Medical Motherhood

About Medical Motherhood

News, essays and insights on the experience of raising disabled children. Sign up for our free weekly newsletter at MedicalMotherhood.com. www.medicalmotherhood.com (https://www.medicalmotherhood.com?utm_medium=podcast)

Publisher

Shasta Kearns Moore

Category

health & fitness · kids & family

Language

en

Explicit

No

First episode

14 Nov 2021

Latest episode

22 Oct 2023

Latest episodes

93 episodes in the feed.

1. 

   22 Oct 2023

   Legal battle at NOLA Catholic schools; Va. paid family program needs improvement; Gender pay gap linked to care needs

   Each week, we showcase a picture of real life from the Medical Motherhood community. Submit one! If you’d like to participate, simply reply to this email. The intent is to show YOUR experience as a medical parent, not your child. What do you want people to know about the #medicalmom life? Subscribers, it’s time to say goodbye to the podcast version of Medical Motherhood. I’ve recorded nearly 100 episodes and learned a great deal about audio production! I would like to focus more time on producing short videos — like TikToks (https://www.tiktok.com/@medicalmotherhood) and Reels (https://www.facebook.com/MedicalMotherhood) — and don’t seem to be able to find the time to do it all. I regret not being able to provide this format to those who prefer it. But, I have applied for Substack’s new text-to-speech function (https://support.substack.com/hc/en-us/articles/7265753724692-How-do-I-listen-to-a-Substack-post-) and hope it will be available soon. As always, I’m available for feedback by simply replying to this email. I hope my new videos are a helpful way to consume this content and thank you for listening for the past two years! Medical Motherhood’s news round up Snippets of news and opinion from outlets around the world. Click the links for the full story. • From PBS News Hour: “Lawsuit accuses Catholic schools in New Orleans of discriminating against students with disabilities (https://www.pbs.org/newshour/nation/lawsuit-accuses-catholic-schools-in-new-orleans-of-discriminating-against-students-with-disabilities)” It’s homecoming season, but one 16-year-old is missing the rite of passage this year. The sophomore, who has cerebral palsy and uses a wheelchair, is home-schooled — and not by choice. The teen’s family has sued two local Catholic schools over what it describes as discriminatory admissions practices against students with physical, emotional, or learning disabilities. Now, it has joined a class-action lawsuit that claims that the Archdiocese of New Orleans asks illegal questions about students’ disabilities on its schools’ application forms. The lawsuit said this kind of practice has denied students with disabilities the opportunity to go to a Catholic school run by the archdiocese. “We’re very angry at the Catholic Church. We have not been back to church since this happened,” said her mom, who asked that she and her family not be named to protect her daughter’s identity. “The fact that the Catholic schools did this to us and no one from the Church even stepped up to make a comment, tried to help us, or offer any kind of empathy and support — it’s very disheartening.” […]The lawsuit claims that by asking unlawful questions about disabilities and requesting medical information of prospective students before they are enrolled, New Orleans-area Catholic schools are violating the Louisiana Human Rights Act, which does not have a religious exemption, and the Louisiana Civil Rights Act for Persons With Disabilities, which explicitly prohibits asking such questions as a matter of admissions. The suit also alleges “widespread segregation” of prospective students with disabilities in New Orleans-area Catholic schools, accusing the Archdiocese of New Orleans of directing parents of students with disabilities to apply to a small handful of schools for “exceptional learners,” in violation of both acts. The lawsuit, originally filed in 2022, was put on hold for close to a year by a judge overseeing the archdiocese’s bankruptcy proceedings, which now includes 500 claims of child sex abuse by priests and other clergy. This year, another judge said the outcome of the bankruptcy process would have no bearing on the discrimination case and allowed the suit to move forward. A trial date has not been set. […]Louisiana has one of the highest rates of private school enrollment in the nation, in part because of the local Catholic culture. More than 518,000 of the 1.2 million people in the New Orleans area identify as Catholic, according to the archdiocese. Twenty-five percent of New Orleans-area students attend private school, more than twice the national average, according to the Cowen Institute at Tulane University, which studies the city’s public education system. […]The archdiocese did not return requests for comment on its admissions or enrollment practices. E.R. and her family will miss out on many high school activities because she’s being homeschooled, but they have learned a valuable lesson on the importance of making sure kids with disabilities do not face more scrutiny than kids without them. “Not only did it bother me about what they were doing to my kid, but how many other kids were they doing that to? It’s been going on for years and years. Nobody did anything about it,” she said. “No matter how hard it is. If you don’t stand up for your child, nobody