Raising a Community
Lack of insurance, increase in drug abuse put youths' health in danger
By Susie Bodman and Stefanie Knowlton • Statesman Journal
November 24, 2008
While a lack of health insurance and burgeoning substance abuse are threatening the health of youth in the Mid-Willamette Valley, area agencies and lawmakers continue to look for ways to develop or expand programs to address these problems.
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Expanding insurance
Access to and the costs of health care are increasingly weighing on the minds of the public, health officials and policy makers.
How do you provide insurance coverage and care to the more than 150,000 uninsured adults and children in the Marion, Polk, Benton, Lane and Linn county region?
Local, state and national efforts are under way to answer that question and provide help to those uninsured.
The main focus in providing health insurance coverage — locally and nationally — is on uninsured children younger than 18.
"The dollars are best spent when we spend them on children," said Andy Walker, public health manger for the Polk County Public Health Department. "Prevention dollars spent on children provide that child with better health for the rest of their lives."
Expanding coverage to all of Oregon's children is at the top of a list of recommendations presented in a recent draft report by the Oregon Health Fund Board, which was formed last year to map out ideas for reforming Oregon's health-care system.
In covering children, the reform may mean an expansion of the Oregon Health Plan to bring more kids under its umbrella. However, the board also recommended extending OHP coverage to more adults, using a combination of taxes to health-care providers and federal funds.
"A lot of data suggests it's really hard to recruit one without the other," said Sean Kolmer, research manager for the state Office of Health Policy and Research.
The target among adults, Kolmer said, would be those with incomes at 100 percent of the federal poverty line. For individuals, that income level is $10,400 a year. If a funding source could be found, the goal would be to enroll another 100,000 adults, he said.
And Oregon Senate President Peter Courtney has said legislators are still working out their health care proposal for the coming 2009 legislative session, which may or may not include a request for a tobacco tax or other increase to expand insurance coverage.
Meanwhile, the Health Fund Board's report warns that unless change is made to the system soon, premiums for family health insurance policies will reach a point where they equal the average family wage.
Likely that means the ranks of the uninsured will increase as individuals and families on the edge financially are forced to choose between health care, food, housing and other basic needs.
Nationwide, a federal push is encouraging states to expand health-care access, especially to children. In some states, that's meant efforts to identify and enroll more young people in public health insurance plans.
Policy analysts and lawmakers also are looking to the new Congress with anticipation. The State Children's Health Insurance Program, which helps get children covered, is due to expire in March. An attempt to pass a bill last year that would have expanded the program met with a presidential veto.
Senator-elect Jeff Merkeley has said he expects the new Congress will pass a similar bill.
Locally, Northwest Human Services, which provides low-cost clinics in West Salem and Monmouth and serves many patients enrolled in the Oregon Health Plan and other public insurance plans, has focused its effort on remodeling and expanding its clinics and services, such as adding more health practitioners.
Opening more clinics also may be on the agenda — provided funding can be found to run them, said Paul Logan, executive director of Northwest Human Services. While federal support is there to go out and establish new clinics, funding to staff and operate them is in short supply.
"It's valuable but not sufficient," he said of the support.
The issue, however, is not only about finding more funding to provide more clinics, services and coverage to those who need it, it also means more outreach to those who are eligible for public and private insurance but not enrolled.
More than half of all the 100,000 uninsured kids in Oregon are now eligible for public or private insurance, but one of the major reasons that families don't insure kids, aside from cost, is administrative hurdles in the application process.
To address this problem, the Health Fund Board has recommended the state simplify application processes to programs such as OHP, increase application assistance and the number of school-based health centers, and extend coverage periods under its public programs from six to 12 months.
Meanwhile, local health departments, Northwest Human Services, other clinic providers, and Salem Hospital are doing their part to help guide people through finding insurance plans and applying for coverage.
"But it's even bigger than the health department; the whole community has to bond together to help with these services," said Pam Heilman, public health division director at the Marion County Health Department.
There are many other ideas to help the uninsured — from calls for tax breaks to offset the cost of insurance to medical IRAs to holding the insurance industry publicly accountable for rate hikes.
