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April 04, 2017 01:00 AM

Lawmakers seek public health support to address child trauma

Steven Ross Johnson
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    A recently introduced bill aimed at expanding Medicaid coverage to provide support to children harmed by trauma faces an unclear path to passage under a Trump administration that seeks to slash domestic spending.

    Last month, a group of Democratic lawmakers reintroduced the Trauma-Informed Care for Children and Families Act. The bill was first introduced in December but stalled in committee. If it passes, the bill would create a task force to identify and recommend best practices in addressing pediatric trauma.

    “As we work to address the root causes of violence, we need to focus on the impact that community violence and other traumatic experiences have on Chicago's children,” said Sen. Dick Durbin (D-Ill.), one of the bill's co-sponsors, in a written statement. “Our bill recognizes the ripple effect that trauma can have and seeks to provide our children with the support to address their emotional scars.”

    Childhood programs such as Head Start as well as services that provide support for primary care, education and child welfare would be eligible to receive federal funds for training in the best practices recommended by the task force.

    The proposed law would expand Medicaid coverage to include child trauma services. It also seeks to increase the number of clinical providers serving communities with high rates of violence by expanding loan repayment and graduate school behavioral health programs.

    Under the bill, the Centers for Disease Control and Prevention would be tasked to improve its monitoring and tracking of adverse childhood experiences and conduct a study on the prevalence of trauma in the U.S. The effort would be led by the Substance Abuse and Mental Health Services Administration, which would receive an additional $20 million in funding under the bill.

    “Lots of kids are resilient and do bounce back after trauma if they're just given appropriate support in their communities and in their homes,” said Tali Raviv, a psychologist with the Center for Childhood Resilience at Lurie Children's Hospital of Chicago. The center helped work with lawmakers on the bill.

    But Raviv pointed out kids who are exposed to multiple types of trauma have higher risks of developing behavioral health and learning problems. Such experiences early on in life can also lead to poorer physical health outcomes compared with children who have not experienced trauma.

    A study conducted by the CDC and Kaiser Permanente that looked at adverse childhood experiences among more than 17,000 individuals found that children with more traumatic experiences were more likely to engage in risky health behaviors such as smoking, unprotected sex and substance abuse. Young people with six or more traumas had an average lifespan that was 20 years shorter than children without such experiences. The lifetime societal cost associated with child trauma has been estimated at $124 billion, including $25 billion in direct medical expenses.

    Raviv said the bill is meant to address the trauma caused by living in communities that experience constant violence by looking into the role discrimination, poverty and other factors have played in creating violent environments.

    But any proposal that includes Medicaid as a funding mechanism could face stiff opposition by Republican lawmakers pushing to roll back expansion of the program. Though efforts to replace the Afffordable Care Act, which expanded Medicaid coverage to all adults earning up to 138% of the poverty level, fell apart, Republican leaders and Trump have said they'll keep trying to repeal the health law.

    Even without ACA repeal, Trump's proposed federal budget cuts released in March put passage of the bill in further doubt. Trump's budget calls for a 16% cut to HHS, including eliminating the department's Community Services Block Grant program, one of the funding streams proposed to support stakeholder A recently introduced bill aimed at expanding Medicaid coverage to provide support to children harmed by trauma faces an unclear path to passage under a Trump administration that seeks to slash domestic spending.

    Last month, a group of Democratic lawmakers reintroduced the Trauma-Informed Care for Children and Families Act. The bill was first introduced in December but stalled in committee. If it passes, the bill would create a task force to identify and recommend best practices in addressing pediatric trauma.

    “As we work to address the root causes of violence, we need to focus on the impact that community violence and other traumatic experiences have on Chicago's children,” said Sen. Dick Durbin (D-Ill.), one of the bill's co-sponsors, in a written statement. “Our bill recognizes the ripple effect that trauma can have and seeks to provide our children with the support to address their emotional scars.”

    Childhood programs such as Head Start as well as services that provide support for primary care, education and child welfare would be eligible to receive federal funds for training in the best practices recommended by the task force.

    The proposed law would expand Medicaid coverage to include child trauma services. It also seeks to increase the number of clinical providers serving communities with high rates of violence by expanding loan repayment and graduate school behavioral health programs.

    Under the bill, the Centers for Disease Control and Prevention would be tasked to improve its monitoring and tracking of adverse childhood experiences and conduct a study on the prevalence of trauma in the U.S. The effort would be led by the Substance Abuse and Mental Health Services Administration, which would receive an additional $20 million in funding under the bill.

    “Lots of kids are resilient and do bounce back after trauma if they're just given appropriate support in their communities and in their homes,” said Tali Raviv, a psychologist with the Center for Childhood Resilience at Lurie Children's Hospital of Chicago. The center helped work with lawmakers on the bill.

    But Raviv pointed out kids who are exposed to multiple types of trauma have higher risks of developing behavioral health and learning problems. Such experiences early on in life can also lead to poorer physical health outcomes compared with children who have not experienced trauma.

    A study conducted by the CDC and Kaiser Permanente that looked at adverse childhood experiences among more than 17,000 individuals found that children with more traumatic experiences were more likely to engage in risky health behaviors such as smoking, unprotected sex and substance abuse. Young people with six or more traumas had an average lifespan that was 20 years shorter than children without such experiences. The lifetime societal cost associated with child trauma has been estimated at $124 billion, including $25 billion in direct medical expenses.

    Raviv said the bill is meant to address the trauma caused by living in communities that experience constant violence by looking into the role discrimination, poverty and other factors have played in creating violent environments.

    But any proposal that includes Medicaid as a funding mechanism could face stiff opposition by Republican lawmakers pushing to roll back expansion of the program. Though efforts to replace the Afffordable Care Act, which expanded Medicaid coverage to all adults earning up to 138% of the poverty level, fell apart, Republican leaders and Trump have said they'll keep trying to repeal the health law.

    Even without ACA repeal, Trump's proposed federal budget cuts released in March put passage of the bill in further doubt. Trump's budget calls for a 16% cut to HHS, including eliminating the department's Community Services Block Grant program, one of the funding streams proposed to support stakeholder training.

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