~h~msrlw~. \Vc bxn1 to mthc sure their ciiiltlrt~li kuou that rhcir fwliligs alx)ut thr transitional procc51 al-t i111p0rtant and 1hat thr\ should he ellcoul~aI- ~~olunterr in the classrooiil. the\ spvlld timt'\vith ttlcnl. etc.Then,lvhen thr~~n~o\~eorentrrotl~r~~~~s;tt.m~ortl~t schoolsvstem, they're not that in!ol\etl. \Vc Itit*] Ihat \\c' need to keep the parents invohwl and kwp that in- votwme~it as the!- make tra~lsitions throtlghout the systems so that our children can be health\ and read\- to lear11. IVe also felt that parents should be in\ohwl in program design and the policl~inakillg decisions that L affect and impact upon their children. One suggestion is that NY form parent boards. which arc ven. pre\Aellt in Hcaci Start but do not exist in man\' other systems. Mter the transition occurs. parents need to continue to be involved. For example, parents that are involved in Head Start need to stay involved as their children grow and 111ove through other programs. Parents need to form their own support groups. M'hen they do, programs should work with them. In other words. Fvhen a parent group forms a support gro~~p to help themselves and to help other parents l\.ork through the transitional process, the programs and systems should be there for them. to support them, help thtw lea~-~l thr tl-ansitional process, and provide niatcrialsor \\,hatevrr thev need to make that transition a'r 5niooth as possible. Program c-ounwlors should be appointed to help ]xl1-cnta pw]x"- for tl1 e transition. Also, parents need to be ;ntare of'llot onlv the needs of their own children, lxlt the iiceds of others-to move away from, "me, ni! four. and no more." (:onsi\ttwc!. is the key to successful transitions. \\`r nrrd to he aware of the impact on children and parents of abolishing programs without notice, and man\ times Ivithout preparation to haIre those needs met through another area. M'e need stabilized funding so that programs can address the problems. instead of just looking at the symptoms. Someone suggested that the transitional process \\.c)r~ltl lx> easier ifIve de\,eloprd an interstate communi- cation \ystcwi. \l.e shol~ld crrate a national computer network so that the information on parents in one State could be readi]\. accewible to another State. \\`hen people st~ch as the Xligrant \cwkers move from one State to~ulothel.and the!.ha\,e toapplyforbenefits, the! haw to closr out theirtilr in the first State, reapply at the IleSt, go through that ~&olr process again, and reopen their tilrs. Of'trn it takes a long time before they get thr brnvfits. Sonit~tinies ttiev are ready to move on to the next grwving wason or the next location before the bellefits e\vn get started. So. if we had a national network. that information Icould be readily available, and that could hprecl up that recertification or reappli- cation process. .Yso, another thing that came up was to create a \~a!. that school credits could be acceptable from State to State. People move through different situations. They have things that are credited in one State, and when they go to the next State, the school says, "I'm sort. but this is not credited here." Then, the child has to go through that whole process again. Establish one-stop shopping-and I won't elabo- rate on that because it has already been stated. Decrease the time spent on paperwork. Make forms less complex. And make an effort to cut down on the duplication of information during the recertification process. hIan\ 76 Parents Speak Out for America'\ Children "Being ready to learn is more than making OUT children ready for the schools. We need to make the schools ready for our children." timec parents go ill to be recertified. alltl they gi1.c tht same information the!. ga1.e 3 month\ ago. Soinc.timt3 in Dela\\,are, I\hen you go to br rccertificd or to get scr\ices. they tell !YNI that you ha\.e to br at the social senice agency at 7:30 a.m. They see IOU at X:30 a.111. or Y:OO a.m., and then they give VOII papu7\wk to fill out that yotl,just filled out the last time. No information has changed, but the!- sa\ . "\Vell, !oii 1iaI.e to do it." LYc could cut down on that process and speed it up. M'orkers need to be sensitive to the needs of the parents \vho conw in and should be a\vare of the stereotvpes and not haw negati\c attitudes tov~cls them, becallse they wmldn't be there if the!. didn't need the help. The other area of concern \vas flexibility. TVe need to make the eligihilit), criteria tlcxiblr. For example. some people have incomes above the gt~itlrlines to receive Medicaid but alw have chiltlwn uith special needs. They can't get regtllar illsllrancc' brcause the child has a preexisting conditioll. so the insl1ranct compan~~does not want to cover them. So those pwplr grt lost in thecracks. \\`r nec~l topa\e tllr\\;l!-of4mooth transitions by rnakillg programs alltl f'Acilitit%s flcsiblc. Chr of 0111` tlrl'g"t'\ erprwcd tl1;tt ,just address the needsofone individual's problems. For example. one of the parents shared that they lvere in the process of suing the school system for some needs for their children and that when that fight is m'er, and that parent lvins. the next parent has to go through thr same process. I\`r think that systems need to Iearn from those fights with parents and those kinds of things that happen. They nerd to learn from the results so that other parents don't have to learn how to light tllr cvstcms better. \Vr 11red to lrlake slure that 0111` pl"`~l`allls are atlrquatd~ fililtlcd so tll;lt the llcwl~ that thc7 ;irt' tlv\ig:llcYl to ,t(ltll.t~cs call IX, ;1Cl(llX~~4 \Ve want the same things. You've got to startworking up from the bottom, and we've got to work harder from the top so that it gets all the way through. You've talked about flexible hours. You want flexible hours; you not only want them, you need them. And we want flexible hours. Last Friday, Secretaq [Louis] Sullivan [Health and Human Services], Sur- geon General Novello, CDC Director Bill Roper, and I were in San Diego to talk about an immunization initiative for infants. And what were we pounding the table about? Flexible hoIn-s, so that parents could bring their kids in the evening, on weekends. Let's make the systems user friendly. You want user-friendly systems; we want user-friendly systems. Let's work together to get it. We're not against each other. W'e're working for the same things, and some- how we have to get it into the middle. And I'm willing to work on that, and I know you ivill as well. I'm simpl! tl?ing to say that we are strijing for what you Tvant, what ~011 are talking about. Perhaps we can p11t 11101~~ ]X)\I.