Children At Risk In America

This collection of essays addresses twentieth-century historical and contemporary issues regarding children who are considered to be at risk. The essays explore the language of risk as it is used by the courts, the schools, governmental agencies, and child advocates, those who discover risks and create correctives for children who both need protection and threaten to disturb the social order. The tasks require an exploration of differing, often contradictory, concepts of the child and society that are embedded in public policy debates. Deepening the complexity of the problems, institutions to which we look for solutions are too often faced with conflicts that arise when the needs of the child are at variance with the needs of the institutions themselves. These dilemmas are central to understanding our failure to achieve adequate public policy solutions for children at risk.

The desire for our children to be free from want and danger and to be able to enjoy their youth in innocence would seem to be universal. Conventional wisdom says that parents in every socio-economic level of society share the dream of preserving their children's innocence. All want to provide a childhood and adolescence that shelters and protects children from the harshness of life and nurtures them until they are able to withstand the onslaught of reality. One need only look at troubled areas of the world, such as Northern Ireland, parts of the Middle East, or any number of other points on the globe, to see how weak is any communion forged out of these universal desires for the welfare of children. Even in the United States, the competition of ideas and values about what represents the "good" society in which to raise our children is fierce-as are differing views about the value of innocence and even life itself. These differing ideas and values affect people's actions even when they have never reflected on them, or have never cared enough to formulate those values into a coherent worldview. Crouse contends that without morals, children are at risk. Moral boundaries, not moral relativism, provide a safe haven for children by preserving their innocence and protecting them from predators and pedophiles. When authentic religious faith has been quashed, children are no longer safe. When the underlying values are wrong, when there are no common values unifying a people, even the best programs and most honorable of intentions are doomed to failure. Well-intentioned programs and policies inevitably fail miserably without an undergirding moral foundation, as is documented by an abundance of data and the social trends in America today.

America's Children is a comprehensive, easy-to-read analysis of the relationship between health insurance and access to care. The book addresses three broad questions: How is children's health care currently financed? Does insurance equal access to care? How should the nation address the health needs of this vulnerable population? America's Children explores the changing role of Medicaid under managed care; state-initiated and private sector children's insurance programs; specific effects of insurance status on the care children receive; and the impact of chronic medical conditions and special health care needs. It also examines the status of "safety net" health providers, including community health centers, children's hospitals, school-based health centers, and others and reviews the changing patterns of coverage and tax policy options to increase coverage of private-sector, employer-based health insurance. In response to growing public concerns about uninsured children, last year Congress voted to provide $24 billion over five years for new state insurance initiatives. This volume will serve as a primer for concerned federal policymakers and regulators, state agency officials, health plan decisionmakers, health care providers, children's health advocates, and researchers.

The desire for our children to be free from want and danger and to be able to enjoy their youth in innocence would seem to be universal. Conventional wisdom says that parents in every socio-economic level of society share the dream of preserving their children's innocence. All want to provide a childhood and adolescence that shelters and protects children from the harshness of life and nurtures them until they are able to withstand the onslaught of reality. One need only look at troubled areas of the world, such as Northern Ireland, parts of the Middle East, or any number of other points on the globe, to see how weak is any communion forged out of these universal desires for the welfare of children. Even in the United States, the competition of ideas and values about what represents the "good" society in which to raise our children is fierce-as are differing views about the value of innocence and even life itself. These differing ideas and values affect people's actions even when they have never reflected on them, or have never cared enough to formulate those values into a coherent worldview. Crouse contends that without morals, children are at risk. Moral boundaries, not moral relativism, provide a safe haven for children by preserving their innocence and protecting them from predators and pedophiles. When authentic religious faith has been quashed, children are no longer safe. When the underlying values are wrong, when there are no common values unifying a people, even the best programs and most honorable of intentions are doomed to failure. Well-intentioned programs and policies inevitably fail miserably without an undergirding moral foundation, as is documented by an abundance of data and the social trends in America today.

The death of a child is a special sorrow. No matter the circumstances, a child's death is a life-altering experience. Except for the child who dies suddenly and without forewarning, physicians, nurses, and other medical personnel usually play a central role in the lives of children who die and their families. At best, these professionals will exemplify "medicine with a heart." At worst, families' encounters with the health care system will leave them with enduring painful memories, anger, and regrets. When Children Die examines what we know about the needs of these children and their families, the extent to which such needs areâ€"and are notâ€"being met, and what can be done to provide more competent, compassionate, and consistent care. The book offers recommendations for involving child patients in treatment decisions, communicating with parents, strengthening the organization and delivery of services, developing support programs for bereaved families, improving public and private insurance, training health professionals, and more. It argues that taking these steps will improve the care of children who survive as well as those who do notâ€"and will likewise help all families who suffer with their seriously ill or injured child. Featuring illustrative case histories, the book discusses patterns of childhood death and explores the basic elements of physical, emotional, spiritual, and practical care for children and families experiencing a child's life-threatening illness or injury.

First published in 1999. Routledge is an imprint of Taylor & Francis, an informa company.