Journal of Applied Research on Children

Informing Policy for Children at Risk

Current Issue: Social Determinants of Health

Volume 15, Issue 1 (2025)Read More

Featured Content

  • Articles
    16 March 2026

    State-level Policies Addressing Maternal Mental Health Conditions: How Texas Compares

    Nicole Cirino
    In 2019, maternal mental health conditions (MMHCs) were the most common underlying cause of pregnancy-related death in Texas, contributing to over 20% of all deaths. Furthermore, it is estimated that 13.2% of all Texas women who gave birth in 2019 had an untreated MMHC. The most common MMHCs leading to mortality were depressive disorders, substance use disorders, bipolar and psychotic disorders. In 2022, the maternal mortality rate for Black women was over twice the rate for White and Hispanic women and three times the rate for Asian women. In addition to maternal harms, untreated perinatal mental health conditions are associated with childhood harms including adverse obstetric outcomes (fetal growth restriction, preterm birth, and stillbirth); impaired neurodevelopment and behavior outcomes; and a cost burden of $14.2 billion annually. Several broad factors specific to the state of Texas pose significant challenges to mental health care access, such as widespread poverty and high levels of uninsurance exacerbated by the state’s decision not to adopt Medicaid expansion. However, over the past decade, Texas policy makers have taken several important steps to directly address maternal mental health concerns. Most notably, the Texas Health and Safety Code 32.046 of 2019 required the Texas Health and Human Services commission to develop comprehensive statewide maternal mental health policies. The result was the Maternal Depression Strategic Plan of 2021-2025, a unique-to-Texas comprehensive strategy that aimed to improve outcomes for mothers and children. The plan deploys 15 strategies in five areas: provider awareness, increasing referral networks, access to peer support services, increasing public awareness and reducing stigma, and leveraging funding to existing programs. Here, we discuss several key initiatives that emerged from the strategic plan, their relevant efficacy data, and how they compare to national benchmarks. These include 1) extension of Medicaid coverage postpartum (including telemedicine); 2) development of a statewide perinatal access program (Peripan); and 3) partnerships with community education leaders and academic centers to provide education on MMHCs and reduce stigma. We will also review national policies with demonstrated efficacy in decreasing MMHCs that Texas has not yet adopted, such as universal postpartum depression screening measures and support of inpatient maternal mental health programs. Our aim is to inform future policy development and research directions that decrease MMHCs and ultimately improve health outcomes for mothers and children.
    Read More

Current Issue: Social Determinants of Health

Articles11 March 2026

Addressing Maternal Cardiovascular Mortality: The Role of Policy in Reducing Preventable Deaths and Disparities

Matthew Mitts, Alexandra Latham, Christina Ackerman-Banks
Maternal cardiovascular conditions now surpass hemorrhage and infection as the leading cause of pregnancy-related deaths in the United States, accounting for roughly one-third of preventable maternal fatalities. Unfortunately, stark racial and geographic inequities persist, with Black and Indigenous mothers dying at two to four times the rate of their White peers. Additionally, geography affects the risk, with rural residents facing a significantly higher risk than pregnant patients who deliver in urban centers. The physiologic changes of pregnancy function as a vascular stress test; therefore, pregnancy and postpartum offer a critical window of opportunity to identify women with a high lifetime cardiovascular risk and then to implement prevention strategies. Evidence-based interventions need to be coupled with coordinated system-wide changes in primary preventive care in order to mitigate the rising number of preventable cardiovascular deaths among women in pregnancy and beyond. Despite evidence of the efficacy of validated screening and prevention protocols, systemic gaps in maternal care persist. Maternal care deserts are expanding. In addition, those areas that offer maternal care often lack sufficient programs that incorporate validated cardiovascular risk-screening tools and do not maintain dedicated cardio-obstetric care teams. Postpartum surveillance for blood pressure and cardiac symptoms remains inconsistent, even though women with hypertensive disorders of pregnancy are nearly four times as likely to develop chronic hypertension within a year of delivery. Together, these systemic barriers, including fragmented insurance coverage and maternal care deserts with limited access even to telehealth, prevent patients from receiving life-saving essential health care, including cardiac screening and prevention programs. Here, we will highlight the differences in federal, state, and hospital-level policies that contribute to these gaps. Additionally, we will discuss evidence-based protocols, including standardized safety bundles, remote blood pressure monitoring programs, and multidisciplinary Cardio-OB clinics, that have shown promising improvements in maternal cardiovascular outcomes. Finally, we will propose policy solutions to remove barriers that limit pregnant and postpartum individuals from accessing antenatal and postpartum care in hopes of achieving meaningful, lasting reductions in maternal morbidity and mortality.
Articles16 March 2026

