“The House on Friday passed bipartisan legislation aimed at fighting the nationwide epidemic of opioid abuse, culminating months of work on the crisis…

Still, some say the legislation is not enough to make the large-scale changes needed to fight the epidemic.
Addiction advocates largely praise the measures as good steps forward, but say that much more work and funding is needed to tackle the issue’s scale…
The legislation, passed Friday, includes a range of measures to fight the epidemic, including lifting some limits on prescribing Buprenorphine, a drug used to treat opioid addiction. The bill also requires health-care professionals to write prescriptions for Medicare beneficiaries electronically in order to better track prescriptions and to allow Medicare to cover treatment at addiction treatment clinics.
The measure’s passage comes days after the House passed additional bills aimed at combatting opioid addiction, some of which included lifting certain limits on Medicaid’s contribution for opioid care at treatment facilities and cracking down on imports of illicit opioids into the United States via mail.” (A)

‘For years, we got the scraps. And now we’re the big time,’ says an anti-addiction consultant.
The House is touting passage of dozens of bills that could help combat the national opioid crisis — but a small handful of companies that have spent millions lobbying Congress could reap a windfall if any of the bills become law.
In a two-week legislative blitz, the House cleared several narrowly tailored measures that would spur sales for companies that have ramped up their influence game in Washington, according to a review of the more than five dozen bills up for votes.
Those poised to benefit include:
• Alkermes, which spent $1 million lobbying in part to support a bill to fund full-service centers where people can detox, receive medical care and start treatment — a setup that could boost the fortunes of its best-selling product, anti-addiction treatment Vivitrol, which has been held back by the need for patients to fully detox before taking the drug.
• Indivior, an Alkermes rival that spent $180,000 largely in support of a bill that eases restrictions on certain controlled substances used in injectable anti-opioid treatments — a change that would make it easier for doctors to buy Indivior’s once-a-month injectable Sublocade.
• Pennsylvania drugmaker Braeburn Pharmaceuticals, which spent $100,000 lobbying and backed the same bill because it is developing a competing injectable.
• A group of drugmakers that produce non-opioid pain relief medications, including California-based Heron Therapeutics, which spent hundreds of thousands to lobby for legislative changes to create an additional Medicare payment for non-opioid pain drugs…
“When you hear they’re investing $3 billion in this in 2018 and $3 billion in 2019, everyone’s ears are going to perk up,” said Andrew Kessler, the founder of behavioral health consulting firm Slingshot Solutions. “For years, we got the scraps. And now we’re the big time.” (B)

(A) House passes bipartisan bill to fight opioid crisis, by Peter Sullivan and Juliegrace Brufke, https://www.politico.com/story/2018/06/22/house-opioid-bills-lobbying-637695
(B) Opioid bills could net millions for companies, by ADAM CANCRYN, https://www.politico.com/story/2018/06/22/house-opioid-bills-lobbying-637695

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Tender-Age Immigrant Children.“They need bilingual workers. Some kids speak indigenous languages, so that’s an issue as well.

Then there are children who may not yet be verbal, and who aren’t able to articulate their needs, and that will have to be addressed.”

“Earlier this week, news broke that some of the nearly three thousand immigrant children who have been taken from their parents at the border are being transferred to “tender-age” shelters run by the Office of Refugee Resettlement (O.R.R.), an office within the Department of Health and Human Services (H.H.S.)…

Converting a facility meant to house teen-agers into one meant for toddlers is not a straightforward task. “Staffing up to care for toddlers and preverbal kids is a time-consuming process, because of licensing requirements, and because of the extra training that staff need,” the former official said. “It’s not just taking folks who have been dealing with sixteen- and seventeen-year-old boys and saying, ‘It’s your job to change a diaper and try to comfort a kid ripped from his or her mom.’ ” Carey told me, “When you’re talking about children who have been forcibly removed from a parent, the trauma is going to be greater, and so are the challenges of caring for those children.”..

