CitySquare has been involved from the start: Health and Wellness Alliance for Children

The Health & Wellness Alliance for Children (the Alliance) is a coalition with the goal that “Every child achieves their fullest health, well-being, and potential.”

·        The Alliance plans to use a “collective impact” approach to work across sectors, including health, education, government, the faith community, nonprofit service providers, and others, to form and implement a common agenda for change in children’s health.

·         The initial clinical focus will be children’s asthma, though over time the Alliance plans to tackle children’s health across issues.

·         The initial geographic focus will be on Dallas County, though the Alliance is working with partners throughout North Texas.

Why asthma?

·         While there are many health issues that demand our community’s attention, it is important to focus on one area in order to have a measurable impact.

·         Addressing asthma allows us to focus on several areas that are crucial to children’s health overall: improving financial and physical access to care, improving quality of health care delivery, equipping children and families with tools for wellness, creating asthma-healthy physical environments.

·         The Alliance can use its experience with asthma to expand focus to other areas in the near future.

·         Asthma and other pulmonary illnesses are the top causes for admission to the emergency department at Children’s Medical Center, indicating a real community need.

·         Other communities around the country have had great success in using a coalition approach to improve child asthma.

Who is involved in this effort?

·      The Steering Committee and Working Groups include representatives from many organizations across North Texas, including hospitals, physicians, school administrators, school nurses, the faith community, family health and wellness service providers, urban planners, city and state government, and others.

·         Children’s Medical Center (Children’s) has committed to catalyzing this effort. However, the Alliance is comprised of and led by a cross-section of Dallas community stakeholders committed to children’s health. The effort is and will be driven by the community, not just one organization or sector. 

·     Children and their families have been involved since the start in interviews and workshops to better understand the challenges they face and potential solutions.

 Dallas County Asthma Data

Asthma outcomes

·         Approximately 60,000 children in Dallas have asthma, 9% of all Dallas children[i]

·         In Texas, 54% of children with asthma missed at least one school day per year due to their condition[ii]

·         In 2012, nearly 1500 children in Dallas County visited an emergency room or were admitted to a hospital due to asthma[iii]

·         The hospitalization rate for African-American children is 3.8 times the rate of white children in Dallas (2010)[iv]

·       Annual economic costs to Dallas including cost to families and to medical care facilities across the community is estimated to be a staggering $60M[v]

Potential contributing conditions

·        18% of Dallas children don’t have health insurance; this exceeds the 15% fraction across TX, which is the highest percentage of uninsured children of any US state (2010)[vi]

·         While 46% of Dallas children are covered by Medicaid and CHIP, it is estimated that 76% percent of Dallas physicians would not accept new Medicaid or CHIP patients[vii]

·         Children with asthma are especially susceptible to the effects of ozone pollution, and Dallas’s ozone levels exceed the EPA’s legal standard[viii]

·         Child poverty in Dallas: 29% of Dallas kids live in poverty; 28% have inadequate food and nutrition; 35% live in a single-parent home[ix]

[i] Harrison, Whitney (MPH, Epidemiologist), Texas Asthma Control Program, Dept. of State Health Services. “Asthma Morbidity and Mortality in Texas and Health Region 3.” October 17, 2011.

[ii] Harrison, 2011.

[iii] Dallas Fort Worth Hospital Council Foundation, 2013.

[iv] Texas Health Care Information Collection (THCIC), Inpatient Hospital Discharge Public Use Data File, 2010.

[v] The cost estimate per child based on: Li Yan Wang et. al; “Direct and Indirect Cost of Asthma in School age Children”.  Preventing Chronic Disease (January 2005).  This number is multiplied by the number of children with asthma in Dallas.

[vi] Harris, J., Hogan, J., and the Beyond ABC Advisory Board, ed. Beyond ABC:  Assessing Children’s Health in Dallas County, 2011.

[vii] “Texas State Health Facts”. Henry J. Kaiser Family Foundation. ; Harris, J., Hogan, J., and the Beyond ABC Advisory Board, ed. Beyond ABC:  Assessing Children’s Health in Dallas County, 2011.

