Kentucky Children's Hospital at UK opens center to treat children who are harmed by abuse and neglect, in which Ky. ranks 14th

University of Kentucky and Kosair for Kids representatives celebrate opening of the Kosair for Kids Center for Safe & Healthy Children & Families at Kentucky Children's Hospital. (Photo by Adam Padgett)

By Hilary Brown
University of Kentucky

Representatives from Kentucky Children’s Hospital and the nonprofit foundation Kosair for Kids cut the ribbon recently on the Kosair for Kids Center for Safe & Healthy Children and Families, a new clinic space for the treatment of children harmed by abuse and neglect at KCH, part of the University of Kentucky. This center was made possible by a $2 million gift from Kosair for Kids.

“I’ve spent the better part of my career looking at the challenges that Kentucky faces, especially when it comes to the ability of vulnerable Kentuckians to get care they desperately need,” said Mark D. Birdwhistell, vice president for health system administration and chief of staff, UK HealthCare. “I’ve seen how hard it can be to effect change for Kentucky’s vulnerable citizens, and that’s why I’m so proud of this new center and of what we’ve been able to accomplish with the partnership of Kosair for Kids.”

Kentucky ranks 14th in the country for child abuse and neglect; according to the state Cabinet for Health and Family Services, in 2022, 11,002 children experienced neglect, 1,146 suffered physical abuse and 756 were victims of sexual abuse. Those numbers have decreased over the years, due largely to the efforts of Kosair for Kids and their partners across the state.

“Today we celebrate opening a center dedicated to giving the best to children who have experienced the worst, said Barry Dunn, Kosair for Kids president and CEO. “Our goal, our aspiration, is that this center serves as a beacon of hope for children who have experienced unfathomable trauma. We stand with them, united in purpose, on the road to healing. We are proud to call them a Kosair Kid, and we want to show them the love and care they deserve. Kosair for Kids is proud of this place, the skilled and dedicated staff on the front lines of this epidemic, and the growing alliance we have formed to protect all children.”

“I’m an ardent believer that you can’t separate physical health from mental and emotional health,” said Dr. Scottie B. Day, physician-in-chief at Kentucky Children’s Hospital. “Maltreatment and childhood trauma have effects that ripple out into adolescence and adulthood and continue to inform patterns of behavior for generations. Through our partnership with Kosair for Kids, we can disrupt generational cycles of abuse and make Kentucky much safer for kids.”

KCH is home to one of only two pediatric forensic medicine programs in Kentucky. Of the five child-abuse pediatricians practicing in Kentucky, four are at KCH’s Division of Pediatric Forensic Medicine along with specially trained advanced nurse practitioners, social workers and psychologists.

Features of the new clinic include:

• Secure and private space to provide trauma-informed care, including three exam rooms and two therapy services rooms
• Proximity to the Makenna David Pediatric Emergency Center and other services such as radiology and sedation with private entrance and egress to those sites
• Space for therapeutic interventions, evidence storage and consultation with law enforcement and other partners
• Technology to consult virtually with the child’s care team which may include state child protective services, guardian ad litem and law enforcement.

The pediatric forensics staff also provides regular education to medical students, family medicine providers as well as community organizations. They developed a core curriculum for the Department of Community Based Services in the Cabinet for Health and Family Services that includes 16 one-hour lectures. Forensics providers lead a multi-hour training to each new class of Kentucky State Police cadets, as well as continued education to healthcare providers in the community.

Children who are abused and neglected may suffer immediate physical injuries, but also may have emotional and psychological problems, such as anxiety or posttraumatic stress. Over the long term, children who are abused or neglected are also at increased risk for experiencing future violence victimization and perpetration, substance abuse, sexually transmitted infections, delayed brain development, lower educational attainment, and limited employment opportunities. Chronic abuse may result in toxic stress, which can change brain development and increase the risk for problems like posttraumatic stress disorder and learning, attention, and memory difficulties.

All Kentuckians are mandated reporters of child abuse and neglect. If you believe a child is being abused or neglected, call the Child Protection Hotline at 1-877-KYSAFE1 or 1-877-597-2331 or report online.

UK study finds intimate-partner violence raises risk of developing diabetes, due to stress; Ky. has high rate of domestic violence

A diabetic checks blood sugar. (Photo by AaronAmat, iStock/Getty Images Plus)

By Sarah Ladd

Kentucky Lantern

People who experience intimate-partner violence, or the threat of it. are much more likely to end up with diabetes, due to increased stress. So says a new study published by a University of Kentucky researcher and others.

Experiencing violence, abuse and neglect as adults and children increased the risk of adult-onset diabetes in women and men by 23% to 35%, said the study, published in the American Journal of Preventive Medicine.

Researchers attributed the heightened risk to the elevated cortisol levels and suppressed insulin levels that occur in the human body in response to violence or chronic stress.

Ann Coker
(Photo provided)

UK researcher Ann Coker, who’s also a professor of epidemiology in the Department of Obstetrics and Gynecology in the university’s College of Medicine, said the study is the first of its kind.

“Before this research, we knew that partner violence was associated with diabetes among women, but we did not know that violence preceded diabetes development,” Coker said. “We had no data on this relationship for men or within racial groups.”

 
A recent statewide report on domestic violence showed nearly half of women and more than a third of men in Kentucky experience intimate partner violence or the threat of it.

In 2020, the Centers for Disease Control and Prevention showed 11.4% of Kentuckians had diabetes, a decrease from the two years prior.

Diabetes is a chronic condition that hinders the body’s ability to make enough insulin to properly break down foods, per the CDC. There are several different types of diabetes.

More than 37 million Americans have diabetes, the CDC says, and many don’t know it.

Additionally, Kentuckians experience high rates of child abuse and adverse childhood experiences.

Researchers collected data for the study before the Covid-19 pandemic. The pandemic may have made the risk of diabetes worse by increasing stress, another researcher in the study said.

“Our findings also show an increased risk in a timeframe before the additional social stress of the Covid pandemic,” said Dr. Maureen Sanderson, the study’s lead author and a professor in the Department of Family and Community Medicine at Meharry Medical College in Nashville, said in a statement.

“This strongly suggests the need for helping professionals across disciplines to implement effective violence prevention and intervention strategies to reduce the short and long-term social and health consequences of partner violence and child abuse,” Sanderson added.

Interventions, Sanderson said, can include “strengthening economic supports for families, promoting social norms to protect against adversity and violence, ensuring strong starts for children, teaching skills, connecting youth to caring adults and intervening to lessen harm.”

More Kentucky youth received emergency care for self-harm in 2021 than in 2020, reversing decline in youths' intentional injuries

Ky. Injury Prevention Research Ctr. graph, adapted by Ky. Health News

By Melissa Patrick

Kentucky Health News

Fewer young people in Kentucky got emergency care in the first year of the pandemic for intentional injuries, but in the second year, the number rose, mainly due to a 15 percent increase in cases where youth, mostly girls, harmed themselves.

That's according to a report from the Kentucky Injury Prevention and Research Center on intentional injury-related emergency department visits among Kentuckians aged 10 to 24. It says people in this age group, which it calls youth, have an increased risk for these injuries that often require medical care. 

