Academic literature on the topic 'Texas. Department of Protective and Regulatory Services'

PurposeExamine whether children with a prior child protective services (CPS) investigation had different healthcare utilization compared to children without a history of CPS investigations.MethodsThe Children's Health Assessment and Planning Survey assessed 6,492 primary caregivers of children ages 0–17 years residing in North Texas in 2015. Caregivers reported prior CPS investigations and child healthcare utilization (emergency department [ED] use, unmet medication needs, and unmet medical care needs).Principle FindingsA total of 408 (5%) caregivers reported their child had a CPS investigation. Children with CPS investigations had greater odds of visiting the ED (OR = 1.9; 95% CI: 1.4, 2.5) and not receiving necessary medical care (OR = 1.9; 95% CI: 1.4, 2.8) compared to children without a CPS investigation.ConclusionsPrior CPS investigation was associated with disparities in receipt of necessary medical care and ED utilization for children.

ABSTRACT Since early December 2019, the coronavirus disease 2019 (COVID-19) has been relentlessly spread worldwide and has hit the healthcare systems with terrible force. Pharmacists play a vital role in the healthcare system in providing medicines, therapeutics, vaccines, clinical services, and other pharmaceutical care services to patients. Therefore, to ensure all these services continued at King Abdulaziz Medical City – Jeddah during the COVID-19 pandemic, the Department of Pharmaceutical Care initiated a departmental crisis preparedness plan, as a part of general hospital preparedness plan. It started with adjusting medication dosing time, instituting a daily medication refill process, working remotely, expanding the use of automation, and modifying employee schedules. Other actions included the following: handling drug shortages, placing restrictions on some medications, using personal protective equipment, changing routine practices of pharmacy aides, revising the medication delivery process, starting a contingency training program, and restricting pneumatic tube operation. We took guidance from the Ministry of Health, our own institute's experience, World Health Organization recommendations, updated scientific research, and the American Society of Health-System Pharmacists regulatory updates. This article aims to describe how health services, policies, and systems were applied and adapted to address a specific problem while maintaining all pharmacy employees' safety. This article reviews the inpatient pharmacy's particular needs and responses to these needs to meet the COVID-19 pandemic challenges.

This study aimed to explore the perceived barriers to physical activity among college students Study Design: Qualitative research design Eight focus group discussions on 67 college students aged 18-24 years (48 females, 19 males) was conducted on College premises. Data were analysed using inductive approach. Participants identified a number of obstacles to physical activity. Perceived barriers emerged from the analysis of the data addressed the different dimensions of the socio-ecological framework. The result indicated that the young adults perceived substantial amount of personal, social and environmental factors as barriers such as time constraint, tiredness, stress, family control, safety issues and much more. Understanding the barriers and overcoming the barriers at this stage will be valuable. Health professionals and researchers can use this information to design and implement interventions, strategies and policies to promote the participation in physical activity. This further can help the students to deal with those barriers and can help to instil the habit of regular physical activity in the later adult years.

ObjectiveDescribe and explain the transition of the syndromic surveillanceprogram at the Houston Health Department (HHD) from being alocally managed and aging system to an ESSENCE system governedby a regional Consortium of public health agencies and stakeholdersin the 13-county area of the southeast Texas.IntroductionSyndromic surveillance systems are large and complex technologyprojects that increasingly require large investments of financial andpolitical capital to be sustainable. What was once a minor surveillancetool in the mid-2000s has evolved into a program that is regardedas valuable to public health yet is increasingly difficult to maintainand operate for local health departments. The Houston HealthDepartment installed a syndromic surveillance system (SyS) sixyears before Meaning Use became known to healthcare communities.The system chosen at the time was the Real-time Outbreak DiseaseSurveillance System (RODS) which, at the time and for its purpose,was a suitable platform for syndromic surveillance. During the past13 years however, maintaining, operating, and growing a SyS by alocal health department has become increasingly difficult. Inclusionin Meaningful Use elevated the importance and profile of syndromicsurveillance such that network growth, transparency of operations,ease of data sharing, and cooperation with other state systems inTexas became program imperatives.MethodsWith support from the informatics group at Tarrant County PublicHealth (TCPH) in the form of mentoring, HHD devised a two prongstrategy to re-invigorate the syndromic program. The first was toreplace RODS with ESSENCE from Johns Hopkins Applied PhysicsLaboratory (JH/APL). The second was to strengthen the regionalnetwork by creating a governance structure that included outsideagencies and stakeholders. The product of this second effort wasthe creation of the Syndromic Surveillance Consortium of SoutheastTexas (SSCSeT) on the Communities of Practice model1usingparliamentary procedure2.ResultsAcquiring ESSENCE and forming SSCSeT were necessary stepsfor the continuing operation of the SyS. The Consortium includesmembers from local health jurisdictions, health care providers, healthpolicy advocates, academicians, and data aggregators. Created asa democratic society, SSCSeT wrote its constitution and by-laws,voted in officers, formed working groups and has begun developingpolicies. The Consortium is cooperating with the Texas Departmentof State Health Services (DSHS) as well as TCPH. Having ESSENCEwill ensure the HHD-SyS will conform to standards being developedin the state and provide a robust syndromic platform for the partnersof the Consortium.ConclusionsSyndromic systems operated by local health departments canadapt to regulatory changes by growing their networks and engagingregional stakeholders using the Communities of Practice model.

