In June of this year, the Centers for Medicaid and Medicare Services (CMS) approved a change for Georgia’s Medicaid program that shifts how school nurses can bill for their services. Before June, Medicaid would only pay for school health services, including nursing services, if the student had a special education plan called an Individualized Education Program (IEP). IEPs are maps that lay out a program of tailored education instruction, supports, and services. These plans are required for all students receiving special education services like students with ADHD, autism, or a speech impairment. The approved change allows Medicaid to pay for more school health services provided to any student with Medicaid coverage.

 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. 

Linda Smith Lowe Health Advocacy Award: Sylvia Caley

Community Impact Award: CaringWorks

Powerhouse Policymaker Award: Commissioner Frank Berry

Power House Policymaker Award: Representative Bob Trammel

Sylvia Caley, JD, MBA, RN recently retired as a clinical professor at Georgia State University College of Law teaching law students and other professional graduate students enrolled in the HeLP Legal Services Clinic. In addition, she teaches Health Legislation and Advocacy, a year-long course in which law students work with community partners to address health-related legislative and regulatory issues affecting the community. She was an adjunct clinical assistant professor at Morehouse School of Medicine, Department of Pediatrics. She is the director of the Health Law Partnership (HeLP), an interdisciplinary community collaboration among Children’s Healthcare of Atlanta, the Atlanta Legal Aid Society, and the College of Law. She is a member of the Ethics Committees at Grady Health System and Children’s Healthcare of Atlanta and also is a member of the Public Policy Committee at Children’s. She also is a member of the Advisory Committee on Organ Transplantation, U. S. Department of Health & Human Services. Her research interests focus on using interdisciplinary and holistic approaches to address the socio-economic and environmental issues affecting the health and well-being of children, specifically the lives of low-income, chronically ill, and disabled children. For her years of service and leadership in Georgia, we are proud to honor Sylvia with the Linda Smith Lowe Health Advocacy Award.

CaringWorks, Inc. was founded in 2002 with a mission to reduce homelessness and empower the marginalized by providing access to housing and services that foster dignity, self-sufficiency and well-being. It was built on the single idea that every citizen, no matter their social or economic standing, should have the chance to improve their quality of life. CaringWorks specializes in providing housing, mental health services, substance use disorder treatment, and an array of related social supports to individuals and families who are experiencing homelessness.

In the 15 years since it’s founding, CaringWorks has grown into one of the largest supportive housing providers in the greater Atlanta area. In 2018, the agency will impact over 900 extremely low-income men, women and children who are facing homelessness, over 90% of whom are expected to achieve permanent, sustainable housing. It collaborates with partners throughout the city of Atlanta, Fulton, DeKalb, Rockdale, Henry and Newton counties to serve the individuals considered to be the most vulnerable and at-risk of injury, illness, or death. For their service, commitment, and impact, we are proud to honor CaringWorks with the Community Impact Award.

Frank W. Berry is the Commissioner for the Georgia Department of Community Health (DCH). In this role, he leads the $14 billion agency responsible for health care purchasing, planning and regulation, and improving the health outcomes of Georgians. The agency administers Georgia Medicaid and the State Health Benefit Plan (SHBP), and provides access to health care coverage for approximately one in four Georgians. In addition to Medicaid and SHBP, he also oversees Healthcare Facility Regulation Division, Office of Health Planning (which implements the Certificate of Need program), and the State Office of Rural Health.

Prior to joining DCH, Berry served as the Commissioner of the Georgia Department of Behavioral Health and Developmental Disabilities for four and a half years, and has more than 30 years of public service experience. He was previously the Chief Executive Officer of View Point Health Community Service Board. Berry serves as the Chairman for the ABLE Board and is a member of the First Lady’s Children’s Cabinet. Commissioner Berry has demonstrated his dedication to bettering health care in Georgia we are proud to recognize him as a 2018 Powerhouse Policymaker.

Bob Trammell practices law at the Trammell Firm, which he founded in Luthersville, Georgia in 2003. He is truly a son of the 132^nd district; his law office is located in the former home of his grandparents. Bob started his legal career as a law clerk in the United States District Court for the Northern District of Georgia. He subsequently practiced law at King and Spalding before returning home to start his own firm. Since 2011, Bob has served as the county attorney for Meriwether County. He is also a member of the Meriwether County Chamber of Commerce and the Meriwether County Bar Association.

