Transcripts For CSPAN Children Families And The Opioid Epidemic 20180209

The Senate Hearing will come to order. This is on the children, families and the Opioid Epidemic crisis. Later today, senator murray and lland senator jung wi introduce legislation to try to address the Opioid Crisis. The National Institutions of help had predicts that a new nonaddictive painkillers could be achieved within five years with more flexible authority to conduct the necessary research. Moreill would give the nih flexibility to address Research Research that addresses the Opioid Crisis. I each haveay and an Opening Statement and well introduce the witnesses. After their testimony, we will have a round of fiveminute questions from the senators. The Opioid Crisis is particularly heartbreaking for families and children. No one understands that more than an east Tennessee Woman who lost a baby in the nearly two decades in which she is struggling with addiction to opioid and other substances. And she entered into recovery in 2012, she had no drivers license or formal education but she had a calling to help those battling with addiction. On a degree working in health and Human Services before working on a masters. And she is a powerful force for pregnant women in east tennessee who are addicted to opioid. She is part of a startup that helps coordinate comprehensive care with expectant mothers who are struggling with opioid abuse. Jesse provide support and encouragement to women going through the same battles she thought with. She falls during her recovery. Davies recovering from opioid abuse may go with withdrawal symptoms and face other health issues. 180 Health Partners works with Care Organizations to help prospective mothers begin treatment and stay in treatment after their baby is born. It has only been around for about a year but it has seen her magic results. Within the 180 Health Partners unit stay in the hospital less time than other babies. 180 Health Partners has also been six russell working with the successful working with mothers in the program to keep their babies. Jesse says we want these moms to understand that they are pregnant and our disease does not turn off because we get pregnant. It is about changing my life through helping other addict. Addicts. I have had numerous mothers tell me my only to port is 180 Health Partners. Only support is 180 Health Partners. Help what theto Tennessee Department of health has called a sharp increase of infants born with withdrawal. The number has tripled from 1999 until 2013. According to one of our witnesses, tennessee has a rate of davies born babies born with drug withdrawal more than three times the national average. The hospital in joshua city, tennessee treats over 300,000 it sends a year born with nas. Nas. Fants a year born with to ark to bring services mother addicted to opioids when they are still in the hospital after having their baby. The Opioid Crisis affects infants and many grandparents have taken on the role of caregiver. In tennessee, there was a 51 increase in the number of parents who lost parental rights because of an opioid addiction. This is a problem seen nationwide. After steadily declining since 2000, there is been a steady increase in the number of children in foster care and in some places the number has even tripled. That is a want of numbers but they represent real children, real families whose lives are affected. It is important for communities to hear how states for this committee to hear how states are helping to ensure newborns and children impacted by drug abuse are being cared for and that they need changes to federal law to improve that care. The focus should be on keeping family stronger, in state and local communities, those on the front lines are taking steps to help children impacted by opioid abuse. The tennessee governor announced a comprehensive proposal to respond to the Opioid Crisis. Included is a targeted outreach to educate young women on the risk of neonatal abstinence syndrome. Our program saw such a sharp increase in babies born with nas that tennessee became the first state to create a statewide database to track how many infants were born with nas each year. Congress has taken steps in is anting our infants, it act that helps federal programs become more successful in helping pregnant mothers struggling with opioid abuse. In 2016, the comprehensive addiction and recovery act and there were updates to the child abuse and treatment act, which has funding for the state to help children impacted by drug abuse. Hildress passed the c abuse prevention act in 1974 to help states protect their children and Child Welfare services. Due to updates, the law requires addressing the needs of the infant and the family member. And Congress Also passed to the 21st century cures act, which this committee worked hard on in 2016, which included 1 billion in grants for states to fight the Opioid Crisis. We hope to learn, are these laws helping . , are therelping federal barriers that states and communities face, we want to make sure states coordinate all that includes the help they may need Like Mental Health of these services abuse services. Im grateful this committee had the chance to focus on the impact the Opioid Epidemic is having on families and individuals and what we can do to help them. Im grateful to all of our witnesses for bravely sharing their stories and lending their expertise. As we have seen again and again, this epidemic is not just impact one person. It has a Ripple Effect that impacts entire families and entire communities. If were going to deal with this Public Health crisis, the estimate sure were providing resources to everyone who is touhced by touched by it. We need to be listening to all stories. The stories told by hospital staff like those i recently visited in longview, washington, who told me half of the babies they delivered were born to mothers suffering from opioid addiction. And the stories of the children struggling with the impact of lacks in school, which the resources needed to meet a very unique needs. The stories told by parents who have watched the children they would do anything for struggle with a disease they feel helpless to do anything against. Parents who do not know where to turn for help even if they can afford it. They feel silenced by the stigma and the story is told by grandparents and relatives who must step up as guardians and caregivers. We need to fight this on all of those fronts and for all of those people. We have to do more than stem the tide of the Opioid Epidemic. We must a knowledge and address the damage of this. My constituent shows why this is so important. When she became pregnant with her daughter, she was struggling with addiction. She was in and out of jail during her pregnancy and by the time her daughter was born two months early and with a small amount of meth in her system, she was facing a prison sentence. Her daughter was immediately place in foster care. She thought for her family, her daughter and her future and she won that fight. She regained custody of her daughter and decided to help others go through the same thing. She works with parents for parents. A program that paris parent pairsrs with families parent mentors with families. Results have shown that the Program Makes it more likely that family stick together and less likely that mothers and fathers lose their parental rights. There are many approaches and they need to have our full support. Congress needs to continue its bipartisan work to address this addressing childhood trauma, train teachers to understand how it can affect children and how to avoid discipline that does more harm than good. You have to make sure young people understand the great risk of misusing opioids and they are equipped to make decisions that could change there was that change their life in one night. Make decisions that could change their life in one night. We need to address the needs of pregnant women, postpartum women and their infants. We must reorient our Child Welfare system towards Prevention Services for families. Programs like headstart offer a two generation approach so children and families get these of work they need to heal, grow and succeed together. Research has shown that children brought to the attention of Child Protective Services are 94 less likely to be in foster care a year later if they are involved in this program. We need to address everyone who the crisis affect and we need to do it in partnership with everyone who needs to affect change. That means working with stakeholders. Working with health care providers, educators and officials and most importantly families. Unfortunately, while President Trump has declared the Opioid Crisis a Public Health emergency, his promises it to address it run hollow in light of the action. The Trump Administration has been sabotaging our health care and making it harder for people to get medicaid, which helps provide treatment. They propose dramatic cuts into drug offices that are designed to provide evidencebased treatment. The president may not be taking meaningful action but i have been really heartened to see congress continue to work in a bipartisan way to solve this issue. That is when we passed the 21st century