`l` iiito our grant applicati0n.s. Let nie.jitst end 1,:. talking about this doctm~en t. \\`e lta\,e Ivltat \ve call Healthy People 2000. This is not a Federal program; it'\ a national program. You helped develop the 22 p - t iority areas and the 300 specific, tneasur- able, realistic goals of'\\hcre this Nation could lx h! the vex 2000. l\`e'\~ pulled Health~~ Children 2000 out of a much thicker document. and of the 3,000 measurable ohjecti\es for the Nation forve'ar 2000, 1'70 of them t-elate to mothers. infants. children, and adolescents. M'e hope that~~,tt~villwork\\itli IISSO that c~en before thr~~earY?OW, as soon as possible, this Sation \vill lta~e arrived at 1vhet.e \`ott-as you helped us de\,elop these--said Ice ought to be. .Xtid we're \villiiig to work lvith you; 1t.e are partners. and we thank YOU for your input. John T. MacDonald, Ph.D. I ~vould like to thank our presenters for~\hat I cotisidet to be an extremely inspirational mewage. hut one that has a great deal of meaning to us. I h~~ild like to focus my comments in terms ofthe presentations 011 children and their families. I just rrturned last night front the Organization ofAmerican States mertingiti ~~tiatemala City on issues that affect the hemisphere in terms of the same kinds of things that lve are talking about toda\.- precisei\ the same kinds ofprohlems that IWI'W brought here. IV'e are dealittg uith a hemispheric prohlern that lve have to address ifIve are going to sutTive. not,jttst as a Sation. hut as a hemisphere. Il'hat I heard tocla!~. in sum, means involvement. flexibility, a role ofadvocacy, and finally. as Larry [Bell] shared with us, consistenc!~, continttit>-. and coordina- tion. I would like to talk a little bit about commitment, as the other C. to children and their families in an integratedwav. a much more integrated wan than M.e'\.e ever done before. In my trips at-oruld the countt? and 80 Parents Speak Out for America'\ Childrrn ;tl~) itt slwnding 34 \KII-s itt this business of children and f`alnilies. I fo~lncl that, on the awareness issue, it ttteatts \X)LI must not only he tnade aware hut you must have access. ,Jim rwd thr term "user friendlv." Our schools txtsicallv have never been user friendly because the scltools that 1%~ har,e todav are designed for a societ),, frankl\-, that doesn't exist today in tnost areas. I can remember, sotnemonthsago, [Secretat-yofEducation] I~mat- [Alexander] convened a group of us with an eminent sociologist, a guy I have a lot ofrespect for and who hasdonealot ofworkin thisareaforvears. Wewere kicking around the question, "M'hy don't our schools \vork any more?" And he said, "Heck, it's very basic. LVhat vou are trying to do with your schools is for a hunch of folks who don't exist any more." This gets to the access issue, what !ou need to do \I-ith folks. They can't get at you, and you can't get at them. So ~41~ don't YOU think about it? I think back to the txprt-icnces I had as a principal years ago, working in an area \vhere poor parents had many of the same prohtettts that ~UII have addressed in your presenta- tions. The\- worked. They had to jvot-k. They had to get tttcir w)ung\ter\ off early they couldn't get hack to " . . . you've got to join us in that message that. . . our schools must become user friendly, to provide a setting for one- stop shopping-places where education can go on and where mukibm3y senices can go on. . . ." cchonl to attend sessions orconf'errnces or this. that. or the other thing. At that time. xve had Title l-that \vas 27 years ago, when I came on board-and lye developed what we called extended school. This is very. similar to what Lamar mentioned that Decatur [Georgia] is doing 1101~. M'e ha1.e the Federal resources to open up the access issue. You can change the mindsets out there if you .join us in that attempt, working \vith our State commissioners, your State legislators, and your local school folks to "a)- that there is a system out there that will support your needs, if it is prop+. designed. LVe want access to it, and we want to use it. But !w~`ve got tojoin us in that message that we arr tqing to get across to people that our schools must become user friendlv, to prwide a setting for one-stop shopping-places where education can go on and where multif:nmil~ services can go on in terms of local agency semices, State agencv services. and. of course, the edrlcational srlvices that should go on on a continumn, places where a school operates from early in the morning until late at night and on weekends and is open during the school year, where it never closes, and it shouldn't. It's your largest real propert!' im.estment. It doesn't mean the teachers. as I.amar pointed oiit iii his remarks. haw to take on all thew other chores. .rhCV ;1l`P not tl.aillcd to do so-fine. But with that kind of setting, or a setting comparable to it in a community, we can reach and provide fi)r children and their families the kinds of needs that 1j.e need to meet today. It really bothers me terribly-to the point where I don't understand it-lvhen I think back to the late 19.3)~ and 1960s. LVhen we built elementam schools, we built little clinics in them, and dental centers, and so forth. TI?. to find a new elemental? school today that has that provision where lve can provide that kind of sellice to a child and his family. It doesn`t happen an! more. \Z'e have to return to some of the things we identified earlier on that parents need and children need and get back to it ancl make those provisions and open up those schools to do those things. Let me talk about transition for a minute. Ldrly [Bell] ux+ talking ahout transition. Let me throw out a bias of mine that we'w been tqing to work with- [<:on~missionr1-- of the ,Administration for Children, Youth and Families, Department of Health and Human Sel-\ices] \l'ade Horn and his folks. Transition. to me, means from conception to birth; it means from birth to school and community; and it means to the final thing that the President has also mentioned, and that is to making a life. Cnless Ive have the kind of system in place that provides for that and can deliver that, we're going to find ourselves generationally not making strides that we need to make to address the needs that we have toda!,. Looking at some of the things that I looked at for the past 3 days in a Third M'orld country-that can't happen here. L2'e have the ingenuity, resources, intel- lect, and experience that most people don't on how to approach this effort, and we can do it. Let me sa!