[viii] “Dallas-Fort Worth: Current Attainment Status”. Texas Commission on Environmental Quality. <http://www.tceq.texas.gov/airquality/sip/dfw/dfw-status>.

[ix] Harrison, 2011.

"Toxic Stress," children and poverty

We've known it for years here at CitySquare.  Our young children live in a noisy, stress-filled world, even chaotic at times.  We are now learning what this means in very practical and often frightening terms.  The article from Nicholas Kristof that follows challenges me.  What it calls for, in my view, is a national covenant, something much more serious than a media campagin.  Rather, we need to step up, sign up and show up when it comes to providing for the well-being of our children.  That means all of us:  rich and poor, educated nad undereducated, parents and teachers, ministers and politicians, right and left and all the in between!  We've got to do better. 

Read on and see if you don't agree. LJ

A Poverty Solution That Starts With a Hug

By NICHOLAS D. KRISTOF
January 7, 2012

PERHAPS the most widespread peril children face isn’t guns, swimming pools or speeding cars. Rather, scientists are suggesting that it may be “toxic stress” early in life, or even before birth.

This month, the American Academy of Pediatrics is issuing a landmark warning that this toxic stress can harm children for life. I’m as skeptical as anyone of headlines from new medical studies (Coffee is good for you! Coffee is bad for you!), but that’s not what this is.

Rather, this is a “policy statement” from the premier association of pediatricians, based on two decades of scientific research. This has revolutionary implications for medicine and for how we can more effectively chip away at poverty and crime.

Toxic stress might arise from parental abuse of alcohol or drugs. It could occur in a home where children are threatened and beaten. It might derive from chronic neglect — a child cries without being cuddled. Affection seems to defuse toxic stress — keep those hugs and lullabies coming! — suggesting that the stress emerges when a child senses persistent threats but no protector.

Cues of a hostile or indifferent environment flood an infant, or even a fetus, with stress hormones like cortisol in ways that can disrupt the body’s metabolism or the architecture of the brain.

The upshot is that children are sometimes permanently undermined. Even many years later, as adults, they are more likely to suffer heart disease, obesity, diabetes and other physical ailments. They are also more likely to struggle in school, have short tempers and tangle with the law.

The crucial period seems to be from conception through early childhood. After that, the brain is less pliable and has trouble being remolded.

“You can modify behavior later, but you can’t rewire disrupted brain circuits,” notes Jack P. Shonkoff, a Harvard pediatrician who has been a leader in this field. “We’re beginning to get a pretty compelling biological model of why kids who have experienced adversity have trouble learning.”

This new research addresses an uncomfortable truth: Poverty is difficult to overcome partly because of self-destructive behaviors. Children from poor homes often shine, but others may skip school, abuse narcotics, break the law, and have trouble settling down in a marriage and a job. Then their children may replicate this pattern.

Liberals sometimes ignore these self-destructive pathologies. Conservatives sometimes rely on them to blame poverty on the poor.

The research suggests that the roots of impairment and underachievement are biologically embedded, but preventable. “This is the biology of social class disparities,” Dr. Shonkoff said. “Early experiences are literally built into our bodies.”

The implication is that the most cost-effective window to bring about change isn’t high school or even kindergarten — although much greater efforts are needed in schools as well — but in the early years of life, or even before birth.

“Protecting young children from adversity is a promising, science-based strategy to address many of the most persistent and costly problems facing contemporary society, including limited educational achievement, diminished economic productivity, criminality, and disparities in health,” the pediatrics academy said in its policy statement.

One successful example of early intervention is home visitation by childcare experts, like those from the Nurse-Family Partnership. This organization sends nurses to visit poor, vulnerable women who are pregnant for the first time. The nurse warns against smoking and alcohol and drug abuse, and later encourages breast-feeding and good nutrition, while coaxing mothers to cuddle their children and read to them. This program continues until the child is 2.

At age 6, studies have found, these children are only one-third as likely to have behavioral or intellectual problems as others who weren’t enrolled. At age 15, the children are less than half as likely to have been arrested.

