Coalition Urges Congress to Include Trauma Provisions in Final Version of Opioids Bill

September 2018

September 19, 2018

The Honorable Mitch McConnell The Honorable Charles Schumer
Majority Leader Minority Leader
U.S. Senate U.S. Senate
The Honorable Paul Ryan The Honorable Nancy Pelosi
Speaker Minority Leader
U.S. House of Representatives U.S. House of Representatives
The Honorable Lamar Alexander The Honorable Patty Murray
Chair Ranking Member
Health, Education, Labor, and Health, Education, Labor, and
Pensions Committee Pensions Committee
U.S. Senate U.S. Senate
The Honorable Orrin Hatch The Honorable Ron Wyden
Chair Ranking Member
Committee on Finance Committee on Finance
U.S. Senate U.S. Senate
The Honorable Greg Walden The Honorable Frank Pallone
Chair Ranking Member
Energy and Commerce Committee Energy and Commerce Committee
U.S. House of Representatives U.S. House of Representatives
The Honorable Kevin Brady The Honorable Richard Neal
Chair Ranking Member
Committee on Ways and Means Committee on Ways and Means
U.S. House of Representatives U.S. House of Representatives
The Honorable Virginia Foxx The Honorable Robert C. Scott
Chair Ranking Member
Education and Workforce Committee Education and Workforce Committee
U.S. House of Representatives U.S. House of Representatives

Dear Senators and Representatives:

We write to thank you for passing your respective versions of the Opioid Crisis Response Act (H.R. 6) and to encourage you to include all of the Senate-passed provisions related to trauma and the impacts of opioids and substance use disorder on children and families in the final version of the legislation.

We are advocates, researchers, practitioners, and community members with expertise and experience in working with and studying children impacted by traumatic events and adverse childhood experiences. We know from our work and from decades of research that traumatic experiences in childhood (adverse childhood experiences or “ACEs”) can have health and other impacts across the lifespan. ACEs include abuse, neglect, and household challenges, such as parental substance abuse or domestic violence. According to the CDC, a child exposed to ACEs is at higher risk of developing chronic diseases, engaging in illicit drug use, attempting suicide, and early initiation of sexual activity among other outcomes. As ACE exposure increases, so does the risk for negative outcomes.

The opioid and other drug and alcohol epidemics impacting our nation’s communities has and continues to have a tremendous impact on children. The impact on children is clearly visible in the increasing number of referrals to the foster care system of children whose parents are struggling with addiction. Less visible, but no less important, is the underlying trauma experienced by children and the current and future impacts that exposure will have on their lives. In addition, we also know that exposure to other forms of childhood adversity and trauma can lead to substance misuse and addiction and any effort to buffer children against those experiences will help prevent future addiction epidemics and lessen impacts on other systems that serve children, including Medicaid and child welfareThe opioid and other drug and alcohol epidemics impacting our nation’s communities has and continues to have a tremendous impact on children. The impact on children is clearly visible in the increasing number of referrals to the foster care system of children whose parents are struggling with addiction. Less visible, but no less important, is the underlying trauma experienced by children and the current and future impacts that exposure will have on their lives. In addition, we also know that exposure to other forms of childhood adversity and trauma can lead to substance misuse and addiction and any effort to buffer children against those experiences will help prevent future addiction epidemics and lessen impacts on other systems that serve children, including Medicaid and child welfare.

Although increasing resources for treatment and innovative efforts to staunch the flow of opioids and other drugs into communities are critical, supporting the children harmed by the epidemic should also be a priority in the final version of the Opioid Crisis Response Act. While the House version of H.R. 6 does include provisions related to trauma, we are aligned in support of provisions in the Senate bill aimed at addressing childhood trauma. Specifically, we encourage you to include the following provisions in the final legislation (section numbers are from the text of H.R. 6, as amended and passed by the Senate):

Section 1414 (“Plans of Safe Care”)- Would provide needed assistance to states to help
implement provisions to protect substance exposed infants.

  • Section 1416 (“National Health Service Corps Behavioral and Mental Health Professionals Providing Obligated Service in Schools and Other Community-based Settings”)- Would create incentives for mental and behavioral health professionals to provide services in schools.
  • Section 1502 (“Programs for Health Care Workforce”)- Adds a focus on trauma-informed care to the Mental and Behavioral Health Education and Training program.
  • Section 1506 (“CDC Surveillance and Data Collection for Child, Youth, and Adult Trauma”)- Authorizes funding for CDC to collect data from states on exposure to Adverse Childhood Experiences (ACEs) through the Behavioral Risk Factor Surveillance System, to understand the state-specific causes and impacts of trauma
  • Section 1513 (“Task Force to Develop Best Practices for Trauma Informed Identification, Referral, and Support”)- Establishes a cross-government task force to develop a national strategy to address childhood trauma and coordinate efforts across federal agencies.
  • Section 1514 (“Grants to Improve Trauma Support Services and Mental Health Care for Children and Youth in Educational Settings”)- Establishes a grant program for local education agencies, Head Start providers, and other educational systems to support students exposed to trauma and enhance collaboration between schools and community providers to better serve children.
  • Section 1515 (“National Child Traumatic Stress Initiative”)- Authorizes increased funding for the National Child Traumatic Stress Network whose mission is to raise the standard of care and increase access to services for children exposed to trauma.