Photo by Anna Hecker on Unsplash ABSTRACT All people deserve the legal ability to outline their care decisions in advance and expect their decisions to govern during a pregnancy. However, until advance directives govern without pregnancy exceptions, people will not uniformly retain the ability to formulate autonomous decisions about their health care planning. INTRODUCTION In the last few years, states have passed increasingly restrictive laws regarding abortion and reproductive health care. Recent legislation in Alabama effectively banned the procedure altogether, while more than a dozen states have passed or are currently in the process of enacting so-called “fetal heartbeat laws,” which ban abortion at roughly six weeks post-conception after the detection of electrical activity in what could develop into fetal cardiac tissue.[1] While courts rarely uphold outright bans and broad sweeping legislation, they garner significant media and public attention.[2] In practice, however, often smaller legislative changes that garner the least attention have the most significant impact by steadily chipping away at healthcare rights. Few people realize the ethical impact of the poorly understood legal means by which a pregnant woman has already lost her right to make autonomous healthcare decisions over her body using an advance directive in nearly every state. BACKGROUND Advance directives are one of modern medicine’s most powerful yet underused tools. Most clinicians and patients think of advance directives as being only for the elderly or terminally ill. This association stems from the 1991 Congressional Patient Self-Determination Act that requires hospitals, nursing homes, and hospice agencies receiving federal funding to inform patients of their legal right to prepare an advance directive. The 2015 announcement by the Center for Medicare and Medicaid Services (CMS) to reimburse for advance directives without requiring a diagnosis code recognizes that all adult patients can benefit from advance directives regardless of illness or life expectancy.[3] Providers should be aware of a small but significant exemption found in most state advance directive laws. This exemption, commonly known as the pregnancy clause, invalidates the advance directive of a pregnant woman, negating autonomy. The pregnancy clause can lead to treatment against medical standards of care and places private interests over public health. Advance directive statutes are frequently amended, but currently, only eight states allow patients to write their pregnancy-related wishes into their advance directive and guarantee that their instructions will be followed. Eleven states automatically invalidate advance directives during pregnancy, while 18 states permit physicians to disregard a pregnant woman’s (or her proxy’s) wishes based on the likelihood of viability, pain, and suffering, or conscientious objector clauses. Thirteen states remain silent on whether an advance directive is binding during pregnancy or have contradictory statutes.[4] Viability has no standard definition for the purposes of the clauses and viability-based pregnancy clauses can lead to the same loss of rights as pregnancy clauses that invalidate advance directives due to pregnancy without any exceptions. Many may wonder about the clinical relevance of pregnancy clauses. The likelihood that a woman will need to effectuate an advance care directive while pregnant is higher than many people would realize. This situation is most commonly assumed to occur in instances of a brain-dead pregnant woman, of which there are a few cases reported each year. But brain death and persistent vegetative states are just two reasons to look to an advance directive. Advance directives more commonly apply to patients with dementia, strong religious objections to medical care, or during cancer treatments, surgery, or acute injury with temporary loss of capacity. In surgery or acute lapses of capacity, a proxy may be asked to make decisions if complications arise. The number of women potentially affected by pregnancy clauses is significant. Each year, 75,000 pregnant women will undergo non-obstetrical surgery;[5] one in 1,500 pregnant women will be diagnosed with cancer;[6] and an estimated 250,000 Americans will exhibit early-onset Alzheimer’s symptoms between the ages of 30 and 50.[7] ANALYSIS Though pregnancy clauses are a seemingly narrow focus, they can nullify an entire advance directive and restrict care not related to the fetus. By negating entire advance directives, the clauses negate proxy appointments, allowing decision-makers other than the intended proxy. Providers and proxies are left with little guidance over who can make decisions on behalf of the patient. Many states will appoint a biological family member as the surrogate decision maker if there is no designated proxy or the directive is invalid. The outdated language and assumptions about nuclear families found in these structures could significantly impact unmarried couples, same-sex partnerships, and relationships that do not meet state-defined partnership standards where the courts may appoint someone other than the woman’s significant other even when she designated them as a proxy.