`in closing thatifweusewhatwe know and use it creatively, lve can de\-elop support for what we are tl:ing to put through in I-ealltllorization ofall the elemen- tal-y and seconday programs-that's 57 programs and currend!. over $9 billioll. Mhat we are tn-ing to say is that \w need a massiw urban inten.ention program utilbing Federal IWOWC~Y ill conjunction \\ith State and local resources to prcnide for communities. an opportunitv to pl;ii~ fir \chatt~\w liiiinht7 of IXYII~ ir take5 to pull those w5iourct~\ lf)j:t~tl~tv. Iocatiqq the scl~ool ~~~~ainotlwr center as a hub to pi-wide an csrcwclctl set-\& or euttwdrd school concept so that children and their families can utilize. thevarious resourcesin collaboration to accommo- date the needs we have. \Vr have many programs out there currcii tly. for example, that can help each other. For example. \Vade's program [Head Start], even with the President's increasr, will still not se17.e all dir ~~oringsters Ivlio are currently eligible. But M'ade can use our program Even Start, which is for children 0 through 7 years old and their parents, to provide not only parenting and child care sel-\ices but also job training and placement ser- vices. That program can buy Head Start seiyices. can be used to expand Head Start sellices, or can create its own. Our Chapter I program, lvhich is basically age neutral. can also be used to by Hrad Start sellices. expand Head Start senices. or bur. their o~vn. In other words, what I am sa!+ng is that in terms of integrating what we haw currentl\~ on the books today, we can do a better job. M'ith our Department of Agriculture, with its LVomen. Infants. and (:hildrtw [MI'IC] programs, \ve've recenth signed a 1lemoran- dum of Understanding I\,ith them so that our \Ligrant programs can iitiliye \+I(: stwice5. \Ve \\aiit lo c~xpantl that to Even Start because (Congress. on our request. has now expanded the age range. Ilot for children from 1 through 7 years old. but from 0 to i: I Irish I could get it from prenatal to 7. But it's in this\va\.that \vv tie things together. and the Surgeon (;cnc~-al and hrr officr l\ith the Healthy Childrrn Read!, to Learn Task Fol-cc has been instrumental in pulling those of us together \vho have been wwrking on this so that, again. Eve are mart integrated than WE have been before. M'el~illcontinrle tostrive in thisdirection, butweare going to need your support lvith Congress to continue in this direction, lvhere we are pulling together and coordi- nating all the Federal efforts around the one focus-lvhat L\-e need to do for our children and our families who need them the most. Thank you VCIT much. Pwsident Bush has told those of us whom he appointed to jobs in his adininistl-atiotl that he wanted us "to work to t-rorient gor.ernmenT to better seme the needs of individuals." 1 rtmember that quote exactly because I thought that was so critical to defining our jobs; it is certainlv critical to defining why Dr. Novello has con- \,ened this Conference: to talk about one group of people-children and their parents-and hog., bywork- ing together with parents on behalf of healthy children, ~vc are helping children be ready to learn and to grow strong. Your confidence in Dr. Novello is vey well placed, and I know that she has been not only an outstanding spokesperson for these issues, but also, in convening all of us together, is making a constructive ef'fort to seeing this happen. I've learned a lot alread! today, and I'd like to share some thoughts in several areas: one-stop shopping, senice coordination, im- pro\iyg services. empowerment, and then finally some ideas about solutions. Before I start. though, first of all I wzit to explain \\-h!. I am here. r\s Secretay. Madigan said when he spoke !wterday. the Department ofAgriculture spends more' than half of its budget on food assistance pro- grams for the poor and for children throughout the country. So in m!. portfolio, I manage the Food Stamp program, school lunch and breakfast, MIC, summel f&d program. food program on Indian resen,ations, food for the elderly, food for childcare centers, Head Start centers, and others--there are 13 programs all together. with Food Stamps, school lunch, and 17C being the largest. Also, I come here as a colleague of the people at the table and as a colleague of Dr. Novello's and Dr. Mason's. Onr-stop shopping, as Dr. Mason said, is abso- lutely a must around the country. We agree totally on that issue in bringing all social services together, and as every speaker here said, that is a critical component. M'e have been sending a lot ofbooks to Delaware because 12 centers there have combined all social senices except forjob training-M'IC. Food Stamps, AFDC, Medicaid, 82 Pa-m\ Speak Out for America's Children \arious child development projects and programs-all together itI one office. I visited one of thaw offices: it was a pleasant place. One receptionist see\ the clients. and all of their information is on a computer. u9~ich sounds simple and makes sense. But it wx\ a Hugh undertaking for the State to cotxince the different Federal agencies ittvolwd to all participate in that project. It is a tnodcl. and \\v encouragt tnan~~ States- we sent many people there--to see how that works, hoping that UY can help them go more tolvard one-stop shopping in putting sewices together. The President mentioned the immunization pro- gram. M'e've been vev involved in that from the M'IC perspective because it isone ofthe fewplaceswherever) \uung children come within the sx-stem. If we can combine setTices and provide immunization services there at L1'IC clinics, it might he a \`et-) productive and helpful program to initiate. To that end, Dr. Mason and I ha1.e bcrn wn-king aggressively with health directors arottnd the countty~ to promotejoint senices for immu- ni/ation and I\?C. Secretar~~ Sladigan yestet-da!- mentioned direct certification fix-children in the school 1~1nch program. This is a ct-itical program. and I Icant to expand on it brieflv. It doew7~ make sense that a child may not be able to access a school lunch or breakfastjust because ofa hunch of papetxw-k that wxsn't turned in. Thewy the system uwrked before direct certification, as you knolv, was that at the beginning of the year, the school sent home a form, through the child, to the parent that said, "Please fill out this form. Your child may be eligible for a free or reduced-price meal; tell us your income." Many times those papers don't get returned; a lot of parents don't want to fill out that paper; sotne parents may never get it; some parents may not be able to read it. So children end up not being in the school lunch and breakfast program, under which they ma) be eligible for free meals, because of paperwork. What direct certification is doing-and in the counties that have started this already, we'\-e had great success. and it jusf began in September-is martying computer lists. The). mart-y the computer list of the kids enrolled in school with the families 1 hat are enrolled in AFDC and Food Stamps. The!, keep this confidential; it follo\vs all the confidentiality requirements. But instead of get- ting a letter stating that `kwtt- child may he eligible," \vhcn this \vorl;s-and it has Ivot-ked so fat- in the mast\ schools that lla1.e startr,d it-pat-ents get a leclc,l- 21 home that s;tu. "\i~~1t~~~ltil~Iis~~li~:il~lr~fi~i~~cil00l IIIll(~I1." .-\ll(]. in f':lcl. \\]lyrhc.t tilt' le.ll(.l c'\t`l gc'lS ll()l11(' (`1 Il"I ()I- []l(, p;,1(`,1, ,(.