Annual policy forum will focus on role of education in health

Individual and public health are influenced by many things, including the educational characteristics of people and their communities. Education will be the focus of the Foundation for a Healthy Kentucky’s 2022 Howard L. Bost Memorial Health Policy Forum, to be held virtually from 9:30 a.m. to 4:30 p.m. Oct. 17.

The forum will look at the connection between educational opportunities and health outcomes of Kentuckians, as one of the social determinants of health. Presenters and panelists will consider education as a cornerstone of Kentucky’s health outcomes. It is offred free of charge. Register here.

“Education is more than what happens between the four walls of a school building,” said Ben Chandler, president and CEO of the foundation. “Educational factors that influence health outcomes include everything from life skills — mental health, emotional literacy, financial literacy, and nutritional literacy — to local community programs, such as out-of-school care and workforce training, to equity issues. It’s important we consider all the factors of health to find ways to make a positive impact.”

Looking beyond the K-12 education system, panelists and presenters will discuss programs that can enhance education and provide more equitable access, while leading to better health outcomes for individuals and communities. Attendees will learn about replicable community-oriented collaborations and coordination between sectors that have led to improved health overall.

The 2022 Kentucky Teacher of the Year, Willie Carver, will give the keynote address. Sessions will include:

• Making the Case for Funding, in Education and Beyond: Considering education as a social determinant of health, panelists will discuss school funding, social safety net programs’ impact on education, and real examples from urban and rural schools.
• Literacy for Life (Critical Lessons for Positive Health): They’re lessons most don’t receive in school but can mean the difference between addressing and overcoming life’s challenges or becoming overwhelmed. Panelists will discuss mental health and emotional literacy, financial literacy and navigating systems, and how nutrition education impacts hunger long-term.
• Linked but Addressable; Helping Families Overcome Obstacles: A look at how family income plays a critical role in the academic outcomes of students, and therefore, the lifelong health of individuals.
• Breaking Down Barriers; Real Examples of Kentucky Communities Making Positive Change: Learn how local communities are lifting up families. Panelists will share about connecting families with early childhood intervention services; public schools and public health collaborating on mental health services; and, how a community is working to chart paths for non-traditional career building.

The forum is designed to raise awareness of the health issues impacting Kentuckians and highlights model strategies and policy opportunities to improve Kentucky’s health. The foundation created it to honor Dr. Howard L. Bost, a notable health economist and a founding member of the foundation’s board of directors. It welcomes a range of audiences, inside and outside the health industry – including health care advocates, providers and educators, business professionals, civic leaders, policy makers and more.

Updates on the forum are at Healthy-KY.org/bost-forum-2022.

 

Senate passes its version of state budget with many health items; $100 million would 'support a response to the nursing shortage'

By Melissa Patrick
Kentucky Health News

The state Senate passed its version of a two-year state budget by a 30-6 vote Wednesday, the same day it passed out of committee. The bill will soon head to a House-Senate conference committee that will write the final version.

The Senate-revised House Bill 1 has a number of health provisions, with some variations from the House version and Gov. Andy Beshear's proposals.

The Republican-controlled chambers and the Democratic governor have three different approaches to addressing the nursing shortage, which has been exacerbated by the coronavirus pandemic. 

Photo from American Nurses Association

The Senate allocated $100 million of federal relief money in the first year of the budget, starting July 1, "to support a response to the nursing shortage," without giving any details. The House included no money for the retention and recruitment of nurses.

Beshear, who said Thursday that the focus needs to be on retention, called for $6 million each year from the General Fund for nursing scholarships; and from relief funds, $5 million a year for five years to create a new student loan-forgiveness program and $2 million for a marketing and outreach campaign.

The House budget and Beshear's budget both include $17.7 million in the first fiscal year and $19 million in the second fiscal year to cover the costs of local health departments required services, but the Senate's budget only allocated money for the second fiscal year in the amount of $19 million. 

