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Thursday Complexity PostAugust 15, 2013

"Crack Baby" Predictions Were Wrong


A neonatologist who led a long term study of babies exposed to crack cocaine in utero has reached a conclusion she and her colleagues did not expect: poverty harms children more than prenatal cocaine use by their mothers. And among the cocaine-exposed, there are some kids who flourished, apparently because they experienced nurturing and lasting relationships with adults despite family poverty and addiction.


Remember the horrifying "crack baby" stories in the 1980s and 1990s? The nation's health specialists and social pundits voiced dire warnings of a generation of children doomed to deficient intelligence and physical disability and deformity. TV, magazines and newspapers spread fearful predictions of damaged babies growing into a huge population of defective children and adults that would overwhelm social services and cost taxpayers billions. One newspaper column envisioned a "human plague almost too horrible to imagine." A prominent college president even suggested "crack babies won't ever achieve the intellectual development to have consciousness of God."


Cheap smokable crack cocaine poured into cities across the country in the 1980s. A study in 1989 found that one in six newborns in Philadelphia hospitals had mothers who tested positive for cocaine. Hallam Hurt, MD, neonatology chair at Einstein Medical Center, organized a study of 224 babies born at Einstein between 1989 and 1992, half of whom had prenatal cocaine exposure, and half of whom had not. All the babies were from low income mostly African American families. All were full term or nearly full term, and all their mothers were serious users, with an average of 99 days of crack use during their pregnancies. Federal funds and contribution from the Einstein Society allowed the study to continue nearly 25 years. The research is described in an NPR RadioTimes discussion and in a story by Susan FitzGerald.  


Each child's development was evaluated at six months, then regularly until early adulthood. Dr. Hurt, who moved her team to Children's Hospital of Philadelphia in 2003 and is now a professor of pediatrics at the University of Pennsylvania, found virtually no differences between the children who had been exposed to cocaine and those who had not. She and colleagues did find that both groups lagged behind middle class kids the same age. So what influence besides cocaine was at work? The team discovered poverty was "the elephant in the room."


"Finding that poverty is a bigger factor than drug use is a really tough finding," Dr. Hurt said in the NPR discussion. "It's much simpler to say that the drug is the problem." It wasn't a popular finding either, she said, because poverty is more complex and much harder to address, as are the cumulative effects of exposure to violence and deprivation that leave kids with post traumatic stress, more anxiety, lower self esteem, and less resilience.


"We began to hear stories when kids came in for testing," Dr. Hurt said. "We'd hear about kids seeing their mother chased by someone with a knife." Measuring exposure to violence, the team found that by age seven, 11 percent of children had seen someone killed; 81 percent had seen someone arrested, 74 percent had heard gunshots, 35 percent had seen someone shot, and 19 percent had seen a dead body outside.


An article in the journal Pediatrics in May described a study led by University of Maryland researcher Maureen Black, PhD. Evaluations of more than 5,000 children between the ages of 11 and 17 whose mothers had used cocaine during pregnancy found most developmental measures within normal ranges. That study too concluded the impact of violence and social environment outweighed cocaine exposure. Updated findings carry messages for medical professionals and the media


A New York Times Retro report on the crack baby scare notes that the stereotype of bad drug abusing mothers, who often lost their children or got arrested, and the florid headlines, fit cultural prejudices of the time. Neither Dr. Hurt nor any other expert suggests it's OK to use cocaine during pregnancy. But Dr. Claire Coles of Emory University says in a Times Vimeo that the hysteria was harmful, and that most actual damage was associated with prematurity, which cocaine use can influence, and alcohol. Prestigious journals as well as popular media hyped the story. Paul Raeburn, writing for the Knight Science blog Tracker, reflects now on a 1987 story of his quoting medical experts on crack babies, and wishes he had been more skeptical.


A college senior studying animal husbandry and business told Radio Times of her family's strengths, values and the good grades she and her siblings earned despite her mother's prenatal and continuing cocaine addiction. Listen to Radio Times here

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Healthcare PlexusCalls 
Wednesday, August 21, 2013 - 1-2 PM ET  
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Robot + Cooperation Between Hospitals = Better Care for Stroke Patients  
Guest: Dean Gushee     

When someone has a stroke, time is of the essence. Faster diagnosis and immediate treatment can often reduce or eliminate the debilitating effects of a stroke. At Mason General Hospital, a community hospital in southwest Washington State, emergency-room physicians are board-certified in emergency medicine, and trained in stroke diagnosis and treatment. And thanks to St. Peter Hospital, twenty minutes away, there is now a neurologist in the room when needed 24/7, via two-way video and a remote telehealth robot. Dean Gushee, medical director for the emergency department and medical director for the hospital, will join the call to talk about the resources that provide better care for stroke patients-and the cultural changes that were needed to allow separate hospitals, with differing policies and practices, to learn to work together. Read his complete bio.

Friday, August 23, 2013 - 1-2 PM ET  
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Complexity Leadership and Communities of the Future   
Guest: Daniel Pesut, Rick Smyre and Robin Cape     

An understanding and appreciation of the principles of complexity science may be key in developing the kind of transformational leadership that communities of the future will need as they face a wide range of new and evolving issues. Asheville, North Carolina may just be a place where people put theory into action. Rick Smyre is an internationally recognized futurist who focuses on community transformation in an increasingly interconnected and complex world. He is working to develop networks of people and organizations interested in the concepts of transformational learning, master capacity building, and what he terms a creative molecular economy. Daniel Pesut, PhD, is professor of Nursing Population Health and Systems Cooperative Unit and Director of the Katharine J. Densford International Center for Nursing Leadership and holds the Katherine R. and C. Walton Lillehei Chair in Nursing Leadership at the University of Minnesota School of Nursing. Robin Cape is a futurist, and a former member of the Asheville City Council, where she focused on sustainability by instituting a two percent energy conservation goal, LEED Gold standards for municipal buildings, and the creation of a Sustainable Advisory Committee on Energy on the Environment. She now works with the Asheville Hub and with Asheville-Buncombe Sustainable Community Initiatives, a nonprofit devoted to enhancing resilience of the community through education and engagement. Read their complete bios.

Nursing Network PlexusCalls 
Wednesday, September 4, 2013 - 1-2 PM ET  
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An Interactive Call on Inter Professional Practice   
Guest: Keith McCandless

Upcoming Event
Liberating Structures Workshop
Westin Kansas City at Crown Center, Kansas City, MO
Thursday, October 17, 2013 - 8:30am-4:30pm
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A pre-conference to the 40th Annual National Conference on Professional Nursing Education & Development, this workshop is open to anyone. Full conference attendance is not required.

This workshop will introduce participants to a portfolio of interaction methods designed to engage staff in innovative problem solving around quality improvement and change initiatives. Liberating Structures include more than three dozen easy-to-learn, adaptable, open source methods that make it quick and simple for groups of people of any size to radically change how they interact and work together, and thus how they address issues, solve problems and develop opportunities. These methods have been used in health care organizations to engage staff in working on a wide range of problems such as reducing infection transmission, improving communication between staff in different roles, and making change initiatives work where adaptive change is needed.

Nurses: Up to 6.25 contact hours can be earned during the Liberating Structures Workshop. The number of contact hours awarded will be based on the number of sessions you attend and verify on your certificate of attendance.


Visit the Plexus Institute Calendar for a detailed schedule of PlexusCalls, Healthcare PlexusCalls, Nursing Network PlexusCalls and other upcoming events from Plexus Institute and others.  


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