A Research and Policy Agenda for Children at Risk

216 Summary and recommendations A RESEARCH AND POLICY AGENDA FOR CHILDREN AT RISK RUTH HANFT, Ph-D.1 Session Chair FREDERICK A. ERNST, Ph.D.2 DAVID SATCHER, M.D., Ph.D.3 BARBARA STEPHENS, MD.4 FREDIA WADLEY, MD.5 Dr. Hanft: I have found this conference both depressing and exhilarating. It has been depressing because the problems that children have lived with for a long time—violence, poverty, racism, inadequate educational opportunities, social deprivation, health woes—seem to be becoming more severe while the resources we have to deal with these problems seem to be diminishing. But the conference has been exhilarating because we know many of the solutions and have heard many success stories. Many of these problems have been with us for years. I grew up on the border of Williamsburg and Bedford-Stuyvesant in Brooklyn. I went to Eastern District High School, one of the worst high schools in the city of New York. The school was rife with ethnic, religious, and racial rivalries, and multicultural problems beyond belief. Knifings in the hall were common enough that police officers were stationed everywhere. Naturally, the dropout rate soared; I think two-thirds of the class failed to graduate. 1 Research Professor, Dept. of Health Services Administration, George Washington University, 600 21st Ave., N. W., Washington, DC 20052 2 Associate Professor, Dept of Family and Preventive Medicine, Meharry Medical College, 1005 D.B. Todd Blvd., Nashville, TN 37208 3 President, Meharry Medical College, 1005 D.B. Todd Blvd., Nashville, TN 37208 * Assistant Professor, Dept of Pediatrics, Meharry Medical College, 1005 D.B. Todd Blvd., Nashville, TN 37208 5 Director of Health, Metro Health Dept., 311 23rd Ave. N., Nashville, TN 37203 Journal of Health Care for the Poor and Underserved, Vol. 2, No. 1, Summer 1991 _____________________Hanft, Ernst, Satcher, et al.__________________217 My fellow students came from broken homes and dysfunctional families, and when school let out, they went home to inadequate housing, including apartments with no plumbing. Their world included incest and child abuse, teenage pregnancy, gangs, violence, and of course, drugs. In those days, it wasn't crack. It was heroin and other substances whose names I no longer remember. (The names change, but the drug problem has been with us for hundreds of years.) As for health care, few families had transportation to the nearest provider; fewer still could afford the cost of services. In the 1960s, the federal government began a series of public programs to address a number of these social problems. We put in place community mental health centers, community health clinics, child abuse programs, maternity and infant care centers, Model Cities, health planning, social services grants, Medicaid , subsidized housing, and many other programs. But in the late 1970s, a conservative mood swept the country, and Congress began to cut back. The state of the economy, the rising costs of health care, public resistance to taxation, the growing influence of special interest political action committees—all played their part in creating this mood. So did the perception that some of these social programs had failed. I would remind you that in the early years of the Head Start program, the first evaluations showed that its goals were not being met. That tendency was later reversed, and today Head Start is regarded as one of the most successful of the educational reforms of the 1960s. We Americans rarely have the patience to wait for outcomes. Once we decide to address a major social dysfunction, we can do it. However, we must recognize that new resources will not be forthcoming for at least three to five years. We must begin organizing now and take the short-term steps to create the basis for new directions and new programs. We need the will to organize, and to minimize political affiliations, disciplinary jealousies, and federal, state, and local quarrels. Then we must redirect our energy to the future of all of us: our children. Our first task is ourselves, the infrastructure. We still have fragmented categorical programs at the federal and state levels. Each has separate authorities , separate structures, separate applications, and separate interest groups promoting them. We waste resources and make it impossible for...