Intentional injuries are violence-related injuries, whether they be directed toward oneself, called self-harm or intentional injury in this report; or directed toward others, which this report refers to as assault.

The researchers found that from 2016 to 2021, Kentucky resident youth made 40,579 emergency-department visits for intentional injuries, amounting to about 6,763 visits per year. It notes that the median cost of an ED visit for self-harm injuries was $2,577 and for assault injuries was $1,644.

In those years, most of the intentional injury-related ED visits occurred in people aged 15 to 24, followed by those 10 to 14, the report says. And when it comes to self-harm, an overwhelming number of those ED visits, or 71%, involved girls or women. 

Slightly more male youths, 52%, visited EDs as a result of assault. Most self-harm injuries (58%) and assault injuries (63%) were among youth living in metropolitan areas.

Most injuries were among white youth, 84% for self-harm and 71% for assault. For Blacks, the numbers were 11% and 24%, respectively.  

The report also breaks down injury-related ED visits by the nature of the injury. The top two self-harm injuries in 2016-21 were drug poisoning, 50.3%, and cut or pierce, 31.5%. The top two assault injuries were striking by or against, 68%, and child or adult abuse, 10.7%. Only 2.1% of the ED visits for assault injuries were related to firearms. 

Among self-harm injuries, the most common types were poisoning (52%), open wounds (22%), and superficial injuries or contusions (11%). The most common types of assault injuries were superficial or contusion (30%), open wound (18%), other effects of external causes (15%), and fractures (13%).

The report also found that most Kentucky youth ED visits for injuries related to intentional harm were discharged to home or to self-care: 48.4% of those admitted for self-harm and 93.8% of those admitted for assault. It said 13.5% of the self-harm patients were discharged to an inpatient facility and 34.2% were discharged to a health-care facility.

The ED visit rate for youth self-harm injuries varied by region in Kentucky from 181 per 100,000 people in the Buffalo Trace Area Development District to 333.7 per 100,000 in the Kentucky River ADD. The Green River ADD had the second highest rate, at 305 per 100,000. 

The ED visit rate for youth assault injuries ranged from 385.4 per 100,000 in the Barren River ADD to 718.3 in the Kentucky River ADD. Two other ADDs were among the highest rates for this measure, KIPDA, at 705.2 per 100,000 and Green River, at 565.6 per 100,000.

Graph by Kentucky Injury Prevention Research Center; for a larger version, click on it.

It's Child Abuse Prevention Month. Child sexual abuse plagues Kentucky. Using it as a political ploy is disgusting, editor writes:

Blackford

OPINION

By Linda Blackford

Lexington Herald-Leader

    If you vote for Ketanji Brown Jackson, you’re “pro-pedophile,” according to QAnon darling Rep. Majorie Taylor Greene, and if you talk about acceptance in Estill County, you’re a groomer, according to my twitter feed. That’s what it seemed like this week, in Kentucky, in Florida, all around the country. “Pedophile” and “child abuser” are the latest insults du jour. The Washington Post did an entire story about, and I’m not kidding on this, “groomer rhetoric.” This is, of course, disgusting, and should be the latest and most important reason for decent Republicans to rise up against their right wing. There could be nothing more horrifically cynical than taking one of the most heinous crimes on the planet and politicizing it with lies to win support and votes.

    Most awful is the fact that child sexual abuse is a real and terrible problem here in Kentucky and elsewhere. But it’s not at Democratic Party headquarters or the Estill County music department. It’s at your family reunion or vacation Bible school, hidden away in shame and secrecy. “These are offensive political maneuvers,” said Terry Brooks, director of Kentucky Youth Advocates. “To politicize child abuse should shock our moral compass and should render those people unqualified for office. I get politics, but this is outrageous.”

    These political battles conflate gender identity and sexuality with child sex abuse, making it harder to pinpoint how the problem needs to be solved. Advocates say the vast majority of child sex abuse perpetrators are “heterosexual,” most of them adult men abusing little girls. Abuse occurs everywhere, across socioeconomic levels, religion, race. Political affiliation has nothing to do with it either. 

    In one of those bizarre twists of life, it just so happens that all these political maneuvers and made up scandals are happening in April, which is Child Abuse Prevention Month, so a lot of advocates are out and about to talk about the real and serious issues. Such as: One in four girls and one in 14 boys will experience child sexual abuse at some point in childhood; and 90 percent of child sexual abuse victims know their abuser. Last year, Kentucky reported 1,853 substantiated cases of child sex abuse, which represents 8 percent of all abuse and neglect cases. It’s not a teacher with rainbow flags in the classroom and it’s not a teacher hosting a group of kids, “It’s the teacher or coach who invites one child to a barbecue after school,” said Winn Stephens, executive director of the Children’s Advocacy Center of the Bluegrass, which provides a full spectrum of victim services, from physical exams to counseling to advocates through the court system. “It’s the coach or the church pastor or the uncle, mom’s boyfriends, step grandparents — the people who are grooming and doing this crime are not strangers.”

    Someone’s sexuality does not make them more likely to abuse, Stephens said. The the vast majority of cases he sees are what we would describe as heterosexual men abusing little girls or women abusing little boys. About 65 percent of the center’s clients are girls. Kentucky ranks somewhere near the top of national rankings for child abuse, although advocates are wary of these rankings because they compare different things and because it might be caused by some of Kentucky’s progress in the area. For example, Kentucky is a mandatory reporting state for everyone, which means every single person is required to report suspicions of abuse and neglect, not just teachers and policemen. (The reporting line is 1-877-KYSAFE1.) In addition, Lexington’s first child advocacy center, started by former commonwealth’s attorney Ray Larson and current Commonwealth’s Attorney Lou Anna Red Corn back in the 1990s, gave birth to 15 more in the state’s area development districts.

    On Wednesday, Prevent Child Abuse Kentucky started a new campaign called “Safety and Awareness for Every BODY,” aimed at getting communities to recognize and talk about child sexual abuse.

    “We know people want to prevent child sex abuse,” said Jill Seyfred, the group’s executive director. “We also know that no one wants to talk about it.” Shame and stigma means children are ignored and adults stay silent. “We can’t make kids responsible for their own safety,” said Janna Estep Jordan, director of operations. “We have to talk about it in the open.” That means talking about correct body parts and being honest and open with kids so they understand the potential dangers.

Angie Bailey

    Angela Bailey, director of development for the Bluegrass Children’s Advocacy Center, who is herself a survivor of child sex abuse, says that’s what she would like to see above all else. “For me it starts at home, with talking to your kids and making sure they’re comfortable with saying no and their own bodies,” she said. “How many times did people say go hug Uncle So and So? Those little simple things that we do with kids send them messages that they’re not allowed to say no. In a recent editorial, Bailey wrote about how she taught her kids to use the proper names for body parts because she didn’t want them to feel shame about their bodies. “That is not grooming or sexualizing children, it’s about making all children feel comfortable with their bodies.

