​​Every person who calls Georgia home deserves to live healthy and thrive. While Georgia has made recent strides to improve the health of our residents, we haven’t yet reached that goal according to Georgians themselves and our state’s health data.

To help state and community leaders make effective and informed decisions about the health and well-being of Georgians, Georgians for a Healthy Future created the illustrated What the health, Georgia guide. This publication is intended to be a reference that decision makers can go back to again and again as they consider new health laws and policies and determine how to invest public funds in health care and public health.

Download a copy of What the Health, Georgia here! 

 Georgians for a Healthy Future (GHF), the Georgia Council on Substance Abuse (GCSA), and the Center for Pan-Asian Community Services (CPACS) are nonprofits focused on building healthier communities. We partner together to promote policies and systems that increase access to substance use and mental health prevention, identification, and recovery services for Georgia youth. 

The pandemic has dramatically shifted the lives of Georgia’s children and families. Children have faced inconsistent and uneven access to school, social isolation, and family stressors (from job loss, illness, or other changes). The potential impacts of these challenges are compounded for vulnerable youth, such as those in low-income families, in communities of color, or LGBTQ+ youth. The changes and challenges over the last year could result in or exacerbate mental illness or substance use disorders among Georgia students. 

According to the Centers for Medicare and Medicaid Services (CMS), COVID-19 has drastically reduced the utilization of mental health services among Medicaid & Children’s Health Insurance Program (CHIP) beneficiaries. In 2020, there was a 34% decline in the number of mental health services used by children under 19. Nationally, this decline means that 14 million fewer mental health services were provided to CHIP enrollees.1 The decline in services means that many fewer young people are receiving needed substance use and mental health services, leaving them ill-prepared to return or continue their educations successfully. Additionally, many students lost a critical lifeline for receiving mental health and substance use services during school closures.2 Prior to the pandemic, over one in three young people relied on schools as their primary source of mental health care. 

School-based substance use and mental health services are critical to ensuring that Georgia’s children have access to the services they need. Such school-based care is essential for ensuring young people are healthy and ready to learn, especially as we build back from the downstream effects of the COVID-19 pandemic. 

Georgians for a Healthy Future, the Georgia Council on Substance Abuse, and the Center for Pan-Asian Community Services offer the following comments with respect to the Georgia Department of Education’s utilization of ESSER funds to address the behavioral health needs of Georgia’s children, with a special focus on substance use prevention and treatment. 

Training School Staff on Substance Use and Mental Health 

School districts should train school health personnel and staff (i.e. school counselors, social workers, and nurses) to identify substance use and mental health needs as students return to the classroom and properly refer them to appropriate services, including community mental health and substance use providers. Identifying substance use and mental health issues early, allows students to get the treatment they need before the situation turns into an emergency. 

One evidence-based technique is SBIRT, which stands for Screening, Brief Intervention, and Referral to Treatment. SBIRT is low-cost, effective, and supported by the American Academy of Pediatrics. SBIRT helps trusted adults (like teachers, school nurses, or counselors) to have structured conversations that identify students’ drug or alcohol use and connects them to follow-up counseling or treatment if needed. Georgia policymakers have also demonstrated their support for SBIRT by adopting Senate Resolution 1135 during the 2018 legislative session, which endorses SBIRT as a “best practice to facilitate academic success and positive school climate.”3 SBIRT can also be combined with other screening tools that may only address depression, anxiety, or other mental health needs so that a student’s full spectrum of needs is addressed. 

Some related training for teachers and other school staff is beginning through the Opioid Affected Youth Initiative grant program from the Criminal Justice Coordinating Council (CJCC). With their OAYI grant, GCSA is already working with the Department of Education to identify high schools in each of the sixteen (16) RESAs that are most in need of training to have compassionate and constructive with their students who either experience overdose and come back to school, or with students who have friends or loved ones who do not survive overdose. This curriculum will serve as a foundation to build the strengths of each participating school, boost their confidence in having these difficult conversations with students about substance use, and lay the groundwork for similar trainings that focus on prevention and early intervention. The program is currently operating in 16 high schools throughout the state. With additional funds from ESSER, the program could be expanded to more schools, additional school staff could be trained, and participants could be trained for conversations that range from prevention to early intervention to support after overdose. 

