What are local organizations doing to address Iowa's childcare crisis?
IOWA — At just 25 years old, Ashley Miranda is the Assistant Director at Conmigo Early Education Center. You'd expect her to have a related degree, but hers is in biomedical science. Her dream is to be a doctor doing missionary work. She has the grades to go to medical school, but also has five younger siblings.
'I was just thinking how I cannot put my family through this financial strain right now,' she says. 'My mom still has babies to deal with. Let me work. Let me save up some money. Let me think about what I really want to do.'
Conmigo gave Ashley the foundation to become a straight A student, and the first in her family to go to college. Many organizations think her work should be rewarded.
'This is not babysitting,' say Jillian Herink and Jeannine Laughlin from the Iowa Association for the Education of Young Children. 'Please. It's childcare, not daycare, not nursery school, it's childcare. And these are educators.'
AEYC works to attract and retain quality employees like Ashley.
'We have the TEACH and the WAGES program here,' explains Herink, 'one pays for people to go to school, one pays extra stipends to keep them working in the childcare workforce, and so that we can kind of level out that pay a little bit more and keep those teachers where they want to teach.'
Ashley is one of three employees at Conmigo in the WAGES program. Two others are benefiting from TEACH. Both are funded by the Iowa Department of Health and Human Services.
In-home provider Becky Huisman is also in WAGES.
'It helps greatly offset what I'm not making,' she says, 'and it's covering a lot of bills that needed to be paid.'
Low wages contributing to Iowa's childcare crisis, experts say
Huisman is also part of the state's voluntary system 'Iowa Quality For Kids' – known as IQ4K – a rating system that also pays bonuses.
'There's professional plans,' she explains, 'what do I need to do to better my program for the kids and make sure I'm still providing the best care I need to for the kids so they can continue to learn and grow from in my program.'
Even with the assistance it's tough to make ends meet.
'I haven't raised rates in four years and now it's harder for me to pay my bills. So I'm going to have to raise rates and hopefully my families can meet those increases,' Huisman said.
Federal funding is already allocated and available to avoid that scenario in the form of childcare development block grants. $91 million from last year remains untouched.
'So I know that it's sitting there for a rainy day,' Jeannine Laughlin exclaims, 'we are in a damn hurricane!'
The governor's office says the state is trying to put that money to use by increasing eligibility for families and reimbursement rates for providers. Alex Murphy, director of communications with HHS released the following statement about the funding:
Yes, Iowa does have federal CCDBG funding that has not yet been dispersed. CCDBG funding has specific stipulations around how the funding can be utilized. Specifically, 70% of funds must be spent on 'direct services', meaning the funds must be spent specifically on family access to child care services. Over the past couple of years, the Iowa Legislature increased eligibility for families and increased reimbursement rates to providers in an effort to utilize unspent funds. HHS continues to work with advocates, legislators, and state leaders to determine the best ways to use the CCDBG funds within allowable parameters.
Alex Murphy, Iowa HHS
The Iowa Women's Foundation created a pilot program called the Childcare Solutions Fund. using public and private dollars, including $3 million from the state. It created 275 new slots in seven communities.
'So, really putting a three legged stool under child care,' says Executive Director Deann Cook, 'with parent tuition, public money, and private money. That's what stabilizes the sector to make it more available for everybody.'
The governor referenced the pilot program in her condition of the state address and she's pledging more funding to expand it. Ultimately supporting people like Ashley and the children and families she serves.
'Everything we do here, every interaction we have with them, they absorb it all and they take that with them in life.'
Below is a list of resources for families and providers:
Iowa Child Care Connect
Iowa Association for the Education of Young Children
Iowa Department of Human Services Child Care Provider search
How to contact your legislators
Copyright 2025 Nexstar Media, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.
