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Date: 10-18-2017

State working out how to pay relatives who provide foster care under recent court decision

FRANKFORT, Ky. — Kentucky's top human services official said Tuesday that the state will comply with a court order to pay relatives who provide free foster care the same as they do licensed foster families.

The court decision comes as a growing number of relatives, many of them grandparents, are caring for children removed from homes because of abuse or neglect and say the extra costs have caused them to burn through retirement savings and raise the children in poverty.The court decision comes as a growing number of relatives, many of them grandparents, are caring for children removed from homes because of abuse or neglect and say the extra costs have caused them to burn through retirement savings and raise the children in poverty.

But Vickie Yates Brown Glisson, secretary of the Cabinet for Health and Family Services, said the cabinet is still analyzing how to apply the court decision.

"Our legal team is studying it," she said in a brief interview.

The court decision comes as a growing number of relatives, many of them grandparents, are caring for children removed from homes because of abuse or neglect and say the extra costs have caused them to burn through retirement savings and raise the children in poverty.

Some have reported losing homes or facing bankruptcy.

Officials say the state's drug epidemic has helped fuel an all-time high of about 8,500 children in state care because of abuse or neglect.

Meanwhile, the lawyer who won the foster payment case and an independent children's advocacy agency say they are getting inundated with calls from anxious relatives who are desperate for financial help and want to know if they are eligible under last week's court decision.

"People are out there, they are suffering," said Richard Dawahare, the Lexington lawyer who won the case on behalf of a great-aunt caring for two young boys who was denied foster payments.

Among them is Vicki Dever, a Shepherdsville grandmother raising six grandchildren, ranging in age from seven months to 13 years. She said the children suffer from the lack of financial help.

"They are not punishing the grandparents. They are punishing the children and it's not their fault," she said.

Terry Brooks, executive director of Kentucky Youth Advocates, said his organization has received dozens of calls since the federal court decision became final Oct. 10. One grandmother drove from another county to his office seeking information in person only to find she didn't qualify, he said.

"We have been inundated with questions," he said, speaking at Tuesday's meeting of the House Working Group on Adoption. "Sadly, the majority of folks we've talked to aren't eligible."

Brooks said even some state social workers with the Department for Community Based Services have called youth advocates seeking information about the court decision.

Glisson said the cabinet soon will send information to its DCBS offices across the state to help them with such questions.

"I want to make sure our DCBS offices know what this case means," she said.

Meanwhile, Dawhare said he is urging people who think they might qualify to contact their social workers to let them know of their interest.

"I'd make my voice heard, in a nice way," he said.

Brooks said his organization has put together a list of questions and answers about the court ruling on its website, kyyouth.org.

The court ruling from the 6th U.S. Circuit Court of Appeals became final after the U.S. Supreme Court refused to hear an appeal by the cabinet of its decision earlier this year that the state must pay relatives who provide temporary foster care for children. 

But the order does not require foster payments to relatives who obtain permanent custody or adopt children.

For that reason, Brooks said it's increasingly urgent that the state find some way to restore Kinship Care, a program to provide financial assistance to relatives who take custody of children. 

The state closed the program to new applicants in 2013 because of a budget shortfall.

The program provides $300 per month per child compared to foster care payments that start at about $25 a day per child or about $750 per month.

Dever, the Shepherdsville grandmother, said she and her husband are not eligible for foster payments for five of the children because they have permanent custody. And they are seeking permanent custody of the sixth child, an infant, she said.

The Devers get Kinship Care payments for three of the children they took in before the state froze the program but even those payments are in jeopardy because the state claims she missed a deadline to file paperwork. Dever said she has appealed and continues to get Kinship Care payments but cabinet officials told her if she loses the appeal, she will have to repay the money.

Even with Kinship Care payments of $900 per month, Dever, 58, who is disabled from a heart condition, said she and her husband, 73, a retired farmer, are barely scraping by.

Recently, she said, she couldn't come up with $20 two of the children needed to attend a school program that required a $10 donation per student. The school said it would accept a lesser donation and the children's great-grandparents provided each child with $1 so they could attend.

