ROANOKE TIMES
Copyright (c) 1996, Roanoke Times
DATE: Sunday, February 11, 1996 TAG: 9602090107
SECTION: EDITORIAL PAGE: F-3 EDITION: METRO
SOURCE: MARGIE FISHER EDITORIAL WRITER
WRITING about the Roanoke area's Child Health Investment Partnership, we often use the phrase ``medical home'' to describe the premise for the program's existence. The idea is that every young child should receive sustained medical care from his or her ``own'' doctor - one familiar with the child's physical condition and health needs, and thus able to prevent many minor illnesses from becoming full-blown medical crises or having long-term health consequences.
The medical concept is vitally important. So, too, to CHIP's mission are the private physicians and dentists who provide the medical homes. Yet, says Dr. Douglas Pierce, the Roanoke pediatrician and CHIP co-founder who has worked tirelessly to ensure the involvement of other doctors in the program, the medical component is ``only a small part of it.''
As I recently went with a CHIP worker, Gloria Charlton, on her rounds of home visits, it was easy to see what Dr. Pierce means.
The children I saw in those homes are beautiful, healthy, rosy-cheeked and bright-eyed. Like most children.
Contrary to what might be expected, CHIP's clientele includes more white than black children. It may also come as a surprise to some that many of the children live with a mommy and a daddy who'd have no need for CHIP's services except that they happen to be poor - working poor.
Unfortunately, however, unmarried mothers are the head of about 75 percent of CHIP's households - and distressing numbers of them are teen-agers. Let me tell you about a couple of them:
One, I'll call Annie (not her real name). She is 14 . She's white. Her baby is black. They live with Annie's mother, who also was an unmarried teen-age mom, and who produced a brood of children - some black, some white, each by a different father.
Another, I'll call Lou. She's 16. The father of her baby was not her first sexual encounter. That came when she was 12. Lou's mother had sold her into sex to raise money to buy drugs.
Fictitious names; true stories. And more common than anyone in Roanoke would like to believe.
Annie and Lou know about as much about parenting as I know about metaphysics, which is zip. But - with the help of Gloria, one of CHIP's family-intervention specialists - they are learning. With Gloria's help, they are also learning what options they have for picking up where they left off in public school, getting job training and, it's to be hoped, avoiding a fall into some of the traps that caught their own mothers.
Dr. Pierce and others very familiar with CHIP are quick to recognize that it's such one-on-one intervention that's earned the program national recognition. Teen-age mothers like Annie and Lou may qualify for Aid to Families with Dependent Children or other welfare programs, and may be part of a government social worker's caseload. But as caring as many social workers are, they don't have the time to hand-hold many clients through the process of learning to be responsible parents.
In contrast, CHIP workers spend an enormous amount of time building a close personal relationship with the young mothers - sometimes playing the role of the grandmother who knows what to do if a child has the croup, sometimes the role of best friend if a young mother simply needs someone to talk with. Many of the mothers are inexperienced and terribly insecure - and frankly scared of government workers' involvement in their lives.
Doctors and dentists also can't take the time to make sure that young mothers follow up on the doctors' orders to schedule a diagnostic test for a child, to get a prescription filled and understand how it is to be administered, or perhaps to tend to a child's special dietary requirements. The Medicaid program's workers also can't do this, but CHIP's professional nurses do.
CHIP, of course, also makes sure young mothers keep the appointments they make with doctors, providing transportation whenever necessary. This is a key reason why most Roanoke-area primary-care doctors support the program and will accept CHIP patients even if they refuse to accept Medicaid patients.
To be sure, CHIP's workers confront some dismal, depressing family situations. Making the rounds with Gloria, I saw more than I cared to. I asked her how she could stand it, day in and day out. Her answer went something like this:
``Well, you go off by yourself and you cry and you get over it. You remember that it's the children who are your clients, and it's the children you're trying to help.''
Indeed, it may not be possible to keep Annie and Lou from a life just like their mothers'. But CHIP may prevent their children's lives from turning out just like Annie's and Lou's.
LENGTH: Medium: 85 linesby CNB