THE PROGNOSIS

Migrants kids taken from their parents under the Trump administration’s “zero tolerance policy” experienced intense trauma as they were crowded into centers insufficiently equipped to care for them psychologically.

Those findings – detailed in a government watchdog report released yesterday – shed more light into how the administration’s controversial move last year affected thousands of children who were separated from their families at the Mexico border and placed in the custody of the Office of Refugee Resettlement at the Department of Health and Human Services.

The report from HHS’s inspector general says the massive influx of children and longer stays at federal facilities posed a particular challenge in addressing children’s mental health needs. The report is based on visits to 45 facilities in August and September 2018, a couple months after the administration ended the policy.

“According to program directors and mental health clinicians, separated children exhibited more fear, feelings of abandonment, and post-traumatic stress than did children who were not separated,” the report says.

“Separated children experienced heightened feelings of anxiety and loss as a result of their unexpected separation from their parents after their arrival in the United States. For example, some separated children expressed acute grief that caused them to cry inconsolably,” it continues.

The health and well-being of children has been front and center in the political battles over how to handle an influx of migrants at the border. Democrats who objected to Trump’s insistence on a border wall dragged their feet in giving HHS more funding to care for the children. And the administration now wants to let children be kept in jail-like settings for longer periods, recently proposing a rule allowing families to stay together in detention centers longer than the current 20-day maximum (we explained that proposal in this Health 202).

Caught in the middle are kids who arrive at the border alone or who were brought by their parents, often fleeing violence and poverty in central American countries.

The family separation policy didn’t originate with HHS Secretary Alex Azar. But it was up to his agency to deal with much of the fallout from it – and the new report details just how many challenges HHS was up against. A few more of its details:

-- There was a sudden and large spike in the number of children – especially young ones – turned over to ORR while the “zero tolerance” policy was in place. The share of kids under age 12 increased from 14 percent in April 2018 to 24 percent the following month. Caring for such young children posed an especially troubling challenge for the facilities.

-- While there’s a requirement of staffing one psychiatrist or psychologist for every 12 children, some clinicians said they managed caseloads of 25 children. Only four of the 45 facilities visited had a mental health specialist on staff; most of the rest contracted with outside providers.

"Children experienced treatment delays when they could not access external specialists," the report says. "Mental health clinicians and program directors reported long waits for mental health evaluations and treatment from external specialists and other providers. Staff described making appointments with psychiatrists and psychologists for dates that were 2 or 3 months away."

-- Mental health clinicians had difficulty gaining the trust of children they tried to help.

“Every single separated kid has been terrified. We’re [seen as] the enemy,” a program director told the investigators. The director said children couldn’t differentiate facility staff from agents who separated them from their families. The report also found mental distress was worse for kids who did not realize why they had been separated from their parents.

AHH, OOF and OUCH

AHH: The Trump administration announced it will dole out more than $1.8 billion in grant funds to states to expand opioid overdose treatment and provide money for data collection in the fight to tackle the opioid crisis.

The Centers for Disease Control and Prevention is set to have $900 million in new funding for efforts in states over three years, while the Substance Abuse and Mental Health Services Administration announced $932 million for state grants. 

In a call with reporters, HHS Secretary Alex Azar said the SAMHSA grants will be used toward  "everything from expanding the use of medication-assisted treatment in criminal justice settings or in rural areas, be it telemedicine; to youth-focused, community-based prevention efforts; recovery supports, like employment coaching; and support for the distribution of naloxone."

“These funds will be delivered to the communities where help is most needed,” Trump during remarks at the White House. “In this effort nothing is more important than defeating the opioid and addition crisis.

The president said the funding will be used to expand access to medication, medication-assisted treatment and mental health resources. “My administration is determined to use every resource at our disposal to smash the grip of addiction,” Trump said. 

OOF: Oregon health officials are investigating a recent death that could be the second vaping-related death in the nation.

The Oregon Health Authority said the individual, who died in July, had used a vaping device that was purchased from a cannabis dispensary. The individual had symptoms similar to others in what is now more than 350 possible cases of the vaping-related illnesses in 29 states.

"We don’t yet know the exact cause of these illnesses — whether they’re caused by contaminants, ingredients in the liquid or something else, such as the device itself," said Ann Thomas, a public health physician with the Oregon Health Authority, said in a statement. Last month, Illinois health officials announced the first death reported from a lung illness linked to vaping.

Our Post colleagues Lena H. Sun and Laurie McGinley reported last week that state and federal health officials are looking into contaminants as a possible cause of the lung illnesses, “narrowing the possible culprits to adulterants in vaping products purported to have THC, the component in marijuana that makes users high, as well as adulterants in nicotine vaping products.”

— In an op-ed in The Post, former FDA commissioner Scott Gottlieb, who during his time at the agency pushed aggressively to combat what he called an “epidemic” of youth vaping, pointed to the recent spate of mysterious illnesses and the role e-cigarettes have played.