Dever said she and her husband never considered letting the kids go into foster care. She said the couple has taken the children in at various times after they were born to her daughter, who was involved with drugs; most recently, they brought the infant home from the hospital.

"They said we could put them in foster care," she said. "We just couldn’t do that. After we took the first one how can you take one and not another. What would you say to them later in life?"

About 70,000 Kentucky children are now in the care of relatives, said Shannon Moody, with the youth advocates organization, addressing the House adoption panel Tuesday.

Of those, about 12,000 have been removed from homes because of abuse or neglect and about 5,788 are covered by Kinship Care, Moody said.

About 1,300 children are in "relative foster care," where relatives are licensed foster care providers and are paid the state's daily rate. But families sometimes get conflicting information about becoming licensed foster parents.

Some grandparents have told the Courier-Journal state workers told them they can't become licensed foster parents in order to get payments for grandchildren. Others have said workers told them there's no guarantee the state would place the children with them once they obtained such a license.

"That information has been really inconsistent in the past," Tara Grieshop-Goodwin, with youth advocates, told the adoption panel.

Cabinet officials said they are working to standardize such information.

By Deborah Yetter
The Courier-Journal

October 12, 2017

TRMC CEO Greg Kiser and Willis Fletcher TRMC CEO Greg Kiser and Willis Fletcher

Congratulations to Willis Fletcher for 10 years with TRMC!!! Proud of our staff!!!

 

October 8, 2017

On Tuesday, Oct. 10, nations, organizations and advocates will recognize WORLD MENTAL HEALTH DAY. The Kentucky Department of Veterans Affairs (KDVA) works every day to ensure veterans receive the mental health evaluation and treatment they need.

“There are mental health programs for veterans throughout the Commonwealth,” said KDVA Commissioner Norman Arflack, “and we want to make sure that every veteran who may need those programs can find and use them.

“Good mental health is as crucial as good physical health,” Arflack said. “The stigma of seeking mental health treatment is long gone. The only thing wrong is not seeking the treatment you need.”

KDVA’s benefits counselors, who serve veterans in every county of Kentucky, are federally certified and can refer veterans to exactly the services they need. KDVA’s services are always free of charge to veterans.

Find the Veterans Benefits Field Representative who serves a particular county here.

World Mental Health Day is observed on Oct. 10 every year, with the overall objective of raising awareness of mental health issues around the world and mobilizing efforts in support of mental health. The Day provides an opportunity for all stakeholders working on mental health issues to talk about their work, and what more needs to be done to make mental health care a reality for people worldwide.

Find resources and information for veterans at these links:

Connect with KDVA for services and benefit information

Mental Health from the federal VA

Locate your local VA

Other free resources:

Give An Hour

Military OneSource

Mission 22

 

From Kentucky Department of Veterans Affairs

October 11, 2017

By MATTIBETH NELSON

Ehlers Danlos Syndrome is a connective tissue disorder that can affect any part of your body. The comorbidies that come with it are growing each year. There are some that are too non specific to pin down so we are depending on research to connect all the dots. In medical school doctors are taught when you hear hoof prints to think horse not zebra making someone with EDS a medical zebra.

Madison, Emma, and Mackenzie Nelson and their mother Mattibeth Nelson.Madison, Emma, and Mackenzie Nelson and their mother Mattibeth Nelson.


As someone who loves her hometown I know our doctors are up to the challenge of learning more about EDS. I have been to the past two learning conferences on Ehlers Danlos Syndrome and have discovered a few things:

*  1. The number of doctors familiar with E.D.S is so scarce that on average people go 5 or more years before they get a diagnosis.

*  2. These patients often have to travel for hours and feel like giving up before having their symptoms are validated.

*  3. The hopes of the new criteria is to serve as a starting point for the EDS (zebra) community.

*  4. This criteria will change as more research is done but we need your help.

 

On March 15th 2017 there was new criteria published for the diagnosis of EDS specifically, hEDS. Although they are searching for the gene mutation at this time, it has not been found so they are relying on a clinical diagnosis. We want to stick local so I implore you to please take the time to read about hEDS and help us stay local.

