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Author Archives: Emily Moore

  1. School Meals Provide a Guarantee That Children Will Get Fed

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    Young people can learn and thrive when they are fed and have access to healthy and nutritious foods. However, in Virginia, one in ten children are considered food insecure and may face hunger. Children are considered food insecure when their households experience limited or uncertain availability of safe, nutritious food at some point during the year.

    While significant efforts to improve food security have been in place during the pandemic—such as the enhanced Child Tax Credit, expanded SNAP benefits, Pandemic EBT, and universal school meals—unfortunately, these programs were designed to be temporary. Many of the supports that helped feed young people and lift their families out of poverty have already come to an end or will end once the Federal Public Health Emergency expires.

    The pandemic demonstrated that when it comes to ensuring young people have access to nutritious, healthy, and culturally appropriate food, there are programs that work. And one thing we are certain of is that school meals play a crucial role in providing the nutrition children need to support their academic success and overall well-being.

    This school year, Congress did not extend the federal waiver authority that allowed all young people access to free school meals over the last two years. As a result, schools have gone back to pre-pandemic operations, requiring families to submit an application to their child’s school to determine if their child is eligible for free or reduced-price meals.

    Voices is grateful to Virginia legislators who included $8.2 million in state funds over the next two years to cover the out-of-pocket costs of Virginia’s young people who qualified for reduced-price school breakfasts and lunches. The state funding will allow roughly 64,500 children from households whose incomes are between 130-149% of the poverty level to get their school meals for free rather than at reduced-price. But that still does not remove the barriers to food access created by the requirement to fill out paperwork for students to receive those meals at no cost to their families.

    A program that does remove barriers is the Community Eligibility Provision (CEP). Through CEP participation, school divisions are able to offer breakfast and lunch to all students at no charge and without processing school meal applications.

     

    How Can Schools Participate and Why Should They?

    A school district, group of schools in a district, or individual school with 40% or more “identified students” can choose to participate in the CEP on a four-year cycle. Identified students are young people who are eligible for free school meals and are already identified by means other than a school meals application, such as:

    • students whose households participate in SNAP, TANF, and in some states (including Virginia), Medicaid benefits,
    • as well as students who are certified for free school meals because they are identified as homeless, migrant, runaway, enrolled in head start, or are in foster care.

    The Community Eligibility Provision promotes equity, reduces stigma, and saves schools significant time by reducing administrative burdens. Some of the benefits of CEP include:

    Helping economically disadvantaged students and their families

    • Parents are assured that students are getting two healthy meals a day at school
    • Families’ financial burden is eased when students eat school meals
    • Offering meals at no charge to all students eliminates stigma and “school lunch shaming”

    Increasing efficiency and school meal participation

    • Families don’t encounter language and literacy barriers to access through the application process
    • Schools do not need to track each meal served by fee category (free, reduced-price, and paid)
    • School nutrition staff do not need to collect fees or lunch numbers from students, allowing the lunch line to move faster and ensuring more students can be served
    • Eliminates unpaid school meal debt

     

    Virginia’s Utilization of CEP

    Virginia has made significant progress to encourage school divisions to reduce barriers to offering free school meals through the Community Eligibility Provision. During the 2021-2022 school year, out of Virginia’s 145 school districts, 97 divisions (67%) were eligible to participate in CEP and 81 of those divisions participated division-wide. According to the Food Research & Action Center, Virginia had the largest growth in the number of school districts adopting CEP, increasing by 25 school districts.

    Despite these numbers, there are roughly 50 school divisions that have no CEP opportunities or CEP opportunities are only available at a limited number of schools.

    As inflation has hit a 40-year high, families across Virginia—especially those in areas with a high cost of living—are struggling to make ends meet. And as a result, families who do not qualify for free or reduced-price school meals are more likely to now experience food insecurity.

    Virginia can work to ensure that less children experience food insecurity by expanding SNAP benefits and working to reduce the SNAP participation gap amongst families, supporting school divisions in an effort to maximize opportunities for adopting CEP, and continuing to fund and maintain the elimination of the reduced-price meal category for school meals.

     

    Voices for Virginia’s Children is a member of the Virginia Food Access Coalition, a statewide coalition that develops policy solutions to increase economic access to healthy and nutritious foods by investing in retail infrastructures and programmatic initiatives to combat areas of food insecurity.

