Title: State Practices in Treatment/Therapeutic Foster Care. 
Author(s): Seibert, Julie.;Feinberg, Rose.;Ayub, Asha.;Helburn, Amy.;Gibbs, Deborah. 
Published: 2018 
Available from: Assistant Secretary for Planning and Evaluation (ASPE) 
http://aspe.hhs.gov/ 
Room 415F 
U.S. Department of Health and Human Services 
200 Independence Av, SW 
Washington, DC 20201 

Printable version (PDF): https://aspe.hhs.gov/system/files/pdf/259121/TREATMENTFOSTERCARE.pdf

Abstract: This federally funded report presents findings from an investigation into how therapeutic foster care (TFC) is implemented and supported by States. Information for the report comes from key informant interviews, representing a variety of perspectives on TFC, and a review of relevant literature. The report provides an overview of the key program elements of TFC defined by States and how States differentiate TFC from foster care. The report also provides a description of how States provide adjunct services, such as case management and behavioral health services to children in TFC. Finally, the report includes information on the different funding strategies employed by States to support TFC services. Findings indicate key elements of TFC include highly skilled caregivers (TFC parents) who are part of the child’s treatment team, enhanced case management, and coordinated delivery of behavioral health and other community-based services. The study also found that although TFC may be a cost-effective alternative to residential care, funding challenges limit its use in many States. States typically fund TFC using Medicaid funds for clinical and therapeutic services and Title IV-E funds for daily care of eligible children. TFC may also be supported with funds from state child welfare, juvenile justice and behavioral health agencies, and provider agency fundraising. Finally, the study found States have employed a variety of strategies to increase Medicaid funding for TFC, such as defining TFC as a service in the state Medicaid plan, categorizing TFC as a rehabilitative service, and using waivers authorized by Section 1115 and Titles 1915(b) and (c) of the Social Security Act. The report concludes TFC is successfully utilized by several States as an alternative to congregate care. Appendices include State profiles. 6 references. 

Trauma-informed care integrates an understanding of the prevalence of adverse childhood experiences and their impact on lifelong health. The science of early brain development reveals that the environment in which children develop—family, community, and culture—impacts brain development, health, and genetics. In the medical home, being trauma-informed is important for prevention and amelioration of this impact.

Title: Trauma-Informed Primary Care: Prevention, Recognition, and Promoting Resilience.
Author(s): Earls, Marian F.
Published: 2018
Journal Name: NCMJ (North Carolina Medical Journal)
v. 79, 2, March-April 2018, p. 108-112
Available from: NCMJ (North Carolina Medical Journal)
PDF: http://www.ncmedicaljournal.com/content/79/2/108.full.pdf+html
Abstract: This commentary explains trauma-informed care integrates an understanding of the prevalence of adverse childhood experiences and their impact on lifelong health. It notes the science ...

Children Placed in Foster Care Because of Substance Use Now More Likely to Go to Relatives than Non-relatives, A Report Finds

The recently updated report from Generations United, Raising Children of the Opioid Epidemic: Solutions and Support for Grandfamilies, shows that -- overall -- foster care systems are relying more on grandparents and other relatives to care for children when their parents cannot. The report includes recommendations on how to connect grandfamilies to the same supports and services that traditional unrelated foster families receive. Read the release, then see the updated report

To prevent youth opioid misuse, many states are more effectively regulating prescriptions

SEP 04, 2018
AUTHORS: ANDRA WILKINSON, HANNAH WINSLOW

The majority of people who misuse drugs start before their 18th birthday. Furthermore, the risk of addiction increases when drug use starts in adolescence, making this period a key prevention window. Leftover prescription pills, either from one’s own prescription or those of family or friends, are the dominant source of opioid pain relievers for adolescents who misuse them.[1] By the end of high school, approximately 13 percent of teens will have misused opioid pain relievers (i.e., used them without prescription, in a manner not prescribed, or to get high). Strategies that address adolescent misuse of prescription opioid pain relievers represent a critical component of any successful effort to address the opioid crisis.

A national study of 12th graders found that, among those with no prior history of drug use and strong disapproval of illegal drug use, a prescription for opioids in high school was associated with a threefold increased risk of later opioid misuse. Opioid pain reliever misuse can substantially increase the risk of initiating heroin use. As such, decreasing excessive opioid prescribing and lowering the number of leftover pills are important strategies for preventing opioid pain reliever misuse—and, potentially, later heroin or fentanyl (a more powerful and lethal synthetic opioid) use among youth.

Adolescent outreach and education is necessary but not sufficient for prevention. To prevent adolescent misuse, many states have implemented policies designed to limit unnecessary prescribing. Recent legislative efforts have included the following strategies:

Despite their effectiveness at reducing misuse, policies targeting the supply of prescription opioids have met varying degrees of resistance. In recent years, opioid prescribing has dropped. Teen prescription opioid and heroin use is now at a historic low, fueling concerns that these new policies may not be necessary, and that poorly implemented policies can—and are—harming terminal patients and those with chronic pain. Furthermore, increased regulation of prescription opioids generally correlates with upticks in heroin use. Ohio, the state with the second-highest opioid overdose death rate, has in recent years passed legislation that includes all three of the previously mentioned policy approaches. In subsequent years, the state saw opioid prescribing fall 20 percent, while its overall overdose death rate continued to rise as the proportion of deaths due to heroin and fentanyl increased.

