themselves. We want to make sure that children know
that their feelings about the transitional process are
importantand that thev should be encouraged to share
or to express those feelings. We should make an
attempt to bolster childrens’ selfesteem so that they
won't be afraid to speak up. At the same ume. we
should bolster parents’ self-esteem so they won't be
afraid to speak up, so that they won't be afraid of the
systems that impact upon them and will be able to
confront the svstem. Some of the parents said that
other parents won't speak up for fear that if they do,
they mav get involved in a system that may end up
investigating them or even make an attempt to take
their children. Because of those kinds of fears, some-
times they are uncomfortable confronting the system.
But we need to encourage parents to stand up and be
the primary advocates for their children.

Another concern was that parental involvement
must be consistent across svstems. Many times parents
who are involved in the Head Start program are con-
stantly involved in the progress of their children: they
volunteer in the classroom, they spend time with them.
etc. Then, when they move or enter other systems or the
school system, thev’re not thatinvolved. We feel that we
need to keep the parents involved and keep that in-
volvement as they make transitions throughout the
systems so that our children can be healthy and ready
to learn.

We also felt that parents should be involved in
program design and the policvmaking decisions that
affect and impact upon their children. One suggestion
is that we form parent boards, which are verv prevalent
in Head Start but do not exist in many other systems,
After the transition occurs, parents need to continue to
be involved, For example, parents that are involved in
Head Start need to stay involved as their children grow
and move through other programs.

Parents need to form their own support groups.
When they do, programs should work with them. In
other words, when a parent group forms a support
group to help themselves and to help other parents
work through the transitional process, the programs

and systems should be there for them, to support them,

76 Parents Speak Out for America's Children

help them learn the transitional process, and provide
materials or whatever they need to make that transition
as smooth as possible.

Program counselors should be appointed to help
parents prepare for the transition. Also, parents need
to be aware of not onlv the needs of their own children,
but the needs of others—to move away from, “me, mv
four, and no more.”

Consistency is the key to successful transitions.
We need to be aware of the impact on children and
parents of abolishing programs without notice, and
manv times without preparation to have those needs
met through another area. We need stabilized funding

so that programs can address the problems, instead of

just looking at the svmptoms.

Someone suggested that the transitional process
would be easier ifwe developed an interstate communi-
cation system. We should create a national computer
network so that the information on parents in one State
could be readily accessible to another State. When
people such as the Migrant workers move from one
State to another and they have to apply for benefits, thev
have to close out their file in the first State, reapply at the
next, go through that whole process again, and reopen
their files. Often it takes a long time before they get the
benefits. Sometimes they are ready to move on to the
next growing season or the next location before the
benefits even get started. So, if we had a national
network, that information would be readily available,
and that could speed up that recertification or reapphi-
cation process.

Also, another thing that came up was to create a
way that school credits could be acceptable from State
to State. People move through different situations.
They have things that are credited in one State, and
when they go to the next State, the school says, “I’m
sorry, but this is not credited here.” Then, the child has
to go through that whole process again.

Establish one-stop shopping—and I won't elabo-
rate on that because it has already been stated. Decrease
the time spenton paperwork. Make forms less complex.
And make an effort to cut down on the duplication of

information during the recertification process. Many
“Being ready to learn is more than
making our children ready for the
schools. We need to make the schools
ready for our children.”

times parents go in to be recertified, and they give the
same information thev gave 3 months ago. Sometimes
in Delaware, when vou go to be recertified or to get
services, thev tell you that vou have to be at the social
service agency at 7:30.a.m, They see vou at 8:30 a.m. or
9:00 a.m., and then thev give vou paperwork to fill out
that vou just filled out the Jast time. No information has
changed, but they sav, “Well, vou have to do it.” We
could cut down on that process and speed it up.

Workers need to be sensitive to the needs of the
parents who come in and should be aware of the
stereotypes and not have negative attitudes towards
them, because they wouldn’t be there if they didn't
need the help.

The other area of concern was flexibility. We need
to make the eligibility criteria flexible. For example.
some people have incomes above the guidelines to
receive Medicaid but also have children with special
needs. They can't get regular insurance because the
child has a preexisting condition, so the msurance
company does not want to cover them. So those people
getlostin the cracks. We need to pave the wav of smooth
transitions by making programs and facilities flexible.

One of our delegates expressed that she has a
special needs child who has been mainstreamed into

the classroom, When that child has te go to the

bathroom, he’s made to go to the other side of the
school because it takes him a little bit longer to use the
bathroom, and thev don't want him to hold up the
other children. We don't think that’s fair, and that
situation needs to be addressed.

We already talked about flexible hours. Employ-
ers need to understand the parents’ need for daycare,
leave for medical visits, and appointments with other
programs. Remember that the familv and their indi-
vidual needs still exist when income levels change.

Transportation was an issue and must be im-
proved and addressed, especially in rural areas. With-
out transportation, the children are not going to be
able to make successful transitions between programs
and obtain other needed services.

Another area of concern is increasing and promot
ing the use of school social workers. Social workers could
act as advocates for parents and children so that they can
help them with the transitional process. Thev can help
families access services and become a primary link be-
tween school systems, parents, and the community.

The last and final area is that legislative action
must be taken to improve our children’s transitions.
First, we see a role of the parent to take the responsibil-
ity to elect family advocates in political offices. We need
to work to develop Federal and State laws and regula-
tions that better address the families’ needs to make the
transitional process much easier. We need to find a way
to enforce the laws that are already on the books. We
also need nottojustaddress the needs of one individual's
problems. For example, one of the parents shared that
they were in the process of suing the school system for
some needs for their children and that when that fight
is over, and that parent wins, the next parent has to go
through the same process. We think that systems need
to learn from those fights with parents and those kinds
of things that happen. Thev need to learn from the
results so that other parents don’t have to learn how to
fight the systems better. We need to make sure that our
programs are adequately funded so that the needs that
they are designed to address can be addressed,

In summary. we want to remind vou of the three

C's.) Consistency. connuin. and coordinadon of

Report of the Surgeon General's Conterence 77
services are necessary to promote healthy children in

families that are readv to learn. We want to issue

 

another challenge—and this is not necessarily to Dr.
Novello—but we not only want our children to be
healthy and ready to learn. Being ready to learn is more
than making our children ready for the schools. We

need to make the schools ready for our children.

Responder Panel*

James O. Mason, M.D.
Assistant Secretary for Health
US. Department of Health and Human Services

T want all of you to know how much I appreciate this

 

 

 

opportunity to be here with vou. IT want to express

 

appreciation to all vou parents, andI don'tneed to tell vou

 

that vour three representatives up here are tremendously Tdon'twant to repeat what has been said by other
articulate and very well prepared. I could talk for 2 hours speakers, but I want to respond to a number of ques-
just in responding to what the three of them have said, ions that were raised. When President Bush came
and obviously I don't have time to do that. Let me say that here and talked about his comprehensive plan for
I'm not just the head of the U.S. Public Health Service: health care reform, he was addressing a number of the
I'm also a father. J have 7 children and 17 grandchildren. problems that have been described. This reform.
so I could sit out there as well as stand up here. [hope | which will provide tax credits or certificates and tax
can express my sympathy for vour point of view both as a deductions, willencompass 9 million Americans. It will
governmental official and as a parent. provide access to health care services for all poor

I think it was Ms. Reeves who talked about the Americans. Itwill create insurance pools so that people
importance of our children. So often we read in the at high risk will not have to pay those higher premiums;
newspapers about being competitive with our automo- thev'll be in the same pool with many other folks, to
biles, electronics, or pharmaceutical industry, but we average the risk out. The President talked to you about
are here to reaffirm that the most important product health insurance security so if you move from one
that this Nation has is its children. Our children are the community to another, or from one job to another,
future of America, and every minute we spend here is your health benefits would be portable. Then he talked
time more than well spent. I believe—and I don’t think about choice. You see, choice and a tax credit (a
it’s just because this is an election year—I've never seen certificate) empower a parent; you don’t have to be
a meeting where the President and three departmental part of a system for just poor people. You take your
heads (three Secretaries) came, and that’s a commit- certificate and vou buy vour health care from a pro-
ment of this Government to the importance of children gram that will provide the quality and the content of

and doing something in this partnership between the

 

Federal level and parents. “The remarks of the Responder Panel have been edited for clarity.

