Counting the cost of health care repeal

 It’s too soon to say, but the people who want to overturn the Affordable Care Act, a group that includes West Virginia’s attorney general, are closer than before to getting what they want, even in the midst of a pandemic that has already killed over 200,000 Americans.

Opponents of the ACA, often referred to as Obamacare, give many reasons for wanting to kill it, although I suspect that, for many, the main reason is that it can be associated with a Black man.

But what would it mean for ordinary Americans if the ACA haters get what they want? The answer is pretty grim, if you do the math.

One feature of the ACA is protection of people with preexisting conditions in qualifying for health insurance. According to the federal Department of Health and Human Services, as many as 133 million Americans, over half of the non-elderly adult population, have some such condition.

Given the frailties of the human body, it has been argued that “life is a preexisting condition,” or at least one waiting to happen. This was especially true for women before the ACA passed, for reasons of medical costs associated with pregnancy, breast cancer and conditions unique to them. The National Women’s Law Center said that before the ACA “just being a woman could be considered a preexisting condition.”

Then there’s Medicaid expansion, a part of the ACA that became a state option after a 2012 U.S. Supreme Court decision. According to the Kaiser Family Foundation, 39 states and the District of Columbia, have adopted this measure, which covers about 12 million Americans, most of whom are low-income working people and many of whom are the “essential workers” that everyone else depends on these days.

The ACA guarantees that states that adopt the expansion will never have to pay more than 10 percent of the costs. Without it, states would be unable to sustain coverage.

About 160,000 West Virginians are covered by the expansion at any given time and probably 200,000 or so are covered during a year. Aside from improving and saving lives, federal expansion funding also helps keep rural hospitals and health care facilities open and supports thousands of jobs.

Medicaid expansion has been a huge help in confronting the opioid epidemic. According to the Georgetown Center for Children and Families, “Medicaid expansion was associated with a substantial increase in opioid addiction therapies, particularly in states with high opioid overdose rates.”

Nationwide, about 800,000 Medicaid expansion recipients are dealing with opioid addiction.

A 2020 article in the Journal of the American Medical Association found that states that adopted Medicaid expansion had a decrease in opioid deaths, compared to states that hadn’t expanded Medicaid.

I’ve interviewed people in recovery about the role Medicaid expansion has played in their access to treatment. One woman summed it up neatly: “Without it, I’d be either dead or in jail.”

Then there are those who buy health care on the marketplaces. Kaiser reports that, in 2020, this amounts to 11.4 million Americans and over 20,000 West Virginians. Of these, an investigative article in The New York Times said that, “If the marketplaces and subsidies go away, a comprehensive health plan would become unaffordable for most of those people and many of them would become uninsured.”

The Times also reports that ACA repeal would hit Medicare recipients as well, affecting around 60 million Americans and over 440,000 West Virginians. Among other effects, if the law were struck down, “Medicare beneficiaries would have to pay more for preventive care, like a wellness visit or diabetes check, which are now free. They would also have to pay more toward their prescription drugs.”

Young Americans also would take a hit. The ACA allows about 2 million young adults to keep their parents’ health insurance up to age 26. The last numbers I could find suggest that about 20,000 young West Virginians are covered in this way. Without it, companies could withdraw coverage.

Killing the ACA also would dramatically increase the cost of health care, including uncompensated care, raising copays and premiums as these costs are passed on to individuals and families. The Urban Institute reports that “Demand for uncompensated care would increase by $50.2 billion, an increase of 82% compared with ACA levels.”

Oh yeah, and then there’s the prospect of millions of Americans losing health coverage while COVID-19 is still ravaging the country and the world.

To sum it all up about ACA opponents, and to paraphrase Winston Churchill, seldom have so few tried to do so much harm to so many. God help the country if they get what they want.

(This ran as an op-ed in the Charleston Gazette-Mail.)

The bad kind of ACE

If you’re playing poker, a handful of aces can be a good thing. If you’re growing up, not so much, especially if the aces stand for Adverse Childhood Experiences.

That kind of ACE was the accidental discovery of Dr. Vincent Felitti, who ran a weight-loss clinic in California for the health care giant Kaiser Permanente in the 1980s.

A star of the program was a woman who initially weighed 408 pounds. She lost 276 pounds in less than a year.

Then, something happened. In less than a month, she put nearly 40 pounds back on.