Implementing SBIRT Pilot Projects 

Pilot projects to address students’ substance use and mental health needs are an innovative and effective use of the time-bound funding appropriated to the state through ESSER. Specifically, we encourage DOE to use the funding to implement SBIRT pilot projects in all Georgia high schools. 

GCSA has successfully implemented two SBIRT pilot projects, one at Marietta High School and one at Decatur High School, that demonstrated the effectiveness of providing SBIRT in high school settings. In both projects, local community members in recovery from substance use were embedded in the schools to lead the substance use screenings and conversations with students. 

SBIRT pilot projects would allow schools to screen students at risk for substance use; provide opportunities for school staff to learn strategies and interventions for addressing substance use; tailor the screening and brief intervention model to the specific needs of a school; capture data and lessons learned for implementing the program successfully throughout the state; and allow schools to adopt sustainable funding mechanisms to support the programs long-term.4 

Sustainable Investments in School-Based Health Services to Address Substance Use 

In 2018, Georgia submitted a State Plan Amendment (SPA) to CMS to remove the Individualized Education Program (IEP) requirement for school nursing services and allow school districts to bill for school nursing services provided to all Medicaid-enrolled students. Implementing this SPA would bring in additional revenue from the federal government and increase resources for schools to address student substance use.5 For example, if the SPA were implemented and the SBIRT pilot projects were successful, school Medicaid reimbursements could cover the cost of sustaining the program. The SPA is currently on hold, but if the state revived it, ESSER funds could be used to cover the costs of setting-up the program, thus making the funding more sustainable. We encourage DOE to collaborate with the Department of Community Health to revisit the SPA and leverage ESSER funds to implement the change. 

Population-based approach

We commend the Department of Community Health for taking a population-based approach to improving the health of Georgia’s Medicaid members. We are especially encouraged by the Department’s commitment to engaging with the care management organizations (CMOs) to monitor and improve racial health disparities among Medicaid members. This commitment is a strong first step, and we believe DCH could go even farther to address and improve health disparities in these three ways:

Planning for Healthy Babies

Planning for Healthy Babies (P4HB) is an important program to improve maternal and infant outcomes and address health disparities, but it serves only a small population of women in Georgia. One of the reasons P4HB is so successful is the targeted outreach efforts to women in areas with poor infant health outcomes. DCH should take a similar approach for all Medicaid eligible populations. By focusing CMO and DCH outreach efforts on areas of the state with poor health outcomes and high Medicaid-eligible populations, they may be able to make a similar impact on health disparities for a larger population.

Meaningful engagement with Medicaid members

To successfully reduce health disparities, we advise DCH and the CMOs to work closely and meaningfully with Medicaid members and community members from the populations experiencing the greatest health burdens to craft impactful strategies tailored to a specific group. There are great opportunities to close racial health gaps among Georgia’s Black & Hispanic communities especially. Georgia has the 2nd largest Black/African American population in the U.S.(The Office of Minority Health, 2021), and 15% of Black Georgians are uninsured (KFF, 2020). Georgia also has the 9th largest Hispanic/Latino population in the U.S., and 47% of Georgia Hispanics are uninsured (The Office of Minority Health, 2021). Black and Hispanic Georgians suffer from chronic and infectious diseases, including COVID-19, at rates higher than those of white Georgians CDC, 2021) and have shorter life expectancies ( The Office of Minority Health, 2021).

Unique barriers (including language, systemic inequities to build wealth, available pathways to coverage, immigration status, social discrimination, and more) block these groups from equitable health status and outcomes. These complex and long-standing barriers to health can only be overcome with meaningful, sustained engagement with members of these and similar groups. Based on GHF’s observations, the infrastructure that DCH and CMOs have for engaging members falls short of what is needed. (GHF humbly offers its assistance to all interested parties re-thinking engagement strategies and programs.)

Beyond language and cultural competency

The Quality Strategy points to translation and language services and cultural competency as strategies to reduce health disparities. These are important components, but they are not sufficient on their own. We encourage DCH to explore additional interventions that better address the root causes of disparities. These interventions could include maximizing the roles of the state’s community health workers (CHWs) and peer support coaches; and incentivizing CMOs to operate robust wrap-around service programs to address housing, food, transportation, and economic needs of members. Numerous studies have shown that CHWs and peer support coaches can play meaningful roles in improving health outcomes, lowering health spending, and reducing health disparities (Chan, 2021).