Education has always been a priority for Bob, particularly because both of his parents are retired educators. Bob is a 1996 summa cum laude graduate of the University of Georgia, where he was a Foundation Fellow majoring in English and Political Science. He obtained his law degree from the University of Virginia School of Law in Charlottesville, Virginia in 1999. Bob believes strongly that education is essential to preparing Georgia’s workforce for the jobs of today and the jobs of the future. Investment in science, technology, engineering, and math programs is the key to creating job opportunities for all Georgians.

Bob and his wife Jenny reside in Luthersville where they are busy raising daughters Mary, three years old, and Virginia, who will be two in September. Jenny, a graduate of the University of Georgia, works as a pharmacist with CVS-Caremark in LaGrange. Bob and Jenny can think of no other place that they would want to raise their family. Bob believes in making Georgia the best place to work, learn, and live for not only his family, but for all Georgians.  For his steadfast commitment to improving the lives of all Georgians, we are honored to recognize him as a 2018 Powerhouse Policymaker.

We hope you’ll join us tomorrow, on September 6th as we recognize our amazing awardees! RSVP

Every day four Georgians die from opioid overdose and recent data from the Centers for Disease Control and Prevention confirm that the epidemic shows no signs of slowing. Health care providers, public health professionals, community leaders, and families are all searching for effective strategies to slow and stop this growing public health crisis. Some initial steps have been taken by Georgia policy makers and others to increase access to life-saving drugs like naloxone, improve and expand the prescription drug monitoring program (PDMP) to prevent over-prescribing, and raise public awareness about the risks of opioids and other substances, but more is needed. Solutions must include evidence-based strategies that emphasize prevention and early intervention, as well as timely treatment and support for recovery.

An exciting development within Georgia’s Medicaid program gives health care providers an additional tool to aid in the fight against substance use disorders, especially among adolescents and young adults. Georgia’s Medicaid agency has activated the reimbursement codes for a tool called SBIRT, which stands for Screening, Brief Intervention and Referral to Treatment. SBIRT is a set of tools that identifies people who use alcohol or other drugs at harmful levels and guides follow-up counseling and referral to treatment before serious long-term consequences occur.

Ninety percent of adults who meet the medical criteria for addiction started smoking, drinking, or using other drugs before they were 18 years old. Because Medicaid and PeachCare for Kids cover half of all Georgia children, the activation of the Medicaid reimbursement codes for SBIRT is a powerful opportunity to identify youth substance use and intervene early. Studies show that simply asking young people about drugs and alcohol use can lead to positive behavior changes and that brief interventions reduce the frequency and amount of alcohol or other drug use by adolescents.

This policy change was the product of a sustained advocacy effort by Georgians for a Healthy Future (GHF) and the Georgia Council on Substance Abuse (GCSA). We anticipate it will lead to the screening of an estimated 145,000 Georgia youth annually and that 36,000 of those youth will present substance use behaviors that prompt a brief intervention with a health care provider. Initial data from Georgia’s Medicaid agency demonstrates that some providers are already making use of the SBIRT codes in their practices.

Notwithstanding these exciting results, we have committed to continue our efforts to improve access to screening, early intervention, and recovery services and supports for young people across Georgia. While the Medicaid reimbursement codes allow physicians, physician extenders, and advanced practice registered nurses to provide SBIRT services, we recognize that RNs, LPNs, licensed clinical social workers, and certified peer counselors can and should be able to provide SBIRT to youth and adults. Further, the codes allow SBIRT to be provided primarily in health care settings, but that excludes schools and other community-based settings where most young people spend their time.

We invite you to join our efforts to prevent substance use among young Georgians. Spread the word by giving our new fact sheet to the providers in your clinic, public health department, or hospital. If you are a health care provider, attend a training to develop the skills to implement SBIRT with the people that you care for. Join our on-going advocacy efforts to activate the reimbursement codes for more practitioner levels (including RNs and LPNs) and more settings by contacting us to let us know you are interested.

The opioid and substance use crisis that is sweeping Georgia and impacting communities nationwide will require a full spectrum of solutions that leverage the expertise of health care providers, public and private resources, and community and family supports. SBIRT is an evidence-based tool that can play a significant role in our collective efforts to reduce substance use and create a healthier Georgia for all of us.