State-level Policies Addressing Maternal Mental Health Conditions: How Texas Compares

Nicole Cirino
In 2019, maternal mental health conditions (MMHCs) were the most common underlying cause of pregnancy-related death in Texas, contributing to over 20% of all deaths. Furthermore, it is estimated that 13.2% of all Texas women who gave birth in 2019 had an untreated MMHC. The most common MMHCs leading to mortality were depressive disorders, substance use disorders, bipolar and psychotic disorders. In 2022, the maternal mortality rate for Black women was over twice the rate for White and Hispanic women and three times the rate for Asian women. In addition to maternal harms, untreated perinatal mental health conditions are associated with childhood harms including adverse obstetric outcomes (fetal growth restriction, preterm birth, and stillbirth); impaired neurodevelopment and behavior outcomes; and a cost burden of $14.2 billion annually. Several broad factors specific to the state of Texas pose significant challenges to mental health care access, such as widespread poverty and high levels of uninsurance exacerbated by the state’s decision not to adopt Medicaid expansion. However, over the past decade, Texas policy makers have taken several important steps to directly address maternal mental health concerns. Most notably, the Texas Health and Safety Code 32.046 of 2019 required the Texas Health and Human Services commission to develop comprehensive statewide maternal mental health policies. The result was the Maternal Depression Strategic Plan of 2021-2025, a unique-to-Texas comprehensive strategy that aimed to improve outcomes for mothers and children. The plan deploys 15 strategies in five areas: provider awareness, increasing referral networks, access to peer support services, increasing public awareness and reducing stigma, and leveraging funding to existing programs. Here, we discuss several key initiatives that emerged from the strategic plan, their relevant efficacy data, and how they compare to national benchmarks. These include 1) extension of Medicaid coverage postpartum (including telemedicine); 2) development of a statewide perinatal access program (Peripan); and 3) partnerships with community education leaders and academic centers to provide education on MMHCs and reduce stigma. We will also review national policies with demonstrated efficacy in decreasing MMHCs that Texas has not yet adopted, such as universal postpartum depression screening measures and support of inpatient maternal mental health programs. Our aim is to inform future policy development and research directions that decrease MMHCs and ultimately improve health outcomes for mothers and children.

Most Popular Articles

Articles
15 March 2011

Human Trafficking, Sex Tourism, and Child Exploitation on the Southern Border

Jim Walters, Patricia Davis
Human trafficking and various other forms of child sexual exploitation on the United States-Mexico border are described from social science and law enforcement perspectives, including current laws and definitions, case examples, and descriptions of victims and traffickers. The Southern Border Initiative of the AMBER Alert Project is outlined as one effort to combat trafficking through collaboration between law enforcement agencies and programs in the United States and Mexico.  Policy recommendations include increasing knowledge and collaboration between law enforcement, social service agencies, and judicial systems across the border region and between the United States and Mexico.
Read More
Articles
6 December 2013

Sexual Violence against Girls in Schools: Addressing the Gaps between Policy and Practice in Awaso, Ghana

Geneviève Proulx, Andrea Martinez
Despite the established relationship between girls' education and several social development outcomes, gender disparities in education remain particularly concerning. Among the many obstacles that still hinder girls’ access to quality education, sexual violence against girls in schools (SVAGS) is one of the most worrying but also one that has received the least attention in light of recent efforts to increase girls’ attendance in school. This article explores the interface between the seemingly solid Ghanaian legal and policy framework to protect children in educational institutions and the high incidence of SVAGS in such institutions. Its purpose is twofold: to identify the major barriers to fighting SVAGS in Awaso, a rural Ghanaian town, and to highlight strategies for lifting those barriers. Using classroom observation, focus group discussions and interviews with students, teachers, parents, NGO staff and government representatives, it explains how lack of knowledge, lack of financial resources, deep-set values and popular perceptions of masculinity, femininity and violence against women and girls contribute to SVAGS.
Read More
Articles
27 March 2013

Examining the Relationship Between Media Use and Aggression, Sexuality, and Body Image