"The Health Fund Board reform plan seems to understand that part of bringing costs down is related to universal coverage," said Joy Margheim, an analyst at the Silverton-based Oregon Center for Public Policy, which conducts research on economic issues.
Regardless of the specific reform that may be adopted or plans used to increase coverage of the uninsured, the need isn't going away any time soon.
"We need to find a way to cover people who aren't insured. If people understood why we need universal care — (that) there is a benefit to everyone involved … probably insurance rates for everyone would go down," Walker said.
"In a society like ours, we have an obligation to look out for more than just ourselves. We should be looking out to care for others as well."
—Susie Bodman
Substance abuse
Drug prevention and treatment programs are struggling to keep pace with the rising tide of drug use among teens in Oregon.
Eighth-graders were almost twice as likely to drink in the last month compared to their peers around the country in 2005 and since then the number has only grown.
And about 40 percent of all eighth graders reported using alcohol or drugs in the last month, according to the 2007 Healthy Teens Survey.
The early use often translates to drug abuse and addiction in latter years.
Oregon estimates that nearly 27,000 teens needed drug treatment last year, but only 6,500 were enrolled in state treatment.
One of the biggest hurdles for drug treatment is proving enough beds for in-patient care. There are only 71 beds around the state for teens and none of these are in Marion County, which means local youths are shuttled to surrounding communities to get help.
Every county should have its own in-patient facility, but the funding isn't always available, said Diane Lia, who oversees drug treatment programs for Department of Human Services Addiction and Mental Health Division.
The good news is that teens who receive care enjoy promising recovery rates.
Oregon requires counties to provide treatment programs based on a wide range of research-based models.
Treatment is evaluated on three key targets when serving youth: better academic performance, lower incidence of arrest within 30 days after treatment and lower incidence of arrest for possession.
Lia said 93 to 94 percent of teens in treatment met those benchmarks in Oregon. In fact teens not in treatment are more than twice as likely to get arrested and more likely to get arrested for possession.
"If we can intervene early, we can help these kids so they can lead productive lives," Lia said.
Mike Maryanov also is interested in helping these kids get back on the right path.
Maryanov is the coordinator for the Marion County STAR Court, or Supervised Treatment And Recovery, program for teens.
The yearlong program helps non-violent teen offenders get clean through treatment, counseling and resource referral. In exchange the court clears their record.
But it's not just a matter of getting clean, Maryanov said.
"There is a whole world of confusion and hurt underlying all this," he said.
Most of the teens are dealing with a history of sexual abuse, violence in the home, mental illness and loss, he said.
So once they're clean, he said, they have to deal with all the underlying issues that led to their drug abuse in the first place.
Overall the teens just want what everyone else does, he said.
"They want to be cared for and loved in a normal way, they want to be in school, they like getting good grades, they want to listen to music on their iPods, they want to ride their bikes and have boyfriends and girlfriends…"
Yet it's difficult to piece lives back together after addiction. Out of the 153 kids enrolled in the program, there have been only 30 graduates since it started in 2001. Maryanov said he doesn't see his kids back in the courts, which is good news.
But the best way to treat drug abuse is to prevent it in the first place.
"Prevention is a very complex process," said Rick Cady, manager of prevention programs for addictions and mental health division of DHS.
Oregon tries to tackle prevention with a wide range of programs that work with everyone from first-time parents on early childhood development to entire communities to change local attitudes about drugs and alcohol.
But Oregon programs need to work harder to reach teens sooner, according to the Oregon Community Addiction Services Investment Strategy report.
Prevention services don't start early enough and aren't consistently applied across school districts, the report concluded.
The state also needs to increase exposure to prevention programs and prevention needs to be a much higher priority for teachers, parents, counselors and school administrators.
Cady said one of the key target groups is fifth and sixth graders because that's the typical age kids start experimenting.
One of the new initiatives this year is a parenting program called Strengthening Families 10 -14, which has proven to dramatically reduce the initiation of drug use and increase family harmony.
For every year you can delay the child's first drug experience, they're 2 to 10 times less likely to abuse drugs, Cady said.
"That's why that age group is so important."
—Stefanie Knowlton

References:
http://www.statesmanjournal.com/article/20081124/RAC/811240313/1001/NEWS