    She also wants people to know that if something happens, it’s imperative to get help. Her abuser had many victims, she said, and one of the others was one of her cousins. Unlike Bailey, her cousin did not ever get treatment or counseling and her life was one of chaos and crisis, one she did not survive.

“We talk about the financial costs of untreated child sexual abuse, but the human toll is much greater,” Bailey said. There will also be a toll to conflating the politics of gender identity with this grave problem. ‘I makes me very sad,” she said. “Gender identity and pedophilia are not the same things — empowering people to not be ashamed of who they are is not the same thing as hurting a child.”

The child abuse reporting hotline is 1-877-KYSAFE1. On Monday, April 11 at 10:30 a.m. the Children’s Advocacy Center of the Bluegrass will hold a pinwheel planting to raise awareness of child sex abuse at their office at 162 N. Ashland Ave. Prevent Child Abuse Kentucky will hold a similar event on the front lawn of the Capitol in Frankfort Monday at 10 a.m. with Gov. Andy Beshear and First Lady Britainy Beshear.

Linda Blackford writes columns and commentary for the Herald-Leader. She has covered K-12, higher education and other topics for the past 20 years at the Herald-Leader, which published this first.

Health chief goes another round with legislators, pushing back on data questions and answering queries on schools, other topics

By Al Cross
Kentucky Health News

FRANKFORT, Ky. – Republican legislators kept up their questioning of the state's coronavirus data Thursday, and the state health commissioner and Democratic lawmakers pushed back.

Sen. Danny Carroll

Sen. Danny Carroll of Paducah, co-chair of the Program Review and Investigations Committee, was the leading questioner and most outspoken legislator, just as he was at the panel's Aug. 13 meeting, when the committee heard from Dr. Steven Stack, commissioner of the Department for Public Health, and Doug Thoroughman, the state's acting chief epidemiologist.

Carroll kept relying Thursday on Thoroughman's tacit acknowledgement, in response to a Carroll question last month, that the positive-test rate that the state reports daily is not accurate, because of imperfect state and federal reporting systems. Thoroughman also said that the rate is useful for comparison over time because its method of calculation remains the same.

Thursday, Carroll noted that some test results have been delayed for weeks, and asked, "How can we have faith in daily numbers?" He said Democratic Gov. Andy Beshear never includes a disclaimer when giving the figure.

Dr. Steven Stack

Stack replied that while the data is "imperfect," it is "incredibly valuable. He noted that the state's daily report has an asterisk leading to a long footnote explaining how the rate is calculated.

He noted that the rate is an average over the previous seven days, and “I believe it becomes a very useful and accurate measure” for seeing trends. He said his department has undertaken "an unprecedented process" to get enough data for rates for about 80 counties.

Carroll replied, "The public sees the governor on TV talking about cases and positive rate" that changes from day to day . . . There is a stress that is put on our people as a result of these numbers." He quoted Thoroughman as saying that the numbers are not accurate, and said. "From an ethical standpoint, I struggle with the comfort level of putting this information out on a daily basis."

Stack replied, "I’m sorry you have such low confidence . . . " and Carroll interjected, "It’s not me. I hear it from my constituents daily. They’re mad about this."

Stack said he hears from others who are grateful for the information, and "It's possible for people to reach different conclusions from same information."

He added, "I don’t feel my ethics are compromised or challenged. . . . The metrics we use and the way we create them are consistent with the state of the art as best as public-health professionals can do it." He said President Trump uses weekly data on positive tests, and told Carroll, "Your concern might be that the president of the United States is misleading the public."

At another point, Carroll noted that the committee had also asked to hear again from Thoroughman, and asked why he wasn't present. Stack replied, "I’ve got him doing a lot of other work and I’m the commissioner," the person ultimately responsible for answering questions about the department.

Carroll said that was "disappointing . . . were it not for Dr. Thoroughman, I’m not sure we would know now that our positivity rates were off."

Toward the end of the meeting, after he and Stack went back and forth about a medical waiver to exempt a special-needs student from the mask mandate, Carroll boiled over.

He said of the state's reporting, "It’s being used to manipulate our people, to make our people scared, to control our people. It’s not accurate and its portrayed as being accurate."

Essentially repeating what he said at the last meeting, Carroll said, "Half of this state does not believe a word that you all say when it comes to the data." He said "All of this could have been avoided had the administration reached out" to leaders of the legislature's Republican majority about pandemic matters.

Sen. Karen Berg, M.D.

Earlier, Democratic Sen. Karen Berg of Louisville, a physician, complimented state health officials' work and said, “They need us to understand it and trust it” so legislators can tell constituents “We have got our best minds working on it . . . It will never be perfect. . . . My constituents have different reactions from Senator Carroll’s. . . . Our responsibility is to get on board and let’s do the best we can.”

Apparently addressing her colleagues, Berg said health-care providers are scared of the virus, and “You all need to understand . . . this is not the flu, this is not a hoax, this has nothing to do with politics or how you want it to be.”

Rep. Adam Koenig

A moderate voice: Rep. Adam Koenig, R-Erlanger, said health-care providers “deserve more thanks than they’re getting,” but “There’s nothing wrong with asking difficult questions.” He told Stack, “It’s been a wonderful opportunity for you to dispel misinformation. . . . No one up here thinks this is a hoax; this is not a political witch hunt; these are questions we get; there’s a lot of frustration.”

Earlier, Carroll had asked Stack, "Why do we not react the same way to these other diseases that we do to covid-19?"

Stack replied, "It's much more dangerous, everybody’s susceptible, and the sheer numbers . . . It's killing a lot more people," and there is no treatment that works on most patients. "There’s over 190,000 Americans who have died in six months. That way outstrips influenza." 

He said that the ultimate mortality rate for covid-19 will probably be about 1 percent, and if only one-third of Kentuckians got infected in a year's time, and 1% died, "That’s 15,000 Kentuckians. . . . That’s why it’s getting so much attention."

Death data: Rep. Lynn Bechler, R-Marion, the other co-chair, asked Stack about the recent notice from the Centers for Disease Control and Prevention that only 6 percent of covid-19 fatalities had no other health conditions that could have contributed to their deaths.

"I didn’t think it was newsworthy, quite frankly," Stack said, "because what we have said all along is that the most vulnerable population is people over 60 or 65 and with chronic medical conditions."

Bechler asked if it was "reasonable to suspect that 94 percent of deaths in Kentucky have underlying conditions." Stack said, "It could be even higher," since Kentucky ranks very high in chronic medical conditions.

Sen. Steve West, R-Paris, told Stack that "a lot of Kentuckians are wondering" about the death rate.

Stack replied, "The question is, how do we assign the immediate cause of death?" He said it's possible that people who have died of covid-19 "would have died in six months anyway" from another condition, but the state "follows the long-established norms we use for any other disease case."

In one of his written responses to questions asked at the last meeting, Stack said, "For death certificates for which the cause of death is not clear as to the contribution of covid-19, or appears to incorrectly include or exclude covid-19 as contributory to the cause of death, the committee reviews patient medical records, discusses the information available, and reaches consensus opinion on whether covid-19 is appropriate for inclusion or exclusion." 

