Healing a Child's Broken Heart

It’s always very challenging for a parent when their child has a serious health condition. It’s even more challenging when their child has a serious condition but has no health insurance to cover the needed care and emergencies. Both were true for one Texas mother whose 12-year-old daughter Evelyn was diagnosed with a heart defect. Evelyn often ended up at her school nurse’s office complaining of shortness of breath. When the nurse encouraged her mother to take her in to the doctor, Evelyn’s mother, who bakes cakes for a living, explained that Evelyn was uninsured and she couldn’t afford the specialist fees that ran into the hundreds of dollars per visit. But the nurse had attended a presentation for school district staff on the importance of connecting students to available health coverage and knew she could put Evelyn’s family in touch with an outreach worker from the Children’s Defense Fund-Texas office to help her apply for insurance.
 
CDF-Texas helped Evelyn’s mother with her application and with the critical follow up after the first application was misfiled. Once those steps were taken the family was rightfully approved and Evelyn was finally able to obtain the health care she desperately needed. Soon after she had open heart surgery to replace a non-functional heart valve. Specialists at the Pediatric Heart Clinic told Evelyn’s family she was very lucky to have had the surgery when she did. Her mother says, “It was not about luck, it was a blessing!” Evelyn’s family says they feel happy and blessed to have had help applying for health coverage when it seemed they had no hope.

Evelyn is one of millions of children whose story now has a happier ending. This year marks the 50^th anniversary of the Medicaid program, which together with the Children’s Health Insurance Program (CHIP) has brought the number of uninsured children to an historic low. Medicaid and CHIP provide comprehensive and affordable health coverage to more than 44 million children—that’s 57 percent of all children in America. With the new coverage options offered by the Affordable Care Act, 93 percent of all children now have health coverage.

But we can never stop working to reach children like Evelyn who haven’t yet been connected to coverage. More than 5.2 million children under age 18 were uninsured in 2013. The overwhelming majority live with working parents and are citizens. More than a third live in three states—California, Texas, and Florida. Uninsured children are more likely to be children of color, children ages 13-18, and children who live in rural areas. More than half —3.7 million—are eligible for Medicaid or CHIP but not yet enrolled.


That’s why CDF continues to work, in partnership with AASA, The School Superintendents Association, to encourage school districts to help get all students the health coverage they need to learn and succeed in school. Our goal is to make school-based child health outreach and enrollment a routine and ongoing part of school district operations. The model is built around a basic question districts add to their school registration materials: “Does your child have health insurance?” Parents who answer “no” or “don’t know” are flagged and receive information from school district staff on Medicaid, CHIP, or other health coverage options. But it doesn’t stop there. Parents also can receive application assistance and often are introduced to community partners to help them successfully navigate the enrollment process the way Evelyn’s mother was connected in Texas.

CDF-Texas with its partners pioneered this technique in the Houston Independent School District almost a decade ago and since then CDF and AASA have partnered with districts in California, Georgia, Louisiana, and Mississippi, including small and large, urban, rural, and suburban school systems, serving elementary through high schools with a rainbow of  Black, Latino, Asian, and White students. Superintendents, principals, teachers, school nurses and other staff have gained a clearer understanding of the critical links between children’s health, school attendance, and ability to achieve in school. Many are now leading public education efforts to engage parents and the broader community in events geared to health and wellness. Keeping children healthy is a win for everyone.

Dr. Kavin Dotson

As Dr. Kavin Dotson, Director of Student Services for the Lynwood Unified School District in California, put it at a recent convening at CDF Haley Farm in Tennessee, “we were unaware of the fact that there were so many students in our district that did not have health insurance.” He now believes that “every school in our country is going to make a 100 percent commitment to ensure that all students are enrolled in some type of health insurance that will meet their health needs.

You too can take action now to spread the word about the importance of health coverage in your own communities with help from the Connecting Kids to Coverage national campaign. Through the end of this month it has print materials and TV and radio ads in English and Spanish that you can customize to reach parents and others assisting children. Children can enroll in CHIP or Medicaid at any time.

How frustrating it is that at the very same time we are celebrating Medicaid’s long and successful history and the recent bipartisan two-year CHIP funding extension and building on successful outreach and enrollment strategies, these critical child health programs are under attack in Congress. The fiscal year 2016 budget resolution proposes deep cuts in Medicaid and structural changes in both Medicaid and CHIP that will jeopardize their reach and make it even more difficult for many more children like Evelyn to get the coverage and care they desperately need. But there’s still time to demand that Congress stop the cuts and efforts to dismantle the structure of Medicaid and CHIP. Why would they fool around with something that is working so well for parents and children? All of us must work together to move forward not backwards to make sure all children get the health care they need to live and learn and thrive.