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Fast Company
2 days ago
- Fast Company
I'm an emergency physician turned corporate leader. Here's how I led our team after a employee's suicide
My plane had just landed. I was anxious to get to the office after the departure of our team leader, a reduction in force culling hundreds of jobs just days before, and an organizational move to an unfamiliar part of the enterprise. As my team's senior ranking member, I needed to help process everything together. I turned on my phone to a deluge of texts. 'Please call as soon as possible,' my colleague wrote. 'Is everything okay?' I responded. 'No,' she replied. I called her as the plane taxied my crammed flight to the gate. 'Priya,' she said, 'Ashley died. She took her own life.' The words echoed in my head—strange sounds that made no sense and didn't feel real. Ashley had been a valued member of the team, a well-loved and developing leader whose deep empathy, perpetual curiosity, and strong work ethic were constant reminders of the nature and value of our role within the company. I didn't quite believe what I was hearing. Sobbing from the other side of the line pulled me back. I instantly donned the mantle of doctor. I had to help my friends and colleagues through this—and separate my own emotion from what needed to be done. It was going to be my job to tell the rest of my team. As an emergency physician, I was the one who told people their loved ones had died. I never expected to do the same in corporate America. And despite working for a healthcare company, I'd soon learn I'd have to do it with little support. The systems I was used to in the hospital were not in place here. Every Company's Duty We live in volatile times. Suicide rates in the U.S. spiked 36% over the past two decades, with nearly 50,000 deaths in 2023 alone. Across the country, job stability is tenuous, risking employer health insurance coverage. Mental health services are beyond capacity. Amid billions slashed in mental health funding and threats to Medicaid coverage, the situation will likely worsen. These tragedies impact the workforce, though precisely how depends on the level and caliber of systems-level organization and preparedness. Even in healthcare companies, clinical expertise and informed leadership can be systemically lacking. When I ran into this absence of coordinated systems, I used skills honed in the emergency department—through treating gunshots, heart attacks, and COVID-19—to help my team. But what if corporate America turned lessons from emergency medicine into a systems-level approach to suicide? We might turn tragedy into psychological safety—improving employee loyalty, productivity, and longevity—to the benefit of the business. Here's how. 1. Build a Coordinated Team and Established Process When a patient presents to the emergency department in a critical state, the team springs into action. The doctor, nurses, and emergency techs focus on the patient, while security, social work, and pastoral care workers support loved ones. In crises, everyone has a role. Under high-pressure circumstances, a single decision could result in death. Protocols such as American Cardiac Life Support (ACLS) and American Trauma Life Support (ATLS) standardize our approaches and maximize opportunity for survival. Large companies should adopt crisis management protocols describing who and how they'll support employees after suicide and other workplace traumas, instead of avoiding such in hope that suicide would be a rare event. Delineating processes, roles, and responsibilities mitigates variation and disorganization while enabling prompt response and engagement. That's fundamental because failing to quickly address a suicide can increase misinformation, distrust, and anxiety. 2. Communicate Immediately and Clearly After communicating with her family, I wanted to tell my team about Ashley face-to-face, just as I would in the emergency department. I also wanted to secure resources should anyone need support. On the cab ride from the airport, I engaged our human resources team and asked for crisis counseling on-site. I reserved a private space on campus for the entire team to gather. Out of respect and dignity not only for Ashley but also for the team as a whole, it was critical that the news was shared in a safe space from a trusted source. Hearing such through the rumor mill would undermine the honor I held central to the process. Human resources teams and leaders should model dignity and respect—and not be the source of word-of-mouth spread. Death-telling is an evidence-driven process that includes a few key actions: gathering loved ones together, providing resources, and meeting people where they are, which means immediately setting context, using clear words such as died, and allowing time and space to process the information. A few hours after I got to the office, it was time. Given the recent reduction in force, I had to stave off my team's top-of-mind fear. 'First,' I said, 'our jobs are secure.' Then I told them Ashley had died. 'We don't know all the details,' I said, 'but we know she died by suicide.' I fell silent, giving space for the shock and emotion that followed, while my own heart broke for everyone. As a close-knit team, sadness shrouded all of us, settling into the room. The air felt heavier. The silence was replaced by gasps and tears. After some time, I made a simple promise: 'I'm here for anything you need. We'll get through this together.' 3. Provide Visible and Tangible Support Suicide is a contagion. Exposure may increase the risk of suicidal thoughts, behaviors, and depression. In the aftermath, companies typically provide information about employee assistance programs or counseling services to help people cope with grief. But merely pointing to resources rather than providing them can make the people processing shock feel overwhelmed. They may perceive it as absent support. Postvention is a process designed to quash the contagion. It alleviates the effects of stress, helping survivors through immediate, short-term, and long-term responses. Visible and strong workplace leadership, with a willingness to discuss and serve as an ongoing resource, is effective in postvention efforts. But when leaders neither acknowledge nor offer safety following the suicide of an employee, that void can feel dehumanizing and propagate stigma. 