America's children

In May and June the Children's Defense Fund (CDF) has been publishing sections of a compilation of national and 50-state data on the nation's children.

The report provides a statistical compendium of key child data showing alarming numbers of children at risk: the number of poor children has increased by 2.5 million since 2000 to 14.1 million, with almost half of them living in extreme poverty, and 8.1 million children lack health coverage―with both numbers likely to increase during the recession.

According to the CDF report, children in America lag behind almost all industrialized nations on key child indicators. The United States has the unwanted distinction of being the worst among industrialized nations in relative child poverty, in the gap between rich and poor, in teen birth rates, and in child gun violence.

The report covers: Key Facts, Child Population, Child Poverty, Family Structure, Family Income, Child Health, and Early Childhood Development. Sections to come: Education, Other Vulnerable Children and Youths, and Gun Violence.

The State of America's Children 2010

12 to life

New York Time's editorial for July 27 online and July 28 in print expresses concern for the children caught in the adult court machinery.

[States] have continued to mete out barbaric treatment - including life sentences - to children whose cases should rightly be handled through the juvenile courts.

Suggesting Congress should correct these states' practices by amending the Juvenile Justice and Delinquency Prevention Act of 1974, NYT mentions a new study by Michele Deitch, of the Lyndon B. Johnson School of Public Affairs at the University of Texas at Austin:

According to the study, every state allows juveniles to be tried as adults, and more than 20 states permit preadolescent children as young as 7 to be tried in adult courts.

The study reports such alarming findings as:

• Policy makers lack reliable data on the numbers of children "shunted into the adult system by state statutes or prosecutors."
• Children 13 and under who commit crimes like burglary and theft are just as likely to be sent to adult courts as children who commit serious acts of violence against people.
• Transferring juveniles to the adult system is counter-productive as a strategy for preventing or reducing violence.
• Juveniles held in adult facilities are five times as likely to be victims of sexual abuse and rape as youth kept in the juvenile system.
• Children under age 14 are as poorly prepared to participate in their trials as adults with severe mental illness.

The study concludes offering ten policy changes, among which include:

• Keep young children in the juvenile justice system.
• Disallow mandatory sentencing of young children in adult criminal court.
• Always provide an opportunity for parole for young children transferred to the adult criminal justice system.
• Young children in the adult criminal justice system should be housed in juvenile facilities.
• Improve data collection on young children in the adult criminal justice system.

From Time Out to Hard Time: Young Children in the Adult Criminal Justice System
(pdf/134 pp, 1.1 MB) Lyndon B. Johnson School of Public Affairs, July 2009

Executive summary (pdf/4pp, 228kB)

LBJ School Alumni Discuss Work: Survey of Statutes of 50 States Began as Supreme Court Certiorari Petition (html)

Child stats

On May 1 the Children's Defense Fund (CDF) released Children in the States Factsheets for the U.S. and each of the 50 states. Data are from November 2008. The factsheets provide basic stats and rankings for racial demographics, poverty, health, hunger, early childhood development, education, child welfare, and youth at risk.

Factsheets for:
      U.S. and all states (pdf, 104pp/608kB)
      Hawaii (pdf, 2pp/60kB)

Recent GAO reports

From the Government Accountability Office (GAO):

FOSTER CARE: State Practices for Assessing Health Needs, Facilitating Service Delivery, and Monitoring Children's Care, GAO-09-26 (pdf, 58pp/944kB), Feb. 6, 2009

State child welfare programs, including foster care, are federally funded by the Administration for Children and Families (ACF), but states are responsible for their foster children's health care, which is often financed by Medicaid. For this study, GAO reviewed policies and practices in 10 states (CA, DE, FL, IL, MA, NY, OK, TX, UT, and WA) of efforts to improve the delivery of health services. It covers state actions (1) to identify health care needs, (2) ensure delivery of appropriate health services, and (3) document and monitor the health care of children in foster care.


TROUBLED ASSET RELIEF PROGRAM: Status of Efforts to Address Transparency and Accountability Issues, GAO-09-296 (pdf, 112pp/2.7MB), Jan. 30, 2009

The Troubled Asset Relief Program (TARP) was authorized by the Emergency Economic Stabilization Act of 2008. Among other information, the report gives the status of $293.7 billion of TARP funds disbursed as of Jan. 23, and a timeline of programs and selected actions under TARP from Oct. 2008 to Jan. 2009. From the Highlights page:

While GAO does not question the need for swift responses in the current economic environment, the lack of a clearly articulated vision has complicated Treasury’s ability to effectively communicate to Congress, the financial markets, and the public on the benefits of TARP and has limited its ability to identify personnel needs

TROUBLED ASSET RELIEF PROGRAM: Status of Efforts to Address Transparency and Accountability Issues, GAO-09-359T (pdf, 13pp/176kB), Feb. 5, 2009

This is testimony by the Acting Comptroller General on the Jan. 30 report.


Update of State and Local Government Fiscal Pressures, GAO-09-320R (pdf, 8pp, 177kB) Jan. 26, 2009

This letter is an update of GAO's testimony of Nov. 19, 2008, covered in an earlier post. GAO has developed a model that simulates fiscal outcomes of state and local governments for several decades into the future. GAO's two findings: (1) Long-term fiscal challenges faced by the the state and local sector are exacerbated by the current recession, and (2) Consideration of state fiscal relief requires attention to targeting and timing of temporary assistance, specifically Medicaid.

