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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

FINANCING (There will never be enough money!)

Stephanie B. C. Bailey, MD, MS

Director of Health

Nashville, Tennessee

February 8, 2006

our stories
Our Stories:
  • …from our neighborhoods
  • …from the practice
  • …from the greater perspective
mary b
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 4 th grade
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 6 th grade
Renaldo, age 11, 6th grade
  • Mother killed at age 6
  • Father lives in East Tennessee
  • 3 cousins in household
amanda age 8
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 5 th grade
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 4 th grade
Kenny, age 12, 4th grade
  • 1 of 6 children
  • Father incarcerated
thomas kindergarten
Thomas, kindergarten
  • Crack baby
  • Kicked out of school for attacking teacher
courtney age 5 kindergarten
Courtney, age 5, kindergarten
  • Mother incarcerated
  • Aunt raising 7 children, none are hers
keisha age 6 1 st grade
Keisha, age 6, 1st grade
  • Dad incarcerated
  • 5 siblings, older teenage sister has a baby
jarvis
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 4 th 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
slide14
Incarceration
  • Handicaps
  • Violence, truancy, suspensions
  • Mixed families
  • Failure (academic)
  • Needing and/or wanting attention
  • Lack of tools
  • Adult indifference
  • Low self-esteem
ms sadie
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.”
slide16
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
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%)
slide18
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 characteristics the who
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
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
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

CAREGIVERS’ HEALTH = SAFETY NET

For

RAPHEAL, KEISHA, JACKIE, KENNY, CHRISTOPHER ….

and the rest….

streams of funding
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?
resource flow
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

resource flow hcfa
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

resource flow hrsa
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

resource flow cdc
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

resource flow samhsa
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

resource flow ophs
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

resource flow state funds
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

resource flow1
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

pedro garcia phd
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!”
w mcdermott
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

REALITY SYMBOL EXTRAORDINAIRE

THERE WILL NEVER BE

ENOUGH MONEY!