'If an organization cannot talk about suicide,' experts have noted, 'it cannot properly support those impacted by it.' Silence from leaders and HR can feel deafening—further undermining survivors' sense of psychological safety and spurring feelings of isolation and neglect. Leaders who support collective mourning, through memorials or gathering events, connect people while dispelling stigma. 4. Help Managers Through It As we began grieving, I did everything I could to give the team space and permission to care for themselves. I cleared noncritical work and nonessential meetings and absorbed parts of their workload. As a physician, I knew each person would have different needs, based on their beliefs, cultural norms, and behaviors. High-pressure postventions usually fall to direct managers, who often have minimal to no training. They may overlook their own trauma and grieving process while tending to the needs of the team and the business. While strict hierarchical structures pervade corporate culture, leaders, including those in HR, should break rank amid crises. They should reach out beyond their direct reports to support the larger team. The better trained and available HR leaders are, the more they can alleviate the pressures on any one manager. 5. Debrief, Learn, and Improve Organized debriefings with leaders to review processes, execution, and opportunities for improvement are standard practice in medicine and for first responders. This not only allows for continuous quality improvement, but also provides an opportunity for various members to voice their personal experiences. Time and space from an acute event brings clarity and refinement. Following the suicide of a colleague, an organized debriefing supports the long-term aspect of the postvention. This is a collaborative exercise, anchored in safety and humility and based in learning and a drive to improve. Through honest feedback and critical evaluation, processes can be honed and the company can benefit as a whole. Helping Employees Heal From Crisis At a time when systems across the U.S. appear to be crumbling, corporate America has a valuable opportunity to assimilate humanity and empathy. Through processes and protocols, organizations can navigate crises by nurturing compassion, vulnerability, and shared healing. That's essential to employee wellness—which is, in turn, essential to engagement and productivity. But systems can't solve everything. Medicine's most refined processes can't prevent the guilt that plagues most survivors of suicide. I still struggle with the questions. Had I seen Ashley in the emergency department rather than the workplace, could I have spotted a warning sign and intervened? Had I fully understood how deeply the reorganization disrupted her sense of safety, what might I have done to mitigate it? I'll never have all the answers. I have only the lessons learned from a tragedy no leader wants to endure but for which every leader must prepare. Ashley left an indelible mark on all of us, both in life and in her absence. The shock and grief may never be gone, and a disappointment in company culture may linger. But our team got through the crisis together—just as I'd promised.
Medscape
4 days ago
- Medscape
The Weight of Two Worlds: Lipo-Lymphedema and Obesity
When Shannon Ashley, now 43 years old, was in her tweens and teens, her legs were noticeably large. Shannon Ashley 'Once I hit 12, my calves were unusually large, like tree trunks,' Ashley said. She tried to hide her outsized lower extremities, a contrast to her slender upper body, beneath wide-leg pants, and the size of her legs made clothes shopping difficult. 'Doctors insisted that I was just fat,' Ashley said. 'I took a free consultation with a plastic surgeon when I was 14 who said he could perform liposuction on my calves if I lost at least 20 pounds, but since I was already struggling with weight loss and dieting, that felt impossible, and my family wasn't in a position to pay for such a surgery anyway.' David Amron, MD David Amron, MD, is a leading lipedema specialist at The Roxbury Institute, with locations in Beverly Hills, California; Tucson, Arizona; and Salt Lake City, and a well-known national and international speaker and surgical advisor on the subject of lipedema and liposculpture. He has treated Ashley off and on since July 2021. He said that sort of reaction isn't all that unusual, although lipedema is actually very easy to spot once you know what you're looking for. 'It's a characteristic column-like presentation that wraps around the legs, typically from the groin area down, and their upper arms tend to become involved years or decades later, and sometimes in other areas, the upper buttock areas — it's a characteristic look; these patients are disproportionate, that's one thing,' said Amron, whose team, through the Advanced Lipedema Treatment Program at The Roxbury Institute, has performed more than 8000 successful lipedema-reduction surgeries. 'These patients also have tenderness to pressure, and finally, they have a family history — there are as many men with the lipedema gene as women, but they rarely show signs of it, so you have to look at both sides of the family.' Research documented that two American physicians first chronicled lipedema at the Mayo Clinic in Minnesota in the 1940s. While they are credited with the initial identification and description, consistent with Amron's outline of a highly distinguishable presentation, lipedema remained relatively unknown and often misdiagnosed for decades after their initial findings. Amron said that today, awareness and understanding of the condition remain hit or miss, even among the clinical community. 