Randy Gooch, executive director of the Jessamine County Health Department, said the Kentucky Health Department Association isn't sure why the Senate would have left out an allocation for fiscal year 2023 and Sen. Chris McDaniel, R-Ryland Heights, who crafted the Senate budget has not yet returned a call for clarification. 

The Senate budget includes Beshear's wish for for 500 new Michelle P. waiver program slots for people with intellectual or developmental disabilities; the House provided for 100. The Senate added 200 slots to the Supports for community Living waiver program for similar beneficiaries, double what Beshear and the House proposed. Both programs have thousands of Kentuckians on their waiting lists.  

The Senate agreed with the House on extra funding for domestic-violence shelters, rape crisis centers and child-advocacy centers, allocating $500,000 more for each in each fiscal year. Beshear proposed a 36% increase each year for each type of organization: $2.5 million, $1.78 million and $1.3 million, respectively.

And while the Senate and House budgets both would fund 200 more social workers, Beshear's budget proposal would have funded an additional 350. 

To implement the new 988 suicide hotline, a three-digit number set to replace the National Suicide Prevention Lifeline in July 2024, the Senate budgeted $3.37 million in the first year and $9.9 million in the second, the amounts Beshear recommended. The House allocated much more: $12.4 million in the first year and $17.6 million in the second, but directed that the money also be used to create more mobile crisis units. 

The Senate allocated $500,000 in each year for the Lung Cancer Screening Program that would be established with the passage of HB 219. The bill passed the House in late January and in the Senate Appropriations and Revenue Committee, which wrote the revised budget. 

The Senate budget also says that each Medicaid managed-care organization that has a participating contract with Kentucky in the next contract renewal will cover lung-cancer screenings.  

Here are some other health-related provisions in the Senate budget. 

From the Tobacco Settlement Fund:

• $500,000 in each fiscal year to support the Kentucky Rural Mental Health, Suicide Prevention and Farm Safety Program, titled the "Raising Hope Initiative."
• $1.4 million each year for substance-abuse prevention and treatment for pregnant women with a history of substance-use disorders;
• $7 million each year for the Health Access Nurturing Development Services Program (HANDS) for poor families with young children;
• $900,000 per year for the Healthy Start initiatives;
• $900,000 a year for early-childhood mental health;
• $900,000 a year for early-childhood oral health;
• $2 million a year for smoking cessation. Advocates have long asked for more smoking cessation funding, asking recently on a Kentucky Educational Television lung-cancer forum that this amount, at minimum, go back to the pre-pandemic level of $3.3 million.
  

From the General Fund:

• $6.25 million in each fiscal year for cancer research and screening to be equally shared by the University of Kentucky and the University of Louisville;
• $500,000 in the first year and $493,500 in the second year for spinal-cord and head-injury research (an amount that was previously taken from the Tobacco Settlement Fund); 
• $93,700 in each year for grants to the Brain Injury Association of America, Kentucky Chapter and the Epilepsy Foundation of Kentuckiana to help veterans who have experienced brain trauma;
• $500,000 each year for the Kentucky Colon Cancer Screening Program;
• $100,000 per year for The Hope Center of Lexington for addiction recovery;
• $900,000 a year for The Healing Place, a Louisville recovery program;
• $1,495,000 a year to support the Lee Specialty Clinic, which provides specialty medical services for individuals with moderate developmental and intellectual disabilities living in residential and community settings. 
• $7.2 million in the first year and $14.48 million in the second fiscal year to expand the senior citizens' meal program. The appropriation will come from federal relief funds. 
• $1 million in the first year to support external performance reviews of substance-use treatment programs administered or funded by the health cabinet. 
• $2.5 million in each year to the Kentucky Pediatric Cancer Research Trust Fund; Beshear's proposal provided $3.75 million in each fiscal year. 
• $750,000 per year for the Kentucky Poison Control Center, unless federal emergency relief funds become available;
• $1 million a year for the Ovarian Cancer Screening Outreach Program at the University of Kentucky; the House budget had $500,000 a year. 
• Federal and state funds are allocated in both years to maintain the pandemic-elevated reimbursement of $29 per day per Medicaid patient in nursing homes.
• Money is provided to support expansion of of a pilot program for Tim's Law to additional locations as a way to ensure statewide access. Tim's Law allows judges to order assisted outpatient treatment for people who have been involuntarily hospitalized, aimed at stopping the revolving door them going in and out of jails and state psychiatric hospitals.

