Multigenerational Approaches to Fostering Children's Health and Well-Being The Opioid Crisis as a Case Study: Proceedings of a Workshop (2019) / Chapter Skim
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2 Practice and Policy Examples to Promote Family Well-Being: Successes and Challenges
2 Practice and Policy Examples to Promote Family Well-Being: Successes and Challenges
Pages 5-18
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From page 5... ...
. CMMI was created under the Affordable Care Act with a goal of testing innovative service delivery and payment models.
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In terms of the opioid crisis, she described the road map developed by CMS, focusing on prevention, treatment, and data: see Figure 2-1. Thompson went on to describe two key models related to the opioid crisis that CMMI has been working on, noting that because the CMMI budget is considerably larger than those of many other federal agencies, she believes the agency has great potential to influence changes.
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, a child-centered local service delivery and state payment model with the goals of reducing expenditures and improving quality of care for children covered by Medicaid and CHIP. The agency hopes to improve coordination and integration of a variety of services for children at risk of adverse outcomes, which demands cross-sector work.
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When the InCK team began its work, they started with pediatric accountable care organizations and hoped to find innovation. However, because people are typically uncomfortable taking on risk with children, there are very few advanced payment models for pediatric populations.
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One of the agency's future efforts in this area will be education, she noted, in response to information from colleagues at other health agencies -- such as the Administration for Children and Families and the Health Resources and Services Administration -- that people working in early childhood systems want to help but don't know how to connect par ents to appropriate treatment programs for adult substance use. Larson also shared some of the resources and initiatives available through SAMHSA related to family well-being and pregnant women with opioid use disorders.
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STATE AND COUNTY LEVELS The two presentations covered in this section represent the state and county levels to examine some of the programs that are closer to the ground and use different approaches for services targeting communities. BOX 2-1 Resources from the Substance Abuse and Mental Health Services Administration Center of Excellence for Infant and Early Childhood Mental Health Consulta tion.
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Interventions include case management services, support groups at various age levels, and counseling services specifically for youth, recognizing that most children who enter the agency's care have at least four adverse childhood experiences.2 Providing some mental health prevention services can help ensure they have healthier futures. Some of the program's support group activities include the following: • Adult support groups: Discuss parental rights, issues with loss and grief, the challenges with parenting two generations (in the case of grandparents)
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Located in a far western corner of Virginia, 22 percent of the total county population and 28 percent of the children live below the poverty line. The county is also at the epicenter of the opioid crisis, with overdose deaths that average 48 per 100,000 population -- one of the highest rates in the state.
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The savings to Wise County totaled $425,334 in jail costs; and in just the last quarter, the county received roughly $340,000 back from the jail in overpayments. These savings allowed the county to avoid laying off teachers and closing schools this year, which had been considered due to tight budgets.
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The center's third main focus area is substance abuse and opioid use disorder including both prevention and treatment aspects. Bighorn Valley also has nurses conduct home visits with pregnant women and families to promote healthy pregnancies and provide connections to all potential resources before babies are born, tackling both healthy pregnancy and substance use disorders.
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Nationwide Children's Hospital, Columbus, Ohio Kelly Kelleher, vice president of community health at Nationwide Children's Hospital, began his presentation by noting that reducing opioid use requires intervention at several levels. The first step is to discuss reducing poverty and building resilience in local communities in central Ohio, he said, and he introduced some of the hospital's key principles to improve lives for their neighborhood.
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With Ohio as one of the worst states in the United States regarding opioid death rates, he emphasized the consequential challenge for babies, with Nationwide Children's Hospital seeing the largest number of babies with neonatal abstinence syndrome (NAS) in the United States, and they have very long average lengths of stay.
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They are branding the centers under a "women's health" umbrella, which can help to address stigma; they have made automated appointments available; and they are adding mobile sites to increase access. Finally, for the immediate postpartum/delivery and discharge periods, they are focusing on adjusting typical neonatal intensive care unit care to be more appropriate and specific for the needs of babies with NAS.
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From page 18... ...
6 Partners for Kids is a pediatric accountable organization that partners Nationwide Chil dren's Hospital with more than 1,000 doctors. See more at https://partnersforkids.org.
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