NYAPRS Note: The 1998 landmarkAdverse Childhood Experiences Study(ACE Study) powerfully demonstrated an association of adverse childhood experiences (ACEs) with health and social problems as an adult. Adverse experiences include physical, sexual and emotional abuse, physical and emotional neglect, household mental health and/or substance use related conditions, parental separation or divorce and incarcerated household member.
The literature is rich with links between ACEs and later prevalence of behavioral health conditions, incarceration, suicide including
https://www.cdc.gov/violenceprevention/acestudy/index.html; http://www.preventchildabuse.org/images/docs/anda_wht_ppr.pdf; https://www.socialworkers.org/assets/secured/documents/practice/children/acestudy.pdf; http://www.nijc.org/pdfs/Subject%20Matter%20Articles/Drugs%20and%20Alc/ACE%20Study%20-%20OriginsofAddiction.pdf; http://www.ajpmonline.org/article/S0749-3797(98)00017-8/fulltext; https://www.samhsa.gov/capt/practicing-effective-prevention/prevention-behavioral-health/adverse-childhood-experiences
NYS Medicaid Director Jason Helgerson is taking the linkage between early experience and an array of later health and social problems to another level via a 10-point plan to improve access to services for children during their first three years. We’ll share details as we get them.
Medicaid Director Calls for New Focus on Children to Prevent 'Super-Utilizers of the Future'
By Dan Goldberg Politico July 20, 2017
Citing the need to prevent the "super-utilizers" of tomorrow, Jason Helgerson, the state's Medicaid director, on Thursday called for a new commitment to improving outcomes for children.
Helgerson, speaking at United Hospital Fund's Medicaid conference in Manhattan, announced the First 1,000 Days on Medicaid initiative, which will, by October, develop a 10-point plan to improve access to services for children during their first three years.
About 59 percent of New York children between the ages of 0 and 3 are on Medicaid, which Helgerson said gives the program a unique opportunity and responsibility to help children develop and work on social determinants that go beyond the scope of traditional health care, such as school readiness.
The project is being chaired by Nancy Zimpher, the outgoing chancellor of the SUNY system.
"Those first few years are so important," Helgerson said. "Medicaid in particular has such as huge role to play with children. ...
Investments in early childhood prevent the super-utilizers of the future."
Helgerson said that if you walked back the life of almost any super-utilizer — the 5 percent of the population responsible for 50 percent of the health care costs — then you would find problems in the first three years of life.
"If we do a better job of trying to influence the lives of our youngest children, we can prevent so much cost, so much misery, so many problems in the future," Helgerson said.
Helgerson first spoke publicly about this idea in the fall, saying the reimbursement for pediatricians should include metrics such as school readiness.
Roughly 40 percent of kids enter public school developmentally behind where they should be, he said Thursday.
The challenge is that a child's development is influenced by so many variables, many of which appear to be beyond the control of the health system, such as epigenetics, genetic predisposition to illnesses, abuse, single-parent households, poverty and more.
"No question, lots of factors go into a child's development and that complexity makes the challenge more difficult," Helgerson said. "There is no silver-bullet solution."
Helgerson also touched on the uncertainty emanating from Washington, where Republican lawmakers continue to search for a way to repeal and replace the Affordable Care Act, which would almost certainly mean less federal money for the New York Medicaid program.
Enrollment in Medicaid, Helgerson said, has grown 26 percent since Gov. Andrew Cuomo took office in 2011. Most of that growth has taken place outside New York City, in areas represented by Republicans in Congress, Helgerson said. Since 2011, Medicaid enrollment has grown 45 percent outside New York City, and 37 percent in rural counties.
There are approximately 6.1 million people enrolled in the state Medicaid program, about one-third of the state.
"I am absolutely floored [by] the degree with which serious people are contemplating a step back in terms of the pursuit of social justice," Helgerson said. "Our history as a nation has been about progress. This is the opposite of progress."
The bills being debated, he said, are not about health care.
"Perhaps it's about wealth redistribution, perhaps it's about philosophical differences in terms of the role of government, perhaps it's about tax reform, but it is certainly not about health care," Helgerson said.