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!