Tag: children

‘So much blood’: Medics tell what they saw and did after Uvalde massacre | CNN

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CNN
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Chilling details of the chaotic and bloody aftermath of the Uvalde school massacre show how emergency medics desperately treated multiple victims wherever they could and with whatever equipment they had, according to never-before-heard interviews.

Some came from off-duty or far away to back up their colleagues sent to Robb Elementary School, where classrooms had become kill zones but there were still lives to be saved.

There was the state trooper with emergency medical certification who always carried five chest seals with him, never imagining he would ever need them all at once; the local EMT who crouched behind a wall as gunshots rang out and was soon treating three children at the same time; and her off-duty colleague who found herself caring for her son’s classmates, not knowing if her own boy was alive.

Amanda Shoemake was on the first Uvalde EMS ambulance to arrive at the school last May 24, she told an investigator from the Texas Department of Public Safety. But with law enforcement officers waiting for 77 minutes to challenge the shooter, she spent time trying to direct traffic to maintain a lane for ambulances to get through once victims started coming out, she said, according to investigation records obtained by CNN.

“We were just waiting for what felt like a while. And then somebody … came and they were like, ‘OK, we need EMS now,’” she said in the interview, part of the DPS investigation into the failed response to the school shooting, in which 19 children and two teachers were killed. At least one teacher and two children were alive when officers finally stormed the classrooms, but they died later.

As Shoemake and colleagues reached the school building, they were told the shooter had not yet been found and could be in the ceiling, she recounted, saying how they sheltered behind a brick wall as the shooter was confronted.

“We just squatted down there and waited there until the shooting stopped,” she said. “And then after some time they brought out the first kid that was an obvious DOA.”

DPS trooper Zach Springer was one of the hundreds of law enforcement officers from across southwest Texas who responded to Robb when alerts went out for reinforcements. He had become certified as an EMT a few months earlier, he told the Texas Ranger who interviewed him.

“I made a conscious decision not to bring my rifle,” he said he thought as he drove up. “I knew there were so many people up there, they’re not going to need rifles, they’re going to need med gear.”

Springer entered the school and started getting a triage area ready at the end of the hallway where armed officers from the school force, local police department, sheriff’s office, state police and federal agencies were lined up. While commanders like then school police chief Pete Arredondo, then acting city police chief Mariano Pargas and Sheriff Ruben Nolasco have given various statements about whether they knew children were hurt and needed rescue, medics from many agencies prepared for victims.

“I set up as best I could,” he said. “I put tourniquets, gauze, Israeli bandages, compression bandages, hemostatic gauze. I was like, ‘I got everything, I think.’ … I had five chest seals, which is ridiculous in my opinion, like I’ve made fun of myself – when am I ever going to need five chest seals?”

He heard the breach and then started seeing children brought out amid the smoke from the brief but intense firefight, he said.

He went to help a Border Patrol medic treating a girl shot through the chest. He said he started checking her legs for injuries when he heard colleagues ask for a chest seal. In the chaos of the response, all had been taken.

Springer said they covered the girl’s wounds with gauze, got her onto a backboard and he repeatedly told the others to secure her head as they moved her, though he later believed the young victim was too small for the carrier.

I can still hear her voice

EMT Kathlene Torres after treating Mayah Zamora

“I don’t think that they secured her head because she wasn’t tall enough for her head to be secured,” he said. And while the girl was thought to be alive when they pulled her from the classroom, she did not survive, he said.

When he ran back in, the hallway lined with posters celebrating the end of the school year had been transformed. “You could smell the iron – there was so much blood,” he said.

Back outside, Uvalde EMS Shoemake had put the first victim in her ambulance to hide him from the crowds of anxious parents frantic for information, when another child was brought out. She saw an unattended ambulance from a private company with its door open and no stretcher, she said.

“I had them put her on the floor of that ambulance and I started treating her there. Then while I was treating her, there was two more 10-year-old boys brought to me and so I put one on the bench and one in the captain’s seat.”

Shoemake’s colleagues including Kathlene Torres came to help and got the little girl onto a stretcher and into another ambulance, working to save her life as they first thought a helicopter would take her and then getting her to the hospital themselves, they said.

Torres told a DPS officer the girl was critically injured but still managed to share her name and date of birth. She was Mayah Zamora, who would spend 66 days in hospital before she could go back to her family. “I can still hear her voice,” Torres said.

At least two of the EMTs had been at Robb earlier in the day to see awards presented to their children. One of them, Virginia Vela, had watched her 4th-grader son at a 10 a.m. ceremony and then two hours later was corralled in the funeral home parking lot across the street from the school with her husband and other parents who were being held back by officers.

She told the DPS investigator that she was recognized as a local EMT and allowed into the funeral home to treat some children who had been hurt climbing through windows to get away from the school.

Photos show chaotic scene as Uvalde students escape

When she went closer to the school to help the other EMTs, she saw the first victim brought out, a boy who was dead, she said.

“I thought it was my son,” she said. “Once I saw his clothes, I knew it wasn’t my son, but the fear … ran through my body.”

More children came for emergency medical treatment.

What I was thinking was ‘run buddy … get the hell away from that school, just run to the bus’

EMT Virginia Vela when she finally saw her son

“One of the kids that I had in the unit, he was shot in the shoulder. The student that I was helping up from the side of the unit, he had bullet fragments on his thigh,” she said. “And then we had another student with blown off fingers. And she was just in and out. We were trying to get her oxygen and trying to keep her alive. And I realized those were my son’s classmates and my son was not coming out.”

Vela opened the ambulance to see if more children were being brought to them. And finally, she saw her boy running from the school.

“I didn’t even run to him. I didn’t go get him. What I was thinking was ‘run buddy … get the hell away from that school, just run to the bus,’” she said. “I grabbed my phone, and I called my husband and my husband’s like, ‘I see him, I see him, he’s getting onto the bus, he’s OK.’ And I said, ‘OK, but I’ve got to stay here with these students.’ And I hung up and I continued to do my job.”

Vela told DPS she remembered a little more of the day after she knew her son was safe, but it was still a blur as she worked with Shoemake and the others, writing a child’s vitals on their arms and getting them on their way – load and go, load and go.

And once the emergency work was done, she had an important question.

“I asked my partner, ‘Did I freeze? Did I even help you?’ She goes, ‘Yes, girl. You were like jumping from unit to unit, helping everybody that was coming out,’” Vela said. “And I was like, I need to know this. I need to know that I continued doing my job.”

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March 18, 2023
In wake of Florida law, additional states seek to restrict certain LGBTQ discussions in schools | CNN Politics
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Washington
CNN
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Bills similar to Florida’s controversial legislation that bans certain instruction about sexual orientation and gender identity in schools are being considered in at least 15 states, data compiled by the American Civil Liberties Union and reviewed by CNN shows.

Some of the bills go further than the Florida law, dubbed by its critics as “Don’t Say Gay,” which sparked a furious nationwide discussion about LGBTQ rights, education policy and parental involvement in the classroom.

The debate reflects the sensitive forces of LGBTQ rights becoming increasingly ascendant at a time when some parents are seeking greater input in their children’s education, especially in the wake of the tumult wrought by the Covid-19 pandemic.

Republicans, arguing that discussions around gender identity and sexuality are inappropriate for young children, have used the banner of “parental rights” to push for a curtailment of such conversations in schools, even though opinions on the matter vary widely among parents. LGBTQ rights advocates see a conscious decision to stigmatize a vulnerable slice of American society and a potential chilling effect on what they believe to be urgently needed discussions.

“These bills are predicated on the belief that queer identities are a contagion while straight, cisgender identities are somehow more pure or correct,” Gillian Branstetter, a communications strategist for the ACLU, told CNN. “In truth, every student has a right to have their own life stories reflected back at them and every student benefits from stories that serve as a window into the lives of people different from them. Censorship and homogeneity benefit no one while denying all students an equal chance to learn, grow and thrive.”

The ACLU has tracked a total of 61 bills across 26 states, though efforts in several states, including Mississippi and Montana, have already failed. Earlier this month, Arkansas approved restrictions against such discussions through the fourth grade.

Ultimately, it’s unclear how many of the bills will be enacted. A Human Rights Campaign report released in January said that of 315 bills that they viewed as anti-LGBTQ that were introduced nationwide last year, only 29 – less than 10% – became law.

Florida’s law, titled the “Parental Rights in Education” bill, prohibits classroom instruction about sexual orientation or gender identity in kindergarten through third grade “or in a manner that is not age-appropriate or developmentally appropriate for students in accordance with state standards.” It also requires districts to notify a student’s parent if there’s a significant change in their mental or emotional well-being, which LGBTQ rights advocates argue could lead to some students being outed to their parents without the student’s knowledge or consent.

“We will continue to recognize that in the state of Florida, parents have a fundamental role in the education, health care and well-being of their children. We will not move from that,” Gov. Ron DeSantis, a Republican, said when he signed the bill in March 2022.

According to the Movement Advancement Project, a nonprofit think tank that advocates for issues including LGBTQ rights, Florida’s law was the catalyst for the bills currently under consideration in other states, which include:
An Iowa bill that passed the state House last week that would prohibit instruction about gender identity and sexual orientation from kindergarten through sixth grade.

A bill in Oregon that would prohibit any discussion on sexual identity for grades kindergarten through third grade without parental notification and consent.

Legislation in Alaska that would require parental notification two weeks prior to “any activity, class or program that includes content involving gender identity, human reproduction or sexual matters is provided to a child.”

Multiple bills in Florida that seek to double down on last year’s legislation, including one that requires instruction that “sex is determined by biology and reproductive function at birth” and another that prohibits requirements for employees to use pronouns that do not correspond with a student’s sex.
A recurring theme in the legislation is a requirement that school employees notify a parent if a child expresses a desire to be addressed by a pronoun that matches their gender identity if it differs from the one assigned at birth.

“We’re not saying that you can’t do this,” Washington Republican state Sen. Phil Fortunato, who introduced legislation that would limit instruction on gender and sexual identity for kindergarten through third grade, told CNN. “I mean, I disagree with it, but, you know, if the parents and the child agree with it, that is their decision. But they shouldn’t be doing it behind the parent’s back when their kid goes to school. And that’s the point of the bill.”

Missouri’s bill is uniquely far-reaching: no employee at a public or charter school would be allowed to “encourage a student under the age of eighteen years old to adopt a gender identity or sexual orientation,” though what the law means by “encourage” is not explained. School officials would be required to immediately notify parents if their child confides in them “discomfort or confusion” about their “official identity” and teachers would not be allowed to refer to a student by their preferred pronouns without first securing a parent’s approval.

The bill specifically calls for whistleblower protections for school employees who report violators, who would then face “charges seeking to suspend or revoke the teacher’s license to teach based upon charges of incompetence, immorality or neglect of duty.”

In a blog post entitled “Evil perpetrated on our children,” Missouri GOP state Sen. Mike Moon, who sponsored the legislation, called it a “lie that boys can be changed into girls and girls can be changed into boys.”

“One thing we must agree on, though, is that parents are responsible for the upbringing of their children,” he continued. “To that end, parents must be involved in the education of their children.”

The measures are likely to face swift legal challenges if enacted, though at least two efforts to block Florida’s law have so far failed to take it off the books. One of those lawsuits, brought by a group of students, parents and teachers in Florida, was thrown out last month by US District Judge Allen Winsor, a Trump appointee, who said the challengers were unable to show that they’ve been harmed by the law.

“Plaintiffs have shown a strident disagreement with the new law, and they have alleged facts to show its very existence causes them deep hurt and disappointment,” Winsor wrote in his order. “But to invoke a federal court’s jurisdiction, they must allege more. Their failure to do so requires dismissal.”

At the heart of opponents’ concerns is the vagueness in the laws’ language as written. LGBTQ issues are not generally a formal part of public school curricula, they point out, leaving educators with the prospect of having to determine where legal fault lines are drawn with nothing less than their careers at stake.

“What counts as classroom discussion? As classroom instruction? Does it just include the curriculum for the class?” asked Alice O’Brien, the general counsel for the Alice O’Brien, in an interview with CNN. “For example, does it include teachers’ lesson plans, or does it sweep so broadly as to include classroom discussion? A teacher answering a student’s question, a teacher perhaps intervening in an incident where one student is bullying another student because of that student’s prestige, sexual orientation or gender identity? It’s very unclear what is prohibited and what is not prohibited.”

There are other concerns. Naomi G. Goldberg, the deputy director of MAP, worries about a “chilling effect on teachers themselves in terms of their ability to support students in the classroom as well as the students themselves in the classroom.”

A similar point was made in a CNN op-ed last year by Claire McCully, a trans mother who is outraged over Florida’s law.

“Like any other parent, I expect my family to be welcomed and accepted by others at the school,” McCully wrote. “And of course, this acceptance might be more likely if some of the children’s stories read in classrooms feature two dads, two moms or even a trans mom.”

Cathryn Oakley, the state legislative director and senior counsel of the Human Rights Campaign, told CNN that using a student’s preferred pronouns is harmless to other students but deeply meaningful to trans children themselves. She urged a cautious approach that recognizes the need for schools to be a safe space for vulnerable children, particularly if there is a risk that outing a child before they are ready could lead to “family rejection or even violence.”

“No one is suggesting that this is information that won’t be relevant to parents,” she said. “But what we are saying is that young folks should be able to have this conversation on their own terms with their parents and not have a third party be forced to broker a conversation that could put that child in danger.”
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March 18, 2023
Child psychologist: The 6 most ‘extraordinary’ types of kids—and how parents can raise them to be successful

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Every parent is capable of raising happy, healthy and emotionally grounded kids. But many struggle along the way.

In my two decades of experience as a child psychologist, I’ve found that when parents aren’t attuned to their child’s temperament and unique traits, they fail to honor and celebrate their kid’s authentic self.

There are six most extraordinary and gifted types of kids. Your child may be more of one than the others, or a mix of all. Knowing their type will strengthen your relationship with each other and help them understand themselves better.

1. The Anxious Exploder

Anxious Exploders are often fussy, irritable and get triggered by the slightest thing.

Their beauty is that they’re highly sensitive and porous. But this means they tend to absorb the anxiety around them. And what to do they do with all of it? They explode!

Parenting tip: Be grounded, firm and calm. If you become reactive, either in anger or anxiety, it can set off a tsunami of emotions.

Praise them for their abilities to process their environment, but teach them to create the solace they need: “When you feel nervous, close your eyes and repeat to yourself, ‘I am safe, I am home, and I am going to be okay.’”

2. The Hyperactive Explorer

Hyperactive Explorers can’t sit still and are and never where you last left them.

These kids are often labeled as “troublesome” by parents and teachers because they can be overwhelmingly active in their mind and body. But their superpower is that they are incredibly curious and engaged.

Parenting tip: Hyperactive Explorers need to be honored and not shamed for their passionate spirit.

Show them unconditional acceptance so that they can accept themselves in a world that may repeatedly shun them: “I admire you for your creativity and imagination. Your different ways of thinking can help you do amazing things.”

3. The Overpleaser

Overpleasers are like butter — soft and pliable, easy to mold and shape — and they are the perfect prey for parents who have a strong need for control.

They fill in gaps, take over chores, and get gold stars. But because they’re eager to help, they often overstep and take over parental responsibilities, becoming the “parentified” adult in the home.

Parenting tip: Honor and teach them how to protect their boundaries.

Remind them that their needs come first: “You are a giver, and you may encounter many who will keep taking from you. Remember that it’s okay to say ‘no.’”

4. The Dreamer-Recluse

Dreamer-Recluse kids tend to be shy and introverted, and can struggle with social and conversational skills.

You may often catch them staring into space, doodling in their notebook, or spending so much time alone that you wonder if they’re even in the house.

Parenting tip: Society may try to tell them they should be the opposite, that they should be more extroverted.

Help them feel secure and highlight their strengths: “Don’t let people tell you how to be. Remember, those who are able to be by themselves are strong people. I admire you just the way you are.”