As more people get vaccinated, the opportunity to reconnect with others increases; experts talk about why touch is so important

ColoradoBoulevard.net photo

By Melissa Patrick

Kentucky Health News

After a year of pandemic-forced isolation, when the simple act of touching became dangerous almost overnight, the arrival of highly effective vaccines means it's OK for fully  vaccinated people to touch again — and experts say it's important we do. 

That's because touching is how we show each other compassion and love, and because it is necessary for our physical, mental and emotional health, said Joe D'Ambrosio, a licensed clinical social worker in Louisville.

"Weighing the responsibility that we have to not increase Covid in this pandemic against human needs, I think that is the balance that we have to make," said D'Ambrosio, who is also a licensed marriage and family therapist, a lawyer and an assistant professor at the University of Louisville School of Medicine.

D'Ambrosio said he has encouraged his clients throughout the pandemic to put on a mask and hug the people to whom they are regularly exposed. "I think that we have to be wise, we have to assess each situation and maybe even risk a bit to care for yourself and care for one another," he said. "We can't always live in a bubble. That's not going to work." 

Other opportunities for touch

D'Ambrosio acknowledged that many people are still scared to touch each other, even if they are fully vaccinated. For them, he advises finding other ways to get that tactile experience. For example, he encouraged them to regularly hug their pets, get a massage or take a warm bath and sleep under a weighted blanket.

There is even value in simply hugging yourself, said D-Ambrosio and Jill Cole, massage therapy coordinator at UK HealthCare's Integrative Medicine and Health. As we wait on restrictions in touch and social distancing to be lifted, and "are able to come back together, I think it's important that we think about opportunities for touch," she said. "The first thing we can do is just simply give ourselves a hug. I know that may sound a little hokey, but that is a form of touch." 

Healthline has reported the benefits of giving yourself a hug, including research showing it can relieve pain, help you feel safe and secure, improve your mood and increase self-compassion. The article also offers instructions on how to do it, titled, "Self-Hugging 101." 

Cole also encouraged people to seek out safe, therapeutic massage as part of their self-care during the pandemic. Information about whether a massage therapist is licensed and in good standing with the state can be found on the Kentucky Board of Massage Therapists website, she said. 

"Touch is important because it's inherent to who we are as humans. We have a significant need to receive and to give touch," she said, later adding, "Touch helps us physiologically, it helps us emotionally, it helps us spiritually, it definitely helps us physically."

Technology can also help seniors stay connected to their loved ones. Sheri Rose, CEO of the Thrive Center, a nonprofit senior-innovation center in Louisville, said it has a pilot program with Louisville's Nazareth Home that uses larger than normal tablet devices that can connect Facebook to Alexa, with the goal of increasing social connectedness between residents and families.

But while such things as artificial intelligence and robotics can help seniors age in place and stay connected, she said, "Nothing will replace the person being there, and that human touch." 

Why touch is important

Touch is required for human survival, just as food and water is, Tiffany Field, director of the Touch Research Institute at the University of Miami, told The Economist, which summarized: "It is the first sense to develop and the only one necessary for survival. We can live with the loss of sight or hearing. But without touch, which enables us to detect such stimuli as pressure, temperature and texture, we would be unable to walk or feel pain. Our skin is the vehicle through which we navigate the world."

As for living in a world where we never shake hands again, as Dr. Anthony Fauci suggested early in the pandemic to slow the spread of the coronavirus, D'Ambrosio said he hopes it never comes to that. 

"When I heard him say that, I thought, 'No, don't say that. Don't, because touching is probably one of the most important things that we could do in life because our skin is the largest organ that we have and there's so much research that shows what touching does to the body, how the body reacts to it," he said.