Evidence of the importance of early experiences has been mounting like snowflakes in a blizzard. For example, several studies examined Dutch men and women who had been in utero during a brief famine at the end of World War II. Decades later, those “famine babies” had more trouble concentrating and more heart disease than those born before or after.

Other scholars examined children who had been badly neglected in Romanian orphanages. Those who spent more time in the orphanages had shorter telomeres, a change in chromosomes that’s a marker of accelerated aging. Their brain scans also looked different.

The science is still accumulating. But a compelling message from biology is that if we want to chip away at poverty and improve educational and health outcomes, we have to start earlier. For many children, damage has been suffered before the first day of school.

As Frederick Douglass noted, “It is easier to build strong children than to repair broken men.”

A tribute to a dog. . .

Prepare to shed a tear here!

This video sent me off down a long memory lane with my own children and, now, my grandchildren.  It also set me to thinking about pets and children from extremely low-income families.  There are a number of dogs in our building here in Downtown Dallas, home to over 250 low-income folks. 

Watch.  Consider.  Enjoy!



[Note: I posted this before learning of the passing of our family's beloved Griffey on Friday. He was an amazing dog. R.I.P., Griffey. We'll never forget you. With much love, Granddad]

Take Action Today: Save AmeriCorps!!!

On Friday, a number of us had the privilege to meet with Robert Velasco, II, the CEO of the Corporation of National and Community Service, best known for its AmeriCorps program created in 1993.  Talking with Mr. Velasco for over two hours allowed me to rehearse some fairly amazing facts and stats about our AmeriCorps program here at CitySquare.  

For example. . .

• 80% of our AmeriCorps resources go out the door to our partners in the community, typically very effecitve but smaller non-profits who use the members to build capacity in operating summer and after-school programs
• Over the past year our members worked with 3,700 low-income children in these programs and at CitySquare
• AmeriCorps members provided nutritious food products to 28,000 individuals, including 8,000 children in our mobile summer lunch program who also participated in enrichment programs focusing on learning and fitness

The list could actually go on and on as to the benefit and cost effectiveness of the AmeriCorps program.  I've witnessed amazing "return on investment" in human and community capital over the past 6 years that we've been involved with AmeriCorps and the Corporation for National and Community Service.

Upon my return to the office from my meeting with Mr. Velasco, I learn that members of the U. S. House of Representatives have crafted a legislative plan to end almost all of the work of the Corporation of National and Community Service!  A truly absurd, short-sighted, ridiculous plan.

Here's the briefing I received:

The Save Service Coalition learned yesterday that the House of Representatives has issued draft legislation to shut down the Corporation for National and Community Service and eliminate funding for AmeriCorps, the Social Innovation Fund, the Volunteer Generation Fund and Learn & Serve America. While we are pleased that the House bill includes funding for the National Senior Volunteer Programs, the bill dissolves the entire service enterprise, cuts over 100,000 jobs, and eliminates essential services that children, seniors, veterans and entire communities rely on.

Please visit the Save Service Take Action page to write and call your Members of Congress immediately to prevent this House bill from becoming law.

All of this comes at a time when the nation's investment in service should be growing to create jobs and better provide services to local communities. We will continue to work with the tens of thousands of Americans who are engaged in the Save Service initiative to ensure our country's policymakers recognize the value national service provides to our country and the critical role that the Corporation for National and Community Service plays in support of the 70,000 nonprofit and community organizations that mobilize Americans in service.

At a time when we need to find inexpensive ways to get things done, provide educational services for children and leverage scarce resourses, destroying AmeriCorps and its family of service solutions makes no sense whatsoever. 

Please take action today to tell your Senators and your member of Congress that you support continuing the vital work of the Corporation for National and Community Service.

Pro Life?

Clearly the Texas legislature functions as a strongly "pro-life" elective body. . .up to a point. 

The legislators' decisions during this session indicate that they are determined to take rather drastic measures to protect the unborn.  However, once a child arrives in a low-income family, all bets are off! 

The following story was reported by Christy Hoppe on the actions of our elected representatives appeared in The Dallas Morning News last Thursday, March 10. 