5. The Rebel Nonconformist

Rebel Nonconformists have the will of an ox. They won’t comply until they’re convinced it’s something they wish to do.

I know how challenging these kids can be. My daughter, Maia, is a Rebel, and she has the type of confidence that makes her unafraid of authority.

Parenting tip: These kids need to feel respected for their determination.

Release control and judgment: “I love your ability to follow your own voice and not be influenced by popular opinions. However, don’t fight rules simply for the sake of fighting, or you will burn yourself out.”

6. The Happy-Go-Lucky

These kids are always laughing and in a good mood. They’re not fussy, demanding or bossy.

The only downside is that they can be too relaxed and seem unmotivated. As a result, some parents may perceive them as not being ambitious enough.

Parenting tip: What parents don’t realize is that Happy-Go-Lucky kids are actually the gurus of living in the present.

Celebrate their positive approach to the world: “You always bring such peace and joy into every situation. Preserve this beat, because it’s a lost rhythm that more of the world need to adopt.”

Dr. Shefali Tsabary, PhD, is a child psychologist and bestselling author of “The Parenting Map,” “The Conscious Parent,” and “The Awakened Family.” She received her PhD from Columbia University and is a wisdom teacher who integrates Eastern spirituality with Western psychology. An expert in family dynamics and relationships, she is also the founder of the Conscious Parenting Coaching Institute. Follow her on Twitter and Instagram.

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March 18, 2023
This community’s quarter century without a newborn shows the scale of Japan’s population crisis | CNN

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Tokyo
CNN
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When Kentaro Yokobori was born almost seven years ago, he was the first newborn in the Sogio district of Kawakami village in 25 years. His birth was like a miracle for many villagers.

Well-wishers visited his parents Miho and Hirohito for more than a week – nearly all of them senior citizens, including some who could barely walk.

“The elderly people were very happy to see [Kentaro], and an elderly lady who had difficulty climbing the stairs, with her cane, came to me to hold my baby in her arms. All the elderly people took turns holding my baby,” Miho recalled.

During that quarter century without a newborn, the village population shrank by more than half to just 1,150 – down from 6,000 as recently as 40 years ago – as younger residents left and older residents died. Many homes were abandoned, some overrun by wildlife.

Kawakami is just one of the countless small rural towns and villages that have been forgotten and neglected as younger Japanese head for the cities. More than 90% of Japanese now live in urban areas like Tokyo, Osaka and Kyoto – all linked by Japan’s always-on-time Shinkansen bullet trains.

That has left rural areas and industries like agriculture, forestry, and farming facing a critical labor shortage that will likely get worse in the coming years as the workforce ages. By 2022, the number of people working in agriculture and forestry had declined to 1.9 million from 2.25 million 10 years earlier.

Yet the demise of Kawakami is emblematic of a problem that goes far beyond the Japanese countryside.

The problem for Japan is: people in the cities aren’t having babies either.

“Time is running out to procreate,” Prime Minister Fumio Kishida told a recent press conference, a slogan that seems so far to have fallen short of inspiring the city dwelling majority of the Japanese public.

Amid a flood of disconcerting demographic data, he warned earlier this year the country was “on the brink of not being able to maintain social functions.”

The country saw 799,728 births in 2022, the lowest number on record and barely more than half the 1.5 million births it registered in 1982. Its fertility rate – the average number of children born to women during their reproductive years – has fallen to 1.3 – far below the 2.1 required to maintain a stable population. Deaths have outpaced births for more than a decade.

And in the absence of meaningful immigration – foreigners accounted for just 2.2% of the population in 2021, according to the Japanese government, compared to 13.6% in the United States – some fear the country is hurtling toward the point of no return, when the number of women of child-bearing age hits a critical low from which there is no way to reverse the trend of population decline.

All this has left the leaders of the world’s third-largest economy facing the unenviable task of trying to fund pensions and health care for a ballooning elderly population even as the workforce shrinks.

Up against them are the busy urban lifestyles and long working hours that leave little time for Japanese to start families and the rising costs of living that mean having a baby is simply too expensive for many young people. Then there are the cultural taboos that surround talking about fertility and patriarchal norms that work against mothers returning to work.

Doctor Yuka Okada, the director of Grace Sugiyama Clinic in Tokyo, said cultural barriers meant talking about a woman’s fertility was often off limits.

“(People see the topic as) a little bit embarrassing. Think about your body and think about (what happens) after fertility. It is very important. So, it’s not embarrassing.”

Okada is one of the rare working mothers in Japan who has a highly successful career after childbirth. Many of Japan’s highly educated women are relegated to part-time or retail roles – if they reenter the workforce at all. In 2021, 39% of women workers were in part-time employment, compared to 15% of men, according to the OECD.

Tokyo is hoping to address some of these problems, so that working women today will become working mothers tomorrow. The metropolitan government is starting to subsidize egg freezing, so that women have a better chance of a successful pregnancy if they decide to have a baby later in life.

New parents in Japan already get a “baby bonus” of thousands of dollars to cover medical costs. For singles? A state sponsored dating service powered by Artificial Intelligence.

Whether such measures can turn the tide, in urban or rural areas, remains to be seen. But back in the countryside, Kawakami village offers a precautionary tale of what can happen if demographic declines are not reversed.

Along with its falling population, many of its traditional crafts and ways of life are at risk of dying out.

Among the villagers who took turns holding the young Kentaro was Kaoru Harumashi, a lifelong resident of Kawakami village in his 70s. The master woodworker has formed a close bond with the boy, teaching him how to carve the local cedar from surrounding forests.

“He calls me grandpa, but if a real grandpa lived here, he wouldn’t call me grandpa,” he said. “My grandson lives in Kyoto and I don’t get to see him often. I probably feel a stronger affection for Kentaro, whom I see more often, even though we are not related by blood.”

Both of Harumashi’s sons moved away from the village years ago, like many other young rural residents do in Japan.

“If the children don’t choose to continue living in the village, they will go to the city,” he said.

When the Yokoboris moved to Kawakami village about a decade ago, they had no idea most residents were well past retirement age. Over the years, they’ve watched older friends pass away and longtime community traditions fall by the wayside.

“There are not enough people to maintain villages, communities, festivals, and other ward organizations, and it is becoming impossible to do so,” Miho said.

“The more I get to know people, I mean elderly people, the more I feel sadness that I have to say goodbye to them. Life is actually going on with or without the village,” she said. “At the same time, it is very sad to see the surrounding, local people dwindling away.”

If that sounds depressing, perhaps it’s because in recent years, Japan’s battle to boost the birthrate has given few reasons for optimism.

Still, a small ray of hope may just be discernible in the story of the Yokoboris. Kentaro’s birth was unusual not only because the village had waited so long, but because his parents had moved to the countryside from the city – bucking the decades old trend in which the young increasingly plump for the 24/7 convenience of Japanese city life.

Some recent surveys suggest more young people like them are considering the appeals of country life, lured by the low cost of living, clean air, and low stress lifestyles that many see as vital to having families. One study of residents in the Tokyo area found 34% of respondents expressed an interest in moving to a rural area, up from 25.1% in 2019. Among those in their 20s, as many as 44.9% expressed an interest.

The Yokoboris say starting a family would have been far more difficult – financially and personally – if they still lived in the city.

Their decision to move was triggered by a Japanese national tragedy twelve years ago. On March 11, 2011, an earthquake shook the ground violently for several minutes across much of the country, triggering tsunami waves taller than a 10-story building that devastated huge swaths of the east coast and caused a meltdown at the Fukushima Daiichi Nuclear Power Plant.

Miho was an office worker in Tokyo at the time. She remembers feeling helpless as daily life in Japan’s largest city fell apart.

“Everyone was panicking, so it was like a war, although I have never experienced a war. It was like having money but not being able to buy water. All the transportation was closed, so you couldn’t use it. I felt very weak,” she recalled.

The tragedy was a moment of awakening for Miho and Hirohito, who was working as a graphic designer at the time.

“The things I had been relying on suddenly felt unreliable, and I felt that I was actually living in a very unstable place. I felt that I had to secure such a place by myself,” he said.

The couple found that place in one of Japan’s most remote areas, Nara prefecture. It is a land of majestic mountains and tiny townships, tucked away along winding roads beneath towering cedar trees taller than most of the buildings.

They quit their jobs in the city and moved to a simple mountain house, where they run a small bed and breakfast. He learned the art of woodworking and specializes in producing cedar barrels for Japanese sake breweries. She is a full-time homemaker. They raise chickens, grow vegetables, chop wood, and care for Kentaro, who’s about to enter the first grade.

The big question, for both Kawakami village and the rest of Japan: Is Kentaro’s birth a sign of better times to come – or a miracle birth in a dying way of life.

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March 18, 2023
Mexican migrant killed in California capsize left daughter

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MEXICO CITY — Yecenia Lazcano Soriano left behind a 4-year-old daughter in her home town of Tehuacan, Mexico, when she set out almost in secret to reach the United States.

The last message she sent to relatives was a heart emoji. Days later, on the California coast, two small boats carrying her and other migrants capsized in rough surf off a beach in San Diego.

The 22-year-old’s body was one of eight recovered shortly after the accident last Sunday at Black’s Beach, one of the deadliest maritime smuggling events near U.S. shores.

A single mother, Lazcano Soriano’s story was almost a microcosm of the desperation that drives many migrants to the United States. Nearly 129,000 migrants were stopped trying to cross the U.S. border in February.

At age 15, Lazcano Soriano went to live with the father of her child, but he was abducted and disappeared, like over 112,000 other Mexicans who have vanished since drug cartel violence picked up in 2006.

Lazcano Soriano dreamed of opening her own store in Tehuacan, a poor agricultural town lying between the cities of Puebla and Oaxaca in south-central Mexico. Most there make a tenuous living growing flowers or corn. The single mother sold fruit and vegetables at a local market.

But with jobs scarce, she decided to follow her aunt, Wendy Valencia, who left Tehuacan to emigrate to Dallas six years ago.

Lazcano Soriano left Tehuacan weeks ago, telling only two of her relatives. The last message she sent was a heart emoji to Valencia. After that, there was silence, until the chilling news came: Authorities had identified her by ID documents found on her body.

“She wasn’t afraid of work,” Valencia said in a telephone interview. “She was a warrior, a woman who was accustomed to struggle.”

She left her daughter in the care of her 72-year-old grandmother and two other aunts, but had hoped to be reunited with the girl.

“Her goal was to give her daughter a better future, an adequate home,” Valencia said. Life was never that kind to Lazcano Soriano; her companion’s disappearance was never solved.

A total of 23 people were thought to aboard the two boats that capsized off San Diego. Many of the other passengers are believed to have made it to land and escaped.

Mexican authorities said preliminary identification based on records found with people’s bodies indicate seven of the eight dead were Mexicans.

Just 25 miles (40 kilometers) from Tehuacan, in the town of Tlacotepec de Benito Juarez, the tragedy touched the family of Alma Figueroa Gorgoria.

Figueroa Gorgoria would have turned 18 next week. She had set out for the United States with her aunt, Ana Jacqueline Figueroa, 23. Both of their bodies were identified in San Diego.

Just seven miles (12 kilometers) in the other direction, the nearby farming community of Santiago Miahuatlan was the hometown of Guillermo Suárez González, who also risked traveling in the boats to reach the United States. A worker at a local export assembly plant, the 23-year-old dreamed of a better life; he left behind four children. Eloy Hernández Baltazar, 58, also lived in Santiago Miahuatlan, and was also among the dead.

The Puebla state migrant aid office said the paperwork has been submitted to return Suárez González to his home town for burial.

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March 17, 2023
This CNN Hero paid tribute to her late father by transforming a library into a center for feeding, teaching, and nurturing her community | CNN

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CNN
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During Guatemala’s violent, decades-long civil war, an estimated 200,000 people were killed. Among them was Brenda Lemus’s father, Bernardo Lemus Mendoza, a prominent academic and intellectual who spoke out against the government.

“There were many people who were fighting for their rights, who were being repressed,” Brenda Lemus said. “My father (fought for) … their right to an education and access to work. He was persecuted, he was exiled from the country many times, and he was ultimately assassinated.”

Lemus’s father grew up in poverty in the small rural town of Purulhá, several hours outside of Guatemala City. Despite the odds, she said he managed to graduate school and eventually become the financial director at the San Carlos de Guatemala University.

During the peace process, the Guatemalan government wanted to dignify the memory of those killed by the state. To commemorate Bernardo and his love of literature, the government donated 180 books to his family to start a library in his hometown. In 2011, the Bernardo Lemus Mendoza Library opened in Purulhá.

Lemus relocated her family there and dedicated herself to getting the library off the ground. Today, it serves as a beacon of hope and a center of learning for young people living in extreme poverty.

From the start, Lemus saw how the community was struggling in many ways.

“The community’s youth had a lot of needs, especially in education,” Lemus said. “But all the books that were given to us … were about the armed conflict. None of them were for kids or young people, and there were no schoolbooks at all.”

Children would arrive at the library looking for books so they could attend school and do their homework. Many families couldn’t afford school supplies. So, Lemus got schools to agree to donate books, and she started giving them to children in the community.

She also saw that students needed notebooks for class. Some were writing on crumpled, old, torn pieces of paper.

“It made me think about when I was younger, going to school and hiding my notebooks because I didn’t want to do my homework. I had everything. And yet here were a bunch of kids who had nothing, holding on to a rotten piece of paper to be able to take notes,” Lemus said. “That filled me with compassion for these kids. I wanted to help them as much as I could.”

Realizing that young people in Purulhá were growing up under similar conditions as her father had, Lemus wanted not only to address their needs but to help them break the cycle of intergenerational poverty.

In 2012, she co-founded Yo’o Guatemala, a nonprofit whose name means “together we go.”

She began providing after-school programming and noticed many students had trouble focusing.

“I had to repeat the subjects often until one of the kids said to me, ‘Please, don’t repeat it to me again. I just can’t concentrate because I’m so hungry,’” Lemus said. “We realized that many of our kids were malnourished, some chronically, and it was impossible for them to focus on anything else.”

Her organization started a nutrition program for more than 40 families suffering from chronic malnutrition and has since expanded, providing extensive literacy, health, and community building programs.

“My goal with all of this is to make sure the kids in this community get a proper education, eat well, and get ahead with the same opportunities as if they were my own kids or yours,” Lemus said. “We are dignifying the memory of my father, and we are dignifying the lives of the children of Purulha.”

CNN spoke with Lemus about her efforts. Below is an edited and translated version of their conversation.

CNN: The assistance you provide is constantly evolving, depending on the community’s needs. How are you helping girls to access education?

Brenda Lemus: In Purulhá, girls stop studying very early, get pregnant, get married, and the cycle repeats itself. It’s a cycle of poverty that seems endless; it’s like a spiral that takes them to the bottom. We want to break (that) through education.

Parents usually reject sending their daughters to school because they help mom at home. The girls don’t perform the same as boys in school because it’s different: The boy goes to school, and when he leaves, he goes to play soccer. The girl goes to school, and comes home to cook, take care of siblings, wash clothes. And so she drops out of school because she doesn’t do her homework. Of course she doesn’t do her homework because she has too much of a burden at home. The girls have the entire burden, and it isn’t easy.

We currently have 10 girls in our residency. The girls come on Mondays, leaving on Fridays. They spend weekends at home. We are in charge of everything with respect to them during that time. And we give the opportunity to the girls who are much more vulnerable when it comes to dropping out of school. I’m convinced that by giving the girls an integral educational opportunity, with quality, we can break the cycle of poverty.

CNN: What is your focus with the “Mi Nino Bonito” program?

Lemus: We began a daycare program for children. We receive them very early because most of their mothers work in the local market. We give them a warm breakfast. We give them all the stimulation that they should have according to their age, but we teach the children to be independent.

They are usually the youngest in their house and the last in the food chain, so they have to fight for a piece of bread. We teach them to wash their dishes, to clean up if they spilled. We give them pediatric check-ups with vitamins, taking care that they don’t get sick. They become very independent children who then excel.

