4 billion each year. So not other they sacrificing a lot of their golden years, but theyre, in fact, helping all of us by taking on that substantial burden. 2. 6 million Grandparents Raising Grandchildren, thats a huge number. And, as i mentioned, senator collins and i have the 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, in fact, having to raise their grandchildren. I wanted to start with mr. Bell and ask whether you think having this information will help support these grandparents and relatives who are raising these children as a result of the Opioid Epidemic . Thank you, senator casey. Dr. Bell, im sorry. Thank you. Senator collins did raise this before she left and, as i indicated, we are very supportive of what you are trying to do here. Its something that we learn from the crack epidemic, that these grandparents need support centers, they need navigatetive programs, they need Financial Resources because the notion of the 4 billion saiflgs savings is because many of these grandparents have not been necessarily informed that they kwo become kinship providers. I wouldnt advocate that we take them and bring them into the foster system because many can do better from the outside. We do need to find a way to provide Financial Support for them to continue to live their lives so theyre not burdened down overly with these children. Because one thing that we saw during the crack epidemic was that their health started to deteriorate had they didnt have the support that they needed. I think youre definitely on the right pathway and would fully support working with you on that. I appreciate it because you bring particular experience and expertise to these issues. So were grateful for that, that help, and it will give us momentum for passing the bill. So i appreciate that. Dr. Patrick, i wanted to raise with you a question that i know that the chairman, chairman alexander, referred to. He and i worked together on the implementation of the plan of safe care legislation and i know that this may also be reiterating what was spoken of earlier. But we have this gao report that just came out yesterday. I had requested that the gao examine the socalled infant plan for safe care improvement act. And what the gao found was a lack of guidance from hhs on how states should be implementing the law. So were going to continue to work on full implementation and sufficient support for the states and being able to carry out the responsibility on plans of safe care. So i guess i ask you as a neonatalist whos on the frontline as these substance affected infants, many of them burdened by the socalled nas syndrome, neonatal absta nant syndrome, have you identified any best practices for assuring a coordinated multidisciplinary approach to this . I think just as the gao report suggested, theres a lot of confusion at the state level of what defines an infant safe plan of care and what that should look like. And resources to be able to carry those out. There are models, theres a couple models, one that im familiar with thats called charm in vermont where they proactively engage families that are in Substance Abuse treatment well before birth, meet with those families throughout, develop plans throughout the pregnancy and work towards a safe discharge. What i experience is far more reactive where a referral is made to dcs around the time of birth and theres no action taken until around the time of discharge. And it tend to be reactive and, in part, i think thats because our overburdened Child Welfare system is reacting to the problem instead of having the resources and training to address it head on. Ill point out one other point, which is in many states they treat substance kpoexposure as y would abuse. And so reframing that specifically on how to work with families early on to keep Families Together where appropriate its really needed. I think your work on this and the infant safe plan of care, implementing that and getting more resources is vital to improving outcomes for family. Thank you, doctor. We have our vote at 11 30 so im going to ask the witnesses and the senators to try to keep the exchange within five minutes and then supplement the answers in written form after the hearing. Senator murk kows sky. Thank you, mr. Chairman and i would hope that he i could do followup questions with members of the panel because this is important. The go around the state, the meetings that i have, the meetings i have with folks here i dont care if youre the Alaska Association of School Boards or whether youre here as a mayor talking about an infrastructure project, we always end up talking about addiction and what is happening in our small communities. And when we think about the addict, we cannot think about the addict without thinking about the families. And the children that are now part of this world of addiction, it is just something that breaks your heart. I was at a meeting down on the peninsula just this past friday and was told, this is still anecdotal but when the office of Childrens Services takes a case, takes children, and not even taking them into the system but just reviewing them, they do a hair follicle test to test for drugs. Nine out of ten of the kids in the system right now are testing positive for drugs because of drugs that are in the household that they have been exposed to. When you think about the addict, you dont necessarily think about the impact, again, to our children, the imimpact on prematernal care, women who are pregnant who are choosing not to get care because theyre afraid theyre going to be told by their doctor that they are bad people, that when they if theyre mothers who have Young Children theyre not telling their doctors about their use because theyre afraid theyre going to lose their children. It is just beyond belief the impact to the children. We had the author of dreamland before the committee some weeks ago. He suggested we need a moon shot approach to get this social movement for recovery. And i suggested that