 

For example, he said touch decreases cortisol levels, a hormone produced in response to stress. It decreases blood pressure, and it lowers a heart rate. It releases oxytocin, a hormone associated with connection and empathy. He also pointed to studies that show an absence of touch in infants can have a negative effect on their growth and their ability as adults to have proper attachment. 

Cole added that research shows massage helps to calm a person's nervous systems, decreases their pain and anxiety and has had some impact on nausea. 

Social isolation, touch and seniors

The pandemic's forced isolation and the lack of touch have been especially hard on those living in long-term care and assisted living facilities.

Tammy Roberts, a licensed practical nurse at Masonic Home Shelbyville, told the story of a lady in her facility who broke down and said she just really needed to be hugged and when Roberts sat down next to her she leaned over and laid her head on her chest and "wrapped her arms around me really tight."

"I do think that is something that each and every one of them needs, a sense of touch. You know, we all do," she said. "I think there is a sense of isolation when you go so long without that human interaction and touch." 

Roberts said some residents  couldn't understand why their family members quit coming to see them, and felt abandoned. When restrictions on visitation were lifted, she said, "Some were very excited, some just couldn't even believe it. You know, it had been so long they just couldn't even believe it."

Kentucky relaxed some of its visitation restrictions at assisted living facilities and other types of group living homes in mid-February, two months after starting vaccinations and giving priority to residents of long-term-care facilities. A month later, it did the same for federally regulated nursing homes, also allowing them to return to group activities and congregate dining. 

WDRB tells the story of the reunion of  a long-term care 
resident at Nazareth Home in Louisville who was finally 
able to reunite with his wife after spending a year apart. 

Even residents who don't have family members are "reconnecting with their buddies. . . . so we're already seeing just the change in mental status, just incredibly, you can just feel it in the air when you walk through," said Karen Venis, chief executive officer of Sayre Christian Village in Lexington. She said, "It just feels so much more like normal, and that's all we're looking for."

Venis said the last year has been "very difficult on all levels" for residents, families and staff. "The connections that are made with family members, and those hugs, are hard for us to fill in those gaps," she said. "We've done as many things as we could to still let love in. We've done virtual visits and window visits, but that sense of touch, there's really nothing you can do to fill that void."  

Laurie Dorough, executive director of Daisy Hill Senior Living in Versailles, said she considers her staff "physicians of the spirit" whose job is to serve, love and minister to their residents. And because of that philosophy and also because they recognized the importance of touch, "We often suited up in PPE and just gave hugs."

Dorough said the new visitation rules have given her residents back their independence, to have fellowship and leave the facility if they choose. "I can definitely tell that the morale in all the residents is much stronger," she said. All her residents have been vaccinated, she said, but as a precaution they ask everyone to wear a mask when socializing unless they are eating.

D'Ambrosio said he understands the public-safety rationale for denying seniors visitation, but wonders about the long-term effects. 

"I watched a number of my clients that I have that are older deteriorate over the year because of loneliness and social isolation and lack of touch. They did not prosper. They deteriorated," he said. "And it wasn't normal aging, it was different than normal aging. It was from the lack of connection, lack of connectivity." 

Moral distress, the inability to do what's right, plagues health-care workers in pandemic; first step to fight it may be talking about it

By Abigail Latimer

Since last spring, news-media headlines have been inundated with stories describing the scary circumstances facing medical workers in hospitals and facilities across the nation. Medical workers have been praised as heroes and regarded as the backbone of fighting this pandemic. We have heard stories of 80-hour-plus work weeks, with physical and mental exhaustion, and many of them contracting Covid-19, sometimes fatally.

The long-term consequences of their work in the pandemic is not yet known. Recently, as another Covid-19 surge overwhelmed some hospitals in other states and triggered restrictions again, we heard cries of burnout and hypothetical phrases like, “You think Covid is bad, wait till you don’t have an ICU nurse.” And they’re not wrong.