`,(I\ I]](, 1(.11(.1 i\ it 1~~1~~\;1111 i1t.t .ill'(' lII(. child grts the lt~itclt or the brwhtlt5t. 1 \\ot~ltl ~ttco~ii~- agt' people to go l10111~ ;tntl il4k their school districl if they ha\7 done this 1~1. On the Food Stamp and .\FD(: hide. I 1~1s at the Department of Health and IIttntan Senices managing the ,\FD<: program beforr I cants IO [the Deparnnen~ of`] Agriculture. One of` the I-casons I ~\`a\ ashed to cot~le is that the;\tltltinistt-atiott caresabout ttying to put these programs together. Alntoat e~~~~otte ~vho is att AFDC rrcipiettt receives Food Sta~ttps, :und tlir ttiajorit\. of Food Statnprecipi~ntrrecri\r,~FD(:. Itcertainl! makes sense to sinnplifi the rules and regulations. The people who determine eligibilit\. have thick books in ever) State for each ofXFDC, Food Stamps, and Medicaid. Atn~~ne having to learn the rules and how to ~vork through them takes OII a fairly remarkable chore. So Ivhat Eve are doing is \2-ot-king on the Federal level to identify eligihilit\ requirements. So far, lve've identified 32 eligihilit\ factors that at-e different in the t~vo programs. ancl \ve are lvot-king now to determine \vhich ones Eve can change to make them the same ot- similar, so it \vill he easier for eligibilit%. ~vorkera to manage. and ttltititatel~ easier for those \vlio at-e in need to access the sl3tettt itt both programs. M'e learned from this process. ho~ve\w, that MY have to idetitie- these [need4 chatige5]. bitt \\`e can'1 make all the changes otu-selves. .\lall\~ of thr ctlall~:es \\ill require congressional approL4. and we \\ill be looking at changes Iv. - can t~iakcc in the Federal (;o\-vrti- ment and idrntifving jvhcn NY nercl to go to (:ottgrew to request other changes. I found out one of thesr changrs lvhtm I first catttt~ to this,job. In Alahat~m I \vrttt to a Food Stamp office to apph for Foot1 Stamps because I wanted to we Ito\\ the system lvorked. I filled out lots of forms. and tltrtt the worker gave me one fortn that inclicated l had to take it home and have tny husband fill it out. I haid. "\I%!~? Yott'rr taking me at rn!. uwrd that I'm the head of the household, and all these other fin-ms are OK for tne to sign. LZ'h\- do I have to take this one home fc,t- him to sign! -** "\Vell, because that's the requirement. Evet-r adult in the housrhold has to siCgn this particular form." iVeIl, that didti't make an! sense to me, \\hatever; it \vas a tctrtn draliug \\ith ~vltrther or ttot \vc' \vere L'.S. citiLettr. So. 1 came back and asked questions about it, and a lot of'tlte cliCgihility workers laughed. M'e'd been telling you that this \+`as duplication fi)r a long time. LVe proposed in the Farm Bill to Congress that they change this and elintinatt: the t~vo signature requirement, and MY got it changed. Thar leas the good news. Then we fottttd out that .XFDC: and Meclicaid have the satne reqttirrtnetit. The final point on setTice coordination that I \vatlt to mention is what I think is the most exciting one we are working ott, and that is called Electronic Betteftt Transfer. M'e ha1.e now in the Food Stamp program a pilot prqject. and I lvant to explain what it is. This EBT, as it's called, is using the equivalent of bank hTAM [Xutomatic Teller Machine] technolog? for the pur- pose of pro\iding benefits for Food Statnps and, poten- Ml!., fat-.kFD(:. \\`I(:. and other programs as well. The \~a\. this ~vot-ks is. or would be, that there are no longer food cot~ponx in any cot~~tnut~ity that undertakes this project. People get a plastic card ancl have a private PIN [Pctvmal Identification Sut~~het-1. The State or the c01111t\ pl-ogl-"llls the atII0~1tIt of inone!. that \\ould otlieruist~ he food coupoti tiiotie\' into the a~~otmt. \Vheti a client takes the card to the grocery store. the t-ecipienr runs this card throttgh a titactiin~ at the checkout line. and it debits the appropriate Food Statnp accotttit for that titotitli. Shr cot~ltl also else it. if it's an .-\FD<: card. in a bank cash machine to take out hr~- .-\FD(: allortn~ttt, ttot ttrccwarily in one lump sum, altliough that is ccl-taittlv her option. hut alro in an\ ~~lllollllt\ that she nxnts for the lllolIttl \Vt- haw, itt the areas \vhet-e we are testing this [EBT]-Reading, PA-\: .-Ubttqttet-que. X51: Casper. L\1. (for \2`1(:): Ramsey- ( :outtt\., 11s; and Baltimore, \ID- onh praise front clients \vho have been using this and from the Governtnent and the pri\.ate sector ~vho ha\.r been using it as ~~211, with one exception that I \\ill mention in a minute. The people uho use Food Stamps in ,AFDC ha\.e hem thrilled with it, and the comments that we heat- and the research that we have Sal' that people like it. They like it because, first of all. it gives them security people don't have to wait at the mailbox 84 Parent\ Spsah Out for America's Children "Children are empowered by getting a good breakfast and lunch at school so that they can learn better." (as they must if' their food coupons or thrir .WD(: is mailed) to make sure they. get it. They dott't have to cash the .%FDC check in one lump ~111 and aomt.tin1t.s pay rnone)' to a check cashing plaw to get it cashed: it empowers them to be able to make decisiona about ho\\ much money the!, scant at each particular titnr.. \tllrn the): use this card in the grocety store. the\, dott't haw to deal with the coupons and counting out the coupons and dealing with it: the\, don't haw to deal with anvone else trving to steal and use their coupons before the!, get to thegrocet-ystore. It'saquicket-wa~toget through the system when they get to the grocety store. In M'yoming, one woman at a cash register told me that she had been a \7C client and now she was working, managing the cashiers in the store. One of the reasons that she liked working there MX that the card took the confrontation away in the tine. Because (this program was in MTC, she said, but it could \vork in M'I(: or Food Stamps) the machine says what's eligible and what's not eligible, there doesn't have to be a battle between two people for that purpose. It's a benefit for the stores; it helps them mo\`e people through the line faster. It's a benefit for the clients on L27(: because !-071 don't get otw~ouchet-, one time a month. MXenvou get one voucher once a month \`ou haw to ust' it all. atid that's tough if they don't have vow type of cereal that day. M'ith this new system, you can go back and use the card again; vou don't have to buy all of vow milk once a month and have it rot in the refrigerator, but you can go back o\et- and over again. It's a real plus. It'salsoa plusfor the taxpayers, I have to say, because it will ensure that all of the money that the taxpayers are spending on food-in out- budget this year is $34 billion- \\,ill be spent on food. and it ~511 be an overall plus. M%at ~vt' have to do is ensure that it's cost effective, and the wav that it's cost effecti\,e \ve hope, through our studies, is through combining set-\-ices. If \ve combine Food Statnps and AFDC and per- haps MI<:, and perhaps someday other programs that \vc can sa1.e on the administrative costs. which I think Eva\ t~~entiot~ed b\, a couple of speakers before, it wilt tl+ 11s ill th' hllg J-1111. That is the one problem: \ve haw not yet pt-owd that it will save administrative Monet-, but lve are determined to do that. States can implement this program for Food Stamps after April 1 of this !