He said the committee had reviewed 41 deaths through Sept. 8 and found that 17 had been removed from the covid-19 list. Through that date, the state had reported just under 1,000 covid-19 deaths.

Sen. Whitney Westerfield

In another written response, to a question posed by Sen. Whitney Westerfield, R-Hopkinsville, Stack said the positive-test rate "is more challenging to make precise due to variable timing of sample collection vs. test-result reporting and due to longstanding limitations in test-reporting policies, processes, and technologies. However, when these limiting variables stay constant, and data are averaged over a period of time, this metric is very helpful for trending purposes."

Asked how long health officials keep contact-tracing data, and whether it is being used for any purpose other than to trace contacts, Stack said, "Basic information is gathered; name, address, phone number, e-mail, etc. Local health departments and Department for Public Health epidemiologists, disease investigators and limited supervisory personnel have access to this. This data is not used for any other purpose other than to trace contacts. Privacy and data security standards are well established and maintained."

Schools: Westerfield asked Stack if he had "any information indicating a return to in-person schooling" before Sept. 28, the date Beshear has recommended.

Stack said they are sticking to that date, and wanted the extra time to learn from the experience of other states. He said he and Beshear are "working on number of things to announce Monday." They have indicated that will include county-level data to guide local decisions.

He said fans are being allowed in stadiums, with strict limits, because "the public demands to be in those stadiums. . ..  Going into a stadium in the middle of an epidemic is not a good idea." He said one stadium wanted 18,000 fans, "which means 600 infected people, shouting and screaming," and people in VIP suites. He estimated that could result in nine to 20 hospitalizations per game, and two deaths.

“We certainly can’t live in fear and not get back to some activities, but we can’t be reckless and careless about it, Stack said. “You could just turbocharge an epidemic,” especially in a major city like Louisville.

In a written question from the last meeting, Westerfield asked if "school data related to abuse/dependency/neglect referrals, substance use [and] behavioral health referrals [is] weighed against covid data when making the recommendations and orders related to schools."

Stack replied in writing, "These are all public-health issues. Social-emotional status of students, food insecurity, drug overdoses, child abuse, etc. all weigh on the minds of public health. Balancing these issues with the effects of a deadly virus that spreads so rapidly presents challenges. However, death or long-term health impacts on individuals from this virus cannot be reversed. Currently, these unintended consequences of managing covid-19 are not contemporaneously measureable as [are] individuals diagnosed with covid and any associated deaths. Data is being collected on abuse/neglect as well as for overdose deaths and other behavioral health impacts. The use of medication-assisted therapy, telehealth and other tele-visitation put in place since the very early stages of covid-19’s entrance into Kentucky has been very helpful. The assessment of the full consequences of covid-19 and impact of the measures taken to minimize the impact on individuals and the economy will be measured and studied for years to come."

A video of the committee meeting is on the KET website.

Public-health officials defend their data, calling it imperfect but useful, and explain support for Beshear's school recommendation

By Melissa Patrick

Kentucky Health News

A legislative committee meeting to review how the state collects and reports coronavirus data shifted quickly Thursday to Republicans' questions about Democratic Gov. Andy Beshear's recommendation to delay in-person schooling until Sept. 28, and his general handling of the pandemic.

Dr. Steven Stack and Doug Thoroughman
(Photo by Dalton Godbey, posted on Twitter)

"We don't close our schools down for influenza, but we do for covid," said Sen. Danny Carroll of Paducah, after establishing that more children die in Kentucky from the flu (six last season) than have died from covid-19 (one so far).

Carroll's "why" question at the meeting of the Program Review and Investigations Committee, which he co-chairs, was answered by Doug Thoroughman, the acting state epidemiologist.

"If you don't take the measures to reduce transmission and keep it slower, unlike flu, you are going to see eventually, like a New York – if you get the hospitals overwhelmed, you lose a lot of people, because you don't have the ability to care for them," Thoroughman said.

Gov. Andy Beshear regularly points out that while children generally have milder cases of the disease, they can spread it to their teachers, staff and caretakers, who are often grandparents, even if they don't have symptoms. And those people are more likely to die from covid-19 than from the flu.

"Mortality is definitely higher for covid-19" than for flu, Thoroughman said. Kentucky has had 810 deaths from covid-19, starting in March; in the past four years, 767 Kentuckians have died from the flu.

Rep. Lynn Bechler, R-Marion, asked if it is safe to say that 99 percent of the population won't die from covid-19. Health Commissioner Steven Stack said that's true, but it's important to recognize exactly how many deaths 1% would represent, noting that is 10 times greater than the fatality rate for the flu. "One percent of 330 million is 3.3 million people. So 1 percent of a big number is still a big number," he said.

Carroll noted that almost two-thirds of the covid-19 deaths in Kentucky have been nursing-home patients, and questioned whether that warranted delaying in-person classes or shutting down businesses.

Stack, a physician, said there's not much he'd change about what he and Beshear have done, saying the opening of schools in other states to in-person learning has shown that the virus spreads like wildfire. 

"I realize we've got to let things get back in motion, and I think that we're starting to do that more and more as we learn where we can pull back and allow things to go," Stack said, "but I still think we are following the general trend where the majority of public health experts are recommending we go, as we are trying to learn as rapidly as possible." 

Schools were a persistent topic of the meeting, held three days after Beshear recommended that schools delay in-person instruction to Sept. 28. Three days before that, the Kentucky Education Association, one of his major political allies, said in-person classes shouldn't resume until the positive-test rate declined significantly.

Carroll referred to KEA's statement and asked Stack, "Are you aware of any political motivations to change that recommendation so quickly?" Stack replied, "No, my recommendations to the governor are based on public health." 

Asked what had changed, Stack said the state saw an exponential growth in cases, and Dr. Deborah Birx, the White House Coronavirus Task Force response coordinator, recommended that the state take aggressive steps to tamp down the infections or risk becoming the next Arizona, Texas, South Carolina or Florida. 

Rep. Steve Riley, R-Glasgow, asked if there had been any consideration for the irreparable academic damage that some students will suffer, noting that there is little substitute for in-person instruction, especially in the lower grades. 

Stack said it is "mission critical" to reopen schools, but suggested delaying the start of in-person instruction will allow the state to see what happens in other states that have already reopened, and could convince some mask-reluctant Kentuckians to change their minds. 

"I think there are still a fair amount of people who don't believe in these masks," he said. "There are still a fair amount of people who don't believe in staying six feet apart. I think if they see all the schools shut down in Georgia and in other states that are opening and not following the rules consistently, it may help others to say 'Maybe if I wear a mask and I stay apart that we can open schools better'." 

Sen. Whitney Westerfield, R-Crofton, asked if Stack and Beshear had considered any of the collateral damage that results from closing schools, such as substance abuse. He said it is up, but abuse referrals and behavioral-health referrals, many of which are initiated in schools, are down. 

Stack concluded a long, detailed response by saying, "I think it's fair to say that we have a pretty robust effort to try to be aware of those different trade-offs and considerations." 