Another solution to reducing health disparities is to ensure every Georgian has a pathway to health coverage. Medicaid expansion would go farther than the proposed Pathways 1115 waiver towards accomplishing this. Several studies have shown that full expansion of

Medicaid (up to 138% FPL) narrowed disparities in health outcomes for Black and Hispanic individuals, particularly related to infant and maternal health (KFF, 2020). While this decision does not lay with the Department of Community Health, your leaders and staff are trusted and important messengers to state lawmakers about how such a move could improve the health of Georgians.

Behavioral health

We were encouraged to see the Quality Strategy call out behavioral health as an area of focus. Data before and during the pandemic supports that behavioral health needs are growing across the population, and there is no doubt that this holds true for Medicaid members.

However, the measures for Goal 1.5 predominantly address mental health (increase screening for depression among adults and adolescents), while largely ignoring substance use. We know that youth substance use is a risk factor for other issues, including school absenteeism, depression, and committing acts of violence. Data show that Georgia youth are experimenting with drugs and alcohol at younger ages (SAMSA, 2019). Therefore, DCH could significantly impact the behavioral health outcomes of young members by adding measures related to substance use screenings and referral to treatment services. To increase screening for substance-use disorders among youth, DCH could leverage CHIP funds for Health Service Initiatives. Utilizing these funds would provide sustainable funding for school-based or population-based services to address substance use.

Access to care via telemedicine

The increased utilization of telemedicine during COVID-19 has proven it is an important method of care for Georgia consumers, including Medicaid members. For that reason, we are pleased to see it identified in the Quality Strategy. However, telemedicine cannot overcome all access challenges because many Medicaid members live in areas with limited internet connectivity, especially those who live in communities of color and rural communities. We encourage DCH to look for additional methods to increase access to care, including addressing transportation gaps.

Notably, the Quality Strategy does not mention the Non-Emergency Medical Transportation benefit for Medicaid enrollees. In our experience, many enrollees do not know about the NEMT benefit and therefore do not make use of it. Additionally, at times NEMT is unreliable and unprepared to meet members’ transportation needs (i.e., sending a regular van to pick up a member who needs a wheelchair-ready van or sending transportation that cannot accommodate a child’s sibling). DCH could increase access to care by promoting the benefit to more beneficiaries and investing in improvements to the program.

Measurement, evaluation, and enforcement

GHF applauds the strong evaluation and enforcement measures included in the Quality Strategy. The inclusion of the value-based purchasing program in the GF 360º program and the intermediate sanctions policy offer strong accountability measures for Georgia’s CMOs.

We were further pleased to see multiple measures of network adequacy, including appointment availability, incorporated into the Quality Strategy. GHF views appointment availability and travel time/distance as perhaps the most accurate measures of network adequacy in terms of increasing access to care. We encourage DCH to hold these measures above other measures like provider member ratios. To meaningfully ensure network adequacy for Medicaid members, we encourage DCH to adopt more robust enforcement measures for these requirements. Specifically, DCH could leverage intermediate sanctions against CMOs with provider directories that are out-of-date or otherwise inaccurate. Requiring CMOs to maintain up-to-date and accurate provider directories will help ensure Medicaid enrollees can receive timely care and avoid costs associated with unknowingly utilizing out-of-network providers.

Legislative update: Week 8

The GHF team prides itself on delivering timely and accurate updates to you on health care happenings at the Capitol. We hope that you enjoy reading our weekly legislative updates and that they help you stay informed and connected. If you enjoy them, please consider supporting our work with a donation today. Thank you for your continued support!

In this week’s update:

• Action alerts: Ask the House Rules Committee to prioritize mental health & substance use recovery today!
• Bills likely to receive a House or Senate vote today
• Approved last week: Emergency services, prior authorization, & the FY22 big budget
• Advocacy events this week: HIV decriminalization & Medicaid expansion advocacy day!
• U.S. Senate approves COVID-19 relief including extra Medicaid expansion funding for Georgia
• GHF’s got you covered this session!

