Welcome to this site, which focuses largely on politics. Those of you who have read my blogs on Huffingtonpost.com, books or articles (see bio below) will find this site at times an elaboration and extension of some of those views.  At other times separate discussions.

June 26, 2009

This is a continuation of my blog on Huffpo, “You Actually Want To TALK To The Doctor?”  If you’ve been reading my blogs for some time, you know I’ve been not only a business professor but preventive medicine professor too.  So, I’ve been studying the organizational and patient sides of medicine over the years and have had some significant first hand experience.  After a one and one half year misdiagnosis of breast cancer when I was thirty, you can be sure I’m not easily satisfied by medical care that is sloppy, indifferent, arrogant, or in any other way less than it should be.  So, I wrote about this one-month wait to hear from a doctor about my daughter’s endoscopy results, not because I don’t know how to manage my own and my family’s healthcare, but because the system is so inept at times that even the most proficient of us does not get good care.  I’ve never waited this long for results, except one time when a young doctor took my mammograms to a conference and lost them in the hotel.  It just so happens that during that time a mammogram showed a suspicious shadow and the tests they could use for comparison had been lost in Chicago.  I was in California.  After much apologizing the hospital put a note on my file prohibiting anyone from removing my tests for any reason without my written permission. 

I did finally hear yesterday from the doctor who performed the endoscopy on my daughter.  We talked at length about the various interpretations of the test and where we go from here.  I will have the test forwarded to our family doctor today  in order to get her opinion.  I had to insist upon talking with the doctor when someone from his staff called yesterday.  She could only give me limited information.  That’s not what I wanted nor is it what we should settle for in any circumstance.  The conversation with the doctor provided a necessary chance for us to share observations about my daughter that are now part of the strategy for moving forward. 

The responses to this blog on Huffpo are very valuable.  They are worth a read for sure.  If we do our part as patients -- being ready to use our doctors’ time wisely -- they are better able to help and to respond effectively.  But that is partly their job as well.  They need to be at least half of the communication and assure that even when patients can’t answer crisply providing much needed information, another way is found to help them do so.  And, as this blog contends through a story, doing tests and not taking time to discuss them with the patient or patient’s family is simply bad medical practice.  And you can bet that most doctors don’t like it either.  They are pressured by their institutions to do far more with less.  But if they accept this because more money is thrown their way if they do, they are part of the problem.  As President Obama works with a team of experts to bring about universal healthcare coverage, we need to find ways to reward doctors for insisting upon conditions that serve their patients well.

I’ll be writing more about medicine.  We need some watchdogs out there, not so much pointing fingers, but making systems work both for patients and for the people trying to serve them.

May 30, 2009

I’ve been away for a bit.  Back now and really quite perturbed by the ludicrous debate surrounding the nomination of Judge Sonia Sotomayor to the Supreme Court.  When Betty Friedan and I taught together, she often spoke of the “second stage” about which she also wrote a book.  She wanted so much for women and men to have moved on from bias and loathing to mutual respect.  We are not yet there.  And, were she here, we’d no doubt argue about that but she’d be angry for sure about the low level attacks being used to block Sotomayor.  Don’t get me wrong, she shouldn’t become a Supreme Court Justice because she is a woman or Latina, but because she has an outstanding track record and admirable judicial temperament. 

It’s sickening to see television stations, newspapers and magazines bringing in the least informed and most despicably hateful among us as experts.  This is about the Supreme Court, not who will be joining the staff of a lemonade shack.  Let’s demand better and refuse to accept anything less.  There are, we know, people out there who would gladly take our rights from us, using the argument that any judge with an opinion can’t be objective, even if they have theirs well in place. 

We can do better, much better.

April 25, 2009

You can tell from my blog about the new ways banks and credit card companies are soaking money from the unsuspecting, that I’m angry.  We all should be angry.  What next?  They’ll be taking money off the top from customers who don’t check their accounts often enough or maybe something more clever and sinister like seeking as customers people who are likely to fall into their latest traps.  This is sick and President Obama and Congress need to put a stop to it.  If they can’t get money through front doors, be assured they’re going to try some back ones.  We need people working for our senators and representatives and at The White House who are faster than these people without a conscience.  Ones who can stop them before they do harm and then simply move on to another way of doing harm.  I don’t want to hear that there are too many things going on in Washington for anyone to focus on this base behavior.  There’s time and there are ways to stop it. Brains, integrity and courage would do the trick.

April 17, 2009

If you read my blog about Barack Obama becoming increasingly presidential, but at the same time revealing some tendencies about which we need to be concerned, you might be disappointed that I didn’t just write glowing things.  If that’s the case, then Naomi Klein’s blog will make you angry or depressed for sure.  But she’s not only bright, she’s gutsy.  And while our president is indeed wowing the world and is a far cry better than George W. Bush, he is making choices that are leaving a lot of supporters feeling abandoned.  He can’t please everyone.  And that shouldn’t be expected.  And these are indeed early days.  But I think we’d better all hold on tight.  Barack Obama the leader/president, more so than the candidate, seems capable of coping with the disappointment of  many people while he does what he thinks is ultimately best for most people.  It’s going to be a rough ride, 

April 16, 2009

Michelle Obama’s article in USA Today reveals, once again, her sense of commitment to helping others and to providing for young people a chance to contribute.  We have been seeing and reading about people doing things for others and it’s an inspiring counter to the greed that brought the economy to its knees.  I wonder when it will become common in conversation to here people talk less about what they do for a living and more about what they do while they’re living. 

If you’re not sure where to start or are thinking about doing more, take a look at the First Star website (www.firststar.org) and perhaps the book, Childhood Denied, written to help them help kids at risk.

April 3, 2009

I don’t get all of this talk about Michelle Obama’s outfits.  She is experimenting, as we all do.  She does not enjoy the benefits of anonymity as the rest of us do.  How glad I am that no one was focused on my choices on St. Patrick’s Day when my daughter and I painted our nails green and went out to dinner.  Let’s hope the media criticism of Michelle’s style during this visit abroad is an exception rather than the rule.  This is an impressive woman with whom we may not always agree, but from whom, I’m learning, very little will come that is not well considered and worth hearing.