cures act to Fund Prevention and recovery and when we pass to the comprehensive addiction and recovery act, which supports civic outreach to postpartum and pregnant women he gives them access to medicated assistant treatment and more. The deal includes Additional Resources as well. Even if we act, we have to listen to those stories like elises and that is why im grateful that we ha get to meet with all of our witnesses today. Before we begin, i do want to submit a statement for the record from the American College of obstetricians and gynecologists. Thank you for your cooperation in planning the hearing and it will be submitted. We would like to ask our witnesses to summarize their testimony in about five minutes and that will lead time to have a conversation with you afterwards. The last senator young to introduce our first witness. Thank you, chairman. This morning i am honored to introduce becky savage. She is a nurse and a mother from indiana. She is turned unimaginable heart break into lifesaving action. ,he is joined by her husband mike, and her son, matthew, and her passionate efforts to combat the Opioid Crisis began after the tragic event of losing her two oldest sons. She lost them on the same night to alcohol and Prescription Drug overdoses. Both graduated high school with honors and were captain of their High School Hockey team. Nick had completed a year of college. He was home for the summer. Jack was preparing for his first semester when their family changed forever. For the breaks savage family. I want to say how much respect that have free a i have for display ofa incredible strength and in the face of unimaginable pain, be cky has turned grief into hope. She turned a foundation to raise awareness of the dangers of drug and alcohol abuse. 525 Foundation Also collaborates with other local groups come along for smith and state agencies to make an impact on the of the crisis. Becky has been an advocate and a source of comfort for parents who share in her grief. Her advocacy today, paired legislative action can help curb the opioid opened in it epidemic that devastated so many communities. I look for to hearing her testimony today. Thank you. Ms. Savage, thank you. Welcome to your husband and your son. We appreciate you being here. Dr. Steven patrick is the dr. Hundred has served as expert consultant for the Substance Abuse and Mental Health services administration. His research has been published in the new england journal of medicine. He has received several prestigious awards for his work. Dr. Patrick, we welcome you today. Senator murray will introduce a third witness. Dr. m honored to welcome bell for joining us today from washington. Hes the chief executive seattle with the mission to provide and improve the need for foster care. He previously served the organization as executive Vice President for child and family services. He was commissioner of new york citys administration for childrens services. He has 35 years of experience working to keep children safe and to keep Families Together. Testimony,or your and thank you for making that long flight out here from washington state. Senator murray knows about that long flight. I do. We will begin with our witnesses. Ms. Savage, why dont you go first. Thank you for inviting me to speak with you today. And for a long meet share my family story of loss and the hopes of helping others. , a nurse, and a mother of four boys. Just like a lot of other families, including yours. We like to spend time together. Together, left together, and dream about the future. 2015, our lives changed forever. That is the day are two older sons were pronounced dead of an accidental alcohol, opioid related overdose. Were likeick and jack many other 19 and 18 euros. They were athletes, had a great circle of friends, and had dreams and aspirations in life. Nick had just finished his freshman year at Indiana University and jack had just graduated high school and was heading into his first year at year. They were best friends. Nick and jack had attended graduation parties for my before , they came home at curfew. They checked in with me. I went to bed and they headed to the kitchen to make a snack. The next morning, i went into jacks room and found him unresponsive. What i was trained to do and initiated cpr after i had called 911. I was yelling, i yelled for neck to come and help me. He never came. Nick was sleeping in the basement with friends, and when i call for help his friends had hurt me and have tried to awaken him but he had passed as well. Boys who had always seemed to make good decisions in life make such a choice that would ultimately cost them their lives . My husband and i do not understand. How could this happen . Prescriptionodys and up in the pocket of a teenager at a Graduation Party . Why wouldnt they just say no . We may never know the answers to all of these questions. We do know is that bringing awareness to this issue could save a life. Our kids were talked to about drugs and underage drinking. They knew it was wrong. Why would they take a prescription that did not belong to them . Prescription drug misuse and abuse was not even on our radar twoandahalf years ago. Therefore, it was never discussed with her children. 2016, we wereof approached by a local coalition that was doing a Community Townhall meeting that was funded by samsara samsa. Since underage drinking contributed to the poor choices are boys made that night, we decided to participate. This marks the first time that we spoke publicly about losing it and jack. A partnership with other Community Advocates and lawmakers who are also looking to answer to this epidemic. Time, their story has been told to over 20,000 students across the United States to help spread awareness of alcohol and prayer Prescription Drug misuse. Every time i tell their story, it takes my breath away. It still does not seem real. It would be so easy to be consumed by grief and never heard from again. Or, we could talk about what happened to us. We went to increase awareness in the hopes of helping others. This is what we have chosen to do. Nick and jack may no longer be able to live their dreams, but by telling their story, we can help others live to reach their dreams and their potential in life. The five to five foundation in memory of nick and jack. Five was jacks hockey number and 25 was next. Nicks. This has allowed us to reach hundreds of High School Students and leaders. This story makes an impact and kids listen. You can hear a pin drop in many of the auditoriums i speak in. We can reach one person every time we tell their story, we have made a difference. Our goal for our foundation is to make a significant difference in our communities. We have partnered with our police, Fire Departments, and other local coalitions to hold pill drops to get opioids and other Prescription Drugs offer streets. At our last community pill dropped, we collected over 500 pounds of unused, or expired, prescription medication. When you think that just one pill could take a life, that is a lot of life saved. There is a need for safe disposal of medication. We have joined drug and alcohol indiana. K force in we partner with our local Health Department will expand educational programs. We are working with Indiana Universitys challenge to establish longterm plans to help combat the opioid misuse and abuse in our state. Our goal is to expand educational curriculums to include prevention at all age levels. A need for increased awareness and education related to opioids. Every week when i talk to a new about oureenagers, families and the dangers of perception drug abuse and misuse, it is evident that there is a knowledge gap. There are still people in this community that are unaware of the dangers, like we were twoandahalf years ago. Is of the essence when you look at the statistics. Cdc, 150 people die every day of an opioid overdose. Today, 115that, families are going to suffer a loss like we did. Who will it be today . Itselfory will repeat 115 times a day and families will continue to be destroyed until we move forward as a nation on all levels. Community, state, and federal. The reason that i am in front of , ands to impress upon you everyone listening, that this epidemic is real. It can happen to anyone. Thank you for your time. Once again, for the opportunity to speak with you. Thank you. It can happen to anyone. Your story takes a breath away. We are grateful for your courage. Thank you. Dr. Patrick. Murray,ng member honorable members of the committee, thank you for the opportunity to speak you today about the impact the Opioid Epidemic is having on our nations families. I direct the National Institute that helped Fund Research programs focus on the effect of the Opioid Epidemic and the impact it is having on infants. I would like to highlight a few recommendations here today. I was caring for sick infant who had been transferred to our neonatal intensive care unit. It was jittery and had rapid weight loss. Something was clearly wrong. The infant was exhibiting classic signs of a postnatal drug withdrawal symptom that occurs after in utero opioids. It can be difficult to diagnose in a newborn. The event was increasingly had difficulty feeding, increased muscle tone and jerking. His