Thursday, April 26, 2007

People are cruel to kids everywhere

UK blogger Helen "Sparkles" (http://www.helensparkles.blogspot.com/) describes in specific detail two recently publicized cases of abuse of kids in foster and kinship care.

Adults can be cruel to children in ways that defy explanation. And abuse can happen without a hand being raised. Our words, our behavior and our reactions to kids can be abusive in some very insidious and horrific ways. Is there anywhere in our world where no children are subject to cruelty by adults who are supposed to be caring for them?

Looking at child abuse statistics around the globe, it is appears that violence towards children doesn't correlate only to tacit societal acceptance of hatred and aggression.

Child abuse is pervasive. But it is never, ever okay.

Wednesday, April 25, 2007

Harry and the Monkeys

Even infants and toddlers have mental health screenings these days. For me, screening babies and toddlers is a respite from so much of my work. I love the time I get to spend with the babies. Snuggling with these little humans, getting spit-up on a clean shirt, wearing pee from a leaky diaper on my levis, wiping noses--the whole trip is a giggle.

Usually.

Sometimes I find babies who don't smile, or reach out, or squeeze fingers and noses, they don't make eye contact and they rarely cry. Many times these are babies whose mothers or caretakers either don't know or don't care that their babies need to be held and rocked and snuggled and loved just as much as they need formula or breast milk or mashed bananas.

Attachment is essential for survival--physical and emotional survival. Study after study supports the fact that babies who don't fully attach to at least one caregiver early in life may become children and adults with serious psychological and behavioral problems. Babies need love to survive.

If you made it through basic psychology class, you probably remember Harry Harlow and the monkeys. In 1958 social scientists spoke of cognition and conformity; "proximity" was more acceptable to discuss than "love." Harlow wasn't content with this, and ignoring mainstream psychology, experimented on the development of love--using monkeys and chicken wire.

I'm not sure if many other experimental psychologists in his day--or this one--would have gotten away with including in a research report poems like this:

The Rhinocerus
"The rhino's skin is thick and tough,
Yet this skin is soft enough
That baby rhinos always sense
A love enormous and intense."

or this:

The Elephant
"Though mother may be short on arms
Her skin is full of warmth and charms.
And mother's touch on baby's skin
endears the heart that beats within.


More by accident than by intent, Harlow discovered that when he took a little cloth pad out of the wire cages in which infant monkeys were held, the baby monkeys had big tantrums. They wanted those soft cloths--they didn't have their monkey mommies, but they had those cloths and had attached to them.

After seeing this repeatedly, Harlow expanded the research. What he found shaped much of the attachment and love research since the now-famous 1958 study was published. You can read his report (and more poetry) here: http://psychclassics.yorku.ca/Harlow/love.htm. The gist goes like this: Infant monkeys, usually a day old, were put in cages with a chicken wire "mother." A baby bottle of milk stuck out of the wire cone-shaped surrogate. Other infant monkeys were caged with the same type cone, except these cones were initially simply covered with soft terry cloth.

The monkeys would virtually always choose to be in very close proximity of the terry cloth cone which had no milk, than to be with the wire cone which had milk. They ran and clung to the terry cloth cones when they were frightened. They slept laying on the cloth-covered wire. Feelings of being comforted, of comfort, was important for developing attachment.

Monkeys who were caged with terry cloth mothers tended to have a much lower infant death rate than those caged with wire cones. Wire cones tended to foster in the infants what we now call Failure to Thrive syndrome.

Babies who feel comforted and loved have a better chance of thriving. And surviving.

In terms of physical effort, it is less taxing to hold and rock a crying, screaming baby than it is to pick the baby up to scream back, or shake him, or hit her. Being a parent means leaving your own frustrations and fears at the door. It means if you're too angry to control yourself, you count, you breathe, you call someone, but you don't take it out on your baby.

Imagine a baby who flinches when you raise your hand to pat her cheek. Or a baby who no longer cries when he's hungry or hurt because no one consistently tries to make it better. Imagine a baby who doesn't look at colors or toys or faces. Babies who won't be comforted--maybe they can't be comforted anymore.

Imagine, then, a world of babies who are loved and comforted. A terry-cloth soft world. It's a much sweeter image.