[8] Members of religious groups whose doctrines prohibit certain medical therapies must be informed that if they become pregnant, their autonomous ability to decide about medical care through an advance directive and their right to freely practice religion can be voided entirely. In addition to infringing on patient autonomy, pregnancy clauses also restrict how clinicians might practice medicine by mandating medically inappropriate treatments against the provider’s recommendations. For example, Illinois’s pregnancy clause stipulates that “if you are pregnant and your health care professional thinks you could have a live birth, your living will cannot go into effect.”[9] This clause places providers in a difficult position of sacrificing their therapeutic obligation to their patients. It may require them to use futile therapy against the patient’s best interest and without regard for prolonged pain and suffering. Pregnancy clauses are void of any consideration of the best clinical interest of the patient or the fetus and instead promote conservative rhetoric that all potential fetal life is paramount. Numerous medical and chromosomal conditions are incompatible with life or present significant potential disabilities that may be accompanied by pain and suffering. The same conditions also pose risks to the mother, including death. Accordingly, the medical profession recognizes that there are instances in which it may not be in the best medical interest of the mother or the fetus to continue the pregnancy. Yet providers are seemingly required by pregnancy clauses to violate codes of conduct and subject pregnant patients and their nonviable fetuses to treatments to which other patients would not be subjected. Without evidence of a patient’s clear and convincing intentions, states have an interest in protecting life, preventing suicide, and maintaining the ethical integrity of the medical profession that could interfere with the person’s ability to refuse care.[10] The legal defense of pregnancy clauses is that the state’s interest in fetal life is sufficiently important to override the mother. As established in Planned Parenthood v. Casey (1992), however, the state’s interest only exists for fetal life post-viability.[11] Therefore, to allow the state interest to override the person’s advance directive when the fetus is not yet viable violates Casey. Individuals have a legal and ethical interest in maintaining bodily privacy, integrity, and freedom from unwanted touching. They have the right to appoint a proxy or use a directive to govern care in the case of incapacity. Even when contemplating brain death, organ donation, and whether to be cremated or buried, there is an expectation that personal wishes will govern. Honoring an advance directive allows providers to uphold the integrity of the medical profession by respecting the principles of autonomy and beneficence. Pregnancy clauses are inherently unethical as their creation was not to further the integrity of the medical or legal profession, nor protect a state’s interest in the patient’s life. In 2016, the American College of Obstetricians and Gynecologists issued a committee opinion that pregnancy is not an ethical exemption to the right of capable patients to refuse treatment.[12] The right to direct treatment while pregnant is consistent with modern medical practice, while the legislative promotion of a singular abstract interest in potential fetal life to the exclusion of all other medical and ethical considerations is not in line with the profession’s values.[13] Many pregnancy clauses are politically motivated, reflecting anti-abortion legality lobbying efforts and attempts to win over conservative voters. When Alaskan Attorney General Harold M. Brown argued the state’s pregnancy clause was unconstitutional, Governor Bill Sheffield – a Democrat in a historically red state – enacted the bill anyway. Georgia’s Governor Bill Kemp narrowly won his election, with some crediting his aggressive messaging against immigration and abortion.[14] With either advance directives, proxies, or even friends and relatives who know what the person (if not incapacitated) would have wanted, courts and legislatures should not have leeway to force care that a person, if conscious, would have refused.[15] The ability to harness advance directive law to force invasive and unwanted treatment upon a pregnant patient’s body continues to occur out of the fear of legal uncertainty. The lack of uniformity between states in their pregnancy clauses further adds to the confusion. Many advance directive statutes create a conditional proposition: if a provider acts in accordance with the carefully drawn circumstances of an advance directive, the provider is granted protective immunity from accusations of malpractice or wrongful death for that conduct. It is neither illegal nor unethical to remove a ventilator, for example, from a patient who has directed such a course of action in an advance directive. A pregnancy clause may remove that immunity making the unethical act of ignoring the directive legal, but the ethical act of following it (removing a ventilator, for example) could subject the practitioner to liability.