National Center for Education in Maternal and Child Health

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June 30, 2000

1. Playgrounds Pose Threat to Children

2. Report Highlights SCHIP Coverage of CSHCN

3. Study Examines Factors Influencing Use of Maternity Leave

4. Barriers to TANF Enrollment Associated with Higher Uninsurance Rates

5. Information Review: Fatherhood

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1. PLAYGROUNDS POSE THREAT TO CHILDREN

A majority of playgrounds in the United States pose hidden threats to children, according to the fifth nationwide investigation of public playgrounds conducted by the US Public Interest Research Group (PIRG) and Consumer Federation of America (CFA). Researchers investigated 1,024 playgrounds in 27 states from March to May 2000.

The report states that each year approximately 170,100 children are injured seriously enough on public playground equipment to require emergency room treatment, and an average of 17 children die each year from playground injuries. Following are findings from the 2000 investigation:

• 80% of the 1,024 playgrounds lacked adequate protective surfacing, a decrease from the 87% that lacked protective surfacing in 1998. Nonetheless, protective surfacing is "the most critical safety factor" on playgrounds because approximately 75% of injuries result from falls.
• 31% of slides and climbing equipment did not have an adequate "fall zone" under and around them. Other equipment and obstacles in the fall zone posed hazards.
• 48% of playgrounds had climbers and 36% had slides whose height was greater than 6 feet, increasing the risk of injury.
• 13% of playgrounds with swings had swing seats made of wood, metal, or other rigid material, which increases the severity of injury if impact occurs.
• 27% of playgrounds with swings had some swings that were either too close together or too close to swing supports, increasing the risk that a child could be hit by a moving swing.
• 34% of playgrounds had improperly sized openings in the play equipment, which poses a head-entrapment hazard that can lead to strangulation.
• 38% of playgrounds had small gaps, open S-hooks, and other protrusions that posed clothing entanglement hazards; however, this represents a significant decline from 1996, when the percentage was 47%.
• 38% of playgrounds had unacceptable dangerous equipment, such as chain or cable walks, animal swings, individual climbing ropes, or exercise rings.
• 47% of all playgrounds had peeling, chipped, or cracking paint on equipment surfaces.

PIRG and CFA offer these recommendations to improve playground safety:

1) States and local governments should adopt CFA's "Model Law on Public Play Equipment and Areas," and
2) Parents, school administrators, child care providers, and parks personnel should evaluate their local playgrounds and work to make each playground safer.

US Public Interest Research Group; Consumer Federation of America. Executive summary. Playing it safe: June 2000. A fifth nationwide safety survey of public playgrounds. The report and state-specific datasheets and summaries are available at <http://www.pirg.org/reports/consumer/playground2000>.

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2. REPORT HIGHLIGHTS SCHIP COVERAGE OF CSHCN

A report by the National Policy Center for Children with Special Health Care Needs finds that state officials and observers remain concerned about the low number of children identified as having special health care needs in some State Children's Health Insurance Programs (SCHIPs), despite recent research suggesting higher estimates. Researchers examined the SCHIPs in five states to assess their ability to meet the needs of children with special health care needs (CSHCN). The results of the study are presented in New Opportunities, New Approaches: Serving Children with Special Health Care Needs Under SCHIP.

Case studies were conducted to assess alternative approaches to meeting the physical and mental health needs of CSHCN. The models studied include wrap-around benefit packages in Connecticut and North Carolina, a service carve-out program in California, a specialty system in Florida, and a mainstream model in Pennsylvania.

Several common themes emerged from the states:

• Recognition of the need for special provisions: State officials understood that CSHCN are present in all economic groups and that these children might not be eligible for Medicaid or Supplemental Security Income (SSI);
• Establishment of screening mechanisms: Although these systems are in the developmental stages, all of the study states had made some effort to screen SCHIP enrollees for special health care needs;
• Provision of enhanced benefits: The SCHIPs' major contribution was the coverage of enhanced medical and behavioral medicine benefits for CSHCN, usually beyond the service limits applied to other children in the programs;
• Use of innovative delivery systems: Several of the study states chose to provide some or all services for CSHCN through delivery systems distinct from mainstream plans and providers used by SCHIP enrollees. States understood the importance of clearly delineating the roles and responsibilities of each system;
• Collaboration with Title V: Four of the five states relied on systems and infrastructures in their Title V CSHCN programs, and the involvement of Title V staff took many forms;
• Family involvement: The involvement of Title V staff often resulted in the involvement of families of CSHCN in the design and oversight of the system; and
• A focus on quality: Several of the states were beginning to focus on assessing the quality of care provided to CSHCN.