mother denied using any substances. After a week in the hospital, the vocal cord screen came positive for an opioid. As i wanted to talk to his mother, i could sense her guilt and anxiety. She cried and wondered aloud if she would lose custody of her infant. She had been afraid of my response and response of child alle fowler welfare along. She became dependent on opioids after next. She was not able to get him a drink pregnancy as she was too scared to ask for help. This combination is disastrous. ,he rapid rise of opiate use federal communities off guard it became more, drop the United States. Rates of neonatal syndrome grew exponentially. From 20002014, the number of infants diagnosed grew nearly sevenfold. One infant is born every 15 minutes with the syndrome nationwide. This needs urgent attention. Legislation would forward important child priorities. These pieces of legislation would benefit from additional action, funding, and if limitation. One resulted in a copperheads of strategy document, but full of meditation is contingent upon funding. Congress should consider additional actions to improve outcomes for women and infants impacted by the epidemic. We should bolster the Child Welfare and Early Intervention systems. Pregnant women with opiate use disorder, accessing treatment is difficult. Muslim and are not most reason most women are not receiving treatments. The increased likelihood that the infant will go to term. There remains an urgent need for an expansion of treatment for opioid abuse disorder. Threat United States, opioid variousinfants received treatments. Were working to disgrace this variability. Decrease this variability. If you play key role in standardizing care and breaking down discontinuities and care for pregnancies into the post natal. Period. Atal in 2050, the number of children entering Foster Care Group 227, 000. Imagine if that woman was actively engaged with treatment before birth. How might her story be different . Our welfare system is in urgent need of attention from congress. This was a great step forward. Those requirements came without clear guidance or sufficient resources for implementation. There is an urgent need for Additional Guidance and resources from the federal government which are infant safety and to keep families intact when that is appropriate. Epidemic is taking a terrible toll on pregnant women and infants. For the women and infants i care for, the Current System is disjointed and does not consider the needs of the woman and the infant. Every day, people are dying. Pregnant women are not getting the treatment they need and infants are spending the first few weeks in withdrawal. A infants will be borne with the syndrome and 10 people will die from opiate related overdose in a time youre sitting here. These are brothers, sisters, and children. The need our help now. Mr. Chairman, thank you for the opportunity to speak today. Thank you dr. Patrick. Good morning term and alexander. Chairman alexander. My name is dr. William c bell. Im the president of Casey Family Programs. Were the largest operating program focused on reducing the needs for foster care and billing communities for help for childrens and families around america. , puertoin all 50 states rico, and the u. S. Virgin islands. With more than 16 tribal nations to influence longlasting improvements to the safety and success of children, families, and the communities where they live. I thank you for the opportunity to be here today to discuss the disruption and trauma the Opioid Crisis is causing for our children, families, and communities. Data shows that parental Substance Abuse is a key reason that the number of children being separated from their families and placed into foster care has been increased significant license 2012. As you have heard, approximately two 7000 children enter the foster care system in 2015. Governors, mayors, Child Welfare leaders, nonprofit leaders, have beenders, working tirelessly to overcome the challenges they face on a daily basis as they struggle to support and strengthen the families impacted by this Opioid Crisis. Increasingly, challenges involving recruiting foster parents, providing cheap and services, treating babies born with prenatal exposure, and healing the mental trauma by families have left Child Welfare strained and challenge to target resources in the best way to help families and devastated communities. There should be no more important, nothing more important to our nation than ensuring the safety of our children and ensuring that they have the opportunity to grow up threaded by a community of hope. I thought this committee for its leadership and the passage of the competence of addiction and recovery act of 2016. It strengthens the requirement that states have different planes of safety are in place that address both the needs of the infant and the needs of their parents. Legislation make a clear that our National Child care response system cannot continue operating as though it is possible to fully address the wellbeing of children without the wellbeing of their families and their communities. Has found thath luhansk and access treatment programs on demand, they are much more likely to become successful in completing the program and more importantly in continuing to improve their capacity to care for the children. Kentucky starts families have had twice those of writing rates and have as many children in foster care as compared to their peers who did not participate in the kentucky starts program. Nationally, grandparents and other relatives are caring for more than one third of all children who have been placed in the foster care due to parental Substance Abuse. Research on kinship foster care tells us that children who cannot remain with her birth parents are more likely to have stable and safe childhoods when raised by relatives. Most greatly, we hear from parents, foster parents, youth, kinship caregivers, Child Welfare leaders and tribes that provideon services longterm sobriety and the ability of sustained services for families with children return home from foster care are the most important improvements can make. Despite everything that we know, there were to keep children safe and supportive families, the vast majority of our funds support a different approach. Every seven dollars on foster care, we spent one dollar on prevention. Must change how we spend federal child where fell funds to make sure we are funding the efforts to get results that our children and their families need. Weknow it is important that intervene as early as possible. States need the ability to target their existing federal resources into an array of prevention and Early Intervention services to keep children safe and reduce the need for foster care whenever it is safe to do so. We also know that one of the most traumatic experiences that a child can have is to be forcefully removed from their family. 2018, this committee will consider the reauthorization of the child abuse prevention and treatment act. We stand ready to be a resource to you and to assist this tomittee and anything we can increase the availability and quality of prevention programs into increased levels of wellbeing and communities all around the world. In spite of the devastation that we have witnessed and only offered from us today, all you of heard from us today, i believe there is hope. I believe in the power that hope brings to those in need of help. I believe the power that hope brings to those of us who have chosen to be the bearers of the help. We are a nation of over comers. Set ae decided to specific challenge, we have always come together and found a way to be victorious. We have found a way to overcome every challenge, once we truly decided that it must be done. This epidemic is no different. This must be done. And sistersfathers and brothers, entire communities and tribes have cried enough tears. This must be done. This is not a problem that family,ike the savage and others in similar situations, should be left to solve on their own. All of us together must face this challenge with them as a nation united. County, city, and local communities taking sure that every child has a permanent and loving home where they can thrive and grow up to live to the fullest, whatever dreams they have had for themselves. Thank you very much for this opportunity to speak with you today. Im happy to answer any questions you may have. Thank you we will now have a fiveminute rounds of question. Im going to try to keep the exchange within five minutes because we have a vote at 11 30. Theory did not like that. Siri did not like that. Light used to be simpler. Light used to be simpler. Ms. Savage, i want to thank you for sharing your story publicly and for being here today. You are clearly a family of tremendous strength. Forward, you are truly saving lives. I just want to tell you that i am i am overwhelmed by your ability to take such a tragedy and turn it into something that is going to help other families avoid when you winter. Just yesterday, i met with a group of mayors from all over the state who had received funding from the drugfree communities program. I was impressed by a group of students from maine come away in the north near the canadian