[16] Without a pregnancy clause, providers retain the ability to both follow an advance directive and to act in the best medical interest of their patient. Pregnancy clauses create confusion over the permissibility of medical acts in an attempt to coerce providers into making decisions that violate the rights of their patients and their own ethical codes of conduct. Pregnancy clauses are a fallacy of consequentialist ethics in which the morality of the outcome justifies actions. Under consequentialist reasoning, any violation to the woman is justified if the fetus develops and results in a live birth. This reasoning is further faulty as it incorrectly assumes that mechanically ventilating an unconscious, sick, dying, or dead body will result in a live birth. Consequentialist theories should be limited to situations with predictable ends. Ethical medical providers refute consequentialism in certain contexts because it treats patients as a means to an end to produce benefit for others. In pregnancy, ignoring advance directives to achieve the chance that a fetus might survive is not justified by consequentialism. Pregnancy clauses also fail through the lens of deontological ethics in which an action must be ethical in and of itself and not based on outcomes. The choice to respect autonomy through an advance directive should be followed uniformly absent special circumstances. Proponents of pregnancy clauses may argue that pregnancy is an appropriate exception because a woman “has chosen to lend her body to bring [a] child into the world.”[17] Minnesota and Oklahoma echo this belief in their statutes, which contain an unjustified rebuttable presumption that all female patients would want life-sustaining treatment if they are pregnant.[18] Pregnancy should not abrogate the rights of a person to assign a proxy for access to an abortion or to control her medical treatment. Pregnancy exclusions are not grounded in the ethical “best interest” standards for the mother or the fetus. Instead, they are rooted in outdated expectations of female gender roles, which reaffirm a legislative assumption that a pregnancy is more morally valuable than a woman’s autonomy. CONCLUSION All people deserve the legal ability to outline their care decisions in advance and expect their decisions to govern during a pregnancy. Providers and the government do not have to approve of a person’s care decisions or values, but medical practitioners must respect a person’s right to dictate their own health narratives. With the push for more patients to execute advance directives, providers and patients must be aware that their advance directives may succumb to the authority of pregnancy clauses. Until advance directives govern without pregnancy exceptions, people will not uniformly retain the ability to formulate autonomous decisions about their health care planning. Advance directive law will continue to be hijacked by politically motivated legislators. When seeking to address inequities in healthcare laws and access, it is essential to take a closer look at not only the headline cases but also the clauses and exemptions to laws seemingly designed to benefit patients. [1] For proposed and current abortion legislation and maps, see https://www.guttmacher.org/state-policy# and Anne Godlasky, Nicquel Terry Ellis, and Jim Sergent, “Where is Abortion Legal? Everywhere, but…” USA Today, May 15, 2019, updated April 23, 2020 https://www.usatoday.com/in-depth/news/nation/2019/05/15/abortion-law-map-interactive-roe-v-wade-heartbeat-bills-pro-life-pro-choice-alabama-ohio-georgia/3678225002/ [2] https://www.guttmacher.org/state-policy# (Many bills fail in legislatures and are not enacted.) [3] Department of Health and Human Services Centers for Medicare & Medicaid Services; 42 CFR Part 405, 410, 411, 414, 425, and 495; “Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2016; Final Rule.” [4] DeMartino, E. S., Sperry, B. P., Doyle, C. K., Chor, J., Kramer, D. B., Dudzinski, D. M., & Mueller, P. S. (2019). US State Regulation of Decisions for Pregnant Women Without Decisional Capacity. JAMA, 321(16), 1629–1631. https://doi.org/10.1001/jama.2019.2587; Villarreal, Elizabeth. “Pregnancy and Living Wills: A Behavioral Economic Analysis.” The Yale Law Journal Forum. Vol. 128 (2019); 1052-1076. [5] “Surgery During Pregnancy.” Intermountain Healthcare: Fact Sheet for Patients and Families, (2018). https://intermountainhealthcare.org/ext/Dcmnt?ncid=520782026 [6] Basta, P. Bak, A. Roszkowski, K. “Cancer Treatment in Pregnant Women”. Contemporary Oncology, 19, no. 5 (2015): 354–360 [7] “31-Year-Old Woman Fights Alzheimer's While Pregnant.” San Francisco Globe. 9 July 2015, sfglobe.com/2015/02/19/31-year-old-woman-fights-alzheimers-while-pregnant. [8] “Health Care Proxies.” Human Rights Campaign, https://www.hrc.org/resources/health-care-proxy. [9] Illinois Department of Public Health website, Statement of Illinois Law on Advance Directives and DNR Orders, http://www.idph.state.il.us/public/books/advdir4.htm. [10] In the Matter of Karen Quinlan, 355 A.2d 647 (1976); Cruzan v. Director, Missouri Department of Health, 497 U.S. 261 (1990); and In re Conroy 486 A.2d 1209 (1985). [11] Planned Parenthood of Southeastern Pennsylvania v. Casey, 505 U.S. 833 (1992). [12] The American College of Obstetricians & Gynecologists Committee on Ethics, Committee Opinion No. 664: Refusal of Medically Recommended Treatment During Pregnancy, (2016). [13] Lederman, Anne D. “A Womb of My Own: A Moral Evaluation of Ohio’s Treatment of Pregnant Patient’s with Living Wills”. Case W. Res. L. Rev. Vol. 45:351 (1995); 351-377. [14] Tavernise, Sabrina. “The Time Is Now: States Are Rushing to Restrict Abortion, or to Protect It.” The New York Times, 15 May 2019. [15] Cruzan. [16] Mayo, T.M. “Brain-Dead and Pregnant in Texas.” The American Journal of Bioethics, Vol. 14, no. 8 (Nov. 2014); 15-18. [17] In re A.C., 573 A. 2nd 1244 (1990). [18] Johnson, Kristeena L. “Forcing Life on the Dead: Why the Pregnancy Exemption Clause of the Kentucky Living Will Directive Act is Unconstitutional.” Kentucky Law Journal. Vol. 100 (2011-12); 209-233.