A program sponsored by EDS awareness.com is now offering free C.M.E.'s for medical professionals. You can sit at home on your computer and get all your C.M.E.'s for free. If that is not enough to interest you then how about this? The number of diagnoses in Louisa is going up and familiar doctors are so full that they are turning away patients.

Our local dazzle (group of zebras) consists of 15 members that have been officially diagnosed to include:

Donna Brady and her daughter, three of my children: Madison, Emma, and Mackenzie Nelson. This list also includes myself now. All residing in Louisa/Prichard area.

There are several in our group that suspect it as well but need more local medical professionals to understand it. Come grow with us. This program is aimed at just the basic explanation of E.D.S. and symptoms that go along with it.

For more information you can go to www.Ehlers-Danlos-CME.org

 

Date: 10-02-2017

A driver crashes into a bus, killing her 1-year-old daughter. She was in a haze from a sedative mixed with medicine meant to curb heroin cravings. A 4-year-old dies after taking his uncle’s pills. A patient in addiction treatment stops taking his medicine, then overdoses and dies.

All of these deaths — blamed on the misuse of the same drug — could have been prevented. Now, two Kentucky researchers are testing a breakthrough treatment that injects addiction medicine straight into the patient’s body, reducing the chance of abuse.

It’s being hailed as a potential “game changer.”

The weekly or monthly injections — called CAM2038 — release buprenorphine over time. Doctors prescribe the narcotic (prounounced bew-preh-nor-feen) to wean patients off heroin or powerful opioid pain pills.

It’s not a new drug. It’s a new, safer way to get the drug into the patient’s body.

For years, doctors have prescribed buprenorphine during medication-assisted treatment to reduce urges for heroin and other opioids that dangerously slow breathing and heart rate. The medicine is the main ingredient in Suboxone, a popular addiction treatment drug.

Buprenorphine also lessens painful withdrawals, which are commonly cited by addicts as an excuse to keep using heroin or other deadly poisons.

Some doctors, patients and their relatives won’t even consider using buprenorphine or other drugs to wean addicts off stronger opioids because of what can go wrong. Dr. Michelle Lofwall, a Lexington psychiatrist who led a national study of CAM2038, said injecting the drug could alleviate most of those concerns.

“This could be a game-changer if it stops the stigma,” she said.

Treatment

First, the proposed injections must win approval by the U.S. Food and Drug Administration. Sharon Walsh, director of the Center on Drug and Alcohol Research at the University of Kentucky, and Lofwall, a faculty member, plan to tout the injections based on their own research when they appear before an FDA panel in November.

If approved, Lofwall said, the treatment could be available as soon as early 2018.

Currently, doctors in Kentucky and Indiana prescribe buprenorphine once a week, twice a week or monthly. Patients are given multiple doses and are supposed to take either a tablet each day or a film that dissolves under the tongue or is placed on the cheek.

The injections are designed to address several current risks of buprenorphine, including:

*   Forgetting to take a daily dose.
This could leave patients more vulnerable to cravings. One relapse can be deadly at a time when heroin and other drugs are being laced with fentanyl. A tiny amount – about the size of Abraham Lincoln’s cheek on a penny – can be lethal.


*   Deciding to stop the pills or films. Some patients who want to go on a bender skip their pills or films for a few days so the euphoric effects of heroin or other strong opioids aren’t blunted.

One of Lofwall’s patients who did this overdosed and died.
“It’s heartbreaking,” she said. “It’s a very unforgiving disorder.
“I can’t help but think if that person had a monthly injection, they would still be alive.”


*   Selling, trading or giving away films or pills. Or leaving the medicine out somewhere it can be stolen.

A North Carolina woman ended up with someone else’s buprenorphine and took a tablet along with a sedative, then got behind the wheel. She lost control in a curve, overcorrected and veered into oncoming traffic, ramming a YMCA bus. The impact killed her 1-year-old daughter.


*  Children could accidentally take the drug if they find the pills or film.

