On October 3, the U.S. Senate voted 98-1 (only Sen. Mike Lee, R-UT voted nay) to approve The SUPPORT for Patients and Communities Act (H.R. 6 signed 10-24-18 or previously titled the Opioid Crisis Response Act), a final step before the President’s signature [Editor's note: President Trump signed the bill on October 24]. The House approved the measure by a vote of 393-8 on September 28. The Senate approved an earlier version of this legislation on September 17 and as reported on ACEs Connection, it includes significant provisions taken from or aligned with the goals of the Heitkamp-Durbin Trauma-Informed Care for Children and Families Act (S. 774), including the creation of an interagency task force to identify trauma-informed best practices and grants for trauma-informed practices in schools.
As reported earlier in ACEs Connection, the trauma provisions are the result of “extensive engagement” of the offices of Senators Heitkamp (D-ND) and Durbin (D-IL) with Shelley Capito (R-WV), and Lisa Murkowski (R-AK). The opioid legislation represents a rare bipartisan, multiple committee achievement.
An earlier version of the House bill did not include the trauma-related provisions but the final bill incorporates all of the key provisions supported by advocates in the Senate version. One of the advocacy efforts included a sign-on letter organized by the George Washington University School of Public Health and the Campaign for Trauma-Informed Policy and Practice. Over 100 groups and trauma experts signed the letter supporting inclusion of strong trauma-related provisions (also attached) directed to key Senate and House leaders.
Most of the specific trauma provisions are included in Title VII (Public Health), subtitle N (trauma-informed care) and can be found on pages 404-431 on the latest version of the legislation which totals 668 pages. The primary trauma-related provisions are also found on p. 19-20 in the Section by Section (also attached). Here are the primary trauma-related provisions excerpted from the Section by Section:
Title VII (Public Health), subtitle N (Trauma-Informed Care)
Section 7132. Task force to develop best practices for trauma-informed identification, referral, and support.
This provision creates an interagency task force to make recommendations regarding best practices to identify, prevent, and mitigate the effects of trauma on infants, children, youth, and their families, and to better coordinate the Federal response to families impacted by substance use disorders and other forms of trauma. It requires the task force to develop a set of best practices regarding prevention strategies, identification of trauma, community-based practices, and state- and local-level partnerships to support children and their families. This provision calls for a national strategy on how federal agencies can implement a coordinated response, including by coordinating existing federal authorities and grant programs where trauma-informed practices are allowable. The task force is required to submit a final report of findings and recommendations to Congress, relevant cabinet Secretaries, Governors, and the general public not less than three years after its first meeting
Section 7133. National Child Traumatic Stress Initiative.
This provision increases the authorization level for the National Child Traumatic Stress Initiative. Funding will provide technical assistance, direct services to communities, and will support evaluations and dissemination of best practices in trauma-informed care for children and families.
Section 7134. Grants to improve trauma support services and mental health care for children and youth in educational settings.
This provision authorizes the Secretary of Education, in coordination with the Assistant Secretary for Mental Health and Substance Use, to make grants to link educational agencies with mental health systems in order to increase student access to evidence-based trauma support services to help prevent and mitigate trauma that children and youth experience. It requires the Secretary of Education to conduct a rigorous, independent analysis and disseminate findings from the grants.
Section 7135. Recognizing early childhood trauma related to substance abuse.
This provision requires the Secretary of Health and Human Services to disseminate information, resources, and if requested, technical assistance to early childhood care and education providers and professionals working with young children on ways to recognize and respond appropriately to early childhood trauma, including trauma related to substance use.
Other provisions that may not specifically reference “trauma” or “trauma-informed care” are also important to highlight. As an example, the “Plans for Safe Care” provisions could reduce childhood adversity significantly. Text from the Section-by-Section on other related provisions follows:
Section 7065. Plans of safe care.
This provision authorizes the Secretary to provide support for states to collaborate and improve plans of safe care for substance-exposed infants. States may use funds to coordinate with various agencies responsible for child and family wellbeing, develop policies and procedures, train health care and child welfare professionals, establish partnerships, and develop and update technology and monitoring systems to more effectively implement plans of safe care. This provision requires the Secretary to provide states with technical assistance and guidance to support their implementation of the plans of safe care assurance, including by enhancing their understanding of the law, addressing state-identified challenges, sharing best practices, and supporting collaboration.
Section 7072. Clarification regarding service in schools and other community-based settings.
This provision allows mental and behavioral health providers participating in the National Health Service Corps to provide care at a school or other community-based setting located in a health professional shortage area as part of their obligated service requirements.
Section 7073. Programs for health care workforce.
This provision improves programs that support education and training in pain care by requiring grant recipients to develop comprehensive education and training plans that include information on the dangers of opioid abuse, early warning signs of opioid use disorders, safe disposal options, and other innovative deactivation mechanisms. This section also requires pain care education and training grantees to include alternatives to opioid pain treatment, such as non-addictive and non-opioid pain treatments, and non-pharmacologic medical products. In addition, this provision updates mental and behavioral health education and training grants to support trauma-informed care.
Subtitle G—Human Services
Sec. 8081. Supporting family-focused residential treatment.
This provision would require HHS to develop and issue guidance to states identifying opportunities to support family-focused residential substance abuse treatment programs.
Sec. 8082. Improving recovery and reunifying families.
This provision provides $15 million to HHS to replicate a “recovery coach” program for parents with children in foster care due to parental substance abuse, which has been shown to reduce the length of time children spend in foster care. This will allow HHS to determine whether the program can be replicated in another state and yield the same results. This provision also contains language clarifying that the provision of new prevention services paid for through the Family First Prevention Services Act will not supplant services funded by other programs.
Sec. 8083. Building capacity for family-focused residential treatment.
Beginning in FY 2019, states are eligible for federal matching funds for maintenance costs when an at- risk child is placed in family-focused residential treatment, as well when the child is placed in foster care. In FY 2020, states will also be eligible to receive funding to provide evidence-based substance abuse prevention and treatment services to families with children at risk of entering foster care, even if the child is not placed in, or eligible for, federally-funded foster care. This provision authorizes $20 million in funding for HHS to award to states to develop, enhance, or evaluate family-focused treatment programs to increase the number of evidence-based programs that will later qualify for funding under Family First Prevention Services Act.
Additional coverage of the provisions of this legislation and its implementation will be posted on the Resilience USA community on ACEs Connection. Please add your comments freely on this post and other reports on federal policy.