The notion that non-profit organizations and churches can pick up the slack in the budget is simply ill-informed.  Further, the costs associated with cuts in funding for the needed care typically are passed along by medical professionals to those with private insurance.  The fact is, helping poor children helps us all. 

But, you read the report and let me know your reactions.

Bill on pre-abortion sonograms comes as Texas legislators plan to slash contraceptive, OB-GYN care for poor


AUSTIN — The Legislature’s push to limit abortions by compelling women to see a sonogram of fetal development comes as the state is cutting back on medical services to low-income pregnant women.

Republican lawmakers are poised to slash $850 million from pregnancy care and family planning in the next two-year budget — a 29 percent cut from current spending.

That would shut down avenues for poor women to find contraception and choke off payments to OB-GYN doctors who might care for those who become pregnant, advocates say.

“There is a responsibility that comes with this desire to tell women what to do with their pregnancy. Clearly, we’re not meeting it,” said Rep. Mark Strama, D-Austin, who has sponsored a bill to extend women’s health services.

Abortion opponents say that although the budget crunch is real, the sonogram requirement isn’t connected to it.

“We can’t solve our problems by eliminating people,” said Kyleen Wright, president of Texans for Life and a strong supporter of the sonogram requirement that both the House and Senate have approved.

The solution, she said, is for private pregnancy crisis centers, adoption services, religious groups and communities to step up their help for poor women.

“We will pick up the pace. We will meet the need,” Wright said.

Fifty-five percent of Texas births are to women on Medicaid.

Payments to doctors

Most of the proposed budget cuts would come through reducing payments to doctors, who are reimbursed for the care they provide pregnant women on Medicaid. It means physicians will either turn away poor patients or lose money treating them.

Tom Banning, chief executive of the Texas Academy of Family Physicians, outlined a grim reality: Medicaid reimburses doctors 70 percent for the cost of services. Most physicians make up the losses in their charges to privately insured patients, but the proposed cuts make that equation harder.

The state has cut reimbursements 2 percent this year and is proposing 10 percent cuts for next year. In addition, Congress is considering a Medicare reimbursement cut of 31 percent.

“It’s got the doctors completely spooked,” Banning said, and many plan to stop seeing patients who require federal help. That will drive more patients to emergency rooms, where their conditions are often worse and
more expensive to treat.

In Athens in East Texas, a group of family doctors began offering prenatal screening for Medicaid patients three years ago. When they started, 120 newborns a year from the area were ending up in the neonatal intensive care unit of Dallas County’s Parkland Memorial Hospital, Banning said.

Last year, it was down to two infants. But if doctors’ payments are cut, “you’ll see a tidal wave hit the emergency room of women who haven’t gotten any prenatal care,” Banning said.

To read entire report click here.

Texas kids: hungry and obese

Recent reports indicate that far too many Texas children battle the twin, and seemingly paradoxical challenges of hunger ("food insecurity") and obesity. 

How can this be? 

Here's a report news report from  Austin, Texas.

Garcia: Texas children sandwiched between hunger and obesity

Eileen Garcia, Local Contributor
Tuesday, July 13, 2010


Two recent reports relayed bad and seemingly paradoxical news for Texas children. According to the latest research, our Texas kids, more than almost any in the country, face threats from both hunger and obesity.

Nearly one out of four Texas children is "food insecure," meaning they might not know where their next meal will come from, says a July 1 report from Feeding America, which ranked Texas 49th in the country for providing reliable food access for children under 18. The same week, however, the Trust for America's Health announced Texas children suffer disproportionately from obesity. More than 20 percent of kids here are obese, and Texas had the seventh-highest child obesity ranking.

Underlying these statistics is a sad reality: Too many children get poorly nourished because their environment—at school, in the neighborhood and their community—proves inhospitable to healthy eating. Four factors help explain why.

To read on, click here.

We've got to focus and find ways to do better.  What do you think?

Henry Folsom Frazer comes home!

Henry Folsom Frazer

So, today at about 4:00 p.m., Henry Folsom Frazer entered our world! 