Measuring childhood obesity prevention

17 percent of all children aged 6-11 and 17.6 percent of adolescents aged 12-19 are obese.

So begins the recent study by the Food and Nutrition Board of the Institute of Medicine of the National Academies (NA). The report released on September 08, 2008 examines the various efforts to combat the adverse consequences of childhood obesity and to promote healthy lifestyles.

Reporting on a June 2008 workshop conducted by the Institute which "featured site-leaders and evaluators representing different locally-based childhood obesity prevention programs," the release documented the

discussion about the challenges and promising approaches for evaluating and acting on complex policy and programmatic interventions to prevent obesity and its health consequences.

Community Perspectives on Obesity Prevention in Children. Workshop Summary
(September 2008, 40pp/NAP Open Document)

Uninsured children and SCHIP - Update

On May 15, Peter R. Orszag, Director of the Congressional Budget Office (CBO), gave testimony on the State Children's Health Insurance Program (SCHIP) to the Subcommittee on Health, House Committee on Energy and Commerce, substantially similar to his testimony to the Subcommittee on Health Care, U.S. Senate Committee on Finance, that was the subject of a previous FR post.

The additional information Orszag presented on May 15 relates to the August 17, 2007, directive from the Centers for Medicare and Medicaid Services (CMS). He stated:

On May 7, 2008, in response to inquiries from the states, CMS released a follow-up letter explaining certain aspects of the August 17 directive. The May 7 letter provides the following clarifications:

• Policies intended to prevent substitution apply only to children entering the program for the first time, not to those already enrolled (unless they leave the program and reapply later);
• States may submit alternatives to the 95 percent coverage test, which CMS will consider and approve if those states present supporting data showing their effectiveness in reducing crowd-out;
• CMS believes most states already meet the 95 percent test and will work with states regarding data sources CMS considers acceptable; and
• The policies stipulated in the August 17 directive do not apply to unborn children.

The clarifications that CMS issued in its letter of May 7 are generally consistent with how CBO originally interpreted the directive of August 17; therefore, CBO has not altered its estimates of the policy’s impact on cost and coverage.

Covering Uninsured Children in the State Children's Health Insurance Program (pdf, 19pp/156kB), May 15, 2008

See also CBO's website on the May 15, 2008, testimony.

Uninsured children and SCHIP

Peter R. Orszag, Director of the Congressional Budget Office (CBO), testified on coverage of uninsured children in the State Children's Health Insurance Program (SCHIP). SCHIP was established in 1997 for children in families with incomes that are modest but too high for Medicaid. In his testimony, Orszag compares SCHIP with Medicaid, and discusses SCHIP's displacement, or "crowding out," of private coverage, the substitution of SCHIP for employer-sponsored insurance, and the effect on SCHIP of the Administration's August 2007 directive on state coverage of children.

Covering Uninsured Children in the State Children's Health Insurance Program (pdf, 20pp/120kB), April 9, 2008

See also CBO's website on SCHIP.

Dismantling the pipeline

The Children's Defense Fund (CDF) recently published America's Cradle to Prison Pipeline, a report on "an urgent national crisis at the intersection of poverty and race": the high lifetime risk of Black and Latino boys going to jail.

Poor children of color are the canaries in America's deep mines of child neglect and racial and economic injustice. At critical points in their development, from birth through adulthood, millions of these children confront a multitude of disadvantages and risks including poverty and its many stresses....These accumulated and convergent risks form a Cradle to Prison Pipeline, trapping these children in a trajectory that leads to marginalized lives, imprisonment and often premature death.

The report's proposed steps to help these children include:

• A fundamental paradigm shift from the first choice of punishment and incarceration to early intervention and sustained child investment
• Health and mental health coverage for every child and coverage of pregnant women
• Quality Early Head Start, Head Start, child care and preschool so that every child is school-ready
• Creating an ethic of achievement and high expectations for every child

The report was released at a summit held at Howard University last month.

According to its website, CDF is a private, nonprofit organization that provides a voice for the children of America, particularly poor and minority children and those with disabilities, and encourages preventive investment for these children. CDF was founded by Marian Wright Edelman in 1973.


America's Cradle to Prison Pipeline (pdf, 244pp/6.6MB)

Less than half for our children

The New England Journal of Medicine current issue includes a study on the quality of care for children in the United States.

On average, according to data in the medical records, children in the study received 46.5%...of the indicated care. They received 67.6%...of the indicated care for acute medical problems, 53.4%...of the indicated care for chronic medical conditions, and 40.7%...of the indicated preventive care.

According to this study, previous results were limited to select groups (e.g., Medicaid recipients), involved self-reporting by caregivers and guardians, or were collected from data on the overall adult population.

In an attempt to address the limitations of previously published studies of the quality of care provided to children, we developed a comprehensive method for evaluating quality on the basis of information in medical records.

Deficits in the quality of healthcare for children "are similar in magnitude to those previously reported for adults." The results were surprising because the participants were more likely to be white and to have private insurance.

The researchers have found no national commitment to improve children health care.

Expansion of access to care through insurance coverage, which is the focus of national health care policy related to children, will not, by itself, eliminate the deficits in the quality of care.

The Quality of Ambulatory Care Delivered to Children in the United States
(The New England Journal of Medicine, October 11, 2007, pdf, 9pp/136KB)

Abstract available (HTML)