Voices for Kids Blog

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Migrant children in government custody deserve healthy meals and adequate nutrition

| July 9, 2018 |

In the wake of the administration’s catastrophic and cruel zero tolerance policy at the southern border, advocates, policymakers and the public are demanding renewed oversight of Office of Refugee Resettlement (ORR) facilities caring for unaccompanied children, as well as investigations into the conditions that children face while still in Customs and Border Patrol (CBP) custody.

As well as ensuring the safety, health, and welfare of the thousands of children in ORR custody, it is vital to safeguard their access to adequate and appropriate food and nutrition.

Along with factors such as violence and persecution, extreme hunger and poverty are major “push factors” that prompt families and unaccompanied children to seek refuge in the United States. Data suggests that devastating drought across El Salvador, Guatemala and Honduras prompted unprecedented levels of food insecurity between 2014 and 2016, coinciding with a surge in unaccompanied children arriving to the US.

Malnutrition and food insecurity make it harder for children to develop, learn, and stay healthy. This is particularly concerning given that unaccompanied children also report mental trauma from violent conditions in their home countries, physical and sexual abuse during the trip to the U.S., as well as mental and physical stress from the journey, including dehydration. The separation of children from their parents is another form of trauma in and of itself. For children released into ORR custody, it is thus of utmost importance to have consistent, healthy meals.

The good news is that thanks to the 1997 Flores Settlement, we have national standards regarding the detention, release, and treatment of all children in immigration detention. These standards prioritize family reunification, requiring that children be released from custody into the care of a parent, legal guardian, adult relative or sponsor, or licensed child welfare program. However, if the government cannot release children, Flores states that they must keep them in the least restrictive setting appropriate to age and special needs in a non-secure facility licensed by a child welfare entity.

Because of these important protections, ORR requires care facilities to have state licenses, and they must meet ORR requirements to ensure a high level of quality care — including the provision of nutritional services in accordance with U.S. Department of Agriculture and U.S. Department of Health and Human Services nutritional guidelines and State licensing requirements. ORR care facilities also must establish procedures to accommodate dietary restrictions, food allergies, health issues, and religious or spiritual requirements, and incorporate cultural awareness into food menus.

Even with those requirements, however, the administration’s policy has prompted an influx of children, including infants and toddlers, into the care of ORR. This is cause for concern, with some arguing that ORR facilities are resource-strapped already, and not generally licensed for, or equipped to engage in, the care of these “tender-age” children. This extends to their nutritional needs, and experts, advocates and lawmakers are demanding more information about the health and nutritional care that the Department of Homeland Security and ORR are providing to very young children. For instance, the American Academy of Pediatrics recommends that infants under the age of 6 months be fed breastmilk exclusively, followed by continued breastfeeding as complementary foods are introduced. The Academy of Breastfeeding Medicine meanwhile argues that separating breastfeeding children from their mothers is a human rights violation, as the U.N. Human Rights Council says that infants in emergency settings, such as refugee camps, have the protected right to be breastfed.

The administration has provided little information on the conditions and care ongoing in tender-age children. Even worse, it is now petitioning to keep families with children in detention — a violation of Flores — and exempt facilities holding children from state licensing requirements. This is particularly disturbing amidst reports that the Department of Defense is scoping out sites to house even more children. Meanwhile, the process of family reunification is happening in fits and starts, with only half of the children under 5 set to be returned to their parents by a court-ordered July 10 deadline.

From coping with trauma to accessing legal counsel, the needs of children who arrived at the border unaccompanied and whom the Department of Homeland Security separated from their parents are varied and complex. Even as we advocate for the reunification of families, quick release of unaccompanied children to appropriate sponsors, and cessation of the Trump administration’s zero-tolerance policy, we must also ensure that the conditions within ORR care facilities and CBP holding facilities aren’t making a tragic situation even worse — down to the food being served.