March 31, 2009

Parkinson’s Disease was the subject of my blog on Huffpo today.  In the midst of so much turmoil about the economy, it may seem a bit off course to write about it.  But as we look ahead to providing healthcare for all Americans, it’s great to have shows like the one Oprah did today providing hope for cures for diseases so long thought “incurable.”  She did a service today for people with PD and their families, but also for others with illnesses that have seemed incurable.  And now, with stem cell research on the increase and skin cells providing and avenue comfortable for all, there is much to be optimistic about. 

March 24, 2009

I’ll probably take a lot of grief from people who think you’re not supposed to even give President Obama constructive criticism because it will hurt his reputation.  But that’s bunk.  And he never operated that way nor have I heard him tell everyone to back off.  He’s tough and he listens and learns from feedback.  In fact, he is a truly promising president and it’s up to us to keep him on track -- at least at times.

And one of those times is now when he isn’t seeking the kinds of opinions that have led in the past to his best thinking.  He is becoming like so many CEOs who go up to the top floor in private elevators and have no idea what is going on below them.  That’s not what he intended to become.  And we can’t afford to allow it.  And neither can he.

That’s why he needs to be on the lookout for fresh ideas.  Before he becomes insular in his thinking, he needs to avail himself of the wealth of expertise out there and find it sometimes in the unlikeliest of places.  That is how creativity happens.  It evolves from openness -- not in place of experience and tried and true methods -- but welcome at the side of both.

March 19, 2009

I had to take a break to deal with a furnace that was leaking gas.  I mention it so that if you’re living in an older place, and especially renting, you don’t neglect having an independent expert come in to check your furnace.  And have carbon monoxide detectors in your home along with fire alarms.

Prevention is the key word here.  And it’s what I just wrote about on Huffpo.  Everyone on the Hill is blaming everyone else and you know they could have prevented this mess.  And they will likely end up allowing AIG’s executives to keep most of the money arguing that they have to honor contracts or not set a precedent of interfering with businesses-- even if we now own them.  What a mess pathological politics is.  And everyone claims to hate it but so many are willing to take from it what they can while they’re complaining. 

There were a lot of chefs spoiling the AIG stew -- for the American people anyway.  And that’s only one company.  And I’m somewhat annoyed at President Obama for telling us stories and claiming the “buck stops here” instead of getting more angry and insisting on more honorable behavior from all involved along with better thinking from his advisers. 

As Anderson Cooper pointed out, you don’t have to make it too simple for the American people.  They can walk and chew gum at the same time.  How about some serious sharing of information and giving it to us straight?  That’s part of change.  That’s what we voted for.

February 28, 2009

Those members of the press trying to humiliate and disparage Vice President Joe Biden merely because he forgot the website address www.recovery.gov, make themselves look ridiculous.  Why didn’t the CBS reporter do her homework?  Hadn’t she listened to the President’s speech?  Why didn’t she know the address?  Why did she ask, “By the way, do you know the website?”  It seemed a set-up.  This is very petty and a gratuitous attempt to reduce the credibility of a very bright man busy doing very important things for this country.  He gave an honest response.  Where’s the credit for that?

February 23, 2009

President Obama was impressive standing before senators and representatives after they’d been in break-out groups coming up with ways to address significant issues facing the United States.  His tone and demeanor were those of a leader in search of good answers rather than one presuming to possess them.

Having raised the issue last week on Huffpo of the dangers inherent in proceeding without due caution to develop and utilize comparative effectiveness criteria for healthcare and having this misinterpreted as opposition to President Obama, I was indeed pleased to hear the president say he wants to learn about the downsides of various processes before moving forward.   He said he welcomes various perspectives on both “substance and process.”  He offered that difficult decisions would need to be made, but he apparently does not wish to make them in the dark.

Unlike his predecessor, he appears more than willing to be a decider but not without hearing from people whose opinions differ from his own or who may have some ideas that would set him on a more productive path.  He deserves considerable credit for what he did today.  And for the good humor he displayed.  This is the “intelligent president” I wrote about a few weeks ago, the one we’d hoped to find in Barack Obama, not fearful of losing credibility as a leader merely by being open to learning.  This “spirit,” as he described it,  will be difficult to sustain on some days, but he has taken a huge step forward.

February 20, 2009

I wouldn’t want to be president right now.  But let’s just say it couldn’t be avoided.  Let’s say you or I had to take the job.  Would we try to save the homes of people who have made mistakes or those who’ve lost their jobs?  What if, as many warn, the money wouldn’t be enough?  Personally, I’d still do it.  While I comprehend intellectually the argument that people who “stayed within the rules,” so to speak, and didn’t take big risks in order to own a home are in a way penalized by having to help bail out a number of people who did, how could a president justify bailing out banks and organizations greedily paying their senior executives exorbitant salaries and/or bonuses and not try to help individual Americans?   How could a president save organizations that failed because of poor management and not at least attempt to do something for individual Americans who, en masse, were duped by some of these same people? 

Besides, those who supposedly did the right thing and didn’t get caught up in the sub prime loans or lose their jobs, wasn’t some of that pure luck?  Success in life is not, as some would have us believe, always a matter of doing things better than the other guy.  There’s a degree of that.  Certainly much of success is working hard.  But sometimes you get a break.  Maybe you’re more intelligent, more attractive, more diligent.  Maybe your parents passed down some important wisdom.  If so, you’re also lucky.

We have to get outside of ourselves and extend a hand when people are hurting.  Otherwise who are we? 

February 16, 2009

I’m going to be keeping an eye on the development of the federal council that will be deciding what treatments are best practices.  I’m not angry about this so much as skeptical.  Until you spend a good deal of time caring for someone who is very ill or doing so for yourself, it’s difficult to understand how political medicine truly is as a field.  If there is to be a council, it should be formulated with intelligence and heart.  That’s a tall order.  But it’s the only order that once filled will meet the goal of lowering medical costs in a humane manner.

As both a medical researcher and patient, I see both sides.  And then there is input from nurses and others who see patients regularly.  There is much to be said for knowing how deep a swamp truly is and what lurks beneath its surface before deciding where and how to build a bridge.

February 13, 2009

A few thoughts about Rahm Emanuel’s comment that President Obama’s team lost control of the stimulus debate when they focused too much on bipartisanship.  And what did they get for it?  Not much, especially after Republican Senator Judd Gregg withdrew his nomination for Secretary of Commerce. 