Now, amid reports that H.H.S. has agreed to share sponsors’ information with ICE, undocumented adults have reason to fear stepping forward. “If we’re saying to people, ‘Come pick up your children, and, by the way, we need to know how to reach you, and we’re going to use that information to deport you,’ not very many people are going to come forward to pick up their kids,” Cancian said…
“To provide settings that are appropriate for adults that also meet human-rights standards for children, and to ramp those up to the scale demanded by the current crisis, is neither cost-effective nor feasible. We can’t create a housing situation that is heinous enough to get parents who are worried about their children’s well-being not to come. So how is this a solution?”

to read the full New Yorker article highlight and click on
The Office of Refugee Resettlement Is Completely Unprepared for the Thousands of Immigrant Children Now in Its Care, by Alexandra Schwartz, https://www.newyorker.com/news/news-desk/the-office-of-refugee-resettlement-is-completely-unprepared-for-the-thousands-of-immigrant-children-now-in-its-care?mbid=nl_Daily%20062318&CNDID=50144682&spMailingID=13744569&spUserID=MjAxODUyNTc3Mjk4S0&spJobID=1422054528&spReportId=MTQyMjA1NDUyOAS2

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“The idea of pulling a child out of a parent’s arms, or identifying a parent but still keeping them separate—it isn’t right.”

“Alicia Hart has worked as an emergency physician in South Texas for ten years, and has seen a stream of migrant children from Guatemala and Honduras come to the U.S. fleeing gang violence…
But then the Trump Administration began to enforce a “zero tolerance” approach toward migrants arriving at the U.S.-Mexico border, a move that included separating parents from their children…
Last week, on a day when Hart was on duty, the charge nurse called her over to examine a child who needed clearance for psychiatric treatment.
“The boy had been in custody for over a month. One of his guardians told me that he had been ‘acting out’ and threatening to harm himself, by jumping from his bed. This man told me, ‘I’m his clinician,’ but he was definitely not a doctor. I don’t know if he’s a social worker, a medical assistant, a housekeeper. I have no clue…
“This boy seemed devastated—quiet and withdrawn. He barely spoke. I asked if he needed a hug. I kneeled down in front of the recliner, and this kid just threw himself into my arms and didn’t let go. He cried and I cried…
“I referred the boy to an inpatient psychiatric unit for treatment. I worry that he may be treated with psychiatric drugs like antipsychotics, also without the consent of his parents. But I still believe that psychiatric hospitalization is our best option. If we get these kids to the psychiatrists, at least they’re in a protective unit, away from these detention facilities, and they will get some of the counselling they need, because they’ve been through a tremendous trauma.”

to read the full New Yorker article highlight and click on
A Physician in South Texas on an Unnerving Encounter with an Eight-Year-Old Boy in Immigration Detention, by Amanda Schaffer, https://www.newyorker.com/news/as-told-to/a-physician-in-south-texas-on-an-unnerving-encounter-with-an-eight-year-old-boy-in-immigration-detention

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Democratic Republic of Congo’s Ebola outbreak has been “largely contained”…

…and no new cases of the disease have been confirmed since the last known sufferer died on 9 June, the World Health Organisation said on Wednesday.
The UN health body said it viewed the situation with “cautious optimism”, despite the difficulty of tracking down people who may have been exposed to the deadly virus in remote forests close to the Congo River.
The outbreak has killed 28 people since early April.
“Slightly over a month into the response, further spread of EVD (Ebola virus disease) has largely been contained,” the organisation said in a report.
The outbreak triggered particular concern because it occurred in a remote north-western area that was hard to reach but close to the Congo River, causing fears it could take root in a neighbouring city or spread to the capital Kinshasa, a city of more than 10 million people.
There were also fears that river transport could help the virus spread to the neighbouring Central African Republic and the Republic of Congo.
This outbreak is Congo’s ninth, but the first to be countered with a “ring vaccination” strategy, where all contacts of known patients are vaccinated to try and stop the spread…
“If no new cases are reported, the last contacts of the known confirmed or probable cases will complete follow-up on 27 June 2018.”..
An Ebola outbreak is normally declared over once 42 days have passed since blood samples from the last confirmed case tests negative for the second time.” (A)

(A) WHO: Ebola outbreak in DRC ‘largely contained’, http://ewn.co.za/2018/06/20/who-ebola-outbreak-in-drc-largely-contained

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“The business of housing, transporting and watching over migrant children detained along the southwest border is not a multimillion-dollar business. It’s a billion-dollar one…

The recent separation of some 2,300 migrant children from their families under the Trump administration’s “zero tolerance” policy on illegal border crossers has thrust this invisible industry into the spotlight in recent weeks, as images of toddlers and teenagers taken from their parents and detained behind locked doors have set off a political firestorm. President Trump’s order on Wednesday calling for migrant families to be detained together likely means millions more in contracts for private shelter operators, construction companies and defense contractors.