Fight for Our Families Protest Showcased Reach of Recent Efforts to End Family Separation

| July 2, 2018 |

Last Wednesday, before the marches that took place during the weekend of more 750 events with Families Belong Together, a group of young children, likely no older than 12, led a march in the pouring rain along Pennsylvania Avenue, from Freedom Plaza to the Capitol building, in protest of the “zero tolerance” immigration policy that resulted in mass separation of immigrant families.

The children exuded innocence — splashing in puddles, opening their mouths to taste the raindrops, laughing amongst themselves — and simultaneously displayed a deep understanding of the very adult issue they were advocating against.

These children held signs and donned t-shirts that read Fight for Our Families and #KeepFamiliesTogether, taglines of the rally sponsored by nonprofits CASA and Fair Immigration Reform Movement (FIRM), and they joined in on the crowd’s chants of “Trump, escucha, estamos en la lucha!” (“Trump, listen, we are still in the fight!”) or “Sí se puede!” (“Yes we can!”).

Some of the children even gave speeches to the crowd before the march began. Eleven-year-old Gabriela Rodriguez shared her and her younger sister’s fear that their family might be torn apart, too. Ten-year-old Izayah Cavero said the separation children on the border are experiencing “is like a sword, stabbed in your heart, of sadness” and just the thought of being separated from his own family gives him that same pain.

The rally and march occurred the morning after a judge in California, by means of a preliminary injunction in the Ms. L v. ICE suit, ordered that children separated from their families at the border must be reunited within 30 days, and children under five must be reunited within 14 days. Just a few days earlier, President Trump issued an executive order (EO) — rife with vague language and lacking in solutions — which called for an end to family separation.

The children who spoke at the rally iterated the executive order was a bandage attempting to cover a years-old wound in this country concerning immigration at the southern border. While the detention of migrants is not new— First Focus has opposed this practice for years — it is the hope of advocates that it will end with each new administration.

President Trump’s order did not put an end to family separation. It simply made family separation a last resort. It directs the Department of Justice to request a modification of the Flores Settlement Agreement so that “accompanied” children may be detained with their parents—it’s important to note, however, that the Flores Settlement Agreement was put in place to protect children and should not be rolled back.

The language in the EO ultimately allows for family detention, which is still leads to long-term trauma for children, family separation when family-friendly facilities run out of beds, and prolonged family separation due to a lack of well-defined reunification procedures.

Judge Dana Sabraw detailed the issue with the order’s lack of solution in her Ms. L v. ICE order:

“The language of the EO is not absolute, however, as it states that family unity shall be maintained “where appropriate and consistent with law and available resources[,]” and “to the extent permitted by law and subject to the availability of appropriations[.]”

The EO also indicates that the Administration’s zero tolerance policy will continue which will result in more family separation.

And finally, although the order speaks to a policy of “maintain[ing] family unity,” it is silent on the issue of reuniting families that have already been separated or will be separated in the future.”

Children should not be detained, period. Like the children I marched with on Wednesday, children crossing the border with or without their families deserve to splash in puddles and drink raindrops whenever they so please. The innocence that remains within them following an approximately 1,000 mile journey to flee violence in their home countries should be preserved at all costs — and detention of any kind causes irreparable harm.

The preliminary injunction in the Ms. L v. ICE case, ordering the somewhat-speedy reunification of separated families, is a great start to fixing the crisis on the U.S. southern border, but it can’t be the end of our fight. Children are still sitting alone in detention centers or living with families of strangers thousands of miles from their parents. There is work to be done, so let’s do it.