CNN: How does your eco-brick program work and what’s its significance?

Lemus: The eco-brick program has a special magic because it is the education of the children, by the children, through garbage. Children whose parents are unable to buy them school supplies have the opportunity to recycle materials such as non-recyclable aluminum or single-use plastics, encapsulating them in PET bottles forever.

The children collect garbage, clean the environment, recycle, and they receive school supplies as the tradeoff – for 10 eco-bricks, they have their full list of school supplies. If they deliver five more bricks, they get to take a brand-new backpack. With (the eco-bricks), schools are built in other parts of Guatemala by volunteers who come from the United States.

The value and dignity of the hard work they do is instilled in all the children. They provide their community with cleanliness and sanitation through recycling; this gives them dignity. The children come here in hopes of being able to finish their studies without dropping out. But they earn it with pure, hard work. This has allowed youth to have better opportunities for more dignified paid jobs.

Want to get involved? Check out the Yo’o Guatemala website and see how to help

To donate to Yo’o Guatemala via GoFundMe, click here

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March 17, 2023
Why is it difficult for children to get a bed at pediatric hospitals? It’s more complicated than you think | CNN
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Effie Schnacky was wheezy and lethargic instead of being her normal, rambunctious self one February afternoon. When her parents checked her blood oxygen level, it was hovering around 80% – dangerously low for the 7-year-old.

Her mother, Jaimie, rushed Effie, who has asthma, to a local emergency room in Hudson, Wisconsin. She was quickly diagnosed with pneumonia. After a couple of hours on oxygen, steroids and nebulizer treatments with little improvement, a physician told Schnacky that her daughter needed to be transferred to a children’s hospital to receive a higher level of care.

What they didn’t expect was that it would take hours to find a bed for her.

Even though the respiratory surge that overwhelmed doctor’s offices and hospitals last fall is over, some parents like Schnacky are still having trouble getting their children beds in a pediatric hospital or a pediatric unit.

The physical and mental burnout that occurred during the height of the Covid-19 pandemic has not gone away for overworked health care workers. Shortages of doctors and technicians are growing, experts say, but especially in skilled nursing. That, plus a shortage of people to train new nurses and the rising costs of hiring are leaving hospitals with unstaffed pediatric beds.

But a host of reasons building since well before the pandemic are also contributing. Children may be the future, but we aren’t investing in their health care in that way. With Medicaid reimbursing doctors at a lower rate for children, hospitals in tough situations sometimes put adults in those pediatric beds for financial reasons. And since 2019, children with mental health crises are increasingly staying in emergency departments for sometimes weeks to months, filling beds that children with other illnesses may need.

“There might or might not be a bed open right when you need one. I so naively just thought there was plenty,” Schnacky told CNN.

The number of pediatric beds decreasing has been an issue for at least a decade, said Dr. Daniel Rauch, chair of the Committee on Hospital Care for the American Academy of Pediatrics.

By 2018, almost a quarter of children in America had to travel farther for pediatric beds as compared to 2009, according to a 2021 paper in the journal Pediatrics by lead author Dr. Anna Cushing, co-authored by Rauch.

“This was predictable,” said Rauch, who has studied the issue for more than 10 years. “This isn’t shocking to people who’ve been looking at the data of the loss in bed capacity.”

The number of children needing care was shrinking before the Covid-19 pandemic – a credit to improvements in pediatric care. There were about 200,000 fewer pediatric discharges in 2019 than there were in 2017, according to data from the US Department of Health and Human Services.

“In pediatrics, we have been improving the ability we have to take care of kids with chronic conditions, like sickle cell and cystic fibrosis, and we’ve also been preventing previously very common problems like pneumonia and meningitis with vaccination programs,” said Dr. Matthew Davis, the pediatrics department chair at Ann & Robert H. Lurie Children’s Hospital of Chicago.

Pediatrics is also seasonal, with a typical drop in patients in the summer and a sharp uptick in the winter during respiratory virus season. When the pandemic hit, schools and day cares closed, which slowed the transmission of Covid and other infectious diseases in children, Davis said. Less demand meant there was less need for beds. Hospitals overwhelmed with Covid cases in adults switched pediatric beds to beds for grownups.

Only 37% of hospitals in the US now offer pediatric services, down from 42% about a decade ago, according to the American Hospital Association.

While pediatric hospital beds exist at local facilities, the only pediatric emergency department in Baltimore County is Greater Baltimore Medical Center in Towson, Maryland, according to Dr. Theresa Nguyen, the center’s chair of pediatrics. All the others in the county, which has almost 850,000 residents, closed in recent years, she said.

The nearby MedStar Franklin Square Medical Center consolidated its pediatric ER with the main ER in 2018, citing a 40% drop in pediatric ER visits in five years, MedStar Health told CNN affiliate WBAL.

In the six months leading up to Franklin Square’s pediatric ER closing, GBMC admitted an average of 889 pediatric emergency department patients each month. By the next year, that monthly average jumped by 21 additional patients.

“Now we’re seeing the majority of any pediatric ED patients that would normally go to one of the surrounding community hospitals,” Nguyen said.

In July, Tufts Medical Center in Boston converted its 41 pediatric beds to treat adult ICU and medical/surgical patients, citing the need to care for critically ill adults, the health system said.

In other cases, it’s the hospitals that have only 10 or so pediatric beds that started asking the tough questions, Davis said.

“Those hospitals have said, ‘You know what? We have an average of one patient a day or two patients a day. This doesn’t make sense anymore. We can’t sustain that nursing staff with specialized pediatric training for that. We’re going to close it down,’” Davis said.

Saint Alphonsus Regional Medical Center in Boise closed its pediatric inpatient unit in July because of financial reasons, the center told CNN affiliate KBOI. That closure means patients are now overwhelming nearby St. Luke’s Children’s Hospital, which is the only children’s hospital in the state of Idaho, administrator for St. Luke’s Children’s Katie Schimmelpfennig told CNN. Idaho ranks last for the number of pediatricians per 100,000 children, according to the American Board of Pediatrics in 2023.

The Saint Alphonsus closure came just months before the fall, when RSV, influenza and a cadre of respiratory viruses caused a surge of pediatric patients needing hospital care, with the season starting earlier than normal.

The changing tide of demand engulfed the already dwindling supply of pediatric beds, leaving fewer beds available for children coming in for all the common reasons, like asthma, pneumonia and other ailments. Additional challenges have made it particularly tough to recover.

Another factor chipping away at bed capacity over time: Caring for children pays less than caring for adults. Lower insurance reimbursement rates mean some hospitals can’t afford to keep these beds – especially when care for adults is in demand.

Medicaid, which provides health care coverage to people with limited income, is a big part of the story, according to Joshua Gottlieb, an associate professor at the University of Chicago Harris School of Public Policy.

“Medicaid is an extremely important payer for pediatrics, and it is the least generous payer,” he said. “Medicaid is responsible for insuring a large share of pediatric patients. And then on top of its low payment rates, it is often very cumbersome to deal with.”

Medicaid reimburses children’s hospitals an average of 80% of the cost of the care, including supplemental payments, according to the Children’s Hospital Association, a national organization which represents 220 children’s hospitals. The rate is far below what private insurers reimburse.

More than 41 million children are enrolled in Medicaid and the Children’s Health Insurance Program, according to Kaiser Family Foundation data from October. That’s more than half the children in the US, according to Census data.

At Children’s National Hospital in Washington, DC, about 55% of patients use Medicaid, according to Dr. David Wessel, the hospital’s executive vice president.

“Children’s National is higher Medicaid than most other children’s hospitals, but that’s because there’s no safety net hospital other than Children’s National in this town,” said Wessel, who is also the chief medical officer and physician-in-chief.

And it just costs more to care for a child than an adult, Wessel said. Specialty equipment sized for smaller people is often necessary. And a routine test or exam for an adult is approached differently for a child. An adult can lie still for a CT scan or an MRI, but a child may need to be sedated for the same thing. A child life specialist is often there to explain what’s going on and calm the child.

“There’s a whole cadre of services that come into play, most of which are not reimbursed,” he said. “There’s no child life expert that ever sent a bill for seeing a patient.”

Low insurance reimbursement rates also factor into how hospital administrations make financial decisions.

“When insurance pays more, people build more health care facilities, hire more workers and treat more patients,” Gottlieb said.

“Everyone might be squeezed, but it’s not surprising that pediatric hospitals, which face [a] lower, more difficult payment environment in general, are going to find it especially hard.”

Dr. Benson Hsu is a pediatric critical care provider who has served rural South Dakota for more than 10 years. Rural communities face distinct challenges in health care, something he has seen firsthand.

A lot of rural communities don’t have pediatricians, according to the American Board of Pediatrics. It’s family practice doctors who treat children in their own communities, with the goal of keeping them out of the hospital, Hsu said. Getting hospital care often means traveling outside the community.

Hsu’s patients come from parts of Nebraska, Iowa and Minnesota, as well as across South Dakota, he said. It’s a predominantly rural patient base, which also covers those on Native American reservations.

“These kids are traveling 100, 200 miles within their own state to see a subspecialist,” Hsu said, referring to patients coming to hospitals in Sioux Falls. “If we are transferring them out, which we do, they’re looking at travels of 200 to 400 miles to hit Omaha, Minneapolis, Denver.”

Inpatient pediatric beds in rural areas decreased by 26% between 2008 and 2018, while the number of rural pediatric units decreased by 24% during the same time, according to the 2021 paper in Pediatrics.

“It’s bad, and it’s getting worse. Those safety net hospitals are the ones that are most at risk for closure,” Rauch said.

In major cities, the idea is that a critically ill child would get the care they need within an hour, something clinicians call the golden hour, said Hsu, who is the critical care section chair at the American Academy of Pediatrics.

“That golden hour doesn’t exist in the rural population,” he said. “It’s the golden five hours because I have to dispatch a plane to land, to drive, to pick up, stabilize, to drive back, to fly back.”

When his patients come from far away, it uproots the whole family, he said. He described families who camp out at a child’s bedside for weeks at a time. Sometimes they are hundreds of miles from home, unlike when a patient is in their own community and parents can take turns at the hospital.

“I have farmers who miss harvest season and that as you can imagine is devastating,” Hsu said. “These aren’t office workers who are taking their computer with them. … These are individuals who have to live and work in their communities.”

Back at GBMC in Maryland, an adolescent patient with depression, suicidal ideation and an eating disorder was in the pediatric emergency department for 79 days, according to Nguyen. For months, no facility had a pediatric psychiatric bed or said it could take someone who needed that level of care, as the patient had a feeding tube.

“My team of physicians, social workers and nurses spend a significant amount of time every day trying to reach out across the state of Maryland, as well as across the country now to find placements for this adolescent,” Nguyen said before the patient was transferred in mid-March. “I need help.”

Nguyen’s patient is just one of the many examples of children and teens with mental health issues who are staying in emergency rooms and sometimes inpatient beds across the country because they need help, but there isn’t immediately a psychiatric bed or a facility that can care for them.

It’s a problem that began before 2020 and grew worse during the pandemic, when the rate of children coming to emergency rooms with mental health issues soared, studies show.

“If we don’t address the surging pediatric mental health crisis, it will directly impact how we can care for other pediatric illnesses in the community.”

Now, a nationwide shortage of beds exists for children who need mental health help. A 2020 federal survey revealed that the number of residential treatment facilities for children fell 30% from 2012.

“There are children on average waiting for two weeks for placement, sometimes longer,” Nguyen said of the patients at GBMC. The pediatric emergency department there had an average of 42 behavioral health patients each month from July 2021 through December 2022, up 13.5% from the same period in 2017 to 2018, before the pandemic, according to hospital data.

When there are mental health patients staying in the emergency department, that can back up the beds in other parts of the hospital, creating a downstream effect, Hsu said.

“For example, if a child can’t be transferred from a general pediatric bed to a specialized mental health center, this prevents a pediatric ICU patient from transferring to the general bed, which prevents an [emergency department] from admitting a child to the ICU. Health care is often interconnected in this fashion,” Hsu said.

“If we don’t address the surging pediatric mental health crisis, it will directly impact how we can care for other pediatric illnesses in the community.”

So, what can be done to improve access to pediatric care? Much like the reasons behind the difficulties parents and caregivers are experiencing, the solutions are complex:
A lot of it comes down to money
Funding for children’s hospitals is already tight, Rauch said, and more money is needed not only to make up for low insurance reimbursement rates but to competitively hire and train new staff and to keep hospitals running.

“People are going to have to decide it’s worth investing in kids,” Rauch said. “We’re going to have to pay so that hospitals don’t lose money on it and we’re going to have to pay to have staff.”

Virtual visits, used in the right situations, could ease some of the problems straining the pediatric system, Rauch said. Extending the reach of providers would prevent transferring a child outside of their community when there isn’t the provider with the right expertise locally.
Increased access to children’s mental health services
With the ongoing mental health crisis, there’s more work to be done upstream, said Amy Wimpey Knight, the president of CHA.

“How do we work with our school partners in the community to make sure that we’re not creating this crisis and that we’re heading it off up there?” she said.

There’s also a greater need for services within children’s hospitals, which are seeing an increase in children being admitted with behavioral health needs.

“If you take a look at the reasons why kids are hospitalized, meaning infections, diabetes, seizures and mental health concerns, over the last decade or so, only one of those categories has been increasing – and that is mental health,” Davis said. “At the same time, we haven’t seen an increase in the number of mental health hospital resources dedicated to children and adolescents in a way that meets the increasing need.”

Most experts CNN spoke to agreed: Seek care for your child early.

“Whoever is in your community is doing everything possible to get the care that your child needs,” Hsu said. “Reach out to us. We will figure out a way around the constraints around the system. Our number one concern is taking care of your kids, and we will do everything possible.”

Nguyen from GBMC and Schimmelpfennig from St. Luke’s agreed with contacting your primary care doctor and trying to keep your child out of the emergency room.

“Anything they can do to stay out of the hospital or the emergency room is both financially better for them and better for their family,” Schimmelpfennig said.

Knowing which emergency room or urgent care center is staffed by pediatricians is also imperative, Rauch said. Most children visit a non-pediatric ER due to availability.

“A parent with a child should know where they’re going to take their kid in an emergency. That’s not something you decide when your child has the emergency,” he said.

After Effie’s first ambulance ride and hospitalization last month, the Schnacky family received an asthma action plan from the pulmonologist in the ER.

It breaks down the symptoms into green, yellow and red zones with ways Effie can describe how she’s feeling and the next steps for adults. The family added more supplies to their toolkit, like a daily steroid inhaler and a rescue inhaler.

“We have everything an ER can give her, besides for an oxygen tank, at home,” Schnacky said. “The hope is that we are preventing even needing medical care.”
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March 16, 2023
Genetic Causes of Three Previously Unexplained Rare Diseases Identified

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Newswise — New York, NY (March 16, 2023) – Using a new computational approach they developed to analyze large genetic datasets from rare disease cohorts, researchers at the Icahn School of Medicine at Mount Sinai and colleagues have discovered previously unknown genetic causes of three rare conditions: primary lymphedema (characterized by tissue swelling), thoracic aortic aneurysm disease, and congenital deafness. The work was done in collaboration with colleagues at the University of Bristol, UK; KU Leuven, Belgium; the University of Tokyo; the University of Maryland; Imperial College London, and others from around the world.

An enhanced understanding of the functions of the genes involved in these and other disorders could pave the way for the development of treatments. The findings were published in the March 16 online issue of Nature Medicine https://www.nature.com/articles/s41591-023-02211-z [DOI: 10.1038/s41591-023-02211-z].

Rare diseases affect approximately 1 in 20 people, but only a minority of patients receive a genetic diagnosis. Fewer than half of the 10,000 recorded rare diseases have a known genetic cause. Genome sequencing of large cohorts of rare disease patients provides a route toward discovering the genetic causes that remain unknown. However, large genetic datasets are challenging to work with, slowing down research significantly, say the investigators.

