It takes some families more than a turkey and some mistletoe to make the season bright

"We have arrived, again, at that festive time of year when the collective American consciousness warmly turns to thoughts of family."

My job as a social worker and parent educator has me intensely focused on the concept of family — every day. For the past couple of years I have been a group facilitator for the Health Promotion Council's 12-week Focus on Families' REMix (Relationship Education in the Mix) healthy relationship class at the Philadelphia Department of Human Services' Achievement Reunification Center (ARC) in Center City.

Most of the participants at the ARC are mandated to be there, but we have also conducted groups with voluntary participants at other locations.

This represents, for me, months and months of listening to the stories of the inner-workings of numerous families and the varied relationships therein. Some of the stories were unbelievably heartwarming; some of them were horrifying. All of the stories are the stuff of ordinary lives.

Examining relationships in conflict

Couples who attend the REMix class together offer particularly startling insights into the often conflicting dynamics of close relationships between partners and between parents and their children. With the REMix course, we hope to impart some strategies to the families that they can use to improve their daily interactions within those relationships.

For many of the people taking the course, it is possibly the first time that they have heard concrete examples of what constitutes normal, healthy relationships. Many of them have endured crippling traumas in their lives that they, in turn, play out in various forms in their dealings with their own mates and in their roles as parents.

Our hope is to help them more closely examine their lives and perhaps break some of their known negative habits, or perhaps even those bad behavior patterns of which they may not be aware.

My experience teaching the REMix class has demonstrated one critical and undeniable fact to me: the enduring importance of family to the healthy development of children and adults. Many of the participants in our classes (mandated or not) are confronting harsh relationship crises, and it is heartening to see how hard people struggle to maintain their family units, no matter how tenuous their bonds may be, or how they define family for themselves.

The issues these families confront are not unique. They are often good people who may (or may not) have made a mistake. Their plights suggest that we would all do well to consider whether or not we are guilty of taking our families for granted.

However defined, the importance of 'family' endures

Very often, the class participants tell me that they feel the other members of the group become like family to them. The classroom setting is a sort of "laboratory family experience" where they can collectively work on issues of communication, values, conflict resolution, etc.

Our discussions around family are sometimes quite emotional, which underscores the critical nature of the subject. For so many of our participants, their legal troubles in the Family Courts have forced them to examine more closely their family connections, sometimes for the first time in their lives.

Whatever one feels about the importance of family, it is clear that the definition of "family" has morphed immeasurably in this country. The modern family may not conform to traditional standards, but it remains somehow "family" nonetheless. The idea is still relevant, and it still forms the backbone of modern life — particularly for our children.

It is interesting to see these REMix participants fight through their family traumas and (usually) find a way to hold their family units together. It doesn't always work out perfectly, but I do see many of them come to the realization that their families are what they treasure most.

With all of the unavoidable changes in this world, it is comforting for me to know that family still matters.

Diabetes and Me

Being diagnosed with diabetes can be rather scary, but overtime the fears will past. Having to learn to live with diabetes can be daunting initially, but once you become more educated about the condition it becomes less cumbersome. When you are first diagnosed many feel as though initially your life is over, and you will never be able to eat any more sweets, or live a normal life.  You just have to remember to enjoy the “fun” in moderation, and live a healthy lifestyle. Diabetes is not a “death sentence” it is however a serious a chronic condition that affects many Americans, especially people of color.

Diabetes Mellitus, or simply diabetes, describes a group of metabolic diseases in which a person has high blood glucose (blood sugar), either because the body is not producing enough insulin, or is not responding to the insulin produced. Due to the complicated nature of diabetes, staying healthy can be very labor intensive.  You must check your blood sugar often, take medications, count carbs at every meal, and even measure insulin to balance what you eat and how active you are. .