Some resources to help reunite families:

House Bill Tackling Opioid Epidemic Emphasizes Needs of Affected Children

| June 28, 2018 |

On Friday, June 22, the House of Representatives passed H. R. 6, SUPPORT for Patients and Communities Act, by a vote of 396 – 14. This language says that states “… shall not terminate eligibility for medical assistance under the State plan for an individual who is an eligible juvenile because the juvenile is an inmate of a public institution, but may suspend coverage during the period the juvenile is such an inmate;

“(B) in the case of an individual who is an eligible juvenile described in paragraph, the State shall, prior to the individual’s release from such a public institution, conduct a redetermination of eligibility for such individual with respect to such medical assistance (without requiring a new application from the individual) and, if the State determines pursuant to such redetermination that the individual continues to meet the eligibility requirements for such medical assistance, the State shall restore coverage for such medical assistance to such an individual upon the individual’s release from such public institution;” and

“(C) in the case of an individual who is an eligible juvenile described in paragraph, the State shall process any application for medical assistance submitted by, or on behalf of, such individual such that the State makes a determination of eligibility for such individual with respect to such medical assistance upon release of such individual from such public institution.”

For youth leaving juvenile detention facilities, this is vital to them maintaining connections to doctors, needed medicine, and therapies. We strongly support its passage in the senate.

Sec. 1002 of this legislation includes a modified version of H.R. 4998, the Health Insurance for Former Foster Youth Act, which clarifies that states must provide Medicaid coverage for former foster youth regardless of which state they move to after aging out of care.

Currently, foster youth who have aged out of the system are only guaranteed Medicaid coverage in the state where they were enrolled in foster care. Sec. 1002 of this legislation includes a modified version of H.R. 4998, the Health Insurance for Former Foster Youth Act, which clarifies that states must provide Medicaid coverage for former foster youth regardless of which state they move to after aging out of care.

Unfortunately, there is a five-year delay for the mandate of this clarification to be implemented in states. However, this will be an important fix for young people who are transitioning to adulthood across the nation, and we hope states will adopt the provision before it is federally required. We are grateful for the Committee’s inclusion of this bill in the SUPPORT for Patients and Communities Act, and we will continue to advocate for this provision to be included in the Senate. You can learn more about the issue in this paper released by the #HealthCareFFY Campaign.

Sec. 1006 requires the Department of Health and Human Services (HHS) to issue guidance to improve care for infants with Neonatal Abstinence Syndrome (NAS) and their mothers. The guidance must include the types of services states may cover under Medicaid, best practices from States with respect to evidence-based models, and recommendations on available financing options under Medicaid and the Children’s Health Insurance Program (CHIP).

The opioid epidemic is having significant repercussions on the health and well-being of children and young adults in the U.S. Children and young adults affected by substance use disorders face trauma and displacement that may result in contact with the child welfare or juvenile justice systems. The sections detailed above, along with many parts of the larger bill, will help ensure that children and young adults have access to critical health services through Medicaid and CHIP to help them deal with the issues brought on by this epidemic.

First Focus will continue to push for policies that help children and young adults affected by the opioid crisis receive the care and treatment they need for healthy development and educational achievement.

Bipartisan Senate Farm Bill Rejects the Harm of the House Version

| June 21, 2018 |

Last week, the Senate Agriculture Committee advanced the Agriculture Improvement Act of 2018, also known as the Farm Bill. Unlike their counterparts in the House, the senators who crafted this bill did so in a bipartisan fashion. As a result, the draft legislation rejects the House’s harmful changes to the Supplemental Nutrition Assistance Program (SNAP)—which is good news for low-income children.

SNAP is the first line of defense against hunger and food insecurity for low-income individuals, especially the 19.2 million children who represent nearly half of all SNAP participants. This Farm Bill acknowledges the critical role that SNAP plays in lifting children out of poverty and keeping food on the table. Specifically, it avoids the House Bill’s many harmful changes that would have resulted in households with children receiving reduced SNAP benefits—if not losing them entirely. It also fully rejects the Administration’s harmful and expensive proposal to fundamentally change the nature of the program by shifting a portion of a family’s benefits to a system of “Harvest Boxes.”

The Senate Farm Bill also invests in the SNAP’s effectiveness by making it easier for seniors—including those who are acting as legal guardians for their grandchildren—to stay on SNAP, and adds additional resources to programs that incentivize SNAP participants to use their benefits to purchase healthy food options such as fresh fruits and vegetables. With this bill, the Senate Agriculture Committee has recognized the fundamental role that food assistance plays in helping struggling families get back on their feet. Preserving the existing structure and scope of SNAP is an investment in the health, education, and future economic success of our nation’s low-income children.