border. They have developed their own program to try to help there. This there appears avoid alcohol abuse and opioids. Think of those kinds of peer counciling groups students and children that there are alternatives to drugs and alcohol . I think anytime a conversation is started, it is a positive. Those pyramid tour groups are incredible. A lot of times just talking about it can start a conversation where a child goes home and talk to their parents about the issue. Any time can happen, that is a success. I think that is a wonderful thing. Thank you. I could not help but, when you are testifying, think that im going to send your testimony to all of the members of that group. I think they would be inspired by it. They are doing great work. So are you. Thank you. Bell, the committee i chair held a hearing in mark march help the committee on grandparents raising children due to the opium crisis. We have seen the number of such families soar in maine by 24 over a fiveyear. Due to the Opioid Crisis. Out, compared to children who are placed in nonrelative care, these children in the care of their grandparents have better outcomes. They have more stability in greaterves, they have preservation of their identity, and they have better behavioral and Mental Health outcomes. What we also learned is how difficult it is for these grandparents, who thought that they were going to be entering , andan easier time of life all of a sudden they are raising children. In some cases, infants. The grandparents talked to me about their need for support. That is why senator casey and i have introduced the supporting grandparent raising Great Children act. It would create a task force to help develop and distribute information designed to help kinship parents. What we heard was that it is hard for them to learn to navigate the School System all over again, it may have been many years. The parents that they were dealing with could have been their children. They did not have the kind of support. Do you have some ideas on what we could do come in addition to respite care, to better support grandparents who find themselves in this unexpected role . Thank you senator. Unfortunately, opioids is not the first time we have been in this position. I was in new york city during the crack epidemic. We dealt with exactly what you are describing. We called it skip generational parenting. Parents,of frontline graham had stepped in. What we found was that they needed support groups, they needed financial support, they needed a Navigator Program that would help them understand where to go. One of the things that we created was the department for aging in new york city, it was called the grand print resource center. It was one through aging connected Senior Centers and other Community Resources so that grand parents would not be alone, our aunts or uncles would not be alone to left to care for this child. That is something we could do in this situation as well. Thank you so much. Thank you for your work on supporting Grandparents Raising Grandchildren. We plan to consider that bill and our markup later this month. Thank you so much for you and your family for being here. The loss andine the tragedy and how hard it has been for you and your family to get through this. I think every parent in the room went, oh my god, that be me. Your courage is incredible. And also inspiring. You used the strength you obviously have to get past what happened to your family to make sure it happens to no one else. Were all really grateful for that. Let me ask you, we have had a lot of witnesses here with great from renovating state prevention programs to treating this as a disease and not as criminalizing it. My me ask you what every parent would like to ask you, what is your best advice to parents in their own communities . What should they be doing within their own families and communities to make sure this doesnt happen . Think you for the question. What can do is just start the conversation, Start Talking. Issue, bringof an it up with your children and Start Talking about it. I talk with parents and encourage them to clean out their medicine cabinets. When i talked to crowds, i ask for a show of hands of how many people have expired medications in their medicine cabinet that they are not using. About 7580 of the crowd raise their hands. Theesent to clean up medicine cabinets and be responsible with the medications they do have. Make sure that they know where theyre at and keep them under lock and key. Treat it as a lethal weapon. They do not think past 2yearold. Right. It is a good lesson to push forward. And all yourto you family. We so appreciate it. Dr. Bell, thank you for being here. The goal of the Casey Family Program is to keep Families Together. The Opioid Epidemic is clearly a challenge for that. We know that in the past five years we have seen almost a 10 increase in the number of children in foster care. It talked about much of which could be attributed to Substance Abuse. Is really concerned. Children in foster care disproportionally faced significant trauma come as you well know, and adverse trauma, as you well know. What are some of the resources that communities need to prevent the need for foster care and keep their families safely together . One of the things that we have seen that which we have spent a lot of time focused on in new york city, the foster care role has continued to go down. That one of the reasons that that is theirs because of the immense amount of Prevention Services that are available in the city. One of the Biggest Challenges for families who are raising kids and kids who are at risk of social isolation. If communities are going to strengthen their ability to keep kids out of foster care, with have to make sure that families have the access to Prevention Services, but their Community Driven supports and services are available to them, and that they are not left alone. Too many of our families have moved away from extended family and are living in communities where they are set apart. We have to create schoolbased program, create sports big programs, we have to create Community Driven programs, so that somebody can see every child. So that the support is there. You think about the protective factors, one of the five core protective factors is preventing social isolation. I think that is what all communities need to strive to do. Thank you for your expertise. I wanted you to talk to us a little bit about nas and what you are seeing and how important it is that we focus on a comprehensive approach to preventing nas. Thank you for the question. I think a comprehensive approach to Substance Use overall we know that 400,000 and kids born every dear year are exposed to substances. That begins with some of the things we have been talking about here, like preventive drug monitoring programs, improving to focus oneatment, improving outcomes for families. I would point out that recent studies so showed that nine out of every 10 tendencies for women who on use use opioids are unintended. We cannot ignore that fact. Thank you. You for holding this important hearing. Ms. Seven, i want to thank you for your strength. Savage, i want to thank you for your strength. As the father of three teenage girls, daughters why cannot get to read anything that i work on when im here, i have no doubt that the will read the testimony they gave today. For that i am internally grateful to you. I wonder whether you could tell the committee a little bit about what efforts in education you find work particularly well with adolescence, what seems not to work. Sometimes people try to commute communicate with young people and it makes it worse. That may be my problem with teenagers. I suspect that maybe with others as well. Thank you. Im no expert on teenagers either. I have a few of them in my home. What i am noting when i go to the schools to talk, the kids listen to real stories. Statistics and things are nice hear but they like to real stories and how this can affect them. I show pictures of my boys before i Start Talking so that they can connect with the pictures. Hockey picture, there could be hockey players in the crowd. I tried to make that connection with them and then i tell her story. They try to connect with that. Stories, isonal usually open it up to questions and answers. What kind of questions you typically get . The questions i get are about fiction drugs. Some of the kids do not understand why Prescription Drugs are dangerous, that they are prescribed by a physician. We talk about that any prescription that is not prescribed to you by your doctor could be lethal to you. They are trying to make that connection between street medication, street drugs, and Prescription Drugs. We are trying to show them that they both can be legal lisa. Lethal. Is it your impression that these people are hearing about this for the first time . And some crowds, yes. Schoolsthe scrolls are like that. They do not understand they can die from one time trying something. The do not understand that there are different strengths of medications. Pharmacist. A you do not know what you are taking when somebody gives you something out of a file vile. Why would you trust them with your life . Thank you for being here again. Bell, thank