  2. 9-8-8 is Just One Step Towards a Comprehensive Crisis Services System

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    This blog is the second post in a two-part series that takes a deeper look into Virginia’s efforts to integrate the 9-8-8 hotline with the behavioral health crisis services continuum. Read the first blog post in the series here.

    For years, communities have advocated for diverting mental and behavioral health calls away from law enforcement and for states to adopt a comprehensive crisis response system. Now, that dream is beginning to come to fruition. On July 16, the National Suicide Prevention Lifeline transitioned to the three-digit number 9-8-8. While this transition was initiated by legislation at the federal level, states are responsible for the rollout and linkages to their crisis response systems when the caller’s needs cannot be resolved over the phone. Virginia has been working on a rollout behind the scenes to link the lifeline to crisis response services that are currently being designed and implemented by state agencies and stakeholders.

    The commonwealth’s plan for minimizing emergency room visits for mental health crises and providing an alternative to calling 9-1-1 is to link the crisis call centers with regionally focused resources by integrating mobile crisis response alongside the Marcus Alert protocols. However, at this moment, this is simply the goal and not the reality. The development and implementation of Virginia’s behavioral health crisis system has been a piecemeal approach, and is not yet fully prepared to deliver comprehensive, trauma-informed, and culturally responsive services to meet individuals’ mental health needs—specifically the needs of young people

    The Surgeon General sounded the alarm in December 2021 by issuing an advisory on the youth mental health crisis. Despite widespread awareness, young people’s mental and behavioral health needs are often an afterthought or part of “phase two” when developing programs and services. Current resources dedicated to young people’s behavioral health make up less than 10% of Virginia’s overall behavioral health agency budget. The lack of sufficient funding and resources further the disparities that historically marginalized communities face in accessing support and services.

    Due to the inconsistent mental health crisis services across regions, law enforcement is often the first point of “care” for mental health emergencies, especially for Black, Latinx, Indigenous, and LGBTQIA+ youth. While most calls to 9-8-8 can be resolved during the call, some crises will require an in-person response based on a four-level call matrix.

    four level call matrix

    This new entry point for mental health support is supposed to be an alternative to law enforcement response, but a new law allows 89 of Virginia’s 133 localities with 40,000 or less residents to opt out of two protocols under the Marcus Alert System. This means that for those living in one of the 89 localities that are not required to implement all Marcus Alert protocols, an attempt to get in-person crisis support may still result in law enforcement, with or without Crisis Intervention Training, responding to your call. The criminalization of youth crises often results in further traumatization. This experience can intensify their crisis, compromise their treatment, and make them and their families less willing to call for help if another crisis occurs. Far too often children and families are met with a response that is not suited to meet their immediate or long-term needs.

    At a time when young people need support the most—while their worlds have been turned upside down by COVID-19—we must ensure there are providers and services in place to provide access to timely, culturally responsive services, and address social determinants of health to support children and families’ overall wellbeing. This requires investments from lawmakers and interagency collaboration.

    For 9-8-8 to be truly transformative, investments are needed now.

    While all these recommendations are not immediate and some are considerations for future policy, Voices for Virginia’s Children suggests the following key recommendations:

    • Mobile Crisis services need to be fully funded across all regions, with an emphasis on providing services in underserved and rural communities. Voices also suggests separate mobile crisis protocols designed specifically for youth, as the intervention points at which young people receive support may include schools, parental consent, developmental appropriateness, or specifically trained professionals;
    • Mobile Crisis and Community Care teams should include a peer specialist, interpreter, community advocate, and child-serving mental health professional;
    • More small-scale children’s Crisis Stabilization Units should be placed in communities across the state;
    • Establish an infrastructure for language access and a culturally diverse and appropriate workforce;
    • Mandatory trainings should include equity-centered concepts, including implicit bias training, trauma-informed care, child and adolescent development, and training specific to special populations (i.e., LGBTQIA+ youth and youth with intellectual and/or developmental disabilities);
    • Stakeholders involved in implementation should include those most impacted, such as youth with lived experience and communities of color;
    • Ensure that crisis response protocols and services are equipped to support systems-involved youth and their family members. Protocols should be designed to avoid future involvement in the child welfare system or juvenile justice system.