Felitti questioned her about what happened. It came out that, after losing the weight, she was sexually propositioned by an older, married co-worker. While Felitti acknowledged that must have been disturbing, he thought the dramatic weight gain was an extreme response.

Then, she revealed that she had been repeatedly sexually abused by a family member starting at age 10. One could see the weight gain as a kind of protection, conscious or otherwise, from unwanted advances.

Felitti checked with other patients who quit the program and found that a majority reported childhood sexual abuse.

Sensing a connection between childhood experiences and adult outcomes, he partnered with Robert Anda, of the federal Centers for Disease Control and Prevention, to survey more than 17,000 adults in the Kaiser system about the extent and effects of childhood trauma, including various kinds of abuse and family disfunction.

The main finding was that these were “vastly more common than recognized or acknowledged” and that they “have a powerful relation to adult health a half-century later.”

This led to the development of a widely-used ACEs test, which identifies whether people experienced one or more of the following: physical abuse by a parent, sexual abuse by anyone, emotional abuse in the household, physical neglect, emotional neglect, loss of a parent (from death, divorce or separation), growing up in a household with an alcoholic or person with substance-use disorder, living with a family member with mental illness, and the incarceration of a household member.

Add up the “yeses” to these and you’ll have an ACEs score.

Research suggests that, while trauma isn’t destiny, a high incidence of ACEs is associated with a much higher risk for behavioral health issues, such as physical inactivity, smoking, alcoholism, drug use and missed work, not to mention things like incarceration.

High ACE scores also increase risk for severe obesity, diabetes, suicide attempts, sexually transmitted diseases, depression, cancer, strokes, heart disease, chronic obstructive pulmonary disease and even physical injuries, like broken bones.

According to the CDC, people with an ACEs score of six or more die 20 years earlier, on average, than those with no ACEs.

Studies suggest that nearly two-thirds of Americans have an ACE score of at least one, and 38 percent have scores higher than one. Around 12.5 percent have ACE scores of four or more. The most common ACEs were physical abuse (28 percent), substance abuse (27 percent) and the absence of a parent (23 percent).

It’s hard to get an exact handle on the economic toll of ACEs, but the annual costs associated with symptoms are in the hundreds of billions of dollars.

Unfortunately, many children dealing with the effects of trauma are misdiagnosed as having conditions such as attention deficit/hyperactivity disorder or other disorders. Or simply as being “bad.”

Research suggests that a better question to ask in such cases is “what happened to you?” rather than “what’s wrong with you?”

What does this mean for West Virginia? In short, a lot.

A 2014 survey suggests that at least 55.8 percent of Mountain State residents had at least one such experience, and 13.8 percent experienced four or more. That’s likely an underestimate, because of slightly different methodologies.

Consider the connection between ACEs and the state’s opioid problem. According to the WV ACEs Coalition,

“A 2016 study found that individuals who reported 5 or more ACEs were 3x more likely to misuse prescription pain medication and five times more likely to engage in injection drug use. Another study found that over 80% of the patients seeking treatment for opioid addiction had at least one form of childhood trauma, with almost two-thirds reporting having witnessed violence in childhood. Among the different forms of ACEs, sexual abuse and parental separation (for women) and physical and emotional abuse (for men) appear to be particularly highly correlated with opioid abuse.”

Follow-up research by Felitti and Anda suggests that boys with six or more ACEs were 46 time more likely to become intravenous drug users as adults than those with none.

That’s on the front end. It gets scarier if we think about the future effects of the trauma experienced by children dealing with the crisis today.

What can we do about it?

First, it’s time to recognize that punishing trauma doesn’t work, neither for children nor adults.

At the individual level, positive connections with at least one adult contribute to resiliency. So do things like physical activity and developing mindfulness skills.

At the larger level, protective factors include things like helping parents manage stress, building social connections, increasing knowledge of child development and parenting skills, concrete support for families in times of need and promoting positive interactions between children and adults. At the systemic level, obvious steps would be ending poverty, reducing inequality and addressing racial disparities.

We can’t change the past, but the future is unwritten.

(This ran as an op-ed in the Charleston Gazette-Mail.)

Getting priorities right for WV's young people

“This could be a really beautiful state, if we fix it.”

Those words were spoken by a young man at a juvenile day report center in Southern West Virginia. They sum up the results of over 100 interviews and surveys of young people conducted over the past year about mental health issues.

They say a lot about how things are now and how they could be.