Criminalizing Poverty

“Held captive.” It was how one 13-year-old described the feeling of growing up poor in our wealthy nation, and for more and more Americans living in poverty, this feeling isn’t just a metaphor. The recent Department of Justice report on police and court practices in Ferguson, Missouri put a much needed spotlight on how a predatory system of enforcement of minor misdemeanors and compounding fines can trap low-income people in a never-ending cycle of debt, poverty, and jail. In Ferguson this included outrageous fines for minor infractions like failing to show proof of insurance and letting grass and weeds in a yard get too high. In one case a woman who parked her car illegally in 2007 and couldn’t pay the initial $151 fee has since been arrested twice, spent six days in jail, paid $550 to a city court, and as of 2014 still owed the city $541 in fines, all as a result of the unpaid parking ticket. The Department of Justice found each year Ferguson set targets for the police and courts to generate more and more money from municipal fines. And Ferguson isn’t alone. The criminalization of poverty is a growing trend in states and localities across the country.

The investigation of Ferguson’s practices came after the killing of unarmed 18-year-old Michael Brown by a police officer, and last month the practice of criminalizing poverty made headlines again after Walter Scott was killed in North Charleston, South Carolina. Scott was shot in the back by police officer Michael Slager on April 4 as he ran away after being pulled over for a broken taillight. Scott had already served time in jail for falling behind on child support, and on the day he was stopped there was a warrant out for his arrest for falling behind again. His family believes his fear of going back to jail caused him to run from the broken taillight stop. His brother told The New York Times that Walter Scott already felt trapped: “Every job he has had, he has gotten fired from because he went to jail because he was locked up for child support,” said Rodney Scott, whose brother was most recently working as a forklift operator. “He got to the point where he felt like it defeated the purpose.” A 2009 review of county jails in South Carolina found that 1 in 8 inmates was behind bars for failure to pay child support. Rodney Scott remembered his brother trying to explain to a judge that he simply did not make enough money to pay the amount ordered by the court: “And the judge said something like, ‘That’s your problem. You figure it out.’”

The Institute for Policy Studies recently released a groundbreaking new reporthighlighting the policies and practices that have led to increased criminalization of poverty, and that report and similar studies are finally shining a light on the way some municipalities are criminalizing poor people just for being poor. The United States legally ended the practice of debtor’s prisons in 1833, and the Supreme Court ruled in Bearden v. Georgia (1983) that it is unconstitutional to imprison those who can’t afford to pay their debt or restitution in criminal cases, unless the act of not paying debt or restitution is “willful.” But poor people are being increasingly targeted with fines and fees for misdemeanors and winding up in illegal debtors’ prisons when they can’t pay—and in some cases, then being charged additional fees for court and jail costs. A recent investigation by National Public Radio, the New York University Brennan Center for Justice, and the National Center for State Courts cited a study estimating between 80-85 percent of inmates now leave prison owing debt for court-imposed costs, restitution, fines and fees. In some jurisdictions defendants are charged for their room and board during lockup, probation and parole supervision, drug and alcohol abuse treatment, DNA samples, and even their constitutional right to a public defender. When poor people can’t pay those fees either, the cycle of debt and jail time continues.

The private companies providing probation services in more than half of the states are some of the biggest winners when poor people are targeted. If people on probation can’t afford the fees they are charged, they breach their probation contract; this can result in more jail time, making it even less likely that they’ll be earning the money they need, and people under the supervision of these private probation companies often become liable for charges exceeding the initial cost of their ticket or fine. Federal law also prohibits people in breach of probation from receiving a range of benefits, including Temporary Assistance for Needy Families (TANF), food stamps, and Supplemental Security Income—once again, exacerbating the cycle of poverty, probation, and prison.

And state and local policies establish barriers that make it more difficult for people who have served any time in prison, including those there because they were poor, to re-integrate into society. According to a study conducted by the American Bar Association’s Criminal Justice Section, there are more than 38,000 documented statutes nationwide creating collateral consequences for people with criminal convictions including barriers to housing, employment, voting, and many public benefits. By denying these citizens access to basic services they need to survive, our policies needlessly increase the risk of recidivism and continue to leave people truly trapped—and when we extend the cycle of poverty by criminalizing poor people, there are only a few greedy winners and many, many losers.