else will. That’s the bottom line. Standing up for your disabled child is not an easy thing, but you have to do it. You may lose things but you’re also going to gain things.” • From The Washington Post (Letters to the Editor): “Empower parents of children with disabilities (https://www.washingtonpost.com/opinions/2023/10/20/virginia-youngkin-disabled-care/)” One step forward and two steps back describe what Gov. Glenn Youngkin (R-Va.) has in mind for intellectually disabled Virginians. He committed to getting services, as covered by the developmental disability Medicaid waiver, to the most at-risk individuals. This is a big relief for the folks trying to get a waiver. In January, he implemented new policies (https://lis.virginia.gov/cgi-bin/legp604.exe?231+sum+HB1963) attempting to ensure that our children don’t live with the people who care for them. Yes, parents of the intellectually disabled can be paid between $12 and $17 per hour to take care of their children. This is care that often includes hygiene, feeding and transportation. The income, under the difficulty-of-care exemption, is not taxable. Now, Mr. Youngkin has brought on managed care agencies (https://richmond.com/lifestyles/health-med-fit/medicaid-managed-care-merger-starts-jan-1-in-virginia/article_29ebd4f8-ebf3-5bea-96f4-949b02af5823.html) to hire the people who care for our individuals. There isn’t enough money to care for our folks, but there is enough to pay agencies? Apparently, Mr. Youngkin is making sure I don’t milk the clock by helping my 23-year-old daughter manage her hygiene. Mr. Youngkin, do away with intrusive policies such as having agency staff come into our homes and decide who is going to care for our children. You talk about empowering parents. Please extend that dignity to the parents of those with intellectual disabilities. Ann Masch, Markham • From The New York Times: “Claudia Goldin’s Nobel-Winning Research Shows ‘Why Women Won’ (https://www.nytimes.com/2023/10/11/upshot/claudia-goldin-nobel-prize.html?searchResultPosition=2)” Claudia Goldin, who won the Nobel Prize (https://www.nytimes.com/2023/10/09/business/economy/claudia-goldin-nobel-prize-economics.html) in economics on [Oct. 9], has documented the journey of American women from, in her words, holding jobs to pursuing careers — working not just to support themselves, but because work is a fundamental aspect of their identity and satisfaction. […]Yet, her research demonstrates, women still lag behind men in various ways — in their pay, their work force participation and the share who reach the top of professions. That’s no fault of their own, her recent work has shown. It’s because of the way work is structured. American jobs disproportionately reward long hours. The most glaring gender gaps would diminish, she has argued (https://www.aeaweb.org/articles?id=10.1257/aer.104.4.1091), if employees had more control over where and when their work got done. […J]ust as women who were children in the 1940s underestimated their career potential, the current cohort of working-age women may have overestimated it (https://www.nytimes.com/2018/08/17/upshot/motherhood-rising-costs-surprise.html). Men’s and women’s careers and pay are basically the same when they start working (https://www.nber.org/papers/w14681), but they change when children arrive (https://www.nytimes.com/2017/05/13/upshot/the-gender-pay-gap-is-largely-because-of-motherhood.html). Her research shows a small dip (https://www.aeaweb.org/articles?id=10.1257/jep.31.1.161) in the share of women working in their late 30s and early 40s. Mothers are less likely than before to quit after their first baby, but slightly more likely to temporarily do so later, after “they try as hard as they can” not to, she has said. […]Closing these remaining gender gaps would require flexibility in where and when work gets done, her research explains. She has said in the past that such a change would require a fundamental remaking of the American workplace, “taking the whole thing down.” But more recently, she has expressed hope that the pandemic may have made that reality more feasible for white-collar workers. “I suppose I am ever optimistic that this will lead to some reasonably good things,” she said. Medical Motherhood brings you quality news and information each Sunday for raising disabled and neurodivergent children (https://www.medicalmotherhood.com/p/why-i-dont-use-the-term-special-needs#details). Get it delivered (https://www.medicalmotherhood.com/subscribe?) to your inbox each week or give a gift subscription (https://www.medicalmotherhood.com/subscribe?&gift=true). Subscriptions are free, with optional tiers of support. Thank you to our paid subscribers! Follow Medical Motherhood on Facebook (https://www.facebook.com/MedicalMotherhood), Twitter (https://twitter.com/medmotherhood), TikTok (https://www.tiktok.com/@medicalmotherhood), Instagram (https://www.instagram.com/medicalmotherhood/) or Pinterest (https://www.pinterest.com/shastakm/). The podcast is also available in your feeds on Spotify (https://open.spotify.com/show/0fdbdjm7aX1VF3OA7lMdre) and Apple Podcasts (https://api.substack.com/feed/podcast/342543.rss). Visit the Medical Motherhood merchandise store (https://shop.spreadshirt.com/MedicalMotherhood/all). Get full access to Medical Motherhood at www.medicalmotherhood.com/subscribe (https://www.medicalmotherhood.com/subscribe?utm_medium=podcast&utm_campaign=CTA_4)

