Disclaimer: Moving Health Care Upstream is a collaborative effort originally co-led by Nemours Children’s Health and the Center for Healthier Children, Families & Communities at the University of California- Los Angeles (UCLA). The views and opinions expressed in this article are those of the author(s) and do not necessarily reflect the official policy or position of Nemours, UCLA or the Moving Health Care Upstream initiative. Additionally, the policy recommendations included in this post reflect the viewpoints of the authors and do not necessarily reflect the viewpoints of others engaged in the development of this report (e.g., interviewees, reviewers).

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Nemours Children’s Health and the Elizabeth Dole Foundation are pleased to announce the national release of Caring for Children and Teens in Military Caregiving Families, a continuing education course to increase healthcare providers’ ability to understand and support the unique needs of children in military families.

The three-part training is designed for primary, specialty, and behavioral health care providers and care team members who see children and teens from military and veteran caregiving families. The recommendations offered in the training were informed by more than 200 survey and focus group responses from parents and guardians of children and teens growing up in military caregiving homes as well as the experts featured in the presentation. The course is intended to provide a high-level overview; it is supplemented by a resource document with links for taking a deeper dive into topics addressed in the modules. 

The course is available via the continuing education platform of Nemours Children’s Health. As part of Nemours Children’s commitment to creating the healthiest generations of children in our service areas and beyond, the course is nationally available at no cost. 

In this video clip, Silvia Lopez, a military caregiving spouse, reflects on the need for healthcare providers to better understand the realities of Hidden Helpers- children of wounded, ill or injured service members or veterans.  

Along with Ms. Lopez, the course features spouses and young adults from military caregiving families along with Nemours Children’s psychologists and physicians. We thank them for their participation in this important work on behalf of military/veteran-connected children and families across the nation.  

“Nemours Children’s is committed to creating the healthiest generations of children. One way we do this is by developing tools and resources for our colleagues on the front line caring for some of our most vulnerable children,” said R. Lawrence Moss, MD, FACS, FAAP, President and CEO, Nemours Children’s Health. “We are honored to partner with the Elizabeth Dole Foundation to make this training available to clinicians at no cost. Together, we can substantively support our providers in offering even better care to these young families who are defending our nation’s freedom.” 

 CALL TO ACTION 

Partners are encouraged to use the communications/promotion toolkit to help us spread the word. The toolkit contains draft social media posts and email or newsletter content, along with images to include.  

BACKGROUND 

In November 2021, Nemours Children’s was proud to be the first pediatric health system to join the Hidden Helpers coalition, a joint initiative of the Elizabeth Dole Foundation, Wounded Warrior Project, and Joining Forces (a White House initiative to support military families). The 60+ member organizations in the Hidden Helpers coalition seek to fill gaps in supports and services for “Hidden Helpers”- the 2.3 million U.S. children of wounded, ill or injured service members or veterans, and to increase awareness of their unique needs. 

 At a White House event, the partners behind the Hidden Helpers coalition announced a series of commitments to address gaps and needs identified in the first major research study focused on military caregiver children and adolescents, Hidden Helpers at the Frontlines of Caregiving: Supporting the Healthy Development of Children from Military and Veteran Caregiving Homes. Nemours Children’s committed to create continuing education resources aimed at increasing the ability of health care providers to understand and support the needs of Hidden Helpers. We collaborated with the Elizabeth Dole Foundation to carry out our commitment.   

FOR MORE INFORMATION 

To learn more, please email [email protected]. 

Disclaimer: Moving Health Care Upstream is a collaborative effort originally co-led by Nemours Children’s Health and the Center for Healthier Children, Families & Communities at the University of California- Los Angeles (UCLA). The views and opinions expressed in this article are those of the author(s) and do not necessarily reflect the official policy or position of Nemours, UCLA or the Moving Health Care Upstream initiative.

Authors:

• Hannah Wagner, MPP, Senior Advisor, Policy Development and Partnership
• Kara Odom Walker, MD, MPH, MSHS, Executive Vice President and Chief Population Health Officer
• Daniella Gratale, MA, AVP, Federal Affairs
• Casey Osgood, MPH, Senior Advisor, Legislative and Regulatory Affairs

Introduction

Poverty is a powerful social driver of health that can impact children’s health and wellbeing throughout their lives. A growing body of evidence supports the positive impact of federal anti-poverty programs, like the Child Tax Credit, to help children perform better in school, live healthier lives, and earn higher incomes as adults. Congress has a unique opportunity to consider new measures to address child poverty.