To learn more, visit our Keeping Youth on a Healthy Path page.

For health care providers: download our new fact sheet here.

We know that helping people with substance use disorders get into recovery is hard and requires a lot of resources—a strong support system, the will to recover, and access to necessary health care services and supports.  The prevention of substance use disorders in the first place can take just as much work and requires similar resources.

We also know that the health care bill being considered by the Senate this week, puts recovery and prevention efforts at risk for millions of people, including thousands of Georgians.

The Senate’s proposed legislation would undermine guarantees that private insurance cover treatment for substance use disorders and mental illness. The bill’s $2.5 billion cut to Georgia’s Medicaid program would mean youth in low-income families could be denied critical preventive health services like screenings for depression or substance use disorders or even something as simple as immunizations or avoid seasonal affective disorder with the Best SAD Lamps from SadLampsUSA. People who need treatment services could lose coverage and access to life-saving treatment.

Congress is trying to mask the damage they are doing to our communities by setting up an emergency opioid response fund as part of the health care bill. This fund is insufficient and is no replacement for reliable health care coverage. This proposed “opioid fund” would not make up for deep cuts in Medicaid and a return to private insurance policies that discriminate against people with pre-existing conditions, including substance use disorders. We can’t afford to return to a time when many state Medicaid programs and private insurers covered only short-term, minimal treatment for substance use disorders, if they covered it at all.

The Senate is set to vote on their health care bill this week and Georgia’s senators need to hear from you. Call Senator Johnny Isakson today! Tell him to oppose the legislation because it would harm people in treatment and recovery, handicap prevention efforts that avoid addiction in the first place, and decimate Georgia’s ability to respond to the ongoing opioid crisis.

Call 202-224-3643 today!

(Don’t know what to say when you call? Here’s some help.)

The Senate Opioid Abuse study committee has begun to flesh out key issues and considerations to draft recommendations for an omnibus bill that includes prevention, treatment, regulatory and enforcement and budgetary provisions to address Georgia’s opioid crisis GHF is encouraged by the committee’s focus on prevention as we have been raising awareness of the need to view substance use disorders as a public health issue that warrants prevention through our Somebody Finally Asked Me campaign. More specifically, we have been advocating for wider use of screening tools such as Screening, Brief Intervention and Referral to Treatment (SBIRT) for youth.

While the committee did not discuss SBIRT, over the past two meetings, the committee heard from hospital systems, pharmacists, the Georgia Division of Family & Child Services (DFCS) and substance abuse research experts on other steps the state could take.

Proposals included:

• Increasing funding and wider promotion of substance abuse education with a focus on opioid use in schools and restoring some public health funds.
• Improving provider education and training around prescribing, especially for pregnant women, and educating patients on prescription drug use and how to take saliva drug test before that.
• Increasing access to drug treatment programs for pregnant women, allowing the sale of narcan over the counter, and adding buprenorphine to the Medicaid formulary, this could lead to addiction because of all the drugs and there are some great reviews for Quick Fix 6.2, but it could easily be taken care of with the help of an intervention, click here if you don´t know what is an intervention.
• Promising protocols and programs that hospitals and emergency departments could implement to improve care delivery for chronic pain management, although if these pains are in a specific area like a headache, is better to visit some headache specialists, also children with neonatal abstinence syndrome and their mothers.
• Current initiatives and ways to improve state and agency-level policies to improve response systems for law enforcement and child welfare services.

Presentations from Northside Hospital, Augusta University, DFCS, Tanner Health System, and the Georgia Substance Abuse Research Alliance are available upon request. The committee plans to dive deeper into analysis of law enforcement policies, therapeutic services and recommendations for budget appropriations during the upcoming meetings and a website for finding rehab facilities near me. GHF will continue to advocate for the committee to consider additional prevention methods in its recommendations. We have requested to present recommendations to activate Medicaid codes to promote the use of a substance use screening tool called SBIRT (Screening, Brief Intervention, and Referral to treatment) at the next committee meeting and are awaiting a response. The next committee meeting is scheduled for November 9, 2016 at 1:00 PM at the Capitol. Stay tuned for more updates and information!