78 Parents Speak Out for America's Children
services that you need. Then he talked about
affordability and cost containment. Ifwe can convince
Congress to enact this plan, it will begin to address some
of the health care problems that vou are encountering
and that I encounter as a grandfather.

I would just like to answer the question: “What are
we going to do?” [just want to mention two things and
then I willsitdown. First ofall, we are here to listen, and
I think listening is probably the most important thing
vou can do so thatyou understand the concerns. You've
heard the recommendations for solving these prob-
lems. But we need to do more than listen. Here's one
example of what I am going to do. Each quarter I meet
with the officials of State and territorial health depart-
ments and with vour State health department comunis-
sioners. Each quarter | meet with the US. Conference
of City Health Officers and the National Conference of
County Health Officers. I'm going to discuss the things
that vou’ve been talking about with them because this
isa partnership. Itwas said that leadership should come
from all of us and. of course, it’s got to come from
parents, our neighborhoods and communities, our
cities, our counties, our State, and the Federal Govern-
ment. Only when we all provide that leadership will this

system really work optimally, and I will pledge to you mv

support to do all I can to work not only at the Federal

 

and we’ve got to work harder from
the top so hat it gets all the way
through. "3

 

 

level but down through that system of health officials to
see whether we can implement your recommendations.

Now let me give you an example, and time doesn’t
permit me to give many. I agree with 98 percent of
everything you've said. Let's talk about one-stop shop-
ping. You want one-stop shopping, and I want one-stop
shopping. Why don’t we have one-stop shopping?
There are communities—and I have visited them—in
the United States of America where they have one-stop
shopping. If we all want it, let's do it! There isn’t any
disagreement. We've talked about having a uniform
application form. I'm holding up a litde document
that’s called a Model Application Form, and this was
published in the Federal Registeron December 4, 1991, a
little over a month ago. It was developed in collabora-
tion with State and local people, and it involved the
Department of Health and Human Services, the De-
partment of Agriculture, and the Department of Educa-
tion. So, at the Federal level, we want a simplified,
unified, uniform application. Now why don’t we have
ity We want the same things. You've got to start working
up from the bottom, and we've got to work harder from
the top so that it gets all the way through.

You've talked about flexible hours. You want
flexible hours; you not only want them, you need them.
And we want flexible hours. Last Friday, Secretary
[Louis] Sullivan [Health and Human Services], Sur-
geon General Novello, CDC Director Bill Roper, and I
were in San Diego to talk about an immunization
initiative for infants. And what were we pounding the
table about? Flexible hours, so that parents could bring
their kids in the evening, on weekends.

Let's make the systems user friendly. You want
user-friendly systems; we want user-friendly systems.
Let’s work together to get it. We're not against each
other. We're working for the same things, and some-
how we have to get it into the middle. And I’m willing
to work on that, and I know you will as well. I'm simply
trving to say that we are striving for what you want, what
you are talking about. Perhaps we can put more power
into our grant applications.

Let me just sav that we often provide funds for

programs that vou use, but we dot hire or fire the

Report of the Surgeon Generals Conterence 79
people that provide those services. We can talk more,
and we will, but we are going to have to work from both
ends ifwe are going to make those services user friendly.
We wantit.and we'll do all we can; we've heard vou. But
dom tlet them kid you down at any other level. We want
it: vou want it: let’s get it. Let's work together.

Let me just end by talking about this document. We
have what we call Healthy People 2000. This is not a
Federal program; it’s a national program. You helped
develop the 22 priority areas and the 300 specific, measur-
able, realistic goals of where this Nation could be by the
year 2000. We've pulled Healthy Children 2000 out of a
much thicker document, and of the 3,000 measurable
objectives for the Nation for vear 2000, 170 of them relate
to mothers, infants, children, and adolescents. We hope
that vou will work with us so that even before the vear 2000,
as soon as possible, this Nation will have arrived at where
vou—as you helped us develop these—said we ought to
be. And we're willing to work with vou; we are partners,

and we thank vou for vour input.

John T. MacDonald, Ph.D.

Assistant Secretary for Elementary and Secondary Education
CLS. Department of Education

T would like to thank our presenters for what I consider
to be an extremely inspirational message. but one that
has a great deal of meaning to us. I would like to focus
my comments in terms of the presentations on children
and their families. I just returned last night from the
Organization of American States meeting in Guatemala
City on issues that affect the hemisphere in terms of the
same kinds of things that we are talking about today—
precisely the same kinds of problems thatvou've brought
here. We are dealing with a hemispheric problem that
we have to address if we are going to survive, not just as
a Nation, but as a hemisphere.

What I heard today, in sum, means involvement,
flexibility, a role of advocacy, and finally, as Larrv [Bell]
shared with us, consistency, continuity, and coordina-
tion. I would like to talk a little bit about commitment,
as the other C, to children and their families in an
integrated way, a much more integrated way than we've

ever done before. In my trips around the country and

80 Parents Speak Out for America's Children

also in spending 34 vears in this business of children
and families. I found that, on the awareness issue, it
means vou must not only be made aware but you must
have access.

Jim used the term “user friendly.” Our schools
basically have never been user friendly because the
schools that we have todav are designed for a society,
frankly, that doesn’t exist today in most areas. I can
remember, some months ago, [Secretary of Education]
Lamar [Alexander] convened a group of us with an
eminent sociologist, a guy I have a lot of respect for and
who has done a lot of work in this area for years. We were
kicking around the question, “Why don’t our schools
work any more” And he said, “Heck, it’s very basic.
What vou are trving to do with your schools is for a
bunch of folks who don’t exist any more.”

This gets to the access issue, what you need to do
with folks. They can't get at you, and you can’t get at
them. So why don’t vou think about it? I think back to
the experiences I had as a principal years ago, working
in an area where poor parents had many of the same
problems that vou have addressed in vour presenta-
tions. Thev worked. They had to work, They had to get

their voungsters off early; thev couldn't get back to

 

 

 

 

 
“.. you've got to join us in that message
that . . . our-schools must become user
friendly, to provide a setting for one-
stop shopping—places where education
can go on and where multifamily services
can go ome.”

school to attend sessions or conferences or this, that, or
the other thing. At that time, we had Title I—that was
27 vears ago, when I came on board—and we developed
what we called extended school. This is verv similar to
what Lamar mentioned that Decatur [Georgia] is doing

now. We have the Federal resources to open up the

access issue. You can change the mindsets out there if

you join us in that attempt, working with our State
commissioners, your State legislators, and vour local
school folks to say that there is a system out there that
will support your needs, if it is properly designed. We
want access to it, and we want to use it. But you've got
to join us in that message that we are trying to get across
to people that our schools must become user friendly,
to provide a setting for one-stop shopping—places
where education can go on and where multifamily
services can go on in terms of local agency services, State
agency services, and, of course, the educational services
that should go on on a continuum, places where a
school operates from early in the morning until late at
night and on weekends and is open during the school
year, where it never closes, and it shouldn't. It’s vour
largest real property investment. It doesn’t mean the
teachers, as Lamar pointed out in his remarks, have to

take on all these other chores. Thev are not trained to

do so—fine. But with that kind of setting, or a setting
comparable to it in a community, we can reach and
provide for children and their families the kinds of
needs that we need to meet today.

It really bothers me terribly—to the point where I
don't understand it—-when I think back to the late
1950s and 1960s. When we built elementary schools, we
built little clinics in them, and dental centers, and so
forth. Try to find a new elementary school today that
has that provision where we can provide that kind of
service to a child and his family. It doesn’t happen any
more. We have to return to some of the things we
identified earlier on that parents need and children
need and get back to itand make those provisions and
open up those schools to do those things.

Let me talk about transition for a minute. Larry
[Bell] was talking about transition. Let me throw outa
bias of mine that we've been trying to work with—
{Commissioner of the Administration for Children,
Youth and Families, Department of Health and Human
Services] Wade Horn and his folks. Transition, to me,
means from conception to birth; it means from birth to
school and community; and it means to the final thing
that the President has also mentioned, and that is to
making a life. Unless we have the kind of system in place
that provides for that and can deliver that, we're going
to find ourselves generationally not making strides that
we need to make to address the needs that we have
today. Looking at some of the things that I looked at for
the past 3 davs in a Third World country—that can't
happen here. We have the ingenuity, resources, intel-
lect, and experience that most people don’t on how to
approach this effort, and we can do it.