It’s never easy to come of age — and living in West Virginia has always had its challenges. But today, many young West Virginians are facing a toxic brew of obstacles, from the addiction crisis to the explosive growth of foster care placement to a changing economy to new technology and social media. Then there are the old problems of persistent poverty and misplaced priorities.

Over the past year or so, my co-workers and I conducted a statewide listening project on young people and mental health issues as part of our work with the American Friends Service Committee. We were motivated, in part, by disappointment at the lack of action of our Legislature to address these issues over the past several years. Some of those who helped conduct interviews were themselves high school students concerned about these issues and frustrated by inaction.

It wasn’t a randomized scientific survey, but we did try to interview young people who varied in age, geographic location, race, ethnicity, social class and sexual orientation. We also spoke with adults who worked with them. The most surprising finding was strong agreement on several key points:

*Young people here face serious and multiple stressors, and many are dealing with undiagnosed and untreated mental health issues and trauma. “There’s no point trying to talk to somebody who doesn’t understand.”

*Things have gotten worse. Stressors identified included addiction, economic hard times, family stability, poverty, overexposure to social media, bullying and various types of discrimination. “It makes you give up hope. You feel like there is nothing in the world that can change the way things are.”

*Many young people with undiagnosed mental health and trauma issues might wind up facing disciplinary proceedings, such as suspension, out-of-home placement or confinement, or they might wind up engaging in destructive decisions. “We need to figure out the root of the problem, instead of shipping them away. Is it drugs? Bullying? Abuse?”

* Existing systems are not prepared to deal with the situation. “I think more money should be spent on counseling for young people. More community involvement would also be good. Instead of people thinking, ‘oh poor thing,’ people should be thinking ‘what can I do to help this person?’”

*Something needs to be done. “We need more people who care.”

Strange to say, nobody asked for charter schools or education savings accounts or the privatization of public education.

It’s no surprise to me that those same themes showed up in the education forums conducted around the state by the West Virginia Department of Education, in which nearly 2,000 stakeholders participated.

Early in April, state schools Superintendent Steven Paine told WV MetroNews, “Overwhelmingly, there was almost unanimous support for social, emotional supports for students. In other words, recognizing that kids are coming from some very, very difficult backgrounds and some of those needs need to be met before we can address their academic needs. That’s probably the one that stood out the most to me.”

There are several policies the Legislature could enact that might help with this situation. Obviously, one step would be to increase the number of mental health professionals who work in schools. With that investment, it would be easier to assess and address issues before a student is suspended or sent to court.

A worthy long-term goal for our state would be to ensure that students in danger of entering the juvenile justice system are assessed and referred to community-based programs whenever possible and appropriate.

Another could be creating a task force to address juvenile mental health and trauma-related issues. West Virginia has already created strategic plans to address chronic diseases, such as asthma and diabetes. These help stakeholders tackle issues by assessing needed services, setting goals, and assigning responsibilities.

Such a task force could not only identify unmet needs but also highlight success stories and best practices that could be replicated elsewhere.

To state the obvious, we’re losing a lot of young people in the state, but many of those who remain have serious, unmet needs. When the Legislature goes back into special session, I hope they don’t use kids as a political football, but, instead, deal with the real problems.

This really could be a beautiful state, if we fix it.

(This ran as an op-ed in last week's Charleston Gazette-Mail)

What's at stake for WV in the health care fight

If you want to know what's at stake for West Virginians in the fight to preserve the Affordable Care Act (ACA), which is once again under attack by Prince Joffrey President Trump, consider this info by Gazette-Mail reporter Lori Kersey:

Low-income West Virginians received $90 million worth of mental health and substance abuse treatment last year, and nearly $300 million over the last four years, under a law the Trump administration is trying to repeal, according to West Virginia health officials.

Under the Affordable Care Act, commonly known as Obamacare, West Virginia expanded its Medicaid program to those who make up to 138 percent of the federal poverty line.

According to the West Virginia Department of Health and Human Resources, the state’s expanded Medicaid program spent about $58 million on mental health and substance abuse in fiscal year 2015, $61 million in 2016, $79 million in 2017 and $90 million in 2018.

Then there's this: according to the WV Department of Health and Human Resources, as of April 1, 160,356 West Virginians were covered by Medicaid expansion, a state option under the ACA. Another 22,600 state residents got coverage under the ACA exchange. Then there are around 12,000 young people who are able to stay on their parent's insurance until age 26, another ACA provision.