“While rare diseases are individually rare, collectively they are quite common. It is important for our understanding of human biology and for the development of diagnostics and therapeutics that the remaining causes are found,” said senior study author Ernest Turro, PhD, Associate Professor of Genetics and Genomics Sciences at Icahn Mount Sinai. “Many people with a rare disease struggle for many years to obtain a genetic diagnosis. By developing and applying statistical methods and computational approaches to find new causes of rare diseases, we hope to expand knowledge of the underlying causes of these diseases, hasten the time to diagnosis for patients, and pave the way for the development of treatments.”

The investigators studied a collection of 269 rare disease classes using data from 77,539 participants in the 100,000 Genomes Project, one of the largest datasets of phenotyped and whole-genome-sequenced rare disease patients. The researchers identified 260 associations between genes and rare disease classes, including 19 associations previously absent from the literature. Through an international academic collaboration, the authors validated the three most plausible novel associations by identifying additional cases in other countries and through experimental and bioinformatic approaches.

“We hope that our computational framework will help accelerate the discovery of the remaining unknown etiologies of rare diseases across the board. For now, we expect that a genetic diagnosis will be attainable for certain families with previously unexplained primary lymphedema, thoracic aortic aneurysm disease, and deafness,” said Daniel Greene, PhD, a postdoctoral fellow at Icahn Mount Sinai and lead author of the study. “We also plan to apply our methods in novel ways and in other datasets, with the aim of continuing to unravel the genetic causes of rare diseases.”

The paper is titled “Genetic association analysis of 77,539 genomes reveals rare disease etiologies.”

For the complete list of authors, and details on funding, see the paper at https://www.nature.com/articles/s41591-023-02211-z.

The National Organization for Rare Disorders has designated the Division of Medical Genetics and Genomics at The Mount Sinai Hospital as a Rare Disease Center of Excellence.

About the Icahn School of Medicine at Mount Sinai

The Icahn School of Medicine at Mount Sinai is internationally renowned for its outstanding research, educational, and clinical care programs. It is the sole academic partner for the eight- member hospitals* of the Mount Sinai Health System, one of the largest academic health systems in the United States, providing care to a large and diverse patient population.

Ranked 14th nationwide in National Institutes of Health (NIH) funding and among the 99th percentile in research dollars per investigator according to the Association of American Medical Colleges, Icahn Mount Sinai has a talented, productive, and successful faculty. More than 3,000 full-time scientists, educators, and clinicians work within and across 34 academic departments and 35 multidisciplinary institutes, a structure that facilitates tremendous collaboration and synergy. Our emphasis on translational research and therapeutics is evident in such diverse areas as genomics/big data, virology, neuroscience, cardiology, geriatrics, as well as gastrointestinal and liver diseases.

Icahn Mount Sinai offers highly competitive MD, PhD, and Master’s degree programs, with current enrollment of approximately 1,300 students. It has the largest graduate medical education program in the country, with more than 2,000 clinical residents and fellows training throughout the Health System. In addition, more than 550 postdoctoral research fellows are in training within the Health System.

A culture of innovation and discovery permeates every Icahn Mount Sinai program. Mount Sinai’s technology transfer office, one of the largest in the country, partners with faculty and trainees to pursue optimal commercialization of intellectual property to ensure that Mount Sinai discoveries and innovations translate into health care products and services that benefit the public.

Icahn Mount Sinai’s commitment to breakthrough science and clinical care is enhanced by academic affiliations that supplement and complement the School’s programs.

Through the Mount Sinai Innovation Partners (MSIP), the Health System facilitates the real-world application and commercialization of medical breakthroughs made at Mount Sinai. Additionally, MSIP develops research partnerships with industry leaders such as Merck & Co., AstraZeneca, Novo Nordisk, and others.

The Icahn School of Medicine at Mount Sinai is located in New York City on the border between the Upper East Side and East Harlem, and classroom teaching takes place on a campus facing Central Park. Icahn Mount Sinai’s location offers many opportunities to interact with and care for diverse communities. Learning extends well beyond the borders of our physical campus, to the eight hospitals of the Mount Sinai Health System, our academic affiliates, and globally.

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* Mount Sinai Health System member hospitals: The Mount Sinai Hospital; Mount Sinai Beth Israel; Mount Sinai Brooklyn; Mount Sinai Morningside; Mount Sinai Queens; Mount Sinai South Nassau; Mount Sinai West; and New York Eye and Ear Infirmary of Mount Sinai.

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March 16, 2023
Vitamin A may reduce pancreatitis risk during ALL treatment

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Newswise — Consuming a diet rich in vitamin A or its analogs may help prevent children and young adults with acute lymphoblastic leukemia (ALL) reduce their risk of developing painful pancreas inflammation during chemotherapy treatment.

Details about this potential dietary solution to prevent a potentially life-threatening adverse event were published March 15, 2023, in Science Translational Medicine. The research team was led by Sohail Husain, MD, chief of Pediatric Gastroenterology, Hepatology, and Nutrition at Stanford University and Anil Goud Jegga, DVM, MRes, a computational biologist at Cincinnati Children’s Hospital Medical Center.

For people with ALL, treatment with the enzyme asparaginase helps starve cancer cells by reducing the amount of asparagine circulating in the blood, which the cancer cells need but cannot make themselves. The medication, often used in combination with other chemotherapies, is given via injection into a vein, muscle, or under the skin.

However, an estimated 2% to 10% of asparaginase users develop inflammation of the pancreas in reaction to asparaginase treatment. For a third of these people, the symptoms can be severe.

Jegga and colleagues developed predictive analytics using over 100 million data points encompassing gene expression data, small-molecule data, and electronic health records to understand more of the mechanisms driving asparaginase-associated pancreatitis (AAP) and identify potential interventions to prevent or mitigate AAP.

First, they analyzed massive amounts of gene expression data to reveal that gene activity associated with asparaginase or pancreatitis might be reversed by retinoids (vitamin A and its analogs). The team found more supporting evidence by “mining” millions of of electronic health records from the TriNetX database and the U.S. Federal Drug Administration Adverse Events Reporting System.

This number crunching and predictive analytics work included use of the AERSMine software developed at Cincinnati Children’s by Mayur Sarangdhar, PhD, MRes, and colleagues. The research team also studied data from mice experiments and compared plasma samples from people with ALL who developed pancreatitis and those who did not.

Ultimately, the team established two sets of human “real-world” experiences. They found that only 1.4% of patients treated with asparaginase developed pancreatitis when they were also taking vitamin A in contrast to 3.4% of patients who did not. Concomitant use of vitamin A correlated with a 60% reduction in the risk of AAP. Lower amounts of dietary vitamin A correlated with increased risk and severity of AAP.

“This study demonstrates the potential of mining ‘real-world’ data to identify therapy modifiers for improving patient outcomes. In cases where a primary drug induces toxicity but is critical to therapy, such as asparaginase, therapy modifiers, such as vitamin A and its analogs, may be of immediate relevance to patients on asparaginase and ‘at-risk’ for AAP,” says Sarangdhar, a co-first author of the study.

Says Jegga: “Our study highlights the power of heterogeneous data integration and analysis in translational research. By leveraging existing ‘omics and patient-centric data and a systems approach, we were able to identify new insights into the development of AAP and potential interventions to prevent or mitigate this side effect.”

Next steps

In some ways, learnings from this study could be applied immediately to patient care. However, more clinical research is needed to establish how much vitamin A would be needed to protect ALL patients from pancreatitis; and whether a protective level can be achieved by diet or via supplements. In fact, target vitamin levels may need to vary according to individual differences in metabolism.

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March 15, 2023
Not magic: Opaque AI tool may flag parents with disabilities

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PITTSBURGH — For the two weeks that the Hackneys’ baby girl lay in a Pittsburgh hospital bed weak from dehydration, her parents rarely left her side, sometimes sleeping on the fold-out sofa in the room.

They stayed with their daughter around the clock when she was moved to a rehab center to regain her strength. Finally, the 8-month-old stopped batting away her bottles and started putting on weight again.

“She was doing well and we started to ask when can she go home,” Lauren Hackney said. “And then from that moment on, at the time, they completely stonewalled us and never said anything.”

The couple was stunned when child welfare officials showed up, told them they were negligent and took their daughter away.

“They had custody papers and they took her right there and then,” Lauren Hackney recalled. “And we started crying.”

More than a year later, their daughter, now 2, remains in foster care. The Hackneys, who have developmental disabilities, are struggling to understand how taking their daughter to the hospital when she refused to eat could be seen as so neglectful that she’d need to be taken from her home.

They wonder if an artificial intelligence tool that the Allegheny County Department of Human Services uses to predict which children could be at risk of harm singled them out because of their disabilities.

The U.S. Justice Department is asking the same question. The agency is investigating the county’s child welfare system to determine whether its use of the influential algorithm discriminates against people with disabilities or other protected groups, The Associated Press has learned. Later this month, federal civil rights attorneys will interview the Hackneys and Andrew Hackney’s mother, Cynde Hackney-Fierro, the grandmother said.

Lauren Hackney has attention-deficit hyperactivity disorder that affects her memory, and her husband, Andrew, has a comprehension disorder and nerve damage from a stroke suffered in his 20s. Their baby girl was just 7 months old when she began refusing to drink her bottles. Facing a nationwide shortage of formula, they traveled from Pennsylvania to West Virginia looking for some and were forced to change brands. The baby didn’t seem to like it.

Her pediatrician first reassured them that babies sometimes can be fickle with feeding and offered ideas to help her get back her appetite, they said.

When she grew lethargic days later, they said, the same doctor told them to take her to the emergency room. The Hackneys believe medical staff alerted child protective services after they showed up with a baby who was dehydrated and malnourished.

That’s when they believe their information was fed into the Allegheny Family Screening Tool, which county officials say is standard procedure for neglect allegations. Soon, a social worker appeared to question them, and their daughter was sent to foster care.

Over the past six years, Allegheny County has served as a real-world laboratory for testing AI-driven child welfare tools that crunch reams of data about local families to try to predict which children are likely to face danger in their homes. Today, child welfare agencies in at least 26 states and Washington, D.C., have considered using algorithmic tools, and jurisdictions in at least 11 have deployed them, according to the American Civil Liberties Union.

The Hackneys’ story — based on interviews, internal emails and legal documents — illustrates the opacity surrounding these algorithms. Even as they fight to regain custody of their daughter, they can’t question the “risk score” Allegheny County’s tool may have assigned to her case because officials won’t disclose it to them. And neither the county nor the people who built the tool have ever explained which variables may have been used to measure the Hackneys’ abilities as parents.

“It’s like you have an issue with someone who has a disability,” Andrew Hackney said in an interview from their apartment in suburban Pittsburgh. “In that case … you probably end up going after everyone who has kids and has a disability.”

As part of a yearlong investigation, the AP obtained the data points underpinning several algorithms deployed by child welfare agencies, including some marked “CONFIDENTIAL,” offering rare insight into the mechanics driving these emerging technologies. Among the factors they have used to calculate a family’s risk, whether outright or by proxy: race, poverty rates, disability status and family size. They include whether a mother smoked before she was pregnant and whether a family had previous child abuse or neglect complaints.

What they measure matters. A recent analysis by ACLU researchers found that when Allegheny’s algorithm flagged people who accessed county services for mental health and other behavioral health programs, that could add up to three points to a child’s risk score, a significant increase on a scale of 20.

Allegheny County spokesman Mark Bertolet declined to address the Hackney case and did not answer detailed questions about the status of the federal probe or critiques of the data powering the tool, including by the ACLU.

“As a matter of policy, we do not comment on lawsuits or legal matters,” Bertolet said in an email.

Justice Department spokeswoman Aryele Bradford declined to comment.

NOT MAGIC

Child welfare algorithms plug vast amounts of public data about local families into complex statistical models to calculate what they call a risk score. The number that’s generated is then used to advise social workers as they decide which families should be investigated, or which families need additional attention — a weighty decision that can sometimes mean life or death.

A number of local leaders have tapped into AI technology while under pressure to make systemic changes, such as in Oregon during a foster care crisis and in Los Angeles County after a series of high-profile child deaths in one of the nation’s largest county child welfare systems.

LA County’s Department of Children and Family Services Director Brandon Nichols says algorithms can help identify high-risk families and improve outcomes in a deeply strained system. Yet he could not explain how the screening tool his agency uses works.

“We’re sort of the social work side of the house, not the IT side of the house,” Nichols said in an interview. “How the algorithm functions, in some ways is, I don’t want to say is magic to us, but it’s beyond our expertise and experience.”

Nichols and officials at two other child welfare agencies referred detailed questions about their AI tools to the outside developers who created them.

In Larimer County, Colorado, one official acknowledged she didn’t know what variables were used to assess local families.

“The variables and weights used by the Larimer Decision Aide Tool are part of the code developed by Auckland and thus we do not have this level of detail,” Jill Maasch, a Larimer County Human Services spokeswoman said in an email, referring to the developers.

In Pennsylvania, California and Colorado, county officials have opened up their data systems to the two academic developers who select data points to build their algorithms. Rhema Vaithianathan, a professor of health economics at New Zealand’s Auckland University of Technology, and Emily Putnam-Hornstein, a professor at the University of North Carolina at Chapel Hill’s School of Social Work, said in an email that their work is transparent and that they make their computer models public.

“In each jurisdiction in which a model has been fully implemented we have released a description of fields that were used to build the tool, along with information as to the methods used,” they said by email.

A 241-page report on the Allegheny County website includes pages of coded variables and statistical calculations.

Vaithianathan and Putnam-Hornstein’s work has been hailed in reports published by UNICEF and the Biden administration alike for devising computer models that promise to lighten caseworkers’ loads by drawing from a set of simple factors. They have described using such tools as a moral imperative, insisting that child welfare officials should draw from all data at their disposal to make sure children aren’t maltreated.

Through tracking their work across the country, however, the AP found their tools can set families up for separation by rating their risk based on personal characteristics they cannot change or control, such as race or disability, rather than just their actions as parents.

In Allegheny County, a sprawling county of 1.2 million near the Ohio border, the algorithm has accessed an array of external data, including jail, juvenile probation, Medicaid, welfare, health and birth records, all held in a vast countywide “data warehouse.” The tool uses that information to predict the risk that a child will be placed in foster care two years after a family is first investigated.

County officials have told the AP they’re proud of their cutting-edge approach, and even expanded their work to build another algorithm focused on newborns. They have said they monitor their risk scoring tool closely and update it over time, including removing variables such as welfare benefits and birth records.

Vaithianathan and Putnam-Hornstein declined the AP’s repeated interview requests to discuss how they choose the specific data that powers their models. But in a 2017 report, they detailed the methods used to build the first version of Allegheny’s tool, including a footnote that described a statistical cutoff as “rather arbitrary but based on trial and error.”

“This footnote refers to our exploration of more than 800 features from Allegheny’s data warehouse more than five years ago,” the developers said by email.

That approach is borne out in their design choices, which differ from county to county.

In the same 2017 report, the developers acknowledged that using race data didn’t substantively improve the model’s accuracy, but they continued to study it in Douglas County, Colorado, though they ultimately opted against including it in that model. To address community concerns that a tool could harden racial bias in Los Angeles County, the developers excluded people’s criminal history, ZIP code and geographic indicators, but have continued to use those data points in the Pittsburgh area.

When asked about the inconsistencies, the developers pointed to their published methodology documents.

“We detail various metrics used to assess accuracy — while also detailing ‘external validations,’” the developers said via email.

When Oregon’s Department of Human Services built an algorithm inspired by Allegheny’s, it factored in a child’s race as it predicted a family’s risk, and also applied a “fairness correction” to mitigate racial bias. Last June, the tool was dropped entirely due to equity concerns after an AP investigation in April revealed potential racial bias in such tools.

Justice Department attorneys cited the same AP story last fall when federal civil rights attorneys started inquiring about additional discrimination concerns in Allegheny’s tool, three sources told the AP. They spoke on the condition of anonymity, saying the Justice Department asked them not to discuss the confidential conversations. Two said they also feared professional retaliation.