you for your work. You describe the benefits of programs where parents have access to treatment and do not use lose their children. Awonder if you could describe more typical experience in america today, if you are somebody who is struggling with opioid addiction. I would. I would hesitate to go typical, because i know that our systems are in various levels of trying to make this happen. When you think about when a parent who has been reported for abusing a substance, the Start Program ive talked about. The referral to the Start Program begins when a mother is testing positive in the second or third trimester for a substance. There is no immediate referral to a Child Welfare institution. Become prima facie of child abuse and neglect to have a positive exposed child. We are working to help folks to understand that, in that aaron might, they are wrestling with the disease. Toike to do the comparison what it was like when crack was the issue. Were trying to do right now is a much more humane approach to dealing with families were struggling with the disease. In the crack epidemic, that woman would have been referred allhild welfare, in likelihood we would have removed your child and placed her child in foster care. She would have been in the court system, maybe represented by quality attorney maybe not. Her child would have been languishing in foster care. She wouldve had a long list of think she wouldve had to complete to get her child back, including housing, parenting skills, overcoming Substance Abuse treatment. At the same time, we also know that stress exacerbates the use of substances. Well will begin treating to that stress by holding her child over here and restricting her access. Court started to use drug treatment courts which began to work in a conversation with price to say, we know that you want your child back. We want you to have your child back. We know that you need to overcome this disease that you have. We will work with you to increase your capacity to see your child is on your working to achieve this friday that we know is necessary and you want to have. Sobriety that we know is necessary and you want to have. There are other states that are saying, this is a person who was wrestling with a very devastating disease and we need to change your systems and protocols so that we can help lift them up. We are well over time. Thank you senator bennett. Casey. I wanted to raise a question that may have been asked. I think it is important to reiterate. Im particularly grateful for the witnesses and your testimony. Horrors of a we have been dealing with is that you have individuals who have lived full lives and then reach the point where, because a son or daughter might have a problem, the grandparents have the grandchildren, or at least play a role. I know that senator collins has worked on this with me and worked on legislation, but this is a human challenge but it is thesehe reality families end up helping all of us in other dollars they say. That by one calculation grandparents and other relatives who raise children outside of the foster care system save something near 4 billion each year. Sacrificing ahey lot of their own years but they are helping all of us by taking on that substantial burden. 2. 6 million grandparents are raising grandchildren, that is a huge number. Mentioned, senator collins and i have legislation called supporting Grandparents Raising Grandchildren act, which creates a federal task force to serve as a onestop resource for resources and information for grandparents who are having to raise the grandchildren. I wanted to start with mr. Bell how do you think having this information will help support these grandparents and relatives who are raising these children as a result of the opiate epidemic . Thank you. Senator collins did raise this before she left. We are very supportive of what you are trying to do here. It is something we learned from the crack epidemic. Need supportrents centers, they need Navigator Programs, they need financial resources. Savingson of 4 billion is because many of these grandparents have not been informed that they can become kinship providers. I would not advocate that we take all of these grand parents and take them into the foster care system. Many of them can do better outside. Need to find a way to provide financial support, respite, opportunities for them to continue to live their lives, so that they are not burdened down overly with these children. Thing we saw during the crack epidemic is utter health started to deteriorate with the do not have the support they needed. You are definitely on the right pathway and we fully support you with you on that. I appreciate it. Particular expertise to these issues. We are grateful for that. Momentum forus passing the bill. I appreciate that. Dr. Patrick, i want to raise with you a question that i know that the chairman referred to. And i worked together on the implementation of the plan of safe care legislation. Benow that this might also reiterating what was spoken of earlier. We have this gao report that came out yesterday. It examineested that the infant plan for safe care improvement act. What the gao found was a lack of guidance from hhs on how states should be implementing the law. Were going to continue to work on full imitation and sufficient support for states and being able to carry out the responsibility on plans of safe care. Neonatologist who was on the front lines when it comes to identifying these ubstance infants inflants,effected have you found a multidisciplinary approach to this . As the report suggested, there is a lot of confusion on the state level of what would define a state of care and what that should look like. And resources to be able to carry. , one that imls familiar with is called charm in for much. They engage families that are in Substance Use treatment well meet with the families without, develop plans drop pregnancy, and work towards a safe discharge. What i experience is far more reactive. There is no action taken until the time of discharge. It tends to be reactive. That is because our overburdened child will care welfare system is reacting to the problem instead of having the resources and training to address it headon. I will put out one other thing, in many states they treat substance exposure as they would severe sexual abuse. That is a paradigm that many Child Welfare systems engage in. Reframing that specifically on how to work with families early on, to keep Families Together where it is appropriate, it is needed. Your work on this and the infant safe plan of care, and lamenting that i getting resources is vital to improving outcomes for families. We have our vote at 11 30 so im going to ask the witnesses and the senators you try to keep the exchange within five minutes and supplement the answers in written form after the hearing. Thank you mr. Chairman. I would hope that i could give followup questions with members of the panel, this is very important. I go around the state. The meetings that i have with do not care if you are the alaskan association of or as aoards are not mayor, we always end up talking about addiction. When we think about the addict, we cannot think about the addict without thinking about the families. Parthildren that are now of this world of addiction. It is something that breaks your heart. I was at a meeting down on the Kenai Peninsula last friday and was told, this is still out of total, that when ocs takes a , they do a hair follicle test to test for jugs. Nine out of 10 kids in the system are testing positive for drugs. It is in the hospital and household. We think about the addict you do not think about the impact to children and prematernal care, women were children parent or choosing not to get care because they are afraid. If their they mothers of young children, theyre not telling their doctors about their just because they are afraid they are going to use their children. It is just beyond belief the impact to the children. We have the author of dreamland the for the committee, he suggested that we need a movement shot approach to get the social movement for recovery. Was aested that it different thing. It gave something for us as americans to us fire to, some to,lofty goal aspire some lofty goal. It is different in addiction. It is still such a stigma attached to it. He said, you need to give a forum to the families to speak out so we viewed differently those that are addicts. Of two ge, as the young men who are no longer with you because of addiction, when we think about the addict of days gone by, it is a different mental image in peoples minds. Addictzing that the today is a different person. Facilitatedo more to conversation about the fact that people who are dealing with this not losers, they are not bottom of the barrel, they these people at the bottom of society. Boys, these are brothers, sisters, parents, people we love. Had we change this so that there is a societal ability to embrace what we have to do to solve addiction . Are boys come i want to clarify, were not combative. They had experimented with a medication that was brought to a Graduation Party. It was a onetime use that killed them. There faced with stigmatism. Every time if somebody says, you