After a 4-year-old Michigan boy found his uncle’s prescribed buprenorphine and swallowed a tablet, the uncle pleaded guilty for his role in the child’s accidental death. He admitted that he failed to get the boy immediate medical care because he didn’t want to get himself or his family in trouble.

Last year, the Kentucky Poison Control Center handled 56 calls about children younger than 6 ingesting buprenorphine, said director Dr. Ashley Webb. Ten more calls involved kids ages 6-18.

Calls to the center’s hotline are voluntary, so the actual number of poisonings is likely much higher, Webb said.

In most of the cases, she said adults left prescription bottles on bedroom nightstands or coffee tables, within reach of children.
Injections would provide a safeguard, said Dr. Ashley Peak, an addiction psychiatrist with the Morton Center.

“It limits the risk of children getting a hold of it,” she said.

‘Not a magic bullet’

Even with injections, some risks remain.

Doctors are concerned about patients combining the medication with alcohol or other drugs. That can be deadly, Peak said, even when mixed with anti-anxiety medicines such as alprazolam, the main ingredient in Xanax.

In one case, a 17-year-old who had an enlarged heart died last year in Jefferson County after taking a buprenorphine film or pill and alprazolam, according to local coroner’s office data.

In another case that resulted in a fatal wreck, an impaired Evansville, Indiana, man crashed his Jeep into a Toyota last year, causing the car to flip on Interstate 64 in Warrick County. The impact ejected a 60-year-old man who died at the wreckage site. The Jeep’s driver had mixed buprenorphine, oxycodone and benzodiazepines.

Still, that’s a fraction of the deaths from heroin and fentanyl – deadly addictions buprenorphine and other medication-assisted treatment are trying to curb. Last year, an average of about one person a day died from an overdose in Jefferson County. Most were from opioids, mainly heroin and fentanyl.

Some treatment centers only promote abstinence-based recovery.
But with relapses common, many people need medication to wean themselves off the powerful poisons, according to a report by the U.S. Substance Abuse and Mental Health Services Administration.

It also recommends counseling and support from family and friends.
Buprenorphine and methadone, also used to treat addiction, trick the brain into thinking it’s still getting the problem opioid, according to the health administration’s Center for Substance Abuse Treatment. The patient feels normal, not high.

If buprenorphine injections are approved, “It’s not a magic bullet,” said Scott Hesseltine, vice president of addiction services at Centerstone, formerly Seven Counties Services. “It just expands options.”

Dr. Mark Jorrisch, medical director of Louisville’s MORE Center, said he has seen many patients regain some normalcy through medication-assisted treatment, maintaining jobs and improving their social and family lives.

“The frequent comparison is diabetes,” Jorrisch said. “There’s a genetic component. You may do all the right things and still need medicine to keep it under control.”

Kentucky researchers’ key role

Before buprenorphine injections gain approval, they need to be tested. And that’s how Kentucky is playing a key role.
University of Kentucky researchers led two multi-state clinical trials that concluded last year.

Both studies were funded by Braeburn Pharmaceuticals, in Princeton, New Jersey, which developed the drug treatment through a partnership with Camurus, based in Lund, Sweden . A similar product by another company also is seeking FDA approval.

Walsh, who has evaluated new opioids used to treat pain as a contractor for the FDA, led a study on CAM2038 conducted at three sites: the University of Kentucky in Lexington, Columbia University in New York City and Vince Associates in Kansas City.

Lofwall led a second study that spanned 36 locations across the country.

Both found that the injections of buprenorphine worked as well as the pills or films in lessening the pain of withdrawals and reducing cravings for heroin and other drugs. Their findings were published in the September issue of theAmerican Medical Association’s monthly journal JAMA Psychiatry.

“If approved, they definitely will provide more options for patients and physicians,” Walsh said.

Jorrisch said he would use the injections with some patients, but not until he first tries tablets or films in case the patient has an allergic reaction or suffers side effects such as headaches, nausea, constipation or sweating. With daily doses, he said, you can stop the medication right away.

Lofwall said, based on her research, she would give it to her own patients.

“It’s a breakthrough,” she said. “It’s something that will give treatment providers one more tool to fight this epidemic.”

By Beth Warren
The Courier-Journal