~at- without a ctetllotlstt-ation project. >-L5 far as imprwing set-\-ices, as Secretary [of@icul- ture] .\Iadigan said. President Bush for the last 2 years has iiicreased the 1\7<: program by proposing larger increases than any president ever-S223 million last year. $240 million this year. That combined total is going to help us set\`e more than 300,000 tnore people in the \?C pre gram. Improving senices in M'IC goes beyondjust putting more people in the program: it extends to improving the actual senices that we provide. One of the things that we've done in the NTC program is to look. for instance, at the issue of protnot- ing breast feeding, and the issue of helping to empolver mothers to make a choice between breast feeding and bottle feeding after they have given birth. Once when I visited a\$`I(: store in Mississippi and Ivent through the line looking at what I Mould buy, I told them I was a breast-feeding mom. I scanted to go through the line as a breast-feeding tnom attd pick up the food I would get. I picked up mv peanut butter. eggs. cereal, milk, and 111:' other products and thn they said. "Oh, rvell. if' \`()I1 \\c*-~JI'~ bt-t~astfecditlg. ltet-c. this i'i the ti~J~l1llI1~l tIl;ll IOIl \\y,(]ld MT'," \l'ell. thrl~c' I\;)\ \O 11111(.h fOJ~lJlll~~l f(,J rlJ(' month that I couldn't carry it out of the `store! It is no wonder to me that onlv 10 percent of M'I(: moms breastfeed, when people may he thinking that they ma! be giving up thislvondet-fit1 option of this great formula for their child. Not only would we like to empowet- women in making this choice. hut also provide mot-e nutrients for women who are breastfeeding. LVe filed a notice with the I;p~~tnl Register asking for comments. and we intend to file a proposed rule as soon as we can to offer a separate package for breastfeeding motns in the MIC program. In closing, school breakfast is critical for children coming to school read\- to learn-all of our studies show that. Half the schools that ha\-e lunch also have breakfast; we can have more. We've been going aroutid the country encouraging schools to offer school break- fasts, and it's realty critical for children to come to school ready to learn. The swmier food progratn is available-schools can offer it during the summer and pri\ate non-profit schools can offer it during the sum- mer to help children have tneats at school. ,-\I1 of these programs empower people. The M1(: program em- powers mothers to help make good decisions hv educa- tion and nutritional support. Childt-et1 at-r empo\vet-ed by getting a good breakfast and lunch at school so that the), can learn better. These programs are empowered by your comments and your direction to us. The solutions? How can we ivot-k together? EBT can start in States for Food Statnps aftet- Xpril of this year. You can tell \our State administrators and own county administrators that you think that thev ought to have EBT. You can work with our regional offices. M'e will work with you, and I will takeJim Mason's lead and work with the public welfare administrators and com- municate )`our comments specifically when I meet with the State Welfare Commissioners in 2 weeks. We can work together with changes that will simplify the appli- cation of AFDC and Food Stamps when we come up with proposals. We can work together becausewe need your help convincing our colleagues on the Agricul- tural, M'avs and Means, Finance, Education, and Labot Committees. It would be helpful if we had similar rules for att of these programs. You also can help by going to 86 Parents Speak Out for America's Children vow school, and ifvou don't have school breakfast, tell the school. school board, or someone else who is a decisionmaker in your community that you want school breakfast for the children in your school. It's an entitte- ment prog~xn; the Bush budget anticipates at least NO schools entering the program next year, but it takes cotntnunit~ leadership and community support to get that done through the schools. Every person in this room, those of us at this table, be they the parent presenters or the people in the Administration, can do a lot to work toget her so that we can take vour direction, the thoughts that we have, and implement. We can implement the President's direction to us to reorient government to better seme the needs of individuals. Thank you vet-y much. Wade Horn, Ph.D. Commissionu~ .-l[lminist,-ntio,,for Children, Youth andFmnilies I `. S. De~xwtm~nt o]`H~nlth nnd Human Sewices It is a pleasure to be here today at the closing day of this Conference and I want to thank the Surgeon General fhr the invitation to participate here, but particularly to thank her for her rzisdotn in acknowledging and t-ecogniAtig the importance of the role of parents in helping to get their kids to school health! atnd ready- to learn. If we needed any mhdation of how criticall\ important parents are, we'\.e heat-d that fi-om the three reprrsentatives here on the panel this mot-nitlg. I lrarn notjust from parents but also f'tx~ii my o\vti children,\vhich I think alI of'u~do. Xnd it'4 Ixxxus~ of.m\ 01vti experiences \vith iii\ olvti kids that I ha\.c t~~iiiaitietl committed to tnitig to help iI\ bc3t I cat1 in 1111 pf-rwtll position, help programs help parettts raiw their kitls. because kids are out-future. I could bc txxl brief`hew and 1 could ~a>`. "Guess \vhat. 1 t-t111 Htwl Stat-t. Head Start loot-ks; it's great." tit doubts, ;iiid cvmhod\ could applaud. Because Head Start i.c a great pt-ogram: Iwotrw it. in fAct. twbodics much of\vhat it is that thr patx*nfs tal!-.ctl about toda\~. It embodies parent inwl\t'm~nt and empowcl-- ment. HeadStart haslongrecogt~i/edth;tt pat-ettt4ar~ tJtt firstand niostitiipot-tatitedttcatot~softltrit~cltil~It~eti. .111tl NY'V~ embodied that etnpo~verment in thr Hcd Start parent policy councils. Also, Head Start integratccl health senices with social senices long ago. Do thou know that Head Start tnakes arrangctnenr.s for one of the largest delivery systems of health senices to poor childt-en in this cou11t1-G Last !