A small network of private prison companies already is operating family detention centers in Texas and Pennsylvania, and those facilities are likely to expand under the new presidential directive, should it stand up to legal review, analysts said.

The range of contractors working in the migrant-shelter industry varies widely.

BCFS, a global network of nonprofit groups, has received at least $179 million in federal contracts since 2015 under the government’s so-called unaccompanied alien children program, designed to handle migrant youths who arrive in the country without a parent or other family member. Many of the contractors, some of which are religiously affiliated organizations and emergency-management agencies such as Catholic Charities, see their work as humanitarian aid to some of the most vulnerable children in the world.

But several large defense contractors and security firms are also building a presence in the system, including General Dynamics, the global aerospace and defense company, and MVM Inc., which until 2008 contracted with the government to supply guards in Iraq. MVM recently put up job postings seeking “bilingual travel youth care workers” in the McAllen area of South Texas. It described the jobs as providing care to immigrant children “while you are accompanying them on domestic flights and via ground transportation to shelters all over the country.”..
The shelters’ rush to house, and cash in on, the surge of children has made them a new target for Democrats, immigrant advocates and a vocal chorus of local, state and federal officials and community leaders…

Some have raised concerns that the rush to expand will make it difficult to properly manage the housing and care of infants, toddlers and teenagers, all of whom have a host of complex emotional, health and legal issues. In recent years, a number of migrant youth shelters have run into problems unseen by the public: fire-code violations, lawsuits claiming abuse, and complaints from employees alleging wrongful termination and unpaid wages.

To read the full article, The Billion-Dollar Business of Operating Shelters for Migrant Children, by Manny Fernandez and Katie Benner, highlight and click on https://www.nytimes.com/2018/06/21/us/migrant-shelters-border-crossing.html

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“If it could happen to them…why can’t it happen to us?”…separating children from their parents

“My older daughter began having nightmares that “the people” would take her away from us and give her to another family. She was inconsolable. “If it could happen to them,” she asked with the cleareyed logic of a 7-year-old, “why can’t it happen to us?”.. (A)

“The Trump administration has set up at least three “tender age” shelters to lock up babies and other young children who have been forcibly separated from their parents at the U.S.-Mexico border, The Associated Press has learned…
The United Nations, some Democratic and Republican lawmakers and religious groups have sharply criticized the policy, calling it inhumane.
Not so, said Steven Wagner, an official with the Department of Health and Human Services.
“We have specialized facilities that are devoted to providing care to children with special needs and tender age children as we define as under 13 would fall into that category,” he said. “They’re not government facilities per se, and they have very well-trained clinicians, and those facilities meet state licensing standards for child welfare agencies, and they’re staffed by people who know how to deal with the needs — particularly of the younger children.”…
“The shelters aren’t the problem, it’s taking kids from their parents that’s the problem,” said Dr. Marsha Griffin, a South Texas pediatrician who has visited many.
“The facilities that they have for the most part are not licensed for tender age children,” said Michelle Brane, director of migrant rights at the Women’s Refugee Commission, who met with a 4-year-old girl in diapers in a warehouse in McAllen, Texas, where Border Patrol temporarily holds migrant families.
“There is no model for how you house tons of little children in cots institutionally in our country. We don’t do orphanages, our child welfare has recognized that is an inappropriate setting for little children.” (B)

“The American Medical Association urged the Donald Trump administration to stop its “zero tolerance’ policy that is separating migrating children from their “parents or caregivers.”
The nation’s largest doctor group said the Trump administration needs to end the policy and should instead focus on supporting “the health and well-being of the children within those families.”
“Families seeking refuge in the U.S. already endure emotional and physical stress, which is only exacerbated when they are separated from one another,” AMA executive vice president and CEO Dr. James Madara said in a letter to U.S. Secretary of Homeland Security Kirstjen Nielsen, Attorney General Jeff Sessions and U.S. Secretary of Health and Human Services Alex Azar.
“It is well known that childhood trauma and adverse childhood experiences created by inhumane treatment often create negative health impacts that can last an individual’s entire lifespan,” AMA’s Madara said. “Therefore, the AMA believes strongly that, in the absence of immediate physical or emotional threats to the child’s well-being, migrating children should not be separated from their parents or caregivers.”” (C)

