When the CR/budget deal was agreed to it included a commitment to provide $6 billion more in 2018 and 2019 to address the opioid epidemic. It is unclear how that will break out between treatment, enforcement and prevention but that will be taking place in these next several weeks as appropriations are dealt with. Senator Jeanne Shaheen (D-NH) and Senator Maggie Hassan (D-NH) have been concerned about passing through funds through current block grants because the $1 billion allocated in 2016 has resulted in New Hampshire receiving only $6 million for a state heavily hit by the problem.
CWLA will be weighing in, as we have with the President Commission, urging more action to implement the unspecified “plans of safe care” that are required under CAPTA. There may also be an opportunity to promote greater collaboration between state child welfare and substance use agencies and well as other tools such as the promotion of family drug courts. There is also a need to help address some of the challenges that child protection workers may face from the increased trauma to physical dangers that can present from factors such as the spread of fentanyl.
The Government Accountability Office (GAO) released a report last week, Substance-Affected Infants: Additional Guidance Would Help States Better Implement Protections for Children. The GAO report found a great deal of uncertainty on plans of safe care. That is not surprising since that term evolved over several versions of CAPTA without any real specific model or plan in existence. Congress latched onto the provision after some news reports in 2015 and 2016 on the increasing numbers of infants born dependent on substances. Those reports noted a lack of actual implementation or support for the small-funded CAPTA safe care plan provisions.
GAO noted that all states reported adopting, to varying degrees, policies and procedures regarding health care providers notifying child protective services (CPS) about infants affected by opioids or other substances. Forty-two states reported having policies and procedures that require health care providers to notify CPS about substance affected infants and eight states reported having policies that encourage notification.
According to the GAO report states reported that plans typically address the infant’s safety needs, immediate medical needs, and the caregiver’s substance use treatment needs. But there were concerns expressed in some of the GAO interviews. These concerns include uncertainty about what to include in plans and the level of intervention needed for infants at low risk of abuse or neglect.
While HHS has provided some technical assistance (something that Congress legislated on in 2016) most states want additional guidance and assistance that needs to include addressing their challenges. HHS does not plan further assistance except through their regional offices and the National Center on Substance Abuse and Child Welfare—a resource center funded by HHS. Several states indicated that HHS guidance has not really helped.
Congress directed HHS to make sure ‘plans of safe care” are carried out through amendments to the CAPTA law but Congress has not been willing to increase funding to the state fund. In fact, since the enactment of the 2011 Budget Control Act they have been more willing to cut CAPTA’s meager state grants of less than $26 million per year. The question is will that change under this additional $3 billion a year allocation of funding to address opioids.
Perhaps in a hopeful sign, the Senate HELP Committee held a hearing last week to discuss opioid impact on children. The HELP Committee hearing on Thursday, February 8, featured testimony by Becky Savage,Co-Founder, 525 Foundation, Stephen W. Patrick, M.D., Vanderbilt University Medical Center, and William C. Bell, President and CEO, Casey Family Programs.
Most compelling were the comments of Dr Patrick who testified that the number of infants with neonatal abstinence syndrome, (withdrawal syndrome that most commonly occurs after in utero exposure to opioids), has increased seven fold between 2000 to 2014. Based on the Medical Center work, he told the Committee that by 2014, one infant was born every 15 minutes in the US with the syndrome. He also highlighted some initial actions that Congress could take to help such as strengthening the Plans of Safe Care but he also pointed out congressional shortfalls:
“Unfortunately, those requirements [plans of safe care] came without clear guidance or, importantly, sufficient resources for implementation. States need additional guidance, funds, and resources from the federal government to ensure infant safety and to keep families intact when appropriate. States …I would encourage the Committee to continue to exercise robust oversight of the federal agencies working with states on implementing and monitoring CAPTA, and to provide funding additional legislative clarity where needed.”
His comments were a rare call on Congress to fortify CAPTA funding to help with implementation and he went on:
“In addition to the severe gap in funding the CAPTA-required plans of safe care, funds to ensure family-centered treatment are currently lacking. Congress should act to ensure that funds allocated across Medicaid, CAPTA, Title IV of child welfare services, and the Substance Abuse Prevention and Treatment Block Grant are flexible, but also targeted to prevent children from being removed from their family whenever possible.
Removing children is itself a form of trauma and one that can often be avoided if we provide families with the treatment and services they need to stay safely together. Treatment programs for pregnant and parenting women funded under the block grant need expansion because the program has not changed in nearly 20 years. It is time for Congress to revisit the funding mechanisms for these two-generation programs and encourage expansion of services for this population through Medicaid, the Block Grant, CAPTA and grants to pregnant and parenting women programs.’
Dr Patrick also noted the need for Congress to reauthorize home visiting (now done) and greater funding for IDEA Part C for Infants and Toddlers—which could help with another CAPTA mandate that requires states to refer infants and toddlers to Part C services—another underfunded program.