Then there's the fact that the ACA brings hundreds of millions of dollars to our economy, creating thousands of jobs and helping to keep rural hospitals and health care providers going.

Those are just numbers, but behind each number is a story. Here's a link to some collected from people who gained coverage thanks to Medicaid expansion.

This is our concern, Dude.

Unfinished business: addressing WV's youth mental health needs

The WV legislative session ended Saturday (thank God!), but Gov. Justice has called for a special session to address "education betterment." One thing we hope to address in improving mental health services for young people. Here below is an op-ed from the Beckley Register-Herald on the subject:

“This could be a really beautiful state if we fix it.”

Those words were spoken by a young man at a juvenile day report center in southern West Virginia. They sum up the results of over 100 interviews and surveys of young people conducted over the last year about mental health issues.

That sentence speaks to the great potential of the state to be a welcoming home for its children and young adults. It also speaks to a sense of brokenness that many young people expressed when they described things as they are.

Coming of age is never easy, even in good times. And living in West Virginia has always had its challenges. But the combination of a public health crisis in the form of the opioid epidemic, the explosive growth of foster care placement, a changing economy that has left many behind, new technology and social media, persistent poverty and misplaced priorities makes this a particularly difficult time to grow up.

My co-workers and I decided to conduct a statewide listening project on young people and mental health issues as part of our work with the American Friends Service Committee (AFSC). We were motivated in part by disappointment at the lack of action of our Legislature to address these issues over the last several years. Some of those who helped conduct interviews were themselves high school students concerned about these issues and frustrated by inaction.

We surveyed young people who varied in age, geographic location, race, ethnicity, social class and sexual orientation. The most surprising finding was strong agreement on several key points:

● Young people here face serious and multiple stressors, and many are dealing with undiagnosed and untreated mental health issues and trauma. “There’s no point trying to talk to somebody who doesn’t understand.”

● Things have gotten worse. Stressors identified included addiction, economic hard times, family stability, poverty, overexposure to social media, bullying and various types of discrimination. “It makes you give up hope. You feel like there is nothing in the world that can change the way things are.”

● Many young people with undiagnosed mental health and trauma issues may wind up facing disciplinary proceedings such as suspension, out of home placement or confinement, or may wind up engaging in destructive decisions. “We need to figure out the root of the problem instead of shipping them away. Is it drugs? Bullying? Abuse?”

● Systems are not prepared to deal with the situation. “I think more money should be spent on counseling for young people. More community involvement would also be good. Instead of people thinking ‘oh poor thing,’ people should be thinking ‘what can I do to help this person?’ “

There are several policies the Legislature could enact that might help with this situation. One would be creating a task force to address juvenile mental health and trauma-related issues. West Virginia has already created strategic plans to address chronic diseases such as asthma and diabetes. These help stakeholders tackle issues by assessing needed services, setting goals, and assigning responsibilities.

Such a task force could not only identify unmet needs but also highlight success stories and best practices that could be replicated elsewhere.

Another promising approach is to help public schools address mental health issues before a student is suspended or sent to court. Several interviewees pointed out that acting out is often a symptom of deeper problems, which often go undiagnosed and untreated. Increasing the number of mental health professionals who work with schools is an obvious step.

A worthy long-term goal for our state would be to ensure that students in danger of entering the juvenile justice system are assessed and referred to community-based programs whenever possible and appropriate.

It may be that there are some juveniles who constitute a major threat to the public and/or themselves. It only makes sense that out-of-home placement and treatment should be reserved for such people as a last and, one hopes, a temporary resort. The rest should be treated, whenever possible, in their homes and communities.

As state leaders, communities and families become more informed about why mental health matters and what can be done about it, West Virginians of all ages will be better able to draw upon our vast reserves of resiliency, caring and compassion.

The Ominous Omnibus

Christmas tree” is a slang term for a piece of legislation that tries to do too much, as in you hang all kinds of things on it. A perfect example of this is the West Virginia Senate’s mammoth omnibus education bill.

Some people I know have already taken to calling it the “ominous bill,” which may be a better fit.

I wish I thought of that.

The proposed legislation could and should be broken up into any number of separate bills, each to be debated on its merits, which in some cases are nonexistent.

To be fair, some provisions are good, such as raising pay for teachers and school support workers and allowing retirees to convert unused sick days into PEIA coverage.

Other provisions, however, would clearly damage public education and move the state further down the road to privatization. These include charter schools, education savings accounts and other means for draining resources from public schools.