“The United Nations Children’s Fund warned of the dangers faced by children who are separated from their parents at the border.
“There is a documented impact of being detained. There is fear and anxiety, and we must not forget that these are children first,” Caryl Stern, CEO of UNICEF USA said in a previous statement. “Parents and caregivers are a steady force in these children’s lives, so when they are effectively ripped from the arms of their protector, of course that is extremely worrisome.”
Stern points to the additional health effects related to releasing these minors to sponsors who may not be suitable caregivers — and the risk of releasing minors into the custody of human traffickers. The Department of Health and Human Services documented the issue and the need for protections of unaccompanied refugee minors in report to the U.S. Senate.
In addition, there are something called ‘push’ factors that have caused migrants to flee their home countries. Ashley Ham Pong, an Associate Attorney at Montagut & Sobral in Washington DC, has worked with detained children for more than three years and now works with both accompanied and unaccompanied children.
“In many cases these migrants are fleeing immense risks in their home countries — for instance gang violence in Central America — is a major push factor which we know affects children’s health,” Ham Pong told ABC News…” (D)

“The Trump administration’s policy of separating migrant children from their parents has alarmed child psychologists and experts who study human development…
Institutions — even the best and most humane — by their nature warp the attachments children long for, the visceral and concentrated exchange of love, tough and otherwise, that comforts, supports and shapes a child’s heart and mind.
In orphanages and other institutional settings, “turnover rate of caregivers is high, as is the number of children per caregiver,” Marinus van IJzendoorn, a professor of human development at Erasmus University Rotterdam, said in an email.
“This causes impersonal, unstable and fragmented care, which not only impacts on attachment or stress regulation but also on physical growth parameters such as height, weight and head circumference, and brain development.”…
“So many of these parents are fleeing for their lives,” Dr. Colleen Kraft, president of the American Academy of Pediatrics, wrote in a public statement after a recent trip to the border. “So many of these children know no other adult than the parent who brought them here.”” (E)

‘On Wednesday, the public pressure from both Democrats and Republicans — and private entreaties from his own family — seemed to have finally worked on the president. Trump announced he will sign an executive order to address the issue, though he didn’t elaborate on how families detained at the border would be kept together or how detentions would be handled going forward.
“We’re going to keep families together but we still have to maintain toughness or our country will be overrun by people, by crime, by all of the things that we don’t stand for and that we don’t want,” Trump said.” (F)

“As with so many Trump decisions, this one has been a moment-by-moment proposition, driven by, and reactive to, the media.”
“Sources who’ve been in the room with Trump tell me he realizes the overwhelming weight of the imagery of the children means he can’t just ride this out as he might have originally thought he could. Anybody saying Trump thinks the family separation issue is a political winner hasn’t been talking to him.” (G)

(A) ‘If It Could Happen to Them, Why Can’t It Happen to Us?’, by Jeanine Cummins, https://www.nytimes.com/2018/06/19/opinion/children-border-separated-foster-care-trauma.html
(B) At least 3 shelters set up for child migrants, https://apnews.com/
(C) AMA To Trump: End ‘Inhumane’ Child Separation Border Policy, by Bruce Japsen, https://www.forbes.com/sites/brucejapsen/2018/06/20/ama-to-trump-end-inhumane-child-separation-border-policy/#21a92e5c60cf
(D) What to know about the negative health effects of separating kids and parents, by AMITHA KALAICHANDRAN, https://abcnews.go.com/Health/negative-health-effects-separating-kids-parents/story?id=55974081
(E) A Troubling Prognosis for Migrant Children in Detention: ‘The Earlier They’re Out, the Better’, by Benedict Carey, https://www.nytimes.com/2018/06/18/health/migrant-children-mental-health.html
(F) Melania Trump Pressured President Trump To Change Family Separation Policy, by Jessica Taylor, https://www.npr.org/2018/06/20/621930721/melania-trump-pressured-president-trump-to-change-family-separation-policy
(G) Axios PM: Trump to end child separation crisis he created; June 20, 2018

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“…Trump’s (family separation) policy amounts to “government-sanctioned child abuse.””