Tuesday, April 10, 2007

Of hugs and bugs.

Chicken killing supports a lot of families in rural southwest Missouri. Along with chicken processing come hatcheries, poultry houses, equipment suppliers, and jobs. It is hard work, but it puts food on the table. In one tiny rural Missouri town, 15 or 20 kids go to a little preschool on the main street while their parents work at the chicken plant. Some of them don't speak English yet, but they're learning. A few parents walk their children to the school, others arrive on a little yellow bus. Most of the children are desperately poor.

A few hours spent inside the cozy home-like preschool is a gold mine of stories.

Under her elastic-waist jeans, Serena wears pretty white mary jane shoes that are so big you'd think she was playing dress up. She is fiercely proud of these shoes, and lights up like Hailey's comet when a big kid from the high school notices them.

Jorge knows he's stylin' and profilin' in the black t-shirt that hangs to his knees. He proudly shows off the glow-in-the-dark logo to everyone at his breakfast table. The Spiderman picture is smeared with play doh and grape jelly but his hugs are so tight and warm that no one notices the jelly transfer.

It is the light-up shoe, however, that makes the biggest fashion statement for the pre-school set. At least half the kids sport shoes that flash red, yellow and blue with each step. Or bounce. Or purposeful stomp on the floor to show off the colored lights.

The cook brings out a nutrition lesson using apples, peanut butter and graham crackers. The little ones use math (counting apples and crackers, measuring peanut butter) and language skills, and the lesson totally incorporates the week's theme about transportation. Each child gets one slice of red, yellow, and green apple to stick to the cracker. Like a traffic signal--get it?

Preschoolers tend to get a little grumpy with each other after a couple of hours, especially when the unexpectedly cold spring rain prevents them from burning off a few zillion kilowatts of energy on the playground. So it's not a complete surprise to find Mason pushing Tysha against the wall. They've been side by side, digging in a big sand table, where they're sifting sand searching for plastic bugs. Fun times. Until you get shoved into the wall, I suppose.

"You can't do that!" he hollers as I step between them, kneel down and look Mason straight in the eye. "Actually, I can," I reply, "and I won't let you push her. Now you stand here with me for a minute and then we'll try again." Oh the tears! They course down his sandy cheeks, making little rivers in the dust. He's upset that he got in trouble, of course, and mad as hell that he's missing those precious moments of bug-finding. When he goes back to the sand table, though, he pulls me by the hand, snuggles into my side and has me watch him sift out 5 tiny black spiders.

Bryce and Tyler stand shoulder to shoulder, covered in plastic aprons and wearing light green safety glasses. They're using soft mallets to pound golf tees into cloth covered boxes filled with styrofoam. It's harder than it looks, and the boys are really working. With a triumphant whoop, Tyler finally gets one in. It's a blissful moment for him so thankfully no one runs over to remind him to "use your inside voice." At 3 years old and barely 30 pounds, Bryce isn't having as much luck. He's avoided hitting his thumb though, and shows me how his dad put his thumb in his mouth when he hit it with a hammer. "He said a bad word, too" he whispers, eyes sparkling with delight.

It's hard to believe this cute little blonde boy just a half hour before had his teeth clenched tightly onto Austin's sweatshirt-covered bicep. Thank goodness for the extra thick fleece--Bryce's sharp incisors could have done some damage. When Bryce responds to the teacher's sharp command to "stop that" (followed quickly with preschool-speak: "Teeth are for biting food, not people"), Austin simply looks down at him and shakes his head. "My little brother does that too. That's just the way it goes sometimes."

The wisdom of age.

Friday, April 06, 2007

They really think we're stupid.

In a Missouri House committee last week, legislators met to hear testimony about problems with the current Medicaid system. A representative of Medicaid's managed care providers was asked what the rate of reimbursement for physicians is under their programs. (To keep folks totally confused, the areas of Missouri including Kansas City and St. Louis--typically referred to as the I-70 corridor--have a Medicaid program that is under contract for managed care, the rest of the state still uses a fee-for-service model).

The managed care representative refused to answer the House Committee, stating that because he "volunteered" to represent these organizations he wasn't able to release the figure. Later in the hearing, the Committee chair directly asked the "Interim" Director of Medicaid to tell him what this rate of reimbursement is.