Let me say in closing thatifwe use what we know and
use it creatively, we can develop support for what we are
trying to put through in reauthorization of all the elemen-
tarv and secondary programs—that’s 57 programs and
currently over $9 billion. What we are trving to say is that
we need a massive urban intervention program utilizing
Federal resources in conjunction with State and local
resources to provide for communities, an opportunity to
plan for whatever number of vears it takes to pull those

resources together, locating the school or another center

Report of the Surgeon General's Conference 81
as a hub to provide an extended service or extended
school concept so that children and their families can
utilize the various resources in collaboration to accommo-
date the needs we have.

We have many programs out there currently, for
example, that can help each other. For example,
Wade’s program [Head Start], even with the President's
increase, will still not serve all the voungsters who are
currently eligible. But Wade can use our program Even
Start, which is for children 0 through 7 vears old and
their parents, to provide not only parenting and child
care services but also job training and placement ser-
vices. That program can buy Head Start services, can be
used to expand Head Start services, or can create its
own. Our Chapter I program, which is basically age
neutral, can also be used to buy Head Start services,

expand Head Start services, or buv their own.

In other words, what am saving is that in terms of

integrating what we have currently on the books today,

we can do a better job. With our Department of

Agriculture, with its Women, Infants, and Children
[WIC] programs, we've recently signed a Memoran-
dum of Understanding with them so that our Migrant
programs can utilize WIC services. We want to expand
that to Even Start because Congress. on our request, has
now expanded the age range, not for children from 1
through 7 vears old. but from 0 to 7; [wish I could get
itfrom prenatal to 7. Butit’sin this wav that we te things
together, and the Surgeon General and her office with
the Healthy Children Readv to Learn Task Force has
been instrumental in pulling those of us together who
have been working on this so that, again, we are more
integrated than we have been before.

We willcontinue tostrive in this direction, butwe are
going to need your support with Congress to continue in
this direction, where we are pulling together and coordi-
nating all the Federal efforts around the one focus—what
we need to do for our children and our families who need

them the most. Thank vou verv much.

82. Parents Speak Out tor America’s Children

Catherine Bertini

Assistant Secretary for Food and Consumer Services

U.S. Department of Agriculture

President Bush has told those of us whom he appointed
to jobs in his administration that he wanted us “to work
to reorient government to better serve the needs of
individuals.” | remember that quote exactly because I
thought that was so critical to defining our jobs; it is
certainly critical to defining why Dr, Novello has con-
vened this Conference: to talk about one group of
people—children and their parents—and how, by work-
ing together with parents on behalf ofhealthy children,
we are helping children be ready to learn and to grow
strong. Your confidence in Dr. Novello is very well
placed, and I know that she has been not only an
outstanding spokesperson for these issues, but also, in
convening all of us together, is making a constructive
effort to seeing this happen. I've learned a lot already
today, and I'd like to share some thoughts in several
areas: One-stop shopping, service coordination, im-
proving services, empowerment, and then finally some
ideas about solutions.

Before I start, though, first of all I want to explain
why Lam here. As Secretary Madigan said when he
spoke vesterday, the Department of Agriculture spends
more than half of its budget on food assistance pro-
grams for the poor and for children throughout the
country. Soin my portfolio, I manage the Food Stamp
program, school lunch and breakfast, WIC, summer
food program, food program on Indian reservations,
food for the elderly, food for childcare centers, Head
Start centers, and others—there are 13 programs all
together, with Food Stamps, school lunch, and WIC
being the largest. Also, ] come here asa colleague of the
people at the table and as a colleague of Dr. Novello’s
and Dr. Mason’s.

One-stop shopping, as Dr. Mason said, is abso-
lutely a must around the country. We agree totally on
that issue in bringing all social services together, and as
everv speaker here said, that isa critical component. We
have been sending alot of books to Delaware because 12
centers there have combined all social services except
for job training—WIC, Food Stamps, AFDC, Medicaid,
 

various child development projects and programs—all
together in one office. I visited one of those offices; it
was a pleasant place. One receptionist sees the clients,
and all of their information is on a computer, which
sounds simple and makes sense. But it was a huge
undertaking for the State to convince the different
Federal agencies involved to all participate in that

project. Itisa model, and we encourage manv States—

 

 

 

 

we sent many people there—to see how that works,
hoping that we can help them go more toward one-stop
shopping in putting services together.

The President mentioned the immunization pro-
gram. We've been very involved in that from the WIC
perspective because it is one of the few places where very
young children come within the system. If we can
combine services and provide immunization services
there at WIC clinics, it might be a very productive and
helpful program to initiate. To thatend, Dr. Mason and
I have been working aggressively with health directors
around the country to promote joint services for immu-
nization and WIC.

Secretary Madigan vesterday mentioned direct
certification for children in the school lunch program.
This is a critical program, and I want to expand on it
briefly. It doesn’t make sense that a child may not be
able to access a school lunch or breakfast just because
ofa bunch of paperwork that wasn tturnedin. The way
the system worked before direct certification, as you
know, was that at the beginning of the year, the school
sent home a form, through the child, to the parent that
said, “Please fill out this form. Your child may be
eligible for a free or reduced-price meal; tell us your
income.” Manv times those papers don’t get returned;
a lot of parents don't want to fill out that paper; some
parents may never get it; some parents may not be able
to read it. So children end up not being in the school
lunch and breakfast program, under which they may
be eligible for free meals, because of paperwork. What
direct certification is doing—and in the counties that
have started this already, we've had great success, and
itjust began in September—is marrying computer lists.
They marry the computer list of the kids enrolled in
school with the families that are enrolled in AFDC and
Food Stamps. They keep this confidential; it follows all
the confidentialitv requirements. But instead of get-
ting a letter stating that “vour child may be eligible,”
when this works—and it has worked so far in the manv
schools that have started it—parents get a letter at
home that savs. “Your child is eligible for school hinch.~
And. in fact. whether the letter ever gers home or nol

or the parent reads the Jeter is trrelevant because the

Report of the Surgeon Generals Conterence 83
child gets the Junch or the breakfast. Ewould encour-

age people to go home and ask their school district if

they have done this vet.

On the Food Stamp and AFDC side. I was at the
Department of Health and Human Services managing
the AFDC program before I came to [the Department
of] Agriculture. One of the reasons Iwas asked to come
is that the Administration cares about uving to put these
programs together. Almost evervone who is an AFDC
recipient receives Food Stamps, and the majority of
Food Stamprecipients receive AFDC. Itcertainly makes
sense to simplify the rules and regulations. The people
who determine eligibility have thick books in every State
for each of AFDC, Food Stamps, and Medicaid. Anvone
having to learn the rules and how to work through them
takes ona fairly remarkable chore. So what we are doing
is working on the Federal level to identify eligibility
requirements. So far, we've identified 52 eligibility
factors that are different in the two programs, and we
are working now to determine which ones we can
change to make them the same or similar, so it will be
easier for eligibility workers to manage, and ultimately
easier for those who are in need to access the system in
both programs.

We learned from this process, however, that we
have to identify these [needed changes}. but we can't
make all the changes ourselves. Many of the changes
will require congressional approval, and we will be
looking at changes we can make in the Federal Govern-
ment and identifving when we need to go to Congress
to request other changes.

I found out one of these changes when I first came
to this job. fi Alabama, I went to a Food Stamp office
to apply for Food Stamps because I wanted to see how
the svstem worked. I filled out lots of forms, and then
the worker gave me one form that indicated T had to
take it home and have my husband fill it out. I said,
“Why? You're taking me at my word that I’m the head
of the household, and all these other forms are OK for
me to sign. Why do [have to take this one home for him
to sign?” “Well, because that’s the requirement. Every
adult in the household has to sign this particular form.”