Incredibly, the bill actually raises the student/teacher ratio for elementary classes.

Still other provisions seem designed to punish teachers and school workers for their historic victory through a strike last year which improved conditions for thousands of West Virginia families, inspired similar successful efforts in other states and revitalized the movement of working people. These include provisions that make it more difficult for workers to pay dues to the organizations that represent their interests and punish work stoppages even if superintendents cancel schools.

This is what revenge looks like. It’s also a not-too-subtle warning to the peasants on the dangers of revolt.

West Virginia’s children and families deserve better. All of them.

For starters, we need adequate funding for education that includes infrastructure, personnel, equipment, textbooks and materials, including pay raises for teachers and support workers and sustainable funding for PEIA. We don’t need another round of corporate tax cuts that would make it harder for state and local governments to support schools.

When it comes to school reform, we need to say yes to innovation but no to privatization. Obviously, we need new and better ways to deal with trauma, promote STEM learning and encourage entrepreneurship. However, these steps can be taken through existing mechanisms such as community schools and innovation zones.

Gov. Jim Justice hit the nail on the head when he said, “I just believe that today as we strive to provide a better education for everyone, we don’t really need to cherry pick the privileged until we get our public education system in a really good way.”

We need to lower student/teacher ratios, not increase them."

We need a major effort to address mental health issues for students. These are tough times to come of age in West Virginia. We need mandated ratios of mental health professionals and nurses in schools. We also need a statewide task force to identify needs, gaps, best practices and come up with a plan to address the needs. This isn’t a luxury; it’s a matter of basic safety.

Another positive step would be to strengthen Local School Involvement Councils (LSICs), including the creation of a statewide LSIC advisory committee and the representation of students, mental health professionals and disadvantaged parents on local LSICs. We also need a virtual schools advisory council consisting of teachers, facilitators, administrators, parents and students to promote best practices in online education.

To really seal the deal for a better future, we should support an expansion of after school programs, including a transportation component; enhanced early childhood and in-home family education; and expanding debt-free post-secondary education.

Nelson Mandela said, “Education is the most powerful weapon which you can use to change the world.”

The real “school choice” facing West Virginia is one between progress and promise or privatization and punishment.

As the old Appalachian mining song goes, “Which side are you on?”

The empire strikes back

Well, I guess the leadership of the WV senate is out to avenge our teachers and school workers for last year's victory. Yesterday, they unveiled their plan, which includes penalties for work stoppages, messing with union dues, charter schools, and ore. Here's Ryan Quinn from the Gazette on the bill.

Before the bill came out, I wrote out some thoughts for supporters of public education about what a decent approach to education reform might be. Here goes:

“Education is the most powerful weapon which you can use to change the world.”—Nelson Mandela

Coming of age is never easy—and growing up in West Virginia has always had its challenges. But today children face an array of problems new and old, ranging from the opioid crisis to a changing economy to persistent poverty. 

It’s been calculated that from birth to the time a child reaches 18 years of age, he or she will spend only around 13 percent of time in a school setting, yet school personnel deal with 100 percent of the child’s issues every day.

When it comes to helping kids cope with the present and prepare for the future, West Virginia’s public school teachers and service workers are in the front lines. Our children need a strong system of public education more now than ever.

To protect and strengthen West Virginia’s system of public education, we support the following principles:

Adequate funding for public education, including infrastructure, personnel, equipment, textbooks and materials. We support pay increases for teachers and school support workers, including sustainable funding of the Public Employees Insurance Agency. We oppose tax cut policies that would reduce the ability of state and local governments to support education, such as eliminating the business machinery property tax.

Innovation yes, privatization no. We recognize the need for education experimentation and innovation, such as community schools, new ways to promote STEM and /or entrepreneurship, and more informed approaches to dealing with trauma. We believe these can be achieved through existing mechanisms such as innovation zones and without further legislation.

We oppose diverting public funding to privatization efforts such as charter schools or voucher programs. We agree with Governor Jim Justice, who said “I just believe that today as we strive to provide a better education for everyone, we don’t really need to cherry pick the privileged until we get our public education system in a really good way,” he said.

We support lowering teacher/student ratios to ensure that students receive adequate personal attention from teachers., including a student ratio 1:15 for elementary, 1:18 middle school, and 1:20 high school.