lost your toolbars, how did it happen . You have that splitsecond of, oh my gosh, here we go. The data an overdose. You get the stigma. Talk about it, we tell exactly what happened. There is that stigma out there. There are some School Systems that i know parents have contacted me about going to talk to in the School System are not ready to have someone come in and talk about opioid misuse or abuse prescription pills because of the stigma. Theyre afraid theyre going to be classified as having an issue at the school. How to combat that other than just talking about it and being more open in talking to people. We talk about it all the time, obviously. Getting easier. Just talking about it hopefully will help fight that stigma. I thank you for the courage as a parent for coming forward and helping others as they deal with the losses and the challenges in their personal lives. Sen. Baldwin are you baldwin. I knew this was going to feel awful personal. I want to thank you all for being here and for your efficacy. Ms. Savage, thank you, you are saving lives. You talked about the power of storytelling when you meet with students. I want to share just a little of mine. People on this committee know that i was raised by my grandparents. I talk about them all the time. Often times the context of Committee Hearings that were having. On aked with senator colin different caregiver measure that was signed into law just two weeks ago, dealing more with supporting families were caring for elderly people who were or adults with disabilities. I do not think i am unsure why was raised by my paternal grand parents. My mother was 19 when i was born and going through a divorce. She moved back home. Her life she struggled with Mental Illness and physical illness. Pain, for which the days long before we labeled and Opioid Epidemic, she was prescribed a multitude of benzodiazepines, narcotics, and other medications. I always knew and had a lot of contact with my mother when i was growing up. She lived very close by. My grandparents were heroes. Upbringinge a stable. They thought they were emptynesters. They were both in their mid50s. Both of their daughters had left the home and i do not think they imagine that they were going to get in infants. I moved in when i was two months old. I had the same Grade School Principal that my mother had when she was in grade school. I know they struggled. One of the issues they struggled with was Health Insurance coverage for me. They were not in the foster system, this was an informal arrangement. Withomon mother struggled saw what my mother struggled with. Semigrandparents, my rocks. Who were with me the whole time. Toad the honor of returning when shemy grandmother was in her 90s and needed caregiving. The issue of supporting our families in these roles from all perspectives, whether it is getting the prison with Substance Abuse issues the help that they need or supporting the families and foster parents who stepped forward and gave a kid a stance chance. I care so deeply about this. Having taken so much of my questioning time, i suspect i will give you some questions for the record. I wanted to ask a little bit the infants dr. Patrick bell they have Significant Health impact of their because of neonatal abstinence syndrome. Measureong championed a that has yet to become law that would expand access to therapeutic foster care. Funds formedicaid children who will need a lifelong care, but to empower family members and foster more than provide just custodial care and love. But also more intensive services. Could talk about the importance of the role of therapeutic foster care and our tolity to get medicaid funds support those families. Dr. Petra, a 13 seconds left. Please summarize that and in writing answer questions. Thank you for your story too. Please go ahead. One of the things we often miss is that substance exposure often leads to preterm birth. I sent home a baby that had been in the hospital for eight months. She was born at 23 weeks. A method that the amount that support the family needs is extensive. When he were talking about is vitally important. Thank you for that. Senator scott. In halfway through your story. Thank you for sharing your personal story. I think it is an informative instructive. Were all appreciative for family members who stepped to the plate when challenges arrived. Savage, the power of your personal testimony is unmatched. I cannot imagine the excruciating pain and misery your family has endured. Articulate his story in these conditions will have impacts threat this nation will neverever we hear about. Lives will be saved because the power and strength to testify. Thank you for your family for being here as well. Dr. Petra, i know you have answered this question couple of times already. I had to go to a banking hearing. In south carolina, according to 20072015, theom number of babies born with nas has gone from four per 1000 27 or 1000. 1000 to 7 per 1000. You talked about the difficulty within the first couple of weeks. Can you speak to the challenges for the next several years and some of these kids as they grow up . Thank you for the question. When i described babies that have drug withdrawal, i also these are infants that are increasingly fussy, they have difficulty breathing and beating beating feeding. You can imagine what that is like. Our approach has changed substantially based on best practices around the country. Come to the infants neonatal intensive care unit. They sit with her mom is possible. Ere please find that keeping mom and babies together decreases the severity of the drug withdrawal and keeps that ponting b onding. It is so important. One of the things we need is additional research. There are not large studies to follow infants as they go to kindergarten. Studies thatolder suggest there may be some issues with attention, maybe with liquid. There are not robust studies. In these be funded. Were doingto what now, one of the vital things we do is support infants for the first years of life. That includes partnering with childcare and early Prevention Services. Speech there he, occupational therapy, so we can maximize their outcome. That. Is so critical. The weight feels for me when i discharge in infants home is and it is on corrugated depends a lot of stress on a family that already has a lot of stress. Thank you very much. Comments i have been thinking about is the thought that shame and the consequences of ones actions lead many folks to hide the challenges and the addictions. I know there is a strong push towards allowing parents who are going through treatment not to lose their children. It sounds like a good idea, but also a doubleedged sword. Can you walk me through that as well . The approach really is one that says we want to honor your relationship with your child. We also want to make knowledge that having the child connected to you is a great motivator to overcoming the challenges that you are dealing with. That, we also would knowledge the need to make sure that there is constant monitoring of the children, that there is constant support for the children, there is respite around fromd to be the parents of the Child Welfare is not doing what we have done in the past, which is have this complete distance, but that we are not leaving the child just with the parents of that something might happen. [captions Copyright National cable satellite corp. 2016] [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. Visit ncicap. Org] i will go over by 14 seconds. We have to vote right now. I will rep it up in just about seven more minutes. [laughter] i will submit that in writing to you. Off. M sorry to cut you ive been trying to be a little bit senator murphy. You, mr. Chairman. I wanted to add my thanks to censor baldwin sharing that story. I have a question pertaining to how we make sure senator baldwin for sharing that story. Myave not much time with fiveminute limit, but dr. Patrick, i want to come back to for this conversation. The yalers ago, conducted a Quality Improvement study to look at the best care for these kids. What they attempted to do was build a comprehensive, nonchronological approach to doing this. That meant low stimulation rooms, feeding on demand, trying to enhance the bond between mother and child. The results were extraordinary. Average length of stay, 28 days to just over 28 days. It increased from 98 to 44 . How important is it to prioritize nonchronological treatment for nas, and are our this . Youready for have to have nurses, a dedicated space to do this right. How important is this treatment, and are we ready to do more of it . My colleagues at yale built a wonderful program. Its vital. None phonological care is vital. Would you rather have your morphine . Putting mothers and babies together, creating the environment is so important. Hospitals as whether are ready for it, we have challenges in many communities. We note a state like ours, tennessee, my birthday west virginia. Theres a high number of opioid exposed infants. Sometimes, theres only one pediatric place in that hospital. When we think about how this is implemented, how we begin to deescalate the care we provide for infants and create a model where families can stay together, it may look slightly