IQ TESTS, PARENTING CLASS

With no answers on when they could get their daughter home, the Hackneys’ lawyer in October filed a federal civil rights complaint on their behalf that questioned how the screening tool was used in their case.

Over time, Allegheny’s tool has tracked if members of the family have diagnoses for schizophrenia or mood disorders. It’s also measured if parents or other children in the household have disabilities, by noting whether any family members received Supplemental Security Income, a federal benefit for people with disabilities. The county said that it factors in SSI payments in part because children with disabilities are more likely to be abused or neglected.

The county also said disabilities-aligned data can be “predictive of the outcomes” and it “should come as no surprise that parents with disabilities … may also have a need for additional supports and services.” In an emailed statement, the county added that elsewhere in the country, social workers also draw on data about mental health and other conditions that may affect a parent’s ability to safely care for a child.

The Hackneys have been ordered to take parenting classes and say they have been taxed by all of the child welfare system’s demands, including IQ tests and downtown court hearings.

People with disabilities are overrepresented in the child welfare system, yet there’s no evidence that they harm their children at higher rates, said Traci LaLiberte, a University of Minnesota expert on child welfare and disabilities.

Including data points related to disabilities in an algorithm is problematic because it perpetuates historic biases in the system and it focuses on people’s physiological traits rather than behavior that social workers are brought in to address, LaLiberte said.

The Los Angeles tool weighs if any children in the family have ever gotten special education services, have had prior developmental or mental health referrals or used drugs to treat mental health.

“This is not unique to caseworkers who use this tool; it is common for caseworkers to consider these factors when determining possible supports and services,” the developers said by email.

Before algorithms were in use, the child welfare system had long distrusted parents with disabilities. Into the 1970s, they were regularly sterilized and institutionalized, LaLiberte said. A landmark federal report in 2012 noted parents with psychiatric or intellectual disabilities lost custody of their children as much as 80 percent of the time.

Across the U.S., it’s extremely rare for any child welfare agencies to require disabilities training for social workers, LaLiberte’s research has found. The result: Parents with disabilities are often judged by a system that doesn’t understand how to assess their capacity as caregivers, she said.

The Hackneys experienced this firsthand. When a social worker asked Andrew Hackney how often he fed the baby, he answered literally: two times a day. The worker seemed appalled, he said, and scolded him, saying babies must eat more frequently. He struggled to explain that the girl’s mother, grandmother and aunt also took turns feeding her each day.

FOREVER FLAGGED

Officials in Allegheny County have said that building AI into their processes helps them “make decisions based on as much information as possible,” and noted that the algorithm merely harnesses data social workers can already access.

That can include decades-old records. The Pittsburgh-area tool has tracked whether parents were ever on public benefits or had a history with the criminal justice system — even if they were minors at the time, or if it never resulted in charges or convictions.

The AP found those design choices can stack the deck against people who grew up in poverty, hardening historical inequities that persist in the data, or against people with records in the juvenile or criminal justice systems, long after society has granted redemption. And critics say that algorithms can create a self-fulfilling prophecy by influencing which families are targeted in the first place.

“These predictors have the effect of casting permanent suspicion and offer no means of recourse for families marked by these indicators,” according to the analysis from researchers at the ACLU and the nonprofit Human Rights Data Analysis Group. “They are forever seen as riskier to their children.”

As child welfare algorithms become more common, parents who have experienced social workers’ scrutiny fear the models won’t let them escape their pasts, no matter how old or irrelevant their previous scrapes with the system may have been.

Charity Chandler-Cole, who serves on the Los Angeles County Commission for Children and Families, is one of them. She landed in foster care as a teen after being arrested for shoplifting underwear for her younger sister. Then as an adult, she said, social workers once showed up at her apartment after someone spuriously reported that a grand piano was thrown at her nephew who was living at her home — even though they didn’t own such an instrument.

The local algorithm could tag her for her prior experiences in foster care and juvenile probation, as well as the unfounded child abuse allegation, Chandler-Cole says. She wonders if AI could also properly assess that she was quickly cleared of any maltreatment concerns, or that her nonviolent offense as a teen was legally expunged.

“A lot of these reports lack common sense,” said Chandler-Cole, now the mother of four and CEO of an organization that works with the court system to help children in foster care. “You are automatically putting us in these spaces to be judged with these labels. It just perpetuates additional harm.”

Chandler-Cole’s fellow commissioner Wendy Garen, by contrast, argues “more is better” and that by drawing on all available data, risk scoring tools can help make the agency’s work more thorough and effective.

GLOBAL INFLUENCE

Even as their models have come under scrutiny for their accuracy and fairness, the developers have started new projects with child welfare agencies in Northampton County, Pennsylvania, and Arapahoe County, Colorado. The states of California and Pennsylvania, as well as New Zealand and Chile, have also asked them to do preliminary work.

And as word of their methods has spread in recent years, Vaithianathan has given lectures highlighting screening tools in Colombia and Australia. She also recently advised researchers in Denmark and officials in the United Arab Emirates on how to use technology to target child services.

“Rhema is one of the world leaders and her research can help to shape the debate in Denmark,” a Danish researcher said on LinkedIn last year, regarding Vaithianathan’s advisory role related to a local child welfare tool that was being piloted.

Last year, the U.S. Department of Health and Human Services funded a national study, co-authored by Vaithianathan and Putnam-Hornstein, that concluded that their overall approach in Allegheny could be a model for other places.

HHS’ Administration for Children and Families spokeswoman Debra Johnson declined to say whether the Justice Department’s probe would influence her agency’s future support for an AI-driven approach to child welfare.

Especially as budgets tighten, cash-strapped agencies are desperate to find more efficient ways for social workers to focus on children who truly need protection. At a 2021 panel, Putnam-Hornstein acknowledged that “the overall screen-in rate remained totally flat” in Allegheny since their tool had been implemented.

Meanwhile, foster care and the separation of families can have lifelong developmental consequences for the child.

A 2012 HHS study found 95% of babies who are reported to child welfare agencies go through more than one caregiver and household change during their time in foster care, instability that researchers noted can itself be a form of trauma.

The Hackneys’ daughter already has been placed in two foster homes and has now spent more than half of her short life away from her parents as they try to convince social workers they are worthy.

Meanwhile, they say they’re running out of money in the fight for their daughter. With barely enough left for food from Andrew Hackney’s wages at a local grocery store, he had to shut off his monthly cell phone service. They’re struggling to pay for the legal fees and gas money needed to attend appointments required of them.

In February, their daughter was diagnosed with a disorder that can disrupt her sense of taste, according to Andrew Hackney’s lawyer, Robin Frank, who added that the girl has continued to struggle to eat, even in foster care.

All they have for now are twice-weekly visits that last a few hours before she’s taken away again. Lauren Hackney’s voice breaks as she worries her daughter may be adopted and soon forget her own family. They say they yearn to do what many parents take for granted — put their child to sleep at night in her own bed.

“I really want to get my kid back. I miss her, and especially holding her. And of course, I miss that little giggly laugh,” Andrew Hackney said, as his daughter sprang toward him with excitement during a recent visit. “It hurts a lot. You have no idea how bad.”

___

Burke reported from San Francisco. Associated Press video journalist Jessie Wardarski and photojournalist Maye-E Wong in Pittsburgh contributed to this report.

___

Follow Sally Ho and Garance Burke on Twitter at @_sallyho and @garanceburke.

___

Contact AP’s global investigative team at Investigative@ap.org or https://www.ap.org/tips/

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March 15, 2023
Not magic: Opaque AI tool may flag parents with disabilities

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PITTSBURGH — For the two weeks that the Hackneys’ baby girl lay in a Pittsburgh hospital bed weak from dehydration, her parents rarely left her side, sometimes sleeping on the fold-out sofa in the room.

They stayed with their daughter around the clock when she was moved to a rehab center to regain her strength. Finally, the 8-month-old stopped batting away her bottles and started putting on weight again.

“She was doing well and we started to ask when can she go home,” Lauren Hackney said. “And then from that moment on, at the time, they completely stonewalled us and never said anything.”

The couple was stunned when child welfare officials showed up, told them they were negligent and took their daughter away.

“They had custody papers and they took her right there and then,” Lauren Hackney recalled. “And we started crying.”

More than a year later, their daughter, now 2, remains in foster care. The Hackneys, who have developmental disabilities, are struggling to understand how taking their daughter to the hospital when she refused to eat could be seen as so neglectful that she’d need to be taken from her home.

They wonder if an artificial intelligence tool that the Allegheny County Department of Human Services uses to predict which children could be at risk of harm singled them out because of their disabilities.

The U.S. Justice Department is asking the same question. The agency is investigating the county’s child welfare system to determine whether its use of the influential algorithm discriminates against people with disabilities or other protected groups, The Associated Press has learned. Later this month, federal civil rights attorneys will interview the Hackneys and Andrew Hackney’s mother, Cynde Hackney-Fierro, the grandmother said.

Lauren Hackney has attention-deficit hyperactivity disorder that affects her memory, and her husband, Andrew, has a comprehension disorder and nerve damage from a stroke suffered in his 20s. Their baby girl was just 7 months old when she began refusing to drink her bottles. Facing a nationwide shortage of formula, they traveled from Pennsylvania to West Virginia looking for some and were forced to change brands. The baby didn’t seem to like it.

Her pediatrician first reassured them that babies sometimes can be fickle with feeding and offered ideas to help her get back her appetite, they said.

When she grew lethargic days later, they said, the same doctor told them to take her to the emergency room. The Hackneys believe medical staff alerted child protective services after they showed up with a baby who was dehydrated and malnourished.

That’s when they believe their information was fed into the Allegheny Family Screening Tool, which county officials say is standard procedure for neglect allegations. Soon, a social worker appeared to question them, and their daughter was sent to foster care.

Over the past six years, Allegheny County has served as a real-world laboratory for testing AI-driven child welfare tools that crunch reams of data about local families to try to predict which children are likely to face danger in their homes. Today, child welfare agencies in at least 26 states and Washington, D.C., have considered using algorithmic tools, and jurisdictions in at least 11 have deployed them, according to the American Civil Liberties Union.

The Hackneys’ story — based on interviews, internal emails and legal documents — illustrates the opacity surrounding these algorithms. Even as they fight to regain custody of their daughter, they can’t question the “risk score” Allegheny County’s tool may have assigned to her case because officials won’t disclose it to them. And neither the county nor the people who built the tool have ever explained which variables may have been used to measure the Hackneys’ abilities as parents.

“It’s like you have an issue with someone who has a disability,” Andrew Hackney said in an interview from their apartment in suburban Pittsburgh. “In that case … you probably end up going after everyone who has kids and has a disability.”

As part of a yearlong investigation, the AP obtained the data points underpinning several algorithms deployed by child welfare agencies, including some marked “CONFIDENTIAL,” offering rare insight into the mechanics driving these emerging technologies. Among the factors they have used to calculate a family’s risk, whether outright or by proxy: race, poverty rates, disability status and family size. They include whether a mother smoked before she was pregnant and whether a family had previous child abuse or neglect complaints.

What they measure matters. A recent analysis by ACLU researchers found that when Allegheny’s algorithm flagged people who accessed county services for mental health and other behavioral health programs, that could add up to three points to a child’s risk score, a significant increase on a scale of 20.

Allegheny County spokesman Mark Bertolet declined to address the Hackney case and did not answer detailed questions about the status of the federal probe or critiques of the data powering the tool, including by the ACLU.

“As a matter of policy, we do not comment on lawsuits or legal matters,” Bertolet said in an email.

Justice Department spokeswoman Aryele Bradford declined to comment.

NOT MAGIC

Child welfare algorithms plug vast amounts of public data about local families into complex statistical models to calculate what they call a risk score. The number that’s generated is then used to advise social workers as they decide which families should be investigated, or which families need additional attention — a weighty decision that can sometimes mean life or death.

A number of local leaders have tapped into AI technology while under pressure to make systemic changes, such as in Oregon during a foster care crisis and in Los Angeles County after a series of high-profile child deaths in one of the nation’s largest county child welfare systems.

LA County’s Department of Children and Family Services Director Brandon Nichols says algorithms can help identify high-risk families and improve outcomes in a deeply strained system. Yet he could not explain how the screening tool his agency uses works.

“We’re sort of the social work side of the house, not the IT side of the house,” Nichols said in an interview. “How the algorithm functions, in some ways is, I don’t want to say is magic to us, but it’s beyond our expertise and experience.”

Nichols and officials at two other child welfare agencies referred detailed questions about their AI tools to the outside developers who created them.

In Larimer County, Colorado, one official acknowledged she didn’t know what variables were used to assess local families.

“The variables and weights used by the Larimer Decision Aide Tool are part of the code developed by Auckland and thus we do not have this level of detail,” Jill Maasch, a Larimer County Human Services spokeswoman said in an email, referring to the developers.

In Pennsylvania, California and Colorado, county officials have opened up their data systems to the two academic developers who select data points to build their algorithms. Rhema Vaithianathan, a professor of health economics at New Zealand’s Auckland University of Technology, and Emily Putnam-Hornstein, a professor at the University of North Carolina at Chapel Hill’s School of Social Work, said in an email that their work is transparent and that they make their computer models public.

“In each jurisdiction in which a model has been fully implemented we have released a description of fields that were used to build the tool, along with information as to the methods used,” they said by email.

A 241-page report on the Allegheny County website includes pages of coded variables and statistical calculations.

Vaithianathan and Putnam-Hornstein’s work has been hailed in reports published by UNICEF and the Biden administration alike for devising computer models that promise to lighten caseworkers’ loads by drawing from a set of simple factors. They have described using such tools as a moral imperative, insisting that child welfare officials should draw from all data at their disposal to make sure children aren’t maltreated.

Through tracking their work across the country, however, the AP found their tools can set families up for separation by rating their risk based on personal characteristics they cannot change or control, such as race or disability, rather than just their actions as parents.

In Allegheny County, a sprawling county of 1.2 million near the Ohio border, the algorithm has accessed an array of external data, including jail, juvenile probation, Medicaid, welfare, health and birth records, all held in a vast countywide “data warehouse.” The tool uses that information to predict the risk that a child will be placed in foster care two years after a family is first investigated.

County officials have told the AP they’re proud of their cutting-edge approach, and even expanded their work to build another algorithm focused on newborns. They have said they monitor their risk scoring tool closely and update it over time, including removing variables such as welfare benefits and birth records.

Vaithianathan and Putnam-Hornstein declined the AP’s repeated interview requests to discuss how they choose the specific data that powers their models. But in a 2017 report, they detailed the methods used to build the first version of Allegheny’s tool, including a footnote that described a statistical cutoff as “rather arbitrary but based on trial and error.”

“This footnote refers to our exploration of more than 800 features from Allegheny’s data warehouse more than five years ago,” the developers said by email.

That approach is borne out in their design choices, which differ from county to county.

In the same 2017 report, the developers acknowledged that using race data didn’t substantively improve the model’s accuracy, but they continued to study it in Douglas County, Colorado, though they ultimately opted against including it in that model. To address community concerns that a tool could harden racial bias in Los Angeles County, the developers excluded people’s criminal history, ZIP code and geographic indicators, but have continued to use those data points in the Pittsburgh area.

When asked about the inconsistencies, the developers pointed to their published methodology documents.

“We detail various metrics used to assess accuracy — while also detailing ‘external validations,’” the developers said via email.

When Oregon’s Department of Human Services built an algorithm inspired by Allegheny’s, it factored in a child’s race as it predicted a family’s risk, and also applied a “fairness correction” to mitigate racial bias. Last June, the tool was dropped entirely due to equity concerns after an AP investigation in April revealed potential racial bias in such tools.

Justice Department attorneys cited the same AP story last fall when federal civil rights attorneys started inquiring about additional discrimination concerns in Allegheny’s tool, three sources told the AP. They spoke on the condition of anonymity, saying the Justice Department asked them not to discuss the confidential conversations. Two said they also feared professional retaliation.

