APA Task Force on Childhood Poverty
A Strategic Road-Map:
Committed to Bringing the Voice of Pediatricians
to the Most Important Problem
Facing Children in the US Today
The Academic Pediatric Association (APA) and the American Academy of Pediatrics (AAP) have both made reducing childhood poverty in the US and alleviating the effects of poverty on child health and well-being a strategic priority.
- Poverty as a Childhood Disease by Perri Klass, M.D. - Reader Comments, New York Times, May 13, 2013
- The most important problem facing American children today by Valerie Strauss - Reader Comments, The Washington Post, May 14, 2013
From Scope of the Problem
The effects of poverty on children’s health and well-being are well documented…The consequences of poverty for child and adolescent well-being are perhaps even more critical than those for health. These are the consequences that may change their life trajectories, lead to unproductive adult lives, and trap them in intergenerational poverty. Children growing up in poverty have poorer educational outcomes with poor academic achievement and lower rates of high school graduation; they have less positive social and emotional development which, in turn, often leads to life “trajectory altering events” such as early unprotected sex with increased teen pregnancy, drug and alcohol abuse, and increased criminal behavior as adolescents and adults; and they are more likely to be poor adults with low productivity and low earnings.
There is, however, no sustained focus on childhood poverty itself, which underlies many of the ills of children, and which needs to be addressed in a comprehensive manner.
From Guiding Principles
Poor children live in poor families. Any solutions to childhood poverty will focus on family poverty and the factors that strengthen the resiliency of families living in poverty.
Neighborhood characteristics (such as poverty, crime, residential turnover, availability of quality child and family institutions, poor social control and interaction, negative normative expectations, and low employment and marriage rates) all have negative impacts on poor children’s health and well-being. Model “place-based” programs to address these issues should be explored.
We plan to communicate the issues of childhood poverty with effective and coherent messaging and with terminology that doesn’t "trigger" partisan and non-productive responses. We will frame these issues in ways that appeal, as much as possible, across the political spectrum. We will endeavor to collaborate with business and social science professionals skilled in messaging. This is not about “welfare” but about the future of our country. This is about half the children in the US, everyone’s children. Child well-being is a public good that benefits us all.
A Strategic Road-Map
The Task Force will focus on specific strategies involving public policy and advocacy, health care delivery, medical education, and research. These strategic priorities [outlined below – see report for details] are a first step in a “war on childhood poverty”.
- Raising families out of poverty
- Providing high quality early childhood programs and high quality affordable child care to poor families
- Promoting a White House Conference on Children and Youth
- Neighborhood Revitalization Initiatives (“place-based” initiatives)
- Developing elements of a Patient-Centered Medical Home for Children (PCMHC) that addresses the needs of poor and near-poor families
- Support for the development of payment systems and structures to support pediatric practices that devote time and resources to reducing the negative impacts of poverty on populations they serve
- Adapting health care systems to address the specific challenges faced for poor and low-income families with children with special health care needs
- Support for the developmental of collocation programs including two generation programs for mothers and children, and collocation of behavioral health programs with medical programs
- Enhancements to Bright Futures: Integrating the issues of poor families more strongly into Bright Futures with appropriate screening tools and tool-kits that help practitioners
- Developing non-partisan programs to encourage families to vote on children’s issues
- Establishing a framework for evaluation of the impact of the expanded PCMHC upon child and family well-being
- Understanding the impact of poverty and other social determinants of health on well-being over the life course and across generations.
- Development of the knowledge, skills, and attitudes necessary to implement the elements of the PCMHC
- Advocacy training toward poverty reduction in conjunction with the AAP Community Training and Advocacy Initiative (CPTI), and models of advocacy training from residency training programs across the US
- Continued research into early brain development and the effect of toxic stress on adaptive self- regulation, executive functioning, social-emotional and cognitive development, and resiliency. In addition, further research on the impact of epigenetics on brain functioning and its relationship to toxic stressors in poverty
- Further research on developing the evidence base for interventions
- Further research to determine how policies, programs and other interventions lift children out of poverty and how they alleviate the effects of poverty on children: filling in the gaps of previous research
- Taking evidence-based practice to scale (implementation and dissemination)
- Community-based participatory research
- Development of valid and reliable measures of important outcomes and determinants related to childhood poverty
- A life course approach to research on childhood poverty