2. 

   15 Oct 2023

   Why a Good Scare Can Be Therapeutic

   As the days get darker and the Halloween decorations come out, I wanted to republish this piece from last year. I still think about my conversation with haunted house creator and medical mama Chrissa Paradis and how cathartic a good scream and a giggle can be. Here’s an excerpt. Follow the link below for the real deal: […] As parents to kids with medical emergencies — or the isolating subset of folks who have to deal with the real possibility of child death (https://www.medicalmotherhood.com/p/when-death-lives-nearby) — visceral terror is not funny or theoretical: It’s some of the most real moments of our lives. But perhaps, even for us, recreational fear can be healthy. “As someone with a heavy amount of stored trauma — screaming, the act of literally screaming and releasing — you feel it free some of that,” says medical mama Paradis, producer and director of guest services at ScareGrounds PDX. “It really does have a restorative nature.” Paradis says it has also been interesting to see how her staff have benefited from creating scares. She says about half of the cast members are LGBTQ and have experienced a lot of struggle in their lives — either coming to terms with themselves or with their family and friends’ reactions. “They all find that creating the scares and taking that control is very healthy for them,” Paradis says. “So we kind of see it on both sides of how this environment provides some very primal healing.”[…] Medical Motherhood’s news round up Snippets of news and opinion from outlets around the world. Click the links for the full story. • From The Texas Tribune: “Disability advocates argue against school vouchers in Texas Senate hearing (https://www.texastribune.org/2023/10/10/texas-school-vouchers-disabilities-special-session/)” Questions about how a voucher program would — or wouldn’t — serve children with disabilities took center stage at a Texas Senate education committee hearing Tuesday to discuss the main school voucher bill (https://www.texastribune.org/2023/10/09/texas-senate-vouchers-education-savings-accounts/) on the table during the Legislature’s latest special session. Senate Bill 1 (https://capitol.texas.gov/BillLookup/History.aspx?LegSess=883&Bill=SB1), authored by Sen. Brandon Creighton (https://www.texastribune.org/directory/brandon-creighton/), R-Conroe, would use taxpayer dollars to create education savings accounts, a voucher-like program that would give families access to $8,000 a year to pay for private school tuition and other educational expenses. Voucher proponents argue that education savings accounts would allow students with disabilities access to specialized schools if public schools are not meeting their needs. Opponents, however, have pointed out that private schools, unlike public schools, are not required by law to provide special education services. Some disability advocates have raised concerns about funneling public dollars into private schools when the state’s public school system, which serves most special needs students in Texas, remains underfunded. The number of students with disabilities in Texas has increased by 200,000 in the last five years, according to Steven Aleman, policy specialist at Disability Rights Texas. “Our public school enrollment is growing. Our special education population is growing,” Aleman testified Tuesday. “We need to focus on supporting that system first and foremost, and [education savings accounts], quite frankly, are just a luxury we cannot afford.” […]Mandy Drogin, campaign director of an education initiative for the conservative think tank Texas Public Policy Foundation, argued the opposite. Drogin said she recently heard from a mother whose son with Asperger’s syndrome tried to take his life after repeated bullying in public school for his disability. “I have heard thousands of parents begging for the opportunity to speak for their child and unchain them from a school that is not serving them,” Drogin said. [The Senate bill’s author acknowledged the potential for discrimination in private school entry but said that should be worked out as a separate bill. […]“Although I understand your concerns that private schools have the ability to approve or deny based on that framework within that private school, moms and dads will be much smarter than us, as senators, in choosing the school that’s best for their child,” Creighton added.