Data debate

The first half of the meeting was spent on how the state gathers coronavirus data and reports it, a complicated system with dozens of testing laboratories, multiple reporting mechanisms, daily cleaning of the data and a governor who needs a daily report for his 4 p.m. news briefing.  

"For covid-19, because we do these daily updates, we are compressing about two weeks for a given case of disease into a few hours each day," said Thoroughman, the epidemiologist. 

One metric reported daily is the percentage of Kentuckians who tested positive for the coronavirus over the past seven days. Thoroughman said this metric isn't perfect because some labs don't report their negative results, despite efforts of the Department for Public Health to get them to do so.

State law doesn't require reporting of negative tests, "so that makes it really difficult to get positivity rate," Thoroughman said. 

Carroll asked, "So why would we even report those numbers to the public when they are nowhere near accurate?" 

Thoroughman replied, "Well, because there is a huge clamoring for it." He also said the state has found a need to show more accurate figures than those reported by the federal government, which are generally 2 to 3 percentage points higher because it misses a lot of negative case numbers due to the ways different labs report. (Also, Stack has said the federal numbers include all positive tests for the same person, but the state "de-duplicates" them.)

"It sounds like we are making decisions based on that positivity rate that is totally inaccurate," said Carroll.

Slide from Health Commissioner Steven Stack's presentation to the committee

Stack pushed back, saying that even though the number is not perfect, it's an important number to pay attention to, and shows trends.

"We're making decisions on a lot of data points and this is just one," he said. "I can assure you our decision making is far more complicated and intricate than relying on any single metric, including this one. . . . The data has been, is and will remain imperfect, but we are committed to doing the best we can, but it is not perfect. But it is still very useful."

On another key metric, daily new cases, which can fluctuate widely, he said, "I look at decision making often on a weekly basis, because the day to day variation may be an artifact, and not representative of what is truly happening." He said regardless of when they are reported, all new cases are unique people.

Near the end of the two and a half hour meeting, Carroll's frustration with the Beshear administration bubbled over. 

"The problem we have right now is half of this state doesn't believe anything you all say, and it hinders the effort," Carroll said. "And in my view, all of that could have been avoided from the very beginning had the governor decided to structure things properly, to reach out to the House, to the Senate, to build a consensus, to bring in a panel of experts maybe as a covid commission, to provide advice and everyone stand up united."

He added, "I think there would be a higher level of trust to what is coming out and at this point, honestly sir, I don't believe a lot that comes out. There's just so many holes in so much of it, and politics has taken over and it's a struggle and I wish it were different,  I truly wish I felt differently, but I don't."

Leaders of the Republican majorities in the Senate and House have complained about Beshear's lack of consultation with them. Carroll asked Stack if he thought it could be done better. Stack said that theoretically it could, since most Americans say they want their politicians to work together. He also noted the strong differences of political opinion that exist in Kentucky, and said they didn't just show up in 2020. 

Carroll said, "If there ever was an incident that we need to be united on in recent decades, this is it, and we just missed it. It falls in different areas. I think we got off to a good start, I think the governor got off to a good start, it just didn't last long. It's just sad that this didn't happen, and that's why there is so much division and that's why people are just mad right now, and it's getting worse, and I hope that, it would be my hope, that we could get past that and we could start working together more closely."

Other questions 

Asked why the state hasn't implemented restrictions by ZIP code or county, Stack said the virus has no regard for a map, nor do people who cross county lines for work, school, church and so on. 

Sen. Karen Berg, D-Louisville, asked about the 123 child-care centers that have reported positive cases, saying that she was hearing some refuse to report them for fear of being shut down. 

Stack said he had heard such stories about churches and businesses, and said there is a fine line between citizens' need to know, to keep themselves safe, and personal or business privacy. He assured Berg that they were making every effort to protect privacy so people will participate in the process. 

Sen. Michael Nemes, R-Shepherdsville, asked the average age of death and a covid-19 death in Kentucky, and was told 75.8 and 77.4, respectively. 

Asked about herd immunity, Stack said only about 5% of Kentuckians have been infected with the virus and that 60% to 70% of the population would need to be infected to reach herd immunity. Thoroughman said he thought it would need to be 95%, because the disease is so infectious. He is an epidemiologist; Stack is a former emergency-room doctor who was president of the American Medical Association.

A 95% level of infection would result in a tremendous number of deaths in a short period of time. Stack said that if somehow 100% of Kentuckians were to get infected over the next 12 months, with a mortality rate of 1%, 45,000 Kentuckians would die from it; and even if that rate were cut in half, that would leave 22,500 Kentuckians dead. 

Rep. Rob Rothenburger, R-Shelbyville, asked about supplies of personal protective equipment. Stack said that he also is concerned because of the surges in other parts of the country, and "It's about to get more difficult to get."

Stack said the state had increased its warehouse space by 116% and wants to have a multi-month supply of PPE. He said it has about a six-week supply for hospitals and first responders in case of a major surge, more than other states in our region. He said hospitals are required to have a 14-day supply.

Stack told Bechler that cases in Kentucky appear to be on a second plateau, and avoiding another increase is important to ensure that the state has enough hospital capacity. He said the recent rise in cases in Eastern Kentucky prompted the Appalachian Regional Healthcare to imposed a two-week hold on all elective procedures in its hospitals, which are filling up with covid-19 patients.

Video to prevent shaken baby syndrome, being seen at birthing centers, wins a state public-health award

A video aimed at preventing shaken baby syndrome, by educating parents about it, has won an award from the Kentucky Public Health Association.

“Many of us remember taking a baby home from the hospital and thinking, ‘Where’s the instruction book?’” said Bill Jones, CEO of WellCare of Kentucky, which so-sponsored the video. “This video doesn’t provide answers for all of parenthood’s challenges, but it will give parents vital information to help keep children safe. As the largest Medicaid provider in Kentucky, we believe strongly in the importance of prevention practices. Often, information is prevention.”

WellCare, a managed-care company, developed the video with Prevent Child Abuse Kentucky and the Kentucky Hospital Association, which shared in the award. They distributed the video to birthing centers throughout Kentucky last year.

The hospital group said the video could be viewed by 50,000 new parents a year, at the state's 46 birthing centers. “Becoming a new parent can be both overwhelming and joyous,” CEO Nancy Galvagni said. “Our birthing hospitals are in a unique position to provide immediate support to new parents, and through this ground-breaking educational video, we can protect thousands of infant lives.”

Shaken baby syndrome is the common name for pediatric abusive head trauma. "Serious traumatic brain injury in young children is largely the result of abuse and results in significant morbidity and mortality," says the Centers for Disease Control and Prevention.

The video focuses on the story of Liz Renner, and her son Colton, Now 4, Colton suffered trauma at the hands of a caregiver as an infant. “My hope is our personal story can be shared with as many new parents as possible so others can prevent this type of trauma from happening to their babies,” Renner said.

Unanimous Senate sends female genital mutilation ban to House

By Melissa Patrick
Kentucky Health News

A bill to ban female genital mutilation in Kentucky unanimously passed the Senate Jan. 22 and went to the House Judiciary Committee for consideration.