We support efforts to address mental health issues for students, including increasing mental health professionals in schools so that students can be assessed and referred to appropriate treatments as necessary; creating a statewide mental health task force to identify strengths, gaps and best practices and create a strategic plan to address the issues; and train teachers and school support workers to better deal with trauma.

Specifically, we recommend a ratio of 1:250 social 1:250 social workers and counselors and a 1:1000 ratio psychologists as well as complete wraparound services including full time in school-based nurses in every school.

We propose the strengthening of Local School Involvement Councils (LSICs), including the creation of a statewide LSIC advisory committee and the representation of students, mental health professionals and disadvantaged parents on local LSICs.

We support after school expansion providing all schools with funding for after school programs including a transportation component.

We support the creation of a virtual schools advisory council to consist of teachers, classroom facilitators, administrators, parents and students in order to promote best practices in online education.

We support expanding early childhood education, including pre-K and in-home family education. We support universal access to voluntary home visiting programs for expecting parents and families with infants and toddlers.

We support efforts to provide free post-secondary education at the vocational and community college level. As a long-term goal, we propose debt-free higher education at public colleges and universities for all students.

We believe that the strengthening of our public schools is vital for the future of our democracy. In the words of Horace Mann, a pioneer in American education, “Education then beyond all other devices of human origin is the great equalizer of the conditions of men the balance wheel of the social machinery.”

Tough times to come of age

Growing up is never easy, but these are particularly tough times for young people in West Virginia, given the opioid crisis, the ballooning foster care population, hard economic times, trauma and all that. As we've argued many times in the past, state bureaucracies seem more comfortable disciplining or confining young people than finding out what's really going on.

That's one of the reasons the two American Friends Service Committee projects in WV teamed up to work on a listening project. Over the last year, we surveyed and interviewed over 100 high school students and people who work closely with them. The results are summarized in this report, including many quotes by those we interviewed.

Some themes were loud and clear (buy you'll have to click the link to see them).

The title came from a moving interview we did with some young men in a day report center in Boone County. One of them said "This could really be a beautiful state if we fix it." Can't sum it up any better than that.

A little background.... A couple years ago, the legislature considered passing a Mental Health Matters bill. The idea was to put together a task force on juvenile mental health to see what we have and, most importantly, what we don't.

It was a kittens, angels and puppies bill that would have cost the state little or nothing but might have eventually helped a lot of kids. Guess what? It died, probably because union busting seemed like more of a priority to the legislative majority.

As we argued in a report we released last fall, the next step in juvenile justice reform in WV would be assessing the mental health needs of young people facing suspension or out of home placement and whenever possible referring them to treatment rather than punishment.

More work to do

In recent years, WV has made progress in juvenile justice reform. We've take a few steps away from locking up kids at $100,000 or more per year for truancy...but there's still more to go. The missing piece is the mental health angle.

We as in AFSC  and the WV Center on Budget and Policy recently released a report on where things are and where we need to go. Here's a link to the full report.

And here's a summary of the key findings. We hope to work with folks in the coming year to move things along:



Every year in West Virginia, around 4,000 juveniles will appear before a judge. Pending the judge’s decision, a juvenile may be given an improvement period to address the behavior, put on probation, referred to a special court, or committed to some form of out-of-home placement. However, the state’s juvenile justice system can be confusing and data is often difficult or impossible to obtain.

This report provides an overview of West Virginia’s juvenile justice system, including historical background, recent reforms, and recommendations for improvements. It also suggests looking at the system through a mental health lens could lead to more constructive solutions and positive outcomes for the state’s youth offenders.

“When West Virginia confines a young person for a minor, non-violent offense, too often it puts him or her at risk of being drawn more deeply into the criminal justice system,” said Sean O’Leary, West Virginia Center on Budget and Policy Interim Executive Director. “While the state has recently embarked on the path of juvenile justice reform, there is still more work to be done. A greater focus on juvenile mental health would help West Virginia build on its recent progress.”

Key Findings

*West Virginia bucks the national trend with its high confinement rates. It was one of only five states where the rate of detention increased, despite a drop in both crime and population.

*In 2013, West Virginia confined juveniles at a rate of 510 per 10,000. By contrast, Massachusetts, with nearly four times the population of West Virginia, had just 393 youth in confinement.

*African American youth were nearly three times as likely to be confined as their white counterparts. West Virginia’s youth confinement rate for African Americans was 1.5 times higher than the national average.

*West Virginia was second only to Wyoming to confining young females. With a rate of 175 per 100,000, the Mountain State far exceeded the national rate of 47.