The little fellow decided to arrive a bit early. . .5 weeks early to be precise!  And that caused a bit of a stir for everyone involved, especially Mom, Dad and Brother, Owen. 

He weighed in at 5 pounds 9.5 ounces and measured a rather long 19 inches.  Huge hands and feet like his big brother.  Lots of dark brown hair and, to quote a nurse "a rather calm disposition." 

He will remain in the little folks ICU for a few days to make certain his lung capacity and eating habits are well in order. 

We are so grateful that he is here.  I can't wait to be able to hold him.

Joanna, the mom here, is doing great!  And, Jordan is doing well as the very relieved father. 

Thankfully, our children have good health insurance, something everyone in the nation deserves. 

Happy Birthday, little Henry!  I'll enjoy my granddad "bonding" ritual real soon.  We're so glad to have you on the journey! 

Let's Move

The following press release hit the news this past week as First Lady Michelle Obama announced her "Let's Move" initiative to combat childhood obesity.  Our friend, Indra Nooyi, PepsiCo chairman and chief executive officer, threw the support of her international corporation behind the effort. 

Here's the beginning of the release to media from PepsiCo.  Note especially the numbered paragraph #1 that mentions our joint endeavor this past summer with PepsiCo here in Dallas. 

Exciting stuff for us!

PepsiCo Supports First Lady's Initiative to Help Reduce Childhood Obesity


Company Pledges to List Calorie Content on the Front of its Beverage Containers, Vending Machines and Fountain Equipment

PURCHASE, N.Y., Feb. 9 /PRNewswire-FirstCall/ -- PepsiCo, Inc. (NYSE: PEP), one of the world's largest food and beverage companies, today expressed its commitment to the White House's "Let's Move" initiative to combat childhood obesity – and announced a new beverage labeling plan in support of the initiative.

To help consumers manage their calorie consumption, PepsiCo will list calorie content on the front of its beverage containers, vending machines and fountain equipment by the end of 2012. Packages up to 20 ounces will be labeled with total calories and multi-serve containers will be labeled with calories-per-serving based on 12-ounce servings.

"We applaud the effort being led by First Lady Michelle Obama to address obesity in the United States and believe that her 'Let's Move' campaign can add significant momentum and leadership to many efforts underway," said Indra Nooyi, PepsiCo chairman and chief executive officer. "We have learned over the years there is no silver bullet to solve obesity. No single entity can do it alone. We need a guiding coalition in which individuals, companies, health agencies, consumer groups and governments all take on their appropriate responsibilities. Major food companies such as PepsiCo are in a unique position to be leaders in health and wellness because of our resources, brands, research and development capabilities, consumer reach and logistics expertise."

PepsiCo's belief in the power of public-private partnerships to help reduce obesity in the United States led to its partnership in the Healthy Weight Commitment Foundation (HWCF). The HWCF involves the collaboration of more than 60 members of the food and beverage industry, retailers and diverse non-governmental organizations. The group provides and promotes solutions that will help people, especially children, achieve a healthy weight by balancing the calories they consume with the calories they burn. The HWCF's efforts will provide people with the tools to achieve energy balance in three key areas: the marketplace, the workplace and schools.

PepsiCo is committed to helping advance action on all four pillars identified by the First Lady and has already taken steps that address each of them:

1. Ensuring that affordable healthy food is available in more communities

Last year, PepsiCo launched "PepsiCo Hope" to help transform inner-city communities by increasing access to affordable nutrition and creating local employment in inner-city neighborhoods. Initiated by PepsiCo employees in Dallas, the program piloted an innovative mobile delivery model that brought over 50,000 free nutritious breakfasts and snacks directly to underserved children in Dallas. With the help of more than 150 PepsiCo volunteers, the program was developed in partnership with Central Dallas Ministries as part of the Department of Agriculture's Summer Foodservice Program. PepsiCo plans to significantly expand its capabilities in Dallas in 2010 and is exploring opportunities for national expansion while sharing what it has learned with other cities across the country. PepsiCo Hope is also beginning to tackle another chronic challenge identified by the local residents: improving access to fruits and vegetables.

To read the entire repot click here.