'Why is it not being diagnosed is a really important thing — it's just ignored,' Amron said. 'I've been involved in this for over 25 years, and awareness has increased a little bit.' In fact, he said, it has increased more among patients and social media and less among providers. He estimates that only 5%-10% of physicians know about lipedema. 'It's lack of awareness that's our biggest problem,' Amron said. 'That goes back to the fact that we still don't teach it in medical schools, and that's a problem.' Holly Lofton, MD Holly Lofton, MD, clinical associate professor of surgery and medicine and director of the Medical Weight Management Program at NYU Langone Health, New York City, agreed with Amron's assessment that the disease must be addressed in medical school curricula and said that providers can get up to speed with additional coursework. 'It is crucial that US medical schools allocate time to teach the lymphatic system as well as comprehensive education on lipedema education and treatment for future providers,' Lofton, who is not connected to Ashley's case, said. Continuing medical education courses on lipedema can update current professionals on diagnostic criteria and treatment options. Increasing awareness by having patients share their stories in media can reduce the stigma related to lipedema and can overall help with patients feeling more comfortable with them talking to their providers about the condition, she said. That's what Ashley, who began researching her symptoms after her body 'exploded' following the birth of her daughter in 2014, did. That research led her to the condition lipedema, which seemed to match what she was experiencing, but none of the doctors she consulted near her home outside of Chattanooga, Tennessee, knew what lipedema was. Ashley said they fell back on the assumption that her diet and eating habits must be the cause of her woes. 'My whole life, doctors told me what to eat or what not to eat and often recommended gastric bypass surgery, but they never actually asked me how I ate,' Ashley said. 'They just assumed I was doing this to myself.' Lofton said that, unfortunately, this is not an unusual response from practitioners who are not accustomed to treating lipedema. 'Many patients with lipedema are advised that they need to treat obesity as a condition, when in fact weight loss does not treat lipedema, as it is an abnormal fat accumulation,' Lofton said. 'It doesn't respond to diet and exercise but instead to other treatments which focus on activating the lymphatic system.' Ashley's health began to decline, and she said that, especially as a single mother, she felt a great deal of responsibility to both herself and her daughter to correct that progression. She knew she had to get an official diagnosis in order to start treatment, and after a great deal of continued research, she met with Amron in 2021. Naming the Enemy Unfortunately, by the time Ashley was able to get treatment with Amron, her lipedema had progressed to the point that her diagnosis was lipo-lymphedema. This condition arises when lipedema progresses to a point where it starts to impair the lymphatic system, leading to secondary lymphedema. Tissue can progress to the point that it becomes hard and inflamed, and Amron says that at worst, it becomes inoperable. 'Lipo-lymphedema occurs because of the chronic inflammation leading to the fibrosis and scar tissue that can begin to scar down the lymphatics and permanently damage the lymphatic capillaries and lymphatic circulation,' Amron explained. 'I find a pattern of a dense fibrosis is more prone to lipo-lymphedema. Generally, patterns of a loose fibrosis don't progress to lipo-lymphedema. So, it's something that we don't completely understand, but certain patients are more prone to this type of development.' Over the course of 2022, Amron performed three lipedema removal surgeries on Ashley, all successful. Ashley, a writer who has been very open on Medium and elsewhere about her battle with lipo-lymphedema, encountered considerable swelling after her surgeries, which Amron said is due to the specific type of scarring that she had developed. 'I define four patterns of fibrosis that I see: Nodular, dense, granular, and more of a spider-like network. Shannon had primarily more of a spider-like, loose network,' Amron said. 'Those patients are more prone to swelling and moving a lot of fluid across membranes because they have a lot of loose connective tissues. In a patient like Shannon, I'll go in and remove 40 liters and make great improvements, and they'll still have consistent swelling.' Amron's practice includes a diagnostic and preventive center where his associate Karen Herbst, MD, provides treatments for patients who experience these symptoms, including dealing with mast cell activation syndrome, evaluation of inflammatory markers, genetic testing, and other modalities. Ashley had an additional battle to face: In July of 2022, decades of carrying the weight of what was now lipo-lymphedema caused her knees to erupt with severe pain. After battling for months just to get an MRI because of her still-high weight, she learned that a torn medial meniscus and several related knee injuries and conditions were causing her pain. This was a real setback for Ashley in terms of her ability to get around and care for herself and her daughter, particularly depressing after all she had been through to get the severely needed surgeries. Lofton said that it's important that patients in situations such as Ashley's are treated with a holistic approach in order to achieve the best results. 'It's important to recognize that lipedema can lead to joint issues due to altered biomechanics and increased weight bearing. It is important that we as providers avoid biases based simply on BMI, or body mass index because this can be falsely elevated in patients with lipedema,' she said. 