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FINANCING (There will never be enough money!)

FINANCING (There will never be enough money!). Stephanie B. C. Bailey, MD, MS Director of Health Nashville, Tennessee February 8, 2006. Our Stories:. …from our neighborhoods …from the practice …from the greater perspective. Mary B. 53 years old Grandmother with custody

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FINANCING (There will never be enough money!)

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  1. FINANCING (There will never be enough money!) Stephanie B. C. Bailey, MD, MS Director of Health Nashville, Tennessee February 8, 2006

  2. Our Stories: • …from our neighborhoods • …from the practice • …from the greater perspective

  3. 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”

  4. 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

  5. Renaldo, age 11, 6th grade • Mother killed at age 6 • Father lives in East Tennessee • 3 cousins in household

  6. Amanda, age 8 • Mother on disability • Old brother, age 17, in jail • Older sister, age 15, pregnant • All three children have separate dad

  7. 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

  8. Kenny, age 12, 4th grade • 1 of 6 children • Father incarcerated

  9. Thomas, kindergarten • Crack baby • Kicked out of school for attacking teacher

  10. Courtney, age 5, kindergarten • Mother incarcerated • Aunt raising 7 children, none are hers

  11. Keisha, age 6, 1st grade • Dad incarcerated • 5 siblings, older teenage sister has a baby

  12. 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……………

  13. 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

  14. Incarceration • Handicaps • Violence, truancy, suspensions • Mixed families • Failure (academic) • Needing and/or wanting attention • Lack of tools • Adult indifference • Low self-esteem

  15. 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.”

  16. 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%.

  17. 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%)

  18. 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

  19. 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”

  20. 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”

  21. 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”

  22. CAREGIVERS’ HEALTH = SAFETY NET For RAPHEAL, KEISHA, JACKIE, KENNY, CHRISTOPHER …. and the rest….

  23. 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?

  24. Resource Flow CMS HRSA CDC SAMHSA OPHS Mental Health Agency MEDICAID Department of Health Substance Abuse Agency State Family Planning Agency State Funds Substance Abuse CHC Department of Health Clinics Community Organizations Family Planning Pregnant Wife, Drug Addicted Husband Children

  25. Resource Flow(HCFA) CMS HRSA CDC SAMHSA OPHS Mental Health Agency MEDICAID Department of Health Substance Abuse Agency State Family Planning Agency State Funds Substance Abuse CHC Department of Health Clinics Community Organizations Family Planning Pregnant Wife, Drug Addicted Husband Children

  26. Resource Flow (HRSA) CMS HRSA CDC SAMHSA OPHS Mental Health Agency MEDICAID Department of Health Substance Abuse Agency State Family Planning Agency State Funds Substance Abuse CHC Department of Health Clinics Community Organizations Family Planning Pregnant Wife, Drug Addicted Husband Children

  27. Resource Flow(CDC) CMS HRSA CDC SAMHSA OPHS Mental Health Agency MEDICAID Department of Health Substance Abuse Agency State Family Planning Agency State Funds Substance Abuse CHC Department of Health Clinics Community Organizations Family Planning Pregnant Wife, Drug Addicted Husband Children

  28. Resource Flow(SAMHSA) CMS HRSA CDC SAMHSA OPHS Mental Health Agency MEDICAID Department of Health Substance Abuse Agency State Family Planning Agency State Funds Substance Abuse CHC Department of Health Clinics Community Organizations Family Planning Pregnant Wife, Drug Addicted Husband Children

  29. Resource Flow(OPHS) CMS HRSA CDC SAMHSA OPHS Mental Health Agency MEDICAID Department of Health Substance Abuse Agency State Family Planning Agency State Funds Substance Abuse CHC Department of Health Clinics Community Organizations Family Planning Pregnant Wife, Drug Addicted Husband Children

  30. Resource Flow(STATE FUNDS) CMS HRSA CDC SAMHSA OPHS Mental Health Agency MEDICAID Department of Health Substance Abuse Agency State Family Planning Agency State Funds Substance Abuse CHC Department of Health Clinics Community Organizations Family Planning Pregnant Wife, Drug Addicted Husband Children

  31. Resource Flow CMS HRSA CDC SAMHSA OPHS Mental Health Agency MEDICAID Department of Health Substance Abuse Agency State Family Planning Agency State Funds Substance Abuse CHC Department of Health Clinics Community Organizations Family Planning Pregnant Wife, Drug Addicted Husband Children

  32. 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!”

  33. “He who has a why to live can bear with almost any how.” Nietzsche

  34. 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

  35. REALITY SYMBOL EXTRAORDINAIRE THERE WILL NEVER BE ENOUGH MONEY!

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