[…] • From CalMatters: “Newsom’s veto lets California counties continue taking foster kids’ money (https://calmatters.org/california-divide/2023/10/california-foster-kids-money/)” Gov. Gavin Newsom has vetoed a bill preventing California counties from taking benefits, such as Social Security checks, from orphaned or disabled children in their custody, to pay for their foster care. The veto disappointed children’s advocates who have pushed for California to instead save those benefits (https://calmatters.org/california-divide/2022/07/foster-care-youth-california/) for children to access when they’re adults. It also defies a nationwide trend (https://www.npr.org/2023/09/12/1197610205/foster-care-social-security-benefits). Increasingly, states led by Republicans and Democrats are stopping their child welfare agencies from the decades-old practice of essentially reimbursing themselves for providing foster care by cashing in certain children’s Social Security checks. Recently Arizona, New Mexico and Oregon have halted the practice, which came under increased scrutiny in 2021 after NPR and The Marshall Project published an investigation. This summer the federal government encouraged states (https://www.acf.hhs.gov/sites/default/files/documents/cb/ssa-hhs-joint-letter.pdf)to help children save their benefits instead, or find loved ones who could receive the payments on their behalf. […]But in a veto letter issued Sunday, Newsom wrote that the measure to stop the practice, AB 1512 (https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=202320240AB1512), would have cost too much, in a year he and lawmakers have to close a more than $30 billion budget shortfall. […]“Governor Newsom let down thousands of hopeful, disabled and orphaned foster youth by vetoing AB 1512,” [Amy Harfeld, national policy director of the Children’s Advocacy Institute at the University of San Diego,] wrote. “Budget challenges or not, picking the pockets of California’s most vulnerable foster youth to fund their care is morally and fiscally indefensible.” […]The state contends child welfare agencies are spending the benefits appropriately — on the children’s care — just as if they were the children’s parents. […State Assembly leader and bill author Isaac] Bryan, a former foster child, described the potential costs to the state as negligible. The entire state’s overall child welfare system costs nearly $5 billion a year. He said he will push for state money to be included in next year’s budget to halt the practice.[…] • From Disability Scoop: “Feds Aim To Ease Shortage Of Special Educators (https://www.disabilityscoop.com/2023/10/10/feds-aim-to-ease-shortage-of-special-educators/30578/)” […]The U.S. Department of Education said it is awarding over $35 million to bolster the workforce of special education teachers and administrators, related services providers, those at early intervention programs and university faculty preparing these specialists. A significant portion of the grants will be used for scholarships and other efforts to help students cover the cost of completing programs to prepare them for jobs serving children with disabilities, officials said. […]“Investing in the preparation and professional development of a strong, diverse workforce to serve children with disabilities is critical, not only to the well-being of individuals with disabilities, but to improve outcomes for all children,” said Glenna Wright-Gallo, assistant secretary for the Education Department’s Office of Special Education and Rehabilitative Services. […A]s of the start of this school year (https://www.disabilityscoop.com/2023/08/17/special-education-teacher-shortage-persists-nationally/30500/), data shows that 42 states and Washington, D.C. had a shortage of special educators. Medical Motherhood brings you quality news and information each Sunday for raising disabled and neurodivergent children (https://www.medicalmotherhood.com/p/why-i-dont-use-the-term-special-needs#details). Get it delivered (https://www.medicalmotherhood.com/subscribe?) to your inbox each week or give a gift subscription (https://www.medicalmotherhood.com/subscribe?&gift=true). Subscriptions are free, with optional tiers of support. Thank you to our paid subscribers! Follow Medical Motherhood on Facebook (https://www.facebook.com/MedicalMotherhood), Twitter (https://twitter.com/medmotherhood), TikTok (https://www.tiktok.com/@medicalmotherhood), Instagram (https://www.instagram.com/medicalmotherhood/) or Pinterest (https://www.pinterest.com/shastakm/). The podcast is also available in your feeds on Spotify (https://open.spotify.com/show/0fdbdjm7aX1VF3OA7lMdre) and Apple Podcasts (https://api.substack.com/feed/podcast/342543.rss). Visit the Medical Motherhood merchandise store (https://shop.spreadshirt.com/MedicalMotherhood/all). Get full access to Medical Motherhood at www.medicalmotherhood.com/subscribe (https://www.medicalmotherhood.com/subscribe?utm_medium=podcast&utm_campaign=CTA_4)

3. 