Well, that didn’t make anv sense to me, whatever; it was

84 Parents Speak Out for America's Children

a form dealing with whether or not we were U.S.
citizens, So, came back and asked questions about it,
and alot of the eligibility workers laughed. We'd been
telling vou that this was duplication fora long time. We
proposed in the Farm Bill to Congress that they change
this and eliminate the two signature requirement, and
we got it changed. That was the good news. Then we
found out that AFDC and Medicaid have the same
requirement.

The final point on service coordination that I
want to mention is what [ think is the most exciting one
we are working on, and that is called Electronic Benefit
Transfer. We have now in the Food Stamp program a
pilot project, and I want to explain what itis. This EBT,
as it’s called, is using the equivalent of bank ATM
[Automatic Teller Machine] technology for the pur-
pose of providing benefits for Food Stamps and, poten-
tially, for AFDC, WIC, and other programs as well. The
wav this works is, or would be, that there are no longer
food coupons in anv community that undertakes this
project. People geta plastic card and have a private PIN
[Personal Identification Number]. The State or the
county programs the amount of money that would
otherwise be food coupon money into the account.
When a client takes the card to the grocery store, the
recipient runs this card through a machine at the
checkout line. and it debits the appropriate Food
Stamp account for that month, She could also use it. if
itsan AFDC card. in a bank cash machine to take out
her AFDC allotment, not necessarily in one lump sum,
although that is certainly her option, but also in any
amounts that she wants for the month.

We have, in the areas where we are testing this
[EBT]—Reading, PA; Albuquerque, NM; Casper, WY
(for WIC): Ramsey County, MIN; and Baltimore, MD—
only praise from clients who have been using this and
from the Government and the private sector who have
been using it as well, with one exception that I will
mention ina minute. The people who use Food Stamps
in AFDC have been thrilled with it, and the comments
that we hear and the research that we have sav that
people like it. Thev like it because, first of all, it gives

them security: people don’t have to wait at the mailbox
“Children are empowered by getting
a good breakfast and lunch at school
so that they can learn better.”

(as they must if their food coupons or their AFDC ts
mailed) to make sure thev get it. Thev don't have to
cash the AFDC check in one lump sum and sometimes
pay money to a check cashing place to get it cashed: it
empowers them to be able to make decisions about how
much money they want at each particular tine. When
they use this card in the grocery store, they don’t have
to deal with the coupons and counting out the coupons
and dealing with it; they don’t have to deal with anvone
else trying to steal and use their coupons before thev get
to the grocery store. It’sa quicker way to get through the
system when they get to the grocery store.

In Wyoming, one woman ata cash register told me
that she had been a WIC client and now she was
working, managing the cashiers in the store. One of the
reasons that she liked working there was that the card
took the confrontation away in the line. Because (this
program was in WIC, she said, but it could work in WIC
or Food Stamps) the machine says what’s eligible and
what's not eligible, there doesn’t have to be a battle
between two people for that purpose. It’s a benefit for
the stores; it helps them move people through the line
faster. It’s a benefit for the clients on WIC because vou
don’tget one voucher, one time a month. When vou get

one voucher once a month vou have to use it all, and

that’s tough if thev don’t have your type of cereal that
day. With this new system, vou can go back and use the
card again; vou don’t have to buy all of vour milk once
a month and have it rot in the refrigerator, but you can
go back over and over again. It’s a real plus.

It'salsoa plus for the taxpayers, I have to say, because
it will ensure that all of the money that the taxpavers are
spending on food—in our budget thisyear 1s $34 billion—
will be spent on food, and it will be an overall plus. What
we have to do is ensure that it’s cost effective, and the way
that it’s cost effective we hope, through our studies, is
through combining services.

If we combine Food Stamps and AFDC and per-
haps WIC, and perhaps someday other programs that
we can save on the administrative costs, which J think
was mentioned by a couple of speakers before, it will
help us in the long run. That is the one problem: we
have not vet proved that it will save administrative
money, but we are determined to do that. States can
implement this program for Food Stamps after April |
of this vear without a demonstration project.

As far as improving services, as Secretary [of Agricul-
ture] Madigan said. President Bush for the last 2 vears has
increased the WIC program by proposing larger increases
than any president ever--$223 million last vear, $240
million this vear. That combined total is going to help us
serve more than 300,000 more people in the WIC pro-
gram. Improving services in WIC goes bevond just putting
more people in the program; it extends to improving the
actual services that we provide.

One of the things that we've done in the WIC
program is to look, for instance, at the issue of promot-
ing breast feeding, and the issue of helping to empower
mothers to make a choice between breast feeding and
bottle feeding after thev have given birth. Once when
I visited a WIC store in Mississippi and went through the
line looking at what I would buy, I told them I was a
breast-feeding mom. I wanted to go through the line as
a breast-feeding mom and pick up the food I would get.
I picked up my peanut butter, eggs. cereal, milk, and my
other products and then they said, “Oh, well, if vou
weren't breastfeeding. here, this is the formula that vou

would vet.” Well. there was so much formula for the

Report of the Surgean General’s Conference 85
month that | couldn't carry it out of the store! It is no
wonder to me that only 10 percent of WIC moms
breastfeed, when people may be thinking that they mav
be giving up this wonderful option of this great formula
for their child. Not only would we like to empower
women in making this choice, but also provide more
nutrients for women who are breastfeeding. We filed a
notice with the Federal Register asking for comments,
and we intend to file a proposed rule as soon as we can
to offer a separate package for breastfeeding moms in
the WIC program.

In closing, school breakfast is critical for children

all of our studies

 

coming to school ready to learn
show that. Half the schools that have lunch also have
breakfast; we can have more. We've been going around
the country encouraging schools to offer school break-
fasts, and it’s really critical for children to come to
school ready to learn, The summer food program is
available—schools can offer it during the summer and
private non-profit schools can offer it during the sum-
mer to help children have meals at school. All of these
programs empower people. The WIC program em-
powers mothers to help make good decisions bv educa-
tion and nutritional support. Children are empowered
by getting a good breakfast and lunch at school so that
they can learn better. These programs are empowered
by your comments and your direction to us.

The solutions? How can we work together? EBT
can start in States for Food Stamps after April of this
year, You can tell vour State administrators and vour
county administrators that vou think that thev ought to
have EBT. You can work with our regional offices. We
will work with you, and I will take Jim Mason’s lead and
work with the public welfare administrators and com-
municate your comments specifically when I meet with
the State Welfare Commissioners in 2 weeks. We can
work together with changes that will simplify the appli-
cation of AFDC and Food Stamps when we come up
with proposals. We can work together because we need
your help convincing our colleagues on the Agricul-
tural, Wavs and Means, Finance, Education, and Labor
Committees. It would be helpful ifwe had similar rules

for all of these programs. You also can help bv going to

86 Parents Speak Out for America’s Children

your school, and if vou don’t have school breakfast, tell
the school, school board, or someone else who is a
decisionmaker in your community that you want school
breakfast for the children in vour school. It’s an entitle-
ment program; the Bush budget anticipates at least 500
schools entering the program next year, but it takes
community leadership and community support to get
that done through the schools. Every person in this
room, those of us at this table, be they the parent
presenters or the people in the Administration, can do
a lot to work together so that we can take your direction,
the thoughts that we have, and implement. We can
implement the President’s direction to us to reorient
government to better serve the needs of individuals.

Thank you very much.

Wade Horn, Ph.D.

Commissioner

Administration for Children, Youth and Families

US. Department of Health and Human Services

It is a pleasure to be here today at the closing day of this
Conference and I] want to thank the Surgeon General
for the invitation to participate here, but particularly to

thank her for her wisdom in acknowledging and

 

 

 

 

 
recognizing the importance of the role of parents in
helping to get their kids to school healthy and ready to
learn. If we needed any validation of how critically
important parents are, we've heard that from the three
representatives here on the panel this morning.