moon shot was a different thing because it gave something for us as americans to aspire to, some big lofty goal. When it comes to addiction, its much harder for the communities as large to embrace this as something that we need to do because there is still such a stigma attached to it. And when i asked him what we, as lawmakers, could do, he said you need to give a forum to the families to speak out so we view differently those that are addicts. And ms. Savage, i want to ask you as the mother of two two young men who are no longer with you and your family because of addiction, when we think about the addict of days gone by, it is a different mental image in peoples minds. And recognizing that the addict todays a different person, how how can we do more to facilitate a conversation about the fact that people who are dealing with this, theyre not losers, theyre not bottom of the barrel, they are not they are not these these people at the bottom of society. These are these are boys, these are brothers, our sisters, our parents, people that we love. How do we change this so that there is this ability as society to embrace what we have to do to solve addiction . Sure. Thank you for the question where are senator. Our boys, i just want to clarify were not addicts, they had experimented with a medication that was brought to a gradation party so it was a onetime use that did kill them. However, we are faced with the stigmatism because every time somebody says how oh, you lost your two older boys, how did they pass away, have you that split seskd oh, my gosh, here we go and they died of an overdose. Do you get the stigmatism. And ive, you know, we talk about it. We tell exactly what happened. But there is that stigmatism ought there. There are some cool systems that i know parents have contacted me about going to talk to and the School Systems maybe dont arent ready to have someone come in and talk about opioid misuse or abuse or prescription pills because of the sigmatism. Theyre afraid that theyre going to be classified as having an issue at their school. So im not sure how to combat that other than just talking about it and being more open with talking to people. We talk about it all the time, obviously. I would like to say that its getting easier, but i think just talking about it hopefully will help fight some of that stigmatism. Well, 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. Thank you, mr. Chairman. It up. Senator baldwin. Thank you, mr. Chairman. I knew when i saw the announcement about this hearing that it was going to feel awfully personal, and i want to thank you all for being here and for your advocacy. Ms. Savage, thank you, you are saving lives. You talked about the power of story telling when you meet with students, so i want to share just a little of mine. I think most of the people on this committee know that i was raised by my grandparents because i talk about them all the time. Often times in the context of Committee Hearings that were having. I worked with senator collins on a different caregiver measure that was signed into law just two weeks ago dealing more with supporting families who are carrying for elderly people who are becoming frail or adults with disabilities. But i dont think ive often shared why i was raised by my maternal grandparents. My mother was 19 when i was born and going through a divorce, moved back home. But throughout her life struggled with Mental Illness and physical illness and chronic pain, for which in the days well before we labeled an Opioid Epidemic she was prescribed a multitude of benzo die as peens, 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. But my grandparents were heroes and gave me a stable upbringing and they thought they were empty nesters. They were both in their mid50s, both of their daughters had left the home, and i dont think they imagined that they were going to get an infant. I moved in when i was 2 months old. I actually had the same Grade School Principal that my mother had when she was in grade school. And i know they struggled. One of the issues they struggled with was Health Insurance coverage for me. They werent in the foster system, this was an informal arrangement. But i saw what my mother struggled with, misusing addiction. And i saw my grandparents, again, just my rocks, my folks who just were with me the whole time. I had the honor of returning to care for my grandmother when she was in her 90s and needed care giving. And so the issue of supporting our families in these roles from all perspectives, whether its getting the person with Substance Abuse issues that help they need or supporting the families and foster parents who step forward and give a kid a chance. I cared so deeply about this. I wanted to having taken so much of my questioning time, i suspect i will give you some questions for the record. But i wanted to ask a little bit about the infants dr. Patrick and dr. Bell who have Significant Health impacts of their own because of neonatal abstament syndrome. I have long championed a measure that has yet to become law that would extend access to therapeutic foster care, employing medicaid funds for children who will need lifelong care but to empower family members and foster parents to provide more than just custodial care and love, but also more intensive services. I wonder if you could talk about the importance of the role of therapeutic foster care and our ability to get medicaid funds to support those families. Dr. Patrick, why dont we start with you. Dr. Patrick, 13 seconds left so if you could summarize that and then perhaps in writing answer senator baldwins question. Tammy, thank you for your story too, that was. Thank you. Thank you for doing that. Please go ahead. I think one of the things we often miss is that substance exposure often leads to preterm birth. I sent home a baby in the last week that had been in the hospital for eight months, born at 23 weeks and the a. Support that family needs is extensive. For many of