From a persuasion vantage point, which is my field, rarely does a strategy work if it is told to the other party in advance.  It doesn’t pay, for example, to tell a schoolyard bully:  “I’m going to make you my friend.”  The likely reaction:  “Yeah right.  In your dreams.”  You don’t telegraph your intentions.   If you’re President Obama, you don’t go around saying, “Lincoln did this so I’m doing it too” because the Republicans don’t want to help you become another Lincoln.

So, unless the advisors around now President Obama didn’t know these things about persuasion, which I doubt, this was always a campaign strategy, not a presidential one.  Bipartisanship had to be attempted in the early days of the presidency, and succeed visibly in a few cases, because it was promised.  But the Republicans no doubt see it as a paltry political device in that little benefit comes to them by cooperating -- yet much praise could accrue to Obama. 

In theory bipartisanship is admirable and even necessary on some key issues.  But pretending that we’re all going to be buddies is disingenuous and treats the American people as gullible.

Selective bipartisanship is more realistic and can provide the same sense of working together as the more comprehensive version being bandied about as a goal of the Obama/Biden Administration.

The Republicans aren’t stupid.  Make it worth their while and they’ll play bipartisanship with you, but otherwise it’s just  Democratic speak for “At least WE tried.”

February 12, 2009

I’m listening to President Obama’s tribute to President Lincoln.  Our new president is an impressive man and right now he is speaking comfortably -- when he is most persuasive.  If I could whisper in his ear, however, I’d advise him to stop calling his cabinet members “my secretary of treasury,” “my secretary of labor” and so on.  They are not his and labeling them so sounds royal rather than presidential and denies each of his cabinet members being “the” secretary which is a credit to their accomplishments.  He’d have a better chance at bipartisanship and Republicans staying with nominations if he dropped the word “my.”  That may seem minor, but it isn’t.  I couldn’t stand, nor should anyone, a dean calling me “my professor.”  It credits him or her.  I could call him “my dean” and we can call Barack Obama “my” or “our” president because he has the higher rank.  The other way is simply too self-focused and self-congratulatory.

That aside, however, it’s impressive how he comfortably speaks and even jokes about the latest drop-out from his nomination for Secretary of Commerce.  He can’t do it all.  So we’ll have to remain vigilant, holding the feet of our representatives to the fire so that this country endures, so that people have, as Lincoln described and Obama reminds, “a fair chance in the race of life.”  They can do so much better.  They can help make this president a great one and leave a legacy of their own, but only if their standards rise and they replace the ease of cowardice with meeting the challenge of courage.

February 10, 2009

Sometimes a picture is worth a thousand words:

http://www.ritholtz.com/blog/2009/02/job-losses-comparing-recessions/

February 7, 2009

I guess I’m getting a bit focused on that transparency we were planning to receive after President Obama’s inauguration.  Trust me, I know he needs time.  But he is the one pushing hard for this stimulus package and yet we’re still waiting on clear explanations of how this money will stimulate the economy, and where, exactly, that stimulation will occur.  We should expect a fair amount of it in Maine given that the senators from there are leaning Obama’s way.  And perhaps that’s politics.  But, what about the rest?  How and where will the stimulus likely occur?  It’s not a hard question to answer.

February 5, 2009

Maybe I was a little tough on our new president in the latest blog, “Winning Isn’t Everything -- In More Than One Sense,” but I’d want my head kept on straight if I were president.  Once you’re inside the beltway as the top dog, I imagine things get a little unreal.  And all those experts in there with you likely start having trouble seeing the for the trees too.  It appears that insular thinking is already taking a toll among the economic gurus.

Besides, we keep hearing about the stimulus package and how we ought to help get it passed but not many specifics about why or how it’s going to affect the lives of us less indispensable people. That’s the term that was being bandied about in reference to some of the Cabinet nominees and it made me shudder.  I thought we were all going to be indispensable this time -- or close to it anyway.

February 3, 2009  Managing Doctor Dialogues

The segment below is an excerpt from book proposal someday to be in search of a publisher.  It’s not directly about PD, as the blog this extends, but applies to all patients. 

Learning to redirect a conversation focusing too much on low priority symptoms is crucial to getting excellent medical care.  Throughout discussions with doctors and medical staff there are choice points for redirecting attention to what’s most important.  Communication, after all, is like chess – each person’s move restricts or expands that of the other.  It’s not an issue of being in charge so much as making sure the conversation with a doctor doesn’t stray from what matters – while being open to his input regarding priorities as well.  Consider this patient doctor exchange:

Doctor:  So you’re feeling tired most days?

Patient:  Right.

Doctor:  Are you exercising?  Eating right?

Patient:  My stomach bothers me a lot.

Doctor:  (looking at the chart)  “Your blood pressure is that of a much younger man.  You look good.  Is there something going on at work?  Maybe too much stress?  Anything else bothering you?

Patient:  I sometimes have a pain in my lower right side.

Doctor:  Is it sharp, dull, or throbbing?  How long does it last?

Patient:  (As doctor examines that area)  It’s intermittent, sharp and more at night.

Doctor:  When was your last GI exam?

Patient:  Three yeas ago.

Doctor:  We should have a GI specialist look at you.

Patient:  What about my stomach?

Doctor:  One thing at a time.

Patient:  But my stomach bothers me most days.  I don’t like to eat and I’m losing weight.

Doctor:  You look okay.  In fact, the weight loss suits you.  Let’s go with what I said.

Patient:  Do you recommend an antacid?

Doctor:  (Writing on the chart – not looking up) Not yet.

Patient:  It’s hard to concentrate at work with my stomach so upset.

Doctor:  Try some ginger ale.

Patient:  I’ve done that.  It does nothing.

Doctor:  We’ll look at the GI results and go from there.  See Dr. Aarons and see me again in a month.

This is not an atypical doctor-patient dialogue.  The doctor started with the fatigue issue, ignored the pressing concern the patient has regarding his stomach, and moved to a GI exam.  While that might get at both, this patient is trying to say, though not effectively enough, that his stomach problem is the highest priority as it affects his life daily.  The doctor has chosen a focus – not the patient’s one.  And while his one-issue-at-a-time approach can yield good results in the long term, this patient needs some short-term relief and isn’t going to get it.  Where were this patient’s choice points – junctures in the exchange where the patient could have redirected to his most pressing interests?