Of course, the Senate Farm Bill does not pursue the types of policy changes that would make SNAP even more effective for children. While SNAP is an incredibly effective program, monthly benefits are often inadequate for families with children, who report exhausting their allotment by the end of the month. Similarly, existing rules that take SNAP benefits away from so-called Able-Bodied Adults Without Dependents (ABAWDs) if they don’t meet work requirements after 3 months can, and do, have spillover effects on children and youth. For instance, youth aging out of foster care experience high rates of unemployment and poverty. Yet this population, as well as unaccompanied homeless youth, faces barriers to accessing SNAP due to existing ABAWD time limits.

These problems have solutions: for instance, Senator Gillibrand has offered legislation—the SNAP for Kids Act (S. 2723)—to increase monthly benefit sizes for families with school-aged children. Representative Lawson last year introduced the College Student Hunger Act (H.R. 3875), which would allow college students to be eligible SNAP if they are in foster care or are classified as an unaccompanied youth who is homeless.

Still, in this polarized political climate, the mere production of a bipartisan bill—even if it does not contain the aspirational policy provisions mentioned above—is a victory, especially when it means families with children won’t have to worry about losing their ability to put food on the table.

The Trump Administration Abdicates Support for Children with Pre-Existing Conditions

| June 12, 2018 |

My last couple years as a child health advocate in Iowa were before, during, and right after the passage of the Affordable Care Act (ACA). Though I worked on kids’ health issues, specifically Medicaid and the Children’s Health Insurance Program (CHIP), I had of course heard many, many stories insurance companies denying private coverage to people, adults and kids, denying coverage to people for the very things for which they needed coverage — their pre-existing conditions.

Sure, they weren’t always denied coverage flat out, sometimes they were priced out of it. One dad, a farmer, told me that even though his child was eligible for affordable and good coverage through hawk-i (CHIP in Iowa), he wouldn’t put his daughter on it because if they weren’t financially eligible in a year or two, due to a good farming season, he knew her asthma, a pre-existing condition, wouldn’t be covered on the individual market. It was a risk the dad, who couldn’t easily afford the private coverage for her even then, wasn’t willing to take. She wasn’t enrolled in CHIP even though it would have saved the family hundreds of dollars a month, because back then, denying someone, even a child, coverage for their “pre-existing condition” was allowable and commonly practiced. If she needed private coverage again, her asthma wouldn’t be covered. One uninsured trip to an emergency room for an asthma attack, could have put the family in real financial danger.

Another story I remember well is the woman who came to the state capitol to advocate for better health care policies. She had had recurring breast cancer and then lost her job. The only plan she was offered on the private market would insure her from the neck up and from her thighs down. None of her major organs were covered. Only her arms, legs, and her head were insured. She was completely terrified. She told me she would was afraid to be without coverage for the cancer especially since she was a mother of two young children. She didn’t want to die and leave them motherless.

Those are just two of the stories, among some from my own family, that I thought about when the ACA passed and excluding people on the basis of having pre-existing conditions became disallowed. It was a joyous, hopeful time. People were excited to finally gain access to health coverage, to start businesses, to change jobs, to go back to school, to save money. Under the ACA, children under age 19 were some of the very first to benefit from the prohibition of the pre-existing condition exclusions. That policy went into effect September 23rd, 2010, six months after the law was signed. Though it benefitted many children, there were insurance companies who immediately stopped selling single plans to children in order to avoid covering kids with what insurers saw as pre-existing conditions. This was infuriating and seemed to be in defiance of the law. It was a precursor of the battles to come.