different for different hospitals, hospitals that may not have the resources they and her belt has. We have a Public Program being created. I think it will look different everywhere, but its vital. Bell. Ected at dr. I want to talk about what happens when a child stays with a majority. One of the things we talked about in the Mental Health reform act of 2016 is, looking at laws and how they may create barriers for parents to stay involved in the care of a loved one of a child, who may have addiction and Mental Illness. We want to respect the privacy rights of adults. A child, when we go from 17 to 18, so the parents can still know about when the appointments are so they can help that 18yearold stay on schedule. I want to pose that question to how you make sure families stay integrated in care when you have that transition. I think its important for young people, particularly entering adulthood, to have a strong suit as strong a support system around them as possible. One of the things we wrestled with in the Child Welfare Services Area has always been, being able to help the individual understand why this is helpful to them. Its a complicated legal matter in trying to override is so much right to privacy. I believe the relationship is the most important factor in getting people to accept that this is helpful to me as opposed to invasive to make. To respect privacy. I believe theres possibilities, a relationship, being able to get that done. Speak, i will yield back the rest of my time. We have several senators, some who have been here the whole hearing. Believe theg i vote may have been moved to 11 45. That may help us. Thank you, chairman. We spoke in my office about how you have been able to help High School Students, not only in increasingly across the country to work with the 25 foundation, which you established. You indicated how so many of these kids have no idea, or little idea about the risk associated with prescription pose,and the risk they and the health of their loved ones. I think adults lack that awareness as well. How do we bring more awareness to High School Students, and do you think we might need a broader Public Awareness campaign to address it . Thank you. Absolutely. Not just with High School Students, but also middleaged students, and also elementary , ad students, and adults campaign with a Public Service announcement, national campaign, would be awesome. Many different age groups. Thanks. We had a little dialogue about that. Im recalling the, this is your brain on drugs i still remember. There might be an analog to that. Dr. Bell, im going to turn to you, sir. I would like to discuss the issue of Predictive Analytics. Maryland is a juvenile war judge in the indianapolis area. She recently set our traditional systems of Early Morning related to Child Welfare are overwhelmed. The caseworkers stretched too thin, we end up with a bunch of kids ending up in the cracks, not just in indiana. We see this around the country. Imagine if we could use existing data to help those kids, targeting muchneeded services for those children who are most at risk. Child welfare expert and former Michigan Supreme Court Justice Maura Corrigan says, if we are data and Child Welfare, intervene with good casework by the mining of that data, perhaps we would reduce the 15003000 deaths from child abuse and neglect in this country each year. Bell,ing to ask you dr. How might we use data to estimate risk for children, and should we be using data from past cases in order to inform decisions . Thank you. I would say by Predictive Analytics. This is a tool, not a solution unto itself. Predictive analytics is a very valuable tool, that has been used for years in low health care, law enforcement, meteorology. Its essentially taking the things that we know, analyzing them, to help us better predict the things we dont know. If we can utilize this tool that ericn so much value ryan crashes. Airplane crashes. Predictive analysis has been paramount. We have to explore every possible opportunity to help our children. We believe Predictive Analytics is one of those things. There are names for things that have been around a while. I guess this is forecasting. ,e ought to apply to this field to improve the lives of our children. Thank you. With my remaining time, im going to ask you about reporting, sometimes aborting it a boring issue. If you have dont have clarity and theres not proper reporting on an issue, youre not sure what to do, and the solution is poorly targeted. 11,000 children enter the foss care foster care children in indiana in 2016. 58 entered care because of parental Substance Abuse. Both experts and Child Welfare agents believe this to be underestimated. Next Nancy K Young said in date said in a 2016 Senate Finance hearing not a Single Person believes this data accurately reflects their experience, and tell us these numbers understate the vast majority of cases, in which a child is placed in productive custody, or related to prevent parental Substance Use disorders. Ive got about 15 seconds left. I want to be respectful of my colleagues. Do we know the full extent Substance Use disorders are associated with the number of children being placed in the foster care is to children system . We dont, but we can. Thank you. [laughter] we can correspond on that. I look forward to that. Thank you, senator young. Senator warren. Senator warren thank you. We recently saw a astonishing data about the impact of the bureaucrats is to our state. They want to better understand the relationship between pregnancy and overdose. They linked up a lot of databases around the state to track the records of mothers who gave birth, then also died in a betweenr period 20112015. They found something heartbreaking. For four out of every 10 women in this group, the cause of. Eath was opioid overdose during the same time period, or Foster Care Group by 19 across the state. State, 10,000 grandparents are primary caregivers for their grandchildren, grandchildren who is often landed in their parents arms, grandparents arms because of this crisis. This crisis isnt just about the lives that are lost. Its also about the struggle of those who have to coax to cope. Dr. Bell. From anarent dies of opioid overdose, what kind of impact does it have on a child . Toi would start by referring basis. As of the leading basis, documented for child for of as is the separation parent, from death. Thats a tremendous experience for child that lasts for the lifetime. Is loss of finances, or a model that was there for them, this protector, chief advocate. Our systems have to be designed to focus on, how do we replace those lost elements of that development . They lose emotional, financial support. Lets fast forward to when the child is 18 years old. In half of our states, foster care and set age 18. If a child stays in foster care, they will be aging out by the time they finish high school. If a child ended up with their grandparents due to death from an opioid overdose of a parent, is grandparents may the in their fixedolder, living on a income. Dr. Bell, at age 18, do use who have lost a parent face Financial Burdens in continuing their education . They absolutely do. Far too many of them do not complete their Post High School dontion, and far to many complete their high school education. One of the ways were trying , when acare of kids working parent dies, the child is eligible for Social Security child benefits for tragic circumstances. ,ntil a couple of decades ago Social Security Survivor Benefits were available for child until they were 22 if they were fulltime students. In 1981, congress changed the rules and cut the benefits off at 18, even for students. The bipartisan policy had a democrats and republicans, looking to restore eligibility up to age 22. Dr. Bell, the average benefit is 820 a month. Is that enough to make a difference for these young people . Given the cost of living, it clearly is not. I would say to you that there are a number of possibilities that we need to work on putting together. I dont believe in any single avenue. Will it help push us in the right direction . Combined with many other things possible, absolutely. Its conversation id love to continue. We are going in a direction we must go in. Good. I think thats important. Mrs. Savage testified. Its not fair to anyone, the Opioid Epidemic. Kids are left to deal with the emotional and Economic Cost of losing a parent. Change Social Security Survivor Benefits. Upon solve every problem, but might move us in the right direction. The least we can do is restore benefits up to age 22 for fulltime students. There are young people eligible haveenefits, who could better lifetime chances going forward. Thank you. Thank you. The vote has started, but we should have time for senator smith and another senator to ask their questions. Thank you very much. Byould like to start out talking about whats an urgent need for immediate action on a program that provides Health Coverage to minnesotans, about 100,000 minnesotans, including coverage for treatment in and recovery, exactly what we are talking about. We have something called basic health lot plan, minnesota care, which serves as a life line for working families. It offers low cost, comprehensive