What is the Child Tax Credit, and why is it important?

Established in 1997, the Child Tax Credit is a federal program that provides a tax break to eligible families with children. The amount of the tax credit is determined by household income, marital status and number of dependent children. Current estimates suggest that the Child Tax Credit lifts about two million children out of poverty each year.

During the COVID-19 pandemic, the American Rescue Plan Act (ARPA) temporarily expanded the Child Tax Credit. The temporary expansion expired at the end of 2021, and child poverty rates increased. Congress is again considering expanding the existing Child Tax Credit, albeit more modestly than the ARPA expansion. An expansion could amplify the impact of the already powerful program by lifting additional children out of poverty, which could, in turn, improve child health and education outcomes.

Public Health Context

Poverty is the single greatest driver of health.

Poverty is the single greatest driver of health. Families that experience poverty may endure both material hardship (e.g., substandard housing, insufficient nutritious food) as well as increased psychological distress – both of which can profoundly impact child health and social outcomes, including developmental delays, chronic illness, and toxic stress.

• Physical health. Poverty can impact birthweight and infant mortality. Additionally, children living in poverty are more likely to experience asthma, hypertension, poor nutrition, and obesity, all of which can affect lifelong health.
• Development. Research demonstrates that living in poverty is associated with differences in brain development in children and adolescents, which can affect cognitive processes related to learning, communication, social emotional processing, and academic achievement.
• Social, emotional and mental health. Children that experience poverty are more likely to experience chronic stressors (e.g., substandard housing, separation from caregivers), which can influence brain development. Children living in poverty are also at increased risk of challenges with self-regulation and executive function (e.g., inattention, impulsivity, defiance, poor peer relationships). Lastly, one study shows that the more time children spend in poverty from birth to age nine, the worse their mental health is as emerging adults.

Poverty can also impact other social drivers of health – like academic achievement.

Substantial evidence demonstrates that as compared to children who are not living in poverty, children living in poverty fare worse in school, which can impact children into their teenage years and adulthood. Moreover, children who experience poverty are more likely to experience poverty as an adult – perpetuating cycles of generational poverty, and the consequences of poverty on one generation can impact generations to come.

The Opportunity to Address Child Poverty

Evidence from the Child Tax Credit expansion during the COVID-19 pandemic suggests the positive impact of the Credit on lifting families out of poverty.

Efforts to expand the Child Tax Credit would build on recent policy successes. Analysis from the Census Bureau shows that the most recent one-year expansion during of the Child Tax Credit during the COVID-19 pandemic, in combination with other relief efforts, contributed to a decline of nearly 50% in child poverty rates, with child poverty rates recorded at 5.2% in 2021, a record low. Poverty rates dropped most dramatically among Black and Hispanic children. Moreover, evidence suggests that the expanded Child Tax Credit helped families meet their basic needs, including decreasing food insecurity, while not decreasing parent/caretaker employment.

Lifting children out of poverty improves child health and wellbeing.

Anti-poverty programs that provide cash or near-cash support can improve child health and wellbeing, including improving physical, emotional and behavioral health, as well as educational outcomes. Moreover anti-poverty programs are also shown to reduce contact with the criminal justice and child protective service system.

Forward momentum on Child Tax Credit in Congress could lift more children out of poverty.

Momentum has been building in Congress to extend the child tax credit. On January 31, 2024, the U.S. House of Representatives passed the bipartisan Tax Relief for American Families and Workers Act of 2024 (HR 7024), a $78 billion tax package that includes a provision to expand the Child Tax Credit. This expansion would make the Child Tax Credit more generous for families who currently cannot claim the credit in full. It would also eventually adjust the Child Tax Credit for inflation. The proposed changes would have a profound impact on the country’s lowest income families, with estimates suggesting that the bipartisan Child Tax Credit proposal could lift over half a million children out of poverty.

On the Senate side, it is possible the bill is amended either in the Finance Committee or on the floor of the Senate. If the Senate passes an amended package, it would need to be negotiated with the House before a final measure could move to President Biden for his signature.

A Step Towards Reducing Child Poverty and Improving Child Health

Alleviating child poverty stands to improve child health outcomes in the short- and long-term. Evidence shows that anti-poverty programs, like the Child Tax Credit and others, can help lift children and families out of poverty and improve their outcomes for years to come.