The ongoing COVID-19 crisis has damaged the mental health of many Georgians and exacerbated the use of alcohol and drugs. Financial stressors, the difficulties of parenting, and almost universal uncertainty brought about by COVID-19 have dramatically increased depression, anxiety, stress, and substance use among Georgians. Some will seek supports and services to manage their health, which may be provided in part by certified peer specialists.

Certified peer specialists (CPS) provide support and education to individuals and families while they navigate mental health and/or substance use recovery supports and services. CPS have played a vital role in Georgia’s mental health and substance use recovery systems for over 20 years.

A recent poll from the Kaiser Family Foundation found that 45% of Americans reported that the COVID-19 crisis has harmed their mental health. Anxiety and fear are common with people concerned about contracting the virus, a loved one getting sick, and the economic impact of the crisis, including job loss, lost income, and loss of health care coverage.

Georgia non-profits and state agencies have come together to ensure resources and supports are available for Georgians who need help with their mental health. The following list provides information and links to resources to help get all of us through these difficult times.

If you need to talk to someone:

• National Suicide Prevention Lifeline
  Call 1-800-273-8255 or use the chat option on their webpage
  en Espanol: 888-628-9454
  Deaf and hard-of-hearing: 1-800-799-4889
  Open 24/7. We can all help prevent suicide. The Lifeline provides free and confidential support for people in distress, prevention and crisis resources for you or your loved ones, and best practices for professionals.

• Georgia Mental Health Consumer Network’s Peer2Peer Warm Line
  Call 888-945-1414
  Open 24/7/365 providing peer support over the phone. Support is available to all Georgians experiencing anxiety or stress, or who need support through the pandemic. Please call any time.

• Georgia Council on Substance Abuse’s CARES Warm Line
  Call or text 844-326-5400
  Open every day, 8:30 am to 11 pm. FREE, confidential, and available to anyone who has questions about addiction and recovery, needs someone to listen to them or wants to talk with someone who is also in recovery from substance use disorders.

• Georgia COVID-19 Emotional support line
  Call 866-399-8938
  Open 24/7. This confidential line offers assistance for those needing emotional support or resource information as a result of the COVID-19 pandemic. The support line is staffed by volunteers, including mental health professionals and others who have been trained in crisis counseling. This is part of a partnership between the Georgia Department of Behavioral Health & Developmental Disabilities, Beacon Health Options, and Behavioral Health Link.

If you need a support group:

• The Georgia Council on Substance Abuse is offering a FREE and confidential series of virtual All Recovery Meetings for those who want to stay connected during COVID-19. To learn more about GCSA and find the most up-to-date meeting times, visit their FaceBook page.
• NAMI Georgia and their local chapters around the state offer virtual support meetings for people with mental illness and family members. To get more information about the meetings, call (770) 408-0625 or email programs@namiga.org.

If you want to learn skills or information about mental health:

COVID-19 and your mental health:

• Learn self-care strategies and get the care you need to help you cope with resources and tips from the Mayo Clinic.
• Mental Health and COVID-19 information and resources, Mental Health America
• Teach Kids Coping Skills, Children’s Healthcare of Atlanta Strong4Life

If you have health coverage:

• Medicaid – If you need mental health or substance use recovery services during this time, check with your Medicaid insurance company and doctor to see if you can schedule a safe, socially distanced in-person appointment or a “virtual appointment” using the internet, video call, or telephone call, instead of going in-person. The contact information for your Medicaid insurance company is on the back of your insurance card.
• Private insurance – If you need mental health or substance use recovery services during this time, call your insurance company using the number on the back of your insurance card or visit their website to search for an in-network health care provider near you who offers the services that you need.
• Uninsured – If you need mental health care services during this time, call the Georgia Crisis & Access Line at 800-715-4225, visit the GCAL website, or download the MyGCAL app to find free or low-cost, local mental health & substance abuse services. Georgians should not let their insurance status get in the way of getting needed support or treatment.
• You can find more insurance information and resources (including how your insurance will cover COVID-19 testing & treatment) on our COVID-19: Your health coverage, health care, & well-being blog.