Some may be familiar with the concept of burnout — the point at which a helping professional has reached maximum capacity to be able to care compassionately while still preserving some trace amounts of sanity and emotional reserve. But what we’re not talking about is the devastating consequences that something called “moral distress” is causing and will likely cause long-term. 

Moral distress is the immediate and lingering reaction that health-care professionals have when they cannot do what they feel is ethically and morally right to do. Moral distress can cause psychological, emotional, and physical pain and consistently contributes to why professionals quit their professions.

Moral distress is not a new concept in health care, but is likely exacerbated by the pandemic. Examples of moral distress could be when there is not enough personal protective equipment or staff to care for a patient, or a medical worker cannot alleviate suffering at the end of life. Feelings like powerlessness, anger, worry, and guilt wreak havoc as so many helping professionals tie their identity to their professional identity; it’s who they are: "If I cannot do my job as I am professionally obligated to do, what does that say about me?" These reactions occur despite many of the situations being out of their control.

We do not yet know how to alleviate moral distress without addressing the sociopolitical and environmental factors that contribute to its presence in the first place. For some, talking with other people and naming their distress has been helpful. For others, distraction and avoidance to get through it seem like the best thing to do.

Treatment for moral injury, a similar concept rooted in military service, tells us that acceptance and forgiveness may help lessen the impacts of accumulating moral distress. But accepting difficult and distressing thoughts and feelings, and then forgiving ourselves or others, are not easy tasks. They are especially challenging when so many of these circumstances could be avoided by the actions of others. But latching on to blame and anger has typically only worsened distressing feelings, as natural and expected as these feelings may be.

Although there are no easy answers or quick fixes to a complicated problem, talking about it may be a start.

Abigail Latimer is a licensed clinical social worker and a Ph.D. candidate in the University of Kentucky College of Social Work, researching moral distress in health-care professionals and advanced illnesses in older adults. This was first published in the Lexington Herald-Leader.

Beshear's proposed budget provides money for many, including health departments and their pensions, pay raises and broadband

Gov. Andy Beshear gave his budget speech via video. (Image screenshot from KET)

By Melissa Patrick
Kentucky Health News

The state budget Gov. Andy Beshear's proposed Thursday would provide additional money to support the work of health departments, and much-needed pension relief for the departments and community mental-health centers. 

Beshear outlined the proposal in a speech presented via video during a joint session of the House and Senate, rather than in person, "to set an example of how we fight the Covid-19 pandemic," he said. It was televised on Kentucky Educational Television, which elicited reactions from legislators.

The budget would also provide funding for 76 more social workers and full-time mental-health staff based at schools, and increase slots for helping people with intellectual or developmental disabilities. 

It is uncertain what portions of the Democratic governor's state budget will pass, since he faces Republican 3-to-1 super-majorities in each chamber of the General Assembly, but "It's going to be hard for the majority to say no to a lot of those things," House Democratic Leader Joni Jenkins said.

The budget is more generous than most close observers expected at first, and Senate President Robert Stivers attributed that to an economy and state coffers fueled by pandemic relief funds from Congress.

Stivers said that means revenue sources will have to be examined. He and House Speaker David Osborne cautioned that Kentuckians should expect a more conservative approach in the final budget. 

"I think that you will tend to see us take a very, very conservative approach," Osborne said. "And we'll still have a very lean budget going forward." 

Broadband: The proposal also includes $50 million to fund "last mile" broadband coverage, which has become even more important during the pandemic as many Kentuckians have sought health care via telehealth.

"We used to think of broadband in terms of just business," Beshear said. "But now we know it touches every part of our lives: the education of our kids, how we receive health care. This is the most important infrastructure of the future."

Beshear said it would be "the first time state dollars have been used to invest in expanding broadband," which probably raised eyebrows among legislators, who have wrestled for years with the Kentucky Wired project started by the governor's father, Steve Beshear, and U.S. Rep. Hal Rogers, R-Somerset.