Right at the start he let the doctor focus on fatigue.  By saying, “My stomach bothers me a lot” he may assume that he’s clearly articulated the link between little sleep and his stomach ailment, but it’s implied at best.  The doctor then goes on to talk about how well he looks and his good blood pressure, which are interesting, but once again off focus.  The question about other symptoms is reasonable, but in this case takes the doctor’s attention again away from the primary ailment to one that is occasional.

At least this patient persists by asking, “But what about my stomach?”  Yet he allows the doctor to again put that issue – the one he came to the office about -- on hold.  There’s no discussion about relief while seeing the specialist.  He doesn’t ask the doctor:  “Is there some problem treating my stomach while checking on the reason for the pain?”  Nor does he mention, “The pain is infrequent, but this stomach problem is everyday.  I came here to do something about my stomach.”  And so this patient will likely tolerate at least another month of stomach upset -- potentially many more after that.

Knowing how your communicate as a patient and how your doctor communicates is critical to obtaining good care, especially with illnesses that are complex and long term.  Doctors get tired.  They aren’t gods, and most aren’t taught to communicate effectively.  So part of the responsibility -- at least 75% -- falls to patients.  Go in prepared, don’t leave until you have the answers you want, and clarify anything that confuses you by having the doctor write it down for you if necessary.  Bring along someone who is helpful in such circumstances, friendly but determined to make sure you get good care.  If you don’t get what you need, let the doctor know and either find a new one or engage him or her in improving the outcomes of your visits.  It’s your health.

As my brother once told me by phone after I’d left an arrogant neurologist’s office confused, exhausted and insulted, “Next time you see him, say, “Who do you think you are, a neurosurgeon?   That’ll get him thinking.”  Sometimes humor is just the ticket.

February 1, 2009

This and the comment before it are extensions of the blog I wrote about “Triage At The White House,” posted on Huffington Post.

The letter below from the CDC indicates that parental training is one of the ways children can be better protected from abuse and neglect, perhaps especially among parents who were abused themselves as children and are seeking a way to break the cycle we describe in CHILDHOOD DENIED.  Instead of throwing up our hands because the problem is to large or insisting that President Obama and Vice President Biden, two very caring people, need to put the economy and other pressing issues ahead of kids rather than along side, studies like these suggest that there are avenues to take.  And as a civil society, we need to pursue them.  

 

Dear Colleague,

 

Children make up one fourth of our population and all of its future. CDC has a goal of increasing the number of children that have a strong start for healthy and safe lives.  The foundation of a population’s health, well-being, and productivity throughout life is established in childhood.  We are learning that biological, social, and environmental exposures in the early stages of life determine people’s long-term health and developmental status.  Exposure to child maltreatment and other adversities are particularly toxic to a child’s short- and long-term health. Promoting safe, stable, and nurturing relationships for children directly contributes to CDC’s goal and the prevention of maltreatment.  Critical to the promotion of safe, stable, and nurturing relationships is helping adults become better parents.

 

A new study, funded by the Centers for Disease Control and Prevention (CDC), shows when parents have access to proven parenting interventions designed to address problems all families face—from tantrums to encouraging good behavior — key measures of child maltreatment fall.

 

Support for families enrolled in the study came through the Triple P—Positive Parenting Program. The program uses a multi-level, parenting, and family support strategy that aims to prevent behavioral, emotional and developmental problems in children by enhancing the knowledge, skills and confidence of parents. Triple P incorporates a wide range of support mechanisms for parents including local media, brief public seminars, and parent consultation by specially trained providers in clinics, schools, churches, and community centers.

 

Researchers estimate for an area containing 100,000 children under age eight that the results found in the study could translate annually into 688 fewer cases of child maltreatment, 240 fewer out-of-home placements, and 60 fewer children with injuries requiring hospitalization or emergency room treatment.

 

To access the complete study, visit the January 2009 online edition of Prevention Science  (http://www.springerlink.com/content/a737l8k76218j7k2/?p=587ecf68cf6745058cb3e636889cdf70&pi=0 )

 

For more information on the Triple P – Positive Parenting Program, visit www.triplep.net. For information on CDC’s prevention research in child maltreatment, visit www.cdc.gov/injury. 

 

Sincerely, 

 

 

W. Rodney Hammond, PhD

Director, Division of Violence Prevention

National Center for Injury Prevention and Control

Centers for Disease Control and Prevention

 

January 30, 2009

This is the link to your senators and representatives in Congress.  Below are the states that scored below a “C” in the First Star study of  (1) which states provide a child with the right to a lawyer and  (2) which ones provide information about child abuse and neglect deaths available to the public in a predictable, consistent and enforceable manner so that the public is aware and can develop better protections for children at risk.

Right to Counsel

Alabama -- D

Iowa -- D

Kentucky -- D

Montana -- D

Oregon -- D

Wisconsin - D

Alaska -- F

Delaware -- F

Florida -- F

Hawaii -- F

Idaho -- F

Illinois -- F

Indiana -- F

Maine -- F

Missouri -- F

Nevada -- F

New Hampshire -- F

North Dakota -- F

Rhode Island -- F

South Dakota -- F

Washington -- F

State Secrecy And Child Deaths

Colorado -- D

Georgia -- F

Maine -- D

Maryland -- F

Massachusetts -- D

Montana -- F

New Mexico -- F

North Dakota -- F

Pennsylvania -- F

South Dakota -- F

Tennessee -- F

Utah -- F

Vermont -- F

Details about the studies can be found at www.firststar.org -- link to litigation-- and access to reports.

A Proposal for University-Based Foster Care

“We can’t solve problems by using the same kind of thinking

as when we created them.”

—Albert Einstein

Excerpt from CHILDHOOD DENIED:  ENDING THE NIGHTMARE OF CHILD ABUSE AND NEGLECT by Kathleen Kelley Reardon an Christopher T. Noblet

The proposal described here was developed by Kathleen Reardon as a

way to bring the resources of universities to the problem of foster care.

The idea of campus-based foster care programs emerged from a discussion

we were having while interviewing and researching for this

book. We spoke about the limitations of foster care and the feelings of

children who are fostered. Such children often feel trapped in a system

that cares for their basic needs but doesn’t seem to pay attention to them

as people. One child described foster care as “a storage place. You were

alive but not living.” Others see it as “a system of punishment,” one

“that messes you up” and one you’d better not get used to because “they

will move you, they will toss you around like a ball.” These children

often don’t feel that anyone listens or believes them and often do feel that

the people who decide their fate don’t know them as anything other than

a number.

