Policy & Practice December 2018

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Admittedly, the trauma-informed approach encompasses much more than what is discussed in this article. However, it is apparent that such an approach produces considerable benefits for the child whose well-being is in jeopardy. Malik Baker is a Policy Fellow at APHSA. Reference Notes 1. See https://www.ojjdp.gov/pubs/239603. pdf 2. See https://www.nap.edu/read/9747/ chapter/5#78

of trauma and mental and behavioral health issues in children is critical to preventing subsequent juvenile deten- tion. It allows caseworkers to identify the events or situations that may serve as “triggers.” Triggers prompt the child to revisit the experience and pain asso- ciated with it. 4 Such awareness allows for recovery and prevention as opposed to regression and repeated pain. Effective identification and tailored case planning can help child welfare systems determine when to refer children for mental health assessment and treatment. This is a direct inter- vention addressing the root cause(s) that increase the child’s probability of entering the juvenile justice system. States can take advantage of several financial opportunities in the Act. Beyond changes in Medicaid, the law creates and reauthorizes several dif- ferent grants for those affected by SUD. One of the most significant of these is the passage of the CAREER Act. The CAREER Act functions as a springboard for people affected by SUD to get back into the workforce through the creation of a grant. The grant, which is authorized and will be funded by the U.S. Departments of Labor and Health and Human Services, will be used to hire case managers, care coordinators, pro- viders of peer recovery support services, and training services that are directly linked to employment opportunities in state and local communities. While the new law is an important step in tackling the opioid crisis, there are several additional measures that legislators can take to remedy the crisis. Increasing naloxone admin- istration and training, expanding MAT, implementing needle exchange programs, and psychosocial treat- ment programs have all contributed to

poor social skills, impulsivity, poor academic performance, and increased risk taking, increase a child’s prob- ability of entering the juvenile justice system. To ensure positive life outcomes for dually involved youth and to prevent children in the child welfare system from encountering the juvenile justice system, experts recommend that the respective systems embrace a “trauma- informed” approach. For example, many systems that have implemented the approach recom- mend a routine screening of all youth entering the child welfare system for trauma exposure and related symptoms. 3 The early identification were previously incarcerated. It also requires states to ensure access to Medicaid for former foster youth up to age 26. These changes in coverage requirements will give health insur- ance to some of the most at-risk individuals in the country. Access to health insurance is a highly valuable tool to intervene in unhealthy behav- iors that could develop into SUD and has the potential to bring medical treatment to those youth who are already struggling with SUD. The Act also enhances treatment options by requiring states to cover medically assisted treatment (MAT) for enrollees who have SUD. MAT refers to medications such as methadone and buprenorphine that are used to wean people with SUD off of opioids and were not previously required for coverage across the country. “Health homes,” housing for individuals with SUD that integrate MAT for Medicaid enrollees, will also be covered. These changes are important expansions in Medicaid coverage that allowmore children, at-risk youths, and families affected by SUD to have different treatment options covered through Medicaid.

3. See http://bit.ly/2qWfNnk 4. See http://bit.ly/2KfwDXe

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decreases in overdoses and improved the quality of life for those afflicted with SUD. Models like the “Hub and Spoke” System in Vermont have also proved an effective way of admin- istering care for people affected by SUD. The Hub and Spoke system is a multifaceted approach to SUD that uses a handful of high-maintenance treatment centers, “hubs,” that service patients at the very beginning of their recovery process and include addic- tion specialists. “Spokes” serve as ongoing treatment centers that can administer MAT but do not offer the same kind of addiction specializa- tion that the hubs offer. The Hub and Spoke model has improved care and reduced costs for Vermont and has the ability to do the same for states nationwide by using a mix of preven- tion and treatment. These policy levers are being utilized around the country and have the ability to transform the opioid epidemic if implemented on a national level.

Anthony Cutillo is a National Collaborative Intern at APHSA.

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