IQ TESTS, PARENTING CLASS

With no answers on when they could get their daughter home, the Hackneys’ lawyer in October filed a federal civil rights complaint on their behalf that questioned how the screening tool was used in their case.

Over time, Allegheny’s tool has tracked if members of the family have diagnoses for schizophrenia or mood disorders. It’s also measured if parents or other children in the household have disabilities, by noting whether any family members received Supplemental Security Income, a federal benefit for people with disabilities. The county said that it factors in SSI payments in part because children with disabilities are more likely to be abused or neglected.

The county also said disabilities-aligned data can be “predictive of the outcomes” and it “should come as no surprise that parents with disabilities … may also have a need for additional supports and services.” In an emailed statement, the county added that elsewhere in the country, social workers also draw on data about mental health and other conditions that may affect a parent’s ability to safely care for a child.

The Hackneys have been ordered to take parenting classes and say they have been taxed by all of the child welfare system’s demands, including IQ tests and downtown court hearings.

People with disabilities are overrepresented in the child welfare system, yet there’s no evidence that they harm their children at higher rates, said Traci LaLiberte, a University of Minnesota expert on child welfare and disabilities.

Including data points related to disabilities in an algorithm is problematic because it perpetuates historic biases in the system and it focuses on people’s physiological traits rather than behavior that social workers are brought in to address, LaLiberte said.

The Los Angeles tool weighs if any children in the family have ever gotten special education services, have had prior developmental or mental health referrals or used drugs to treat mental health.

“This is not unique to caseworkers who use this tool; it is common for caseworkers to consider these factors when determining possible supports and services,” the developers said by email.

Before algorithms were in use, the child welfare system had long distrusted parents with disabilities. Into the 1970s, they were regularly sterilized and institutionalized, LaLiberte said. A landmark federal report in 2012 noted parents with psychiatric or intellectual disabilities lost custody of their children as much as 80 percent of the time.

Across the U.S., it’s extremely rare for any child welfare agencies to require disabilities training for social workers, LaLiberte’s research has found. The result: Parents with disabilities are often judged by a system that doesn’t understand how to assess their capacity as caregivers, she said.

The Hackneys experienced this firsthand. When a social worker asked Andrew Hackney how often he fed the baby, he answered literally: two times a day. The worker seemed appalled, he said, and scolded him, saying babies must eat more frequently. He struggled to explain that the girl’s mother, grandmother and aunt also took turns feeding her each day.

FOREVER FLAGGED

Officials in Allegheny County have said that building AI into their processes helps them “make decisions based on as much information as possible,” and noted that the algorithm merely harnesses data social workers can already access.

That can include decades-old records. The Pittsburgh-area tool has tracked whether parents were ever on public benefits or had a history with the criminal justice system — even if they were minors at the time, or if it never resulted in charges or convictions.

The AP found those design choices can stack the deck against people who grew up in poverty, hardening historical inequities that persist in the data, or against people with records in the juvenile or criminal justice systems, long after society has granted redemption. And critics say that algorithms can create a self-fulfilling prophecy by influencing which families are targeted in the first place.

“These predictors have the effect of casting permanent suspicion and offer no means of recourse for families marked by these indicators,” according to the analysis from researchers at the ACLU and the nonprofit Human Rights Data Analysis Group. “They are forever seen as riskier to their children.”

As child welfare algorithms become more common, parents who have experienced social workers’ scrutiny fear the models won’t let them escape their pasts, no matter how old or irrelevant their previous scrapes with the system may have been.

Charity Chandler-Cole, who serves on the Los Angeles County Commission for Children and Families, is one of them. She landed in foster care as a teen after being arrested for shoplifting underwear for her younger sister. Then as an adult, she said, social workers once showed up at her apartment after someone spuriously reported that a grand piano was thrown at her nephew who was living at her home — even though they didn’t own such an instrument.

The local algorithm could tag her for her prior experiences in foster care and juvenile probation, as well as the unfounded child abuse allegation, Chandler-Cole says. She wonders if AI could also properly assess that she was quickly cleared of any maltreatment concerns, or that her nonviolent offense as a teen was legally expunged.

“A lot of these reports lack common sense,” said Chandler-Cole, now the mother of four and CEO of an organization that works with the court system to help children in foster care. “You are automatically putting us in these spaces to be judged with these labels. It just perpetuates additional harm.”

Chandler-Cole’s fellow commissioner Wendy Garen, by contrast, argues “more is better” and that by drawing on all available data, risk scoring tools can help make the agency’s work more thorough and effective.

GLOBAL INFLUENCE

Even as their models have come under scrutiny for their accuracy and fairness, the developers have started new projects with child welfare agencies in Northampton County, Pennsylvania, and Arapahoe County, Colorado. The states of California and Pennsylvania, as well as New Zealand and Chile, have also asked them to do preliminary work.

And as word of their methods has spread in recent years, Vaithianathan has given lectures highlighting screening tools in Colombia and Australia. She also recently advised researchers in Denmark and officials in the United Arab Emirates on how to use technology to target child services.

“Rhema is one of the world leaders and her research can help to shape the debate in Denmark,” a Danish researcher said on LinkedIn last year, regarding Vaithianathan’s advisory role related to a local child welfare tool that was being piloted.

Last year, the U.S. Department of Health and Human Services funded a national study, co-authored by Vaithianathan and Putnam-Hornstein, that concluded that their overall approach in Allegheny could be a model for other places.

HHS’ Administration for Children and Families spokeswoman Debra Johnson declined to say whether the Justice Department’s probe would influence her agency’s future support for an AI-driven approach to child welfare.

Especially as budgets tighten, cash-strapped agencies are desperate to find more efficient ways for social workers to focus on children who truly need protection. At a 2021 panel, Putnam-Hornstein acknowledged that “the overall screen-in rate remained totally flat” in Allegheny since their tool had been implemented.

Meanwhile, foster care and the separation of families can have lifelong developmental consequences for the child.

A 2012 HHS study found 95% of babies who are reported to child welfare agencies go through more than one caregiver and household change during their time in foster care, instability that researchers noted can itself be a form of trauma.

The Hackneys’ daughter already has been placed in two foster homes and has now spent more than half of her short life away from her parents as they try to convince social workers they are worthy.

Meanwhile, they say they’re running out of money in the fight for their daughter. With barely enough left for food from Andrew Hackney’s wages at a local grocery store, he had to shut off his monthly cell phone service. They’re struggling to pay for the legal fees and gas money needed to attend appointments required of them.

In February, their daughter was diagnosed with a disorder that can disrupt her sense of taste, according to Andrew Hackney’s lawyer, Robin Frank, who added that the girl has continued to struggle to eat, even in foster care.

All they have for now are twice-weekly visits that last a few hours before she’s taken away again. Lauren Hackney’s voice breaks as she worries her daughter may be adopted and soon forget her own family. They say they yearn to do what many parents take for granted — put their child to sleep at night in her own bed.

“I really want to get my kid back. I miss her, and especially holding her. And of course, I miss that little giggly laugh,” Andrew Hackney said, as his daughter sprang toward him with excitement during a recent visit. “It hurts a lot. You have no idea how bad.”

___

Burke reported from San Francisco. Associated Press video journalist Jessie Wardarski and photojournalist Maye-E Wong in Pittsburgh contributed to this report.

___

Follow Sally Ho and Garance Burke on Twitter at @_sallyho and @garanceburke.

___

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March 15, 2023
Opinion: An often overlooked solution to prevent accidental gun deaths | CNN

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Editor’s Note: Jamie Gold is a wellness design consultant and author of “Wellness by Design: A Room-by-Room Guide to Optimizing Your Home for Health, Fitness and Happiness.” The opinions expressed in this article are her own. Read more opinion at CNN.

CNN
—

President Joe Biden signed an executive order on Tuesday seeking to increase the number of background checks for gun purchasers. The measure does something else that doesn’t get nearly enough attention: It would promote the secure storage of firearms.

I’m a city girl whose family didn’t own guns but as a teenager, I got to see what secure gun storage looks like. I lived with my cousin’s family in Brooklyn during my senior year of high school. My uncle, a retired New York City police detective, enjoyed deer hunting upstate and would take his sons with him on many of those outings.

I remember seeing trophy photos in their house, but never the rifles. Those were secured out of sight and reach from young hands. Kids were only allowed to safely handle them while he was supervising. It’s the way many responsible parents teach their children to respect the power of firearms and protect their families from harm.

Many, but unfortunately, not all.

There were news reports this week of what has become a spate of incidents in which young children get their hands on unsecured firearms, with tragic consequences.

A 3-year-old girl fatally shot her 4-year-old sister in Houston, Texas over the weekend in an incident authorities called “tragic” but “very preventable.” Law enforcement officials said the child got hold of a loaded semi automatic pistol in the home.

And in January, a six-year-old Virginia boy allegedly shot a teacher with his mother’s handgun. While the state prohibits anyone from leaving a loaded gun in a place or manner to endanger a child younger than 14, or providing a firearm to a child younger than 12, it does not require that guns be locked away.

This meant that a schoolboy was able to swipe his parent’s firearm and smuggle it to school in his backpack, a teen could use it to commit suicide, a person with dementia or other mental illness could harm a loved one, or someone could just take your gun from your home and use it to commit other crimes.

Broadly speaking, gun owners are doing a better job of securing their weapons. According to a 2021 survey by the Journal of the American Medical Association (JAMA Network), the percent of firearm owners with children who were more likely to safely store their weapons increased to 44.1% from 29% six years earlier.

But that still leaves more than half of gun-owning parents ignoring this vitally important safety measure. In 2020, (the most recent year in which data was available from the Centers for Disease Control and Prevention), firearms were the number one cause of death for children ages 1-19 in the United States, claiming the lives of 4,357 children, according to the Kaiser Family Foundation. This drives home the importance of safely securing one’s guns in the home, especially for parents and guardians of the estimated 30 million children who lived in households with these weapons as of April 2021, according to JAMA.

A growing number of states have secure storage laws to keep guns away from minors. And while Americans are deeply divided on guns, one policy with broad bipartisan support, (87%, according to Pew Research), is keeping them away from people with mental issues. Secure storage is one of the ways to do that in shared households with people of all ages and household members whose diagnoses suggest that they shouldn’t have access to firearms.

Secure storage is also one of the few measures that’s accepted by both sides of the gun debate – from the firearm industry’s trade organization to gun safety advocates to a broad swath of the healthcare community.

Research has shown that personal protection tops the list of reasons why gun owners say they keep a firearm. It’s certainly understandable that people want to protect themselves and their families. I know that feeling as a survivor of violent crime myself.

Women often feel more vulnerable – with some justification. (The first fact on Harvard’s School of Public Health page about firearms research blares, “Across states, more guns = more female violent deaths.”)

So having a firearm close at hand adds a measure of security and comfort when something goes bump in the night. If she shares her home with others, though, that weapon can become a safety risk to her or her housemates.

How do you balance safety and risk with firearms at home? And how does this fit into my professional focus as a wellness design consultant? The answer to both is that secure gun storage contributes to safer home environments.

Safety and security is a key facet of wellness design, the practice of creating spaces that support the well-being of their occupants.

Since I concentrate on spaces where people live, and four in 10 American adults say they live in a home where someone owns a gun, that becomes a wellness design concern. What can be done to make their living spaces safer, respecting both well-being and rights?

For the person who wants a firearm within reach while sleeping, there are gun safes designed to fit inside nightstands, and even nightstands with built-in gun safes. The latter is a better option, as it doesn’t allow someone to easily walk off with a small, portable lockbox.

You also want your safe to have either biometric access, so you’re not fumbling for a key in the dark and only your fingerprint can open it, or a keypad if you have no problem remembering obscure numbers, even when your adrenaline is pumping.

If you own a shotgun or rifle, or a collection of firearms, they’re not going to fit into a bedside safe. Then you have other secure storage options and considerations, including the best (and worst) locations in your home, access, weight (vis-à-vis floor joists), flooring type, fire and theft. Gun safes are not simple purchases, and some larger solutions benefit from professional insight and installation.

You’ll quickly realize that the elegant closet system you chose probably isn’t going to suffice to secure your firearms either. As one luxury designer shared in a message, “Secure? I can put a lock on anything, but it’s not a safe. We can build around and hide safes or secret hiding places where you need a code to get in. But with TFL, [thermally-fused laminate, formerly called melamine], if you put enough force, it can be broken.” That set-up might keep your kids or their friends out of your closet-housed gun storage, but not necessarily an angry ex or serious thief.

You need a firearms storage expert to help secure your weapons, especially if you own more than one. (Since there are about 120 guns for every 100 Americans, according to one survey, it’s not a small number of owners who are in need of larger safe storage.)

There are numerous online guides to choosing and buying gun safes. Many are published by the safe companies themselves, sources that aren’t owned or tied to a manufacturer or seller are going to be your best bet for unbiased advice.

The 79-year-old publication Gun Digest published a buying guide on its site. The Gun Safe Reviews Guy posted a four-minute Gun Safe FAQ on his site, along with extensive buying and installation guides. His self-described background as an engineer with residential construction experience comes through in his site’s advice.

The dealer who sold you your guns can possibly recommend a secure storage dealer. Or once you’ve chosen a make and model after reviewing the advice sites, the company’s website can likely refer a local professional to sell and install it – an improperly-installed safe may not work as it should.

Will secure gun storage prevent every gun injury or death? No, but it can help reduce the number of accidents, suicides and access to firearms by those who shouldn’t have them – including under your roof.

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March 14, 2023
Paris Hilton’s path from party girl to icon of ‘extra’

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“Paris: The Memoir” by Paris Hilton (Dey St. Books)

Dubbed the “OG Influencer,” club kid-turned-mogul Paris Hilton pioneered becoming “famous for being famous,” in the early 2000s, a playbook since adopted by everyone from the Kardashians to Housewives and countless social media influencers.

Hilton became a staple on the New York City club circuit in her teens in the late 1990s, decked out in designer fashion and towering heels, an irresistible magnet for paparazzi.

In her 20s, her fame became mainstream with the nearly simultaneous debut of her reality show “The Simple Life,” and the leak of a scandalous sex tape.

“I knew I wasn’t trying to build an ordinary career,” Hilton recalls of her early days of being paid to party and attract the paparazzi. “I was building a brand that would eventually turn into multiple income streams … but that sounds way more calculated than it was.”

Born into the family dynasty of hotel magnate Conrad Hilton, Hilton spent her childhood in a rarefied world of privilege, collecting a menagerie of animals like ferrets, gerbils and a baby goat and earning the family nickname of “Star.”

But a diagnosis of ADHD put a damper on the idyllic childhood, making it difficult to focus in school. Her constant need for excitement and penchant for escaping over fences and through bathroom windows branded her a troublemaker.

“I don’t just love fun. I need fun. Fun is my jet fuel,” she writes.

After Hilton started sneaking out at night to go to clubs, sometimes disappearing for days, her parents took a “tough love” approach and sent her to a series of schools for troubled teens, with devastating consequences. Locked away at the schools for nearly two years, Hilton says she was psychologically and physically abused and sexually assaulted during sham gynecological exams.

Once she was released at 18, she stuck to the story concocted by her family that she’d been away at a London boarding school. She didn’t open up about the abuse for 20 years, finally discussing it in her 2020 YouTube documentary “This is Paris.” Since then, she’s become an advocate for reform in the “troubled teen” industry, testifying before Congress about her experience.

Now embracing her ADHD as her “superpower,” these days Hilton focuses on being a mogul with a perfume and jewelry line and other ventures, with a legion of fans she calls her “Little Hiltons.”

She married husband Carter Reum in 2021 and the couple now have a son. Hilton says she appreciates how Reum accepts the “endless spin cycle” of her life. “Where most people see a dumpster fire, Carter sees Burning Man,” she writes.