If you want to help:

• If you have completed Mental Health First Aid training and are interested in volunteering to provide support via the Georgia COVID-19 Emotional Support Line please email your name and contact info to MHFAvolunteer@dbhdd.ga.gov

Georgia consistently ranks poorly among states in children’s mental health services, this year ranking 51st in a report from the Commonwealth Fund.  However, state leadership has been adamant about improving Georgia’s system of care through the infusion of additional dollars for children’s mental health services in the state budget and through innovative programs like Project Advancing Wellness and Resilience Education (AWARE).

Georgia Project AWARE is a youth mental health initiative focused on improving the experiences of school-aged youth in Georgia, and is funded by a grant from the Substance Abuse and Mental Health Services Agency (SAMHSA) to the Georgia Department of Education (GaDOE).

The purpose of Georgia’s Project AWARE is “to increase awareness of mental health issues among school-aged youth; provide training in Youth Mental Health First Aid; and connect children, youth, and families who may have behavioral health issues with appropriate services.”

The four main goals of Georgia Project AWARE are:

1. Increase participation of families, youth, and communities and mental health providers in efforts to identify the mental health resources available to meet the needs of students and families;
2. Increase awareness and identification of mental health and behavior concerns, and student and family access to mental health providers through the PBIS framework in Georgia Project AWARE (GPA) schools; 
3. Increase the percentage of Georgia youth and families receiving needed mental health services through collaboration between school systems and community mental health providers; and
4. Train educators, first responders, parents and youth group leaders to respond to mental health needs of youth by providing free training in Youth Mental Health First Aid (YMHFA).

Georgia’s Project AWARE grant supports the participation of three Georgia school systems: Griffin-Spalding County School System, Muscogee County School District, and Newton County Schools. The GaDOE has partnered with these school districts to provide training in Youth Mental Health First Aid and to develop innovative ways to connect youth and families to community-based mental health services.

Through Project AWARE, elementary and middle school teachers conduct universal screenings of their students and the screening results are used in two ways. School-, grade-, and classroom-level data is used to guide decisions about what universal supports or programs may be needed to better support the social and emotional needs of students. For example, if the results of the screening show high rates of anxiety for an entire grade of students, school leaders and teachers may make changes to school practices that may contribute to student anxiety or implement a program to help reduce or address the anxiety students are feeling.

Individual level screening results are used to identify those students who could benefit from extra social and emotional supports. These students are then connected to the appropriate behavioral services through partnerships the schools have developed with community-based providers.

Georgia Project AWARE has already screened a total of 18,713 students in 29 schools. Georgia State University’s Center for Leadership in Disability and the Center for Research on School Safety, School Climate and Classroom Management provide support for the program through analysis of the screening results and trainings for school leadership and staff.

In Getting to know Project AWARE: Part II, we’ll learn more about Youth Mental Health First Aid and how it helps educators meet the social and emotional needs of their students.

To learn more about Georgia Project AWARE:

• Visit the Georgia Department of Education (GaDOE)
• Read more from the Substance Abuse and Mental Health Services Agency (SAMHSA)
• Read the latest issue of the Georgia Project AWARE Digest

Suicide is third leading cause of death among 10-24 year olds in Georgia. In order to combat this growing issue Governor Deal and the state legislature included an additional $21.4 million in the FY2019 state budget to improve and expand children’s behavioral health services. Out of that appropriation, $1,092,000 was directed to suicide prevention efforts, which will in part go towards expanding the capacity of the Georgia Crisis and Access Line (GCAL). GCAL provides 24/7 online and telephone support for Georgians who are seeking services for or in crisis as a result of developmental disabilities, mental health, or substance use conditions.

GCAL connects callers with trained professionals and clinicians who screen and assess the severity of callers’ need for service. The GCAL operators then provide the appropriate assistance, referrals to necessary services, or dispatch crisis services when needed. The call center can:

• Provide telephonic crisis intervention services,
• Dispatch mobile crisis teams or emergency services when needed,
• Assist individuals in finding an open crisis or detox bed across the state,
• Link individuals with urgent appointment services,
• Help individuals find a mental health, substance use treatment, or developmental disability provider in their area in a non-emergency; and
• Connect families and individuals with community-based support services.

GCAL also provides language assistance for people with limited English proficiency.