*Incarceration or other forms of detainment early in life are a major life disruption in the ordinary life course, which can have ripple effects into the future. Prior incarceration was a greater predictor of recidivism than carrying a weapon, gang membership, or poor parental relationships.

*In 2013, only one out of every eight committed youth in West Virginia was locked up based on a violent crime, such as homicide, aggravated assault, robbery, or sexual assault.

*Community-based programs were more cost-efficient and effective with recidivism rates than DJS facilities.

*In 2014, Governor Earl Ray Tomblin convened the West Virginia Intergovernmental Task Force on Juvenile Justice, which brought together legislative and judicial leaders as well as system experts to conduct a comprehensive analysis of the state’s system and to produce policy recommendations.
West Virginia’s juvenile justice system has made real progress, however, it continues to face significant problems, particularly in the area of juvenile mental health.

*Looking at the system through a mental health lens could lead to more constructive solutions and positive outcomes for youth offenders. Some next steps include: creating a task force to address juvenile mental health; build the infrastructure to help public schools address mental health issues before a student is suspended or sent to court; and a long-term goal should to build an infrastructure which would ensure that students in danger of entering the system are assessed and referred to appropriate community-based programs whenever possible and appropriate.

West Virginia’s communities, families, and youth will benefit if the only young people who are confined or detained in out-of-home facilities are those who constitute a threat to the public or themselves.

Full load

A lot of interesting items have caught my eye recently. First, El Cabrero's beloved state of West Virginia is, according to a Gallup poll, officially the most stressed state. Hawaii was the least. Maybe they ought to send us to Hawaii for a while and see how that works.

ONE POSSIBLY STRESSED WEST VIRGINIAN is a Republican legislator who suggested elementary kids should have to work for their meals, the poor ones anyway. Stories about the debate on the Feed to Achieve Act, when the comments took place have shown up on the Huffington Post and a Washington Post blog.


Here's what he said during the debate: "If they miss a lunch or they miss a meal they might not, in that class that afternoon, learn to add, they may not learn to diagram a sentence, but they'll learn a more important lesson."

I'm not sure what that lesson might be. 

AT LEAST OUR LEGISLATURE DIDN'T DO THIS. According to the Post's Wonkblog, Montana may have blown its chance to expand Medicaid because one confused legislator cast an unintentional vote. Doh!

HAIRY THUNDERER OR COSMIC MUFFIN? Another study suggests that people who believe in a punitive God are more likely to have emotional problems. And, I would surmise, to kill people in the name of that God.

GOAT ROPE ADVISORY LEVEL: ELEVATED

WHERE HAVE ALL THE (GOOD) THEOLOGIANS GONE?

Caption: Seamus McGoogle is still working on his theological masterpiece.

Say all the bad stuff you want to about the 20th century, but it did produce some good theologians. They were thoughtful people of faith who spoke to a large public audience of believers and non believers and had a significant positive impact.

Three in particular were big ones for El Cabrero. In no particular order, they included Reinhold Niebuhr, the Jewish theologian and philosopher Martin Buber, and German emigre Paul Tillich. Each came from a specific tradition (Calvinist, Hasidic, and Lutheran, respectively) but had something to say to people from widely different traditions.

I'm not sure we have anybody of their caliber today, but maybe I'm missing something.

Niebuhr (1892-1971) put sin back on the map. Here's a good profile of him by the late Arthur Schlesinger from 2005. I've had the privilege of learning from some people who were taught by him and consider myself a second-generation student. Niebuhr is an excellent antidote for personal and national self-righteousness and we need him now.

Martin Buber (1878-1965) is best known for his work I and Thou, which deals with human relationships with other people, nature and the spiritual world. I had to hit it three times (once with a commentary) before anything sank in but it was well worth the effort. His other biblical and philosophical writings are worthwhile as well.

And then there was Tillich (1886-1965), a German theologian from the Lutheran tradition who came to the U.S. as a refugee from Nazi Germany. But he'll keep till tomorrow...

CARING FOR VETERANS. Many veterans have been and will be returning from Iraq with serious mental health issues. According to this item from the Washington Post, the outlook isn't good that they'll get the timely help they need.

LONG STRANGE TRIP. Here is an op-ed by yours truly recapping the 10 year fight to raise the minimum wage. And here is a good editorial from the Saturday Gazette about inequality.

GOAT ROPE ADVISORY LEVEL: ELEVATED