Texas Newborn Screening Program’s Benefits Vary for Families

Newborn Screening1 is done through a simple heel prick to get a blood sample followed by a lab analyzing the molecular weights of the newborn’s metabolites. The process is seemingly harmless to newborns, and can reduce disability progression and morbidity of serious diseases. As a resident of Texas, where life expectancy can be predicted from a person’s zip code, one can’t help but wonder if newborn screening provides equal outcomes for every baby screened. 2 

Why is equality of outcomes important? Newborn screening is a public health program aimed at reducing overall disability and morbidity of certain early childhood diseases, which is thought to save money throughout the population on healthcare expenses. If the uninsured and underinsured are not able to appropriately treat diseases found in newborn screening, this public health policy would be increasing inequality in child healthcare. Healthcare equality is important because it lowers the healthcare expenses of citizens that rely on subsidized insurance, increases overall population health, and promotes equitable quality of life. 

One problem faced by families after newborn screening is access to healthcare facilities.3 A newborn who is screened as likely to have a metabolic disease must undergo follow up examinations to actually diagnose them. In such a large state, access to specialty doctors varies greatly. Rural areas struggle to provide families with appropriate follow up care for diagnosis and proper facilities to provide treatment after diagnosis. Rural areas also have a harder time submitting samples due to their distance from testing sites in cities, meaning rural families may get results later than urban families. Rural pharmacies will take longer to get uncommon prescriptions or special formulas, or families may have to travel to a pharmacy which carries what they need. 

Another barrier to healthcare equality for newborn screening lies in the educational materials offered to families.4 Healthcare providers are not always aware of the education materials provided by the health department, and thus may not offer them to families who are confused at the process. The educational materials are offered in English and Spanish, so families who do not know how to read one of these languages will require help with the materials. Doctors may hand the families the reading material instead of sitting down and talking with them. This would also affect parents who struggle with literacy. The educational materials are close to high-school level readings, which many people have not achieved. 

The barriers discussed apply to all areas of healthcare, not just newborn screening. In order for NBS and other healthcare initiatives to reach their full potential, there must be an organized effort to reduce barriers in healthcare equality.  

1. Texas Administrative Code §37.51 requires all babies born in Texas participate in Newborn Screening, with a religious exemption.

2. https://www.texashealthmaps.com/lfex

3. https://www.dshs.state.tx.us/lab/NBSgapsWeaknessSummaryReport.pdf

4. https://www.dshs.state.tx.us/lab/NBSgapsWeaknessSummaryReport.pdf

Through the lens of the US Child Welfare System: Disproportionate treatment of Black children Part 1

First, looking from a historical view of Black families in the early days of the child welfare system showed signs of prejudice and racial processes and procedures. In 1973, Wilder v. Sugarman was brought by the NY Civil Liberties Union, which sues NY City for using racial discrimination in their child welfare system processes and procedures. [i] Shirley A. Wilder, a Black 12-year-old, was rejected services from city-funded Roman Catholic or Jewish foster-care agencies, which resulted in Shirley receiving lower-quality care.[ii] The suit, later taken over by American Civil Liberties Union, was finally settled in 1986.[iii] The settlement did require NY city to use a more fair and equal process for their child welfare system, but from Shirley’s view, she was around 24 years old by this time.[iv] That time-lapse brought an oppressive systemic issue to Shirley’s involvement with the child welfare system. Due to Shirley being a Black child, she was forced to receive lower-quality care, and this oppression more than likely affected many other Black children.

Additionally, in 1974 the Child Abuse Prevention and Treatment Act (CAPTA) was passed to deal with the national problem of child abuse.[v] The goal of CAPTA is to tackle reports of child abuse by providing funds and guidance to states, public agencies, and nonprofit organizations.[vi] CAPTA, which has been amended several times, was put in place to rectify child abuse cases.[vii] Yet, the proportion of children in need of abusive situations is small, and there lacks sufficient evidence that the services provided through CAPTA have reduced abusive incidents.[viii]

From the time of passing CAPTA, the child welfare program’s representation of Black children started increasing. With this increase, the process of screening, investigating, and assessing Black families who had a report of child abuse and/or neglect became more likely to be assigned for investigation. In the state of Texas, a study found that even when a Black family has a lower risk score than Whites, Blacks were more likely to have their case acted upon, either by some type of service provision or possibly having the child taken away from the parents. This sample shows that the individuals who work the cases have dissimilar risk approaches based on a family’s racial makeup. [ix] With the federal statute of CAPTA being enacted, there was a trickle-down effect to ensure that this legislation is making a broad change in abuse cases. Yet, statistics and studies show that the broad change with the passage of CAPTA targets Black families. Black families are seen through the media and others implicit/explicit bias as the families that are more than likely abusing their children at higher rates than other racial families. This has put a detrimental burden on Black families to not only do their best to not be reported to not experience such scorn treatment from a broken CPS system, but also it creates an oppressive feeling that no matter how hard a Black mother and/or father might try to avoid being reported abuse and neglect there is a still a strong possibility a small slip up can result in a broken family.

[i] Wilder v. Sugarman, 385 F. Supp. 1013 (U.S. D. N.Y. 1974).

[ii] Id.

[iii] Wilder v. Bernstein, 645 F. Supp. 1292 (U.S. D. N.Y. 1986).

[iv] Id.

[v] Lindsey Duncan, The Welfare of Children, 22 W. Mich. Univ. The J. of Socio. & Socio. Welfare 148 (1955).

[vi] Id.

[vii] Id.

[viii] Id.

[ix] Supra at note 2 (May 15, 2021, 5:05 PM).

SNAP Benefits Reduce Future Criminal Convictions, According to New Empirical Research

Child benefits are in the news, specifically the Child Tax Credit and its future in the Build Back Better plan. Empirical research on welfare benefits can help us understand just what is at stake for the children affected by welfare policies.

A new paper, forthcoming in the Journal of Human Resources, links the availability of SNAP benefits during childhood to future criminal convictions[1]. The result may be unsurprising – more SNAP benefits results in less criminal convictions – but the magnitude of the results and the racial characteristics are extremely interesting.

The authors observed that when SNAP benefits were being rolled out in North Carolina, some places were getting them sooner than others in a staggered, predictable way. This means that some kids, for no reason other than the randomness of the programming, got more benefits than others. This allowed the researchers to observe just how beneficial SNAP is to kids, and whether it affects their future likelihood of criminal convictions.

The magnitude of the results is a bit startling: “Each additional year of FSP availability in early childhood reduces the likelihood of a criminal conviction in young adulthood by 2.5 percent.”[2] One might think that the racial disproportionality of both poverty and incarceration is at play here, and the authors considered this explanation. The percent decrease in criminal convictions is even larger for non-whites. The authors attribute this larger effect to non-white families’ higher participation in the food stamps program.

These results are historical: Food stamps were rolled out in North Carolina in the 1960s and 1970s, but the lessons remain relevant. Children who are well-fed and provided for are less likely to fall into the pipeline to prison. It’s common sense, which these authors have backed up with robust empirical evidence.

Hopefully, as the debates around the Build Back Better bill and child benefits rage on, legislators will consider evidence like this. It may be a way to argue that child benefits are actually the policy of law and order! After all, who doesn’t want healthier kids and less crime?

[1] Here is a link to the author’s webpage, where this paper and others of interest to Children and the Law Blog readers may be found

[2] Barr, Andrew, and Alexander Smith, Fighting Crime in the Cradle: The Effects of Early Childhood Access to Nutritional Assistance, 2020 (working paper)