our babies they unfortunately dont have families to go to. So what youre talking about is varietially important as we support families, particularly foster families that come in and care for infants that have complex needs. So thank you for that. Thank you very much, senator baldwin. Senator scott. Thank you, mr. Chairman, and to senator baldwin, thank you. I came in halfway through your story. Thank you for sharing your personal story with all of us. I think its informative and instructive as well. Were all appreciative of family members who step to the plate when challenges arise with our caregivers. Ms. Savage, the power of your personal testimony is unmatched and i cant imagine the excruciating pain and misery that your family has endured, but the ability to arctic coupe late your articulate your story through this nation that well never hear but lives will be saved because hut power and strength toth testify. Thank you to your family, your husband, and your son for being here as well. Dr. Patrick risch know youve answered this question a couple of times already hand to go to a banking hearing and other hearings. But in south carolina, according to many reports from 2007 to 2015, the number of babies born with nas has gone from four per 1,000 to seven per 1,000. My understanding its very difficult to treat these babies. Can you once again illuminate perhaps briefly how we could do a better job first, and second, my question is when i was hear and listening to your testimony you talked about the difficulty within the first couple of weeks. Can you speak to the challenges for the next several years in some of these kids as they grow up . Thank you for the question. When i describe a baby that has drug withdrawal i describe them as a colic i can baby times five. These are infants that are fussy, difficulty feeding, sometimes difficulty breathing and less commonly they can also have seizure. So you can imagine what thats like for a familiarly go through and for the infant go through. Our approach has changed substantially at vanderbilt based on best practices around the country. No longer do infants that have drug withdrawal come to the Neonatal Intensive Care Unit. They stay with their mom in possible in the newborn nursery and then go to a hospital outside the icu. We find that keeping mom and babies together it decreases the severity of the drug withdrawal and keeps the bonding from early on, its so important. Your questions around longterm outcomes are really important. One of the things that we need say dishl research to understand. There really arent large prospective studies to follow infants as they go to kindergarten. We have some older studies that suggest that there may be some issues with attention, maybe with language, but there arent robust studies. Its an area that needs to be funded. As we think through this and react to what were doing now, one of the vital things that we do is support infants for those first few years of life and includes partnering with Child Welfare. So every infant thats substance exposed should be referred for Early Intervention services, speech therapy, occupational therapy, so we can maximize their outcome. I think that period of time going home is so critical, and right now the way it feels for me when i discharge an infant home is that its uncoordinated an it puts a lot of stress on a family that already has a lot of stress. Thank you very much, dr. Bell. I thank you for being here as well. One of the comments ive been thinking about as ive been listen sgt thought th listening is the thought of shame and consequences of ones action leads folks to hide the challenges and addictions. I know theres a strong push for parents going through treatment not to lose their children which sounds like a good idea but also a doubleedge sword. You can walk me through that as well . So the approach really is one that says we want to honor your relationship with your child, we also want to acknowledge that having that child connected to you is of great motivator to overcoming the challenge that youre dealing with. But in doing that, we also acknowledge the need to make sure that theres constant monitoring of the children, that there is constant support for the children, that theres respite for the child time period so the child will be away from the parent. So that Child Welfare is not doing what we typically done in the past which is having this complete distance. Yes. But that we are not leaving the child just with the parent so that something might possibly happen. And were continuously working with that mother and father and other family members to improve their capacity to care for the children. Thank you. Using my last 14 seconds here as wisely as i can which means im going to go over my 14 seconds, the senator baldwins story as it relates to the involvement of her grandparents, how often do you see the grandparents senator scott, im going to have to we have a vote right now and four senators waiting. Ill wrap it up just about seven more minutes. Ill submit that in writing to you. Thank you, mr. Chairman. Im sorry to cut you off, but i totally understand. Ive been trying to be a little bit senator murphy. Thank you very much, mr. Chairman, i want to add my thanks to senator baldwin for sharing that story with us and i actually may have a question pertaining to how we make sure that families are truly involved in the care for their loved once if i have time with my strict fiveminute limit. But i wanted to come back to dr. Patrick to expand on this conversation about neonatal absta nens syndrome. A few years ago yale Childrens Hospital conducted a Quality Improvement study look at the best care for these kids and what they attempted to do was build a really comprehensive nonform logical approach to faring for these infants, low stimulation rooms, feeding on demand, trying to enhance the bond between mother and child. The results were really extraordinary. Average length of stay in the nick cue went f