Tlearn not just from parents but also from my own
children, which I think all of us do. And it’s because of mv
own experiences with my own kids that I have remained
committed to trving to help as best I can in my present
position, help programs help parents raise their kids,
because kids are our future. I could be real briefhere and
I could sav, “Guess what, 1 run Head Start. Head Start
works: it’s great,” sit down, and everybody could applaud.
Because Head Start isa great program: becaitse it, in fact,
embodies much of what itis that the parents talked about
today. It embodies parent involvement and empower-
ment. Head Start has long recognized that parents are the
firstand most important educators of their children, And
we've embodied that empowerment in the Head Start
parent policy councils. Also, Head Start integrated health
services with social services long ago. Do vou know that
Head Start makes arrangements for one of the largest
delivery systems of health services to poor children in this
country Last vear, more than 600,000 children in Head
Start got free medical and dental screenings and followup
treatment, as well as immunizations, through the Head
Start program.

It has also been a leader in removing barriers to
children with disabilities in terms of incorporating
them and involving them in the program as well. Head
Start has long recognized that children with disabilities
need to be mainstreamed. We were doing that back in
1965. Iwas in the 5th grade, butin 1965, we were doing
that. And we were a leader in that. In fact, todav, almost
14 percent of all children enrolled in Head Start are
children with disabilities. We even pay parents for their
knowledge. Do you know that almost 40 percent of all
paid staff in Head Start are parents of children either
currently enrolled in Head Start or formerly enrolled?
But I'm not satisfied, and we shouldn't be satisfied
because there is still much to be done.

Lam just going to mention three new challenges

and initiatives we are undertaking in Head Start. First

ofall, we need more money; we need to serve more kids.
The President, over the last 4 years, has increased our
budget by $1.6 billion. That's an incredible achieve-
ment—that’s real money, even here in Washington.

The second thing we need to do is increase services
to adults of children enrolled in Head Start. In the old
davs. we had this naive belief that we could save children
by taking them out of the home, working with them, and
sending them back. We know that doesn’t work. Ifwe are
going to help children, we have to help their parents.
Over the last 3 vears we have been improving the kinds
and quality of services to adults of children enrolled in
Head Stat, particularly in the area of adult literacy. By the
end of this vear, we will have an adult literacy program in
every Head Start program in this country. We need to do
a better job of working with substance abuse problems
where thev exist in the families we serve. A recent study
shows that at least 20 percent of all adults who have
children enrolled in Head Start have a serious substance
abuse problem. We need to do a better job, and we've
been working with Dr. Mason and his staff, particularly in
the Office for Substance Abuse Prevention and also with
the Office of Treatment Improvement, to try to better
coordinate services around substance abuse issues in
Head Start. focused on the parents.

The third thing we need to do is to use Head Start
as a wedge to increase job skills of the parents who have
their children enrolled in Head Start, and we’ve been
doing that in active collaboration with the new [Job
Opportunities and Basic Skills training] JOBS program,
the 1988 Family Welfare Act. and also with trving to merge
or coordinate with the [Job Training Partnership Act]
JIPA programs as well.

We have to recognize that times have changed. We
have a number of homes with no parents at home when
Head Startis done at 12 noon. We have to doa better job
of coordinating with new childcare monies, and particu-
larly childcare development block grant monies to
ensure that, for those Head Start children who have
parents emploved outside the home, we can keep those
centers open so those kids don’t have to be bused across
town toanother cenler or worse vel (and it a vs happen h

sent home with the hope that somebody is there.

Report af the Surgeon General's Conterenee 87
Finally, in terms of transition, we have to do a better
job of moving kids from Head Start into the public
schools. Larrv Bell talked about making our kids ready for
school. but he also said that we have to do a better job of
making our schools ready for our kids. We do. Sometines
people point to Head Start. and they sav, “Do vou thinkit’s
asuccess? It’snotasuccess. Because vou know what? After
your kid gets a vear or two of Head Start, 5 vears down the
road, the gains start to clissipate.” And I say, “Sure. If the
child graduates into neighborhoods that are riddled with
violence, ifthe child graduates into homes thatare riddled
with substance abuse, if the child graduates into schools
that are unresponsive to the needs of their children, what
do vou expect?” Head Start is not an inoculation against
evervthing that can possibly go wrong in that child’s
community. The fault is not Head Start’s; we need to do
a better job of what happens to those children when thev
leave Head Start. That's why it’s been so gratifing over
the last 3 vears to work with Jack MacDonald in ensuring
that we make those connections between Head Start and

the public schools. Thank vou for the invitation to be here.

Christine Nye

Director

Medicaid Bureau

Health Care Financing Administration

J want to thank [parent presenters] Larry Bell. Sherlita
Reeves, and Ellie Valdez-Honevman for vour comments
this morning. It’s always so crucial and important that we
hear the things that concern and interest vou, Much of
what I heard this morning had to do with the Medicaid
program. The interesting thing about this Conference
and what I’ve heard this morning is thatitstruck a relevant
chord for me not only as a parent but also as an adminis-
trator of the Medicaid program.

As Dr. Mason said, I really didn't know how to frame
my remarks to vou this morning, but it’s absolutely true
that vou want these things to happen. We want these
things to happen too, so why don’t they happen? Let's
make them happen, and I think that is so important. Not
only are we all as parents somehow affected or infected by
the things that vou said this morning; it goes deeper than

that in other wavs too.

88 Parents Speak Out for America’s Children

For example, Pm the parent of two daughters, one
of whom would have been 4+ a month ago, but who,
despite all the efforts of technology, died. And I’m also
the parent of a little girl who will be 3 next week. So I
have, personally, because of that, a deep commitment
to manv of the things that vou do. Similarly, I can go
through people in the Medicaid Bureau who are work-
ing on eligibility policy, on home- and community-
based waivers, who also have a commitment to making
things better, not only as professional people working
in the Medicaid program, but who also are personally
involved in some of the things that vou are involved in
as well. And that occurs not only at the Federal level—
that we as people share these things—but also at the
State and local levels.

Iwanted to make afew comments today, and there
are many things that] could say—so many things that we
are trving to accomplish, so manv areas where we are
sull falling short. so many things that we have to work on
together, Medicaid is a massive program. It serves
almost 30 million Americans, and 17 million of those
are Children. Children are disproportionately repre-
sented in terms of the number of those in poverty that
are served, More children in poverty are served than
adults or the disabled, for example. But despite that,
and you all know this, it's become such a visible thing of
late, that we still serve less than 50 percent of people in
poverty in this country despite the fact that we are
spending over $100 billion on Medicaid this vear. So,
Medicaid is receiving a lot of focus, not only through
reforms in the Medicaid program but also, more re-
cently, through the President’s proposal for health
reform in terms of Medicaid’s kev role in that svstem
and also through additional key reforms that have to be
made in Medicaid to make it more responsive to the
American people.

There have been enormous changes in the Med-
icaid program lately in response to the concerns and
issues vou've raised. There have been expansions in
eligibiliwv. There are options and mandates in many
States; as many as 20 States have enormously expanded
eligibility for children to the maximum. There are

changes for pregnant women and for infants, again,
enormous changes, in response to the concerns ex-
pressed by you and others. I think the concern thatI’ve
heard expressed repeatedly is about the dropoff or the
“falling through the cracks.” That problem is one that
has not been addressed adequately so far, but again I
think that the President's proposal is one that would
address it.

In terms of service expansion, again, in Medicaid,
there is an enormous recognition of some of the prob-
lems that are faced—increased flexibility in providing
waivers to keep disabled and other children at home
and notin institutions, and enormous changes in terms
of the increased use of case management for various
population groups in Medicaid, particularly for preg-
nant women and for children, but also for disabled
children. What I consider the greatest child health
reform in Medicaid since it was enacted is the enormous
expansion in the Early Periodic Screening, Diagnostic.
and Treatment Program, the EPSDT Program, the
child health screening program in this country.

Along with service and eligibility expansion, there
are also enormous concerns about access. Trving to
streamline these application forms, getting eligibility

workers out to places, and trying to expand the amount

of dollars paid to community health centers and persons

 

you can effeet change, through your
effective advocacy.”

 

 

  

providing obstetrical and pediatric services are allaccess
issues in dealing with red tape problems, trying to
overcome some of the barriers that physicians and
other providers have with Medicaid. But again, as Dr.
Mason said, these are things that vou and I believe, and
they are happening, but we need to continue to make
them happen.