`ear, more than 600,000 children in Head Start got free medical and dental screenings and follwup treatment, as well as itnmunilations, through the Head Start program. It has also been a leader in removing barriers to children with disabilities in terms of incorporating them and involving them in the program as well. Head Start has long recognized that children with disabilities need to be mainstreamed. M'e were doing that back in 196.3. I was in the 5th grade, but in 196.3, we \vere doing that. And we were a leader in that. In fact, today, almost 14 percent of all children enrolled in Head Start are children with disabilities. We even pay parents for their knowledge. Do you know that almost 40 percent of all paid staff in Head Stxt are parents of children either currentI\- enrolled in Head Start or formerlv enrolled? But I'm not satisfied. and we shouldn't be satisfied because there is still much to be done. I ani,just going to mention three titw challctigt3 and initiati\-e\ we are undertaking in Head Start. Fit \I of all, \ve need more money we need to serve more kids. The President, over the last 4 years, has increased our budget by $1.6 billion. That's an incredible achieve- mcnt--that's real money, even here in \%shington. The second thing we tteed to do is increase senices to adults of children enrolled in Head Start. In the old da\-s. \vc had this naive belief that we could save children 1~~ taking them out of`the home, working with them, and wnding rhrm back. Lye know that doesn't work. Ifwe are going to help children, UY have to help their parents. O\w the last 3 vears 1t.e have been improving the kinds attd quAiF. of senices to adults of children enrolled in Hcxl Stat-t. particularl!.in the area ofadult literacy. By the twd ol'this~~eat-, \ve lvill have an adult literacy program in e\w?. Head Start progt-atn in this county. M'e need to do a beuet-,job of' \\,ot-king lvith substance abuse problems \vhtw the\. exist in the families we serve. A recent stud! sho~~x that at least 20 percent of all adults who have children enrolled in Head Start have a serious substance abuw problem. \Ve need to do a better job, and we've hem workingwith Dr. Mason and his staff, particularly in the Office for Substance Abuse Prevention and also with the Office of Treatment Improvement, to tv to better coordinate senices around substance abuse issues in Head Stat-t. focused on the parents. The third thing we need to do is to use Head Start as a wedge to increase job skills of the parents who ha\ie their children enrolled in Head Start, and we've been doing that in active collaboration with the new Uob Opportunities and Basic Skills training] JOBS program, the 1988 Family M'elfare Act. and also with trying to merge or coordinate with the [Job Training Partnership Act] JTP.A prOgI-dlllS aS Well. M'e have to recognize that times have changed. We have a number of homes with no parents at home when Head Start is done at 12 noon. \Ve have to do a betterjob of coordinating with new childcare monies, and particu- larly childcare development block grant monies to etlsm-e that, for those Head Start children who have parents employd outside the home, NY can krrp thw ctmters optw so tliosr kid\ dotl't h;nc to be bttwY~ aCl~()~~ t,)\,.ttT();tll()tllt.t cc'ttI(`t.or.\\ot4(`\(`t ~~rt~tlittlot~~lt.t~~~~~~tt~. ,tallt IIOI~I~. \\itlr t11c. 1101x' tltitt \~~~I~c~~N~(I\ i\ tftc,tc'. Finall\-, in WI-ms of`tl-ansition. wv haw to do ;I better ,job of mo\ing kids from Head Start into the public schools. IAI-IT Bell talked about nuking our kids rcad\, fir school. but he also said that \VY ha1.e to do 3 better- job of makiligo~u-schoolar~ad~-fi,rolII-kids. \Vv do. Sonictimes people point to Hracl &II-t. a11t1 thev sin. "DOYOU think it's a success? It`s not ii stIccess. BCYXL~Y~~ kno~vnhat? LUteI vow kid gets a vear w tuv of Head Start. .5 wan doum the road, the gains start to dissipate." A~lcl I ~a!-, "Sure. If the child graduates into neighborhoods that are riddled \vith violence. ifthechildgraduate5into homes thatarr riddled with substance abuse, if the child graduates into 5cl1ools that are unresponsive to the needs of their children. rthat do you expect?" Head Start is not an inoculation against eveI?thing that can possibly go MIXES in that child's communitv. The fault is not Head Start's; \ve nerd to do a better job of jvhat happens to those childwn nllrn the\, leave Head Start. That's why it's been 50 grati+ing o\w the last 3 vears to work with Jack ~IacDonald in enawing that we make those connections het\veen Head Start and the public schools. Thankvou for the imitation to be hew. Christine Nye Diwcto~ .\lrclircd Hll ww 11 I want to thank [parent presentvr~] I .~I-I?' Bvll. Sliwlita Reeves, and Ellir \.alcle/-Ho~~e~111~111 li)r \our comments this morning. It's ahvays so crucial :ulcl important that \\c' hear the things that concern and intt'wst yu \luch of' what I heard this morning had to do Lvith the .\ledicaid pro`gram. The intereatiyg thing about this (Zonfcrence and\\.hat I've heard thismorningiis that it ctrncka rrle\wit chord for me not onh, as a parent but also a5 an adminis- trator of the Medicaid program. `1~ Dr. X4ason said, I reall!~ didn't know hou, to fl-ame 111~ remarks to YOU this morning, but it's absolutel~~ true that you lvant these things to happen. M'e IVdIlt these things to happen too, so \vhy don't the!. happen? Let's nuke them happen, and I think that is so important. Sot only are we all as parents sorneho~~,affected or infected b! the things that you said this morning; it goes deeper than that in other ways too. Forexample, I'm the parent oft~\,odaughters, one of ~vhom should ha\.c lxen 4 a month ago, hut who, despite all the efforts oftechnolofl, died. .&id I'm also the parent of a little girl l\ho lvill he ?J next week. So I ha\v, personall>-, lx~ause of that, a deep commitment to man>. of the things that you do. Sirriilarl!,, I can go through people i11 the Medicaid Bureau \vho are lvork- ing OII eligihilit\. pohc!., on home- and community- based 1vaiI.er.s. ul~o also have a commitment to making things better, not only ;IS professional people working in the Medicaid program, but who also are per$onall! inwh.etl in some of the things that VOLI are involved in as well. And that occurs not only at the Federal level- that WY as people \hare these things-but also at the State and local lt3.elr. 1 I\ nnted to make a few comments today, and there are man! things that I could say-so may'things thatwe arc toting to accomplish, so man\ areas \vhere \ve are still falling short, so man!` things that we have tolvork 011 togc-thrr. \fedicaid is a massive program. It senes almost :. cnsurt tnasinttm fi-cedom of choice, atid give e\.et7.fatttil~.-rich or poet`. 5icE, 01` healthy-access to IlPaltll cat-e. I kllO\\ how important thi5 is. patxicttlarl~ for parrnts !vho lta\v childreti with special needs. \I\- plan \vill cw4t1rc tltat wtt can change jobs \vithout etitlatt~c`riti~ the health insurance on which 10111 cltild d~.pettds. \\`c't.c brtiltl- ing on our sv\teni'\ \tt.etlglhs. \\.r't-c ;i\oidiiig tht pitfitlls of`tiatiottali~~tl care. tllc kind that propIt. fi.otn all over the I\-orltl cotiie to .\tiirt~ica to ~w;tpt'. .