DENVER – Health care advocates are warning that a new rule proposed by the Trump administration could effectively block children's access to health, dental and mental services.

The rule would make it easier to deny immigrants legal status by expanding the definition of what it means to be a public charge, or dependent on government programs.

Sarah McAfee, director of communications at Center for Health Progress, says the move already is having a chilling effect, and notes many families with U.S. citizen children have stopped accessing health care.

"Parents are afraid to enroll in any of these public benefit programs, and so it is already having an impact on children's health, which has long-term impacts on their future," she states.

McAfee says parents' and children's health are inextricably linked, because children are far more likely to get care if their parents have coverage.

She adds it's critical for children to have regular access to pediatricians and says early life relationships with caregivers help lay a foundation for healthy development as children get older.

Proponents of the rule change argue it will promote immigrant self-sufficiency and save taxpayers money.

A recent Cato Institute report found that native born Americans are more likely to tap government programs than immigrants.

McAfee says safety net programs such as Medicaid are important investments, because when health care needs go unmet, it makes it a lot harder for children to grow up to be healthy, contributing adults.

"Immigrants contribute enormous amounts to our culture, to our economy, to our communities,” she stresses. “They pay much more in tax dollars than they use in public benefits."

The public charge rule would primarily impact documented immigrants and their families, as people without documentation are not eligible for most government programs.

McAfee says her group and others are encouraging people concerned about the rule's potential impact on children to submit comments at Regulations.gov. Comments must be received before Dec. 10.


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Maryland is facing a significant shortage of behavioral health professionals and a new report from the Maryland Health Care Commission offered some suggestions to fix the problem.

All but two counties in Maryland are labeled as a partial or complete mental health shortage area. Years of underinvestment and high rates of burnout for behavioral health specialists has caught up with the state. The report found a 50% shortage in the number of professionals needed to adequately care for Maryland's population.

Tiara Fennell, assistant clinical professor and clinic director of the Center for Healthy Families at the University of Maryland-College Park, said behavioral health professionals have long been undervalued, which can lead to burnout. The COVID-19 pandemic, she added, is also partly to blame.

"A lot of it has nothing to do with their intent or their desire to help people," Fennell explained. "It's because of their desire to want to be able to take care of themselves. One of the major things that is a deterrent is people not getting paid enough."

The report showed 45% of behavioral health professionals currently working in Maryland are expected to either retire, leave the state or exit the profession in the next five years.

To tackle the shortage, the Maryland General Assembly passed a Behavioral Health Workforce Investment Fund in 2023 and commissioned a report on how to spend the money. The report recommended focusing on investments in behavioral health. It suggested implementing more "earn while you learn" programs, with paid apprenticeships, fellowships and stipends to lessen the costs of college. More flexible schedules and mentorship programs were also recommended to address the nonfinancial issues of burnout.

Fennell pointed out many behavioral health internships are unpaid and she believes efforts to increase pay and reduce work loads for these professionals will boost recruitment and retention.

"That would make a huge difference getting people interested in this type of work," Fennell contended. "Also, maintaining that workforce -- and having people want to be there long-term, and spend the majority of their employment history -- however long that will be, working in this space."

The Behavioral Health Workforce Investment Fund will allocate more than $148 million over the next five years.


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The excitement of the holiday season is celebrated with family get-togethers. But for Alzheimer's patients, large groups can produce fear and confusion. The disease causes brain cell deterioration and the ability to rapidly process information diminishes daily.

Macie P. Smith, a licensed social worker and gerontologist, advised paying attention to nonverbal cues when a patient appears agitated.

"If you're going to have a small, intimate gathering, I also recommend doing name tags," Smith suggested. "Go ahead and put the person's name and the relationship to the person on the shirt, so that way they won't have to guess and wonder and try to figure out who this person is. It just helps with the ease of engagement."

Reminiscing over the family photo album is a traditional holiday favorite. Despite the best intentions, Smith explained, asking an Alzheimer's patient to identify a relative can be frustrating. The questions cause them to use brain cells that are severely impacted and could produce combativeness and aggression. She recommended singing or playing music as better choices.

The Alzheimer's Association Illinois chapter reported 311,000 caregivers cook meals, assist with basic hygiene and monitor medication intake. The needs of patients are unpredictable, leaving them with sporadic break times.

Additional stress from gift shopping and work obligations underlines the importance for a caregiver to routinely nurture their physical and mental well-being. Smith advised using a calendar for scheduling enjoyable activities.

"I've asked caregivers, 'So, what do you like to do?' They don't know, or they don't remember, because they have been so engulfed with caring for someone else and depleting everything that they've had, they've lost a sense of self," Smith observed.

For unmanageable situations, Smith recommends contacting a professional respite care service through your local department on aging. The agencies offer vouchers to pay a certified person to sit with your loved one. Another choice is asking for help from a church member, trusted neighbor or a Medicare or Medicaid-funded adult day service.


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A new study found more than 1.4 million children in the U.S., including many in California, have lost a family member to overdose, emphasizing the collateral damage of the drug epidemic.

The study focused on children younger than 18 as of 2019 who had lost one or more parents, siblings, grandparents, aunts or uncles, or cousins to overdose.

Emily Smith-Greenaway, professor of sociology at the University of Southern California-Dornsife and a co-author of the report, explained the effects overdoses have on those left behind.

"Being exposed to drug overdose is a particularly pernicious experience in young kids' lives, because we know drug overdoses are really traumatizing deaths to undergo," Smith-Greenaway explained. "There's probably a lot of hardship leading up to the death. Those deaths are probably very confusing for young kids to process and to understand."

Researchers found most kids who lose family members to drug overdose are between ages 10 and 18. Data show the reach of the problem is getting dramatically worse, because kids younger than 10 are experiencing drug overdoses in their family at younger ages relative to their slightly older peers.

A 2024 study in the Journal of the American Medical Association Psychiatry looked at children who have lost parents to overdose and found the highest rate among non-Hispanic American Indian and Alaska Native families.

Smith-Greenaway pointed out there is currently no system in place to identify, track or monitor children affected by overdose and offer them specialized counseling.

"We need clear supports for identifying this population," Smith-Greenaway urged. "But then also providing them the supports to ensure that there's not a cyclical trauma here that replicates across generations."

Help is out there for parents or caregivers in California looking after a child who is coping with loss due to overdose. Some options include the website of the nonprofit Eluna, or Ronnie's House of Hope, based in Palm Desert.