More than 25.8 million people in the United States (8.3% of the population) have diabetes. Of these, 7.0 million have undiagnosed diabetes. In 2010, about 1.9 million new cases of diabetes were diagnosed in people aged 20 years or older and if current trends continue, 1 of 3 U.S. adults will have diabetes by 2050.[1]

The burden of diabetes is much greater for minority populations than the white population. For example, 10.8 percent of non-Hispanic blacks, 10.6 percent of Mexican Americans, and 9.0 percent of American Indians have diabetes, compared with 6.2 percent of whites.[2] Certain minorities also have much higher rates of diabetes-related complications and death, in some instances by as much as 50 percent more than the total population.[3]

HPC works diligently to combat the complications of diabetes among the communities we serve thru health promotion, education and intervention programs. One such program is PA cAARds! a statewide multidisciplinary training model used to educate health care professionals and para-professionals in evidence based interventions to address the dual risk of diabetes and tobacco use while linking them to valuable community-based resources. Through BE A BRIDGE and PA cAARds!, HPC has worked to address tobacco and chronic disparities through integrated evidence based strategies since 2007 training and building the capacity of more than 1,000 individuals representing more than 473 organizations in over  80% of Pennsylvania counties.

To learn more about HPC and its programs visit our website at www.hpcpa.org

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[1] Centers for Disease Control and Prevention. National diabetes fact sheet: general information and national estimates on diabetes in the United States, 2010. Atlanta,GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2008.

[2] Mokdad AH, Ford ES, Bowman BA, et al. Diabetes trends in the U.S.: 1990-1998. Diabetes Care 000;23(9):1278-83.

[3] Carter JS, Pugh JA, Monterrosa A. Non-insulin-dependent diabetes mellitus in minorities in the United States. Ann Intern Med 1996;125(3):221-32. (AHRQ Grant HS07397).

ADA. (nod). Retrieved from http://www.diabetes.org/living-with-diabetes/know-your-rights/how-to-get-help/success-stories.html

(n.d.). Retrieved from http://www.healingwell.com/library/diabetes/info5.asp

Justice for Youth Too, not Just Us

The problem of public leadership is calling into existence a public that can understand and act on its own interests.

                -John Dewey

There is a misconception regarding public health organizations working to combat the prevalent community health obstacles of our day. This misconception revolves around the belief that communities lack the capacity to lead and instead require a benevolent intervention to ‘put them right’. On the contrary, our communities suffer only from a lack of an ability to organize its leadership and coordinate its advocacy. This deficit of structure produces a deficit of purpose. Public health as a discipline depends most heavily on an extensive network of social support that empowers a public to purposefully understand and act on its own health interests.

The days of uninformed constituencies suffering from poor disease management, a lack of a prevention and/or promotion plan is over. Empowerment through the Health Promotion Council’s advocacy work builds community capacity to simultaneously combat health risk factors and bolster health protective factors. The diversity of services provided through this advocacy lens grants our communities the knowledge and organizations the capacity to develop relevant and appropriate prevention/promotion strategies.

In particular, HPC’s Advocacy Institute (AI) empowers stakeholders to organize, mobilize, and advocate for sustainable community change. Through work focused on the connection between public health and policy, community health, and the implementation of a strategic advocacy action plan, we prompt participants to call their communities’ capacity into existence and create healthy change. This innovative educational program prepares participants to be the change their communities need as their strategy for action grows and their leadership skills mature. Ultimately it’s this maturity that facilitates the development of sustainable community health. HPC’s advocacy work has the potential to ‘put the city right’  by empowering individuals, families, communities, institutions, and policymakers to call into existence a vision for health that respects leadership at all levels.

On a personal note, as one of the primary contributors to the development of AI, I see the program as a vehicle for capacity building for so many public health stakeholders. From youth developing leadership skills to school administrators working towards systemic reform to city policymakers making public health more accessible, these groups are more like puzzle pieces awaiting transformational leaders. AI engages stakeholders; primarily youth to this point so that they can see where they ‘fit’ in the picture. To this point, the public health picture has a piece missing and we are working to convince youth to take their rightful place.

AI has proven to be extremely enriching for those who have participated from legislative trips to community events and school seminars. My hope is for participants to find their individual and collective voices to speak up and their individual and collective feet to stand up. Ultimately, no one can push youth into their place as leaders. They’ll have to advocate on their own behalf. Good thing they have the Advocacy Institute.

Navigating the New Health Insurance Marketplace

Approximately 80% of Americans participate in employer- or government-sponsored health insurance plans. However, approximately 15% of individuals are currently uninsured. In Philadelphia, 14.5% of adults and approximately 5% of children are uninsured.