However, the relationship observed between decreasing supplies of prescription opioids and increases in heroin use is complex, and research shows that the overall increase in heroin use began long before efforts to decrease opioid prescribing. For this reason, lawmakers should consider ways to expand treatment while taking careful steps to limit supply, as confirmed by a recent predictive model. Although prescribing has dropped overall, it still varies considerably across states; for example, certain states have prescribing rates more than twice as high as their neighbors. Some researchers also assert that state policies are important for continued declines in prescription opioid use among youth.

Policies regulating access to prescription opioids are certainly not a cure-all, but they do provide an opportunity for policymakers to intervene before youth addiction begins. As prescription pain relievers continue to be one of the most common drugs of choice for first-time users in adolescence, state policy initiatives to reduce excessive prescribing may be a powerful tool for lawmakers. However, to ensure that prescription opioid regulation corresponds with decreases in overdose deaths, policies limiting supply must not harm chronic pain patients and must go hand-in-hand with expanded and comprehensive addiction treatment.

[1] Child Trends analyses of the 2016 National Survey on Drug Use and Health.

[2] State policies related to opioid prescribing change rapidly. For the most up-to-date information, please consult http://www.ncsl.org/research/health/injury-prevention-legislation-database.aspx.

 
Published in Children's Justice Act

A newly revised field manual, Child Protection in Families Experiencing Domestic Violence, is now available. The manual reflects recent practice innovations, the latest research and data, and a greater emphasis on family preservation and in-home services.

The comprehensive user manual informs child protective services (CPS) workers, supervisors, and related professionals on multiple issues related to the co-occurrence of child maltreatment and domestic violence. The newly revised edition reflects the Children's Bureau commitment to a collaborative and community-based approach to child protection and offers guidance on:

  • Ensuring the safety of children in incidents of domestic violence
  • Ensuring domestic violence survivor safety
  • Perpetrator accountability
  • Agency response

The updated manual also addresses the following practice issues:

  • Guidelines for assessing families experiencing domestic violence
  • Perpetrators of domestic violence
  • Adult survivors and child witnesses
  • Complexity of children's issues and trauma-focused approach
  • Safety and wellness for CPS workers
  • Building collaborative responses for families experiencing domestic violence

The revised manual is part of the Children's Bureau Child Abuse and Neglect User Manual Series—last updated in 2003—and serves as a companion piece to Child Protective Services: A Guide for Caseworkers, a second revised manual in the series. The updated manuals from the U.S. Department of Health and Services' Children's Bureau Office on Child Abuse and Neglect are available at https://www.childwelfare.gov/pubs/usermanuals.

For a series of tip sheets on how to respond to families experiencing domestic violence and child maltreatment—including general practice recommendations, suggestions for engaging families, and guidance on documentation, assessment, decision-making, and planning—see the Child Welfare Capacity Building Center for States' Domestic Violence and the Child Welfare Professional Series at https://capacity.childwelfare.gov/states/focus-areas/child-protection/domestic-violence.

Published in Children's Justice Act

Pediatricians Put It Bluntly: Motherhood And Marijuana Don't Mix

Kaiser Health News - August 27, 2018

More and more people consider smoking marijuana harmless or even beneficial, but mounting research suggests women who are pregnant or breastfeeding should avoid it altogether.

https://khn.org/news/pediatricians-put-it-bluntly-motherhood-and-marijuana-dont-mix/

Published in Children's Justice Act

The Opioid Crisis and its Impact on Children

Legal Executive Institute - August 23, 2018

Although the impact on adults is tragic, an increasing number of children are also suffering, especially as opioid addiction reaches crisis levels. From birth on, these children are living with the consequences of their parents' addiction.

http://www.legalexecutiveinstitute.com/opioid-crisis-impact-on-children/

Published in Children's Justice Act

Medicaid Covers Foster Kids, But Daunting Health Needs Still Slip Through The Cracks

Kaiser Health News - August 24, 2018

Medicaid, the federal-state health insurance program for the poor, picks up the tab for nearly all children in foster care and often continues to cover them if they are adopted, regardless of their parents' income. And as a result of the 2010 Affordable Care Act, foster children who have Medicaid at 18 can retain the coverage until they turn 26. Yet, Croom and other foster parents say that even with the coverage they struggle to meet the extraordinary health needs of their children. Part of the trouble is too few doctors accept Medicaid, most notably mental health specialists.

https://khn.org/news/medicaid-covers-foster-kids-but-daunting-health-needs-still-slip-through-the-cracks/

Published in Children's Justice Act

CMS Initiative to Create Pediatric APMs to Address Opioid Crisis

Revenue Cycle Intelligence - August 23, 2018

The recently announced Integrated Care for Kids (InCK) initiative will require Medicaid and local providers to develop alternative payment models to combat the opioid crisis for children. To address the opioid crisis affecting children, The Centers for Medicare & Medicaid Services (CMS) intends to use the InCK initiative to support physical and behavioral health integration for the pediatric population. One in three children in Medicaid and CHIP has some type of behavioral need, but one one-third of these individuals receive care, the federal agency reported.

Also: Integrated Care for Kids (InCK) Model Fact Sheet: https://www.cms.gov/newsroom/fact-sheets/integrated-care-kids-inck-model

https://revcycleintelligence.com/news/cms-initiative-to-create-pediatric-apms-to-address-opioid-crisis

Published in Children's Justice Act

Matching Service to Need: How Family Drug Courts Identify, Assess and Support Families to Achieve Recovery, Safety, and Permanency: A Practice Brief.
Children and Family Futures (Organization)
2016
Sponsoring Organization: United States. Office of Juvenile Justice and Delinquency Prevention.

http://www.cffutures.org/files/Matching_Service_to_Need.pdf

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