-Ul these appl-oat-lirs f'ot. Inec,titig oui- goal of healthy children wads- to 1t';irii must build 011 ;I Ix~aic truth, that, in thiscotIttti3. f';itiiilics COIIIC first. (;o\ct-tt- tllrllt l~"ogl-allls that cnxTtaLe tl1r I'l* `~rlitfitl tx~l~ of' l'attti- liesa~~tlcotniiiut~iti~s.tl~It~ tltvitt thr. fi-cctlotII of`c~ltoicx~. ot- hind tlivtii itp in t-cd tape ;II`C ~itirpl\~ ttttac~cept;tblc. Our tiio~x~nietit i\ about sttxwgth~iiitt~ f':ttttilitx O\YI- the next fc-\vdms. I'm tolrl\-oti~~illco~ttittt~t~;~~t-that national dialog. slim-e it~fotm~atiott. esplotx~ nc'xv i&a\. and then r~tiwti to u)t~r c.otntiiutiitit.~ to lead thv good fight. Your coniniittneut is an in+t-atiott. and I thattk T~LI for inviting nie to get a f'wlitig of` it fit-sthatid. May God bless all O~`\YNI. Thank you al1 and tna> God bless America. Thank you \-et-!. vu-\- mt~ch. Louis W. Sullivan, M.D. Secreta~r~ of Health and Hurnnn Services G ood morning. It is a sincere pleasttrr to b~elconte eveqm~te to the "Health!, ~~hildren Ready to Lxarn" Cotiferencr. I'd like to take a nmnent to commend m)- colleague, Dr. Antonia Novello. wtw has ken working diligvntl~~ during her tenttrt' at the Ikpartnwnt of Health and Humat~ Set~ices to improw the health and wzll- being of America's children. This vu?. timel! and itnporta~~t Conference is the culmination of' 18 niontl~s of planning among the Office of the Surgeon Gmetxl, the Departtn~nt.s c)f.Agricultttrr and Education. the Sadonal Go~xm~ors AwF ciation. and so tnanv others. I ant confident that this C:onfrr- encc' \\ill pIa\ ail cwtwtial role in 0111` dt'l~tt-ttltc'llt-\\idt, t%ftc )rt to itnpt-ow school waditi~ss. J'ou know it is not often that we policytnakers in \Vashington stop to conf&- with the real experts about the challenges fxing,1nwtican children. But todaywe arc. Today. 1t.e arc convening parents from evey State in our Sation. Together with educators and health pt-of'+ssionals ft-om the front lines, \ce can network, share promising progran~s. and strategire about holvlve c;ut tnt'et thr President'\ first Sational Education Goal tliat "b!. the x.eat- 2000 all children in America will start \c11001 1xYid\ to learIl." .-\s \ve all knojv, ;I good beginning is often the lie! to wcct'ss. This is v\pt,cially true tvhen we speak of cltiltlt~cn. .\s parettts. health cat-e professionals, psy- cltologict~. edttcators, and othet-s who u~~t-li with chil- dtwtt uill atteat. the rxpetiences of childhood shape the ~otirsi(~ of` ;I lifetime. This sentiment leas beautifull> c;tptrtrtd b\~,john \lilton, \vhow-ate: "Childhood sholvs thr. tttan as mot-nitlg sho\vs the day." M'hat determines whether a childhood is a beau- tiful sunrise in wartn tones of amber and crimson, or a grim, colorless dawn? First and foremost, a child needs to be secure in the love of his or her parents. h father who reads to his child each night before bed, or a mother who proudly displays crayon masterpieces on the refrigerator, is real])- laying the groundwork for a positive school experience. In addition, a warm, color- ful childhood is a healthv childhood. Children's health and their ability to learn are mutually dependent. Be- ing ready to learn depends upon a child haling enough to eat, being protected frotn preventable diseases, grow- ing up free from environmental pollutants, and having access to health care. Helping parents to provide a healthy childhood for their children is a central part of the mission of my Department. In his fiscal year 1993 budget, President Bush has provided us a blueprint for action. The President's budget proposal has three areas of emphasis: First, j\e must imrest in children; second, we must focus on preyen- tion; and third, programs must empower parents. Investing in Children Investing in children is sitnpl!, good health care polic!. The time and resources we devote to children now will pay continuous dividends in the future in the form of healthier and tnore productive citizens. In recognition .- _ : "I tr@j%&%zv~ &at th&amiIy is redly the fi&vd best department ofl<h and humAn.services. And:I"d like to say, as well, &at parents axe a child's first and -best .d-epartment of education,? _ __ r ofthis tact, the Pt-esidrnt's b@get proposes to increase im.estmettt progt-ams serving children to $100 billion, up from S60 billion in 1989. Healthy Start The first few years of life, beginning in the womb, are the most crucial period of child development. There- fore, if we truly desire to invest in the next generation, we must begin before the child is even born. We must begin bv making sure every mother receives early, quality prenatal care. Overall, nearly 25 percent of all women-and nearly 40 percent of Black and Hispanic women-do not receive prenatal care in their first trimester of pregnancy. Lack of prenatal care is a contributing factor to this Nation's disgraceful it&ant mortality t-ate. Despite spending tnore on health cat-e than an): other nation, the United States retnains 23th among nations in the rate ofsur~i~A of'infants. Each \`eat-, 40,000 American babies do not 1il.e to celebrate their first birthday. Black babies art' more than twice as likely as white babies to die. The President and I ha1.e made infant mortality a national priorit\ by developing a new infant health initiative, Health\ Start. Our strategy is to concentrate resourcw in 1 .i contn~ut~ities Ivith stubbornly high in- fant mortalit!. rates. Each community is given the flesibility to create a mix of setTices tailored to the tireds of their population. \Ve are requesting 5143 million to prwide these 1.5 communities with the re- sources necessary to full!, implement their detailed strategies for reducing infant mortality rates by at least 50 percent ovet- a .5-!,eat- period. We will use the kno\vledge gained from these demonstration prqjects as a model for other communities across the Nation. Focus on Prevention The President's budget also will focus resources and attention on pre\,entive health programs. Common sense argues that it is better to invest in prevention and screening programs than to Ivait until the advanced stages of disease. when treatment is more cotnplicated and more costly. 