On October 1, a new option for health insurance for uninsured and under-insured individuals became available through the Health Insurance Marketplace (Marketplace) created by the Affordable Care Act. The Marketplace offers uninsured and under-insured individuals a way to obtain affordable health insurance coverage.

To prepare for the October 1 launch, HPC has been working with PHMC to educate individuals throughout Philadelphia about the Marketplace through a grant PHMC received from US Department of Health and Human Services Health Resources and Services Administration. The grant has allowed PHMC and HPC to hire Outreach and Enrollment Specialists to help individuals become insured through the Marketplace.

Together, PHMC and HPC Outreach and Enrollment Specialists have been conducting outreach and education events at PHMC health centers and other community sites to raise awareness about the Marketplace -- sharing information about how the Marketplace works, who is eligible, and how to enroll. Beginning October 1, Outreach and Enrollment Specialists also began assisting individuals with enrollment. Outreach and enrollment activities will continue through 2014.

HPC is excited about this exciting opportunity to partner with PHMC and to utilize its expertise in community outreach and education to support community members in obtaining health insurance through the new Health Insurance Marketplace!

The Cultivating Communities Campaign

The Cultivating Communities Campaign (CCC) enables access to fresh and local produce by families or individuals living in the greater North Penn region of Montgomery County by developing and expanding coordination between community gardens and food distribution sites. Health Promotion Council (HPC) and other core partners collaboratively lead the CCC with generous support of the North Penn Community Health Foundation.

The CCC was designed to be an initiative that can be adopted and sustained by the North Penn communities after project funding is complete. For example, HPC with support from the core partners, has developed a volunteer strategy that helps garden and food distributors find the extra helpful hands they need throughout the year, especially during the peak of the growing season. This kind of resource sharing socially and economically supports the integrity of the distribution network between growers and consumers. 

In 2011, the CCC started with 5 garden and 2 food distribution partners and has grown to include 35 partners. This year, 2 new farms joined CCC and will donate a portion of their harvested produce through the coming year to local food pantries. We are confident that the connections within the North Penn community that have been established and expanded as a result of CCC will continue to strengthen in the coming years.

If you have questions about the Cultivating Communities Campaign or would like to learn about volunteering please contact: Hamzeh Abuyounis, Program Coordinator, at habuyounis@phmc.org.

Worksites: The Venue to Health and Wellness

A recent study conducted by the CDC showed that 80% of Americans do not get their recommended amount of daily physical activity[i].  Another CDC study also indicated that only about one-third of adults consume the daily recommended amount of fruits and vegetables[ii].  These statistics are disheartening because physical activity and fruit and vegetable consumption can reduce one’s risk of developing chronic diseases, such as diabetes.  The United States Department of Health and Human Services reports the cost for treating chronic diseases accounts for 75% of all US medical cost[iii].

What factors are causing people to not exercise or eat nutritious foods on a regular basis? Most people indicate not having enough time.  This response is validated by the U.S Department of Labor, which reports an employed American has many demands on their time, spending an average of 7.7 hours a day at work, 1 hour commuting to and from work, 2.6 hours on household activities, 2.0 hours providing care to others, and 8.0 hours sleeping[iv].  Because Americans spend the majority of their time at work, employers are enacting “worksite wellness” strategies to incorporate time for physical activity into the workday such as on- and off-site programs and policies that allow employers to easily engage in health promoting habits.

Employers are implementing worksite wellness programs to improve the health of their workers and reduce their health cost expenditures. These programs may come in the form of annual employee health screenings, tobacco- free hiring policies or encouraging employees to sit on exercise balls during meetings. These types of programs are a win-win for both the employee and the employer. For the employee, there are rewards of overall improved health and wellness. The employer has a healthier workforce that will shrink their healthcare expenditure, reduce worker absenteeism, and increase overall productivity.

The Obama Administration recognizes the importance of worksite wellness programs. On March 23, 2010 President Obama signed the Patient Protection and Affordable Care Act into law, ensuring affordable health care access for everyone and safeguarding consumers from abusive insurance company practices. This Act includes provisions to encourage employers to implement worksite health and wellness programs with incentives and tax credits. Beginning on January 1, 2014, employers may reward employees with up to 30% of the cost of their health insurance plan for participating in a wellness programs. Those employees enrolled in tobacco cessation programs have the potential to receive rewards or incentives in an amount up to 50% off the cost of their health insurance coverage[v]. Conversely, employers can charge higher insurance premiums to individuals who are not enrolled in a wellness program.

