to share with his or her child. The book is theirs to keep. A bookplate is placed inside the front cover of each book so the parent can inscribe a special note to his or her child.In March, Hartford Hospital's Helen and Harry Gray Cancer Center, Memorial Sloan-Kettering Cancer Center, New York University Cancer Center, and CancerCare for Kids in New York City started to participate in the book drive. Mostly through word of mouth, people learned of the book drive and started donating new books, so that within only a few weeks, several thousand new books were received.On April 12 Pauporte appeared on both ABC and NBC television to publicize the drive. After that, she got phone calls and e-mails from hospital staff in California, Michigan, Chicago, Washington, D.C., and Toronto indicating that they wanted to participate in the book drive.When asked how psychiatrists might help her with her book drive, Pauporte said: “To get people they know, friends, to donate new books.... The main thing is getting the word out.... A thousand books will go in a couple of days, there are that many cancer patients in each hospital.”If only one of her dreams about the project could be fulfilled, she said, it is that the “project will go on long after I am not here.”Pauporte completed her first three years of psychiatry residency at Cornell University Weill Medical College, and her fourth one at Hartford Hospital. In addition, she was a member of the 2002-2004 class of the APA/Bristol-Myers Squibb Fellowship in Public Psychiatry.Her supervisors in both of her residency programs commented on her and her book drive.“Joelle is a passionate, committed, young psychiatrist.. .who has a strong background in the care of children with special needs,” said Elizabeth Auchincloss, M.D., director of psychiatry residency training at Cornell. “I am not surprised to learn that even as she is struggling with her own health, she is interested in contributing to the care of others. The book drive is an exciting, creative, and much-needed effort to attend to the emotional well-being of children and families in crisis.”“Joelle is a talented, creative, and generative person who was determined to enhance our program and did just that,” said Harold Schwartz, M.D., psychiatrist in chief at Hartford Hospital. “Her attention more recently has focused on making something positive out of her experience... .Realizing that, when energies for all else were flagging, she could always sit and read to her daughter and that the connection established by doing so was invaluable to both, she has thrown herself into the Light One Little Candle Book Drive as a lasting legacy.“But more important than providing the books, she has provided the model for maintaining the connection between parent and child through the imaginative power of reading in the face of the most challenging adversity. In this way, she has established herself as a therapist and educator for our entire community.”More information about the Light One Little Candle Book Drive and donating books to it is posted online at<www.lightonelittlecandle.org>.▪ ISSUES NewArchived