Government Affairs and Advocacy

June 17 Federal Update: Senate Finance Committee Examines Concerns and Reforms for Youth Residential Treatment Facilities

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June 17, 2024

On June 12, the Senate Committee on Finance held a hearing to address concerns regarding the treatment of children in some Youth Residential Treatment Facilities (YRTFs), focusing on instances of abuse, unsafe conditions, and inadequate care. This hearing followed a report detailing such harms. However, it is essential to note that most of these facilities operate safely and are standards-based, providing critical care to children with complex needs.

Chairman Ron Wyden (D-Ore.) emphasized the trauma that children can endure in certain facilities and criticized profit-driven motives leading to falsification of records and understaffing. He vowed to end the abuse cycle and praised survivors for their courage. Wyden stated, “The experiences and trauma these kids are left with read like something out of a horror novel” and called for bold actions to improve oversight and standards for YRTFs.

Ranking Member Mike Crapo (R-Idaho) highlighted the need for oversight and patient-centered, best-practice-informed care, emphasizing that residential facilities should be a last resort. He stressed the importance of integrating patients into the community as soon as possible and ensuring that facilities provide high-quality, medically necessary treatment in safe, therapeutic environments.

Reagan Stanford, an abuse and neglect managing attorney for Disability Rights Arkansas, described widespread abuse, neglect, unsafe conditions, and lack of therapy and educational services in some Arkansas facilities. She recounted numerous incidents of violence and neglect, illustrating the need for significant reforms. Stanford recommended investing in community-based services, discontinuing funding for inadequate models, and improving oversight and data transparency.

Elizabeth Manley from the University of Connecticut identified challenges like insufficient infrastructure and misaligned funding incentives in certain facilities. She emphasized the importance of accessible, community-based, trauma-responsive care. She highlighted the success of New Jersey’s model, which has resulted in low rates of group care utilization and youth suicide. Manley underscored the necessity of technical assistance and comprehensive care systems to effectively support children and their families.

Kathryn A. Larin from the Government Accountability Office (GAO) echoed prior GAO reports on the misuse of psychotropic medications and restraints and the need for better staff training, a single state agency for abuse cases, and information sharing on best practices. Larin’s testimony highlighted the challenges of monitoring out-of-state placements and ensuring the appropriate use of medications and restraints. She stressed the importance of federal and state oversight in safeguarding the well-being of youth in residential facilities.

Throughout the hearing, senators and witnesses stressed the importance of providing high-quality in-home and community-based services and the potential of allowing Medicare to incentivize such services. They highlighted the need for oversight of specialized treatment, aligning funding with effective, patient-centered care models, strengthening staff training and penalties for abuse, and improving data transparency and research to validate effective therapies.

While significant issues were highlighted during the hearing, it is crucial to recognize that not all YRTFs experience these problems. Many facilities strive to provide safe, supportive, and effective care for children in need. The majority of YRTFs operate with a commitment to high standards, offering essential services to children who cannot be adequately cared for in family or community settings due to the complexity of their needs.

Examining the Impact of Abortion Bans on Women’s Health and Equity: A Senate Hearing Recap

On Tuesday, June 4, 2024, the Senate Committee on Health, Education, Labor, and Pensions held a hearing titled “The Assault on Women’s Freedoms: How Abortion Bans Have Created a Health Care Nightmare Across America.” The hearing marked nearly two years since the Supreme Court decision in Dobbs v. Jackson Women’s Health, which granted states the authority to determine the legality of abortion. The focus was on the severe impact of abortion bans on women’s health care, particularly for those in marginalized communities, and how these bans intersect with broader issues of health equity within the current federal policy agenda.

Although Senator Bernie Sanders (D-Vt.) is the chairman of the Senate Committee on Health, Education, Labor, and Pensions, he asked Senator Patty Murray (D-Wash.) to chair the hearing. In his opening statement, Sanders detailed the historical struggle for women’s rights and the ongoing lack of representation in the Senate, emphasizing the importance of this hearing in addressing these critical issues.

Senator Murray shared poignant stories about the daily struggles women and families face when forced to carry pregnancies against their will and the challenges in accessing reproductive care. She highlighted the threats physicians face, including the risk of incarceration and the loss of medical licenses for providing reproductive health services.

Ranking member of the committee, Dr. Bill Cassidy (R-La.), acknowledged the diverse political views on abortion and encouraged continued dialogue. He emphasized the importance of supporting women throughout pregnancy and postpartum to ensure their health and wellness while underscoring the value of a child’s life before birth.

Madysyn Anderson, a college senior from the University of Houston, shared her personal experience with pregnancy just two weeks after Texas’s S.B. 8 law went into effect, banning abortion after six weeks. She recounted the difficulty of finding a clinic that would provide an abortion, eventually traveling to Mississippi at great financial and emotional cost. Her story highlighted the significant barriers and stress women face under restrictive abortion laws.

Dr. Nisha Verma, a board-certified obstetrician and gynecologist, spoke about the severe impact of abortion bans in Georgia, where she practices. She described the challenges her patients face, including increased economic hardship, staying with violent partners, and serious health issues due to the lack of access to abortion care. Dr. Verma emphasized the broader implications of abortion bans on women’s overall health, including mental health conditions like postpartum depression, which is a leading cause of pregnancy-related deaths in the U.S.

Destiny Lopez, acting co-CEO of the Guttmacher Institute, discussed the profound impact of abortion bans on people of color, those already parenting, and individuals with limited financial resources. She noted that the number of abortions provided by clinics increased by 10% from 2020, a testament to the resilience and determination of those seeking care despite the barriers. Lopez called for evidence-based policies that ensure all people have access to high-quality, affordable abortion care where they live.

Dr. Allison Linton, a complex family planning specialist, detailed the complexities of determining when an abortion is necessary to preserve a mother’s life under Wisconsin’s restrictive laws. She described the fear and confusion among physicians and patients alike, leading to delays in care and increased risks to women’s health. Dr. Linton stressed the need for clear guidelines and protections to allow healthcare providers to offer necessary care without the threat of legal repercussions.

Dr. Christina Francis, an OB/GYN hospitalist, presented the risks associated with abortions, including preterm birth and mental health issues. She highlighted the importance of in-person consultations to ensure fully informed consent and screen for coercion, intimate partner violence, and trafficking. Dr. Francis emphasized that while some view abortion as a necessary service, it carries significant health risks that must be carefully considered.

Melissa Ohden, founder of the Abortion Survivors Network, spoke about the experiences of individuals who survive abortion attempts and the need for comprehensive support beyond pregnancy termination. She stressed the importance of providing emotional, medical, and financial assistance to those affected by failed abortion attempts.

The hearing underscored how abortion bans disproportionately affect marginalized communities, exacerbating existing health disparities. Social Current, in its 2022-2024 federal policy agenda, considers abortion and other reproductive healthcare as critical health equity issues. The organization emphasizes the importance of advancing equity, ensuring equitable access to resources, and responding effectively to behavioral health needs. The testimonies highlighted the need for a holistic approach to health care that includes reproductive rights as a fundamental aspect of women’s health and well-being. Ensuring access to abortion care is essential for achieving health equity and supporting the broader goals of federal policy initiatives aimed at improving health outcomes for all communities.

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