Add to this the hazards faced and created by many young people

who exit the foster system—family dissolution, substance abuse, homelessness,

domestic violence, and losing their own children to foster care.

The abrupt end of support or supervision at age 18 contributes to many

deficits for these young adults. Clearly, the present overloaded and

overstressed system isn’t working for many children or the adults they

will become.

Over time, certain notions of how to cure a long-term problem have

taken hold and become dominant. Many children have suffered and are

suffering as a result. By accepting the status quo, we pass our troubles

along to future generations, perpetuating them at colossal societal and

human cost.

The answer is not to blame an overloaded system, but to relieve it

with something that works. That something needs to be multilayered,

capable of meeting the needs of abused and neglected children at many

levels. Certainly, we need to encourage more individual families to take

in foster children. We also must do more to train, assist, regulate, and

support them. In reality, though, a tremendous shift in that direction—

necessary though it may be—is unlikely to be achieved any time soon.

That is why the issue of how to improve institutional foster care is a

subject worthy of urgent attention.

This is where universities and colleges come in. Consider the environment

that university and college campuses provide for their own

students. Many students arrive feeling lonely, confused, or apprehensive,

sometimes even isolated. Yet, within days or weeks, most are becoming

or have become part of the campus culture. The support systems are

there: counselors, peers, older students, support staff, and professors,

all of whom can be turned to with issues. There is no foster mother or

father, but rather a spectrum of resources for dealing constructively with

academic and personal concerns. The whole student is the concern of

any university or college worthy of a sound reputation. Doesn’t this

begin to sound like a reasonable model for how we could help foster

children as well?

Family fostering works for many children—and for some of them it

works well indeed. It would be a mistake to uproot children from supportive,

familiar families if there are means to keep them there. But when

such measures fail or are unavailable despite diligent efforts, we need other

programs that respond thoroughly and appropriately to the foster child.

Good professors—and indeed all good teachers—know that when

new students come to our office doors looking bewildered, often enough

they’re not there just to learn more about the subject. Very often they

need to connect with someone. Each professor or lecturer is one lifeline

among the many available to them.

Foster children need multiple lifelines too. They need them sooner

and for longer. One possible advantage of campus-based residential care

for foster children is competition for funding. Conducting federally or

privately supported projects in professional, ethical ways is required by

the rules of academic research. Stringent requirements minimize the likelihood

of haphazard research, especially where human subjects are concerned.

Fierce competition helps ensure adherence. Funding agencies

therefore take university-based grant proposals seriously. No system is

perfect, of course, but research universities and colleges are set up to

ensure that funded projects are undertaken in the manner proposed.

University and college grant awards require thorough applications and

experts committed to carrying out the projects. Even if universities and

colleges benefit financially, as they will, our concern is that the child benefit

as a whole person. Because Kathleen has been a principal investigator

on grants and has served as a reviewer for the National Institute of

Health, she knows the level of competition out there. This competition

can serve the needs of at-risk children who have been removed from their

homes, by providing acknowledged experts planning residential

programs for children who’ve waited too long and for those who are

about to enter the foster system for the first time.

Substantial governmental funds are already being deployed to support

children in far-from-ideal institutional foster care. This support

averages $4,000 per child per month nationally. The cost per child

per year was $220,000 atMcLaren Hall, the Dickensian warehousing facility

for foster children recently closed by Los Angeles County. The new

university-based model proposed would ultimately save money and, more

important, it would both allow children to be children, and serve society

by better preparing them to successfully join family foster homes when

possible, and in any case to live more fulfilling and productive lives. Of

course, depending on the school, there is the benefit of access to specialists

in medicine, psychology, sociology, communication, and education.

There is one other great plus to this proposal.

College and universitycampuses have hundreds—sometimes even thousands—of young people

interested in giving their time to worthwhile causes. They are at college for

four or more years. Whether they major or do graduate work in social

work, psychology and other social sciences, education (including special

education), child development, family relations, communications, business,

bioengineering, theatre, or chemistry, they can help foster children feel that

people and society truly care about them. For starters, a campus-based

program modeled on Big Brothers and Big Sisters would be quite feasible.

People to help with homework, to play ball, and to talk are readily available

on campuses. After graduation, or in graduate school, kids helped in

this way are good sources for young, enthusiastic employees in the area.

We would want to be very concerned with who receives grant

awards. Children should be housed properly, served excellently, and not

used as guinea pigs. But these and other concerns are highly addressable.

In this context, the model of Hope Village, a program in Mississippi

that is admired by First Star, warrants further examination. Hope Village

has created individual cottages, staffed by married couples who live in the

cottages full time, enabling long-term bonding and a familial atmosphere

for the two to six children fostered in each cottage. Economies of scale

and supervision stem from grouping the cottages on a single campus

where activities and services can be coordinated centrally as appropriate.

The proximity of many colleges and universities to urban areas will

be helpful as foster children are encouraged to maintain positive linkages

to friends, relatives, and places as appropriate. At the University of

Southern California, for example, we are surrounded by a huge, low income,

inner-city area where a large number of children who cannot be

locally accommodated in individual family foster care are regularly

exported over large distances to institutional care in different parts of

sprawling Los Angeles County.

Many colleges and universities have excellent on-campus or campus affiliated

elementary and secondary schools. Given the right kind of

support, it is likely that many foster children could be successfully tracked

from these schools into higher-level education and good jobs. Children at

such programs would be far less likely to fall off the cliff of supervision

and support that is unfortunately too frequent across the United States.

The key is support every step of the way and affection, familiarity, and

consistency for these children. The responsibility of taking children onto

(or nearby) campus may seem daunting to some, especially when some of

them have special needs, but we are convinced of the potential.

Much needs to be considered, but we’re on the right track if we

think of how many options are likely to emerge.

Summary

January 22, 2009

From my blog today, “Smart Power and The New Secretary of State,” there is little doubt that my regard for Hillary Clinton has not waned.  For that I’ve taken a lot of criticism and nasty swipes.  But that’s life.  It never kept me from writing of her strong and impressive qualities.  And today is no different.  She got up over the last several months, brushed herself off, and dazzled us with her intellect and grace under pressure.  She deserves to celebrate and to have us with her for these few moments before the tough job starts.