The report summarizes the major advantages of the different models used by the states studied; it also highlights some of the states' challenges: 1) outreach and enrollment; 2) defining and identifying CSHCN; 3) access to special services; 4) coordination of care; 5) providing comprehensive mental health services; and 5) monitoring and ensuring quality of care.

The National Policy Center for Children with Special Health Care Needs. New opportunities, new approaches: Serving children with special health care needs under SCHIP. 2000. Vols. I & II. Available at <http://www.jhsph.edu/centers/cshcn/publications.html>.

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3. STUDY EXAMINES FACTORS INFLUENCING USE OF MATERNITY LEAVE

Researchers examining maternal and family leave policies in Minnesota concluded that leave created by company policy resulted in longer post-childbirth leave for women. They also found that unmarried women took an average of 11 fewer days of maternity leave than married women and that a "dramatic" difference exists between the amount of leave taken by married women whose spouses had higher incomes and those whose spouses had lower incomes.

This study investigated the extent to which women's maternity leave is influenced by company leave policies. By analyzing the experiences of women in Minnesota, the state with the highest percentage of women in the work force, the authors determined that paid leave policies and spousal earnings are the primary determinants of the length of women's leave from work after childbirth. This study focused on more than 600 women in the 2 years before the implementation of the Family and Medical Leave Act of 1993.

Noting other studies indicating that time off after childbirth positively affects maternal health, the authors reported these findings:

• The average duration of maternity leave among sample subjects was 10 weeks;
• Women with access to paid maternity leave took an average of 10.5 weeks of leave, but women without access to paid leave took an average of 6.6 weeks;
• When women with high incomes and women with low incomes had access to paid maternity leave, women with higher incomes used less leave than women with lower incomes; and
• For every additional $1,000 a woman's spouse or partner earned, a woman took an additional 0.68 day of leave.

The authors conclude, "While many factors affect women's time off work, policy attributes, individual economic factors, and job flexibility dominate the effects.… Private and public policy makers need to ensure that, at a minimum, those most vulnerable not only have access but can afford to use such policies."

McGovern P, et al. The determinants of time off work after childbirth. Journal of Health Politics, Policy and Law. 2000. 25(3):527-564.

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4. BARRIERS TO TANF ENROLLMENT ASSOCIATED WITH HIGHER UNINSURANCE RATES

Policies that deter enrollment in Temporary Assistance to Needy Families (TANF) may contribute to declines in Medicaid enrollment and to increased uninsurance, according to a study published in the American Journal of Public Health.

The study examined the welfare policies and insurance enrollment rates of all 50 states. Data sources included national surveys conducted by the National Governors' Association and the Center on Budget and Policy Priorities, Health Care Financing Administration (HCFA) 2082 reports, and Census Bureau Current Population Surveys.

Findings showed that TANF enrollment declined in states that reduced the entire family's cash grant for noncompliance with work requirements, that did not offer child care for families enrolled in TANF, and/or that required individuals to document their job search efforts before applying for TANF.

The authors note that this research should be considered preliminary rather than definitive because it is subject to several limitations, including the omission of economic variables and the lack of qualitative information on state policies. Nonetheless, they assert that this study contributes to the literature demonstrating that increases in uninsurance have followed the 1996 implementation of welfare reform and that "policies which deter TANF enrollment may contribute to these changes."

Chavkin W, Romero D, Wise PH. State welfare reform policies and declines in health insurance. American Journal of Public Health. 2000. 90(6):900-908.

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5. INFORMATION REVIEW: FATHERHOOD

Increasingly, attention is being focused on the roles of fathers in children's health and well-being. Research indicates that fathers contribute in distinctive ways to children's development and achievement and are a positive influence on their overall welfare. This month's Information Review focuses on a variety of electronic resources that provide information on fatherhood.

