According to the 2018 National Survey of Children’s Health (NSCH), one in three children under the age of 18 have experienced stressful or traumatic events that are strongly related to a wide range of health problems throughout a person’s lifetime.  The NSCH is an annual survey conducted by the Health Resources and Services Administration collecting information on several of these experiences, including:  having divorced/separated parents or a deceased parent, living with anyone with a drug or alcohol problem or who is mentally ill, having a parent who served time in jail, seeing or hearing parental violence, and witnessing or being the victim of neighborhood violence.  Last year, the National Advisory Committee on Rural Health & Human Services examined adverse childhood experiences from a rural perspective and made recommendations to federal policymakers.   The data can be accessed by clicking here.

The U.S. Department of Health & Human Services released a guide for clinicians on tapering or discontinuing long-term opioid prescriptions.  Individual patients, as well as the health of the public, benefit when opioids are prescribed only when the benefit of using opioids outweighs the risks.  But once a patient is on opioids for a prolonged duration, any abrupt change in the patient’s regimen may put the patient at risk of harm and should include a thorough, deliberative case review and discussion with the patient.  While rates of prescribing have declined in recent years, the Centers for Disease Control and Prevention reports data showing opioid prescribing rates have been significantly higher in nonmetropolitan counties than in metropolitan counties.  The Guideline can be accessed here:  New Guidelines for Long-Term Use of Opioids.

Pennsylvania Partnerships for Children’s (PPC) work leading the Pritzker Children’s Initiative Prenatal-to-Age-Three state planning grant continues, with a full policy agenda expected by the end of the year.

The leadership team of the initiative recently traveled to Atlanta with the nine other states and the District of Columbia who are part of the planning grant process. The PA team was joined by various state officials, showcasing the partnership of advocates and the administration in this initiative. The group worked on refining the policy agenda and compared notes with Pritzker and other states on best practices moving forward.

Currently the agenda is comprehensive and ranges in topic from child care to prenatal/maternal health, and from home visiting to children’s health, including lead exposure, nutrition, insurance coverage and infant and toddler mental health.

Keep an eye out in the next few weeks, as our subgroups will continue meeting to finalize the agenda and the full table of advocates and state partners will meet again in person in November. In the meantime, PPC is partnering with the United Way of Pennsylvania to conduct a series of community engagement events throughout the state to gather parent and provider input. Next up on the calendar is an event in Johnstown on November 7, 2019.

At the conclusion of the planning grant process, PPC will be eligible to apply for an implementation grant to execute the policy agenda currently being developed. Of the ten states in the planning process, up to five will be selected for this phase of the work. We will keep you posted on our progress as we move closer to early 2020!

Did you know children are the most undercounted group in the census? In fact, 10 percent of all children under age 5 were missed in the 2010 Census. Pennsylvania Partnerships for Children (PPC) is the sole voice for young children in both the Keystone Counts coalition and as an affiliate of the Pennsylvania State Data Center, which is represented in the governor’s Complete Count Committee.

In the coming weeks and months, PPC will be producing a variety of print and digital deliverables our partners can use to get the word out the importance of a complete count and the serious consequences that would result from an undercount of young children.

In the meantime, check out these resources to help you with your advocacy efforts. You’ll find helpful fact sheets in English and Spanish, data and statistics, and more!

Harrisburg, PA – On October 9, 2019, Pennsylvania Governor Wolf’s Administration announced that, under the guidance of the Department of Human Services (DHS), it is expanding home visiting supports to first-time mothers and mothers of children with special needs covered by Medicaid. The expansion, made possible in collaboration with physical health Medicaid managed care organizations (MCOs), will guarantee at least two home visits to new parents and families with children with additional risk factors across Pennsylvania, expanding access to evidence-based models that promote and support healthy child and family development.

“There is no more important focus of my administration than giving all children and families a strong start,” Gov. Wolf said. “By expanding access to evidence-based home visiting programs, we will put more kids, parents and families on a path to a healthy, happy future.”

Since 2015, investments totaling nearly $16.5 million in state funds have helped increase the number of children and families who can receive home visiting supports in communities around Pennsylvania. Guaranteeing a minimum of two home visits to all first-time mothers and mothers of children with special needs through Medicaid continues this work.

“Being a parent can be a challenge for anyone,” said Secretary Miller. “Because children don’t come with an instruction manual home visiting programs create support systems for families to learn to better understand children’s needs, monitor milestones, and identify other opportunities for support that can continue to facilitate healthy long-term growth. A home visitor can be a major resource for parents to bond with their child(ren) and create bridges to success in early childhood and primary education.”

The home visiting expansion is effective January 1, 2020 through the MCOs’ 2020 agreement. Under the new agreements, MCOs will be required to establish an evidenced-based, standardized maternal, infant and early childhood home visitation program for all first-time parents and parents of infants with additional risk factors. All parents and children identified through this effort will receive at least two home visits at no cost, and depending on need, may be referred to other established home visiting programs to continue these services. DHS expects that these programs will be in place with eligible new parents receiving home visiting services s by July 1, 2020.

Evidence-based home visiting family support programs have a family-centered focus and strength-based approach that works with both the child and parent. A home visitor can help parents gain the skills and connect to resources necessary to improve their family’s health, safety, economic security, and success in early childhood education. Studies of various nurse-family partnership programs have shown positive impacts for the mother and baby during pregnancy and after birth, such as a decrease in domestic violence and smoking during pregnancy, a significant decrease in pre-term births, and a majority of babies being born at a healthy weight.