One thing that isa reality about Medicaid is that it
is a Federal-overseen and State-administered program.
States have enormous flexibility, which is both a strength
and a weakness in the program as vou try to make the
kind of changes that are most appropriate for vour
communities. Through your networks, the power and
cohesion vou are developing, vou can effect change,
through vour effective advocacy. I would suggest, as a
followup to this conference, and maybe this is already
planned, that you debrief vour State Medicaid people
about the kinds of things that vou discussed and that
came out of this conference.

We had a handout here; it was a one-page informa-
tion sheet about Medicaid, and on the flip side was a list of
all the regional offices for the Health Care Financing
Administration and the people there whom we have
designated to be responsible for maternal and child
health issues. Those people are available to you to help
vou to approach and access the svstem. Also, we have a
wonderfully knowledgeable person, Bill Hiscock, who will
be more than willing and eager to answer your questions.

In terms of your questions, “What are you going to
do with these recommendations and all the time that
we've spentand the heart-felt feeling thatwe have about
changes that need to be made?" I have found this
enormously helpful and also rejuvenating in terms of
my commitment in trying to make some of these things
happen, clarifying policies in what Medicaid will and
will not cover and in transportation, and making sure
that States are implementing the child health screening
service appropriately. So, for that I want to thank you.
I wish you much success when vou return to your States
and discuss at that level the things that vou have discov-

ered or heard.

Report of the Surgeon General's Conference 89
Lou Enoff

Principal Deputy Administrator

Social Security Administration

laccepted a call from Dr. Novello Jast evening, and I will
tell vou I'm glad I came. I'm glad I accepted, and it isa
real pleasure to be here. I, too, am a parent. My
youngest is graduating from high school this vear, but I
am also an expectant grandparent, I don’t have a
picture yet, but I have a sonogram, if vou'd like to see
that. We're anxiously awaiting that. I’ve been involved
in the activities of all three of our children in the
schools, in the curriculum council, and in the PTA, and
I just want to say, keep up what vou are doing.

I'm here not only because I'm a parent. You're
probably saying, “What the heck does Social Security
have to do with kids?” Well, most people think of Social
Security as a retirement program. And we are, I think,
avery successful retirement program. We have a budget
of over $300 billion, and we pay 40 million checks every
month on time—we’ve done that for more than 50
vears. We have 1,350 offices around the country, where
Tassume you all get verv good service when vou go there.
We have people who serve you with compassion and
efficiency. We're proud of that. But many people don't
realize that we at Social Security also have a great deal to
do with children. Every month, we pay more than SI
billion to more than 3 million children under one of the
Social Security programs because, in addition to retire-
ment, Social Security has a survivor's program and a
disability program. We pay children of retired workers,
children of disabled workers, children who are them-
selves disabled, and children whose parents are de-
ceased and where there is a need for income. So, everv
month we do pay 3 million kids more than $1 billion.

Let me speak for a moment about some of the
things that we have done in response to the questions
that have been raised here. First, in terms of access, a
few years ago Social Security installed an 800 telephone
number, toll free, nationwide, 12 hours, from 7 a.m. to
7 p.m., so that you can call us from anywhere in the
country. You'll get someone who will help you, includ-
ing bilingual help. If you need a referral, we can refer

from there. We're talking about Social Security

90 Parents Speak Out for America’s Children

 

   

“We are.your servants here
here to help you.” p

business, generally. We can’t refer you for everything,
but we will help vou if vou call us on that 800 number.
We can make an appointment for you in one of the
offices if vou need to come into the office. We're trying
to bring that service to where people can access it from
their home, if they need it.

Second, I would mention the program that we
administer called SSI, Supplemental Security Income.
Itreaches another 4 or 5 million eligible people. Com-
missioner King launched an SSI Outreach Program.
We recognize that we in government cannot do this
alone. We cannot find the people who might be
eligible for this program and who have a needs base
there. Butwe know that vou in the community do know
about people, so we've begun an outreach campaign in
all of our local offices where we trv to educate those who
are involved in the community to help us find those
who may be eligible for the program. It’s been very
successful, and we've had a 20 percent increase in
applications in both of the last 2 years, and we are
continuing to forge those partnerships with commu-
nity organizations. We need your help, and we'd be
glad to work with you in any of your organizations in
helping to find persons who may be eligible for SSI.

Also in the last 2 vears, we have launched a special

program for children with disabilities who may be
eligible for SSI. Some of you may have heard of the
Zebley court case. In that situation, we've developed a
whole new procedure for determining disability in
children. We’ve worked with pediatricians, school so-
cial workers, and others to define what disability means
in a child. We’ve had a lot of help from the Public
Health Service, and we've had a lot of input from
community groups. During the last vear and a half,
we've taken 450,000 applications from children with
disabilities, and we've increased the number of persons
receiving those benefits from about 200,000 to more
than 400,000.

You mentioned one-stop shopping. Working with
our colleagues in agencies represented here, we've
begun to integrate our services. We are locating our
offices whenever we can together with other State, local,
and Federal offices that have the same clientele that we
do. Secretary Sullivan has launched a program of inte-
gration of services, and all of us in [the Department of
Health and Human Services] HHS are working closely
to try to coordinate our service delivery at the local level.
We do have a standard of service. For the first time, we
have published standards of service for our offices, and
we have just begun receiving public input to that. We
will be modifying that as we go along, and we will be
publishing our goals and how long it should take you to
receive service in a Social Security office. We issue a
Social Security card, for instance, in 10 days now. It used
to take us a month to do that. We have other goals, too.
We are trying to determine what is most important to
the public so that we can put our emphasis in that area.
I think it was Ms. Reeves who said, “What will we do, ifwe
don’t like what we hear?” Well, I hope you'll call us, if
you have a problem or a concern about Social Security.
I mentioned the 800 number; if you call that number
and don’t get satisfaction, I hope you'll call me. My
number is 410-965-9000. We are your servants here; we

are here to help you.

Report of the Surgeon General's Conference 91
ov Jajydeyy)

Commitment of

 

Our Leaders

Fz

 

 

 

 
Chapter 5

Commitment of Our Leaders

resident George Bush and prominent members

of his administration expressed their personal
commitment to the Healthy Children Ready to
Learn Initiative by attending the Conference and speak-
ing to the participants. President Bush delivered his
keynote address in the afternoon of the first day. In
addition, each day of the Conference began with a
keynote speech given by heads of the cosponsoring
Governmentagencies: Secretary of Health and Human
Services Louis Sullivan; Secretary of Agriculture Ed-
ward Madigan; and Secretary of Education Lamar
Alexander. Roger Porter, Assistant to the President for
Economic and Domestic Policy, also addressed the

participants. This section contains their remarks.!

George H. Bush
President of the United States

ight I just say at the beginning of these brief

remarks that J am very proud of Lou Sullivan

and what he’s doing as Secretarv of Health
and Human Services. He’s doing a superb job, and we all
are grateful to him. And let me just say it’s a pleasure to
be here today to help launch this historic Conference.

I particularly want to thank our Surgeon General,
Antonia Novello. She has inspired people all across the
country with her example and her message. And she
“AH children
have a right to be healthy.” Then she says, “We need to

sums it up this way, better than anyone:

speak for those who cannot speak for themselves.”
That’s whv you’ve gathered here this week, and
you've come to lead a great movement of parents,
doctors, teachers, public programs, and private enter-
prise—a movement destined to transform America.
Here’s our goal: By the year 2000, every American child
will start school healthy and ready to learn. Our success

will provide a lifetime of opportunity for our children.

 

‘Some of these remarks have been edited for clarity.

94 Parents Speak Out for America’s Children

It will guarantee the health and safety of our families
and neighborhoods, and it will ensure that America
remains the undisputed leader of the world.

Now, Iam proud that our administration is part of
this movement. In this administration, families come
first. We're proud to join hands with people like Trish
Solomon Thomas, who has come from New Mexico to

be here this afternoon. She has two children, both of

 

nourishment that no government
program can ever hope to.provide.”

 

 

 

them with special health needs. She perfectly expressed
the spirit of our movement when she said, “I used to be
shy, but I had to learn to stand up for my kids.” And
that’s why we're here, to stand up for our kids. We will
not let them down. Our movement draws its strength
from Trish and the millions of parents like her. The title
of this Conference says it all: “Healthy Children Ready
to Learn: The Critical Role of Parents.” Parents are a
child's first teachers, offering the love and spiritual
nourishment that no government program can ever
hope to provide.