The ACA has withstood many challenges at the state, local, and federal levels in court, and from within Congress. While preserving the bulk of the ACA, the Supreme Court decided the mandated Medicaid expansion of coverage was “coercive” and gave states the option to do it, leaving millions and millions of people without that benefit in states that haven’t yet expanded. The Obama administration defended the law time and again, and it held as the law of the land in courts of law. Last summer Republican members in Congress tried numerous times to repeal and replace the law, but were unsuccessful when people around the country fought back. Then came the tax bill in late 2017. In that bill, the financial penalty within the ACA’s mandate to have insurance was removed starting in 2019. Following that, a lawsuit was filed in Texas in early 2018 declaring the whole ACA unconstitutional, based on the repeal of that monetary penalty.

Now comes the letter from Attorney General Sessions to Speaker Ryan saying the Department of Justice (DOJ) will not defend the individual mandate in court and will also argue that without the individual mandate, the pre-existing protections within the ACA are also unconstitutional.

Pre-existing conditions, those health issues that start before one’s health insurance benefits are in effect, some of us know so very well, include an expansive list. In terms of children, think of every child you know who was in the NICU at birth, who has asthma, maybe takes ADHD medication, has juvenile diabetes, childhood cancer, developmental disabilities, or cystic fibrosis. Those are the kids who could lose coverage for those specific illnesses, or total coverage, once again. They could lose their medications, therapies, treatments, and hospital care. Those are the kids whose parents are terrified right now, even though this case could take a long time to be resolved in the courts. These are the kids, millions of them, this administration will not defend.

No family should have to go through this fear again. After all they went through to eliminate the pre-ex barriers, and after all families did to protect themselves last summer and fall against the attacks on the ACA, no one should have to worry about this again.

And yet, here we are.

House TANF Bill Does Not Go Far Enough in Reducing Child Poverty

| June 1, 2018 |

Last week, the House Ways & Means Committee passed the Joining Opportunity with Benefits and Services (JOBS) for Success Act (H.R. 5861), which reauthorizes the Temporary Assistance for Needy Families (TANF) program for five years and makes some fairly significant changes to the program.

While we were pleased with some of the changes included in the (JOBS) for Success Act, including the addition of child poverty reduction as an explicit goal of TANF, we remain very concerned that the changes to TANF proposed in the bill will not significantly strengthen TANF’s ability to reduce child poverty.

Research makes clear that money matters to child well-being. Numerous studies show that when family income rises, it has positive effects for healthy child development, including academic achievement and educational attainment. TANF is the only federal program that provides cash assistance for families, which is critical to help with the cost of resources not covered by other programs, such as diapers, clothing, transportation, utilities, and more.

The overwhelming majority of TANF recipients are children, yet fewer and fewer children are receiving cash assistance, with just under 25 percent of all poor families with children receiving cash assistance today. As a result, the effectiveness of TANF in reducing child poverty continues to diminish. Due to its nature as a fixed block grant, TANF is not able to be effective in responding during times of increased need and the block grant has fallen in value by over 30 percent due to inflation since 1996.

The JOBS for Success Act does not propose to increase funding for the block grant or improve upon the ability of TANF to respond during times of increased need. Without improvements to these aspects of the program, TANF’s potential to reduce child poverty in the U.S. remains limited.

The shift to evaluating state performance based on parental employment outcome measures is positive, however, states must be held accountable to helping people exit TANF with quality employment that provides their family with a wage sufficient for long-term household economic security. States must also allow parents to meet work requirements through pursuing higher education, skills training or vocational education, and guarantee child care assistance, transportation assistance, and other supports.

Yet the overwhelming majority of TANF funds go to children, and nearly 40 percent of TANF cases are “child-only,” meaning that only the child in the household is receiving assistance. Therefore, in order for states to meet this added goal of reducing child poverty, it is critical that state performance is not only measured on parental employment upon leaving TANF, but also on how many children are lifted out of poverty in all TANF caseloads.