Sen. Julie Raque Adams

The sponsor of Senate Bill 72, Majority Caucus Chair Julie Raque Adams of Louisville, told senators that FGM has no health benefits and  creates life-long physical and physiological harm. It is usually performed on girls between 4 and 14.

“Female genital mutilation is one of the most egregious forms of child abuse," Adams said. "It is internationally recognized as a violation of human rights and a form of discrimination against women."

Kentucky is one of 15 states where FGM is still legal. A federal ban that had been in place for more than two decades was found unconstitutional in 2018, putting the responsibility on states.

The United Nations Population Fund estimates that 200 million women and girls have suffered FGM. The federal Centers for Disease Control and Prevention estimates that 513,000 American females are at risk of FGM or have undergone it. In Kentucky, that number is estimated at 1,845, according to the Population Reference Bureau.

An FGM survivor named Jenny, who asked that her last name remain private, gave several reasons for the bill at the Jan. 15 Senate Health & Welfare Committee meeting.

She said a law banning the practice would offer support to women who are surrounded by people who still believe in it, but want to give their daughters "an out;" prompt women who have had FGM to ask questions, since many think it is done to all females; let people in other states know that Kentucky is not a "safe haven" for it; and promote badly needed education about it.

The bill would make FGM a felony if performed on a female under 18. It would ban trafficking girls across state lines for FGM, and revoke the licenses of medical providers convicted of the practice. It classifies FGM as a form of child abuse and would require mandatory reporting of it.

It would also mandate training for law enforcement and require the state Department for Public Health to produce and disseminate educational materials about it, and allow victims of the practice to file civil lawsuits up to 10 years after turning 18.

The bill had 12 sponsors, representing both parties. Click here for a fact sheet about FGM.

New AG vows to fight child abuse (Ky. ranks No. 1 in it); child-advocate groups want changes in state laws to protect children

Kentucky's new attorney general called a press conference to declare his office's commitment to partner with child-advocacy organizations and state and federal prosecutors to prevent child abuse, and to prosecute abusers to the fullest extent of the law.

Atty. Gen. Daniel Cameron spoke at a press conference
about child abuse. (Louisville Courier Journal photo) 

"We are No. 1 in child abuse and neglect, and that has to stop, especially as we move into the new decade," Attorney General Daniel Cameron said at a press conference with Kentucky Youth Advocates in Louisville Jan. 7.

Kentucky has ranked first or second for each of the past six years for child maltreatment and has ranked among the 10 worst states for more than a decade, Deborah Yetter reports for the Louisville Courier Journal.

Yetter reported in August, in a story titled "Tortured and Abused: Why Kentucky can't stop hurting -- and killing -- its children," that federal statistics show Kentucky has the nation's highest rate of child abuse or neglect, with some cases so severe an independent panel has classified them as "torture."

In September, Yetter reported that the number of Kentucky children killed or nearly killed from abuse or neglect is likely even higher than what the state reports to the federal organization that compiles the data. "In some cases, Kentucky social service officials decline to classify the deaths as caused by abuse or neglect, therefore keeping the numbers lower," she wrote.

In 2017, Kentucky reported 16 deaths and 56 near-deaths of children from abuse or neglect. In 2018, 24,066 Kentucky children were victims of abuse or neglect, KYA said in a news release.

Substance abuse and addiction occur in as many as 70 percent of the cases investigated by the Cabinet for Health and Family Services, Yetter reports.

Keith Inman, president of Kosair Charities, asked for the public's help in identifying, reporting and helping prevent child abuse. Six years ago, Kosair founded the Face It Movement to end child abuse in Kentucky, which now includes more than 100 groups, Yetter reports.

Cameron said his office will develop a prosecutor's manual to help commonwealth's and county attorneys statewide better prosecute adults for abuse and neglect of children.

KYA Executive Director Terry Brooks said Face It will seek several changes in state law, including removing the clergy-penitent exemption for child abuse so clergy can report it to the authorities; clarifying rules around mandatory reporting of child abuse, to keep an agency from investigating itself; and tightening the rules for home schooling so that parents suspected of abusing or neglecting children can't remove them from school and claim to be home schooling in order to avoid scrutiny.

KYA would also like to reform the county-coroner system, with more training of the elected officals and standardized systems of investigating and reporting child deaths, Yetter reports.

Learn more about Face It’s 2020 policy priorities at faceitabuse.org/policy/. If you suspect child abuse or neglect, make a report at 1-877-KYSAFE1.

As CJ spotlights child abuse and issues of substance abuse, state social-services staffers start new substance-abuse training

On the same day the Louisville Courier Journal published a five-part series on child abuse and its link to substance abuse in Kentucky, the state's social-services department announced that it has started training employees on how to better address substance-use disorder in families they serve.

Trainees in the Department for Community Based Services will learn about stigmas surrounding substance-use disorders, treatment and recovery, risk and safety assessment of those disorders, and how adverse childhood experiences or early trauma can negatively affect childhood and beyond, said a news release from the state Cabinet for Health and Family Services.

“Drug and alcohol addiction is a behavioral health condition, and we know that substance-use-disorder treatment works. Recovery is possible,” DCBS Commissioner Eric Clark said. “This training helps support our staff to remove any stigma and to better engage with families to recognize safety concerns and assess treatment options.”

The state reports that substance abuse contributed to 75% of all foster-care placements in the fiscal year that ended June 30; as of Aug. 4, it said, 9,660 children were in "out-of-home care" in Kentucky.

The training is part of the Kentucky Opioid Response Effort, the cabinet’s overall effort to combat the opioid crisis. More broadly, the release says, it is part of a larger reform program that the state will launch in October called the federal Family First Prevention Services Act, which will allow states to invest more money in prevention in hopes to head off the need for foster care.

The state already has two programs to help parents with addictions to keep their children out of foster care while keeping the child safe. However, Sobriety Treatment and Recovery Teams (START) and Kentucky Strengthening Ties and Empowering Families (KSTEP) are offered only in certain counties. Clark said in the release that the state hopes to expand these programs.

Banner photo for Courier-Journal series: grave of a Menifee
County toddler who was raped and murdered by her mother's
boyfriend (Louisville Courier Journal photo by Matt Stone)

The five-part Courier Journal series titled "Tortured and Abused," written by Deborah Yetter, paints a grim picture of child abuse and its relationship to substance abuse in Kentucky. She reports that since 2017, seven Kentucky children have died from abuse.

"Kentucky has come in first or second each of the last six years for child mistreatment and has ranked among the 10 worst states for more than a decade," she reports. Kentucky currently leads the nation.

The first of Yetter's stories focuses on the issues of child abuse at large, the second on the state's efforts to address the problem and the third focuses on how stress and high caseloads are causing social workers to quit faster than they can be replaced. The fourth tells the story of a foster child who was failed by the system, but was able to turn her life around and the fifth features a family recovery court in Jefferson County that is funded by private donors, who want to replicate it elsewhere.

Yetter notes that Clark recently told state legislators, "We have to own and acknowledge we lead the nation in child abuse in Kentucky, and we have to do better."