ASHLIN Management Group, LLC, is leading the Work@Health™ Employer Training Program, which is an $8 million dollar national initiative that is funded through the Affordable Care Act and supported by the Centers for Disease Control and Prevention.    The Work@Health™ initiative will train up to 600 employers and organizations that support employers across the country on implementing worksite wellness programs and provide them with technical assistance through a peer learning network, subject matter experts, and seed money to support science-based interventions.

Health Promotion Council (HPC), as a subcontractor on the project, is supporting the project’s “technical assistance learning community” by connecting employer participants to peer networking opportunities, workplace health and wellness “Subject Matter Experts” (SMEs) and community resources for planning and implementing their programs, strategies and policies. Using online tools and face-to-face meetings, employers will network with peers to share successes, resolve challenges and resources. Through web-based presentations, Q&A sessions and discussion groups, Subject Matter Experts will guide employer participants in implementing best practices and key workplace health and wellness strategies. HPC will also train employers on accessing and leveraging resources from the national to the local level using online mapping and resource identification tools, such as Community Commons and SAMHSA.

Workplace health is now in the spotlight for how we can improve the health of the U.S. population, and therefore, as research shows, the economy of the nation’s small, medium and large employers. The workplace is where we spend most of our lives providing the greatest opportunity for promoting and engaging in healthy behaviors through a supportive and engaging environment. Health is not a luxury. It is necessary for the future of the nation.

For more information on HPC or the Work@Health program please visit the following website: www.hpcpa.org/

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[i] CBS News (2013). CDC: 80 Percent of Americans Adults Don’t get Recommended Exercise .

Available from http://www.cbsnews.com/8301-204_162-57582759/cdc-80-percent-of-american-adults-dont-get-recommended-exercise/ 

[ii] Centers for Disease Control and Prevention (2009). Majority of Americans not Meeting

            Recommendations for Fruit and Vegetable Consumption. Available

             from http://www.cdc.gov/media/pressrel/2009/r090929.htm           

[iii] Centers for Disease Control and Prevention (2009). The Power of Prevention: Chronic Diseases…the

Public Health Challenges of the 21^st Century. Available from  http://www.cdc.gov/chronicdisease/pdf/2009-power-of-prevention.pdf

[iv]United States Department of Labor (2013). American Time Use Survey Summary. Available from

                http://www.bls.gov/news.release/atus.nr0.htm

United States Department of Labor (2013). The Affordable Care Act and Wellness Programs.

Available from  http://www.dol.gov/ebsa/newsroom/fswellnessprogram.html

Integrating Nutrition Factors and Smoking Cessation

We already know that tobacco smoking can lead to lung cancer, coronary heart disease and other serious medical issues. We also know that exposure to second-hand smoke negatively affects other non-smokers.  Quitting smoking is a sensible and healthy option, so what's holding you back?  Is it the fear of gaining weight? You are not alone…

Weight gain is a common reason why people shy away from quitting smoking. Here is some information you should know about quitting smoking and weight gain.

Nicotine suppresses hunger by switching off the receptors associated with appetite and food intake.  Also, time spent puffing on a cigarette is time spent not snacking.   On average, people who quit smoking gain about 10 pounds.  

 Tobacco cessation program staff are trying to tackle the problem of weight gain associated with quitting smoking with a holistic model by addressing both nutritional factors and tobacco cessation. A local Montgomery County program  implemented by Mercy Health  and administered by Health Promotion Council, exemplifies this new integrated model. The  cessation counselors regularly give nutrition counseling to clients in their smoking cessation program. Cessation counselors across the United States are adopting this integrated approach dedicated to keeping patients healthy, nutrition-oriented, smoke-free, and active.  