Babies and toddlers are amassing huge followings on social media, achieving microcelebrity status, and raking in five figure sums. In East Asia, many of these lucrative “micro­-microcelebrities” rise to fame by inheriting exposure and proximate microcelebrification from their social media Influencer mothers. Through self-branding techniques, Influencer mothers’ portrayals of their young’ children’s lives “as lived” are the canvas on which (baby) products and services are marketed to readers as “advertorials”. In turning to investigate this budding phenomenon, I draw on ethnographic case studies in Singapore to outline the career trajectory of these young children (under 4yo) including their social media presence, branding strategies, and engagement with their followers. The chapter closes with a brief discussion on some ethical considerations of such young children’s labour in the social media age.Influencer MothersTheresa Senft first coined the term “microcelebrity” in her work Camgirls as a burgeoning online trend, wherein people attempt to gain popularity by employing digital media technologies, such as videos, blogs, and social media. She describes microcelebrities as “non-actors as performers” whose narratives take place “without overt manipulation”, and who are “more ‘real’ than television personalities with ‘perfect hair, perfect friends and perfect lives’” (Senft 16), foregrounding their active response to their communities in the ways that maintain open channels of feedback on social media to engage with their following.Influencers – a vernacular industry term albeit inspired by Katz & Lazarsfeld’s notion of “personal influence” that predates Internet culture – are one type of microcelebrity; they are everyday, ordinary Internet users who accumulate a relatively large following on blogs and social media through the textual and visual narration of their personal lives and lifestyles, engage with their following in “digital” and “physical” spaces, and monetize their following by integrating “advertorials” into their blog or social media posts and making physical appearances at events. A pastiche of “advertisement” and “editorial”, advertorials in the Influencer industry are highly personalized, opinion-laden promotions of products/services that Influencers personally experience and endorse for a fee. Influencers in Singapore often brand themselves as having “relatability”, or the ability to persuade their followers to identify with them (Abidin). They do so by make consciously visible the backstage (Goffman) of the usually “inaccessible”, “personal”, and “private” aspects of mundane, everyday life to curate personae that feel “authentic” to fans (Marwick 114), and more accessible than traditional celebrity (Senft 16).Historically, the Influencer industry in Singapore can be traced back to the early beginnings of the “blogshop” industry from the mid-2000s and the “commercial blogging” industry. Influencers are predominantly young women, and market products and services from diverse industries, although the most popular have been fashion, beauty, F&B, travel, and electronics. Most prominent Influencers are contracted to management agencies who broker deals in exchange for commission and assist in the production of their vlogs. Since then, the industry has grown, matured, and expanded so rapidly that Influencers developed emergent models of advertorials, with the earliest cohorts moving into different life stages and monetizing several other aspects of their personal lives such as the “micro-microcelebrity” of their young children. What this paper provides is an important analysis of the genesis and normative practices of micro-microcelebrity commerce in Singapore from its earliest years, and future research trajectories in this field.Micro-Microcelebrity and Proximate MicrocelebrificationI define micro-microcelebrities as the children of Influencers who have themselves become proximate microcelebrities, having derived exposure and fame from their prominent Influencer mothers, usually through a more prolific, deliberate, and commercial form of what Blum-Ross defines as “sharenting”: the act of parents sharing images and stores about their children in digital spaces such as social networking sites and blogs. Marwick (116-117), drawing from Rojek’s work on types of celebrity – distinguishes between two types of microcelebrity: “ascribed microcelebrity” where the online personality is made recognizable through the “production of celebrity media” such as paparazzi shots and user-produced online memes, or “achieved microcelebrity” where users engage in “self-presentation strateg[ies]”, such as fostering the illusion of intimacy with fans, maintaining a persona, and selective disclosure about oneself.Micro-microcelebrities lie somewhere between the two: In a process I term “proximate microcelebrification”, micro-microcelebrities themselves inherit celebrity through the preemptive and continuous exposure from their Influencer mothers, many beginning even during the pre-birth pregnancy stages in the form of ultrasound scans, as a form of “achieved microcelebrity”. Influencer mothers whose “presentational strategies” (cf. Marshall, “Promotion” 45) are successful enough (as will be addressed later) gain traction among followers, who in turn further popularize the micro-microcelebrity by setting up fan accounts, tribute sites, and gossip forums through which fame is heightened in a feedback loop as a model of “ascribed microcelebrity”.Here, however, I refrain from conceptualizing these young stars as “micro-Influencers” for unlike Influencers, these children do not yet curate their self-presentation to command the attention of followers, but instead are used, framed, and appropriated by their mothers for advertorials. In other words, Influencer mothers “curate [micro-microcelebrities’] identities into being” (Leaver, “Birth”). Following this, many aspects of their micro-microcelebrities become rapidly commodified and commercialized, with advertisers clamoring to endorse anything from maternity hospital stays to nappy cream.Although children of mommybloggers have the prospect to become micro-microcelebrities, both groups are conceptually distinct. Friedman (200-201) argues that among mommybloggers arose a tension between those who adopt “the raw authenticity of nonmonetized blogging”, documenting the “unglamorous minutiae” of their daily lives and a “more authentic view of motherhood” and those who use mommyblogs “primarily as a source of extra income rather than as a site for memoir”, focusing on “parent-centered products” (cf. Mom Bloggers Club).In contrast, micro-microcelebrities and their digital presence are deliberately commercial, framed and staged by Influencer mothers in order to maximize their advertorial potential, and are often postured to market even non-baby/parenting products such as fast food and vehicles (see later). Because of the overt commerce, it is unclear if micro-microcelebrity displays constitute “intimate surveillance”, an “almost always well-intentioned surveillance of young people by parents” (Leaver, “Born” 4). Furthermore, children are generally peripheral to mommybloggers whose own parenting narratives take precedence as a way to connect with fellow mothers, while micro-microcelebrities are the primary feature whose everyday lives and digital presence enrapture followers.MethodologyThe analysis presented is informed by my original fieldwork with 125 Influencers and related actors among whom I conducted a mixture of physical and digital personal interviews, participant observation, web archaeology, and archival research between December 2011 and October 2014. However, the material presented here is based on my digital participant observation of publicly accessible and intentionally-public digital presence of the first four highly successful micro-microcelebrities in Singapore: “Baby Dash” (b.2013) is the son of Influencer xiaxue, “#HeYurou” (b.2011) is the niece of Influencer bongqiuqiu, “#BabyElroyE” (b.2014) is the son of Influencer ohsofickle, and “@MereGoRound” (b.2015) is the daughter of Influencer bongqiuqiu.The microcelebrity/social media handles of these children take different forms, following the platform on which their parent/aunt has exposed them on the most. Baby Dash appears in all of xiaxue’s digital platforms under a variety of over 30 indexical, ironic, or humourous hashtags (Leaver, “Birth”) including “#pointylipped”, #pineappledash”, and “#面包脸” (trans. “bread face”); “#HeYurou” appears on bongqiuqiu’s Instagram and Twitter; “#BabyElroyE” appears on ohsofickle’s Instagram and blog, and is the central figure of his mother’s new YouTube channel; and “@MereGoRound” appears on all of bongqiuqiu’s digital platforms but also has her own Instagram account and dedicated YouTube channel. The images reproduced here are screenshot from Influencer mothers’ highly public social media: xiaxue, bongqiuqiu, and ohsofickle boast 593k, 277k, and 124k followers on Instagram and 263k, 41k, and 17k followers on Twitter respectively at the time of writing.Anticipation and Digital EstatesIn an exclusive front-pager (Figure 1) on the day of his induced birth, it was announced that Baby Dash had already received up to SGD25,000 worth of endorsement deals brokered by his Influencer mother, xiaxue. As the first micro-microcelebrity in his cohort (his mother was among the pioneer Influencers), Baby Dash’s Caesarean section was even filmed and posted on xiaxue’s YouTube channel in three parts (Figure 2). xiaxue had announced her pregnancy on her blog while in her second trimester, following which she consistently posted mirror selfies of her baby bump.Figure 1 & 2, screenshot April 2013 from ‹instagram.com/xiaxue›In her successful attempt at generating anticipation, the “bump” itself seemed to garner its own following on Twitter and Instagram, with many followers discussing how the Influencer dressed “it”, and how “it” was evolving over the weeks. One follower even compiled a collage of xiaxue’s “bump” chronologically and gifted it to the Influencer as an art image via Twitter on the day she delivered Baby Dash (Figure 3 & 4). Followers also frequently speculated and bantered about how her baby would look, and mused about how much they were going to adore him. Figure 3 & 4, screenshot March 2013 from ‹twitter.com/xiaxue› While Lupton (42) has conceptualized the sharing of images that precede birth as a “rite of passage”, Influencer mothers who publish sonograms deliberately do so in order to claim digital estates for their to-be micro-microcelebrities in the form of “reserved” social media handles, blog URLs, and unique hashtags for self-branding. For instance, at the 3-month mark of her pregnancy, Influencer bongqiuqiu debuted her baby’s dedicated hashtag, “#MereGoRound” in a birth announcement on her on Instagram account. Shortly after, she started an Instagram account, “@MereGoRound”, for her baby, who amassed over 5.5k followers prior to her birth. Figure 5 & 6, screenshot March 2015 from instagram.com/meregoround and instagram.com/bongqiuqiuThe debut picture features a heavily pregnant belly shot of bongqiuqiu (Figure 5), creating much anticipation for the arrival of a new micro-microcelebrity: in the six months leading up to her birth, various family, friends, and fans shared Instagram images of their gifts and welcome party for @MereGoRound, and followers shared congratulations and fan art on the dedicated Instagram hashtag. During this time, bongqiuqiu also frequently updated followers on her pregnancy progress, not without advertising her (presumably sponsored) gynecologist and hospital stay in her pregnancy diaries (Figure 6) – like Baby Dash, even as a foetus @MereGoRound was accumulating advertorials. Presently at six months old, @MereGoRound boasts almost 40k followers on Instagram on which embedded in the narrative of her growth are sponsored products and services from various advertisers.Non-Baby-Related AdvertorialsPrior to her pregnancy, Influencer bongqiuqiu hopped onto the micro-microcelebrity bandwagon in the wake of Baby Dash’s birth, by using her niece “#HeYurou” in her advertorials. Many Influencers attempt to naturalize their advertorials by composing their post as if recounting a family event. With reference to a child, parent, or partner, they may muse or quip about a product being used or an experience being shared in a bid to mask the distinction between their