If I can brag for just a minute here today, you may
know of Barbara’s work promoting literacy. I’m very
proud ofher. She wants to help parents understand just
how important it is to read to their kids. When parents

read aloud to their young ones, they open their children
to the jov ofa larger world; thev teach the self-assurance
and curiosity that comes from learning. Barbara asked
me to extend her best wishes. She's now on a learning
program, an education program right this minute, in
the State of Mississippi.

Our movement instills the habits of good health:
wholesome nutrition, sound hygiene, and protective mea-
sures like earlv immunization. Parents know that learning
and health are two sides of the same coin. Again, parents,
families, and communities are the kev. But government
can help and must help. Last June, for example. Dr.
Sullivan and I, with able advice from Dr. Novello. took
steps to ensure that no American child is at risk from
deadly diseases like polio, diphtheria, and measles. We
launched an initiative to support childhood immuniza-
tions, especially immunizations for kids in the early vears
of life. Now, that’s a crucial step toward meeting our goal.
I'm proud we've been able to help. Since 1988, we've
more than tripled the dollars for Federal immunization

efforts, from $98 million to $297 million for 1992.

 

On Friday, Dr. Sullivan and the Surgeon General
and I] were outin San Diego, and we had the privilege of
visiing Logan Heights Family Health Center to see
firsthand the benefits of this initiative. We spoke with
parents and community leaders, and everv one of them
stressed the importance of early immunization in pre-
venting illness. Logan Heightsis, one of many, I'm sure,
a perfect example of what can be done if concerned
inclividuals set their minds to it. The Center was founded
by a wonderful woman named Laura Rodriguez, who's
become one of our administration's Points of Light,
helping others and setting an example in the process.
Laura saw a need, and with hard work and dedication,
she rolled up her sleeves and did something about it.
Logan Heights now serves 75,000 patients a year. So 1
sav, “Thank God for people like Laura. She’s an ex-
ample for all of us.” There are many, many other
examples right here in this room.

For those kidswho needa head startin preparing for

school, we’ve made sure that thev'll get it. In the last 3

years, we have almost doubled the funding for Head Start

 

Report of the Surgeon General's Conterence 95
programs. and this year, | have proposed the largest single
increase in Head Start’s historv: $600 million. This vear’s
increase will ensure that 157,000 more kids will be able to
start school ready to learn. Head Start brings children and
parents into the classroom and into the learning process.
Head Start works because parents take the lead. You may

not know this, but volunteers in Head Start outnumber

 

“Our great challenge, then, istokeep
what worksin our system, and then
reform what doesn’t work.”

 

 

 

paid staff by eight to one. Head Start works because

people care. We're making sure it continues to work. If

it’s good for America’s kids, it's good for America.

These are important steps. But there’s more to
do. We must address the larger issues of American
health care. Last week, I proposed a four-point plan to
do just that. Every American family must have access to
affordable, high-quality health care.

I don’t need to tell you that the American health
care svstem has problems. The crisis has probably
touched many of vou right here in this room. Right
now, more than 8 million children go without health
insurance because skyrocketing costs have placed cov-
erage bevond the reach of their parents. And even
parents whoare covered worry about losing their family’s
insurance if they move on to a different job or, worse

still, lose the job they have. You shouldn’t have to live

96 Parents Speak Out for America’s Children

with this kind of uncertainty. No American family
should, and mv proposal would put an end to that.
Yet I think we should keep one thing in mind. It’s
important to remember that, for all its problems, our
health care svstem still provides the best health care in the
world. That's why people from all over the world come
here seeking better care. Most often they're trying to
escape health care systems in which the government
dictates how much care you'll get and what kind you'll get
and when you'll get it. In America, that’s unacceptable.
Our great challenge, then, is to keep what worksin
our system, and then reform what doesn’t work. We
must maintain a maximum freedom of choice and the
highest quality care. At the same time, we must make
sure that our children have access to health care their
parents can afford, sick or healthy, rich or poor.

That's what this four-point plan does, and let me

just briefly spell it out for you. First. I want to make

health care more affordable and accessible. I want a
$3.750 tax credit for low-income families to help them
buy health insurance; for middle-income families, I’ve
proposed a tax deduction for the same amount. Poor
people, those who don't file taxes, also would be cov-
ered under this plan.

Second, to cut costs, we will make health care
more efficient. The math is simple: The larger the
group being covered, the lower the cost per individual.
So we've proposed health insurance networks that bring
companies together to cut administrative costs and
make insurance affordable for working parents.

And third, we must cut out waste and abuse. We
can start with medical malpractice lawsuits that drive up
the cost of care for evervone. A doctor pestered with
frivolous litigation ends up passing his legal costs right
along to you, the American people, and right along to
the patient. When vou go to the doctor, I don’twantyou
to have to pav a lawver, too. Just pay the doctor.

Finally, we must slow the spiraling costs of Federal
health programs. These costs are rising far beyond the
rate of inflation, and that only endangers important
benefits while making less money available for more

pressing needs.
There it is. A common-sense reform that will
maintain high-quality care, cut costs, ensure Maximum
freedom of choice, and give every family—rich or poor,
sick or healthy—access to health care. IT know how
important this is. particularly for parents who have
children with special needs. Mv plan will ensure that
vou can change jobs without endangering the health
insurance on which vour child depends. We're build-
ing on our system's strengths. We're avoiding the
pitfalls of nationalized care. the kind that people from
all over the world come to America to escape.

All these approaches for meeting our goal of
healthy children ready to Jearn must build on a basic
truth, that, in this country, families come first. Govern-
ment programs that overtake the rightful role of fami-
liesand communities, deny them the freedom of choice.
or bind them up in red tape are simply unacceptable.

Our movement is about strengthening families.
Over the next few davs, Pm told vou will continue agreal
national dialog. share information, explore new ideas,
and then return to vour communities to lead the good
fight. Your commitment is an inspiration, and | thank
vou for inviting me to get a feeling of it firsthand.

May God bless all of vou. Thank vou all and mav

God bless America. Thank vou very, very much.

Louis W. Sullivan, M.D.

Secretary of Health and Human Services

ood morning. It is a sincere pleasure to welcome
evervone to the “Healthy Children Ready to

Learn” Conference. I'd like to take a moment to
commend mv colleague, Dr. Antonia Novello, who has been
working diligently during her tenure at the Department of
Health and Human Services to improve the health and well-
being of America’s children. This very imely and important
Conference is the culmination of 18 months of planning
among the Office of the Surgeon General, the Departments
of Agriculture and Education, the National Governors’ Asso-
ciation, and so manv others. | am confident that this Confer-
ence will play an essential role in our departmentavide effort

10 improve school readiness,

You know it is not often that we policvmakers in
Washington stop to confer with the real experts about
the challenges facing American children. But today we
are. Todav. we are convening parents from every State
in our Nation. Together with educators and health
professionals from the front lines, we can network,
share promising programs, and strategize about how we
can meet the President's first National Education Goal
that “by the vear 2000 all children in America will start
school ready to learn.”

As we all know, a good beginning is often the key
to success. This is especially true when we speak of
children. As parents. health care professionals, psy-
chologists, educators, and others who work with chil-
dren will attest, the experiences of childhood shape the
course of a lifetime. This sentiment was beautifully
captured bv John Milton, who wrote: “Childhood shows

the man as morning shows the day.”

 

 

 

 

 

Report of the Surgeon General's Conference 97
What determines whether a childhood is a beau-
uful sunrise in warm tones of amber and crimson, ora
grim, colorless dawn? First and foremost, a child needs
to be secure in the love of his or her parents. A father
who reads to his child each night before bed, or a
mother who proudly displays cravon masterpieces on
the refrigerator, is really laying the groundwork for a
positive school experience. In addition, a warm, color-
ful childhood is a healthy childhood. Children’s health
and their ability to learn are mutually dependent. Be-
ing ready to learn depends upon a child having enough
to eat, being protected from preventable diseases, grow-
ing up free from environmental pollutants, and having
access to health care. Helping parents to provide a
healthy childhood for their children is a central part of
the mission of my Department.

