Monday, June 15, 2009

News: Education Begins At Home Hearing

The Children's Monitor Online, an e-newsletter from CWLA (and a great source of info on action at the federal level - subscribe here) reports that the House held a hearing on the Education Begins At Home Act...

Key Committee Hearing on Home Visiting

On Tuesday, June 9, the House Ways and Means Subcommittee on Income Security and Family Support held a hearing on proposals to provide federal funding for early childhood home visitation programs. The focus was largely placed on how to produce the best practical, cost-effective home visiting programs. Chairman Jim McDermott (D-WA) began the hearing by bringing attention to the startling fact that less than 15% of families in need of home visitation actually receive services. He also indicated the possibility of the legislation, the Early Support for Families Act, HR 2667, moving as part of health care reform.

The hearing included many expert witnesses. The first witness, Joan Sharp, Executive Director of the Council for Children and Families of Washington in Seattle, echoed the appropriateness of thinking about home visiting in the context of health care reform, as there are many negative health outcomes for children who are victims of child abuse and neglect. Dr. Jeanne Brooks-Gunn, a developmental psychologist, centered her testimony on the outcomes that should be associated with any form of intervention, strategies for enhancing the lives of children and their families, the factors that determine the effectiveness of a given program, and how to best invest in home visiting. Cheryl D'Aprix, a Family Support Worker with the Starting Together Program in Canastota, New York, described her experience with home visiting as both a participant and a home visitor, and expressed the life changing possibilities of home visiting. Finally, Sharon Sprinkle, a Nurse Consultant with the Nurse Family Partnership (NFP) shared her success with the NFP model and asked that Congress look closely at this program as a way to improve the lives of low-income, vulnerable families. For a complete copy of the testimonies from the hearing, visit the Ways and Means Committee website.

A number of themes dominated the hearing, including the cost for this new initiative and how to meet it, as well as determining how to reach the most vulnerable families, finding approaches for including fathers, and understanding that no one program will reach all families because different families have different needs. CWLA has endorsed HR 2667 and will continue to work with Congress to refine and to pass this initiative.

Monday, June 08, 2009

Brain Injuries: Diagnosis and Management

The New York Times reports on a controversy about the identification and management of concussions in high school sports...Link

It points out the importance of social context in framing the issue for high school students.

New Guidelines on Young Athletes’ Concussions Stir Controversy
Published: June 7, 2009

New guidelines for the care of youth athletes who sustain concussions are causing controversy among brain-injury experts, reigniting the debate over whether strict rules regarding concussions can actually leave athletes at greater risk for injury.

An international panel of neurologists, updating their recommendations on concussion care in the May issue of The British Journal of Sports Medicine, said that any athlete 18 or younger who was believed to have sustained a concussion during a game or practice should never be allowed to return to the playing field the same day. The group had previously said that such athletes could return if cleared by a doctor or certified athletic trainer, but now contend that such determinations are too difficult and dangerous for same-day return to be considered safe.

Other doctors, many of whom work the sidelines of high school athletic events, said they feared the effects of such strictness. They predicted that athletes would respond by hiding their injuries from coaches and trainers even more than they are already known to do, leaving them at risk for a second and more dangerous concussion.

The panel’s recommendation to remove all players suspected of concussion has no direct influence on rules governing United States youth sports, which are generally made at the state and local levels. But it does spotlight how some attempts to improve concussion-related safety can instead compromise it, a paradox encountered at levels as high as the N.F.L.

“So many bad decisions are made when trying to assess whether a player is symptomatic or not,” said Dr. Robert Cantu, an author of the guidelines who is also a director of the Neurological Sports Injury Center at Brigham & Women’s Hospital in Boston. “We know that an unacceptable number of kids are being sent back while symptomatic, and sometimes with devastating effects. The majority believe that the bullet should be bitten, and not let a kid go back into the same contest.”

But Dr. Bob Sallis, a past president of the American College of Sports Medicine and a longtime sideline doctor in Southern California, said he saw the recommendation as a step backward.

“More kids will be hurt seriously because of this, either by players not admitting they might have gotten a concussion or coaches encouraging them not to be up front about their symptoms, whether subtly or overtly,” Sallis said.

Asked how the guidelines could have any influence on league rules throughout the country — in Iowa, for example — Sallis said: “It does put the people in Iowa in scrutiny. When a kid gets hurt, they’ll get sued and be told, why didn’t you follow those guidelines?”

High school athletes in nine primary sports sustained an estimated 137,000 concussions in the 2007-8 school year, according to a study conducted by the Center for Injury Research and Policy at Nationwide Children’s Hospital in Columbus, Ohio. Football had the most, with more than 70,000, followed by girls soccer (24,000), boys soccer (17,000) and girls basketball (7,000). These were only reported concussions; more were almost certainly sustained but went unrecognized or ignored.

“Sometimes, postconcussion symptoms can be delayed for hours or even days, like difficulty sleeping or concentrating,” Cantu said. “It’s a clinical decision that’s difficult or sometimes damn near impossible to be made on the sideline, and we aren’t doing a very good job at it. Athletes, even when assessed by qualified people, seem to be returning to contests prematurely or when symptomatic — an unacceptable number of cases.”

The panel also emphasized the importance of not just physical rest for players found to have a concussion, but cognitive rest as well. It said that teenagers should be kept from activities ranging from schoolwork to video games and text messaging while recovering from a concussion.

“That is the No. 1 management issue in our clinic — how do we manage the cognitive activity that stresses that brain’s abnormal metabolism?” said Gerry Gioia, the chief of pediatric neuropsychology at Children’s National Medical Center in Washington. “Studying for an algebra exam, reading a lengthy text, sitting in a classroom for an hour and a half trying to keep notes and keep up — it extends recovery, it feels miserable to the kid, and it’s misunderstood by the school and public.”