Cumberland Pediatric Foundation

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Interesting Statistics from Metro

Metropolitan Social Services

Planning, Coordination & Social Data Analysis Newsletter

October 2015

Child Poverty Affects Adult Success

Child Poverty and Adult Success from the Urban Institute (September 2015) notes that children in the U.S. are disproportionately poor, with one in five children in poverty compared to one in eight adults.  Among ever-poor children (poor for at least one year before age 18), 38.8% are poor for at least one full year before they are age 18, with the rate much higher for black children at 75.4%.

Child Poverty indicates that 10.5% of all children and 38.5% of black children spend at least half their childhoods living in poverty (persistent childhood poverty).  This often results in impaired academic achievement and later employment challenges.  It describes findings from 40 years of data (1968-2009) from the Panel Study of Income Dynamics that suggest that persistently poor children have impaired outcomes compared to other poor children.

The future of persistently poor children is linked to the length of time they are in poverty.  Persistently poor children are 13% less likely to graduate from high school and 43% less likely to complete college than children who are poor but not persistently poor. 

The educational level of their parents is connected with the academic achievement of persistently poor children.  Another factor related to lower academic achievement for persistently poor children is residential instability (moving three or more times).  Living in multigenerational households (that include both parents and grandparents) improve the chances for children in persistently poor households, but not in ever-poor.

The data is compelling to show that, “Adult achievement is related to childhood poverty and the length of time they live in poverty.”  Many other factors are described in Child Poverty, which also notes ever-poor children living in a female-headed household increases the likelihood of being arrested, but not related to educational achievement, employment or teen childbearing.  However, with persistently poor children, the longer a child lives in a female-headed household, the less likely the child is to complete high school.

Child Poverty says that compared to never-poor children, the ever-poor children are “less successful in their educational achievement and employment, and they are more likely to have a nonmarital teenage birth and some involvement with the criminal justice system.  Children who spend half their childhood living in poverty fall even further behind.”  It highlights the significance of parental education, childhood residential stability and potential benefits for persistently poor children living in a multigenerational household.

 According to the 2014 American Community Survey, the poverty rate for those under age 18 was 33.1% in Davidson County, compared to 26.2% for Tennessee and 21.7% for the U.S.

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KIDS COUNT Ranks Davidson 87th of Tennessee Counties

The Tennessee Commission on Children and Youth recently released the annual KIDS COUNT data on child well-being.  KIDS COUNT is a project of the Annie E. Casey Foundation and provides public officials and advocates with reliable data, policy recommendations and tools to improve policies to benefit children and families.

The 2014 report ranks Davidson County 87th out of 95 Tennessee counties on factors related to child well-being (safety, health, education, nurtured, engaged).  The map shows that Davidson County is in the lowest quintile, while most of the surrounding counties are in the highest quintile. 

Out of 95 counties, Davidson County ranked extremely low in some specific indicators:  92nd in school suspensions, 90th in high school graduation rate, and 82nd in TCAP reading.  Rankings for every Tennessee county are available online.
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Davidson County Poverty Increases from 2013 to 2014

The U. S. Census Bureau released the 2014 American Community Survey on September 17, 2015.  The data shows that poverty rate in Davidson County increased from 17.8% in 2013 to 19.9% in 2014.  During that time, the Tennessee poverty rate increased from 17.8% to 18.3% and the U. S. poverty rate slightly decreased from 15.8% to 15.5%.  The chart shows the Davidson County’s poverty rate for the past five years. 

The poverty rate for children is even higher.  Among minor children (under age 18), the 2014 Davidson County poverty rate was 33.3%.  The highest rate of poverty, 47.9%, was experienced by single mothers with children under age 5.

Additional data will be released by the Census Bureau through December.  Much more data and analysis will be available in the 2015 Community Needs Evaluation that will be released in Spring 2016.  Previous editions of the annual Community Needs Evaluation are online.

