2020 Legislative Agenda
Health & Wellness
Healthy Births and Healthy Moms
Improve infant and maternal health through policies to promote healthy births and reduce racial disparities in maternal and infant health. The US has one of the highest maternal mortality rates in the world. Research shows that Black mothers are two to three times more likely to die during pregnancy or in their first year of motherhood because they lack access to stable health care and often face institutional biases which create barriers to receiving appropriate care. Policies targeted to low-income mothers and women of color will help to reduce these disparities.
Ensure continuous health insurance coverage for mothers postpartum by extending eligibility for FAMIS MOMS from 60 days to 12 months. During the first year postpartum, mothers are at increased risk of death and adverse health outcomes. Recent findings in Virginia indicate that a significant percentage of maternal deaths occur between 43 days and one year postpartum. Access to coverage for an additional 10 months postpartum would enable women to seek care for serious health conditions that may otherwise go untreated due to a break or loss of health insurance coverage.
Improve access to community doula and midwifery services for pregnant women. High maternal mortality rates disproportionately impact women of color, women living in rural areas and those with low income. Increasing access to community-based doula and midwifery services allow more women to receive a broad array of services that are individualized and culturally-sensitive.
Eliminate 40-Quarter Work requirement for Legal Permanent Residents. Virginia is one of only six states that requires Legal Permanent Residents to establish a 40-quarter (ten-year) work history before qualifying for Medicaid. The current requirement prevents otherwise eligible individuals from receiving needed care and increases unnecessary and expensive emergency care covered by Medicaid.
Expand access to home visiting services for pregnant women and families with young children. Less than 10% of targeted families currently receive prenatal and early childhood home visiting services to improve health connections and help parents in their role as their child’s first teacher. Creating a Medicaid reimbursable service for home visiting will expand access to home visiting and bring down additional federal funds.
Children’s Mental Health
Support the integration of mental health services in primary care by building capacity for the Virginia Mental Health Access Program (VMAP). VMAP is a new integrated care pediatric program that increases access for children and adolescents to behavioral health services through enhanced pediatric training, psychiatric consultations, tele-health, and care navigation. Partially funded in 2019, additional funds are needed to build capacity and expand access to all regions of the state.
Improve Access to children’s mental health outpatient services through continued implementation of STEP-VA. Voices will continue to advocate for the implementation of STEP-VA, the plan for improving statewide community mental health services for adults and children. Efforts this year are focused on providing the remaining funds needed to build out outpatient mental health services for children and adults at all 40 CSBs.
Improve access to mental health services by increasing Medicaid reimbursement for mental health providers. In Virginia, there is a critical shortage of licensed mental health professionals available to treat children and adolescents in need. This request is to increase rates for mental health providers to the equivalent of 110 percent of 2019 Medicare rates for these services. Increasing Medicaid reimbursement rates for mental health providers is necessary to promote access to specialized behavioral health services.
Create a student loan repayment program specifically for behavioral health providers. The CSBs continue to struggle with a workforce shortage and high staff turnover. A student loan repayment program specific to behavioral health safety net providers will make the CSBs a more desirable choice for employment.
Provide supports in schools to respond to trauma. Help schools to implement trauma-informed practices by increasing the support personnel resources in schools. Build on efforts to reduce the counselor to student ratio and fund schools at the necessary level to provide more staff positions to provide counseling, mental health support, and to recognize and address trauma in students. In addition, take steps towards increasing access to school-based health centers.
Early Childhood Education
Early Learning Opportunities for Every Child
The achievement gap starts as an opportunity gap between low-income students and higher income peers who are more likely to attend high-quality early care. To create an equitable playing field, the state must help create more affordable and accessible early learning settings for economically disadvantaged young children. We can increase enrollment by adding funding and flexibility to the Virginia Preschool Initiative (VPI). Aligning child care and preschool funding between education and social services agencies will enable the state to better target quality improvement efforts and serve more children.
As Virginia creates new early learning systems, policymakers should prioritize helping parents navigate access to care, building supply in child care desserts, and helping to smooth the processes for enrollment and transitions.
- Increase access to preschool for economically disadvantaged 3 & 4 year-olds by increasing VPI funding and making its uses more flexible.
- Build one system to help parents learn more about how to choose and find quality early care. The quality improvement can benefit all children, especially economically disadvantaged kids when targeted to them.
- Consolidate state oversight of early learning in to one state agency. Better coordination of federal resources targeted to economically disadvantaged families, including leveraging Head Start as an important part of early learning landscape.
Address preschool suspension and expulsion by creating an ECMH consultation model. Although suspension and expulsion in early childhood settings should be avoided at all costs, there are no formal channels to prevent it in private settings and no targeted interventions for the preschool years. Early Childhood Mental Health Consultation (ECMHC) has demonstrated impacts for improving children’s social skills, reducing teacher stress and turnover, improving child-adult relationships and preventing preschool suspensions. Adopting a statewide ECMHC model for all children 0-5 will give early care providers, parents and children resources to address challenging behaviors. A recent study by the National Center for Children and Poverty found that 63% of Virginia preschool teachers identified access to early childhood mental health consultation as a top priority. To implement ECMH consultation statewide, we must identify an agency to provide oversight and what resources are needed to fund it.