Kentucky leads the nation in child abuse, which in most cases is neglect that equals abuse; April is Child Abuse Awareness Month

From an editorial by The Winchester Sun

Kentucky ranks first in the nation in a terrible way, according to a recent report.

The most recent Child Maltreatment Report, issued in late March by the the Children’s Bureau of the U.S. Department of Health and Human Services, reveals Kentucky has the nation's highest rate of child abuse, which includes child neglect.

According to the report, Kentucky had 22,410 child-abuse victims in 2017, the last year for which data is available. That equates to a rate of about 22 victims per 1,000 children in the commonwealth, which is more than twice the national average rate of nine. Ten child fatalities were attributed to abuse in Kentucky in 2017.

Kentucky’s child-abuse rate has increased annually from 2013, when it was 17.3 per 1,000. That's an increase of more than 27 percent over the four-year period. Among the victims in 2017, more than 15,000 were first-time victims, meaning more than 7,000 children had been abuses in previous years.

Most of the the 22,410 cases (21,313) in 2017 were attributed to neglect. There were 487 cases of medical neglect, 1,533 cases of physical abuse, 44 cases of psychological maltreatment and 852 cases of sexual abuse. Many involved more than one of these serious issues.

More than 3,000 of Kentucky’s cases of child abuse involved alcohol abuse by their caretaker and nearly 12,000 involved drug abuse. Also, according to the report:

• Nationally, evidence indicates children are most likely to be abused by their parents
• Children in their first year of life have the highest rate of victimization at 25.3 per 1,000 children of the same age in the national population. In Kentucky, 3,090 cases were reported in children younger than 1 year in 2017.
• “Child fatalities are the most tragic consequence of maltreatment,” according to the report. “For 2017, 50 states reported 1,688 fatalities.”

While many die each year, and others are treated, there are likely thousands more cases in our state where the abuse goes unreported. These children survive, but are destined to deal with the negative ramifications of their childhood abuse for the rest of their lives — often prohibiting them from becoming well-functioning, healthy, productive adult citizens.

April is Child Abuse Awareness Month, a time dedicated to honoring and remembering the lives lost too soon to abuse and neglect. The month also serves as an opportunity for the community to band together to raise awareness, educate about risk factors and indicators and advocate for children.

It’s a problem that has no easy solution, but one that must be addressed from multiple angles and quickly. We can all take part in reversing this negative trend and helping survivors. The most important things we can do are advocate and educate. Learn about the indicators of abuse. There are many, including unexplained bruises, cuts, welts, scars, fractures and burns.

There are also behavioral indicators, like aggressiveness or withdrawal. Other obvious signs are children who are frightened of their parents or say they are afraid to go home. Be mindful of children who report being extremely hungry, who exhibit bad hygiene or dress inappropriately for the season.

Watch for children in your community who are often unsupervised, especially for long periods of time or in potentially dangerous scenarios. Report potential abuse to the police or by calling the Child Help National Child Abuse Hotline at 1-800-4ACHILD.

Encourage your legislators to support laws that protect children and strengthen punishments for abusers. Additionally, our state must continue fighting against addiction, including drugs and alcohol. They play a huge role in the quality of life for our families and children, and as this research indicates, contribute to child abuse and neglect in our state.

Our state needs to also allot more funding for the Department for Community Based Services and other child-welfare programs. There are shortages of qualified social workers and foster parents to help these children find their way out of abusive homes and into loving, safe places.

Finally, we need to improve access and funding for programs for parents, including parenting classes, HANDS programs, educational programs and other assistance programs to reduce the burden of stress many parents, especially first-time, young or low-income parents feel, which might result in abuse or neglect.

Childhood should be fun. It should be a time of growth and learning. It’s a time to be nurtured and loved. Our children are our future and they deserve better.

Be mindful. Speak up. Stop abuse. Report it. Be an advocate. Help make the world a better place for children.

Study of Ky. kids' well-being finds less smoking in pregnancy, fewer low-birthweight babies and pregnant teens; has local data

By Melissa Patrick
Kentucky Health News

Kentucky continues to make progress in expanding the number of children with health insurance, having fewer low-birthweight babies, and lowering rates of teen pregnancy and smoking during pregnancy, but it has high rates of children living in out-of-home care because of abuse or neglect, according to the annual Kentucky Kids Count report. It shows those rates vary widely by county.

The report, released Tuesday by Kentucky Youth Advocates and the Kentucky State Data Center at the University of Louisville, is part of the 28th annual release of the County Data Book, which provides data on overall child well-being through 17 measures in four areas: economic security, education, community strengths, and health and family. Nearly one in four Kentuckians are children.

Kids Count Data Center map of births to mothers who
smoked during pregnancy, 2014-16.

A bright spot in the report is that fewer Kentucky women are smoking during pregnancy.

Statewide, the report found that rates of smoking during pregnancy dropped to 18.1 percent in 2014-16, from 21.3 percent in 2009-11, with 110 of the state's 120 counties showing improvement.

"Tobacco addiction is so difficult to break, but this report is proof positive that women all over Kentucky are finding a way to protect their babies from the dangers of smoking while pregnant," Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky, said in a news release. "They're reducing the risk that their babies will be born with birth defects or die suddenly without explanation during infancy. And they're increasing the chances their babies will be born full-term and at a healthy weight."

Seventy-three counties saw a reduction in low-birthweight babies. Statewide, this rate dropped to 8.8 percent in 2014-16, from 9 percent in 2009-11.

But amid the good news, there is bad news. Since 2009-11, 45 counties have seen an increase in their percentage of low-birthweight babies. Ten counties saw higher rates of women smoking during pregnancy, including: Allen (23.9 percent in 2014-16), Carroll (28.3), Clinton (28.8), Estill (33), Fulton (23.7), Graves (17.7), Henderson (21.2), Lewis (30.9), Magoffin (31.9) and Wayne (28.1).

And while smoking during pregnancy declined in Lee and Owsley counties, more than 40 percent of expectant mothers in those counties smoked in 2014-16 -- and 22 counties had smoking-during-pregnancy rates of 30 percent or higher.

The state's teen-pregnancy rate continues to drop. It declined to 31.7 teen births per 1,000 females aged 15-19 in 2014-16, down almost a third from 45.9 per 1,000 five years earlier. Kentucky's rate still remains about half again as high as the national rate, 20.3 teen births per 1,000.

Differences between counties remained great, ranging from a low of 7.9 teen births per 1,000 in Oldham County to a high of 79.5 teen births per 1,000 in Elliott County. And while 108 counties saw a drop in their teen-birth rates, several of the remaining 12 had large increases, including: Lawrence County by 14 points, to 52.4 per 1,000; Lee County, up 10 points to 49.6 per 1,000; and Menifee County, up by 12, to 59.6 per 1,000.