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Measuring Poverty

On September 18, 2015, Pew Charitable Trusts released Poverty Rate Drops in 34 States, DC.  It discussed the 14.8% of the U.S. population who lived in poverty, the equivalent of 46.7 million, similar to the magnitude for the previous four years.  It noted that Official Poverty Measure might not reflect the actual circumstances of the household because it uses so few factors for the formula (cash income and number in the household).  (The Official Poverty Measure is used in the American Community Survey.)

 

The Census has provided a Supplemental Poverty Measure (SPM) that considers other economic factors, but the SPM is used only for research and not for program eligibility or for the state or local poverty data.  In addition, it indicates that some states are considering creating their own poverty measures to more effectively estimate how many people in their states “have financial stress or live on the edge of poverty.”

According to the 2014 American Community Survey, Tennessee’s poverty rate for 2014 was 18.3%.  Out of 50 states and the District of Columbia, Tennessee ranked 7th from the bottom.

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Metropolitan Social Services

800 Second Avenue North, Nashville, TN 37201

 

Direct Services – 615-862-6458         Planning, Coordination & Social Data Analysis – 615-862-6494

 

Welcome October!

“October’s Party

October gave a party;

The leaves by hundreds came –

The Chestnuts, Oaks, and Maples,

And leaves of every name.

The Sunshine spread a carpet,

And everything was grand,

Miss Weather led the dancing,

Professor Wind the band.” 

― George Cooper

What are we supposed to be officially aware of this month?

October

  • National Breast Cancer Awareness
  • National Down Syndrome Awareness Month
  • Eye Injury Prevention Month
  • Health Literacy Month
  • Healthy Lung Month
  • Home Eye Safety Month
  • National Physical Therapy Month
  • SIDS Awareness Month
  • Spina Bifida Awareness Month (promoted by the Spina Bifida Association)
  • Pregnancy and Infant Loss Awareness Month
  • Domestic Violence Awareness Month
  • Mental Illness Awareness Week (first full week of October)
  • Bone and Joint Health National Awareness Week (12-20)
  • National Health Education Week (third full week of October)
  • International Infection Prevention Week (third full week of October)
  • Respiratory Care Week (last full week of October)
  • Red Ribbon Week (last week of October)
  • World Mental Health Day (10)
  • Pregnancy and Infant Loss Awareness Day (15)

Preparing for the Winter

This article was originally meant for parents, but it does contain some great pointers and information on seasonal depression. 

Winter Blues – Seasonal Affective Disorder and Depression

 

For some children, the change in season brings with it a shift in mood. Is it a passing phase, or something more serious? Here’s what you need to know about depression, SAD, and your child.

Depression can be a serious problem for adults and children alike. Regardless of the season, shifts in a child’s mood and/or attitude are not something to ignore or dismiss. What appears to be a teenager’s newly developed bad attitude could actually be a case of depression or, in some instances, Seasonal Affective Disorder.

Seasonal Affective Disorder (SAD) — often referred to as “winter depression” — is a subtype of depression that follows a seasonal pattern. The most common form of SAD occurs in winter, although some people do experience symptoms during spring and summer.

While SAD is almost always talked about in terms of adults, children and adolescents are not necessarily immune. “SAD might exist among children, but it has not been well studied,” says Eve Spratt, M.D., MSCR, associate professor of pediatrics and psychiatry at the Medical University of South Carolina. “I am not aware of any evidence-based studies that have examined SAD rates or treatment in children.”

A Season’s Symptoms

SAD usually develops in a person’s early 20s, and the risk for the disorder decreases as you get older. SAD is diagnosed most often in young women, but men who have SAD may suffer more severe symptoms. People with a family history of SAD or those who live in northern latitudes where daylight hours during winter are shorter are at a higher risk for developing SAD.

As winter approaches, 10 to 20 percent of us begin to suffer mild symptoms of SAD. We are saddened by the shortening days, climb into bed earlier and resent waking up when the morning light grows dim. For 14 million Americans, these symptoms grow considerably worse as winter progresses.

People with SAD may crave comfort foods, including simple carbs such as pasta, breads, and sugar. With excess unhealthy calories and a lack of fresh fruits, vegetables, and whole grains, fatigue often sets in. They may become depressed and irritable. Eventually, they are no longer able to maintain their regular lifestyle. They may withdrawal socially and no longer enjoy things that used to be fun. It’s as if a person’s batteries have just run down. For parents, SAD can obviously have a sharp impact on the ability to be an effective parent.