The state has had to put millions of extra dollars into the project, but not for the "last mile," the extension of fiber-optic cables to homes and businesses. Kentucky Wired is a high-speed network into which any internet service provider, including local governments and businesses, can tap into.

Big picture: Beshear called the budget "fiscally responsible" and stressed that it does not rely on new taxes, the passage of new revenue measures or spending cuts. The Lexington Herald-Leader reports that Kentucky has cut more than $2.3 billion in state spending since the Great Recession in 2008-09.

Among the broad major proposals in the budget were a 1 percent pay raise for state employees and a $1,000 pay hike for every school employee. Osborne and Stivers sounded skeptical of giving raises to state and school workers when many in Kentucky are unemployed and still waiting for benefits.

The governor urged lawmakers to work together in support of all Kentucky families, to take the coronavirus seriously and to set politics aside. He did not refer to bills moving quickly through the legislature that will reduce his powers, but to conflicts in general.

“Let me be clear: Every moment in this short session we spend fighting is a loss for our Kentucky families," he said. "Such fighting will leave us empty-handed and further behind those states that recognize this moment and this opportunity. Our goal should be to act swiftly and with wisdom on behalf of the people of the commonwealth."

Action on the budget will be swifter than usual, because Beshear presented it early and legislative leaders plan to start picking it apart and negotiating changes during the recess that will run through Feb. 1. The leaders decided Thursday to delay the start of the recess from Saturday to next Thursday, apparently to complete work on bills now moving. 

The budget is for the fiscal year that begins July 1. The state usually has a two-year budget, but because of the uncertainty of pandemic expenses it opted for one-year budget in the last legislative session.

What's in it for health? 

Medicaid: Beshear's proposal would fully fund the program that provides health care for a third of Kentuckians. The budget summary notes a rise in enrollment during the pandemic, and anticipates a 14% enrollment increase in the current fiscal year and a decline in the new fiscal year. The summary notes that due to the pandemic, Congress has boosted states' Medicaid funding 6.2% through June 30. The federal government normally pays about three-fourths of Medicaid costs.

Medicaid waivers: The proposal would provides $3.5 million for 250 more slots in the "Michelle P." waiver program and 50 slots in the Supports for Community Living waiver program, both of which help people with intellectual or developmental disabilities. Thousands of Kentuckians are on waiting lists.

Social workers: Beshear's plan would provide $7 million to add 76 social workers for children's protective services, for a new total of 1,401, with $1 million to discourage them from leaving their jobs.

Health departments: The plan would double the state's financial support to local health departments, to $24 million, to improve their capacity for epidemiology and clinical care. 

The proposal also provides pension relief to the state's quasi-governmental agencies, which includes all health departments except the one in Jefferson County and 13 community mental-health centers. 

The groups are facing increased expense of about $60 million to meet their a new pension-financing rate, 85% of payroll costs. The budget's summary says it would support their transition from the Kentucky Employment Retirement System non-hazardous plan to a fixed allocation, or prorated amount of the actuarially accrued liability for each employer, as proposed in House Bill 8, co-sponsored by Rep. Jim DuPlessis, R-Elizabethtown, and Rep. Steve Sheldon, R-Bowling Green. A similar bill passed out of the House last year, but was not heard in the Senate.

"The governor’s budget adds $33.5 million each year for the health departments and $18.8 million each year for the Community Mental Health Centers from the General Fund to fund 100% of the additional cost of employer contributions for these critical health providers," the budget summary says. 

In prepared statements, Sara Jo Best, health director of Lincoln Trail District Health Department and president of the state health-department association, called the pension funding "crucial." Steve Shannon, executive director of  the Kentucky Association of Regional Programs, applauded the financial support in the proposed budget for community mental health centers.

"The additional funding assistance for the escalating public pension costs permits the CMHCs to continue operating as the behavioral health public safety net for all Kentuckians," he said. "Thank you, Gov. Beshear!”