personal and commercial material. bongqiuqiu frequently posted personal, non-sponsored images engaging in daily mundane activities under the dedicated hashtag “#HeYurou”.However, this was occasionally interspersed with pictures of her niece holding on to various products including storybooks (Figure 8) and shopping bags (Figure 9). At first glance, this might have seemed like any mundane daily update the Influencer often posts. However, a close inspection reveals the caption bearing sponsor hashtags, tags, and campaign information. For instance, one Instagram post shows #HeYurou casually holding on to and staring at a burger in KFC wrapping (Figure 7), but when read in tandem with bongqiuqiu’s other KFC-related posts published over a span of a few months, it becomes clear that #HeYurou was in fact advertising for KFC. Figure 7, 8, 9, screenshot December 2014 from ‹instagram.com/bongqiuqiu›Elsewhere, Baby Dash was incorporated into xiaxue’s car sponsorship with over 20 large decals of one of his viral photos – dubbed “pineapple Dash” among followers – plastered all over her vehicle (Figure 10). Followers who spot the car in public are encouraged to photograph and upload the image using its dedicated hashtag, “#xiaxuecar” as part of the Influencer’s car sponsorship – an engagement scarcely related to her young child. Since then, xiaxue has speculated producing offshoots of “pineapple Dash” products including smartphone casings. Figure 10, screenshot December 2014 from ‹instagram.com/xiaxue›Follower EngagementSponsors regularly organize fan meet-and-greets headlined by micro-microcelebrities in order to attract potential customers. Photo opportunities and the chance to see Baby Dash “in the flesh” frequently front press and promotional material of marketing campaigns. Elsewhere on social media, several Baby Dash fan and tribute accounts have also emerged on Instagram, reposting images and related media of the micro-microcelebrity with overt adoration, no doubt encouraged by xiaxue, who began crowdsourcing captions for Baby Dash’s photos.Influencer ohsofickle postures #BabyElroyE’s follower engagement in a more subtle way. In her YouTube channel that debut in the month of her baby’s birth, ohsofickle produces video diaries of being a young, single, mother who is raising a child (Figure 11). In each episode, #BabyElroyE is the main feature whose daily activities are documented, and while there is some advertising embedded, ohsofickle’s approach on YouTube is much less overt than others as it features much more non-monetized personal content (Figure 12). Her blog serves as a backchannel to her vlogs, in which she recounts her struggles with motherhood and explicitly solicits the advice of mothers. However, owing to her young age (she became an Influencer at 17 and gave birth at 24), many of her followers are teenagers and young women who respond to her solicitations by gushing over #BabyElroyE’s images on Instagram. Figure 11 & 12, screenshot September 2015 from ‹instagram.com/ohsofickle›PrivacyAs noted by Holloway et al. (23), children like micro-microcelebrities will be among the first cohorts to inherit “digital profiles” of their “whole lifetime” as a “work in progress”, from parents who habitually underestimate or discount the privacy and long term effects of publicizing information about their children at the time of posting. This matters in a climate where social media platforms can amend privacy policies without user consent (23), and is even more pressing for micro-microcelebrities whose followers store, republish, and recirculate information in fan networks, resulting in digital footprints with persistence, replicability, scalability, searchability (boyd), and extended longevity in public circulation which can be attributed back to the children indefinitely (Leaver, “Ends”).Despite minimum age restrictions and recent concerns with “digital kidnapping” where users steal images of other young children to be re-posted as their own (Whigham), some social media platforms rarely police the proliferation of accounts set up by parents on behalf of their underage children prominently displaying their legal names and life histories, citing differing jurisdictions in various countries (Facebook; Instagram), while others claim to disable accounts if users report an “incorrect birth date” (cf. Google for YouTube). In Singapore, the Media Development Authority (MDA) which governs all print and digital media has no firm regulations for this but suggests that the age of consent is 16 judging by their recommendation to parents with children aged below 16 to subscribe to Internet filtering services (Media Development Authority, “Regulatory” 1). Moreover, current initiatives have been focused on how parents can impart digital literacy to their children (Media Development Authority, “Empowered”; Media Literacy Council) as opposed to educating parents about the digital footprints they may be unwittingly leaving about their children.The digital lives of micro-microcelebrities pose new layers of concern given their publicness and deliberate publicity, specifically hinged on making visible the usually inaccessible, private aspects of everyday life (Marshall, “Persona” 5).Scholars note that celebrities are individuals for whom speculation of their private lives takes precedence over their actual public role or career (Geraghty 100-101; Turner 8). However, the personae of Influencers and their young children are shaped by ambiguously blurring the boundaries of privacy and publicness in order to bait followers’ attention, such that privacy and publicness are defined by being broadcast, circulated, and publicized (Warner 414). In other words, the publicness of micro-microcelebrities is premised on the extent of the intentional publicity rather than simply being in the public domain (Marwick 223-231, emphasis mine).Among Influencers privacy concerns have aroused awareness but not action – Baby Dash’s Influencer mother admitted in a national radio interview that he has received a death threat via Instagram but feels that her child is unlikely to be actually attacked (Channel News Asia) – because privacy is a commodity that is manipulated and performed to advance their