health care to make for families who make too much to qualify for medicaid, but cant go on the private market. Recent actions by the administration have jeopardized the longterm stability of this program, and is putting minnesota care cover minnesota Care Coverage at risk. People stand to lose my state stands to lose 800 million, a big blow. I want to thank chair alexander and Ranking Member murray and other members of the committee for working with me to reverse cuts. We are counting on a bipartisan effort to stabilize this market and help us in minnesota. It relates directly to what we are talking about today, the need to not only recognize a desperate Public Health crisis, but also have the resources to provide treatment and recovery to people who need it. Thent to thank you for opportunity. We will turn to a question. Miss savage, so grateful for you being here today. Im a mother of two sons. Tablesalso sat around and coffee shops in minnesota, and talked. I want to date say similar stories, but every situation is a unique tragedy. I want to recognize that. Ive talked to a lot of parents and teachers, and School Officials in minnesota about this epidemic. I hear a lot about the need to strengthen Mental Health systems especiallyols, Mental Health workforce. Its like an Early Warning system in schools. In minnesota, we have done some unique things to try to strengthen this length between schools and Community Health providers. Its a big problem. Im working with senator murkowski in a way of making this work better. I would be interested to hear from your perspective you spent a lot of time in school. A stronger Mental Health system in our Public Schools would help with this. Well, any time you can strengthen anything in the School System, its a good thing. Mental health being no different. With that, i know that students who may be do have some Substance Abuse issues its because of the Mental Health issue as well. If you can strengthen that, you might be able to help on the other aspect of this addiction process as well. Thank you very much. I want to ask a followup question. Around this question, familybased treatment, how that might work. Last week, i had the chance to meet with representatives from minnesota, start providers. How,were telling me about what pressure it has put on the head start system, this opioid Public Health emergency we have. We literally do not have enough arms to hold the intense. The infants. Im wondering if you could talk about how we might use existing helpms like head start to support families, parents and children, who were dealing with absence. Thank you for the question. It begins with a comprehensive approach. As far as our existing resources, i think many of the , there is a welfare system that will engage families and utilize those resources of Child Welfare, early throughout the continuum of care. I think thats really vital. Thank you very much. Thank you, senator smith, and thank you for your remarks about the Minnesota Health care plan. Senator murray and i are working on a way to lower insurance rates that would specifically solve that problem. I hope we can finish that work properly. I appreciate that. Thank you, mr. Chair, Ranking Member murray. To our panelists, thank you for your work and patience and attention this morning. Before we start, i want to address the bipartisan funding we agreement the senate reached yesterday that would increase federal funding to combat field beyond crisis, an important next step in strengthening a response to this epidemic. These need to be prioritized for states like my own, new hampshire, which has been disproportionately hit by this crisis. Know we will need funding beyond this measure. I want to thank the leadership of this committee, because theyve assembled an extraordinary panel. Theres really a. Of this terrible epidemic. The individual loss and lives ,hanged forever, as a result the longterm effects for our next generation that both dr. Patrick and bell are talking about as well. Testimony. R i was reminded of the experience who lostd jean moses, their 26yearold son, adam, in a somewhat similar experience to what you describe with your son. One of the steps they have taken is called the zero left campaign. I take it from your nodding that you know about it. Would you like to address it . Its a Wonderful Campaign that i just became familiar with. Jim has reached out to our organization about perhaps partnering with it to help spread but they are trying to do. To getcampaign to try people to clean out their closets and medicine cabinets, leave zero left behind. Have a proposal for prescription medications. They can put them in a pouch and mix it with water. Prescriptionf the medications. Its a Wonderful Campaign. They are working with hospitals so when a doctor prescribes an opioid, you get a warning about the impact of even though legally prescribed drugs can have. Ofthis is a great example the work families are doing to try to prevent this from happening. Week, i wasst honored to have a person join me as my guest at the state of the union. Mckenzie works as a Program Administration for the office of School Wellness in new , which focuses on preventing Substance Abuse to address students all around Behavioral Health and wellness. Theyve been hard hit by the epidemic. The schools are working to stem the tide. They have seen a great improvement in Student Wellbeing that providing kids by providing kids counsel. Dr. Bell, you have worked with children your entire career. Can you speak to what more schools should be doing to help wellbeing, especially schools where children may be exposed to substance misuse in their homes, and how can we hear congress that . T thank you senator for the question. I think schools have always been an should continue to be institution, whatever ailments are challenging their communities. Particularly with the opiate crisis, this can become a safe haven for other people. We know theres a lot going on in our schools. I think we need to focus less on the policing we are doing in our schools and more on the protecting. We need to have conversations with the community. School should not close down at 3 00. The schools have to become a schoolbased community center, where our children and families can go to get protection, to be safe, to learn how to protect their lives and improve the conditions that they want to be in. Thats more than we can do in that area. I think both you and dr. Patrick. One of the things you have both been talking about is the importance of integration integrated care and services, prevention that can come with that. My experience as a governor, it takes resources to coordinate and integrate things. You cant just say its a good thing. Of us here,number myself included, who will get you guys on the front lines, those kinds of resources. Thank you, mr. Chair. Thank you. Voted . Joseph, you not yet. One quick question. This wont take but a second. I appreciate your testimony, and as a lawyer, before i came here, i had clients that had similar issues. One of the things i would like the money andis legislation, you mentioned a community drop. Senators can also use their positions, community engagement. Like to know more about what you did, how to how you put that together, so perhaps in alabama, we can go back and organize that. We dont have much time, so i apologize. I will be quick. We worked with a lot of other community coalitions, and organized the drop, where we picked a saturday and got dea epproval, and manned fiv different locations across our community. From 10 002 00 p. M. , in t hose four hours is when we picked up was 500 pounds of pills. Did you advertise that . We did. We had facebook, local media picked it up and advertised us. It was a constant flow of traffic coming through. We went through the Fire Department stations. They would pull in, hand out their pills in little ziploc baggies that we asked they bring in. They put them in a box. Right. They would drive through. I just wanted to hear briefly about that. You are welcome to supplement that answer. We need to go vote. Im going to line up the hearing. We respect and appreciate the effort that each of you has made to come. We will ask unanimous consent of senator mcconnell be put into the record. Members may submit more information within 10 days. The committee will meet on tuesday, february 13, for a meeting. Minimum improving animal health. Thank you for being here today. The committee will stand adjourned. [indecipherable chatter] and, the Senate Health committee, funding for fighting opioids included in this budget that the senate may photo 1 00 a. M. Eastern time, 30 minutes away. In the meantime, the federal government has shut down for the past 30 minutes on capitol hill, waiting for senate action, to see what will happen, as a twoyear budget awaits action in the senate. Part of the problem . Some of the holdup because of senator rand paul, who is against the raising the spending caps that the twoyear budget would allow lawmakers on both sides of the aisle to do. Well take your phone calls. You can let us know what you think about this shutdown, the fifth one since september. We were in a similar situation 17 days ago. Republicans, the lines to call is