Lawmakers pass one-year budget, including pension reprieve for health departments; funding remains similar to last year's budget

By Melissa Patrick
Kentucky Health News

Amid an expected revenue shortfall from the coronavirus pandemic, Kentucky lawmakers passed a conservative one-year budget, instead of the usual two-year one, that offers another reprieve for health departments in a year that they were looking to enact big reforms.

The budget will freeze pension contribution rates for health departments, regional universities and quasi-governmental agencies at 49.47 percent of payroll, allowing them to dodge for another year the looming 93% rate that was set to kick in on July 1.

Many health departments have said that rate would force them to close. The legislature was planning to revamp the contribution system, but the uncertainty about state revenues killed that idea, at least for now.

"While this budget doesn’t provide the language or funds to support our public health transformation and ensure the number of foundational employees to meet our statutory obligations, we understand as well as anyone the uncertainty of our times and recognize the legislatures need to try and maintain current operations for all government another year," Randy Gooch, executive director of the Jessamine County Health Department, said in an e-mail. "However, I have great confidence the legislature will now have more clarity than ever of the need to fund public health at a an appropriate level and will take that action when considering changes to the budget in the future."

The budget provides $23 million for regional mental health boards' pension payments and $25.4 million for health departments' pension payments. The overall budget for public health remains about the same as the previous budget, around $370 million.

Health departments, state health officials and legislators worked for months to help the departments afford their pension obligations, and were nearing success when the coronavirus hit, making likely a huge drop in state revenues. Costs are expected to rise, too, and exactly how much financial help the state will get from federal government remains an unknown.

"We have no way to know how far this recession is going to go, how deep it will truly be and what it will mean to the coffers here in Frankfort," House budget chair Steven Rudy, R-Paducah, said on the House floor while offering the House-Senate compromise budget bill April 1.

All of this has resulted in a one-year budget for the fiscal year that begins July 1 that largely keeps spending at current levels, with plans to pass a budget next year for the 2021-22 fiscal year.

Here are some of the health-related provisions in the budget:

From the Tobacco Settlement Fund:

• $500,000 for a rural mental-health and suicide-prevention pilot program 
• $1.4 million for substance-abuse prevention and treatment for pregnant women with a history of substance abuse 
• $7 million for the Health Access Nurturing Development Services Program (HANDS)
• $942,000 for Healthy Start initiatives
• $942,000 for early childhood mental health 
• $989,100 for early childhood oral health
• $2 million for smoking cessation, much less than advocates want  

From the General Fund:

• $93,700 each for grants to the Brain Injury Alliance of Kentucky and the Epilepsy Foundation of Kentuckiana to help veterans who have experienced brain trauma
• $7.4 million for more school-based mental health services
• $300,000 in the current fiscal year and $1.9 million in the next one for the Kentucky Poison Control Center, which operates the recently created covid-19 hotline
• $500,000 for the Kentucky Colon Cancer Screening Program 
• $2.5 million to the Kentucky Pediatric Cancer Research Trust Fund
• $500,000 for ovarian cancer screening

The budget does not provide any money for additional social workers, or raises for social workers, as had been included in all previous versions of the budget. It also lacks any new waivers for community-based care for individuals with disabilities, as all previous versions had provided.

The General Assembly will reconvene April 13 to reconsider bills Beshear vetoes. House Speaker David Osborne said that more bills are also likely to get passed, including one to help rural hospitals.

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."

Lexington Herald-Leader wins grant for reporter to cover health and social services, monitor big state agency that handles them

The Lexington Herald-Leader has won a grant to hire a reporter to cover health and social services in Kentucky, with special attention to the state agency "that wields enormous power over Kentucky’s most vulnerable citizens with frighteningly little scrutiny and transparency," the newspaper says.

The grant comes from Report for America, which places talented emerging journalists in local newsrooms to report on under-covered topics and communities. It is the latest initiative of the Ground Truth Project, a nonprofit funded by several foundations and other phuilanthropies. Last year it funded an Eastern Kentucky reporter for the Herald-Leader, and has renewed that grant.