Improve access to early intervention services to meet increased need. The early intervention caseload of infants and toddlers is growing by approximately 6% per year. In the most recent year targeted intervention therapies reached 20,000 infants and toddlers, an increase of 24% in a four-year period. The increase in children identified can be attributed to increasing numbers of substance-affected infants and toddlers and earlier identification of autism spectrum disorders. Additional funding is needed to maximize federal resources and to fully fund services to meet the need.
Family Economic Stability
Promote economic stability for families that have experienced economic hardship and trauma. Long-term economic hardship is an adverse childhood experience and creates toxic stress on a young brain. The child poverty rate in Virginia has remained virtually unchanged since the 2008 recession, and financial support for families, such as monthly cash assistance provided by TANF, have not kept up with inflation. To provide more financial security the state should take advantage of a surplus in federal TANF funding to increase TANF payment rates and eligibility levels and to test proven anti-poverty initiatives.
Scale-up Evidence-Based Practices to Achieve Better Outcomes for Children and Families
Enable providers to implement more trauma-informed and evidence-based practices by funding efforts to train providers in new models. To support implementation of the Family First Prevention Services Act we must continue to invest in the infrastructure to scale up evidence-based services.
Create Structure for Virginia’s Kinship Care System
Virginia must create a financial assistance program for kinship caregivers. Additional financial assistance can incentivize relatives and kin to take children in and avoid foster care placements. Research shows that children placed with relatives or kin are more likely to achieve permanency than children in non-relative placements. Half of children of color who are discharged from foster care go to live with relatives. Although studies show that the best family for a child in foster care is a relative, Virginia’s practice does not provide financial or social support to relatives and kinship caregivers outside formal foster care placements. The implementation of Family First provides an opportunity to support kinship caregivers but it will not provide financial assistance.
Stabilize the Foster Care Workforce
Increase the minimum salary for local DSS Family Services Series positions and provide a salary adjustment for current Family Services employees. The 2018 JLARC report highlighted that stability of the foster care workforce as one of the primary challenges. Turnover rates for an entry-level Family Services Worker Specialist is 42%, with retention efforts being an even greater issue is small, rural agencies. The minimum starting salary for an entry level position is $30,828, which is only slightly above the 2019 Federal Poverty Level for a family of four. The impact of the high-turnover of caseworkers on children is found in our low rate of permanency of children and the number of placements children experience.
Help Foster Care Youth Have Normal Adolescent Experiences
- Codify Family Partnership Meetings (FPMs) to increase parental and youth involvement in case planning. Virginia has a low rate of parental and youth involvement in case planning. While many local departments hold regular FPMs at critical case decision points to ensure input in the development and compliance with case plans, many other local departments do not, or do not include important elements of FPMs. Additional structure and guidance is needed to ensure that case planning includes a family and youth voice. (VPLC Lead)
- Help foster youth obtain drivers licenses and transportation to attend school and to find employment. Support foster youth to obtain a driver’s license by providing reimbursements for foster parents, kinship caregivers, and youth in Fostering Futures for their car insurance premiums.
- Codify Fostering Futures. In 2016, Virginia was able to extend foster care services for older youth in foster care by obtaining additional funds in the budget. Now we must pass a law to put the program in code to ensure it is always available for young people. Virginia has one of the highest utilization rates of extended foster care in the country.
- Create a children’s ombudsman as an independent investigative office. Establish an independent and autonomous agency that handles and investigates complaints from citizens and families related to child welfare services that protects the interests and rights of children and families.
Increase compensation for Guardian Ad Litems. Many young people who have experienced foster care say they never met their Guardian Ad Litem. One of the reasons for this is the two-level compensation for GALs, who are paid $75 per hour for in-court work, and $55 per hour for out-of-court work. But their work outside the courtroom, ascertaining what a child’s best interests may be, is their most important duty. GAL compensation should reflect what we value most: a child’s best interests, not speaking to a judge.
Replace the Virginia Department of Social Services data tracking system known as OASIS. Updated technology, along with updated training and child welfare courses, will allow social services to serve children and families more efficiently. This can reduce the length of time between a child entering foster care and finding permanency through reunification, kinship care, or adoption.
To reduce the impact of trauma and adverse childhood experiences (ACEs), communities must be prepared to identify ACEs and respond appropriately. There are two critical ways to build the resilience of the community. One is to ensure that community members, with a focus on child-serving professionals, are trained to recognize and respond to trauma. The second is to build a network of providers and professionals to share best practices and cross-sector connections to transform systems.
Provide funding to support community-based trauma networks. The Family and Children’s Trust of Virginia provides financial and technical support to community-based trauma networks across the state. Currently FACT only has enough funding to support six of the more than 20 community networks. Additional state resources are needed to provide more operational support to local networks, as well as evaluation and technical assistance.
Continue statewide rollout of ACEs Interface training. The nationally recognized ACEs Interface model has been supported by the state as a training program to help child-serving professionals identify trauma in children and families they serve. Additional funds are needed to scale up the number of communities and providers who can participate in the training and to provide oversight and administration of the training protocol.
For questions about our 2019 legislative agenda please reach out to Emily Griffey, policy director, at emily_at_vakids_dot_org.