During the mark-up, Congressman Danny Davis offered an amendment to create a national child poverty target in the U.S., which would set the goal of cutting child poverty in half within a decade and eliminating it within 20 years. As members of the U.S. Child Poverty Action Group discussed in a letter sent to the Ways & Means Committee, this would be a significant step in holding federal, state and local governments accountable to reducing child poverty through TANF and other programs. While this amendment failed, we were encouraged that Chairman Brady and Congresswoman Jenkins’s expressed a commitment to working with Congressman Davis’s office on this effort.

Reaching economic security is a long road for many families. While parents and caregivers are working towards upward mobility, we need to ensure that every family is provided with enough cash assistance to provide sufficient resources for children while their brains are undergoing critical stages of development.

For additional details on the JOBS for Success Act:

House Ways & Means Committee Section by Section Summary

Mark-Up Video and List of Amendments

For recommendations on TANF reform from the U.S. Child Poverty Action Group:

Children Living in Poverty Need TANF Reform

A Child-Focused Approach to TANF Reform

The Greatest Investment in Our Pediatric Workforce Needs Support

| May 25, 2018 |

The House Energy and Commerce Committee held a hearing on the Children’s Hospital Graduate Education Program (CHGME) this week. This vital program trains physicians who are on the front lines of treating our nation’s children.

Funded last year at $300 million, the program is the nation’s greatest single investment in our pediatric workforce. CHGME was created in 1999 as Congress recognized that a dedicated source of support for training in children’s hospitals was necessary to strengthen the pediatric workforce. Since then, CHGME funding has enabled children’s hospitals to dramatically increase training overall, and, in particular, grow the supply of pediatric specialists.

According to testimony provided to the House Energy and Commerce Committee, between 2000 and 2015, hospitals supported by CHGME increased the number of residents trained by 113 percent.1

Unfortunately, even with this investment, the program has only funded the residency of only 40 percent of the general pediatric residencies across the nation. It also only funds approximately 50 percent of the of all pediatric specialists, approximately 7,000 annually.

First Focus is thankful for this vitally important hearing, especially for shining a light on the need to train more sub-specialists, where there is a greater need.2

Based on data by the American Medical Association, the number of programs around the country fall short of meeting the nation’s need. For instance, there are only 73 pediatric emergency medicine programs around the country that trained 463 residents in 2015. During that same year, there were only 125 child and adolescent psychiatry programs training 787 residents.3

This has also caused children to spend a significant amount of time before meeting with a specialist. For instance, children with developmental disabilities wait, on average over 18 weeks for an appointment. 4 Children requiring psychiatric services are waiting close to 10 weeks. 5

CHGME is a discretionary program that has to date received bi-partisan support. It has also provided considerably less than what the nation requires. This country can do more for our children. While we invest in the other systems of development for our children, let’s make sure kids with the most need can see a doctor best suited for them.

1 Testimony by Gordon E. Schutze M.D. F.A.A.P., Baylor College of Medicine to the House of Representatives, Committee on Energy and Commerce.

2 Children’s Hospital Association

3 American Medical Association 2015 Data

4 Children’s Hospital Association

5 Children’s Hospital Association

This Foster Care Month, Pass Laws to Improve the Lives of Foster Children

| May 7, 2018 |

May is National Foster Care Month. Last week President Trump issued a statement in support of this recognition and expressed gratitude for the thousands of families who generously open their homes to children and youth who have experienced abuse and neglect. National Foster Care Month brings attention to needs and resilience of children and youth currently in foster care and those who have aged out of foster care, the selfless work of child welfare advocates and providers, and the compassion of kinship caregivers and foster families.

In 2017, national headlines uncovered the uptick in numbers of kids entering foster care due to the national opioid crisis and highlighted a need for reform in our nation’s approach to child abuse and neglect and treatment for parents in need of substance use treatment. The recent passage of the Family First Prevention Services Act (FFPSA) was a major victory for many child welfare advocates on both the state and federal levels. FFPSA is bipartisan legislation that allows states and tribes to devote Title IV-E funding to mental health and substance use treatment, and parenting education and skills programs that help keep families intact and out of the child welfare system. The First Focus is supportive of this legislation and stands ready to assist state partners with technical assistance and advocacy efforts for effective implementation of the law.

