The opioid epidemic is having a devastating impact on children and families and placing a significant strain on states as they work to develop effective programs and find new funding to respond to this crisis.
To address the crisis and promote healthy child development, states are implementing innovative whole-family approaches to prevention and treatment (see below). On the federal level, new funding is available and recently the federal Center for Medicare and Medicaid Innovation announced its Integrated Care for Kids model, which states can use to improve care and outcomes while reducing costs through early identification, integrated care coordination, and case management for physical and behavioral health care and non-clinical local services.
Children can experience many negative consequences as a result of their parents’ opioid use disorder (OUD). Prenatal opioid exposure can cause neonatal abstinence syndrome in infants, which is usually treated by costly hospitalizations and may increase the risk of developmental disabilities. Children affected by parental substance misuse are at increased risk of adverse childhood experiences and trauma, which can have significant short- and long-term physical, mental, and behavioral consequences.
A new National Academy for State Health Policy (NASHP) issue brief, written in partnership with the Alliance for Early Success, identifies the following promising state strategies developed by Kentucky, New Hampshire, and Virginia to support children and families:
- Facilitate access to and coverage of services by improving identification of at-risk infants and children, enabling rapid access to treatment, expanding coverage of services, and enhancing provider capacity. For example, New Hampshire’s Project First Step embeds licensed alcohol and drug counselors (LADCs) within its Division of Children, Youth, and Families (DCYF) district offices. The LADCs train child welfare and juvenile justice staff about substance misuse — including screening and facilitating access to treatment — to enable DCYF staff to better meet the needs of children and families affected by OUD.
- Implement family-focused care delivery models, such as providing family-centered treatment approaches for the family unit, offering care at home and in the community, coordinating care, and providing trauma-informed care. Virginia’s Medallion 4.0 Medicaid managed care program contract requires Medicaid managed care organizations to provide specialized care coordinators for substance-exposed newborns and align a mother’s and infant’s care plan. Additionally, Virginia’s Medicaid 4.0 contracts promote delivery of trauma-informed care, particularly for children impacted by the foster care system.
- Align and maximize resources across systems by sharing data and leveraging diverse funding sources. Kentucky’s Sobriety Treatment and Recovery Team (START) program is a family-centered, service delivery model within the state’s child welfare system that pairs families affected by substance use disorder (SUD) with a child protective services (CPS) worker and a family mentor who has lived experience with SUD. The CPS workers and family mentors coordinate care, offer rapid access to treatment, and provide comprehensive wrap-around services. The program weaves together funding from a Title IV-E waiver demonstration, Medicaid, the Temporary Assistance for Needy Families block grant, and state general funds. The state has also established a data-sharing agreement to advance the program between its Department for Community Based Services and its Department for Behavioral Health, Developmental, and Intellectual Disabilities.
An additional report and webinar exploring state strategies to support pregnant and parenting women affected by substance use disorders, including opioid use disorder, will be published in the weeks ahead.
The opioid epidemic continues to have devastating consequences for children and families across the country, with growing social and financial implications for states. The National Academy for State Health Policy (NASHP), in partnership with the Alliance for Early Success, interviewed Kentucky, New Hampshire, and Virginia officials representing state Medicaid, child welfare, and behavioral health programs to explore how their child-serving agencies were responding to the opioid epidemic. This new report explores:
- State strategies to support young children and families affected by the epidemic;
- Available state and federal funding sources for these initiatives; and
- Key considerations for states working to improve services and outcomes for this vulnerable population.
- Listen to a webinar that featured two New Hampshire officials detailing their state’s strategies to support families affected by the opioid epidemic. The speakers are:
- Geraldo Pilarski, Bureau of Community, Family, and Program Support Administrator, New Hampshire Division for Children, Youth and Families, and
- Erica Ungarelli, Bureau for Children’s Behavioral Health Director, New Hampshire Division for Behavioral Health
Download webinar slides. View the webinar:
- Explore resources from #NASHPCONF18’s session: Turning the Tide: State Strategies to Meet the Needs of Families Affected by Substance Use Disorder.
The first years of life significantly impact long-term health and well-being and policymakers have worked hard to create initiatives that help children during this important period. Recently, the National Academy for State Health Policy (NASHP) convened state and federal leaders from agencies serving young children to discuss innovative approaches to advance healthy child development in a time of increased scrutiny and potential funding cuts. Read about their recommendations to promote healthy child development through delivery system, data, and payment strategies here.
State policymakers increasingly recognize the need to address the social determinants of health — housing, employment, education, and income — to reduce health care costs and improve population health. Educational attainment, for example, provides dividends for overall health. People with higher levels of education generally live longer and experience healthier lives.
