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Child advocacy: The need is great
Child Advocacy: . The Need Is Great
T
he child advocacy role of the pediatric nurse practitioner must once again receive time and attention. Initially, as the nurse practitioner role evolved, these professionals were envisioned as a source of health care for low income families. Pediatric nurse practitioners worked hard to increase accessfor children’s health care. Today the need for advocacy still exists, and nurse practitioners must again develop strategies to tackle these health care problems. We must again become the vocal, visible, and successful advocates for health care for all children and their families. The need for advocacy is great today because of problems such as the increasing infant mortality rate, the everpresent homeless children and their families, and increasing poverty among children and young families. While nurse practitioners cannot be expected to eliminate these situations themselves, they can serve as advocates to let others know about these problems and what can be done. The lack of improvement in infant mortality rates is a potential problem for all health care providers. Black infants are especially at risk as the mortality rate for them recently has increased, reversing a 20year downward trend and widening the black-towhite ratios for infant mortality (CDF Reports, 1988). The causes of infant death often can be prevented by good prenatal care as well as good infant care, but this care -particularly early prenatal careis often not available. Homeless children and their families are another group in need of better health care programs. Homelessness is a complex problem and the solution will not come easily, but, in the meantime, many children face each new day with fear and anxiety. Bassuk and Rubin, (1987) in a study of homeless children and families, found that many of the children showed evidence of developmental delays. In addition, there was a high proportion of learning disabilities, depression, and anxiety. Many of the school-age children stated they thought about suicide. The authors found that approximately half of the children required psyJOURNAL
OF PEDIATRIC
HEALTH
CARE
n
chiatric referral and evaluation. Unfortunately, when family concerns are focused on survival, psychiatric care is not a priority. Nevertheless, the typical childhood for these children is one of chronic stress and has the potential to alter their functioning as adults. These children need advocates to help them get the services they so desperately need. Although homelessness is a major problem in America, it is just one manifestation of the increasing numbers of families living in poverty. The number of these families has increased by more than 40% in recent years (U.S. Congress, 1986). Nearly 13 million children less than 18 years of age live in poverty, approximately 40% of both black and Hispanic children. In addition, children in female-headed households are five times more likely to be poor than children in male-headed households (CDF Reports, 1987). Furthermore, the median income of families with heads of household who are younger than 30 years has fallen by 30% between 1973 and 1986. These families cannot afford adequate house or health insurance. These are the families who in the late 1980s need our help, just as the families in the 1960s did when the nurse practitioner role was developed. Nurse practitioners can develop strategies to help solve these family problems, both individually and through joining groups of nurse practitioners, other health professionals, or community activists. One major approach is to publicize the problems, particularly at the local level. National statistics often seem remote or overwhelming, but reporting local situations to community groups, local newspapers, and radio and television stations can have major impact. Problems must be seen at the local level, then action plans can be developed. This does not mean ignoring national efforts to solve these problems; national associations,
agencies and task forces can provide
guidelines for local action. Legislative input is needed at all levels; legislators need to be shown how their constituency is affected 1
2
Volume 3, twmber 1 January-February 1989
Nelms
by these situations and what is needed to help. Asking for money is not enough; specific organized plans must be developed. As child advocates, nurse practitioners will be competing for funding of the health care dollar. This will become more difficult as the elderly population increases and health care funds are limited. However, cost effective programs are always of interest and nurse practitioners can demonstrate how monies for early identification and prevention can save in the long run. Finally, nurse practitioners can teach clients how to become advocates for themselves. Numbers have influence ifthose numbers turn into votes and active communitv voices. Such teaching has always been an important function of nurse practitioners, but today the need is even greater. Looking back can often be beneficial. While many nurse practitioners are embarking on new roles and I-. 1 survrvar,I u._ 1s an are concernea II. aoout proressronar
important that role come the need our
time to review the factors that stimulated development initially and once again beadvocates for the children and families who care. n Bobbie Gew Nelms, PbD, RN, CPNP Editor
REFERENCES Bassnk, E. & Rubin, L. (1987). Homeless children: A neglected population. American Journal of O&xpycbiuty 57, 279-285. Children’s Defense Fund (CDF). (1987). United States’ progress in saving infants’ lives has stopped, according to recent data. WF Remts, 9(8), 1. Children’s DefenseF&d (CDF). (1988). Child poverty rate stays high. WF Repmts, 9(4), 1, 8. U.S. Congress House of Representatives. (1986). Safety net programs: Are they reaching children? Hearings before the Select Committee on Children, Youth and Families. Government -.rrmtmg -r?umce, ._ Mlashington, DC.
