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Helping victims of childhood trauma heal and recover

July 11, 2013

Far too many children—especially those known to the child welfare system—have experienced trauma related to neglect, exposure to violence, physical and sexual abuse, and psychological maltreatment.  Rates of trauma exposure, for example, are approximately 90% among children in foster care. But despite the amazing work of the dedicated professionals who care for these vulnerable children, we know there’s more we can do.

Today, I’m pleased to announce a critical step forward.  The Department of Health and Human Services is issuing critical new guidance to improve the wellbeing of children and families who have experienced trauma. Based on new research, it provides a clear pathway for child welfare professionals and providers to incorporate and finance better trauma screening, assessments, and evidence-based best practices.

Read the guidance on Medicaid.gov (PDF – 136 KB)

The guidance is informed by emerging research as well as the landmark Adverse Childhood Experiences (ACE) Study, which demonstrated that adverse childhood experiences may increase the likelihood of chronic disease in adulthood, such as adult strokes, diabetes, cardiovascular disease, cancer, and early death—and may lower job performance and employment levels.  Over half of the more than 17,000 participants in the study had been exposed to at least one adverse childhood experience, such as abuse, neglect, or household dysfunction.  Adults who had six or more adverse experiences were more likely to die 20 years sooner than those with none.  These consequences represent unfulfilled human potential and significant costs to health care systems.

The letter released today introduces a new model of service delivery and workforce training.  It will improve the way we promote and protect the health of children in child welfare and mental health systems.  And it describes how comprehensive approaches can be funded or reimbursed by three federal sources: child welfare, mental health and Medicaid.

The guidance in the letter builds on the incredible work the Affordable Care Act supports to improve the wellbeing of children who may have experienced trauma.  New home visiting investments will support a range of programs that have been proven effective in reducing traumatic events such as child maltreatment.  In addition, coverage expansions through health reform will mean that more individuals have access to treatment for psychological trauma.

Additionally, HHS has announced that up to $1 billion is available through Health Care Innovation Awards to test new payment and service delivery models across four broad categories.  Children in foster care, among others, are identified as a priority population to highlight their specialized needs. There is ample evidence that investments in improved care for this population could yield significant savings to multiple public systems, including Medicaid.  A recent article by Centers for Disease Control researchers in the journal Pediatrics found that child maltreatment costs the Medicaid system an estimated $5.9 billion per year.

Today’s guidance also complements the growing interest and action in states, territories, and tribes that are implementing effective approaches to meet specific needs of vulnerable children and their families.  The letter released today is an effort to help further that work, and we hope the information is helpful in current efforts and spurs new thinking and partnerships.

We know childhood trauma has long term consequences. But we also know that children can heal and recover, and that every child deserves a chance to live a healthy and productive life.