Children and adolescents can also suffer these symptoms. They may experience feelings of low self-worth and hopelessness. Children with depression struggle to concentrate on their schoolwork. Their grades may drop, worsening feelings of low self-esteem. Symptoms that last more than two weeks are cause for concern.

Spring and summer SAD is characterized by anxiety, insomnia, irritability, and weight loss. The symptoms more closely resemble mania than depression.

No Known Cause

Researchers have not pinpointed what causes SAD. There is some evidence pointing to a disruption of a person’s “circadian rhythm” — the body’s natural cycle of sleeping and waking. As the days shorten, the decreasing amount of light can throw off the body’s natural clock, triggering depression. Sunlight also plays a role in the brain’s production of melatonin and serotonin. During winter, your body produces more melatonin (which encourages sleep) and less serotonin (which fights depression). Researchers do not know why some people are more susceptible to SAD than others.

“In general, SAD is a better-recognized disorder in adults because so many children’s mental health disorders emerge over time,” says Dr. Spratt. “Diagnosing SAD in a child is not easy, because determining the pattern of depression takes time. A doctor will typically attempt to determine whether a child is suffering from depression or anxiety first, then look at the pattern over time.”

In order to diagnose SAD, doctors need to perform a medical exam to rule out other possible causes of the symptoms, such as hypothyroidism, hypoglycemia, or mononucleosis. Doctors can administer questionnaires to determine mood and also to look for a seasonal pattern. “It’s difficult to diagnose children with depression in the first place, because it often presents as irritability, and they have a hard time understanding terms like ‘sad mood’ or ‘feeling blue,’” says Dr. Spratt. She points out that one of the most telling markers of depression in children is anhedonia — which means “absence of pleasure.” “So a good screening question to ask children is, ‘When was the last time you had a really good time?’”

Treating SAD

Several effective treatments can help adult sufferers of SAD. Simply bringing more sunlight into your life can treat mild cases. Spend time outdoors everyday, even on cloudy days. Open window shades in your home. Exercise regularly and eat a healthy diet, one low in simple carbohydrates and high in vegetables, fruit, and whole grains.

Researchers at the New York State Psychiatric Institute at Columbia University suggest using a “dawn simulator,” which gradually turns on the bedroom light, tricking the body into thinking its an earlier sunrise.

People with SAD sometimes find that their symptoms go away when they travel in or move to more Southern latitudes. If possible, plan a mid-winter family vacation in a sunny climate.

As with adults, depression in children can be addressed effectively. “Depression is very treatable with medication and therapy,” says Dr. Spratt. “There are several evidence-based studies showing that cognitive behavioral therapy is effective in treating depression in kids.”

For severe cases of SAD in adults, several treatment options exist. The most common treatment is light therapy. Patients sit for up to three hours in front of strong light boxes or wear light visors, with UV rays filtered out. However, light therapy is not recommended for children, says Dr. Spratt. “I know of no evidence-based studies showing light therapy to work for children, and I have never recommended it for children,” she says.

When to Medicate?

Left untreated, SAD can lead to serious complications for adults, including suicidal behavior, problems at school and work, and substance abuse. If other treatments prove ineffective, prescription antidepressants may help regulate the balance of serotonin and other neurotransmitters that affect mood. Antidepressants, however, come with a “black box” warning about the risk of suicidal thoughts and behavior. Parents with children on antidepressants need to be vigilant in watching for agitation, anxiety, or insomnia and make sure they continue to see their physician on a regular basis.

Dr. Spratt points out that a recent analysis of 27 studies published in the Journal of the American Medical Association found that the benefits of using antidepressant medication to treat major depressive disorder outweighed the risks. But the benefits were more limited in younger patients. “In children younger than 12, only fluoxetine (Prozac) showed benefit over placebo,” she says.