Georgians for a Healthy Future was excited to meet and engage colleagues in rich discussions around policy, grassroots organizing and coalition-building to make prevention counseling more widely available for young people. This June, we joined advocates from other states in Philadelphia for the Community Catalyst Substance Use Disorders Advocacy Convening. The three-day conference gave us valuable insight for the next phase of our advocacy and policy efforts to expand the use of Screening, Brief Intervention and Referral to Treatment (SBIRT) through the activation of Medicaid codes for youth. Activating Medicaid codes would allow providers to be reimbursed for the time they spend conducting SBIRT and would encourage greater use of the tool.

Over the past three years, in partnership with the Georgia Council on Substance Abuse, GHF has advocated for turning on SBIRT codes and raised up youth substance use disorders as a critical public health issue that can no longer be overlooked in Georgia. We will publish a white paper on the potential benefits for turning on the Medicaid codes for youth SBIRT services in Georgia in the coming months. Check out our website to find out more about our Somebody Finally Asked Me campaign, additional resources on youth substance use prevention, and how you can get involved.

Georgians for a Healthy Future staff attended the Connections 2016 conference hosted by the Healthcare Georgia Foundation on March 29^th and 30^th. The conference, held every other year, is an opportunity to network and learn from Georgia’s health and public health practitioners, professionals, advocates, and experts.

This year’s conference theme was partnerships, and in keeping with that theme, GHF was invited to present on how we use coalition building and mobilization as a strategy for policy change at the state level. Cindy shared how our history created an organizational environment that fosters and supports the development of strategic partnerships and coalitions. Laura added to that with an overview of GHF’s five coalitions, a coalition case study, and a review of some selected best practices in coalition development and management. You can see their presentation here.

As a result of the two-day conference, GHF staff came away with new contacts to partner with in the future and new ideas about what partnership might look like. The conference also provided the opportunity to network with existing partners, learn about their emerging work, and identify ways to collaborate moving forward.

If you would like to partner with GHF or join any of our five coalitions, contact Laura Colbert, Director of Outreach and Partnerships, at lcolbert@healthyfuturega.org.

• The Access to Care and Equity (ACE) coalition focuses on ensuring that coverage translates to access to care and has been working most recently on the issue of network adequacy
• The Cover Georgia coalition advocates for closing Georgia’s coverage gap that leaves 300,000 Georgians without a coverage option
• The Georgia Enrollment Assister Resource (GEAR) Network connects people and organizations working to help consumers enroll in coverage
• The Health Advocates coalition is open to health advocates representing non-profit organizations who want to coordinate efforts with other advocates

• The Preventing Youth Substance Use Disorders coalition works together to raise awareness about and advocate for a public health approach to preventing addiction

Georgians for a Healthy Future and the Georgia Council on Substance Abuse have joined together to advocate for making substance use prevention services more widely available to kids, teens, and young adults in our state.  That’s why we are promoting a cost-effective, evidence-based preventive screening tool called SBIRT: screening, brief intervention, and referral to treatment. Today, we are excited to release a new policy brief that explains the role of prevention in addressing youth substance use disorders, describes the three major components of SBIRT, reviews successful prevention-based pilot projects in Georgia, and makes policy recommendations for the state to activate Medicaid codes for SBIRT services. The policy brief makes the following recommendations to ensure that our young people are healthy and have a bright future:

• Open Medicaid billing codes for alcohol and/or substance use structured screening and brief intervention services
• Authorize the set of providers listed under Medicare guidelines to bill for SBIRT services in Georgia’s Medicaid plan
• SBIRT services should be implemented in emergency departments, primary care offices and school settings
• Provide SBIRT coverage for individuals age 12 and older

Yesterday’s policy forum featured a panel of experts who shared their academic, research, and personal experiences, demonstrating not only the need for, but the effectiveness of SBIRT. Check out the videos below to hear what some of them had to say.

Dr. Paul Seale of Navicent Health and Mercer University School of Medicine on Georgia’s potential to lead of substance use prevention.

Georgia Overdose Prevention Project’s David Laws is a parent who is passionate about the impact SBIRT can have on Georgia’s youth.

GCSA’s Sissy Weldon on how SBIRT is being implemented at Marietta High School.

Dr. Kuperminc of Georgia State University on the research that has been done on SBIRT’s effectiveness.

Call to Action