Home visiting can also improve parents’ child development knowledge and skills, help develop social support systems, and improve access to education, health, and community services. Examples of services include:

• Regularly scheduled home visits with trained family development specialists;
• Monthly parent meetings; and
• Routine screenings to identify post-partum depression and detect potential problems with vision, hearing, growth, and learning age-based milestone

Gov. Wolf is committed to helping the youngest Pennsylvanians. In September, his Ready to Start Task Force released its report, including two priorities tied directly to home visiting: to “increase availability of high-quality childcare and home-visiting service slots” and to “promote education, engagement, and support of parents and families as children’s first teachers.”

“This significantly expanded access to home visiting truly helps to fulfill our mission for increasing the ways to help our youngest residents get a strong, focused beginning,” Gov. Wolf said.

Read the Ready to Start Task Force report.

For more information on home visiting programs, visit dhs.pa.gov.

This toolkit from the National Academy for State Health Policy highlights state initiatives to help older rural adults age in place by increasing services that help people remain in their homes, expanding and professionalizing the caregiver workforce, and making delivery system reforms within Medicaid programs.  According to research referenced in the toolkit, more than 85 percent of older adults prefer to remain in their own homes and communities, and serving older adults in their homes is usually less expensive than housing people in facilities. This resource was funded by the Geriatrics Program in the Bureau of Health Workforce at the Health Resources and Services Administration.   The Toolkit can be accessed here.

The U.S. Department of Health & Human Services is seeking input from the public on a 10-year national strategy for addressing vaccine-preventable diseases.  The plan will update all aspects of vaccine research and development, supply, financing, distribution, and safety, and address causes of an increased reluctance to vaccinate that led to recent outbreaks of pertussis, hepatitis B and measles.  Last year, the Centers for Disease Control and Prevention released research showing a lower rate of vaccination for rural teenagers and made recommendations for making it a routine part of clinical care.   Click here to access the Federal Register notice.  Comments are due on October 24, 2019.

In 2017, the Health Resources and Services Administration (HRSA) launched its Strategy to Address Intimate Partner Violence, with targets and projects that involve each of the agency’s bureaus and offices.  This month, HRSA’s Office of Women’s Health released the first progress report for that initiative, describing its achievements between 2017 and 2018.  Victims in rural areas may be reluctant to report intimate partner violent abuse, and unaddressed abuse has an impact that goes beyond the individual and into communities.

As urbanization increases, an older, sicker and poorer population remains in rural America. New infographics from the National Institute for Health Care Management (NIHCM) Foundation depict the population shifts driving these changes, the corresponding health care challenges, and promising tools to improve rural health. In rural areas, 18.4 percent of the population is over 65 years of age compared to 14.5 percent in urban areas, and rates of obesity, diabetes and smoking are higher.   The infographics can be accessed here.

Depression is on the rise. So is suicide, particularly among young people and military veterans. And Pennsylvania recently concluded that addressing mental health needs is the best defense against school shootings.

Yet, because of a shortage of psychiatrists, people commonly wait six months for an appointment in central Pennsylvania. That means some people badly in need of help continue suffering, and may become dangerous to themselves or others, before they can begin getting better.

“It’s terrible,” says Marge Chapman, executive director of the Dauphin County chapter of the National Alliance on Mental Illness, or NAMI.

Kathleen Zwierzyna, head of the NAMI chapter for Cumberland and Perry counties, tells of a relative who waited more than five months for an appointment with a psychiatrist. “We know many families who have lived through it,” she says.

Long waits extend to young people who show signs of mental illness at school and are referred by school staff, says Dan Daniels, executive director of the NAMI organization serving York and Adams counties.

Nearly half of Pennsylvania counties have no psychiatrist, says Christine Michaels, CEO of NAMI Keystone Pennsylvania.

“Yet there’s a crisis with suicide,” she says, noting areas that lack psychiatrists tend to be economically-depressed and have higher rates of depression among residents.

Psychiatrists, who are medical doctors, play a key role in diagnosing mental illness and deciding what treatment and medication should be used. Sometimes, symptoms return in patients who have been doing well, putting them in need of a psychiatrist to change or adjust their medication.

When people experiencing mental illness have to wait to be diagnosed, or begin medication or have it adjusted, it can disrupt their ability to work, attend school or care for their family, says Dr. Erika Saunders, chair of psychiatry at Penn State Health Milton S. Hershey Medical Center. Worse, it can put them at high risk of having to be hospitalized, ending up in jail or committing suicide, she says

Beyond that, delays can trigger other health problems and cause harrowing and destabilizing times for families. “There is a huge burden on families who are trying to care for their loved one,” Saunders says.

One central Pennsylvania resident who doesn’t want his name published experienced a return of a condition that had been well-controlled for years with medication. He learned his Harrisburg-area psychiatrist had retired. He says he contacted the area’s three major health systems: Penn State Health, UPMC Pinnacle and Geisinger Holy Spirit.

None could offer a near-term appointment, he says. One provided a list of private psychiatrists, but none were available. One suggested he try again in fall.  “We have a severe shortage of mental health professionals,” Saunders says. “We’re doing our best to care for [the sickest] patients, but we need to expand access for all patients.”

The shortage is severe not only in Pennsylvania but in much of the United States.

Read the entire article here.