    Voices will continue to advocate for increased access and improved coordination of quality mental health services for all children in Virginia, regardless of where they live or at what point they seek mental health services. The future wellbeing of our state depends on how we support and invest in the next generation.

    To learn more about Virginia’s plan for crisis system transformation, visit these resources: Virginia’s Crisis System Transformation and Marcus Alert and STEP-VA.

  3. How the 988 Hotline Can Break Down Systemic Barriers to Health Care

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    This blog is the first of two posts that will take a deeper look into Virginia’s efforts to integrate the 988 hotline with the behavioral health crisis services continuum.

    **This blog contains information and statistics on suicide and mental health. If you or a loved one are experiencing a crisis or need mental health resources, contact the National Suicide Prevention Lifeline at 1-800-273-8255 (en Español: 1-888-628-9454; deaf and hard of hearing: 1-800-799-4889) or the Crisis Text Line by texting HOME to 741-741.

    On July 16, a new three-digit national hotline–988–will launch to connect callers with trained counselors through the National Suicide Prevention Lifeline to provide 24/7 call or text support for anyone experiencing a mental health crisis or in need of suicide prevention services. Though the hotline is administered through the national Lifeline, calls to 988 will be routed based on area code to regional crisis call centers that can connect individuals with crisis and emergency services that are available in their local communities.

    Virginia is utilizing the national 988 hotline implementation as an opportunity to link the three-digit dialing to the broader behavioral health crisis services continuum that is being developed across the state. Eventually, this will mean that more young people and their families will have access to mental health professionals responding to a crisis instead of law enforcement. This is especially important given the compounding traumatic effects of the COVID-19 pandemic, systemic racism, LGBTQIA+ discrimination, and gun violence in this country.

    The Need for a Lifesaving Hotline

    Suicide is the second-leading cause of death among young people aged 10 to 24. However, deaths from suicide are only part of the problem. Each year, approximately 157,000 youth between the ages of 10 and 24 receive medical care for self-inflicted injuries at emergency departments across the U.S.

    The Centers for Disease Control reported that during 2020, mental health–related emergency department visits among youth aged 12 to 17 increased 31% compared to 2019. Specifically, emergency department visits for suspected suicide attempts among 12 to 17-year-old girls were 50.6% higher in February to March 2021 than during the same period in 2019; among boys aged 12 to 17, such emergency department visits increased 3.7%.

    In Virginia, the percentage of students who experienced feeling sad for two weeks or more increased significantly from 2011 (25.5%) through 2019 (32.4%). And among those who reported feeling sad for two weeks or more, 39.1% reported that they considered attempting suicide, 29.5% made a suicide plan, 18.0% attempted suicide and 4.9% made an injurious suicide attempt.

    The pandemic is deteriorating children’s mental health to new lows, with more than 25% of high school students nationally having reported worsened emotional and cognitive health.

    Figure 1: Percentage of Students who felt sad or hopeless almost every day for 2 weeks or more, VYS, 2011-2019

     

    Figure 1. ED visits related to suicidal thoughts, self-harm, and suicide attempts among Virginia youth aged 9-18 years, 2016-2021

     

    Figure 2: ED visits rates for suicidal thoughts, self-harm, or suicide attempts among Virginia youth aged 9-18 years, by sex, 2016-2021

    Barriers to Accessing Mental Health Services

    Although rates of mental health problems are not statistically different by race, the rate at which children of color receive mental health care is much different than white children. A National Center for Health Statistics data brief reported that non-Hispanic white children (17.7%) were more likely than Hispanic (9.2%) or non-Hispanic Black (8.7%) children to have received any mental health treatment in the past 12 months.

    As noted in Voices’ Children’s Mental Health Discussion Paper, “systemic barriers such as eligibility criteria for health insurance and accessibility of services contribute to lower participation among Black and Latinx children. A history of racism and disinvestment in communities of color have made mental health services less accessible for children of color by geography, cultural fit, and language.”

    LGBTQIA+ youth also often lack access to affirming spaces, which include health care and mental health care services. The Trevor Project’s 2022 National Survey on LGBTQ Youth Mental Health reported that 60% of LGBTQIA+ youth who wanted mental health care in the past year were not able to get it. Some of the reasons youth cited for wanting care but not having access include fear of discussing mental health concerns (48%), concerns with obtaining parent/caregiver permission (45%), fear of not being taken seriously (43%), and lack of affordability (41%).