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March 14, 2023
Advocates for Nationwide Newborn Screening for GAMT Deficiency Celebrate Important Milestone

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BYLINE: Lisa Carricaburu, ARUP Laboratories

Newswise — When you ask Becky Tribe how her son is doing, her smile widens. “He’s doing just great,” she says. Woodward, or Woody, as he’s called, is a thriving 2-year-old. He’s adorable, energetic, and loving. Becky and her husband, Stewart, celebrate as he achieves each developmental milestone.

That last part is important to the Tribes because life might have been different for their son. When Woody was born in December 2020, he became the first infant in the nation to be identified as having guanidinoacetate methyltransferase (GAMT) deficiency as a result of the rare inherited condition being added to a state’s newborn screening panel.

GAMT deficiency affects the body’s ability to produce creatine. Without sufficient reserves of this organic compound, the body is unable to store and use energy properly, potentially resulting in cognitive impairments that can be severe. If detected early, however, the condition is treatable with supplements and a controlled diet. “Woody’s early diagnosis changed his life, and it changed our lives,” Becky Tribe said. “We’re so, so lucky that GAMT was caught early.”

Pioneers in GAMT deficiency diagnosis and treatment

The Tribes live in Utah, the first state to add GAMT deficiency to its newborn screening panel, thanks to the sheer will and determination of two University of Utah Health scientists and Heidi Wallis, the mother of two children who have the condition. The married couple of Marzia Pasquali, PhD, section chief of Biochemical Genetics at ARUP Laboratories, a nonprofit enterprise of the U and its department of pathology, and Nicola Longo, MD, PhD, a pediatrician and chief of the Medical Genetics division at U of U Health and member of the Biochemical Genetics department at ARUP, are pioneers in the diagnosis and treatment of GAMT deficiency. Wallis, now executive director of the Association for Creatine Deficiencies, is a committed advocate for her own children and others affected by the disorder.

Pasquali, Longo, and Wallis have since helped get GAMT deficiency added to the newborn screening panels of a few other states, and now they are celebrating an important new milestone that will help get the disorder added to newborn screening panels nationwide. Based on an application they first submitted in 2016, U.S. Secretary of Health and Human Services Xavier Becerra in early January approved the addition of GAMT deficiency to the Recommended Uniform Screening Panel (RUSP), a list of disorders that is carefully curated by the Advisory Committee on Heritable Disorders in Newborns and Children (ACHDNC).

“This is a big deal,” Wallis said. Some states are required by law to add disorders to their newborn screening panels within a limited time frame after they’ve been added to the RUSP. Most states, and even other countries, rely on the RUSP to guide what they should add to their panels, she said. “We’re grateful to each of the experts who gave their time and expertise to this effort.”

A life-changing difference

The effort involved was significant. A disorder must meet rigorous criteria to be included in the RUSP. The initial application included detailed information about GAMT deficiency, how to screen for and then perform confirmatory testing for the disorder, and, “The big question was, is there a difference if you treat the disease early compared with later,” Longo said.

Evidence from the extensive research he and Pasquali have done was critical, but so, too, was input from families with children diagnosed with GAMT deficiency, Longo said. Wallis’ input was compelling because she knows well the difference that infant screening can make. Her daughter Samantha’s (Sam’s) developmental delays went undiagnosed, and therefore untreated with effective therapies, until she was 5 years old, when a test to measure biochemical changes in the brain detected a lack of creatine. Subsequent genetic testing identified a mutation in the gene that provides instructions for making the enzyme GAMT, and that likely explained the lack of creatine in Sam’s brain. The enzyme converts guanidinoacetate to creatine. When GAMT is deficient, creatine is deficient, too, unless some type of intervention occurs.

Sam’s diagnosis ensured that Wallis’ son Louis was tested at birth. He, too, was confirmed to have GAMT deficiency, but early intervention has meant that 11-year-old Louis has none of the cognitive impairments that continue to challenge his sister, who is now 19.

The Tribes’ story also was key to GAMT deficiency’s addition to the RUSP. To meet the ACHDNC criteria, Pasquali, Longo, Wallis, and others needed to show that infants would be identified through routine newborn screening, then confirmed to have the disorder through further testing. Woody’s diagnosis in December 2020 provided that evidence, as did the diagnosis through newborn screening in New York state of a second infant in February 2021.

With this final piece established, the application was resubmitted in May 2021 and approved for evidence review in August 2021, Wallis said. An evidence review committee presented its findings in May 2022, and members of the ACHDNC unanimously recommended that GAMT deficiency be added to the RUSP. Becerra’s approval on January 4, 2023, completed the matter.

A new hope for families

Pasquali said the addition of GAMT deficiency to the RUSP is a good example of effective collaboration by all parties involved. “Newborn screening is not simply a test, it’s a whole system,” she said.

The laboratory must identify an infant with the disorder and confirm the diagnosis, then a clinician must treat the condition as the family cares for the infant. Importantly, the treatment must also be effective. “We have to demonstrate that the whole system works,” Pasquali said.

She and Longo said the effect of GAMT deficiency’s addition to the RUSP won’t be immediate because it will take time for states to add it to their panels. Timelines will vary depending on resources and other factors. Pasquali is optimistic, though, in no small part because she expects manufacturers to add GAMT deficiency screening to the kits for the panels that state public health laboratories use to perform newborn screening.

For the Tribe family, it can’t happen soon enough.

“As parents who found ourselves in the thick of this, it just boggled our minds to learn that this screening wasn’t more prevalent and readily available to everyone,” Stewart Tribe said. “It just seems like such a simple thing that can make a life-changing difference.”

Above all, Wallis is relieved.

“This is so important to our families,” she said. “It gives us hope.”

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March 13, 2023
I Was Drinking A Liter Of Vodka A Day. Then A Single Word From My Son Caused Me To Seek Help.

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When I was growing up in Scotland, drinking was a rite of passage — and, as it did with me, typically started around age 13. During my teenage years, I associated alcohol with the good times: birthdays, house parties and summer holidays.

It wasn’t until I left home for college that my drinking took a dark turn.

In the U.K., the student experience is centered heavily around going out to the pub and getting drunk. I stayed in the dorms during my first year, living with other students in a culture of binge drinking. If you wanted to make friends, then you had to be comfortable with drinking.

While many enjoyed their nights out and still made their way to class the next day, I was often still drinking. Alcohol stopped being about the social aspect for me — in fact, I preferred drinking alone.

My time at university was very isolating. I was socially awkward, found it difficult to make friends, and used alcohol to escape loneliness and provide comfort as I sat alone in my room. Drinking began to take priority over everything else in my life.

As my alcohol abuse worsened, I dropped out of university and moved back to my hometown with a girl I had met while working a bar job. It was my first relationship, but looking back, I think we mostly found comfort in each other.

We had been together for five years when she found out that she was pregnant.

When I learned I was going to be a dad, I felt genuine happiness, something that I hadn’t experienced in a long time.

We stayed together during the pregnancy, and I helped her out — when I was sober enough. By that point, I was drinking a liter of vodka a day. I only left the house to go to work, which was in a dingy restaurant across the road where no one cared that I smelled like booze. I had cut off the few friends I had, and drinking myself into unconsciousness became the norm. When my wages were spent, I turned to my parents for money. I would lie about why I needed the extra cash, telling them that my shifts had been cut at work or that I needed help with bills.

However, the single biggest consequence of my drinking was the way I treated the mother of my child. I would get irritated, start arguments over nothing and call her terrible names. It was inexcusable behavior, but that’s what addiction does — it turns us into the very worst versions of ourselves.

When Neil was born, his mother and I were still together, but things between us deteriorated quickly after his birth. I developed postnatal depression — which was, of course, exacerbated by my drinking — and she had to look after our newborn child almost entirely alone. Instead of using those first few months to bond with my son, I chose to sit in our bedroom drinking myself into oblivion.

Neil’s mum had finally had enough and left me when Neil was about 6 months old. She told me that I could see Neil whenever I wanted, but she urged me to get help. However, at the time, I refused to accept that my drinking was a problem.

When he was 2, Neil was over one day and amusing himself with his toys on the living room floor. I playfully asked him, “Do you love Dad?”

He stopped, locked his eyes on me and clearly replied, “No.”

I had always struggled to deal with my emotions and usually resorted to suppressing the hell out of them. But at that moment, I couldn’t stop the tears from pouring. I wasn’t just crying because I had failed my son, but I was also ― for the first time — accepting the fact that I was an addict, and I needed help.

As much as it pains me to say, Neil’s response to my question didn’t come as a total shock. So far in his life, his dad was someone who was always yelling ― because I was either hungover or still drunk from the night before — and showed him almost no affection.

I rarely cuddled him, hardly ever said “I love you,” and I almost never played with him because I was usually lying on the couch, nursing a splitting headache.

On one occasion, Neil was supposed to be getting dropped off by his mom, but I had gotten blackout drunk the night before and didn’t answer the door. I eventually came to when I heard an even louder knock, which was enough to get me on my feet to stagger over and see who it was.

When I opened the door, I saw two police officers. They had been asked to do a wellness check after receiving a worried call from my mother. As it turned out, I had been drunk-calling people all night in some sort of cry for help.

I have no recollection of that night. And yet, I still carried on drinking.

Children learn what love is from their parents, and today when I think back to that moment when Neil said he didn’t love me, I realize that it’s because he wasn’t sure if I loved him. His mom had shown him what it meant to be loved, and he knew he wasn’t getting that from me.

After accepting that I had a drinking problem, my mom was the first person I reached out to. She told me that she had been waiting for this call for a long time, and was so pleased I was finally accepting that I had an addiction and needed help. As well as my weekly 12-step meetings, my mum has been my crutch during recovery.

Seeing Neil for the first time after getting sober is a moment that will stay with me forever because I was finally able to give him something that he deserved from the start: a dad. I was no longer an empty shell of a person, focused only on feeding my habit. I was sober and ready to be a dad that my son could love.

Today, my son looks forward to staying with me, running into my arms with a smile on his face when he’s dropped off. I take him on days out, we play with his toys together, we laugh, we cuddle, I read him bedtime stories, and I kiss him good night. Neil now tells me that he loves me because he knows that I love him, and I tell him so every day.

After only months of sobriety, I know there’s a long road ahead, and recovery hasn’t been without its challenges. But focusing all my efforts on rebuilding my relationship with my son and being the best dad I can be has given me a purpose in life that alcohol had deprived me of for too long.

There’s one thing, more than any other, that is keeping me sober, and that’s having a son who says, “I love you, Dad.”

Need help with substance use disorder or mental health issues? In the U.S., call 800-662-HELP (4357) for the SAMHSA National Helpline.

Do you have a compelling personal story you’d like to see published on HuffPost? Find out what we’re looking for here and send us a pitch.

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March 13, 2023
WV legislators OK transgender care ban with health exemption

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CHARLESTON, W.Va. — West Virginia’s Republican supermajority House of Delegates swiftly OK’d a proposal to add mental health exemptions to a bill that would ban certain health care for transgender youth during the last day of its 60-day legislative session Saturday.

The chamber approved changes made by the state Senate late Friday that would allow some transgender youth to continue receiving medical interventions, including hormone therapy, if they are at risk of self-harm or suicide.

The bill now heads back to the Senate for final approval, which it is likely to receive Saturday before heading to the desk of Gov. Jim Justice. The Republican governor has not taken a public stance on the measure.

Lawmakers in West Virginia and other states advancing bans on transgender health care for youth and young adults often characterize gender-affirming treatments as medically unproven, potentially dangerous in the long term and a symptom of “woke” culture.

But every major medical organization, including the American Medical Association, the American Academy of Pediatrics and the American Psychiatric Association, supports gender-affirming care for youths.

House members — who passed a much more restrictive version of the proposal last month that included no mental health exemptions — voted to approve the amendment in a unanimous voice vote with little discussion. The amended bill then passed 88-10, with all ‘no’ votes coming from the body’s shrinking delegation of Democrats.

The only lawmaker who spoke on the floor prior to the vote was Democratic Del. Ric Griffith, who cited data from peer-reviewed medical journals showing that hormone therapy and other interventions can drastically reduce psychological distress and suicidal ideation for transgender adolescents.

“We talk a lot about, ‘Parents know what’s best for their children,’” he said. “This is a fairly narrow allowance when a child could potentially be suicidal.”

The rate of suicide ideation, or having suicidal thoughts or ideas, for transgender youth in Virginia is three times higher than the rate for all youth in the state, according to research complied by WVU Medicine physicians using West Virginia Youth Risk Behavior Survey data.

West Virginia’s bill would outlaw those under 18 from being prescribed hormone therapy and fully reversible medication for suspending the physical changes of puberty.

But the change approved by House lawmakers Saturday — proposed by Senate Majority Leader Tom Takubo, a trained physician — would allow young people to access puberty blockers and hormone therapy if they are experiencing severe gender dysphoria, under certain circumstances.

Gender dysphoria is defined by medical professionals as severe psychological distress experienced by those whose gender identity differs from their sex assigned at birth.

Takubo referenced 17 peer-reviewed studies showing a significant decrease in the rates of suicide ideation and suicide attempts among youth with severe gender dysphoria who have access to medication therapy.

“These kids struggle, they have incredible difficulties,” he said.

He found a supporter in another trained physician, Sen. Mike Maroney, chair of the Senate Health and Human Resources Committee. Maroney said lawmakers would set “a dangerous precedent” by disregarding medical research in favor of political gain.

“Who are we, to win an election, to tell people how to practice medicine? To change treatments? It’s unbelievable,” the Republican said, adding that lawmakers wouldn’t apply the same standard for drugs for cancer or mental illness.

The legislation includes a ban on gender-affirming surgery for minors, something medical professionals emphasize does not happen in West Virginia.

With Takubo’s change, a person under 18 would have to be diagnosed with severe gender dysphoria by at least two medical or mental health providers to gain access to medication therapy. One would have to be a mental health provider or adolescent medicine specialist.

The dosage must be the lowest possible necessary to “treat the psychiatric condition and not for purposes of gender alteration,” according to the bill.

Providers must be specifically trained to diagnose and treat severe gender dysphoria in adolescents and would have to provide written testimony that medical interventions are necessary to prevent or limit self-harm or the possibility of self-harm. The minor’s parents or guardians would be required to give written consent to the treatments.

Hormonal therapy could not be provided to minors before the age of puberty, something West Virginia physicians say doesn’t happen anyway.

The bill includes exceptions originating in the House version for individuals born with a “medically verifiable disorder,” including people with ambiguous “external biological sex characteristics” and for people taking treatments for infection, injury, disease, or disorder that has been “caused by or exacerbated by the performance of gender transition procedures.”

People also can access treatment if they are in “imminent danger of death, or impairment of a major bodily function unless surgery is performed.”

The House vote came two days after a crowd of protesters descended on the state Capitol, where cries of “trans kids matter” could be heard from the Senate chamber as lawmakers debated bills. Democratic Del. Danielle Walker, the Legislature’s only openly LGBTQ member, led chants of the state motto: “Mountaineers are always free.”

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March 11, 2023
West Virginia Senate passes modified transgender care ban

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CHARLESTON, W.Va. — West Virginia’s Republican supermajority Senate passed a bill Friday that would ban certain health care for transgender youth after approving a significant change to add exceptions for young people at risk for self harm or suicide.

“These kids struggle, they have incredible difficulties,” said Majority Leader Tom Takubo, a pulmonologist, who urged support for mental health protections.

The bill would outlaw those under 18 from being prescribed hormone therapy and fully reversible medication suspending the physical changes of puberty, buying patients and parents time to make future decisions about hormones.

The rate of suicide ideation for transgender youth in Virginia is three times higher than the rate for all youth in the state, according to research and data complied by WVU Medicine physicians using the West Virginia Youth Risk Behavior Survey.

During a speech on the Senate floor, Takubo referenced 17 peer-reviewed studies showing a significant decrease in the rates of suicide ideation and suicide attempts among youth with severe gender dysphoria who have access to medication therapy.