Temple Northup
Objectives: The primary purpose of this research is to understand the media's impact on individual attitudes and behaviors related to aggression, sexuality, and body image. This research is of particular importance because it uses up-to-date data reflecting effects based on the current media environment. Additionally, it includes a racially diverse sample. Methods: A survey of 407 students at a large, public university was conducted. The survey instrument contained general measures related to media consumption, including overall television, video game, and internet use, as well as more specific questions related to particular types of media, such as pornography. For the dependent variables, questions were included that measured both attitudes and behaviors related to aggression, sexuality, and body image. Results: Consistent with predictions, media use impacted both attitudes and behaviors related to aggression, sexuality, and body image. Specifically, overall television consumption led to increased levels of aggression (r=.18, pr=.20, pr=.24, pr=.42, pr=.40, p Conclusions: The media continue to play an important role in the development of attitudes and behaviors. It is warranted, therefore, to continue to investigate what media can cause negative outcomes, as well as to determine how those outcomes vary based on race and gender.
Read More
Articles
3 October 2012

For Safety’s Sake: A Case Study of School Security Efforts and Their Impact on Education Reform

Rachel Garver, Pedro Noguera
Several studies have shown that the need to create safe and orderly schools has increasingly been addressed in a manner that disconnects these priorities from broader concerns related to student success, school culture, and child development. In this paper, we explore the consequences of expanding security procedures in response to an incident involving interracial conflict at an urban high school in the United States. We offer this case study to demonstrate how the primacy placed on safety and security resulted in the neglect of other important educational goals, such as academic engagement and a positive school culture. Through an analysis of observational, interview, focus group, and survey data, we show that while it is essential for schools to take measures that ensure the safety of students and staff, it is equally important for safety to be recognized as part of a larger set of goals that schools must concurrently pursue in order to meet the educational and developmental needs of the students they serve.
Read More
Articles
27 March 2013

Addressing the Challenges of Child and Family Homelessness

Kerri Tobin, Joseph Murphy
Homeless children in families comprise the fastest-growing group of homeless persons in the United States. Indeed, the American Academy of Pediatrics considers homelessness to be an issue with which pediatricians should be concerned. In this article, we review existing literature to provide a background for researchers, policymakers, and social service providers hoping to understand the phenomenon of child and family homelessness and various strategies used to address it. We begin with a definition and description of the population of homeless families with children. We then offer a broad consideration of the effects of child and family homelessness, from physical health problems like malnutrition and increased incidence of infection to emotional and academic impacts. We end with a platform of policies and other action steps for addressing the problems of homelessness for children and their families.
Read More
Articles
15 March 2011

Sex Trafficking of Minors in the U.S.: Implications for Policy, Prevention and Research

Kimberly Kotrla, Beth Ann Wommack
Context: Information currently available on the trafficking of minors in the U.S. for commercial sexual exploitation includes approximations of the numbers involved, risk factors that increase the likelihood of victimization and methods of recruitment and control. However, specific characteristics about this vulnerable population remain largely unknown. Objective: This article has two distinct purposes. The first is to provide the reader with an overview of available information on minor sex trafficking in the U.S. The second is to present findings and discuss policy, research, and educational implications from secondary data analysis of 115 cases of minor sex trafficking in the U.S. Design: Minor sex trafficking cases were identified through two main venues - a review of U.S. Department of Justice press releases of human trafficking cases and an online search of media reports. Searches covered the time period from October 28, 2000, which coincided with the passage of the VTVPA through October 31, 2009. Cases were included in analysis if the incident involved at least one victim under the age of 18, occurred in the U.S., and at least one perpetrator had been arrested, indicted, or convicted. Results: A total of 115 separate incidents involving at least 153 victims were located. These occurrences involved 215 perpetrators, with the majority of them having been convicted (n = 117, 53.4%), The number of victims involved in a single incident ranged from 1 to 9. Over 90% of victims were female who ranged in age from 5 to 17 years. There were more U.S. minor victims than those from other countries. Victims had been in captivity from less than 6 months to 5 years. Minors most commonly fell into exploitation through some type of false promise indicated (16.3%, n = 25), followed by kidnapping (9.8%, n = 15). Over a fifth of the sample (22.2%, n = 34) were abused through two commercial sex practices, with almost all (94.1%, n = 144) used in prostitution. One of every five victims (24.8%, n = 38) had been advertised on an Internet website. Conclusions: Results of a review of known information about minor sex trafficking and findings from analysis of 115 incidents of the sex trafficking of youth in the U.S. indicate a need for stronger legislation to educate various professional groups, more comprehensive services for victims, stricter laws for pimps and traffickers, and preventive educational interventions beginning at a young age.
Read More

Readership Activity