West Virginia’s Most Affected Kids Are Its Youngest

by Dr. Mike Brumage and Kelli Caseman

It’s been years since the drug crisis began, and still, in earnest, as a country and state, we’ve spent little time and funding on understanding how the crisis is affecting kids. When pieces of relevant data are reported, it’s important that we take notice and respond. Last month, two reports highlighted startling information that together should compel us to act.  

Given the impact of opioids on West Virginia, it should be no surprise that our state has the highest rate of impacted children. United Hospital Fund’s new report, The Ripple Effect: National and State Estimates of the U.S. Opioid Epidemic’s Impact on Childrenconfirms this. In 2017, 28 out of every 1,000 children in the United States were impacted by opioids—specifically, they lost parents to imprisonment or death, were introduced into the child welfare system, or themselves had opioid use disorder or had accidentally ingested opioids.

In West Virginia, 54 out of 1,000 were affected, making us the national leader, with at least twice the rate of 17 other states. Importantly, the demographic of children most affected by the crisis were the youngest. In 2017, over 41% of West Virginia’s affected children were ages 0-5.

According to WVDHHR, 24% of children in foster care are ages 0-2—the largest demographic of children in the system. Around 41% of children in West Virginia’s foster care system are ages 0-5, and 44% of children removed from the home during 2017 were ages 0-5.

And as is often reported, West Virginia’s rate of infants born with neonatal abstinence syndrome (NAS) is the country’s highest. In 2017, five out of every 100 babies born in our state had NAS and in some counties, that rate is doubled.

Clearly, the children most impacted by the crisis are the youngest. Consider, for a moment, that the first 1,000 days of life are a time of both tremendous potential and vulnerability. The decisions we make now to respond to their health care needs will significantly determine what their future looks like, as well as our state’s.

Now, consider this. Last week, Georgetown University Center for Children and Families released the report, Nation’s Youngest Children Lose Health Coverage at an Alarming Rate. From 2016-2018, West Virginia saw a 69.8% increase in the number of uninsured children under 6, the largest increase for this demographic in the country. While this translates to a little over 1500 children, it illustrates a national trend—young children losing health coverage—and West Virginia, sadly, is at the forefront.

And so, the demographic of children most affected by the drug crisis are also the most likely to have lost, or at risk of losing, their health insurance. Considering their increased need for care and services, and the important developmental period they’re in, we can’t sit back and watch the most vulnerable among us lose access to care that’s essential to their physical and psychological wellbeing.

What can we do? For starters, we can stop treating children impacted by the drug epidemic as afterthoughts. Their needs shouldn’t be tucked away in larger plans and projects that focus on the needs of adults. Kids grow up fast; to help them, we must make them a priority, study the data we have, and respond in real-time. That means strategically investing in ways to help mitigate the effects of children born with NAS, growing up in toxic environments, and suffering the trauma of being removed from their homes, and doing this work immediately, with a sense of urgency.

Secondly, we can build on what we have in place and capitalize on strong foundational supports. All children qualify for health insurance. Medicaid has a comprehensive pediatric benefit that covers medically necessary services. West Virginia receives a great federal match for eligible Medicaid services, meaning that getting more kids in for the care wouldn’t be such a heavy lift financially for the state. We should be working harder to ensure all of our state’s kids have health insurance.

The health care system is an important entry point to direct families to other resources to support children’s health and development. There is potential here for real improvements. We should beef up the navigational paths that lead parents/guardians to health insurance enrollment, a medical home where kids get their recommended checkups, and promote referrals to specialty care in ways that ensure kids don’t fall through the cracks.

Next steps could be family navigators in multiple settings—going to where the parents and caregivers are, instead of insisting they come to the healthcare setting. We can require managed care plans to create a kids’ quality agenda that focuses on improving the referral process to important programs like Birth to Three, and finally—here’s a big but important lift—breaking down silos within state government so systems share data. When transitioning between health care, preschool, child welfare etc., children’s records should indicate whether they are insured, receiving well-child care and referral services, and not falling off the radar if someone important in their lives is missing or inattentive. 

Our state has many children’s advocates in policies, healthcare, trauma-informed care, and keeping track of the data among other things, but there is no corresponding centralized leadership effort at the state or national level to keep our eyes focused on kids and their needs. This is a real emergency. Our future deserves that kind of attention.

Most importantly, our state must spend more time and resources in data-driven, strategic responses with coordinated leadership to impact the needs of these kids. For the littlest ones, the clock is ticking.

Kelli Caseman is the Executive Director of Think Kids.

Dr. Mike Brumage is a physician, medical director for Cabin Creek Health Systems, and co-chair of the West Virginia ACEs Coalition.