He found a supporter in Senate Health and Human Resources Committee Chair Sen. Mike Maroney, another trained physician, who said lawmakers would set “a dangerous precedent” by disregarding medical research in favor of political gain.

“Who are we, to win an election, to tell people how to practice medicine? To change treatments? It’s unbelievable,” the Republican said, adding that lawmakers wouldn’t apply the same standard for drugs for cancer or mental illness.

The legislation also includes a ban on gender-affirming surgery for minors, something medical professionals emphasize does not happen in West Virginia.

But Takubo’s approved change would allow young people to access puberty blockers and hormone therapy if they are experiencing severe gender dysphoria, under certain circumstances.

Gender dysphoria is defined by medical professionals as severe psychological distress experienced by those whose gender identity differs from their sex assigned at birth.

Lawmakers in West Virginia and other states advancing bans on transgender health care for youth and young adults often characterize gender-affirming treatments as medically unproven, potentially dangerous in the long term and a symptom of “woke” culture.

During Friday’s debate, Republican Sen. Eric Tarr repeated those concerns, saying the medical interventions doctors are practicing are too extreme and driven by “woke” culture.

“They’re trying to take pronouns out of our textbooks for kids,” Tarr said.

Every major medical organization, including the American Medical Association, the American Academy of Pediatrics and the American Psychiatric Association, supports gender-affirming care for youths.

With Takubo’s change, a person under 18 would have to be diagnosed with severe gender dysphoria by at least two medical or mental health providers to access medication therapy. One would have to be a mental health provider or adolescent medicine specialist.

The dosage must be the lowest possible necessary to “treat the psychiatric condition and not for purposes of gender alteration,” according to the bill.

The providers must be specifically trained to diagnose and treat severe gender dysphoria in adolescents and would have to provide written testimony that medical interventions are necessary to prevent or limit self-harm or the possibility of self-harm.

The minor’s parents and guardians also would be required to give written consent to the treatments.

Hormonal therapy could not be provided to minors before the age of puberty, something West Virginia physicians say doesn’t happen anyway.

The bill now goes back to the state House of Delegates for approval. It’s unclear what House lawmakers will make of the bill’s changes in the Senate. The proposal that passed the House by a wide margin last month included a ban on puberty-blocking medication and hormone therapy, with no exemptions for mental health.

The bill passed the House 84-10, with all ‘no’ votes coming from the body’s shrinking delegation of Democrats. They accused GOP lawmakers of putting children’s lives at risk to score political points with the national conservative movement.

That version provides exceptions for individuals born with a “medically verifiable disorder” including people with “external biological sex characteristics that are irresolvably ambiguous” and for people taking treatments for infection, injury, disease, or disorder that has been “caused by or exacerbated by the performance of gender transition procedures.”

People also can access the treatment if they are in “imminent danger of death, or impairment of a major bodily function unless surgery is performed.”

Speaking against Takubo’s amendment Friday, Republican Sen. Mark Maynard said he didn’t see why any changes were necessary. He worried additions could make the state vulnerable to a lawsuit.

“This amendment would disintegrate the clarity of the bill in its very simple terms,” Maynard said. “These guardrails are already in this bill as it came to us from the House.”

The vote came a day after a crowd of protesters descended on the state Capitol, where cries of “trans kids matter” could be heard from the Senate chamber as lawmakers debated bills.

Democratic Del. Danielle Walker, the only openly LGBTQ member, led chants of the state motto: “Mountaineers are always free.”

“They are trying to come for trans kids in West Virginia, and they’re going to come for every single one of us next,” said Sam Green of Huntington, wearing a transgender pride flag draped around their shoulders while addressing the crowd.

Cecelia Moran, an 18-year-old high school student from Marion County, said she feared banning any kind of medically proven health care could result in more young people leaving West Virginia, one of only three states to lose population in the 2020 U.S. Census.

“I think a lot of young people already struggle to stay here and feel welcome here and are already planning on getting out of the state as soon as possible,” she said.

Her mother, Rebecca Moran, said the bill is “just completely unnecessary” and decisions about healthcare should be made by families and health care providers.

“This is not what’s harming our kids,” said Rebecca Moran, a city councilor in Fairmont. “There’s so many other things: homelessness, poverty.”

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March 10, 2023
Bill would ban marriages under age 16 in West Virginia

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CHARLESTON, W.Va. — A child marriage bill was passed by the West Virginia Senate on Friday night after it was changed to prohibit anyone younger than 16 from getting married and to ban age gaps of more than four years for 16- and 17-year-olds.

The Senate passed the bill on a 31-1 vote. It now goes to the House of Delegates, which previously passed its own version. The legislative session ends Saturday.

“I want us to pass something because our current situation is intolerable,” Morgan County Republican Sen. Charles Trump said.

Currently, children can marry as young as 16 in West Virginia with parental consent. It allows anyone younger than that to get married with a judge’s waiver.

The Senate bill would remove the possibility that anyone younger than 16 could marry. Those ages 16 and 17 would have to obtain parental consent and they couldn’t marry someone more than four years older than them.

Existing legal marriages, including those done in other states, would be unaffected.

The bill was thought to be dead on Wednesday night when the Senate Judiciary Committee rejected it, but the bill was resurrected by Trump on the Senate floor Thursday and moved to Friday’s final vote.

According to the nonprofit group Unchained At Last, which seeks to end forced and child marriage, seven states have set the minimum age for marriage at 18, all since 2018. Supporters of such legislation say it reduces domestic violence, unwanted pregnancies and improves the lives of teens.

Trump said most states allow 16- and 17-year-olds to marry with some requirements attached.

“I know this has been a contentious issue among a number of people,” Trump said. “My hope is this will be viewed as a reasonable and acceptable compromise and a necessary change to our law. It would bring West Virginia in line with the vast majority of states in the country.”

Although recent figures are unavailable, according to the Pew Research Center, West Virginia had the highest rate of child marriages among the states in 2014, when the state’s five-year average was 7.1 marriages for every 1,000 children ages 15 to 17.

Putnam County Republican Sen. Eric Tarr said he got married in high school at 17 and his first child was born five days after graduation. He said he liked Trump’s version of the bill because it “protects family.”

Kanawha County Republican Sen. Mike Stuart said his mother was married at 16 and his parents are still together.

“I don’t say that with any amount of shame,” he said.

A former federal prosecutor, Stuart added the bill wouldn’t be a cure to child sex exploitation in the state. He said that challenge would be helped through more education, funding, law enforcement and prosecutors.

“Our law in West Virginia is pretty darned good. With this amendment it becomes even better,” Stuart said. “And there’s not a state in the country that can hold a candle to West Virginia on these issues.”

The lone vote against the bill came from Cabell County Democratic Sen. Mike Woelfel.

“Our state has invested a lot of money in improving our national image,” Woelfel said. “Every time we have a debate like this talking about child brides, we add to that negative image. Let’s leave it at 18. My God, it’s marriage. How in the world can teenagers negotiate a marriage at this point. Marriage is for adults.”

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March 10, 2023
Is it Dangerous for My Teenager to Turn to TikTok for Medical Advice?
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BYLINE: Dr. Angelia Spurgin

Ochsner Health blog

Newswise — “I’m so worried,” “I can’t focus,” “I’m just so down,” “I just don’t know what’s wrong with me.” These are common phrases psychologists regularly hear from children and adolescents in our communities. According to the Centers for Disease Control and Prevention, there is a substantial increase in mental health crises for youth in the United States, especially those in underserved communities. ADHD, depression, anxiety, eating disorders and substance abuse are the most diagnosed mental disorders among teenagers, with depression and suicide reaching their highest levels in a decade.

Treatment rates vary among disorders, with the National Institutes of Health reporting roughly one in four youth receive mental health services. Various limitations contribute to a lack of seeking treatment: limited access in the community, finances, stigma associated with mental health and fear of judgment. As a result, teenagers seek alternative methods to help with their mental health challenges.

What alternative methods are teens using?

Today, social media is a powerful influence on teen culture. According to the American Academy of Child & Adolescent Psychiatry, roughly 90% of teens have used social media, with 51% reporting they visit it daily. On average, teens are online for approximately nine hours per day. YouTube was reported to be the most popular site among teenagers, followed by TikTok, Instagram and Snapchat.

A newer trend currently amongst teens includes seeking social media therapy. It has been reported the term “mental health” has been searched on TikTok over 67 billion times. Teenagers regularly turn to social media platforms to find support for their mental health struggles. Most teens view social media as a safe place to talk or vent about what is going on in their lives. They find helpful coping resources, there is minimal judgment associated with researching mental health via social media and they often feel validated in their struggles when hearing from peers experiencing similar challenges. Additionally, access to social media far surpasses access to a trained mental health professional in their community. Social media usage can be helpful when done responsibly; however, significant limitations pose potential dangers to teens.

Why can seeking medical advice on social media be a bad thing?

Many social media influencers are not trained professionals in mental health; these influencers do not have the background to provide accurate diagnoses. Additionally, there is no guarantee of confidentiality, the information on social media is traditionally not vetted by a trained professional and the skills/resources provided are not guaranteed to be evidence-based treatments. Self-diagnosis can be a slippery slope, especially for teenagers. Most social media platforms operate from an algorithm that organizes content based on an individual’s searches.

Therefore, when searching for information on mental health, one runs the chance of having their feed flooded with various mental health topics, which may lead to further over-diagnosing of themselves and their symptoms. When seeking mental health treatment, connecting with someone trained in the diagnosis and appropriate treatment is important.

What signs should I look for in my child’s mental health?

For caregivers, it is crucial to be aware of their teen’s screen time and social media usage. High levels of time spent online may impact overall mental health and contribute to sleeping challenges, decreased academic performance, reduced social time with others, limited physical activity, weight or mood problems, or lower self-esteem or body image issues. Additionally, guardians need to be aware of their teen’s mental health. Signs to be aware of may include the following:
- Changes in sleep, weight, eating habits or other everyday patterns
- Loss of interest in the things they previously enjoyed
- Withdrawing more than usual from friends or family
- Academic struggles that seem different or more intense
- Excessive thoughts or worries they can’t stop.
- Refusing to talk about what’s bothering them, even after you’ve made it as safe as possible to discuss hard issues openly
- Obsession with a specific goal, possibly with the belief that if they don’t achieve it, their life will never be the same
- Signs of drug or alcohol use
- Signs of self-harm, such as cuts, burns and bruises that your teen tries to hide or can’t explain fully and credibly
How can I support my teen’s mental health?

Here are tips for caregivers on talking to their teens about mental health from the American Academy of Child & Adolescent Psychiatry:
- Make it safe for your child to discuss challenging issues with you. Kids often avoid discussing touchy subjects, especially if they expect to be judged, lectured or punished. Confirm that your teen can tell you anything if you still need to clarify this. Emphasize that these conversations will take place in a judgment-free zone. Explain that you want to understand what they’re going through and provide loving support.
- Resolve to listen more than you speak. Nothing will send your teen running the other way faster than failing to see and hear them fully. It would help to manage your fears during the conversation to avoid autobiographical listening. This happens when you filter everything through your life lens instead of listening for deep understanding.
- Consider ways to avoid putting your teen on the defensive. Naturally, you can’t be sure how they will react when you ask about their mental health. But fair, factual statements are usually best. Instead of saying, “You’ve been acting strange these past few weeks,” you could start with an example: “I noticed you hate coming down to dinner lately – and you don’t seem hungry at other times. I wondered if something in your life is making it hard for you to enjoy the stuff you usually love, like my killer oatmeal cookies.”
- Accept some silence. Your child might not know what to say, especially if they’ve been trying to hide their feelings or manage things independently. People having mental health struggles often feel shame and fear on top of everything else. This can make it hard to open up to anyone (even someone they trust). Although you’re worried, you can wait for them to think about what they want you to know. If they don’t return to you independently, restart the conversation in a few days.
- Realize that mental health stigma still exists. Despite much progress, some people still believe that having a mental health condition means someone is broken, untrustworthy or potentially violent. Many don’t seek mental health treatment because they fear what others will think of them.
Additional points to keep in mind:
- Mental health is a key part of human health. Caregivers and teens do not need to feel ashamed or fearful in seeking treatment. It’s no different from getting care for a broken bone, a serious infection, or other health concerns.
- Try not to blame yourself for your child’s struggles. Life is hard, and kids are doing their best to manage the pressures they face (just as you are, too). Show compassion for yourself and your child as you move forward.
- Even if you have a history of mental health issues, you are not the root cause of your child’s difficulties. Showing love, trust and respect for yourself and your teen is the healthiest way to ensure you both find the necessary resources.
Are there any resources available?

If you or someone you know has a mental illness, is struggling emotionally, or has concerns about their mental health, there are ways to get help. Use these resources to find support for your teen, a friend or a family member.

To schedule your own interview with Dr. Angelia Spurgin, pediatric psychologist, .
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Ochsner Health

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March 10, 2023
Screen Time Tied to Suicide Risk for Tweens – But Don’t Panic
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Newswise — No one can blame parents for being spooked by new research finding that tweens’ risk of suicidal behavior increases with their amount of screen time. However, lead researcher Jason Nagata, MD, of UCSF Benioff Children Hospitals, says that caregivers should view these findings mostly as a reminder to ingrain healthy screen use habits in their kids as early as possible.

So your study found that screen use increases suicide risk?

The more time kids spend using screens from ages 9 to 11 years old, the higher their odds of suicidal behaviors two years later, at ages 11 to 13. Specifically, each additional hour of screen time increased the risk by 9%. The risk was highest with texting, followed by video chatting, watching videos, and playing video games. Social media didn’t show an effect, but that may be because, technically, kids aren’t allowed to be on social media platforms until they are 13 (though some still are), so we didn’t have as much data there.

What does “suicidal behavior” mean?

It means thinking about suicide, with or without a specific plan, as well as attempting suicide. We weren’t able to separate attempts versus types of thoughts in this study. I should also note that, overall, suicidal behavior was uncommon in these young kids, occurring in just 1.38% of the 11,633 kids we studied. The risk of suicidal behavior tends to increase with age, so this could be seen as an early warning sign.

Why does screen time increase suicidal behavior?

Time spent on screens often displaces time spent on in-person socializing, physical activity and sleep – all of which are good for mental health. Screen usage can lead to cyberbullying, poor eating habits, isolation and disrupted sleep – all of which can worsen mental health. It also increases exposure to potentially anxiety-provoking or otherwise distressing content.

Is all screen time bad for tweens?

Screens can be helpful in some cases, like for kids who, say, are LGBTQ and don’t have real-life access to support, and to stay in touch with friends and family who live far away. I’d say it’s about being thoughtful about how kids engage with screens and keeping an eye on what they consume.

What can parents do to help kids use screens safely?

It’s important for parents to do what’s developmentally appropriate. For older teens, it’s about giving advice. With younger children, preteens and young teens, it makes sense to have a more hands-on approach, like using parental controls and keeping them off social media until they are 13. This time, during early adolescence, is when you set the behaviors that will help kids develop healthy screen habits later on.

What healthy screen habits do you recommend for tweens?
- Avoid screens before bedtime. We know screen use interferes with sleep, and good sleep is so important for mental health.
- Avoid snacking while using screens, to make eating more intentional; and no use of screens during family meals. That helps keep family time about connection, and also helps parents monitor their kids’ eating, which is important because screen overuse is connected to disordered eating, a mental health issue.
- Parents can also establish screen-free zones, like bathrooms and bedrooms. Kids are less likely to get into violent or harmful content in public spaces in the home.
- Parents should try to model all these behaviors for their kids, which can be the hardest part.
What questions are you still trying to answer about screen time and suicide risk?

One is whether screen use causes suicidality, or whether the increased odds of suicide is because kids who are already depressed are more prone to using screens. With this paper, we see a little more evidence that it’s screens leading to suicidal behavior, because we adjusted for mental health at baseline and we looked at the kids two years later.

Another question is, how can we identify the 1% of kids who might tip into suicidality? We need to learn more about the type of content they consume and how it might play a role.
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University of California, San Francisco (UCSF)

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March 10, 2023