'Once a patient is diagnosed with lipedema, they can work with vascular surgeons, physical therapists, and other specialists to develop comprehensive treatment plans.' Treatments and Outcomes Ashley's knees have continued to be a battle, as no orthopedists have been willing to take her on due to her BMI, even at Amron's urging. However, in the spring of 2024, she signed on with a new nurse practitioner who 'actually had a basic understanding of lipedema.' Then, after several months of physical therapy and trying a few rounds of medication for her knee pain, Ashley was able to get access to compounded tirzepatide injections, though still at a very high out-of-pocket cost. The results weren't instantaneous, but Ashley noticed rapid progress. 'After several weeks on the shots, but before I lost any real weight, my knees began to feel much less painful, and I quit getting such bad joint flares. I also quit swelling up so much in my calves,' she said. 'As of now, I've lost nearly 80 pounds, and my knee pain rarely bothers me. My range of motion in my knees is still poor, and I am still regaining my strength with physical therapy, but I am finally seeing some real progress.' The dramatic effects of tirzepatide on patients with lipedema came as a surprise to Amron, who originally thought it would just be a complementary tool in the arsenal available to his patients. 'Initially, I assumed that it would be another weight loss strategy — it's almost like simply dieting, so you're taking in less food, so of course you're going to lose weight, but you're going to lose weight in the areas you don't have lipedema, and the areas you have lipedema aren't going to respond,' Amron said. 'We subsequently see that these medications can help with inflammation quite a bit.' Ashley is still fighting her battle against lipo-lymphedema, including against the limitations placed on coverage of the disease by the insurance industry. 'I'm stuck with limits like only 20 total covered therapy sessions per year — that includes lymphedema therapy and physical therapy together, not each. They won't cover my tirzepatide injections despite my positive results,' Ashley said. The issues at the heart of getting insurance companies to cover lipedema and expanding provider understanding of the disease are the same: Awareness and understanding. That's why Ashley has made her case public, and that's why she continues the fight.
Yahoo
28-05-2025
- Yahoo
Butt-lift injector banned from carrying out procedures
A self-styled "beauty consultant" who specialises in liquid Brazilian butt-lifts (BBLs) has been banned from carrying out any form of cosmetic surgery across England and Wales following a BBC investigation. Ricky Sawyer was found to be performing risky BBL treatments - which involve injecting up to 1,000ml of dermal filler into clients' buttocks to make them look bigger. He was exposed while working in a rented office block in London, performing dangerous procedures and handing over medication illegally. The BBC's findings were submitted to Manchester Civil Justice Centre as part of a civil action brought forward by Trafford Council. On Wednesday a judge granted an injunction against Mr Sawyer, banning him from carrying out or arranging cosmetic surgeries in England and Wales until 27 May 2028. The court heard evidence that included video footage from the BBC's original documentary, and graphic pictures of one of Mr Sawyer's client's injuries. James Parry, the lawyer who brought the case on behalf of Trafford Council, told the judge that the injuries were akin to that of "serious knife crime". Mr Parry later told the BBC: "I think that the level of injury that people have suffered and have produced evidence of their suffering of is quite shocking." Judge McAdam, in granting the injunction, agreed that the images were "shocking" and concluded that the breadth of the order was necessary to prevent further public harm. The injunction prohibits Mr Sawyer from undertaking or facilitating any invasive cosmetic procedures, including but not limited to the BBL, anywhere in England and Wales. It also bars him from possessing related surgical equipment or any antibiotics typically used in such treatments, unless prescribed for his own use. The court attached a power of arrest to key clauses in the order, meaning police may arrest Mr Sawyer without a warrant if he is found to be in breach of its terms. Mr Sawyer has been given 21 days to challenge the injunction. The BBC has heard testimony from nearly 40 women who reported serious complications, including sepsis and necrosis, after undergoing procedures by Mr Sawyer. Ashley, 27, attended one of Mr Sawyer's pop-up clinics last spring, and said she was drawn to Mr Sawyer by his low prices and celebrity endorsements. She travelled from her home in Liverpool to London and was directed to an office block. Despite misgivings about the location, she decided to go through with it. She said that after the injections started the pain was instant. "I nearly fainted" she said. At one point Ashley turned around and saw Mr Sawyer covered in blood. "He butchered me, there is no other word for it." Ashley said she left the clinic barely able to walk and covered in blood. Three days later, she was rushed to hospital with an infection and told she could have died without treatment. While Ashely has made a full recovery her voice still shakes when she recounts the experience at Mr Sawyer's hands. Reacting to Wednesday's court proceedings, Ashley said: "I am relieved, it makes me feel that we're being taken seriously." Several councils have banned Mr Sawyer from practising in their areas. And since the BBC documentary aired three further councils - Trafford, Salford and Manchester - have also banned him. Trafford Council said it would continue to monitor compliance with the injunction and encouraged anyone with information about unlawful cosmetic procedures to come forward.