    LGBTQ youth who wanted mental health care but where unable to get it cited the following top ten reasons.

    Of the LGBTQIA+ youth aged 13 to 17 that were surveyed, 73% reported symptoms of anxiety and 67% reported symptoms of depressive disorder in 2020. Almost half of those youth surveyed seriously considered attempting suicide in the past year.

    These statistics demonstrate the clear need for appropriate and effective mental health services for young people. Lack of access can lead to serious and lasting impacts across all areas of a child’s life. Ensuring that emergency services are accessible, unintimidating, and culturally competent will take creating programs like the 988 hotline and implementing them with full funding and public support.

    As lawmakers work to streamline Virginia’s mental health and behavioral health system, Voices is focused on opening these services to all our communities and addressing past harms in the way of healing.

    Stay tuned for more on the 988 hotline and children’s mental health.

  4. General Assembly 2022: Health and Wellness Wrap-Up

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    Understanding the social determinants of health (SDOH) that impact children’s lives informs how we advocate for policies that improve the health and well-being of all children, especially children of color and economically disadvantaged children. During the 2022 General Assembly Session, Voices joined partners, advocates, and youth in asking lawmakers to invest in equity and provide access to language services across state agencies, healthy and nutritious foods, and comprehensive health care.

    After months of negotiation, the legislature has reached an agreement on the state budget, including many of these initiatives. Policy changes in legislation and budget language have made progress towards holistically addressing the inequities and disparities faced by Virginia’s children and families.

    Creating an Equitable Health Care System

    • HB 987, sponsored by Delegate Tran, was signed into law and requires the Board of Medical Assistance Services to ensure that all medical assistance program information provided to applicants is made available in a manner that is timely and accessible to individuals with limited English proficiency through language access services. This includes oral interpretation, written translations, and auxiliary aids and services for individuals with disabilities as a reasonable step to provide meaningful access to health care coverage.
    • HB 229, sponsored by Delegate Coyner, was signed into law and requires the Department of Health to collect and analyze information, including demographic data, regarding social determinants of health and their impact on health risks and health outcomes of Virginians.
    • To address Medicaid enrollment, language is included in the budget directing the Secretary of Health and Human Resources to establish a Task Force on Eligibility Redetermination. This task force will help plan and advise the Department of Medical Assistance Services on the unwinding process to ensure Virginians do not lose healthcare coverage. The language also adds American Rescue Plan Act (ARPA) funding to be used for operational challenges linked to eligibility redetermination, such as technology needs and paying staff overtime at local DSS agencies.
    • The legislature has directed $2.5 million in FY23 to continue the contract for an integrated e-referral system for one year. It is expected that the e-referral system will continue beyond FY23 with user fees supporting its operations. The purpose of the system is to connect government agencies, health care providers, and community-based partners to enable participants in the system to refer patients to public health and social services.

    Increasing Language Access and Equity

    • While the funding amount was reduced from the original budget, $2.5 million per fiscal year remains in the current budget to be provided to state agencies for facilitating and improving language access. This funding will allow each state agency to designate a language access coordinator who will be responsible for making sure that agency materials and communications are accessible to all Virginians, especially those who have limited English proficiency.

    Increasing Food Access and Nutrition Security

    • To ensure access to healthy and nutritious foods and boost the buying power of the Supplemental Nutrition Assistance Program (SNAP) benefit for fruits and vegetables at farmers markets and food stores, $1 million per fiscal year will be directed to Virginia Fresh Match.
    • HB 582, sponsored by Delegate Roem, was signed into law and requires public institutions of higher education to ensure that young people in college have access to information on SNAP benefits, including eligibility and how to apply. The bill also requires each institution to advertise information on the SNAP benefit process on their website and in orientation materials distributed to students.
    • HB 587, sponsored by Delegate Roem, was signed into law and requires every public elementary or secondary school to process web-based or paper-based applications for participation in the School Breakfast Program or the National School Lunch Program, administered by the U.S. Department of Agriculture, within five working days after the date of receipt of the application.

    Creating a future where Virginia’s children can thrive will require intersectional approaches, including equitable, healing-centered policies that dismantle systemic barriers so that all young people can lead long, healthy, and successful lives. While the budget takes important steps forward, we must continue uplifting youth voices to improve policies impacting their health and well-being.