The enactment of the Family First Prevention Services Act is just the beginning. More can and should be done for youth in foster care, youth aging out of foster care and the families affected by a child’s entry into the child welfare system. Several bills aimed at addressing the concerns of children in foster care have been introduced in the 115th Congress. While we applaud the introduction of such effective legislation, more action is needed to ensure these policies are enacted and put to work for our most vulnerable young people.

Among the bills yet to be enacted is a bipartisan bill introduced by Chairman Hatch (R-UT) and Ranking Member Wyden (D-OR), the Child Welfare Oversight and Accountability Act of 2017 (S.1964). This bill would follow the recommendations of a two- year investigation to strengthen accountability of child welfare systems and individual providers throughout the nation. The Health Insurance for Former Foster Youth Act (S.1797/H.R.4998), introduced by Sen. Bob Casey (D-PA) would correct an unintended loophole to ensure that Former Foster Youth have continuous coverage as they transition to adulthood. Other important bills include the Fostering Stable Housing Opportunities Act of 2017 (S.1638 / H.R. 2069), Higher Education Access and Success for Homeless and Foster Youth Act (S.1795), Timely Mental Health for Foster Youth Act (S.439/H.R. 1069) and the Foster Youth and Driving Act (H.R. 2512). You can see the complete list of bills here.

In honor of National Foster Care Month, we urge congressional leaders to come together in a bipartisan manner to these legislative proposals that will enhance the quality of life for current and former foster youth. Over the course of the month First Focus Campaign for Children will be highlighting child welfare bills that have been introduced in the 115th Congress that need action. We urge you to join us in making children the priority in Congress.

Follow us on Twitter @Campaign4Kids to help promote the movement of these policies.

For the latest on these policies and others affecting children, check out the First Focus Campaign for Children Bill Tracker.

A New Effort to Boost Children’s Oral Health and Family Success

| April 30, 2018 |

While you might not think about your oral health until you suffer from dental pain, tooth decay remains the most chronic condition among children nationwide. It can hurt a child’s ability to eat, sleep, and learn. In fact, children with poor oral health are four times more likely to earn lower grades than their healthier peers. As kids grow up, poor oral health can lead to lower wages or limited job prospects. Those are some pretty hefty consequences for a disease that can be prevented if children and families get the right support.

How can we improve children’s oral health so they can reach their full potential?

Having dental coverage is a piece of this puzzle. We are proud to have collaborated with First Focus in the hard-won fight to protect a key source of dental coverage for kids – the Children’s Health Insurance Program. It was thankfully renewed for a decade earlier this year. And, we continue to work together to safeguard Medicaid against threats that could jeopardize oral health access for children in struggling families. Due, in part, to the guaranteed pediatric dental benefits in CHIP and Medicaid, nearly 9 in 10 children have dental insurance today. Gains made by the Affordable Care Act have also made a difference. Coverage can open the door to children getting needed dental care, whether to prevent or treat harmful decay.

But having coverage alone isn’t enough to keep our kids healthy. As First Focus knows, a child’s health and well-being are affected by the opportunities and challenges their parents or caregivers face, from their access to jobs with a living wage to their own access to health coverage. Even without current threats to Medicaid coming to fruition, parents and caregivers in most states have greater barriers to dental coverage and care than their children do. These are among the circumstances that keep many families from being able to place their children on a path of good oral health, and have broader implications for family success.

The Children’s Dental Health Project (CDHP) wants to know more about how these crucial links can inform policies to help more kids stay healthy. As our new video highlights, CDHP has launched a new initiative addressing oral health within the context of families and the many barriers to family well-being.