Disclaimer: Moving Health Care Upstream is a collaborative effort originally co-led by Nemours Children’s Health and the Center for Healthier Children, Families & Communities at the University of California- Los Angeles (UCLA). The views and opinions expressed in this article are those of the author(s) and do not necessarily reflect the official policy or position of Nemours, UCLA or the Moving Health Care Upstream initiative. Additionally, the policy recommendations included in this post reflect the viewpoints of the authors and do not necessarily reflect the viewpoints of others engaged in the development of this report (e.g., interviewees, reviewers).

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Authors:

• Hannah Wagner, MPP, Senior Advisor of Policy Development & Partnership, Nemours Children’s Health
• Daniella Gratale, MA, AVP, Federal Affairs, Nemours Children’s Health
• Josh Traylor, MPH, Executive Director, Center for Health and Research Transformation
• Josh Ogburn, MPH, MPP, Population and Whole Child Health Program Advisor, Nemours Children’s Health
• Alycia Steinberg, MPH, Principal, Burton Policy Consulting

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About Whole Child Health

Whole child health approaches go beyond clinical care to cultivate healthy minds  and create a strong foundation for a healthier, brighter future for children and youth. Such approaches address multi-faceted developmental, physical, mental, behavioral and social needs through cross-sector (e.g., healthcare, education, social services) collaborations that help children and youth reach their full potential. Informed by interviews with more than 30 key stakeholders, the Whole Child Health Alliance (the “Alliance”) recently released Advancing the Key Elements of Whole Child Health: State Case Studies and Policy Recommendations. The report takes a deep dive into how Massachusetts, North Carolina and Washington have implemented key elements of whole child health that help children and youth thrive. Key findings and recommendations are summarized in the Executive Summary.

[Read more…]

Disclaimer: Moving Health Care Upstream is a collaborative effort originally co-led by Nemours Children’s Health and the Center for Healthier Children, Families & Communities at the University of California- Los Angeles (UCLA). The views and opinions expressed in this article are those of the author(s) and do not necessarily reflect the official policy or position of Nemours, UCLA or the Moving Health Care Upstream initiative.

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Authors:

• Kara Odom Walker, MD, MPH, MSHS; Executive Vice President, Chief Population Health Officer; Nemours Children’s Health
• Laura Hogan, MPA, Consultant, Laura Hogan Consulting
• Daniella Gratale, MA; Associate Vice President, Federal Affairs; Nemours Children’s Health

Thank you to Hannah Wagner, MPP, Senior Advisor, Policy Development and Partnership, Nemours Children’s Health, for editing this blog post.

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“[The] challenges today’s generation of young people face are unprecedented and uniquely hard to navigate. And the effect these challenges have had on their mental health is devastating […] If we seize this moment, step up for our children and their families in their moment of need, and lead with inclusion, kindness, and respect, we can lay the foundation for a healthier, more resilient, and more fulfilled nation.”

– Vivek Murthy, MD, MBA, US Surgeon General, Protecting Youth Mental Health Advisory: The U.S. Surgeon General’s Advisory, 2021

America’s children and youth report staggering rates of sadness, depression, anxiety, and loneliness. This can result in high risk for suicide, depression, substance use disorder, poor academic performance, and other severe consequences. Nearly 60% of female high school students and about 30% of male students surveyed reported experiencing persistent feelings of sadness or hopelessness for two weeks or more in the past year. Moreover, a 2023 survey showed that 86% of children report that they worry, and 36% report being sad or miserable when they worry. While substance use among young people decreased over recent years, the spread of fentanyl has led to a tragic epidemic of overdose deaths. And, younger children are showing signs of acute distress with suicide now reported as the second most common cause of death for children ages 10 to 14. [Read more…]

Disclaimer: Moving Health Care Upstream is a collaborative effort originally co-led by Nemours Children’s Health and the Center for Healthier Children, Families & Communities at the University of California- Los Angeles (UCLA). The views and opinions expressed in this article are those of the author(s) and do not necessarily reflect the official policy or position of Nemours, UCLA or the Moving Health Care Upstream initiative.

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On December 1^st, Nemours Children’s Health, March of Dimes (MOD), Children’s Hospital of Philadelphia and the Ann & Robert H. Lurie Children’s Hospital of Chicago hosted the third annual Hot Topics in Neonatology^® 2022 Cindy Pellegrini Maternal & Child Health Advocacy Day.

This virtual event honors Cindy Pellegrini, who passed away in 2019, leaving behind a legacy as a tireless advocate for maternal and child health. The event brings together health care professionals and advocates to share their experience and expertise and ask Congress to act on important infant and maternal health policies.
[Read more…]