   8 Oct 2023

   Who is allowed to save the world?

   The care economy (https://research.american.edu/careworkeconomy/blog/2021/04/02/what-is-the-care-economy-and-why-we-should-know-more-about-it-particularly-now/) is a reality that businesses across the spectrum need to reckon with, particularly as the job market continues to improve (https://www.npr.org/2023/10/06/1204179771/jobs-labor-market-employers-economy-inflation-interest-rates). Flexible work options and outcomes-based metrics are key to allowing family caregivers a place in the workforce. On the second Sunday of every month, we feature Where is the Manual for This?!, an editorial cartoon about the medical mom life from Lenore Eklund (https://thisasthat.wixsite.com/thisasthat). Medical Motherhood’s news round up Snippets of news and opinion from outlets around the world. Click the links for the full story. • From Well+Good: “Parents of Kids With Disabilities Are in Mental Health Crisis (https://www.wellandgood.com/parent-mental-health-kids-with-disabilities/)” […]as study (https://journals.sagepub.com/doi/abs/10.1177/1053451217712956) after study (https://journals.lww.com/jped/Fulltext/2019/37030/Stress_mediated_quality_of_life_outcomes_in.4.aspx) after study (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8391692/) shows, high levels of stress and mental health strain are incredibly common among parents of kids who have disabilities. Talk to any parent whose child has a disability, developmental condition or delay, neurodivergence, or other unique needs, and you will find that these things are true: They love their children with an inextinguishable fierceness, they're locked in a constant struggle to secure services for their children that would help them thrive, and they often feel isolated and forgotten. All of this can negatively affect a parent’s mental health in both the short- and long-term. "Based on my clinical experience, isolation, anxiety, depression, and burnout are common mental health issues faced by parents of kids [with disabilities]," says Tasha Oswald, PhD (https://opendoorstherapy.com/dr_tasha_oswald_phd/), a psychologist and the founder and director of Open Doors Therapy (https://opendoorstherapy.com/), a neurodiversity-affirming counseling group. She points to the "greater responsibilities" of parents whose children will not usually meet milestones on typical timelines, if ever: "The kids will need more help from their parents along the way. In addition, there are fewer relevant parenting resources and [more] misinformation. So, your job is harder and you’re given fewer resources. And on top of it, you likely don’t have a community who gets it." […]To be clear, children are not the cause of parents' mental health challenges. Instead, the stress and burnout associated with parenting a child with disabilities comes as a result of navigating a complex and ever-evolving system of care. It's the expensive evaluations, the clinical visits, the endless mountains of paperwork, appointments to schedule and reschedule, phone calls to insurance companies, and—more often than you might imagine—legal battles to secure necessary services like medicine, equipment, and education. "There's a lot of trauma that goes into parenting kids like ours," says [mom Samantha] Kilgore. "But it's not from dealing with our children's challenges—it's from negotiating our child's right to exist in a world that is not set up for them. The fact that we even have to negotiate is enraging." Elizabeth Hughes, PhD, BCBA (https://www.iaba.com/children-and-adolescents), the executive clinical director at the Institute for Applied Behavior Analysis (https://www.iaba.com/) in Orange, California, says that "trauma" is indeed the appropriate word to describe what parents of kids with disabilities must navigate bureaucratically and administratively. […]Similarly, Jessica Miller*, whose daughter was born with hearing loss, points to red tape around access to care as being problematic. "My mental health issues are not stemming from her disability," she says. "They're from how we're having to manage everything around it that the world presents to us, whether that's education systems or trying to get supportive therapies or even going to the doctor for more hearing tests." […]Well-meaning people often tell burned-out parents of kids with disabilities to prioritize self care (https://www.wellandgood.com/self-care-new-parents/), but a spa day or therapy session can't solve what's inherently a societal and systemic problem. "I've taken advantage of therapy and medication, and I've gone to different support groups," Miller says. "Those are all really important, but they're also very individualized solutions. So I try to also keep in mind: At the same time, what can I be doing on a structural level? What does that look like?" […]Another important aspect of supporting parental mental health involves addressing the isolation so common among parents of disabled children. "Finding parent communities who deeply understand your situation can be validating and help you reconnect to your inner wisdom," Dr. Oswald says. "Talking with others who don’t get your parenting challenges and who give unsolicited advice or judge you can lead you to question your parenting and disconnect from your inner wisdom. Finding a supportive community can help you feel validated, appreciated, and inspired. Finding a community where you can express your worries and speak about those things that feel shameful can release you from the shame cycle."