In particular, we want to take a closer look at what opportunities we create (or miss) when we address the oral health of the entire family. Taking a more holistic and multi-generational approach could improve children’s and families’ oral health, improving their overall health and success. At this stage, CDHP is focused on the intersection of oral health and:

  • the economic stability of families
  • family stressors and/or mental health
  • adverse childhood experiences
  • children’s educational outcomes
  • more that we have yet to discover

We hope this investigation leads to new policies that integrate oral health into where we live, work, and play, and how we use and pay for health coverage and care. Solutions that recognize the relationship between these factors and the oral health of the whole family could help more children and families get the support they need.

Embarking on this project, we invite First Focus and its partners to join us. CDHP is new to the bigger frame of family success, “2Gen” approaches, and whole family interventions. In fact, we aren’t even sure what to call it, and we know we need to learn more about the role of oral health in these models. We don’t claim to have all the answers. However, we are opening our doors to new and exciting collaborations to offer our knowledge and experience on oral health — and to learn from experts who have been working on these broader issues for decades. We want to challenge you to think about the role of oral health in your current work, and together strengthen systems that can help kids and families nationwide reach their full potential.

Meg Booth is executive director of the Children’s Dental Health Project, a policy institute in Washington, DC advancing solutions so all children achieve oral health. Learn more at www.cdhp.org.

New HUD Proposals Are the Wrong Direction for Children

| April 27, 2018 |

Affordable housing remains one of the main barriers to economic stability for many families. Housing costs continue to increase in the United States, yet family income has not kept pace. One-third of U.S. children live in households with a high housing cost burden, defined as spending more than 30 percent of the household’s monthly income on housing.

Housing instability, which includes situations such as being behind on rent and making multiple moves, is associated with an increased risk of poor child health, including hospitalizations and of maternal depression.

Sustained housing instability can lead to homelessness, which can further destabilize families, causing trauma with severe negative implications for children’s healthy development and hurt their opportunities for educational achievement and attainment.

Access to housing assistance remains extremely limited—only one in four families who are eligible for rent assistance in the United States receive it. Yet earlier this week, U.S. Department of Housing and Urban Development (HUD) Secretary Ben Carson announced a proposal that would further limit access to housing assistance for families.

Secretary Carson proposed to:

  • Increase rent for tenants in subsidized housing from paying 30% of their gross income to 35% of income, affecting 4.7 million families
  • Triple minimum rent for households to $152, which raise rents for about 1.7 million people
  • Give HUD unlimited, unilateral authority to impose additional rent increases
  • Allow public housing agencies to impose work requirements
  • Remove deductions from income calculations for medical expenses and child care costs

While elderly and individuals with disabilities are exempted from the work requirements and rent increases (for a six-year period), there is no similar exemption for families with children.

In most low-income households with children, there is at least one family member who is working. Yet due to low wages and skyrocketing rents, parents still struggle to make ends meet.

Imposing work requirements would only create bureaucratic documentation barriers that would result in families with children losing this important assistance. Combined with the increases in rent and elimination of a deduction for child care costs, these changes would have a devastating impact for low-income families with children.

The Center on Budget and Policy Priorities estimates that increasing the minimum rent for households would put a million children at risk of homelessness. Child and youth homelessness is already skyrocketing, with 1.3 million students identified as homeless by the U.S. Department of Education.

In addition, HUD officials have claimed that due to budgetary constraints, they will be prioritizing housing for seniors and people with disabilities, as well as removing lead-based paint from housing.

First Focus urges that, along with seniors and people with disabilities, we must prioritize families with children. The U.S. has the ability to assist all of these populations simultaneously, and it is crucial that children have stable housing while undergoing critical stages of development.

In order to actually help families achieve economic security, we should make investments in affordable housing, childcare, transportation, higher education, and job training.

When it comes to increasing access to stable housing, we need to increase rental assistance, expand access to civil legal services for families facing evictions and other housing disputes, and build upon programs that pair housing with wraparound services. This includes increasing and building upon partnerships between public housing authorities and public school systems designed to improve the educational outcomes of children living in subsidized housing.

To learn more:

Housing Instability in the U.S.: Not Just a Problem of Housing Affordability