All in the Family

My mother was doing drugs, specifically cocaine, crack cocaine... I almost
died. They said that I was either going to be deaf or retarded or I wasn’t
going to survive past childhood or infancy because there were so many chemicals
in my system.

The odds were stacked against Britiny Lee before she was born. Her mother was addicted to drugs, like Britiny’s grandfather and many others in their poverty-stricken Cleveland neighborhood. Britiny’s mother used drugs throughout her pregnancy and went to prison for a year just after Britiny’s birth. As a poor, Black “crack baby” with an addicted, incarcerated mother and an absent father, Britiny started life in danger. Being born into an unstable poor family or to a single, teen, incarcerated, or absent parent are all known risk factors in America’s Cradle to Prison Pipeline® crisis. The disadvantages millions of poor children and children of color face from birth along the continuum to and through adulthood—which can  include no or inadequate prenatal and health care; no or little quality early childhood education and enrichment; child abuse and neglect; failing schools; grade retention, suspension, and expulsion; questionable special education placements; dropping out of school; unaddressed mental health problems; violent drug infested neighborhoods; and disproportionate involvement in the child welfare and juvenile justice systems—cumulate and converge and funnel so many poor children of color into a pipeline and trajectory that too often leads to marginalized lives, imprisonment, and premature death. Entering the child welfare system would have been still another risk factor for baby Britiny but she was lucky. 

Watch Britiny's Story

That was where Britiny’s grandmother stepped in who already had custody of Britiny’s older brother and sister. She brought Britiny home too and Britiny says, “My grandmother stepped up to the plate to raise us because she didn’t want us to go into the foster care system.” Britiny’s grandmother didn’t have a lot of money, but she was a stable source of love and support throughout childhood and Britiny flourished in her care. Despite doctors’ concerns when she was born as a drug addicted child, Britiny was resilient and became a straight-A student who loved school from the beginning. Britiny’s grandmother was her rock even while struggling with the autoimmune disease lupus, which got worse as Britiny got older. When she was 8 years old her grandmother suffered a seizure when they were home alone together and Britiny had to call 911 and ride in the ambulance with her grandmother to the hospital. 

From then on she was terrified of losing her grandmother. Britiny’s mother Felicia, who had come in and out of her life throughout her childhood, was struggling towards sobriety. Nine months after Felicia became sober, when Britiny was 10 years old, her grandmother died. Felicia remembers the moving moment: “[My mother] held my hand and she told me, ‘Licia, I want to go home.’ And I thought that she meant go home, like put her in the car and take her home. No. She was saying she was tired and she was ready to go home to Glory... She looked at me in my eyes, and she said, ‘And God told me that you were ready, that you were ready to be a mom, that you’re going to be a good mom, that you’re not going to use drugs anymore, and that I could go.’” Britiny’s mother was finally ready to step in, regain custody, and learn how to be the parent her daughter needed and deserved. Today Britiny is a high school senior about to graduate from Cleveland’s John Hay School of Science and Medicine and dreams of becoming a cardiac surgeon. She recently received a Beat the Odds® scholarship from Children’s Defense Fund-Ohio. She says of her beloved grandmother, “She’s looking down on me. I’m sure she’s proud, and right now I just want to make her even more proud. I want to show her that she didn’t fight for me for nothing.”  

Britiny’s grandmother was one of the many caregivers raising children in “kinship care” or “GrandFamilies”—headed by grandparents or other relatives who step in when parents are unable to do so. Sometimes a child is removed from parents’ care by the state and placed with relatives in foster care; in other cases, children like Britiny are placed informally with relatives outside foster care. More than 6 million children are being raised in households headed by grandparents and other relatives. Of those 6 million, 2.5 million children are living in households without their parents present. These relative caregivers like Britiny’s grandmother are willing to care for the children, but often need financial or other help to appropriately meet their children’s needs.

A number of states have used subsidized guardianship programs to support kinship families and GrandFamilies. Kinship care has been found to help children maintain family, and oftentimes community, connections. There is also strong evidence that children placed in kinship care experience greater stability, have fewer behavioral problems, and are just as safe—if not safer—than children in non-relative care. In Britiny’s case, all of these positive outcomes came to pass, and after her grandmother “stepped up to the plate” a child who could easily have become a statistic is beating the odds and is a star with a bright future.