In his fiscal year 1993 budget, President Bush has
provided us a blueprint for action. The President's
budget proposal has three areas of emphasis: First, we
must invest in children; second, we must focus on preven-

tion; and third, programs must empower parents.

Investing in Children

Investing in children is simply good health care policy.
The time and resources we devote to children now will
pay continuous dividends in the future in the form of

healthier and more productive citizens. In recognition

 

 
  

“T
the fir

 

id best department off ealth
vservices. And:¥’d like to
say, as well, that parents ay

first and best. eMepargnent of

 

   

98 Parents Speak Out for America’s Children

of this fact, the President's budget proposes to increase
investment programs serving children to $100 billion,
up from $60 billion in 1989.

Healthy Start

The first few vears of life, beginning in the womb, are
the most crucial period of child development. There-
fore, if we truly desire to invest in the next generation,
we must begin before the child is even born. We must
begin by making sure every mother receives early,
quality prenatal care. Overall, nearly 25 percent of all
women—and nearly 40 percent of Black and Hispanic
women—do not receive prenatal care in their first
trimester of pregnancy.

Lack of prenatal care is a contributing factor to
this Nation's disgraceful infant mortality rate. Despite
spending more on health care than any other nation,
the United States remains 24th among nations in the
rate of survival of infants. Each vear, 40,000 American
babies do not live to celebrate their first birthday.
Black babies are more than twice as likely as white
babies to die.

The President and [ have made infant mortality a
national priority by developing a new infant health
initiative, Healthy Start. Our strategy is to concentrate
resources 1n 15 communities with stubbornly high in-
fant mortality rates. Each community is given the
flexibility to create a mix of services tailored to the
needs of their population. We are requesting $143
million to provide these 15 communities with the re-
sources necessary to fully implement their detailed
strategies for reducing infant mortality rates by at least
50 percent over a S-vear period. We will use the
knowledge gained from these demonstration projects

as a model for other communities across the Nation.

Focus on Prevention

The President’s budget also will focus resources and
attention on preventive health programs. Common
sense argues that it is better to invest in prevention and
screening programs than to wait until the advanced
stages of disease. when treatment is more complicated

and more costly.
“It ismo surprise that our most suc-
cessful programs for children—like
Head Start—are built upon direct
parental involvement.”

 

 

Immunizations
Childhood immunizations are among the most cost-
effective prevention activities. A $1 investment in
measles-mumps-rubella vaccine mav return $14 in
avoided medical care costs. We can be proud of the fact
that 97 percent of American children entering school
are immunized. However, to be fully protected, chil-
dren need to be properly immunized by the time they
are 2 years old. Our rates among preschoolers are much
lower, and in some inner-city areas, the immunization
rate among 2 vear olds is an abysmal 20 percent.

That is why the President has requested $52 mil-
lion for our immunization activities—an increase of 148
percent since 1989. My Department will use this in-
crease to target those children most at risk. These
dollars will translate into 6.7 million polio vaccinations,
4.1 million measles-mumps-rubella vaccinations, and

2.6 million hepatitis B vaccinations.

Lead Poisoning

Lead poisoning, the most common environmental dis-
ease of young children, is another preventable disease. As
many as 3 to 4 million American children under 6 vears
old may have lead levels in the blood high enough to cause
developmental delavs, learning disabilities, behavioral

problems, decreases in intelligence, and even death.

Low-income, minority children growing up in ur-
ban areasare mostat risk of having dangerously high levels
of lead in their blood. The President’s budget requests
$40 million, a 90 percent increase, for CDC Lead Poison-
ing Prevention Grants. These grants will support about 30

statewide lead poisoning screening programs.

Empower Parents

The third emphasis of the President’s budget is the critical
role of parents and the need to support programs that
empower parents. I trulv believe that the family is really
the first and best department of health and human
services. And I'd like to say, as well, that parents are a
child's first and best department of education.

Educators often speak of the “hidden curriculum
of the home” to describe the important lessons we learn
during our first few vears of hfe. We learn that our
parents love us verv much, and that gives us a sense of
security. We learn how to share, and we learn right from
left and right from wrong.

These are not easy lessons to teach. And all too
often this learning does not occur because parents
cannot, or do not, attend to the needs of their children.
It is no surprise that our most successful programs for
children—like Head Start—are built upon direct pa-

rental involvement.

Head Start
Head Start has won the confidence of the American
people. It is known as a program that works and a
program that is worthy of our tax dollars. Many of you
in the audience are familiar with Head Start; some may
even serve on parent councils, which guide the opera-
tions of the individual centers.

President Bush, a firm believer in the value of Head
Start, has proposed the largest single-vear funding in-
crease in the historv of Head Start. The $600 million he
has requested will serve an estimated 157,000 additional
children in 1993. These additions would mean that
funding for Head Start has more than doubled since
President Bush came to office. This unprecedented
increase in Head Start supports participation ofall eligible

and interested disadvantaged children for one vear.

Report of the Surgeon General's Conference 99
The President's Health Care Proposal

In addition to targeted interventions such as Head
Start and Healthy Start, the President announced last
week his health care reform proposal. Under the
President’s plan, the middle class will get help to pay
for health care through a new income tax deduction.
For poor families, the plan guarantees access to health
care through another new feature: a health insurance
credit. In combination, these tax provisions will help
more than 90 million Americans and cover 95 percent
of the uninsured.

This morning I’ve outlined the tremendous new
resources that the President wants to make available for
children. But more money alone is not enough. The
critical element of any initiative to help children is par-
ents. Unfortunately, for reasons ranging from parental
exhaustion to preoccupation with careers, children todav
spend 40 percentless time with their parents than they did
in 1965—an average of onlv 17 hours aweek! To put that
figure in perspective, American children spend an aver-
age of 25 hours watching television each week.

I'm encouraged to see so manv parents and child
experts gathered for this Conference. Over the next
few days, you will have the opportunity to use your
combined expertise to move this Nation toward the
goal that all children will begin school ready to learn.
To borrow again from Milton, vou will have the oppor-
tunity to make childhood a warm and radiant sunrise,
ushering in a dav of golden hope.

Thank you all. Godspeed to all of the Healthy
Children Ready to Learn participants.

Edward Madigan
Secretary of Agriculture

utrition is basic. All things can be possible for
a child who is well fed; very little is possible for
a child, or a pregnant mother, or anyone for
that matter, who doesn’t get the nutritious foods we all
need to grow, to learn, and to excel. It’s our job to get
that information to you and before the public and into

everyday practice. There are 64 million children in the

100 Parents Speak Out for America’s Children

United States today, and all of them share this need.
That’s why we're here this morning.

The President recognized the importance of a
strong nutrition foundation in his education initiative.
The first of his six National Education Goals is that “By
the year 2000, all children in America will start school
ready to learn.”

To achieve this, we have to ensure that they re-
ceive the nutrition thev need for healthy minds and
bodies. That responsibility begins before children are
born. Working with mothers, we must ensure that the
number of low-birthweight babies is significantly re-
duced through good prenatal care.

Although we are investing large amounts of money
and effort to help, it's the parents of children in these
programs who have the primary role to play in their
care and feeding. One of our best programs for
reaching both children and the parents of children at
risk is the Supplemental Food Program for Women,
Infants, and Children, or WIC. This program provides
supplemental food and nutrition education to low-
income pregnant, postpartum, and breastfeeding
women: infants; and voung children—all at nutritional
risk. WIC serves one in three babies born everv vear.
That's about 5.3 million participants this month alone.
And our highest priority is low-income pregnantwomen
and their infants. What's more, WIC has become a
gateway to other government services, especially health
care. Through WIC, pregnant women are learning
about and obtaining health services they need. Local
WIC agencies refer applicants to Medicaid if it’s likely
thev're eligible.

WIC is an adjunct to health care that participants
receive at local health clinics. For example, WIC per-
sonnel promote breastfeeding among program partici-
pants, coordinate with State and Federal immunization
programs, and provide alcohol and drug abuse preven-
tion education and referrals.

WIC is cost-effective. A major study done in
1987-88 in five States showed that Medicaid-eligible
pregnant women who participate in WIC do indeed

have healthier babies than low-income women who do