micro-microcelebrities’ careers. As pioneer micro-microcelebrities are all under 2-years-old at present, future research warrants investigating “child-centred definitions” (Third et al.) of the transition in which they come of age, grow an awareness of their digital presence, respond to their Influencer mothers’ actions, and potentially take over their accounts.Young LabourThe Ministry of Manpower (MOM) in Singapore, which regulates the employment of children and young persons, states that children under the age of 13 may not legally work in non-industrial or industrial settings (Ministry of Manpower). However, the same document later ambiguously states underaged children who do work can only do so under strict work limits (Ministry of Manpower). Elsewhere (Chan), it is noted that national labour statistics have thus far only focused on those above the age of 15, thus neglecting a true reflection of underaged labour in Singapore. This is despite the prominence of micro-microcelebrities who are put in front of (video) cameras to build social media content. Additionally, the work of micro-microcelebrities on digital platforms has not yet been formally recognized as labour, and is not regulated by any authority including Influencer management firms, clients, the MDA, and the MOM. Brief snippets from my ethnographic fieldwork with Influencer management agencies in Singapore similarly reveal that micro-microcelebrities’ labour engagements and control of their earnings are entirely at their parents’ discretion.As models and actors, micro-microcelebrities are one form of entertainment workers who if between the ages of 15 days and 18 years in the state of California are required to obtain an Entertainment Work Permit to be gainfully employed, adhering to strict work, schooling, and rest hour quotas (Department of Industrial Relations). Furthermore, the Californian Coogan Law affirms that earnings by these minors are their own property and not their parents’, although they are not old enough to legally control their finances and rely on the state to govern their earnings with a legal guardian (Screen Actors Guild). However, this similarly excludes underaged children and micro-microcelebrities engaged in creative digital ecologies. Future research should look into safeguards and instruments among young child entertainers, especially for micro-micrcocelebrities’ among whom commercial work and personal documentation is not always distinct, and are in fact deliberately intertwined in order to better engage with followers for relatabilityGrowing Up BrandedIn the wake of moral panics over excessive surveillance technologies, children’s safety on the Internet, and data retention concerns, micro-microcelebrities and their Influencer mothers stand out for their deliberately personal and overtly commercial approach towards self-documenting, self-presenting, and self-publicizing from the moment of conception. As these debut micro-microcelebrities grow older and inherit digital publics, personae, and careers, future research should focus on the transition of their ownership, engagement, and reactions to a branded childhood in which babies were postured for an initimate public.ReferencesAbidin, Crystal. “Communicative Intimacies: Influencers and Perceived Interconnectedness.” Ada: A Journal of Gender, New Media, & Technology. Forthcoming, Nov 2015.Aiello, Marianne. “Mommy Blog Banner Ads Get Results.” Healthcare Marketing Advisor 17 Nov. 2010. HealthLeaders Media. 16 Aug. 2015 ‹http://healthleadersmedia.com/content/MAR-259215/Mommy-Blog-Banner-Ads-Get-Results›.Azzarone, Stephanie. “When Consumers Report: Mommy Blogging Your Way to Success.” Playthings 18 Feb. 2009. 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For almost 100 years, the Settlement Home for Children has provided an anchor of stability in the uncertain lives of hundreds of abused and neglected Texas children and young adults. The child welfare organization has evolved to fit the needs of the Central Texas community, transforming programs or overhauling its system of care when legal or social changes in child welfare called for reform. Advocates and state officials have lauded the Home as a model of innovation in statewide foster care services. Today, however, this century-old establishment faces an uncertain future as the state implements its long-awaited Texas Foster Care Redesign. Some Settlement Home staff said the redesign could change the entire structure and operation of their programs. It will cut state funding to child placement agencies. Redesign eliminates the list of criteria used to place children in appropriate care, and could change how – and to whom – the Home provides care. The privatization of the entire foster care system is the foundation of redesign and will alter the Home's relationship with the state, potentially forcing the Home to close down as a child placement agency.
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Using a Decision-Making Ecology (DME) approach and proportional hazards models, the study reviewed in this chapter isolated four case factor profiles that interacted strongly with race and resulted in disparate reunification outcomes for African American children compared with Anglos. The four interrelated factors were drug involvement, a solo infant case, single mothers, and relative placements. A cohort of 21,763 children from the Texas Department of Family and Protective Services who were placed for the first time in care, who were under 13, and were either Anglo or African American were followed for 20 months or more post entry into care. Starting with an initial model consisting of main effects only and consistent with other studies, African American children had a 12% lower hazard rate of reunification compared to Anglo children. However, when a set of case profiles involving combinations of single parents, single infants, drug involvements, and kinship placements were crossed with race, the magnitude of the effect of race on hazard rates fanned out from no difference to as much as 68% that of Anglo children. The results show that racial disparities in outcomes resulting from complex, contextual decision-making cannot be modeled well with simple main effects models.