n Guest Blog: San Francisco Public Health Professional Addresses Family Planning | Fair Start Movement

Recently a public health professional in California contacted Fair Start Movement to discuss the impact of family planning on the lives of children. This is what they had to say.

As a public health professional working for the City and County of San Francisco, I am passionate about improving outcomes for at-risk youth and families. Over the years, I have contributed to the evidence-base on what works in mental health and behavioral health care. My greatest interest lies in prevention work, intervening early enough in life to ensure that children get the love and support they need to thrive and become healthy adults. It’s a passion that pervades my personal life, as I plan to foster and adopt my first child – a decision I’ve made for ethical reasons and one that reflects caring for those in need rather than creating new need.

Child welfare is an issue that has risen to near-crisis level in San Francisco. The hasty decision to close our Juvenile Hall is evidence of a broken system whereby community organizations, child welfare and juvenile justice fail to effectively work together on developing long-term solutions, in one of the wealthiest cities in the world. The affordable housing crisis is driving many in the next generation into the streets.   

Families are one of the strongest socializing forces in our lives

Unfortunately, many children come from homes with considerable conflict, putting them at high risk for negative health outcomes. In San Francisco, children and families that come into regular contact with human service agencies, like Child Welfare, Juvenile Probation, and Behavioral Health generally have low socioeconomic status and experience chronic stress related to this. It is common to see children, and their siblings, with mental diagnoses such as oppositional defiant disorder, major depression, and PTSD. 

A substantiated allegation of abuse or neglect can result in a child being removed from their home, however, this is often too late as trauma can permanently impact developing minds. Also, removal from the home brings additional challenges. Children removed from the home may already have attachment issues due to a lack of a stable family environment and they are now being asked to trust multiple providers (case workers, doctors, foster parents, probation officers, etc.). Given the lack of consistent relationships in their lives, they do not know who they trust, and lose a sense of identity and place, putting them in a very vulnerable position for exploitation. In fact, 60% of all sex trafficking victims have a history of involvement with the child welfare system.  Oakland is considered a national hub for child-sex trafficking.

Similarly, juvenile justice-involved youth can be removed from the home. They tend to be older and more criminally sophisticated, and it is therefore challenging to find foster/resource families. Instead, youth are placed in group home facilities, or, depending on the nature of the crime, a more secure facility. In California, the cost to maintain a youth in a group home facility is approximately $10-12K per month with negative outcomes such as running away, early mortality, being in and out of the prison system in adulthood, mental health and behavioral health issues, and chronic homelessness. Teens and youth with multiple placements present a significant barrier to reunification.

All of this creates a pipeline for human trafficking, and horrific cases of domestic violence. I’ve seen the moms and kids stuck in this world with my own eyes. And I know the problem began long ago, in families where the children were being set up for failure. The opioid crisis has only amplified to levels that are breaking public health and child welfare systems around the country.  

A big challenge is how can we intervene early enough to impact children’s lives so that they can thrive and become healthy, contributing members of society? A major challenge is keeping up with the pace of this public health crisis whereby so many children and their siblings are experiencing early neglect and trauma, essentially becoming pawns of the “cradle to prison” pipeline.

Family planning is prevention work

By changing the way we plan families, we take prevention work to another level, finding ways to encourage all parents to have smaller, more equitable and better-planned families, thereby reducing the scale of this crisis and re-purposing resources to focus on evidence-based services that improve long-term outcomes. Programs such as the Perry Preschool Program which focuses on the developmental growth of at-risk children and resulted in a 7–10% per year return on investment based on increased school and career achievement, as well as reduced costs in remedial education, health, and criminal justice system expenditures.

As a society, we need to create policies that uphold the rights of children. Smarter family planning leads to better outcomes. Period. It is time to take a long-range prevention approach and embrace better family planning models like Fair Start.

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