Dr. Jeffrey Wigand (tobacco industry whistleblower depicted in the movie The Insider) who is currently working to assist Australia, New Zealand and Canadian cities to  go tobacco-free states:  

“Successful tobacco addiction treatment should be approached holistically where all body systems are addressed.  Like other addictions, it permanently transforms brain circuitry (neurochemistry), affects appetite and dietary choices as well as alters the user's ability to exercise.  Having accurate vital statistics assists the counselor to better understand and treat the individual more effectively in an integrated manner.  Nutrition is especially critical because many nicotine dependent individuals shy away from help for fear of gaining weight.  By simply measuring a client's height, weight, blood pressure and body fat on each visit, treatment is more tailored leading to greater awareness of nutritional needs and restrictions for clients.  The expected outcome is less weight gain, increased ability to exercise and better overall health....most important of which is a better outcome in the treatment of the underlying addiction. Behavior modification is critical for the management of nicotine addiction.”

Contact http://www.sepatobaccofree.org/site/index.phpfor assistance with quitting smoking!

Dads Matter

I recently found myself thinking about a conversation I had with a female participant in our REMix: Healthy Relationships in the Mix class. She was talking about her child’s father, with whom she has had a strained relationship for the past two years. She said, “He’s a waste of my time. I don’t need him anyway. I can give my son everything he could, and more.” This statement echoes a sentiment we hear often, especially with our female clients - a sentiment that is often repeated both overtly and subtly throughout our culture. When she made this statement, I paused and asked her if she thought that was true of every family in her situation - can a mother give her children everything and more than a father can? She replied with a definite “Yes, absolutely.” I then went on to ask her if the same applies to men in her situation - a father raising his child alone with no help from the mother. Can he give his child everything and more than the mother could? Her response was “Of course not. Every child needs their mother.”

I decided to pose these questions to the entire class, which included mothers and fathers. We asked them to name all the things mothers can do for their children. We then asked them to name everything fathers can do for their children. To the participants’ surprise (but not to the facilitators’), they listed the exact same things, maybe using a different word here and there. The only thing they could name that a father cannot do is breastfeed. Then we asked the question, “Do children need both their mother and father - or at least trusted males and females - to be a part of their lives?” This question was met with a resounding “Yes” from the group.

What do fathers and other male caregivers provide for children? How do they do this parenting thing differently than mothers? Do they have an important role to play in their children’s healthy development? These questions are raised a lot in the work we do with men. We’re always heartened when we hear our female clients say things like, “I want him to be more involved; my child needs him.” Or, “My father did so much for us; he would drop anything for us.” Unfortunately, for every client that says fathers are important, we have two that say women are always the better parent – and even sadder, many of our male clients are the ones saying so.

So what do fathers bring to the table? Looking at the research will show you that children who are raised by two involved, loving, and stable parents are less likely than children raised by only one parent to have behavioral problems, to drop out of school, to commit crimes as teenagers AND as adults, to be abused and neglected, to use drugs or alcohol, and to become sexually active at a very young age. They are more likely to do well in school, have stable friendships, understand gender roles, live in stable housing, attend college, and have positive self-confidence. Fathers and males, in general, approach some of the same parenting tasks in different ways that women. For instance, males are more likely to get down on the floor and play with their children. They roughhouse more (which is a very typical male-bonding approach). They are more likely to let their children take positive risks (“You can climb a little higher. You won’t fall.”). They can let their children fail and try to work out a task or problem on their own. And they often let their children decide how they feel before reacting and helping them. 

When we teach these concepts to fathers in our Focus on Fathers classes, we can sometimes see the internal struggle going on in the men who stated they believe mothers are better nurturers. They have been told all their lives that men can’t raise children as well as women. Some have been told by their own families and children’s mothers that their job is to make the money and mete out punishments – the rest the woman can do, better. They get excited to hear that getting on the floor and roughhousing with their children helps the child control his or her emotions and provides bonding experiences, especially for boys. They are happy that they can now put into words why they don’t automatically intervene when a child is working through a problem. They are relieved to be told that they can and should do things like sit down and read to their kids, comfort them when they are sad or hurt, and show them how much they love them. It’s a bittersweet thing to hear a man break down and say, “Why have I been hiding behind this tough-guy façade with my son? He needs me to talk to him, comfort him, help him with his problems. I needed all those things from my father, but didn’t get them. Why hasn’t anyone ever told me this before?” Our message is always the same: You are important. Don’t let anyone tell you differently.