We believe the above provisions can improve the lives of children impacted by the opioid epidemic and lead to better health, educational, and other outcomes, including reducing and preventing future substance misuse for those children and other children exposed to trauma.

Thank you for your continued work to address the opioid epidemic. Should you have questions or wish to discuss the contents of this letter, please reach out to Jeff Hild at the George Washington University School of Public Health ( jeffhild@gwu.edu ) or Dan Press with the Campaign for Trauma Informed Policy and Practice ( dsp@vnf.com ).


Sincerely,
Organizations
National Head Start Association
ACE Interface
Center for Youth Wellness
Cope Family Center
CommCARE Behavioral Health of Missouri
Trillium Family Services, Oregon
Judson Center
Alliance for Strong Families and Communities
Dr. William Dietz, Chair, Redstone Global Center for Prevention and Wellness
Becky Haas, Community Crime Prevention Programs- Johnson City Tennessee Police
Tracey Rowe, Cincinnati Early Learning Centers
Center for Gender and Justice
Trauma Informed Care Network
Resilience Builders LLC
Trauma-Resiliency Collaborative, Utah
Tennessee Justice Centers
Joining Forces for Children, Greater Cincinnati
Child Focus, Inc.
Big Cities Health Coalition
Child Care Aware of America
National Association of County and City Health Officials
Health Federation of Philadelphia
The Ohio Children’s Alliance
Great Circle
New Jersey Alliance for Children, Youth and Families
Children & Families First Delaware, Inc.
Maryland State Council on Child Abuse & Neglect
Maryland Essentials for Childhood
The Faithful City
The Children’s Guild
Maryland State’s Attorney Association
First Five Years Fund
Adverse Childhood Experience (ACE) Awareness Foundation
Maryland Family Network
Children, Inc., Covington, Kentucky
United Way Greater Lehigh Valley
Oasios Center, Inc.
The Family Center
STARS Nashville
Trauma Informed Oregon
A2Z Community Connections
Ounce of Prevention Fund
Trauma Camp
Tennessee Voices for Children
Minnesota Communities Caring for Children
Prevent Child Abuse MN
MomsRising.org
Save the Children
Renewal House
NYC Trauma-Informed Learning Community
Places for People, Inc.
Nemours Children’s Health System
Division of Early Childhood of the Council for Exceptional Children
The Art Therapy Way
Individuals
Sahaan McKelvey
Heather Larkin, PhD, Associate Professor, State University of New York at Albany
Jennifer Trail, LMSW
Lisa A. Dominisse, President/CEO, Family Service Society, Inc.
John Patrick Lydon, CEO, Auberle
Derry Holland, LCSW, CEO, Oaks Integrated Care
Kelly Kinnear
Donna Simon
Melissa Peters
Marcy Webb, Mercy Community Healthcare
Betsy Krieger, Zanvyl and Isabelle Krieger Fund
D/Cpl Matthew Gullion
Jennifer Alvaro
Brad Ewing
Carlo DiClemente, UMBC Center for Community Collaboration
Julie Cehula
Patricia K. Cronin, The Family Tree
Jamie Shepard, Former Foster Parent
Susan Camardese RDH, MS
Jane Hedrick, PhD, RN, Nursin Professor, Saint Luke’s College of Health Sciences, Kansas City, MO
Wendy Ellis, Project Director, Building Community Resilience Collaborative and Network
Grant Winter
JW Randolph MPH
Jana Lauderdale
Kathleen Anthony, Vanderbilt University Medical Student, Class 2019
Jared Elzey, Meharry Medical College, Office of Research
Adam Dizer
Sarah Grace White
Preston Spencer
Anna Arts
Kayla Bohanan
Dr. Tony R. Majors
Freida Outlaw, PhD, RD, FAAN
Dominque Shanks
Jill C. Obremskey, MD, FAAP
Honorable Sandra V. Moore
Brookfield Mitman
Denise Messineo
Erin Saul, Joining Forces for Children
Vickie Lawson
Victoria Mannes
Allison Hill, LMSW
Erin King
Amy Romashko