T
he child advocacy role of the pediatric nurse practitioner must once again receive time and attention. Initially, as the nurse practitioner role evolved, these professionals were envisioned as a source of health care for low income families. Pediatric nurse practitioners worked hard to increase accessfor children’s health care. Today the need for advocacy still exists, and nurse practitioners must again develop strategies to tackle these health care problems. We must again become the vocal, visible, and successful advocates for health care for all children and their families. The need for advocacy is great today because of problems such as the increasing infant mortality rate, the everpresent homeless children and their families, and increasing poverty among children and young families. While nurse practitioners cannot be expected to eliminate these situations themselves, they can serve as advocates to let others know about these problems and what can be done. The lack of improvement in infant mortality rates is a potential problem for all health care providers. Black infants are especially at risk as the mortality rate for them recently has increased, reversing a 20year downward trend and widening the black-towhite ratios for infant mortality (CDF Reports, 1988). The causes of infant death often can be prevented by good prenatal care as well as good infant care, but this care -particularly early prenatal careis often not available. Homeless children and their families are another group in need of better health care programs. Homelessness is a complex problem and the solution will not come easily, but, in the meantime, many children face each new day with fear and anxiety. Bassuk and Rubin, (1987) in a study of homeless children and families, found that many of the children showed evidence of developmental delays. In addition, there was a high proportion of learning disabilities, depression, and anxiety. Many of the school-age children stated they thought about suicide. The authors found that approximately half of the children required psyJOURNAL
OF PEDIATRIC
HEALTH
CARE
n
chiatric referral and evaluation. Unfortunately, when family concerns are focused on survival, psychiatric care is not a priority. Nevertheless, the typical childhood for these children is one of chronic stress and has the potential to alter their functioning as adults. These children need advocates to help them get the services they so desperately need. Although homelessness is a major problem in America, it is just one manifestation of the increasing numbers of families living in poverty. The number of these families has increased by more than 40% in recent years (U.S. Congress, 1986). Nearly 13 million children less than 18 years of age live in poverty, approximately 40% of both black and Hispanic children. In addition, children in female-headed households are five times more likely to be poor than children in male-headed households (CDF Reports, 1987). Furthermore, the median income of families with heads of household who are younger than 30 years has fallen by 30% between 1973 and 1986. These families cannot afford adequate house or health insurance. These are the families who in the late 1980s need our help, just as the families in the 1960s did when the nurse practitioner role was developed. Nurse practitioners can develop strategies to help solve these family problems, both individually and through joining groups of nurse practitioners, other health professionals, or community activists. One major approach is to publicize the problems, particularly at the local level. National statistics often seem remote or overwhelming, but reporting local situations to community groups, local newspapers, and radio and television stations can have major impact. Problems must be seen at the local level, then action plans can be developed. This does not mean ignoring national efforts to solve these problems; national associations,
agencies and task forces can provide
guidelines for local action. Legislative input is needed at all levels; legislators need to be shown how their constituency is affected 1
2
Volume 3, twmber 1 January-February 1989
Nelms
by these situations and what is needed to help. Asking for money is not enough; specific organized plans must be developed. As child advocates, nurse practitioners will be competing for funding of the health care dollar. This will become more difficult as the elderly population increases and health care funds are limited. However, cost effective programs are always of interest and nurse practitioners can demonstrate how monies for early identification and prevention can save in the long run. Finally, nurse practitioners can teach clients how to become advocates for themselves. Numbers have influence ifthose numbers turn into votes and active communitv voices. Such teaching has always been an important function of nurse practitioners, but today the need is even greater. Looking back can often be beneficial. While many nurse practitioners are embarking on new roles and I-. 1 survrvar,I u._ 1s an are concernea II. aoout proressronar
important that role come the need our
time to review the factors that stimulated development initially and once again beadvocates for the children and families who care. n Bobbie Gew Nelms, PbD, RN, CPNP Editor
REFERENCES Bassnk, E. & Rubin, L. (1987). Homeless children: A neglected population. American Journal of O&xpycbiuty 57, 279-285. Children’s Defense Fund (CDF). (1987). United States’ progress in saving infants’ lives has stopped, according to recent data. WF Remts, 9(8), 1. Children’s DefenseF&d (CDF). (1988). Child poverty rate stays high. WF Repmts, 9(4), 1, 8. U.S. Congress House of Representatives. (1986). Safety net programs: Are they reaching children? Hearings before the Select Committee on Children, Youth and Families. Government -.rrmtmg -r?umce, ._ Mlashington, DC.