1. Culturally Appropriate Health Care Services National Standards for Culturally and Linguistically Appropriate Health Care Service (CLAS) have been developed by a number of federal and national organizations for U.S. Department of Health & Human Services Office of Minority Health. The final report is available at: Final National Standards on Culturally and Linguistically Appropriate Services (CLAS) in Health Care Published . 2. Reaching Hard-to-Serve Families: A Framework for Local and Federal Intervention For welfare reform to succeed, policymakers need to focus on hard-to-serve families who experience domestic violence, substance abuse, or serious mental health problems, either singly or in combination, according to a report by the National Center for Children in Poverty. It states that welfare reform and the idea that children should enter school "ready to learn" provide a framework for local and federal intervention for this "vulnerable and ignored population." The report notes that parental risk factors are disproportionately high for women receiving welfare, because of high rates of substance abuse, domestic violence and depression in this population. The report highlights research explaining the connection between parental risk and child development: although some at-risk children are "resilient," others have developmental delays, attachment disorders, or other mental health conditions. The author discusses using early childhood services; substance abuse, mental health, and domestic violence services; and welfare agencies as points of entry to address the needs of children and families. Although such entry points exist in every community, difficulties in addressing this population's problems include funding challenges and a lack of research on the cost of prevention and early intervention and their impact on children. The author's key recommendations include * Strengthening the capacity of the early childhood community (including Head Start, Early Head Start, child care, preschool, home visiting programs, resource and referral agencies, and family resource programs) to serve the most vulnerable young children and their families in the context of welfare reform; * Enhancing adult-focused substance abuse, mental health, and domestic violence services so that they can better meet the needs of the most vulnerable young children and their families in the context of welfare reform; * Using welfare reform as a catalyst to address the needs of hard-to-serve adults who are on, transitioning off, seeking to stay off, or sanctioned under Temporary Assistance for Needy Families (TANF) and their young children; and * Creating federal legislative and other incentives to develop strong policy and research agendas to promote cost-effective prevention and treatment for problems of the most vulnerable young children and their families in the context of welfare reform. Knitzer J. 2000, March. Children and Welfare Reform Issue Brief 8. Promoting Resilience: Helping Young Children and Parents Affected by Substance Abuse, Domestic Violence, and Depression in the Context of Welfare Reform. New York: National Center for Children in Poverty. 3. Analysis of Pediatric Dental Visits in 1996 An analysis of the Medical Expenditure Panel Survey (MEPS) in the journal Pediatric Dentistry reveals that 43% of all children ages newborn through 18 years visited a dentist at least once in 1996. Although national data are available on dental health status and disparities connected to income and race, the authors note that little data exist on children's use of dental services. Findings include the following: * Among children who see a dentist, the average number of dental visits during 1996 was 2.7; * Low-income, a low level of education, and minority status are all associated with both lower odds of a child having visited a dentist and a lower number of visits per child; and * Children under the age of 6 had visited a dentist less than half as often as older children overall, and the number of the younger group's per-person visits was lower. The authors found that children's socioeconomic status and race correlated less with the number of times they had visited a dentist than with whether they had ever visited one. The disparity in the number of times children in different socioeconomic conditions visited a dentist increased with the children's age: The youngest children of all conditions who see a dentist average 1.6 visits regardless of their socioeconomic status, while adolescents have significantly more visits if they are white or if from a higher income and education family. Adolescents may have more visits because they require more complex treatment (for example, orthodontic care). MEPS is a government-sponsored, nationally representative health survey. In the 1996 survey, researchers analyzed 6,595 persons who were 18 years old or younger-representing 75,297,788 noninstitutionalized American children. Of the sample, 49% were female, 45% were either black or Hispanic, and 28% were between the ages of 6 and 10. A limitation of MEPS data is that it is self-reported, but the authors state that MEPS data are "reasonably current, describe the magnitude of pediatric dental visits, and establish a baseline for rates of pediatric utilization for the United States population." Edelstein BL, Manski RJ, Moeller JF. 2000. Pediatric dental visits during 1996: An analysis of the federal Medical Expenditure Panel Survey. Pediatric Dentistry 22(1):17-20.