Other key findings about Kentucky's children in the report:

• Nearly 97 percent of Kentucky's children have health insurance, and all 120 counties showed improvement.
• One in four Kentucky children live in poverty, defined as annual household income of $24,339 or less for a family of four. The good news is that this rate decreased in 93 of the 120 counties.
• The rate of children in out-of-home care increased in 92 counties, "fueled by parents struggling with addiction." Elliott County had the highest rate, with 118.2 in out-of-home care per 1,000 children aged 10-17. The state rate is 43.7 per 1,000.
• The number of children being raised by a relative has increased by 75 percent, from 55,000 in 2012-14 to 96,000 in 2016-18.
• 119 of 167 school districts saw an increase in the rate of students graduating on time; graduation rates declined in 46 districts. About 90 percent of Kentucky's high-school students graduate on time.

This year's report also explores the issue of child abuse in Kentucky, noting that 20 of every 1,000 children in the state experienced abuse and neglect in 2016, more than twice the national average. As part of a five-page essay, titled "Putting a Plug in the Abuse to Prison Pipeline," the report calls for "collective engagement across systems" to tackle the issue.

“These pressing challenges call for smart policies, innovative solutions, and focused attention on our priorities,” Dr. Terry Brooks, executive director of KYA, said in a news release. “The more we support all Kentucky children to grow up healthy, hopeful, and contributing to the community, the brighter our future looks.” 

The Kids Count Data Center is also available for a deeper dive into the data. It offers a profile sheet for every county that shows rankings and can be used to create maps and charts for comparisons.

KYA will hold "Kids Count Conversations" in Paducah, Glasgow, Louisville, Manchester and Covington to help community leaders use local data to inform policy that impacts their youth. E-mail KYA at kidscount@kyyouth.org if you would like to have such a conversation in your community.

The 2018 County Data Book was made possible with support from the Annie E. Casey Foundation and local sponsors Passport Health Plan, Delta Dental of Kentucky and Kosair Charities.

Kentucky's decade-old program to help children who are at risk from drug-using adults is becoming a model for other states

Recovered opioid addict Raven Mosser credits her success in staying sober to Kentucky's START program. She moved to Ohio to become a recovery coach for other parents struggling with addiction. (Kaiser Health News photo by Sholten Singer)

Kentucky's program to help children placed at risk by adults' drug use has become a model for other states. Ohio's new plan is modeled explicitly on Kentucky's, and Indiana and North Carolina are launching initiatives too, Shefali Luthra reports for Kaiser Health News.

"Kentucky was a pioneer, starting in 2007, when opioid addiction first emerged as a public health concern. The program, called 'Sobriety Treatment and Recovery Teams' — or START — emphasizes a wraparound approach for at-risk parents that includes frequent home visits, vouchers for child care and transportation and mentorship from people in recovery," Luthra writes. "Under the Kentucky model, when child protection specialists learn a child is at risk, authorities specifically assess whether substance abuse could be a factor. If so, the parent is fast-tracked into treatment and assigned a 'recovery team,' which coordinates among agencies such as children’s aid, mental health, social services and recovery mentors."

One of the less-discussed effects of the opioid epidemic has been the strain it places on foster-care systems. Ohio, which has the nation's highest rate of heroin-overdose deaths, has been particularly hard hit. "Ohio's opioid epidemic is seen as the direct cause of an 11 percent increase in children in state custody over the past six years, according to the Public Children Services Association of Ohio," Dina Berliner reports for The Athens News.

Only 7,200 families are registered as foster parents in Ohio, but there are 15,000 children in the state's foster-care system, says state Attorney General Mike DeWine. And half of those kids are in foster care because one or both of their parents are opioid addicts, according to a 2016 survey by the Public Children Services Association.

It's a trend seen in other states. "Data from the U.S. Department of Health and Human Services show that from October 2012 to September 2015, as addiction surged, the number of kids entering the foster system rose 8 percent," Luthra reports.

59 percent of Ky. adults have experienced at least one adverse childhood experience, linked to physical and mental health issues

Robert Wood Johnson Foundation illustration

By Melissa Patrick

Kentucky Health News

Many health-care providers have started looking at adverse childhood experiences when assessing their patients' poor health because ACEs have been linked to risky health behaviors, chronic health conditions, low life potential and early death, and because 59 percent of Kentucky adults were exposed to at least one such experience as a child.

"There are things that happen to us early that make a huge difference in what happens to us as we get older," Dr. Connie White, senior deputy commissioner for the Kentucky Department of Public Health, said at a March 22 meeting in Frankfort to prioritize the state's top health issues.

ACEs are "potentially traumatic events that can have negative, lasting effects on a person's health and well-being, including early death," the department says. They include: physical abuse, sexual abuse, emotional abuse, physical neglect, emotional neglect, a mother being treated violently, parental separation or divorce, substance misuse within the household, mental illness in the household, and having an incarcerated household member.

White said it is important for children to live in a secure and nurturing environment during the first two years of their life because this is when brains are "hard-wired" for social-emotional development. But she said it is just as important for children to grow up in an environment that is free of traumatic events.

"It's like building a house," she said. "There is a foundation, and if you don't start out with a very good foundation you are going to have a very unstable house."

White said children who grow up with ACEs often struggle academically and behaviorally.

"These children have impaired memory, they have an inability to concentrate, it's hard for them to stay seated, it's hard for them to follow directions, they are constantly on edge, they are easily provoked and they are impulsive because of the toxic stress they have at home," she said. "So these are children that are hard to deal with and I think the folks in our judicial system see these children all the time."

At least one program in the state is working to inform educators on how to deal with ACEs. The Louisville program, called the "Bounce Coalition," provides training on ACEs and resiliency to school staff and out-of-school activity providers in two Jefferson County public schools and will soon expand to three more and more than 500 YMCA programs this spring. This work, funded by a grant from the Foundation for a Healthy Kentucky, is expected to evolve into a state model for addressing ACEs.

Research shows that the impacts of ACEs don't end in childhood. The original ACE study, conducted by the Centers for Disease Control and Prevention and Kaiser Permanente, found a clear scientific link between many types of childhood adversity and the adult onset of physical disease and mental health disorders.

The report said that as the number of ACEs increases, so does the risk for things like alcohol abuse, chronic disease, poor work performance, financial stress, domestic violence, suicide and poor academic achievement, to name a few. It also found that people with six or more ACEs died nearly 20 years earlier than those without ACEs.

Kentucky just started surveying for ACEs on its 2015 Behavioral Risk Factor Survey. The poll found that 59 percent of Kentucky adults had experienced one or more ACEs, 64 percent had two or more and 17.5 percent had experienced four or more, higher than any other state that surveys for ACEs.

Kentucky's survey found similar results as the original national study, showing that the more ACEs a Kentucky adult had, the more likely he or she was to have smoked cigarettes, use and abuse alcohol use, bear or father children in their teens, attempt suicide during adolescence, have chronic depression as an adult, have impaired work performance, and have many chronic diseases.

"So this is an issue that I think we all need to be cognizant of so that we are not asking people what's wrong with you, but we start to think what happened to you and how did you get where you are right now," White said, noting that it is never too late for a person to learn how to be more resilient.

She added: "We can't go back and fix what's happened, but we can work on trying to figure out where people are coming from and how we can help them be better."