[…] • From 10News (Tennessee): “TN expands system providing early intervention services for young children with disabilities (https://www.wbir.com/article/news/health/tennessee-early-intervention-services-expansion-to-five-year-olds/51-a60200e8-33c5-4f15-8cdc-813fca0a9f5f)” Tennessee is expanding the services available for young children with disabilities to those who are an additional year old. According to a release, the federal government approved the state to start offering eligible families the choice to continue receiving services from the Tennessee Early Intervention System (https://www.tn.gov/didd/for-consumers/tennessee-early-intervention-system-teis.html) until the start of the school year following their child's fifth birthday. It's the full age range allowed for early intervention services in Part C of the Individuals with Disabilities Education Act. TEIS is voluntary and offers therapy, as well as other services, to infants and young children with developmental delays or disabilities. It's free to families and in the fiscal year 2023, it provided services to around 17,990 children.[…] • From We Are Iowa: “Iowa promises services to kids with severe mental and behavioral needs after lawsuit cites failures (https://www.weareiowa.com/article/news/health/iowa-hhs-interim-settlement-medicaid-eligible-children-mental-behavioral-services-lawsuit/524-47d52b28-6008-4b53-a63e-911ed641aa2e)” Iowa’s health agency will take steps to develop home and community-based services for children with severe mental and behavioral needs as part of an initial agreement with civil rights groups that filed a class action lawsuit. The lawsuit was filed in January on behalf of three children. It alleges that Iowa has for decades failed (https://www.weareiowa.com/article/news/health/iowa-mental-health-resources-disability-rights-iowa/524-f346522e-bcf1-4e58-b97c-ce6935f7d454) to meet its legal obligations to Medicaid-eligible children who should have access to individualized and coordinated care plans, in-home therapy and emergency services. The complaint includes children who have been institutionalized for services that they were previously recommended to receive — and say they were entitled to receive, given the Medicaid Act — in their communities or homes. "There was a desperate need to build a statewide children’s health system with an effective array of services," said Catherine Johnson, executive director of Disability Rights Iowa. “The complaint that we’ve filed alleges that these services are not available in anywhere in Iowa. They just don’t exist.” […]Johnson is optimistic about the work over the coming months, but she added that “time is of the essence” for these children and families. “They would like to have these services — well, they would have liked them years ago,” she said. “There is certainly an urgency to providing these services.” Medical Motherhood brings you quality news and information each Sunday for raising disabled and neurodivergent children (https://www.medicalmotherhood.com/p/why-i-dont-use-the-term-special-needs#details). Get it delivered (https://www.medicalmotherhood.com/subscribe?) to your inbox each week or give a gift subscription (https://www.medicalmotherhood.com/subscribe?&gift=true). Subscriptions are free, with optional tiers of support. Thank you to our paid subscribers! Follow Medical Motherhood on Facebook (https://www.facebook.com/MedicalMotherhood), Twitter (https://twitter.com/medmotherhood), TikTok (https://www.tiktok.com/@medicalmotherhood), Instagram (https://www.instagram.com/medicalmotherhood/) or Pinterest (https://www.pinterest.com/shastakm/). The podcast is also available in your feeds on Spotify (https://open.spotify.com/show/0fdbdjm7aX1VF3OA7lMdre) and Apple Podcasts (https://api.substack.com/feed/podcast/342543.rss). Visit the Medical Motherhood merchandise store (https://shop.spreadshirt.com/MedicalMotherhood/all). Get full access to Medical Motherhood at www.medicalmotherhood.com/subscribe (https://www.medicalmotherhood.com/subscribe?utm_medium=podcast&utm_campaign=CTA_4)

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