My only regret is that children may have lost one of their most ardent advocates.  Working with First Star (www.firststar.org) and writing a book -- Childhood Denied -- to help them with their efforts to protect children from abuse and neglect, to get states, counties and our country to do better by them, I know it is a loss when someone on their side must be otherwise preoccupied for a while.  We can hope that being in the Cabinet, she will have access to President Obama, to those who will make sure we listen more to the children who need us -- that the “village” continues to thrive and far more people in it reach out to help those whose voices we barely hear.

January 21, 2009

While I’m troubled by the Oops defense used by Timothy Geithner that we all know wouldn’t apply to us, there must be some reason why President Obama would use such a huge political chit to get past that and place Geithner as Secretary of Treasury.  Beats me.  There’s something called “idiosyncracy credits” psychologists and communication experts use to describe how we allow some people a pass because we like them or think they’re geniuses.  We wouldn’t give such passes, such personal credit, to others acting in the same way.  That seems to be going on here, likely in order to instill confidence in those on Wall Street. 

But there was the bright spot today in the confirmation of Hillary Clinton for Secretary of State.  And while there are still a lot of people opposed to whatever she does, the vote today was a clear indication of the respect she enjoys from her colleagues.  Congrats, Hillary.  It was a long road.  And you traveled it with grace.

January 19, 2009

What a gift to America.  Who doesn’t feel a part of this excitement, whether you are in Washington, D.C. or living vicariously through those who are?  There is no corner in this country right now where people need feel left out.  We all have a ticket this time, whether or not we attend a ball or are present when Barack Obama becomes the 44th President of the United States.  He has invited all of us to participate.  This is, thereby, a celebration for all.  And no matter what we face ahead, there is a time for celebration and this is certainly one.  Dr. King must be smiling because his dream for all of us is finally coming true.  America has looked into a mirror, seen its flaws, and chosen change.

January 18, 2009

We knew he was bright, impressive even as a work in progress, but now we know Barack Obama is a true genius. There are multiple forms of intelligence, and embodied in this man are surely most of them. He evokes passion in a way we've not seen since John F. Kennedy. He is vivacious in mind and spirit, a family man, who reaches out beyond lines and labels, past offenses of the past in service of the future. To him, we all matter. And so he is not a man for the times but a man crafting our times - for the better.

By his side is Joe Biden, a man of sincerity, depth, and commitment to his state, his commuter train companions, his family and all of us. In his understated way, a compliment to the President-elect, this man of great accomplishment and sensitivity is like an able, purposely imperceptible hand that grasps the anchor of a mesmerizing kite, helping it to soar, to twist and dazzle -- to transport onlookers if even for a precious moment -- but not too high or too far from the designated course.

These are two men who will err at times, but they have captured our hearts, our minds, and our imaginations. In so doing they have altered our futures by giving us this memorable moment in time when promise abounds.

January 8, 2009

I was reading Digby, as I often do, about how she’d warned us that the Democrats would attack Obama in a myriad of ways to demonstrate that they had not lost control.  Yesterday she returned to something she’d written during the campaigns about the way Democrats, past present and future, treat presidents from their party:

They run to the press with the news that they scolded them so they can make sure everyone knows they are the ones running things.(I know everybody's forgotten how that used to be because the Republicans don't constantly air dirty laundry in public for their own aggrandizement. They usually work these things out among themselves for the good of the party.)

If the Democrats win the presidency, expect many more of these little dramas. The inflated egos of powerful Democratic Senators and Congressmen require that they consistently step forward to knee-cap their president whenever possible lest anyone get the idea that he (or she) is actually in charge.

It reminded me, as have the events of the last few weeks, of a blog I wrote last January entitled “Why Are We Kidding Ourselves?  All of These Candidates Are Politicians.”  In it I wrote:

You could get dizzy from the back-and-forth about who is lying and who is so honest sainthood is in the wings. There are no saints in politics. When there is something of value at stake and more than one person interested in obtaining it, politics is in the mix. When it comes to presidential politics, the stakes are enormous and the only people capable of even reaching the final group are extraordinary street fighters...

It pays to step back once in a while to recognize the nature of the activity in which we're involved. Otherwise we're like sheep -- the lot of us. We despise those who disagree with us about a candidate even though we actually know little of that person. It's a form of ignorance -- the same kind that delivered George W. Bush into our lives twice.

So what should we do? We should observe and critique -- not like the many MSM "experts" whose lips move but nothing of substance comes out -- but as people who aren't voting for prom king or queen. The next president will need to protect us from the demise of democracy, the economic fall of a great country, and respond to the needs of Americans instead of their own lust for power or unquenchable greed. That calls for opening our eyes and seeing all of them as first and foremost politicians and then deciding, after considerable observation and skepticism, the one among them who is competent, compassionate, and capable of rising above his or her thirst for power to do what's best for us.

They are all politicians and too many of them are maneuverers.  Take earmarks, for example.  Those are on the face of it just plain wrong.  But they exist so that our government representatives can play power games.  It’s wrong.  But earmarks are still around.  So are lobbyists with lots of money to throw around, even when senators and representatives are being carted off to jail.  Those are the ones who went too far.  Excuse me!  Too far is taking ANYTHING from a lobbyist. 

If television “journalists” were less interested in interviewing each other and hired analysts and more interested in revealing behind-the-scenes machinations that hurt this country, we’d have a chance of getting out of the mess we’re in now.  But they don’t even do research anymore.  “Some people say” is a favorite phrase used by the top anchors to justify a leading question or to introduce spin into a story.  This is the depth to which credibility has fallen.  What happened to real experts?

We’re surrounded by selfishness and shallowness.  And that’s the context in which Barack Obama will be trying to turn this country around.  I’d like to hear him call them on some of this.  How about saying, “No more earmarks ever!” And then, “No more lobbyists who are using anything other than persuasion.”  And the next time someone from the press says, “Some people say,” I’d like to hear President-elect Obama ask, “Who?” 

Now that would be something!

January 2, 2009

My blog today on Huffington Post provides a way to look at how Barack Obama confronts issues rather than, as a few contended, an excuse for any particular decision he has made.  High cognitive complexity does incline people to look at issues from several sides.  President Bush lacked this ability or else the sides from which he approached issues were terribly similar and very much in line with Dick Cheney’s views.  Barack Obama takes an intellectual approach to most decisions, even choosing a dog for his children.  We haven’t seen much of that since President Clinton was in office.  And, there certainly were times when he made a lot of us angry too.