The US Department of Health and Human Services (DHHS) Fatherhood Initiative at <http://fatherhood.hhs.gov> is the department's response to President Clinton's June 1995 request that all federal agencies review and strengthen their programs and policies on fatherhood. The Web site includes links to other federal and national efforts to support fathers; reports, studies, and publications focusing on fatherhood; information on demonstration projects and outreach programs; and a variety of other father-friendly resources. As part of the initiative, DHHS developed a database, the Responsible Fatherhood Management Information System (RFMIS), to help fatherhood programs across the country maintain information on the services needed by and delivered to fathers. The database guide and instructions are available at <http://fatherhood.hhs.gov/guidebook99/index.htm>.

Child Trends has published three research briefs on fatherhood that are available at <http://www.childtrends.org/r_fh.cfm>. These briefs discuss fathers' contributions to their children's well-being, the significance of fathers' involvement with their children in terms of social and cognitive development, and the social, economic, and cultural factors that influence fathers' involvement with their children.

The National Fatherhood Initiative (NFI) at <http://www.fatherhood.org> promotes responsible fatherhood and supports men in their efforts to be positive figures in their children's lives. The organization promotes state policy initiatives that recognize the importance of fatherhood, develops public education campaigns, and provides information to help fathers become better parents. A publications catalog, tips from fathers, and links to other Web sites are available on the site. Among the NFI resources available on their site is "Seven Things States Can Do to Promote Responsible Fatherhood," by Eric Brenner and Wade F. Horn, Ph.D., President of NFI, in collaboration with the Council of Governors' Policy Advisors.

The National Center on Fathers and Families at <http://www.ncoff.gse.upenn.edu> at the University of Pennsylvania conducts research on previously understudied minority populations and is expanding the knowledge base of fathers' involvement in their families. The site features the FatherLit database, which contains more than 8,000 research-oriented publications on fatherhood and related family issues; a programs database with links to organizations with similar research scopes; and an events database of upcoming special events for researchers in the field. The site's publications page contains full text briefs, literature reviews, and a series on state policy.

Talking with Kids About Tough Issues--Special Focus on Dads at<http://www.talkingwithkids.org/dads/index.html> features a 1998 survey of children ages 10 to 15 years and their parents. Highlighted are survey results indicating the level and type of involvement fathers have in communicating with their children about sex, HIV/AIDS, violence, drugs, and alcohol; how fathers influence their children's views of these issues; percentages of fathers who currently discuss these issues with their children; and the positive outcomes associated with such communication. The site also contains related reading materials and links to other organizations.

The Healthy Start Initiative (HSI) <http://www.healthystart.net/>, a community-based infant mortality reduction program, is currently operating in 94 communities across the United States. Some local and regional sites have developed male initiative programs, including the following:

• The Pittsburgh/Allegheny County (PA) Healthy Start's Male Initiative Program (MIP) informs fathers and "other male support persons" about their influence on pregnancy outcomes and children's health and well-being. The program's Web site, at <http://trfn.clpgh.org/hspgh/MIP.html>, describes program objectives and goals (such as promoting parenting skills and responsible parenting strategies) and offers information on children's social and health outcomes in the absence of a father figure.
• In conjunction with the Chatham-Savannah (GA) Youth Futures Authority, Chatham- Savannah Healthy Start developed a male responsibility initiative called Project MIND (Males Involved in Nurturing and Developing). Featured at <http://www.youthfutures.com/component/healthystart/maleinvolvement.asp>, the initiative focuses on African-American males between the ages of 10 and 29 and includes a Males Only Clinic and Male Responsibility Curriculum.

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MCH Alert. 2000. Arlington, VA: National Center for Education in Maternal and Child Health. <alert>.

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SENIOR EDITOR: Jessica Grumet
EDITOR: Jennifer Burek Pierce
EDITORIAL STAFF: Ruth Barzel, Anne Mattison, Beth Rosenfeld
CONTRIBUTING STAFF: Beth DeFrancis, Terry McHugh
FOUNDING EDITOR: Laura Kavanagh

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The MCH Alert is produced by the National Center for Education in Maternal and Child Health under its cooperative agreement (MCU-119301) with the Maternal and Child Health Bureau, Health Resources and Services Administration, US Department of Health and Human Services.

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