Working Through It Together

Parents of children with depression should participate in their child’s treatment and recovery. Learn about the disorder and share what you learn with your child. Make sure your child completes his treatment everyday, no matter what form your doctor prescribes.

Plan low-key quality time together. Your child won’t have the energy for an arcade, but reading a book or playing a family board game can be fun. Encourage your child to get exercise and spend time outdoors. Plan daily walks together. Fix healthy meals for your family, and establish a set bedtime to ensure he gets enough sleep and the same amount of sleep every night.

Your fatigued child will probably need help with his homework. Take time to work through schoolwork together, and communicate your child’s situation to his teachers. Be patient with your child and reassure him that these issues will get better.

Whether noticing symptoms of SAD in yourself or depression in your child, take it seriously. Treating this disorder early and diligently can turn the dark days of winter into a pleasant time of togetherness for your family.

Helpful Resources

American Academy of Pediatrics: Tips on Preventing Teen Suicide

This article was featured in Healthy Children Magazine. To view the full issue, click here.

Last Updated
 
8/20/2015
Source
 
Healthy Children Magazine, Winter 2008
The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

 

Something to Chew On

Some August 2015 studies have evidence that picky eating in early childhood may be a sign of anxiety disorders. This is an interesting and useful link as it would allow these disorders to be addressed/treated earlier in the child’s life. To read more about the studies google “Intervention urged for preschool children with selective eating habits”

Two-way text reminders boost adolescent vaccine use

From Pediatric News: pediatricnews.com

Sending parents text messages that request a response increased the likelihood that their adolescent children would receive all their needed vaccinations and other well-child services, according to a recent study.

Receipt of all services was highest among children whose parents texted back requesting that the pediatric office call them to set up an appointment.

“Providers in diverse settings should consider text messaging as a viable method of reminder/recall in their adolescent patient populations, and the use of bidirectionality as a prompt for an intended action deserves further study,” Dr. Sean T. O’Leary, of the University of Colorado at Denver, Aurora, and his associates wrote. “Text messaging, because of its potential for automation and scalability, may represent the future of reminder/ recall.”

The randomized controlled trial ran from September 2012 to August 2013 and included 4,587 adolescents, aged 11 to 17, whose parents had a cell phone number and who were patients at one of five private or two safety-net pediatric practices in the greater Denver area.

All participating patients were due for either a well-child care visit and/or one of the recommended adolescent vaccines (tetanus-diphtheria-acellular pertussis, meningococcal conjugate 4, or human papillomavirus).

The parents of the 2,228 adolescents randomized to the intervention received up to three personalized text messages asking for a response. Parents had three response options: clinic will call to schedule; parents will call clinic; or STOP, which would opt them out of the text service.

Parents who responded to the original message did not receive further texts. The other 2,359 adolescents formed the control group and received usual care with no reminders during the study (Pediatrics. 2015 Oct 5, doi: 10.1542/peds.2015-1089.).

According to mobile phone carrier data, 84% of the parents received the text reminder that was sent to them. Among all parents who were sent a message, 30% responded by text. Nearly two-thirds of responses occurred after the first text attempt.

More than 40% of parents requested a call from the clinic, 28% said they would call the clinic later, and 22% texted STOP to opt out of the text service. Another 9% responded in some other way, such as asking a question, according to the researchers.

Adolescents whose parents received the text messages were 31% more likely than those in the control group to receive all their needed services, including well-child care and all recommended vaccinations (risk ratio: 1.31). Patients in the intervention group were 29% more likely to receive all needed vaccinations (RR: 1.29) and 36% more likely to receive any vaccination (RR: 1.36).

Adolescents were 89% more likely to receive all needed services if their parents responded with option 1, indicating that the clinic should call them to schedule a visit (RR: 1.89).

For individual vaccines, no difference existed between groups for the MCV booster. However, intervention group patients were significantly more likely than controls to get any of the needed HPV doses (16% vs. 12%, P less than .0001). The effect of the text intervention on first HPV dose was significant, but modest (11% intervention vs. 9% control, P = .04).