When I’m being led, I like to know where and by whom.  I want to know if that leader in committed to the side of an issue I favor or simply inclined to see it my way.  There’s a big difference between the two.  Important, too, is how a leaders thinks.  What he thinks can change in a heartbeat.  How he thinks lasts longer.

On many issues Barack Obama is inclined to think like most of the people who voted for him and committed on some issues.  He knows there will, and must be, trade offs.  If you know this about a leader, you can live with it.  You can even learn from him or her.  If you know what you’re dealing with in terms of how a leader makes decisions, as was the intension of the blog, you know what you need to do to advance your issues.  And it isn’t sitting around thinking he is terrific and going to do all you wish he would.

He’s a good man facing some terrible decisions.  I’ll be angry at him sometimes.  But unless I’m reading him wrong, it will be far less often than I’ve found myself at odds with the current president.  Just knowing he is open to persuasion -- willing to learn -- is a big step forward.

January 1, 2009

Happy New Year!  These three words are possessed of optimism.  And they are said repeatedly by people even as they are struggling with the many sharp curves that life presents.  I have a couple of friends who seem to escape mercurial misfortune.  But most people are not so fortunate.  I’ve commiserated several times during the last few weeks with friends, acquaintances and relatives about the process that is life.  Perhaps we shouldn’t wish each other “Happy New Year” but rather one of relative equanimity.  We don’t need happiness half so much as we need strength, courage, fortitude, and, granted, some good laughs.  I can’t help but wonder if we deceive ourselves by seeking happiness when satisfaction with a job well done or a relationship well served is more deeply satisfying by far.

 

December 28, 2008

There’s a considerable amount of discomfort being expressed in the media and on blogs about Barack Obama’s choices for those he wants advising him.  While some of his choices wouldn’t have been mine, the discontented might ask themselves why they didn’t see this coming.  Barack Obama is a person who can accommodate within his views and values what others see as contradictions.  His own complexity, I venture to suggest, causes him to appreciate the same in others.  And what is complexity other than possessing ways of looking at the world and acting that are not easily categorized?  It involves abstract rather than concrete thinking.  For the cognitively complex among us, the gray area is broad.

In this sense, Obama is Emersonian.  To him, “a foolish consistency is the hobgoblin of little minds.”  Of course, rampant inconsistency is dangerous.  But there are among us people whose words and actions appear inconsistent because we view them from a single framework.  Barack Obama is not only a person guided by more than one viewpoint, he is making clear by his choices of advisors that he does not intend to change that about himself. 

He is not so much cautious, as has been suggested in the press, but considered.  We knew this about him.  He is not inclined to rush to judgment.  Why?  Because of fear?  I don’t think so.  He likely has a healthy respect for the dangers associated with rashness, but more importantly he has a healthy regard for the amount and quality of knowledge required to make decisions likely to work in tumultuous times.  He isn’t indecisive out of concern for offending others -- as his Rick Warren invitation indicates --so much as he is processual  in decision making.  He takes time to identify options likely to succeed in the long run or ones that serve what he sees as higher order or more pressing goals.  By necessity, therefore, some people are going to be disappointed.

In many ways this is all quite laudable.  But cognitively complex individuals often overestimate the complexity others are likely to bring to judgments of actions.  People willing and able to entertain complexity on a host of issues are not always willing and able to do so regarding their passions.  In other words, as Frank Rich has implied, Barack Obama may overestimate at times his ability to bridge differences, especially among people who have found it necessary to forgo broad thinking in order to advance what they consider to be correct or moral thinking.  As much as I personally prefer reasoned discourse to stridency, change agents know it is difficult to achieve their goals from constant, passionless hovering about the middle.

I don’t know Barack Obama personally, but we are all creatures of pattern and he is no exception.  Like you, I’ve been observing him.  For a man intent on change, he relies heavily on the way he has made decisions for many years.  He lines up the ducks.  He looks past the obvious.  He prioritizes.  He contradicts in one sense  in order to be consistent in another.

We elected a complex man.  If  anyone expected he’d agree with any particular interest group on all issues, he or she wasn’t paying attention.  But if the president-elect thinks he can train all of us to think at his level, with openness and understanding, that we’ll come around to his thinking even if he breaks our hearts, he may not have been paying attention either.

December 16, 2008

My latest blog about Caroline Kennedy’s bid for Hillary Clinton’s senate seat is not likely to make me a lot of friends among many whose company I usually enjoy.  But, if you have been regularly reading what I write, you know I’m more interested in turning over some leaves and debris to get at what’s really going on than advocating for one candidate or another. 

I’ve learned too much about politics to be oblivious.  I’ve written books and articles so others won’t be either.  It’s important to ask whether Caroline had her eye on Hillary’s seat months ago.  If so, Barack Obama is not the only one who benefited from Kennedy support.

She wouldn’t be the first politician to plan ahead.  So, I’m not blaming her for that.  She is also more concerned about people than many already in the Senate and her family has given much to this country.

But it’s good to have our eyes open.  If she planned ahead, then maybe she is a better potential politician than many think.  If she planned ahead, she is not only a philanthropist and someone who encourages and praises courage, an impressive person, but also a clever one.

In any case, it’s good to know.

December 11, 2008

My blog on Huffpo today is focused on something that has been bothering me for some time -- the use of the title “czar” for people about to spend our money in less than admirable and intelligent ways.  Also, this word doesn’t belong in the language of democracy.  In fact, its widespread use can undermine our core principles.  Words do have an impact on our thinking.  Research has demonstrated that, especially persuasion research.  Our thinking impacts our word choices and vice versa.  So this is no small matter.  I hope you’ll read the blog and think about how the use of “czar” may actually indicate ways of thinking that have crept into our collective mindset, thereby doing us harm. 

And this is to say nothing of the use of “czar” to refer to someone whose decisions are not to be questioned.  This lets congress off the hook.  I mean, no one questions the czar without serious personal and professional consequences.  Right?  It’s a way of so handsomely honoring by title the person ambitious or stupid enough to take the job on alone so he or she won’t point fingers when failure happens.  After all, if you agree to be the “czar,” you get the cool title, but you’re in charge and you’re to blame.  It’s the backbone deprived congressional way of saying, “So, don’t call us.”