Here's the shocker:

The Medicaid Director has no idea how much physicians and other providers are paid for their services under the managed care version of Medicaid.

He does not know.

You could hear jaws dropping all over the room.

He claims that under their contract, they only have to state a total amount of money used, but do not have to specify how it is used. In other words, the managed care company is within their contract to not tell us, the taxpayers, what we are paying to physicians in the I-70 corridor for their work with Medicaid recipients.

I've heard politicians refer to their constituents as "Joe and Mary Beercan." This sort of back-room, wink-wink/nudge-nudge agreement is an example of just how stupid they believe taxpayers are.

Don't let them get away with this. Ask your representative why our government, who funds these managed care companies through hard-earned tax dollars, doesn't know how much they pay providers. Ask who signed the contract that prevents us from knowing how our money is used.

Joe and Mary Beercan do think. We must not let them forget it. Ever.

Thursday, April 05, 2007

Chocolate Stout and a Grin

Local blogger and all-around eccentric, John "X" Stone died suddenly Tuesday. John died while doing what he liked to do--taking pictures and discussing his civil rights with the police. Look, the dude was the Webster's version of eccentric: "deviating from the recognized or customary character, practice, etc.; irregular; erratic; peculiar; odd." But given that his IQ was probably more than a few standard deviations above the mean, it stands to reason that his behavior would reflect a few deviations as well.

Along with being brilliant, cantankerous, funny, and a little bit kooky, he was also a inveterate dirty old man--his goofy comments made me feel all girly, and though I rolled my eyes and laughed him off, behind the laugh was my own goofy grin.

His life as a pilot, teacher, researcher, photojournalist, and Hooters regular will be remembered over chocolate stout tonight at Patton Alley. If he was right about String Theory, maybe he'll slide down the twine and join us in spirit.

Monday, April 02, 2007

He is serious, and that's dangerous.

Jiffy Lube as a model for health care? It's got to be a joke, right? Surely this is an early April Fool's gag--providing health care services for Missouri's working poor, disabled, disenfranchised, even children, based on the model for a profit-making company providing automobile oil changes? It wasn't a joke. Governor Matt Blunt, along with State Senators Mike Gibbons and Charles Shields, kicked off a "statewide tour" touting their MoHealthNet program at a Columbia, MO Jiffy Lube.

No joke. No April Fools gag. He means it.

Matt Blunt thinks that Missouri's poor should receive healthcare in much the same way we get the oil changed in our cars. He talked about how Jiffy Lube maintains computer records with information about your car that can be accessed from any of their locations. Blunt believes that healthcare would be much better if it just made good use of technology.

Admittedly this sort of thing increases my paranoia "like looking in the rearview mirror and seeing a police car" (David Crosby, who else?)--I mean does he really want medical professionals to be able to access emergency records, or is it yet another way for Big Brother to get as much information about us as they can for their own purposes?

But when you set the paranoia aside, Blunt's apparent total lack of understanding about the realities of healthcare for Missourians living in poverty is dangerous. His focus on using technology to track patients completely misses the obvious fact that his cuts to Medicaid make it so that a huge percentage of folks who need healthcare coverage are unable to get it.

To borrow Blunt's analogy: If you can't afford to put gas in your car, you're probably not spending money getting your oil changed. Preventive medicine, like preventive maintenance, costs money. And most folks who need Medicaid aren't exactly flush with "disposable income."

When you have to wait until pus is running out of your child's ear before you take him to the Emergency Room because you can't afford an office visit co-pay, or when you're unable to eat solid food well because your teeth have rotted but you can't afford a dentist, whether or not you have an electronic record on file, or whether the physician's office has lots of high tech equipment utilized to prevent "fraud and abuse" is totally, completely irrelevant.

Matt Blunt's record is fraught with examples of his lack of compassion and tendency to make decisions that benefit a few at the risk of many. At first blush it is tempting to give him the benefit of the doubt--maybe he's just incredibly out of touch and doesn't understand the negative effects of his choices. By this time there are so many examples, though, and the people have spoken so loudly about these issues, that it could easily be said that Blunt must know the impact of his decisions.

He knows, and he just doesn't care.