financing (there will never be enough money!) stephanie b. c. bailey, md, ms director of health...
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FINANCING (There will never be enough money!)
Stephanie B. C. Bailey, MD, MSDirector of Health
Nashville, TennesseeFebruary 8, 2006
Our Stories:
…from our neighborhoods …from the practice …from the greater perspective
Mary B. 53 years old Grandmother with custody Food stamps, small government
check and children on TennCare Has not seen a doctor in years “better not to know” “too many other things to think
about”
Raphael, age 10, 4th Grade Mother incarcerated “waited all day to talk to mentor,
wanting only to tell her about seeing his sister being shot the night before”
Expelled at end of school year because someone said something about his mother
Renaldo, age 11, 6th grade
Mother killed at age 6 Father lives in East Tennessee
3 cousins in household
Amanda, age 8 Mother on disability
Old brother, age 17, in jail
Older sister, age 15, pregnant
All three children have separate dad
Christopher, age 12, 5th grade 1 of 6 children Father on disability Suspended 2 x week, in school,
for anger All brothers expelled from
school 2 older/2 younger
Kenny, age 12, 4th grade 1 of 6 children
Father incarcerated
Thomas, kindergarten Crack baby
Kicked out of school for attacking teacher
Courtney, age 5, kindergarten
Mother incarcerated
Aunt raising 7 children, none are hers
Keisha, age 6, 1st grade
Dad incarcerated
5 siblings, older teenage sister has a baby
JARVIS Age six, first grade Two older brothers, ages 16 and 17 Lives with aunt because both
parents incarcerated on drug charges
October 2005, placed back in first grade……………
Jackie, age 12, 4th grade
Family has been put out of MDHA Was in room when uncle was shot Has been raped WHEN SHE GROWS UP….
……………she wants to be a doctor
Incarceration Handicaps Violence, truancy, suspensions Mixed families Failure (academic) Needing and/or wanting attention Lack of tools Adult indifference Low self-esteem
Ms. Sadie “My daughter was not sending them to
school and their father didn’t want custody. She was on drugs. I took them in my home and I got legal guardianship because they needed to be in school. I was hoping she would be able to take them back when she came out of rehab. I was told she had a terminal illness caused by HIV. She died almost 4 yrs ago.”
Between 1990 and 1998, the number of grandchildren being raised solely by grandparents and with no parent living in the home increased to more than 1.3 million – an increase of 53%.
Relative Caregivers Substance Abuse, by a birth parent
(38%) Incarceration, (17%) Abandonment, (17%) Removal by child protective services
because of neglect/abuse, (11 %) Teen pregnancy Emotional Problems/Mental Health, (11%) Parental Death, (6%)
The majority in one study, simply assumed care giving informally out of a strong sense of familial obligation and love – the grandparent being a constant and stable presence in a child’s life.
...but in most studies, grandparents were in a crisis situation when they assumed the care and had no prior plans to raise their grandchildren
Summary Characteristicsthe “WHO” Typically female Black Unmarried Unemployed Living at or below poverty level Undereducated Additionally, “they fear being unable
to raise their grandchildren to adulthood”
One grandmother said….
“ If they don’t take me out of here in an ambulance, I’ll care for them. I’ve had to almost crawl to the kitchen sometimes but they’ve never gone without a meal”
One 63 years old Grandmother: “when I had a son I started him on
cereal when he was 4 weeks old, fruits and vegetables when he was 6 weeks, and meats 2 weeks after that…..for my granddaughter I was told to give no rice cereal until she was 5 months old”
“I use to give half an aspirin for fever if my son had a reaction to immunizations, but I was told not to do that now”
CAREGIVERS’ HEALTH = SAFETY NET
ForRAPHEAL, KEISHA, JACKIE, KENNY, CHRISTOPHER ….
and the rest….
Streams of Funding Categorical Each with its own set of forms Does it address the wholeness? Does it create the impact? Does it prohibit working together? An answer; but is it the answer?
CMS
Pregnant Wife, Drug Addicted HusbandChildren
State FundsSubstance
AbuseAgency
Departmentof Health
MEDICAIDMentalHealthAgency
FamilyPlanning
CommunityOrganizations
ClinicsDepartmentof Health
CHCSubstance
Abuse
CDC SAMHSA OPHS
State FamilyPlanningAgency
HRSA
Resource Flow
CMS
Pregnant Wife, Drug Addicted HusbandChildren
State FundsSubstance
AbuseAgency
Departmentof Health
MEDICAIDMentalHealthAgency
FamilyPlanning
CommunityOrganizations
ClinicsDepartmentof Health
CHCSubstance
Abuse
CDC SAMHSA OPHS
State FamilyPlanningAgency
HRSA
Resource Flow (HCFA)
CMS
Pregnant Wife, Drug Addicted HusbandChildren
State FundsSubstance
AbuseAgency
Departmentof Health
MEDICAIDMentalHealthAgency
FamilyPlanning
CommunityOrganizations
ClinicsDepartmentof Health
CHCSubstance
Abuse
CDC SAMHSA OPHS
State FamilyPlanningAgency
HRSA
Resource Flow (HRSA)
CMS
Pregnant Wife, Drug Addicted HusbandChildren
State FundsSubstance
AbuseAgency
Departmentof Health
MEDICAIDMentalHealthAgency
FamilyPlanning
CommunityOrganizations
ClinicsDepartmentof Health
CHCSubstance
Abuse
CDC SAMHSA OPHS
State FamilyPlanningAgency
HRSA
Resource Flow (CDC)
CMS
Pregnant Wife, Drug Addicted HusbandChildren
State FundsSubstance
AbuseAgency
Departmentof Health
MEDICAIDMentalHealthAgency
FamilyPlanning
CommunityOrganizations
ClinicsDepartmentof Health
CHCSubstance
Abuse
CDC SAMHSA OPHS
State FamilyPlanningAgency
HRSA
Resource Flow (SAMHSA)
CMS
Pregnant Wife, Drug Addicted HusbandChildren
State FundsSubstance
AbuseAgency
Departmentof Health
MEDICAIDMentalHealthAgency
FamilyPlanning
CommunityOrganizations
ClinicsDepartmentof Health
CHCSubstance
Abuse
CDC SAMHSA OPHS
State FamilyPlanningAgency
HRSA
Resource Flow (OPHS)
CMS
Pregnant Wife, Drug Addicted HusbandChildren
State FundsSubstance
AbuseAgency
Departmentof Health
MEDICAIDMentalHealthAgency
FamilyPlanning
CommunityOrganizations
ClinicsDepartmentof Health
CHCSubstance
Abuse
CDC SAMHSA OPHS
State FamilyPlanningAgency
HRSA
Resource Flow (STATE FUNDS)
CMS
Pregnant Wife, Drug Addicted HusbandChildren
State FundsSubstance
AbuseAgency
Departmentof Health
MEDICAIDMentalHealthAgency
FamilyPlanning
CommunityOrganizations
ClinicsDepartmentof Health
CHCSubstance
Abuse
CDC SAMHSA OPHS
State FamilyPlanningAgency
HRSA
Resource Flow
Pedro Garcia, PhD Superintendent of Schools
“he will never use ‘not having enough money’ as an excuse for not achieving…..money makes it easier and without it is just more challenging!”
“He who has a why to live can bear with almost any
how.”
Nietzsche
W. McDermott “Medicine in Modern Society”
Public Health System Constituency Type System Healthy ‘watchdog’ Balance is critical Aiding developing individuals in their
continuous interaction with the environment
REALITY SYMBOL EXTRAORDINAIRE
THERE WILL NEVER BEENOUGH MONEY!
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