December 2, 2008

Speaking of control, as I was in the blog posted today on Huffpo, I spent last night until 4 A.M. in an emergency room with my teenaged daughter who was folded over in abdominal pain.  Now we’re on the path of trying to discover how that happened.  Life is not without its surprises.  And, you know what they say about “the best laid plans.” 

There is no reason to believe that the presidency carries with it some immunity from chaos.  Certainly President Obama will have far more people around him than I did last night sitting in the emergency room worried and exhausted.  But the point is that he will oversee far more than I in any given day, which raises the odds of the unexpected occurring.  So why would he put in his Cabinet and in other high level positions, with some exceptions, people on whom he cannot rely for exceptional advice and skilled execution?  It would be interesting, but not practical, and not safe either for any of us.

He has done something else with his selections for top posts.  He has shown an awareness of the power of interest groups on the course his administration will take.  Nicholas Lemann wrote (August 11, 2008 article in The New Yorker) of Arthur Bentleys largely forgotten perspective that “all politics and all government are the result of the activities of groups.”  Now days when we think of interest groups, we think of lobbyists.  But there are interest groups who are far less visible and exceptionally powerful even without such advocates.  Obama has show that he intends to have under his tent leaders from many of those.

I’ll write about this more.  Suffice it to say, that Barack Obama is a smart guy.  He knows that any major advance comes from standing “on the shoulders of giants.”  He appears to know, too, that grasping the gold ring is exciting but without the adulation and support of those who’d enjoy taking it from you, it’s a fleeting accomplishment.

November 27, 2008

Happy Thanksgiving.  I tried something new this past week.  Instead of telling my teenaged children that we won’t be buying this or that, I told them that this week is what we’re calling “a lean week.”  And it’s not the last of them.  They’ve been learning about the economy and how hard it is hitting so many Americans.  When my daughter brought four items over to me to put in a basket at CVS, I reminded her of the “lean week.”  She said, “But they’re good buys.”  Two of them she didn’t need.  One could be bought for less elsewhere and the last one we decided to buy.  This Thanksgiving a lot of people are thinking twice about what they really need.  Maybe we’re also thinking about dusting off that definition of happiness:  It’s not getting what you want, but rather wanting what you have. 

There’s  a lot to be said for that.

November 20, 2008

Why Barack Obama Didn’t Break The Favor Bank

Reciprocity is one of the most fundamental rules of human relationships.  Children learn early to share, to thank, to reciprocate kindness.  Several years ago I studied the gift customs and reciprocity expectations of various cultures.  Around the world, obligation to return favors is part of retaining relationships.  In fact, failing to do so can lead to social isolation and/or career failure.

Even in America where a spirit of independence is encouraged and valued, knowing how to give and take is critical to enduring relationships. 

Expecting Barack Obama to disregard reciprocity and to choose for his cabinet and other advisors people who never lifted a finger to help him or who offer nothing in terms of potential to help in the future would be political suicide.  Not only would it leave a number of highly visible people feeling betrayed or dismissed, onlookers familiar with the contributions of those summarily dismissed would be disgruntled as well. 

Why would anyone do favors for Barack Obama ever again if he does not reciprocate favors to people who stood by him when he needed them most?  And that includes Hillary Clinton who persuaded her angry followers to vote for the man who dashed her presidential hopes.

If you voted for Barack Obama, you likely did so in part because he is smart – far smarter than his predecessor.  But there are many forms of intelligence and one of them is political.  He became president elect in part because he excels here.  When he became a senator, early on he did what was needed to garner favor.  He didn’t do so in a cheap way, being obsequious without regard for his own principles, but he reached along the rows and across the aisle to create and sustain important relationships.

If you voted for Barack Obama, you likely also did so because you believed he would change Washington.  And I’m convinced that you were right.  But he won’t do this by total newness so much as a kind of savvy balance of the old and new.

Barack knows no one can deal with the massive mess left to him without people who have been around Washington for a while.  He knows, too, that there is indeed an advantage to powerful people peeing outside the tent instead of inside.  And that is especially true when things begin to go wrong.

Wouldn’t we much rather have a president who surrounds himself with experts, no matter their affiliations, than one who surrounds himself with novices and calls it change or one who knows so much he doesn’t need to ask anyone?

In an environment where no matter what Joe Lieberman does and has done, he gets to stay a buddy of the Democrats, Barack Obama would be committing himself to only four years were he to sweep the White House halls clean and start from scratch.  You don’t have to go to Harvard to know better.

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Dr. Kathleen Kelley Reardon is a Phi Beta Kappa, Professor at the USC Marshall School of Business and for years served on Preventive Medicine faculty.  She received her Ph.D. "with distinction"  from  UMASS, Amherst.  She was co-author and researcher of the feasibility study that launched Starbright -- serving critically ill children -- chaired by Steven Spielberg and now conjoined with Starlight. 

Books:

Persuasion in Practice (Sage, 1991)

Gift-Giving Around the World used by Chiefs of Protocol to guide presidential and diplomat decisions on gift customs in negotiation

They Don’t Get It, Do They?  1995

It's All Politics (Currency, Doubleday 2005)-"Top 100" -Amazon

The Skilled Negotiator (JosseyBass, 2005)

The Secret Handshake (Currency,Doubleday, 2000) Amazon Best Seller

(www.amazon.com:.webloc)

Dr. Reardon is also the author of the Harvard Business Review reprint bestseller, "The Memo In Every Woman's Desk" and more recently "Courage at Work." 

She is a Trustee with First Star(www.firststar.org), a nonprofit endeavoring to better the lives of children in foster care and those at risk for abuse and neglect. 

Childhood Denied:  Ending The Nightmare of Child Abuse and Neglect

(Sage Publications, Nov. 2008) was written with Christopher Noblet and in collaboration with First Star.

Dr. Reardon received First Star’s Achievement Award October 28, 2008 in Washington, D.C.

Her books have been translated into Chinese, Korean, Portuguese and Arabic.

She is a painter of oils and watercolors and has developed a website for those injured in war or dealing with difficult illnesses so that they might also enjoy learning to paint - “Painting Doc” (www.bardscove.com/Site_2/painting_doc/html).

Dr. Reardon can be reached for press interviews via Slowey-McManus for new book CHILDHOOD DENIED or  SheSource.org

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