98 Parrnta Speak Out for America's Children "It is fto surprise that our most suc- cessful ~pfugrams for children-like Head Start-are built upon direct parental involvement." Immunizations Childhood immunizations are a~nong the most cost- effective prevention acti\,ities. Z\ Sl investment in measles-mumps-rubella Gwcine ma\- return S 11 in avoided medical care costs. M'e can be proud of the fact that 97 percent of American children entering school are immunized. Ho\\.ever, to be fully protected, chil- dren need to be properly immmlized by the time the! are 2 years old. Our rates among preschoolers are much lower, and in some inner-city areas, the immunization rate among 2 year olds is an abysmal 20 percent. That is whv the President has requested $.?2 mil- lion for our immunization activities-an increase of 138 percent since 1989. My Department will use this in- crease to target those children most at risk. These dollars will translate into 6.7 million polio vaccinations, 4.1 million measles-mumps-rubella vaccinations, and 2.6 million hepatitis B vaccinations. LeadPoisoning Lead poisoning, the most common environmental dis- ease ofyoung children, is another preventable disease. As many as 3 to 4 million American children under 6 years old may have lead levels in the blood high enough to cause developmental dclal.5. learning disabilities. heha\ioral problems, decreases in intelligence, and tA\.en death. Low-income, minority children growing up in ur- ban areasare most at risk ofhaving dangerously high levels of lead in their blood. The President's budget requests S40 million, a 90 percent increase, for CDC Lead Poison- ing Prevention Grants. These grantswill support about 30 statewide lead poisoning screening programs. Empower Parents The third emphasisofthe President's budget is thecritical role of parents and the need to support programs that empower pal-ents. I trul!. believe that the family is real]) the first and best department of health and human sel-\ices. LAnd I'd like to say, as well, that parents are a child's first and best department of education. Educators often speak of the "hidden curriculum of the home" to describe the important lessonswe learn during our first few years of life. We learn that our parents love us vel? much, and that gives us a sense of securitv. IZ'e learn how to share, and we learn right from left and right from wrong. These are not eas!' lessons to teach. And all too often this learning does not occur because parents cannot, or do not, attend to the needs of their children. It is no surprise that our most successful programs for children--like Head Start-are built upon direct pa- rental involvement. Head Start Head Start has won the confidence of the American people. It is known as a program that works and a program that is worthy of our tax dollars. Many of you in the audience are familiar with Head Start; some ma! even seme on parent councils, which guide the opera- tions of the individual centers. President Bush, a firm believer in the value of Head Start, has proposed the largest single-year funding in- crease in the histoy of Head Start. The $600 million he has requested will seme an estimated 157,000 additional children in 1993. These additions would mean that fUnding for Head Start has more than doubled since President Bush came to office. This unprecedented incrraae in He;ltl Start suppol-ts participation of`:ill vligit)lc ;uld iljtel.c4tc(l cti4;ld\;Itll`l~(.(l chiltllc'll 101' OII<' x(`;Il.. The President's Health Care Proposal In addition to targeted intet>.entions such as Head Start and Healthy Start, the President annout~ced last week his health care reform proposal. Under the President's plan, the middle class will get help to pa! for health care through a new income tax cleduction. For poor families, the plan guarantees access to health care through another new feature: a health insurance credit. In combination, these tax provisions Fuill help more than 90 million ;\mericans and covet- 93 percent of the uninsured. This morning I've outlined the tremendous ne\\ resources that the President wants to make available for children. But more money alone is not enough. The critical element of any initiative to help children is par- ents. Unfortunately. for reasons ranging from parental exhaustion to preoccupation with careers. children toda\ spend 40 percent less time rvith their parents than ther.did in 1963-an average of only 17 hours a \\,eek! To put that figure in perspective. Xmerican children spend an aver- age of 2.5 hours watching television each l\,eek. I'm encouraged to see so many parents alit1 child experts gathered for this Gmference. O\,er the next few days, you will have the opportunit!, to USC ~~~nr combined expertise to I~OIY this Sation to\vard the goal that all children lvill begin school read\- to learn. To borrow again f?om Milton, !-on jvill ha\.e the oppor- twnity to make childhood a \varm and radiant sunt-i$e. ushering in a day of golden hope. Thank you all. Godspeed to all of the Health!- Children Ready to Learn participants. Edward Madigan Secretary of Agm'culture N utrition is basic. hll things can be possible fol a child who is well fed: \er). little is possible to1 a child, or a pregnant mother, or anyone fat that matter, who doesn't get the nutritious foods \ve all need to grow, to learn, and to excel. It's ourjob to get that information to you and before the public and into e\,eryday practice. There are 64 million children in the United States t&a!,, and all of them share this need. That's why we're here this morning. The Prrsident recognized the importance of a strong nutrition foundation in his education initiative. The first of his six National Education Goals is that "B\ the \`ear %M~. all children in Xmerica will start school ready to learn." To achieve this, we have to ensure that they re- ceive the nutrition thev need for healthv minds and bodies. That responsibility begins before children are born. M'orking lvith mothers, we must ensure that the number of low-birthweight babies is significantly re- duced through good prenatal care. Xlthoughwe are investing large amounts ofmoney alld effort to help, it's the parents of children in these programs \vho have the primary role to play in their care and feeding. One of our best progratns for reaching both children and the parents of children at risk is the Supplemental Food Program for M'omen. Infants, and (:hilclren. or M'IC. This program provides suI~plrn~rntal food and nutrition education to low- incomr pregllant, postpartum. and hrrastfeeding \vomen: infants: ant1 voung children-all at nutritional risk. \\`I(: scr~.es OIIC in three babies born e\-etT' year. I That's about .!.?I million participants this month alone. ;\nd our highest priorit~~is 101\.-income pregnant \vomen and their infiints. LShat'.s more, \17C has become a gatr\\.a\.toothergo\.ei-ilmeiit ser\.iccs, especiallvhealth carr. Through \!I(:, pregnant women are learning about and obtaining health selyices they need. L.ocal 1VI(: agencies refer applicants to Sledicaid if it's like11 thw'rt` eligible. \2'1<: is an acljunct to health care that participants recei\.e at local health clinics. For example, M?C per- sonnel promote hreastfeeding among program partici- pants, coordinate with State and Federal immunization programs, and provide alcohol and drug abuse preven- tion education and referrals. \2'1<1 is cost-effective. X major study done in 1987-88 in five States shon-ed that Medicaid-eligible pregnant women who participate in MTC do indeed have healthier babies than low-income women who do 100 Parents Speak Out for America's Children