In recent good news, the opioid bill that is garnering wide bipartisan support has multiple provisions that address childhood trauma and provide support for impacted children and families. Last week, the Senate Health, Education, Labor and Pensions (HELP) Committee unanimously approved The Opioid Crisis Response Act of 2018.
The focus of the Opioid Crisis Response Act is the substance use epidemic, and some advocates worry the proposed bill is not strong enough on that front. However, the Senate HELP Committee bill does include multiple provisions that advance the movement for trauma-informed care. Drawing largely from Sen. Heidi Heitkamp’s (D-ND) and Sen. Dick Durbin’s (D-IL) 2017 bill, Trauma-Informed Care for Children and Families Act, this new bill would bolster support for children and families who have been impacted by trauma. This is a very positive first step for advocates working to shift the national conversation to a proactive children’s health agenda that acknowledges the effects of trauma.
What is the connection between substance use and trauma?
Trauma and substance use disorders (SUD) are linked in numerous ways. The acknowledgement that people with SUD and their families often have trauma histories or are currently experiencing traumatic events is necessary in order for us to move past stigma and siloed treatment and toward a more holistic and effective system of care. Childhood trauma often precedes SUD, and the development of SUD can be related to psychological impacts of traumatic experiences and the use of substances for escapism, energy, or self-medicating to manage both emotional and physical pain. Addressing childhood trauma through appropriate mental health services and supports is an important aspect of SUD prevention. Additionally, SUD treatment systems must address childhood trauma histories in order for patients to maintain recovery.
Childhood trauma and SUD have a cyclical and mutually reinforcing relationship. In addition to supporting and providing services to persons with SUD, we must also acknowledge the experience of children whose parents or caregivers have an active SUD. Growing up in a home with parents or guardians that have SUD can have a profound and lasting impact on a child’s development and can make a person more susceptible to certain behavioral illnesses, including SUD. This experience is categorized as an adverse childhood experience (ACE). Other ACEs include various types of child abuse, neglect, witnessing violence at home, not feeling safe in your neighborhood, parental divorce, incarceration of a close family member and living in poverty. Including trauma histories and ACEs in our understanding of prominent health issues, such as SUD, is necessary in order to create lasting solutions for prevention and treatment.
How does the proposed legislation address trauma?
The bill contains multiple elements that would greatly and positively impact states’ ability to prevent, understand and address trauma. It includes measures that would increase access to behavioral and mental health care in areas with a health professional shortage and strengthen school-based health services. Additionally, the bill would expand behavioral and mental health education and training to include trauma-informed care.
Several of the provisions would increase funding for the development and dissemination of evidence-based practices for screening, preventing and mitigating the harms of trauma, particularly as experienced by children and families. Lastly, the bill would allow the CDC Director to, in cooperation with states, collect and report data on adverse childhood experiences through existing public health surveys. This is important for understanding the prevalence of ACEs and for developing effective strategies for supporting those most impacted. The trauma-informed measures would bring evidence-based practices and services to schools, address workforce shortages, develop and disseminate best practices, and increase our understanding of the prevalence of ACEs.
Talking about Trauma-Informed Care is a Step Forward
Senate Majority Leader Mitch McConnell has indicated the Senate is moving forward on a comprehensive bill, perhaps in part because his own proposals, the Protecting Moms and Infants Act, aimed at addressing prenatal opioid exposure, and the CAREER Act, which would expand work opportunities for people moving from treatment to recovery, will be included. Sen. Lamar Alexander (R-TN), the bill’s sponsor, is hopeful the Senate will move forward with the bill this summer. Whether or not The Opioid Crisis Response Act becomes law, the inclusion of so many trauma provisions is an important recognition by federal policymakers that we must not only address substance use disorders, but also trauma, a prominent root cause of life-long illness and pain. It also elevates the move towards trauma-informed care. As children’s advocates, we see the integration of trauma-informed practices as imperative to developing a health system that treats the whole health of children and families.
For more on this issue, listen to our recent webinar on the topic.