“Even if most of the lung-injury cases are traced to the oils and chemicals used to emulsify THC or CBD into illegal vaping ‘juices,’ that doesn’t let legally sold, nicotine-based e-cigarettes off the hook,” he writes. “…The longer that legitimate e-cigarette companies reject their obligations to help distinguish acceptable products from dangerous ones, the more they will be lumped in with those contributing to the growing glut of illegal products. That’s bad for preserving their businesses, and it’s bad for protecting the public health.”

OUCH: Stanford alums Adam Bowen and James Monsees wanted to disrupt and innovate the tobacco industry when they helped create e-cigarette company Juul, our Post colleague Marie C. Baca reports, describing a product design thesis from the pair of graduate students at Stanford 15 years ago who wanted to impact “the national future of smoking.”

But now Bowen and Monsees are the chief technology officer and chief product officer of a company that’s at the center of criticism over how it contributed to a youth vaping crisis, even as Juul maintains that its product is meant for adult smokers.

“So how did Juul go from its Silicon Valley roots to being associated with Big Tobacco?” Marie writes. “…Today, Juul dominates the e-cigarette market with its devices, despite challenges from other big companies. In the three years after it launched in 2015, the company captured nearly 70 percent of the e-cigarette market, according to a Wells Fargo analysis of Nielsen sales data. But the company has drawn scrutiny for marketing practices critics say were aimed at teenagers and potential health problems related to vaping generally.”

Marie details more about Juul as a company and why lawmakers have begun cracking down on Juul’s and other e-cigarette devices that have become popular with young users. Even as it faces a number of lawsuits and numerous hurdles to selling products in the United States, the company is working on expanding abroad. It’s also working on efforts such as age-verification standards for retailers.

REPRODUCTIVE WARS

— Planned Parenthood Federation of America announced it’s expanding its virtual care with a telemedicine app that is set to be available in all 50 states by the end of next year. As of now, the app is available in 27 states and in Washington, D.C. and is meant to help patients get birth control, acquire a prescription for treatment for urinary-tract infections or make an appointment at a Planned Parenthood clinic, among other resources.

“The Planned Parenthood Direct app is helping minimize barriers that patients face,” PPFA acting president and chief executive Alexis McGill Johnson said on a call with reporters.

The app, which is free and can be downloaded through the Apple App Store or Google Play, accepts debit, credit and prepaid cards, but patients will be able to use insurance to pay for medications if they opt in some states to pick up medication at a pharmacy.

INDUSTRY RX

— Facebook and Instagram will start showing users pop-up windows that are meant to warn them about vaccine misinformation.

Users will see the pop-ups if they search for vaccine-related content, click on vaccine-related hashtags on Instagram, or go to a Facebook group or page on a related topic, CNN’s Jacqueline Howard reports.

The user in the United States will be connected to the Centers for Disease Control and Prevention for factual information about vaccines, while non-U.S. users will be directed to a World Health Organization website for more information.

“We know that parents often turn to social media to access health information and connect with other parents, and it can be difficult to determine what is accurate and who the credible sources of information are,” CDC spokeswoman Kristen Nordlund said in a statement to CNN.

It’s the latest move by the social media company to deal with medical misinformation on its platforms. In March, the company said it would look to combat anti-vaccine theories and misinformation by no longer recommending pages with anti-vaccine messages on Facebook and Instagram and by blocking ads with false vaccine information. In July, Facebook also said it would limit the reach of false and dangerous claims in private Facebook groups that push natural treatments for cancer and other illnesses, as our Post colleague Abby Ohlheiser reported then.

— And here are a few more good reads: 

A federal judge reviewing a Justice Department decision to allow U.S. pharmacy chain and benefits manager CVS Health Corp (CVS.N) to merge with health insurer Aetna said on Wednesday that the agreement was in fact legal under antitrust law.
Reuters
HEALTH ON THE HILL
Rep. Hakeem Jeffries (D-N.Y.) announced Wednesday that he is cosponsoring "Medicare for All" legislation in the House, giving a boost to the legislation from a high-ranking House Democrat. 
The Hill
STATE SCAN
Virginia Politics
National groups view Va. election in November as a key proving ground for next year’s presidential contest
Gregory S. Schneider
Missouri hospitals on Wednesday helped launch a campaign put Medicaid expansion on the ballot in November 2020.
Modern Healthcare
Many addicts have turned to fentanyl, a stronger and more addictive drug than heroin that requires more frequent doses: A heroin addict who shot up once or twice a day with a needle is now using 15 times a day.
Boston Globe
MEDICAL MISSIVES
Fact Checker
The former vice president says there are more suicides "by a long shot" but his claim is surprisingly difficult to confirm.
Glenn Kessler
National
The storm left behind an “absolute catastrophe” and is threatening a possible landfall on the Outer Banks.
Anthony Faiola, Maria Sacchetti, Tim Craig and Joel Achenbach
DAYBOOK

Today

  • The Research!America’s 2019 National Health Research Forum will be held on Thursday and can be livestreamed here
SUGAR RUSH

'Are you going nuts?': Stephen Colbert mocks Joe Biden's gaffes: