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Posts Tagged ‘healthcare

Why Parents Shouldn’t Be Able to Refuse Medical Treatment for an Ill Child

[One of 50 articles written and published for Demand Media in 2013]

Legally, refusal to provide or access medical care for children can be termed medical neglect. According to the latest available national statistics, documented child abuse and neglect in 2011 affected more than 675,000 children, or nearly 1 in a 100 kids. On average, 3 percent was stemmed from medical neglect in 41 reporting states. Some states average higher. Arkansas’ medical neglect rate is 7.5 percent, while the District of Columbia, Georgia, New York and Puerto Rico all average about 5 percent. The lowest rates are in Delaware and Utah at 0.04 percent and 0.02 percent respectively, plus both Wisconsin and Nebraska at 0.01 percent.

Medical neglect can have several causes, including economic hardship, lack of access to care or health insurance, family chaos and disorganization, lack of awareness, knowledge or skills, lack of trust in health care workers, impairment of caregivers, caregivers’ beliefs and children’s behavior, according to a 2007 article in the journal “Pediatrics.” Of these causes, two can involve active refusal of care: caregivers’ belief systems and children’s behavior.

Legal Exceptions
In most instances, medical neglect is legally actionable. The exception is faith-based exemptions, which are written into law in most states, according to These exemptions vary in scope. Forty-eight states permit exemption from immunization programs. Most states permit exemption from metabolic testing of newborns that can detect developmental problems, including some that can be prevented with treatment. Ten states have religious exemptions for eyedrops that can help prevent blindness in children who contact a venereal disease carried by their mothers. Seventeen states have religious exemptions to felony crimes against children.

A study titled “Child Fatalities from Religion-Motivated Medical Neglect” in the American Academy of Pediatrics journal found that of 172 cases of child fatalities attributed to faith-based medical neglect, 140 had excellent (90 percent positive) prognosis with standard treatment. Many of the remaining 32 children were treatable, with good outcomes likely. The consequences of not participating in immunization programs can be widespread. In 1991, “The New York Times” reported on an outbreak of 492 measles cases in Philadelphia that led to the deaths of six children, two of them unrelated to the Faith Tabernacle and First Century Gospel churches at the center of the outbreak. A later check of the Faith Tabernacle school found 201 of the children in attendance had never seen a doctor.

Most faith-based cases of medical neglect leading to illness and death are preventable. The nonprofit educational charity Children’s Health Care Is a Legal Duty lists other treatable conditions that resulted in the deaths of children in the care of Christian Science parents between 1974 and 1994; five by meningitis, three of pneumonia, two of appendicitis, five of diabetes, two of diphtheria, one of measles, one of septicemia, one of a kidney infection, one of a bowel obstruction, and one of heart disease. In the Philadelphia outbreak, three children were hospitalized under court order to ensure treatment. However, as long as religious exemptions remain in place, the justice system has legal limits on what they can do.

American Academy of Pediatrics: Religious Objections to Medical Care
U.S. Department of Health and Human Services, Administration for Children and Familes: Child Maltreatment 2011 report
U.S. Department of Health and Human Services, Administration for Children and Familes: Child Neglect: A Guide for Intervention
American Academy of Pediatrics: Recognizing and Responding to Medical Neglect
American Medical Association: Miracle vs. Medicine: When Faith Puts Care at Risk

Written by Influential Prose

June 26, 2015 at 3:11 am

Child Behavior Checklist Items

[One of 50 articles written and published for Demand Media in 2013]

As children develop, parents like to see them hitting normal developmental milestones. When it appears something is not quite right, a screening behavioral review is an early step. The widely accepted Achenbach System of Empirically Based Assessment offers two screens, one for children ages 18 months to 5 years, another for children 6 to 18. The preschool list has 100 questions, while the school-age list has 113. Some areas examined include anxiety, depression, aggression, attention, language and sleep.

Checklist Structure

Items on the child behavior checklists are graded by a short scale:

0 = Not True (as far as you know)
1 = Somewhat or Sometimes True
2 = Very True or Often True

The scale allows for a measure of intensity. Teenagers can be moody; some more or less so than others. Scale provides a sense of frequency and extent of the behavior. Some screens come with an additional component, such as the Language Development survey, which measures vocabulary. There are also multicultural supplements that adjust behavior scores as appropriate for cultural context.

Aggression is sometimes related to lack of empathy. This shows up in two items from the preschooler screening: “cruel to animals” and “hurts animals or other people without meaning to.” Actually aggressive behavior is signaled by several other items: “destroys his/her own things,” “destroys things belonging to his/her family or other children” and “physically attacks people.” Items asked of the K-12 set include these and some additions: “cruelty, bullying or meanness to others” and self-aggression — “deliberately harms self or attempts suicide.”

Items indicative of anxiety among preschoolers include “afraid to try new things,” “clings to adults or too dependent,” “doesn’t want to sleep alone,” “gets upset when separated from parents.” Among young children and adolescents, some additional markers are “feels he/she has to be perfect,” “feels or complains that no one loves him or her,” “feels worthless or inferior.”
Everyone experiences anxiety at some time; intensity is a key diagnostic element in assessment. Excessive anxiety can be alleviated with treatment.

Some items can apply to multiple syndromes. For example, “avoids looking others in the eye” could be a sign of inattention, anxiety, depression or anger, depending on context. Having multiple items related to single syndromes helps triangulate the source of the behavior to discern which syndromes are applicable. Attention-related items for preschoolers are “can’t concentrate, can’t pay attention for long,” “can’t sit still, restless or hyperactive,” “can’t stand waiting, wants everything now,” and “demands must be met now.” From 6 to 18, additional items are “fails to finish things he/she starts,” “daydreams or gets lost in his/her thoughts,” “impulsive or acts without thinking,” and “inattentive or easily distracted.”

Written by Influential Prose

June 26, 2015 at 3:02 am

Workout Guide for Teen Guys

[One of 50 articles written and published for Demand Media in 2013. Published version here.]

Getting ripped and looking good is a goal desired by many and attained by few. Why do so many fail? In a word, persistence. Despite what ads for supplements might tell you, there’s no way around it — getting fit is hard work. Results can take longer than you expect, demand more daily time than you planned, and require energy and effort you didn’t anticipate.

The first key ingredient for successful workouts is mental. Your teen should realize it will be hard and he’ll have to put exercise above other activities. Be ready to put in the time, patience and dedication to make it happen, especially when your teen is discouraged by the pace of improvement. It’s simple — if your teen doesn’t do the work, he won’t get results. “No pain, no gain” is short and to the point, but temper that phrase with the recognition that serious pain is your teen’s body telling him to back off or see a doctor.

Before your teen begins, have her establish goals. Make them as specific as possible, and don’t just list a major goal — add in milestone goals to fulfill along the way. For example, if your teen’s goal is to run a 5K, milestone goals might be to run around the block once five times, run around the block twice five times, then around the block three times in a row, working up to 5K. Start small and build on it. Hitting milestone goals helps your teen measure her progress and bolster her motivation, so have your teen build plenty of them into her plan.

Get Specific
Once your teen has set goals, have her map out a detailed plan on how to achieve them. There’s no shortage of workout programs available, so find a program that matches her goals, whether it’s building muscle mass, increasing endurance or losing weight. Then determine exactly how much time she’ll dedicate to this program daily. The more specific your teen is with her plan, the better she’ll be prepared mentally when she starts. Instead of planning workouts around other activities, plan other activities around the workout. That’s the level of commitment your teen needs to succeed.

Discipline doesn’t only extend to how your teen burns calories. You’ve got to watch how many and what kind of calories he consumers. This will likely require some changes in how he eats, what he eats and how often he eats — not an easy adjustment. Dietary changes depend on goals. Some foods that are good for building muscle mass might not be the right choice for building lean muscle for endurance. Building muscle and losing fat might not initially show up as weight loss, because muscle is denser than fat. Your teen needs energy to work out, and calibrating the right amount of food and the right kinds of food might take some trial and error. Don’t let your teen be discouraged by errors.

Written by Influential Prose

June 26, 2015 at 2:48 am

How Does Biotechnology Affect Kids?

[One of 50 articles written and published for Demand Media in 2013]

Biotechnology can affect children before they are conceived, before they are born and as they age. The knowledge base is expanding quickly, with new tools for DNA analysis. The ability to model and image molecular and atomic interactions, together with sophisticated scanning techniques that allow doctors to peer into tissue, has bolstered our capacity to re-engineer life. The power of such knowledge is obvious. It can be used for good, by repairing or replacing damaged organs and tissues, or it can be used for ill, by screening out traits that some perceived to be undesirable.

Immunization of children is a routine safeguard against disease, and despite the fears of a small minority, it has been and remains an effective defense against serious illness. Children today no longer need to fear diseases such as polio, measles, rubella, whooping cough and meningitis. These diseases once destroyed lives, and still do in regions around the world. Even as those historical dangers fade, new vaccines provide protection against HPV, which can cause cancer in women. HPV infection rates have fallen 56 percent among teenage girls since immunization for HPV became available.

Clean Clothes
Laundry soap enzymes help ensure kids live and play in clean clothes by breaking down proteins, starches, fats and grease. Proteases break down proteins in egg, gravy and blood, and amylases tackle starches, lipases take out fat and grease. Other common enzymes used include cellulase, mannanase and pectinase. This biotechnology has existed since the 1960s, but less well known is that the enzymes used in modern detergents are genetically modified organisms designed to lower costs.

Genetically Modified Foods
Genetically modified foods, which include children’s cereals, have been controversial since their inception, primarily due to the lack of comprehensive safety studies, concerns about their effect on the environment and legal issues related to intellectual property. However, it is certain that world population is growing and food prices will rise unless agricultural yields can be increased. Whether GMO foods can meet this challenge and maintain a record for safety is still a point of contention. The American Association for the Advancement of Science has noted that the “World Health Organization, the American Medical Association, the U.S. National Academy of Sciences, the British Royal Society, and every other respected organization that has examined the evidence has come to the same conclusion: consuming foods containing ingredients derived from GM crops is no riskier than consuming the same foods containing ingredients from crop plants modified by conventional plant improvement techniques.”

Human Genetic Modification
Since the human genome was mapped in 2003, much has been learned about gene expression, interaction and the phenomenon of epigenetics, the response of genes to environmental cues. The first publicized germline genetic modification of humans occurred in 2001, resulting in the birth of 30 healthy children born with genes from three people. Germline genetic changes are passed on to future generations. Genetic alternations that prevent a debilitating or fatal disease will prevent children from acquiring these genes and becoming ill. They then pass this protection on to their children.

Written by Influential Prose

June 26, 2015 at 2:35 am

System for Tracking Kid’s Good and Bad Behavior

[One of 50 articles written and published for Demand Media in 2013. Published version here.]

There are a variety of ways to track behavior, and tracking systems for children are generally intended to aid in behavioral management. This can be for home, school, or long family road trips. Behavior is measured and recorded for the purpose of encouraging positive behavior and discouraging negative behavior. The measurement rules and results are shared in some form with children to deliver clear, fair feedback on what behavior is deemed appropriate. For example, bullying is a behavior to discourage, and some children may need more frequent and intensive feedback to learn it’s unacceptable.

Token Economy
Token economies are a positive behavioral system. They reward positive behavior, while negative behaviors are treated neutrally. Tokens can be anything — star charts, wooden nickels, lego blocks in favorite colors – and these tokens are exchanged for rewards. For example, from the start of each day Jimmy earns a token for every hour he doesn’t throw spitballs at Jenny. If it’s been a bad day, he earns no tokens and no reward. Try again tomorrow. Maybe he does better the next day, but not quite well enough to earn a standard reward. He can trade what he has for a lesser award or attempt to save tokens and earn more to earn a better reward.

Self management systems begin as a collaboration between the student and teacher, or parent and child. In this system, both the adult and child rate the child’s behavior over an agreed timespan, be it 5, 20 or 60 minutes. Points are earned for positive behavior and close agreement in ratings. This encourages the child to behave positively and give an honest self-evaluation. This technique works to promote both better behavior and acknowledgment of mistakes.

Number Line System
This system is useful for providing comparative feedback to groups and individuals at the same time. Children are given clear guidelines on behavior and an understanding of how points are assigned. Points are tracked on a number line for each student and averaged for the group. This setup can also be split into two groups to create a friendly competition between groups for best behavioral points.

Clip Chart
This is similar in concept to the number line, but it is presented vertically. Students begin the day at 0 and move clips up and down the line in accordance with their behavior. The students move the clips themselves, providing a tactile dimension to aid recall and reinforce learning. This system is simple enough for young children to grasp, making it ideal for the K-3 set.

Written by Influential Prose

June 26, 2015 at 2:28 am

Strategies Used for Disruptive Aggressive Behavior in Children

[One of 50 articles written and published for Demand Media in 2013]

Benjamin Franklin famously said that an ounce of prevention is worth a pound of cure. Strategies for dealing with aggressive behavior fall into two categories. Prevention is using techniques to minimize or eliminate continuing aggression. Intervention is dealing with aggression as it happens.

Preventive strategies are time-consuming and require patience. But they work, and they are superior to dealing with chronic aggression, whether it is physical, verbal or relational (spreading gossip, rumors, exclusion, etc.).

Prevention Before Aggression
The first preventive strategy for dealing with aggressive behavior is to minimize risk. Think about the environment where aggressive behaviors occur. Aggression can target property, other people, or the self. Self-aggression can concern either the aggessor’s self (suicide threats, for example) or you. Survey the home, classroom and play areas, and clear away or block access to obvious hazards.

In situations where aggression is chronic, it’s important to pay attention and think ahead. When you are familiar with the child’s behavior patterns, it’s often possible to see the storm approaching long before the rain starts falling. Intervene early when you see the elements for an aggressive episode coming together.

Preventive Intervention
When you see a conflict between children heating up, separate them. When you see one child provoking another, step in and call out the behavior. When you see attention-seeking behavior that typically leads to aggression, redirect the child’s attention to another activity.

Redirection is a very effective technique; with practice and skill it can prevent many episodes. Keep a written or mental list of alternative activities so you have something ready to suggest when you need it. Also remember that each child is unique. Compare notes on what works and what doesn’t with your co-workers, the child’s parents and others familiar with the child; they may have helpful tips or knowledge. The more you know, the easier it is to head off trouble.

There are many reasons for aggression. Part of prevention is determining an aggressive child’s motivations. It’s not always clear, even to the child. They may be angry about something they wanted and didn’t get. They may be suffering abuse, seeking attention or responding to provocation. Motivations matter; knowing them can help you address their concerns and devise specific strategies.

Discerning motivation requires communication, and there are three things to do: listen, acknowledge and empathize. This doesn’t necessarily mean you agree with the child. The child may lie, bluff and exaggerate. Stay with it. Gently confront obvious contradictions and dishonesty. Your purpose is to understand motivation, then build respect, trust and rapport to the point where the child’s mind is open to positive suggestions. Ask questions when the child is calm: How did this start? Why did it happen? How can we prevent this from happening again? What can you do differently to prevent this? Most importantly, listen.

Situational Intervention
When a physical fight erupts in a workplace, such as a school or day care center, your intervention strategy is determined by your workplace policy. If your workplace doesn’t have one, it needs one. Know the policy and be clear on it so you’re prepared when the time comes. If there are specific interventions required, get training for them.

In other places, such as at home or on a playground, you have decisions to make. Do you intervene physically? This may be a practical solution with small children, but you have to take into account the reaction of other parents and risk of injury to children. What about athletic teenagers? Physical intervention in that context could lead to severe injury or death. When you are concerned about attacks on yourself, prearrange defensive help in place or nearby.

Very often, your authority as an adult is enough to stop a fight. Simply stepping forward and saying, “Alright, that’s enough, break it up NOW.” is sufficient. If not, you may add that the police will be called if they don’t cool it. The key is to remain calm and firm — be the adult. Adult authority can also be applied to verbal and relational altercations, but with lower intensity. Talk. Invoke the golden rule – are you treating others the way you would want to be treated? Why not?

Prevent aggression when you can. Get help when you need it. Review incidents afterward for lessons learned, then apply them to future situations. Finally, praise positive behavior. Aggressive children are accustomed to being disciplined. They need feedback when they do good, too.

Written by Influential Prose

June 22, 2015 at 9:39 pm

The World’s Largest Private Deaf Employer

Employment Matters column,

Do you know who is the largest private employer of deaf staff anywhere?

Yes, anywhere. There are other places – deaf schools, mostly – with many deaf staff, but they’re publicly funded. We’re talking about a private business here, with well over 100 deaf staff. We’re talking about full time workers earning $28,000 to $32,000 a year, and often more with overtime. There are deaf people in management – some have worked there since the business opened over 6 years ago. And what does this band of deaf professionals do for a living?

They work with deaf customers. The customers, in this case, are psychiatric patients living at the National Deaf Academy (NDA). And full disclosure – I work at NDA. So this is an inside view.

Psychiatric care is not easy work. The patients who arrive at NDA have often been abused, misunderstood, neglected. Some have wonderfully supportive families, and others have no family at all, or have been abandoned by their families. Many of them need all the support and guidance they can get – and that’s what NDA does.

The support includes a team of deaf and hearing therapists, teachers, doctors, nurses and Mental Health Technicians, all who watch over the patients from day to day. They teach them, care for them, encourage them when they grow frustrated, intervene when they become upset, praise them when they progress.

The work requires extraordinary patience. The customers arrive with serious issues, and it takes time to sort though the problems and develop a program that will match the patient’s needs. The key to making it happen is being able to communicate effectively with the patient, and NDA has more collective experience doing this than any other place in the world.

Because NDA is a residential facility, there is staff on duty 24 hours a day, in three shifts. The morning team begins bright and early at 7 a.m. and hands over responsibility to the afternoon shift at 3 p.m. At 11 p.m the night crew arrives and works until daybreak, when the morning staff returns and the cycle begins again.

The customers span a wide age range, from young children to adolescents and adults. Most of the MHT staff is younger, in their 20’s, with a few 30-, 40-, and 50-somethings sprinkled through. They’ve all worked long, hard hours, through holidays, weekends, on-call and standby shifts, dealing with autism, severe mood swings, bipolar behavior, aggression, low functioning, bickering between the residents and much more. There’s never any shortage of drama.

It’s a very human environment – the philosophy of care at NDA rejects straightjackets and locked rooms. Patients enter a scheduled, structured program with strict rules, and the staff begins with five days of intense training on how to handle everyday business and emergencies. People who have been at NDA for several years have developed a special bond that comes from working together through tough situations.

What makes NDA stand out for the patients is the ability to talk to nearly everyone. Some of them have been placed in hearing psychiatric care before, where the communication abilities of the staff are limited. This often leads to endless frustration.

At NDA, it’s a different story – there are plenty of people they can talk to, work with, vent their angst, and learn to trust. This is a big deal for people who have been insulted and treated poorly in other places. Still, building that trust takes time – sometimes years.

It’s also a big deal for deaf staff to earn a living working with many other deaf employees. There are not many such places. NDA is just north of Orlando, Florida, so it attracts people with good climate, an easy drive to the beach and a lower cost of living than much of the nation.

This summer will bring growth, with a new 46-bed building opening for adults. NDA is preparing now by hiring more staff.

Written by Influential Prose

October 1, 2009 at 4:18 pm