Even though GCAL’s name includes the word “crisis,” consumers do not need to be in crisis to call or visit the website. As mentioned above. GCAL provides non-emergency or crisis services. Call center staff are available to answer routine questions about behavioral health and provide callers with a choice of providers and assistance in scheduling appointments for service.

Georgia consumers can call 1-800-715-4225 or visit mygcal.com if they or someone they care for is facing a behavioral health crisis or in need of services. For more on how GCAL is making a difference in the lives of individuals and their families, check out this video from Voices for Georgia’s Children.

Georgians for a Healthy Future hosted an educational forum titled Strong Foundations: Building a System of Care to Address the Behavioral Health Needs of Georgia Children on Tuesday, May 15. The forum explored the behavioral health needs of Georgia children and youth, Georgia’s publicly-supported behavioral health landscape, and successes and opportunities in the current system of care. The event also raised awareness about Georgia’s system of care in an effort to improve access to behavioral health services for children and youth.

The event began with Respect Institute speaker Tammie Harrison, who shared her experiences navigating the behavioral health care system and getting to a place of recovery.

Because many of the event attendees were new to the topic of children’s behavioral health (BH), GHF’s Executive Director Laura Colbert provided some foundational information about the prevalence of children’s BH conditions, contributors to poor BH, and the pathways to BH care and supports for young Georgians. You can find Laura’s PowerPoint slides here. She also debuted GHF’s new behavioral health fact sheet.

Dante McKay, Director of the Office of Children, Young Adults, & Families at the Georgia Department of Behavioral Health & Developmental Disabilities (DBHDD) provided attendees with an overview of DBHDD’s work, the 2017 System of Care state plan, and how the recently signed FY19 budget would impact the department’s ability to serve Georgia children and youth.

Dr. Erica Fener-Sitkoff, Executive Director of Voices for Georgia’s Children moderated a panel discussion of BH service providers, which included Wendy Farmer of Behavioral Health Link, Laura Lucas of Project LAUNCH (DBHDD), and Monica McGannon of CHRIS 180. The panelists discussed barriers to accessing BH services, which they said include continued stigma, lack of trained workforce, and transportation. The panel also identified innovative efforts, like Project LAUNCH and mobile crisis services, to bring BH services closer to consumers when and where they need it. When asked how Georgia’s next Governor could continue to make progress in the area of children’s behavioral health, panelists suggested a focus on workforce development, increasing access to community-based substance use treatment for teens, and prevention and early intervention.

If you missed the event, a recording of the webcast is available here.

To see photos, review materials, and read more about our Strong Foundations event, please visit the event page.

Despite several missed opportunities to address consumer health concerns during this year’s state legislative session, the FY2019 budget includes several impactful investments. Last week, Governor Nathan Deal traveled through Georgia and held budget signing ceremonies in Atlanta, Acworth, Blue Ridge, Statesboro, and Tifton for the $26 billion spending plan which will begin on July 1 of this year through June 30, 2019. The infusion of dollars into children’s mental health is especially noteworthy and exciting because of the impact it is expected to have across the state.

Governor Deal has recently made children’s behavioral health one of his top health care priorities and this year included in his proposed budget $20.6 million to fund recommendations from the Governor’s Commission on Children’s Mental Health. During its consideration of the state budget, he legislature ultimately increased the funding dedicated to these recommendations to $21.4 million.

These funded recommendations include behavioral health crisis services, supported employment and education for young adults with behavioral health needs, provider training and telehealth, and opioid abuse prevention for youth. Funding for suicide prevention will in part go towards expanding the capacity of GCAL, the Georgia Crisis and Access Line, which provides 24/7 online and telephone support for people who are seeking services for developmental disabilities, mental health, or substance use issues. Some of the additional funding is also dedicated to the Georgia Apex Program, a school-based mental health program that improves early identification, access to and coordination of needed behavioral health (BH) services for children with BH needs..

In the coming months, we will break down the Commission’s funded priorities and their impact on young Georgians. Look for our Healthy Minds, Healthy Bodies blog mini-series.

Looking for more information on this topic? Georgians for a Healthy Future will be hosting an educational forum later this month during which we will explore the behavioral health needs of Georgia children and youth, Georgia’s publicly-supported behavioral health landscape, and successes and opportunities in the current system of care. Join us in person or via webcast for this exciting and important event!