Addressing the Unmet Health Care Needs of Children Affected by the Drug Crisis

“Individually, we are one drop. Together, we are an ocean.” – Ryunosuke Satoro

Addressing the devastating effects of the drug crisis on our children’s health has been an identified priority since the onset of this organization. Systemic reform is needed to address the unmet health care needs of affected children in many systems, including health care, public education, child welfare, foster/kinship care, and the court systems. Collectively, these systems must bridge their efforts to address the health care needs of the children they serve, to ensure appropriate care is accessible, affordable, and effective.

Statement of Need, Prior to the Spread of COVID-19

At the heart of our nation’s opioid epidemic lies West Virginia, and in the middle of this crisis are its children. The increase of parental drug misuse and abuse, impaired parenting, incarceration, extended separation from parents, overdose deaths, and introductions into the child welfare, court, and foster care systems have resulted in a children’s health crisis in our state.

The statistics tell a dark story: According to the West Virginia Department of Health and Human Resources, since 2013, there has been a 67% increase in the number of children in state custody, from 4186 to 7000. Between 2011- 2017, abuse and neglect filings in circuit courts rose 70%. Between 2014-17, there was a 22% increase in abuse and neglect referrals, and a 34% increase in open child protective services (CPS) cases. Our state currently averaged a 27% vacancy rate for CPS positions. As of March 2020, there are 7,233 children in the foster care/child welfare system, and over 10,000 of West Virginia’s public school students self-report as homeless.

For these children, adverse childhood experiences (ACEs) are highly prevalent and associated with a heightened risk for poor health outcomes in both childhood and adulthood. Our pediatric health care system remains medically underserved; there is no concerted effort to assess or improve the system to address the increasing need for comprehensive care. West Virginia’s response to the drug epidemic has been a patch work of reactionary, adult-focused programs and services that have been systemic, siloed, and do not address the health care needs of affected children.

COVID-19

In the span of just a few weeks the coronavirus has changed the world as we know it. In the middle of this chaos, there has only been a limited focus on perhaps the most vulnerable group among us: children. From a medical perspective, the effect of the pandemic appears mixed. Kids with preexisting medical conditions are also more vulnerable, but by all counts, this isn’t like the H1N1 virus – this isn’t considered a children’s disease. Yet the threat to children goes well beyond falling sick from the virus. This pandemic has real consequences for many of West Virginia’s kids. Some of these are immediate.

The statewide shutdowns of schools and daycares means that thousands of our state’s children are no longer seeing mandated reporters — the school employees, after-school staff and childcare providers who are required, under state law, to relay child abuse concerns to authorities. Like many states, West Virginia has seen the number of calls to the centralized intake of its child abuse hotline number decrease by half over the past few weeks.

Healthcare providers are also mandated reporters who no longer have access to their patients. Currently, children are treated like other patients– encouraged to stay out of the clinic setting unless it is an emergency.

And so, the immediacy of a collaborative response from these systems is critical to the safety of children isolated in high-risk households. We must ensure systems that are connecting with these children– a telehealth visit, delivery of meals, or perhaps an altercation leads to a visit from law enforcement– are also connecting with one another.

Over the next several months, establishing better connections between health care and the public education and child welfare systems will be critical. Experts do not presume that the COVID-19 virus will ever be eradicated until there is a vaccine. Rather, there may be seasonal outbreaks, or when “hot spots” of virus activity spread in locations across our country, social isolation may again be encouraged, schools cancelled, and the same barriers to connecting with these vulnerable children are emplaced. 

Next Steps for Our Work

For the remainder of 2020, Think Kids intends to pivot from its project, Addressing the Unmet Health Care Needs of Children Affected by the Drug Crisis, to focus specifically on the needs of this same demographic of children as the pandemic unfolds.

Specifically, this means working with stakeholders across systems– healthcare, public education, child welfare, foster care, and the court system– to collaborate on identifying challenges, elevate best practices, and coordinate efforts to respond to the needs of children and their families.

With these stakeholders, we’ll work collectively with communities, to assess response at the community level, identify challenges, and prioritize next steps.

Together, we’ll form a network of system and community stakeholders to respond to the unique and acute needs of high-risk children as they are affected by the COVID-19 pandemic. We’ll draft and promote needed policy reform to ensure their safety and wellbeing and the crisis continues.