Rates of well-child care visits did not significantly differ between the two groups, but 69% of adolescents in the text intervention group missed an opportunity for vaccination, compared with 75% of the control group adolescents (P = .002).

The cost of the text reminder program ranged from $855 to $3,394 per practice.

“It is not clear if the bidirectional nature of our intervention offered much advantage over a unidirectional text message. Parents who responded with an intention, though, were more likely to have their child vaccinated compared with those who did not respond,” the authors wrote. “Psychology research has shown that simply prompting people to develop a plan for a desired action can increase the likelihood of success.”

The research was funded by the National Center for Immunization and Respiratory Diseases and the Centers for Disease Control and Prevention. The authors reported having no financial disclosures.

Baseball Social Review

CPF loves to support our wonderful Sounds with you! We had so much fun getting to know more of our members at these events and enjoyed some great side line conversation about upcoming CPF events, mentoring, and QIP involvement. And let’s not forget our amazing raffle drawing! Winners of the hand selected prizes are pictured in the top left corner. The game on September 3rd concluded the baseball season, but you can still hang out with CPF at the events listed in our calendar! (http://cumberlandpediatric.org/cpf-calendar-list-view) We hope your fall season has swung off to a great start. 

Love, 

CPF

Career Corner

Did you know that CPF loves matchmaking?

Send us your resumes, CVs, or job descriptions and we will help get you matched up with the perfect fit for your next career step!

Here are just a few of the lovely inquiries we have saved up in our files:

Career Corner

  • Account Specialist position open at Terrace Pediatrics, for more information click here
  • Medical Assistant position open at Terrace Pediatrics, for more information click here
  • Receptionist Position open at Terrace Pediatrics, for more information click here
  • PA position open at Tennessee Pediatric and Adolescent Center
  • Floor Manager position open at Rainbow Kids Clinic. LPN or RN license required. For more information click here
  • Physicians Assistant interested in working in a pediatric setting
  • Pediatric Nurse Practitioner interested in working in a pediatric setting
  • Pediatric Nurse with administrative experience looking to relocate to Nashville
  • RN looking to to work in a pediatric setting
  • Experienced Pediatrician looking to relocate to Nashville
  • Acute Care Pediatric Nurse Practitioner interested in practicing in the Nashville area
  • Physician needed for Nashville area practice

For inquiries, contact a CPF staff member (615) 936-6053 or email cpfnashville@gmail.com 

 

CPF Open House

You read right! 

It’s time for the CPF Open House again! And yes, the networking opportunities ARE endless. 

CPF is so excited to welcome all of our members to come together in the Vanderbilt Children’s Theatre to get to know one another. It will be a night of learning, catching up, and introducing as our members stroll around all of the practice tables. 

Dying for more details? Read the event description below or call the CPF Office at 615.936.6053.
 

CPF/Vanderbilt Open House

Thursday, September 24, 2015


6:00 PM – 8:00 PM


Monroe Carell Jr. Children’s Hospital at Vanderbilt – Children’s Theater Room

The Cumberland Pediatric Foundation and the Department of Pediatrics at Vanderbilt have partnered together to host our annual CPF/Vanderbilt Open House to promote communication and camaraderie between the community pediatricians, current pediatric residents and the pediatric specialists at the Monroe Carell Jr. Children’s Hospital at Vanderbilt.

This is a great networking opportunity in a fun environment to mingle with your peers. The community practices and specialists will have a table to showcase information about their practice which may include anything from brochures to a fun activity displaying information about your partners in your clinic. Everyone in attendance will have the opportunity to visit the other practice and specialist tables in order to be able to mingle with one another. This event provides an opportunity for collaboration in clinical care and also in building your network with other physicians. We hope you will join us!

Refreshments will be provided for your enjoyment

***To register, you must be logged in

Having trouble logging in? Contact the CPF office (615) 936-6053

DATE: 
Thursday, September 24, 2015 – 6:00pm to 8:00pm

PLACE: 
Monroe Carell Jr. Children’s Hospital at Vanderbilt – Children’s Theater Room
 
To Register, please visit our event calendar: http://cumberlandpediatric.org/content/cpfvanderbilt-open-house