The quality of education a student receives impacts educational attainment and overall health. Evidence shows the overrepresentation of certain groups of students in separate classrooms or other settings of poorer quality overwhelmingly affects students of color. Teachers have identified students of color as having disabilities at higher rates than white students, with research documenting racial bias as influencing their decisions to remove students from the classroom. Students removed from mainstream education settings are less likely to make progress, build skills, and/or return to general educational settings. Black and Latino students are more likely to be affected by disproportionality.
|Disproportionality occurs when any racial or ethnic group’s numbers in special education classes or programs are statistically higher than other students.|
States are uniquely positioned to promote the mental health and educational achievement of all children by addressing the mechanisms that underlie racial and ethnic differences in mental disorder onset and persistence, and the causes and consequences of disproportionality in out-of-regular classroom settings, such as resource rooms, separate schools, or separate facilities. Using the resources of a variety of agencies, including public health, Medicaid, mental health, and education, can address disproportionality. Drawing from interviews with state officials conducted in conjunction with Massachusetts General Hospital’s Disparities Research Unit, the National Academy for State Health Policy (NASHP) identified state policy levers and programs, including mental health consultation, data sharing, convening authority, systemic interventions and supports, that states can use to eliminate mental health disparities.
State Levers to Address Disproportionality in Educational Settings
- Mental health consultation programs: Minnesota, Delaware, Colorado, Ohio and Connecticut utilize mental health consultation programs that can support efforts to address disproportionality. Mental health consultation varies across states, but commonly mental health providers support child care professionals and teachers, including Head Start, Part C Early Intervention Program, and child care workers, to improve their ability to identify and ameliorate mental health issues in children. States are also investing in training resources to improve the skills of early childhood mental health clinicians. Mental health consultants are typically funded by Medicaid agencies, education agencies, state general revenue or federal funds, or grants, and may receive cultural awareness training designed to improve their skills while reducing implicit cultural and racial bias. With leadership from the Substance Abuse and Mental Health Services Administration and other federal health and education agencies, states increasingly expect mental health consultants to carry out their consultative and clinical services in ways that help teachers provide supportive learning environments for all children.
- Data usage: State departments of education are required to monitor, report, and address disproportionality based on race and ethnicity as required by the US Department of Education’s Equity in Individual with Disabilities Education Act final regulation effective July, 1, 2018. Some state officials mentioned having a longitudinal data system to track disproportionality would be helpful, and would provide an opportunity for state health and education agencies to collaborate.
- Advisory groups: Colorado, Minnesota, and Delaware benefit from advisory groups that facilitate interagency collaboration that can address disproportionality. In Minnesota, an interagency task force including the Medicaid agency (Department of Human Services), Department of Health, and Department of Education promotes coordinated efforts to achieve equitable, universal early childhood screening and referrals. Minnesota’s task force laid the foundation to include mental health consultation services within its school-linked grants under its early childhood mental health infrastructure grants. Delaware, Connecticut, and Colorado were able to generate statewide attention to disproportionality by addressing school suspensions and expulsions. Connecticut became the first state to prohibit expulsions in publically-funded preschools and has recently instituted policies to ensure accountability.
- Ohio’s Cultural and Linguistic Competency Plan: Ohio’s Department of Mental Health and Addiction Services instituted a statewide Cultural and Linguistic Competency Plan to promote health equity and eliminate disparities. Ohio provides cultural competence and linguistic trainings to state employees that reference the Culturally and Linguistically Appropriate Services Standards. Additionally, the plan highlights incentives for providing culturally-competent services. Culturally-competent services can result in lowered health care costs stemming from a reduced number of medical errors, unnecessary or avoidable treatments, and lower numbers of missed medical visits. They also can support new business and revenue-generating opportunities, improved performance on quality measures, and alignment with Medicare and Medicaid, which have placed priorities on cultural and linguistic competency. The state also developed a business case for achieving health equity cited in its Cultural and Linguistic Competency Plan.
Mental health inequities can result from disproportionality and are systemic. Addressing this issue involves:
- Unraveling policies and practices that negatively impact students of color of all ages; and
- Implementing systemic interventions and supports to identifying and assisting individual children with specific needs.
As demonstrated by numerous states, state health officials can use several mental health policy levers and strategies to improve students’ overall health and success in school.
This blog was supported by the Massachusetts General Hospital Disparities Research Unit.
1. Green, J.G., McLaughlin, K.A., Alegria, M., Bettini, E., Gruber, M.J., Kwong, L., Sampson, N., Zaslavsky, A.M., Xuan, Z., & Kessler, R.C. (unpublished manuscript). Ethnic/racial inequities in educational placement for youth with psychiatric disorders.
The early years of a child’s life are critical for growth and development. Identifying developmental delays early and providing appropriate referral and treatment can help prevent more severe issues as well as considerable costs. State Medicaid agencies can play an important role in promoting early identification of developmental delays by reimbursing and tracking the use of standardized developmental screening. Medicaid agencies take different approaches to doing so: setting reimbursement rates for screening; recommending or requiring certain screening tools; specifying when developmental screenings can be administered; and leveraging Medicaid managed care contracts. This brief examines developmental screening reimbursement policies in three states in the top quartile for parent-reported developmental screening rates: Georgia, Minnesota, and North Carolina.
Read the full brief here.