Read more here: https://www.kentucky.com/news/state/kentucky/article224586210.html#storylink=cpy

The new grant is also for a year, and is renewable. The newspaper will take applications for the job through Feb. 8, and plans to put the reporter on the payroll June 1.

John Stamper, the paper's accountability and engagement editor, writes that the reporter "will focus on the region’s health problems, expose flaws in Kentucky’s social-services programs, give voice to people struggling to care for themselves and their loved ones, and offer potential solutions to problems that have plagued the area for a century.

"In particular, this reporter will serve as a watchdog of the Kentucky Cabinet for Health and Family Services," which gets relatively little journalistic attention because of the decline in the number of newspaper reporters, especially in Frankfort. The reporter will spend much in the state capital, especially during sessions of the legislature, and also report from Eastern Kentucky.

Two Northern Kentucky police departments have hired social workers, the first in the state to do so; helps in drug fight

The Alexandria Police Department in Northern Kentucky was the first police department in the state to hire a full-time police social worker. It's been so successful they are hiring another one and the nearby Erlanger Police Department has hired one too.

Kelly Pompilio, Alexandria Police Department's first police
social worker, rides along with a police officer. (Photo by Jim
Robertson, Kentucky Law Enforcement Magazine)

"For the first time in my career I'm seeing this agency help people work through problems that we have never been able to help with," Police Chief Mike Ward said on the Kentucky Educational Television program "Disrupting the Opioid Epidemic."

The Kentucky Enquirer reported that Lexington, Louisville and Bowling Green have previously hired social workers that focus on victims' advocacy, but Alexandria's hire "will focus, as programs in Illinois and Wisconsin do, on every kind of case from helping children impacted by domestic violence to criminal cases."

"People in crisis cannot self-advocate . . . and that's where the police social worker comes in and helps guide people to the right services," Ward said on KET. He added that 67 percent of their calls for service are non-criminal in nature and said, "When people don't know what to do, they call 911."

Van Ingram, who served with the Maysville Police Department for more than 23 years, six as chief, and is now the executive director of the Kentucky Office of Drug Control Policy, called Ward's idea to hire a police social worker "genius."

"A lot of police are often reluctant to step into that social workers role because frankly, that's not what we are trained to do," Ingram said. "But to have one there at the police department to make those referrals, that can help with those situations is just genius in my mind."

Abbie Darst of Kentucky Law Enforcement Magazine reported last year how Ward learned about the police social work position and how it's working out.

Pompilio leaves these cards with heroin
users or their family members in the hopes
they will seek treatment. (WCPO image)

One of the programs spearheaded by Kelly Pompilio, the agencies' police social worker, is the Angel Program, which was created by the Alexandria police and has been replicated across the state. This program, with the help of volunteers, not only helps people with substance use disorders get into treatment, but also helps them move through recovery to find jobs or educational opportunities. The program has reached out to more than 90 individuals, with over 40 entering treatment.

Abby Anstead and Kristyn Hartman of Cincinnati's WCPO-TV reported in detail about Pompilio and the Angel Program.

“The biggest thing I do is helping families in crisis getting linked to what they need and being able to make those phone calls for them,” Pompilio told them. “With our drug treatment programs, each addict, I probably call 10 facilities each time and put them on waiting lists, find out what insurance they accept, what the waiting list is, what their program looks like, their availability -- and for a family member to have to do that when they’ve already been emotionally drained, that’s very difficult.”

Ward's advice to other police departments: "Hire a darn social worker and let them do the job, they are phenomenal."

The Erlanger Police Department has done just that, Breanna Molloy reports for WCPO. Inspired by Alexandria, the Erlanger department hired its own social worker, Becky Strouse, who told Molloy in April that in her two months on the job, she had already followed up on dozens of calls related to mental illness, drug abuse and domestic violence.

"For example, there was a domestic violence situation where we had been called multiple times in a three-day time frame. And then we were able to get the mom and the children out of the home and get them placed into a safe place," Strouse said.