At the end of the REMix class, the young lady came up to me and told me she had never had anyone dispute her beliefs that she could do it all on her own. She was amazed and surprised to hear that the rest of the class felt strongly that kids need positive male role models and admitted that maybe she really couldn’t do it all as well as she thought. Over the next few weeks she updated me on the progress she was making with her child’s father. She had called him soon after that first session and agreed to let him see their son. By the end of the twelve-week series, her son’s father was calling to talk to them every night of the week and spending time with his son every weekend. She said the changes in her son’s behavior were amazing – he was more compliant, didn’t act out as much, was doing better in school, and just seemed all-around happier… And so was she. 

Written by Nichole E. Kang, Director, Social Services for HPC’s Focus on Families program and facilitator of fatherhood classes for six years. 

Health Intervention Program (HIP)

One of Health Promotion Council’s newly-acquired programs is the Health Intervention Program (HIP), which has been, since 2006, working with families with at least one child with special health care needs. Some of the more noteworthy work HIP has conducted over the years is with immigrant families. Many times, new immigrants have only small social support networks and have difficulty understanding the workings of the US benefits and healthcare systems, which greatly limits their ability to provide for their children’s advanced needs. The expertise, patience, support, and concern the HIP staff provides the families helps to relieve their stress and anxiety and makes them better able to cope. One family, in particular, benefited greatly from the work of HIP and other service providers throughout Philadelphia.

 

The *Basri’s are immigrants from a Middle Eastern country. When they began HIP services, they had an 8-year-old daughter with intellectual disabilities and a set of infant twins who were born prematurely. They were having a difficult time understanding the medical issues their twins faced and found it difficult to give their daughter the time and attention she needed. The HIP team introduced the family to the medical specialists at Children’s Hospital of Pennsylvania. HIP helped the family set up all the appropriate appointments, accompanied them to their medical appointments in order to help them understand and be involved in treatment planning, educated them about the medical services, and trained them to respond to possible medical crises. One of the main goals of HIP is to make the family as self-sufficient and confident as possible before reducing or discontinuing services. Through this intervention, HIP was able to help them create and maintain a stable, on-going relationship with their medical providers. Establishing these relationships was an important step because the children will be in need of services for many years, but the family would be eligible for HIP services for only one year. HIP staff modeled appropriate parenting skills, including how to engage the children and use the designated activities to promote healthier development of the twins and their older daughter. HIP also helped the family understand and use the special education system in the public schools and to access and use local immigration services, which allowed for them to become documented citizens.

 

When Mr. Basri’s mother fell ill in their country of origin, HIP stepped in to help the family gain visas so they could travel to the Middle East to spend time with her. This process involved securing three months’ worth of a rare medication that all three children needed for the trip, and without which their health would have been greatly affected. During the time needed to plan the trip, HIP ensured the family was able to appropriately grieve the inevitable death of Mr. Basri’s mother. The family was incredibly grateful for the opportunity to visit their home and say their goodbyes.

 

The importance of social support during hard times permeates every service HIP provides. One of our newest case managers, Rachael McInnes, recalled a recent conversation she had with a mother of a child with autism. The mother asked, through a tearful gaze, if her son would ever “get better.” This is a difficult question to answer by even the most well-trained case manager, because the answer is almost always a “no.” Rachael had to take a deep breath and explain to this mother that, while her son would not reach the same milestones at the same time as his typically-developing peers, he would have the ability to reach his own milestones in time with support and care. She wanted the mother to understand that with all the work she and her son are doing, and through all the specialists he sees, his quality of life will be much improved, but not “perfect.” She also wanted the mother to know that she and her family would be supported emotionally by HIP and other social services as long as she sought that support. The conversation ended in tears, but showed Rachael this mother’s unconditional love for her son. Rachael is confident that, over time, this mother will come to accept that her son will always have special needs and that she will rise to the occasion every time her son needs her.

 

I leave you with a quote from Rachael, which sums up her feelings about the parents with whom she works. “As children age, their intellectual and physical disabilities become more evident to parents. At times, these disabilities illustrate the harsh reality of the difficulties their child may face. But these visible reminders can move parents to climb any obstacles with their child. “

 

*name changed in the interest of privacy.

 

The Health Intervention Program is funded through Philadelphia Department of Health’s Maternal, Child, and Family Health division.