The president of the American Academy of Pediatrics on Monday said President Trump’s “zero tolerance” policy separating families at the U.S.-Mexico border “amounts to child abuse.”
“I can’t describe to you the room I was in with the toddlers,” Kraft said. “Normally toddlers are rambunctious and running around. We had one child just screaming and crying, and the others were really silent. And this is not normal activity or brain development with these children.”
Kraft stated that Trump’s policy amounts to “government-sanctioned child abuse” when asked by CNN host Kate Bolduan, saying that the U.S. government is taking away the one constant in these children’s lives. “ (A)

“…the Trump administration’s policy (is) to forcibly remove children from parents caught trying to enter the U.S. illegally as they are seeking asylum from violence, presumably to deter people from entering the country illegally.
Their children, including babies and toddlers, are then labeled “unaccompanied alien children” (a phrase never intended to be applied to children who could not yet walk) and placed in the custody of the Office of Refugee Resettlement (ORR)…
Many of these families are fleeing trauma and violence in their home countries, only to be faced with the new trauma we have inflicted through forcible separation. The impact of these traumas on young children and their developing brains is real. Trauma is different from the typical stressors children experience in their normal daily life; those are the healthy stresses from which children learn and grow.
This trauma, the trauma of being forcibly separated from a parent by strangers and then transported to other strangers for prolonged periods of time, is different. This kind of trauma overwhelms the body. It causes feelings of terror and helplessness. Stress hormones flood the body.
Without the nurturance and calming support of a caring adult who is known to the child, these traumas can alter the structure of the developing brain. Long term, we know that this toxic level of stress can affect other organ systems, leading to long term adverse health outcome such as mental illness, substance abuse, cardiovascular disease, and premature death…” (B)

“Pamela Florian is an attorney at the Florence Immigrant and Refugee Rights Project, a nonprofit that provides free legal services to immigrants who have been detained in Arizona
“Our social-services program trains us to understand biological and brain development. We really focus on trauma-informed interviewing, so we don’t traumatize the children any more than they are. We talk about stress reactions, and how to work specifically with different age groups. We also get ethics training for working with kids, and we take into consideration cultural differences. If the child is younger, we see that he or she may speak a different language, and we try to figure out what it is so that we can call an interpreter. There are children who speak indigenous languages, so we can’t assume that everyone speaks Spanish.” (C)

“A report from the New York Times over the weekend highlighted another layer of the situation: the fact that some immigrant parents are being deported without being able to recover their children first. They try to cross the border, are separated, and then are sent back to their home countries without their children.
The Times highlights the story of Elsa Johana Ortiz Enriquez, a Guatemalan woman who tried to enter the country with her 8-year-old son, Anthony. The 25-year-old Ortiz was sent back to Guatemala, but her son is still in the US. Immigration officials say this isn’t supposed to happen, but apparently, it does. And then parents only have two options, per the Times:
They can have a family member who is living in the United States take sponsorship and custody of the child, or the child can be flown home and delivered into the custody of the authorities in the parent’s home country — and from there to the parent.
Parents are given a hotline to try to find their kids.” (D)

“The Trump administration has created a policy that is abusive to children and intentional in its cruelty. It is using this assault on a defenseless population as leverage against parents seeking to enter the U.S. without documentation. More than 1,500 boys are being held in a detention center in Texas. Other children have been placed into foster care while their parents are incarcerated hundreds of miles away.
Being wrenched from parents is every child’s worst nightmare. In addition to being traumatized by a forced separation, these children are at risk for further abuse and exploitation as the government ward system is imperfect in protecting children. This policy inflicts psychological injury on children, and its malicious intent may lessen the provision of compassionate treatment by those holding these children.
What is even more disturbing to me is that these family separations are occurring in full public view, as if they are done with honor or pride instead of with shame. Such brazen and unflinching cruelty against a highly vulnerable group — immigrant children — suggests that any group could be a target for unjust and cruel treatment by our government.” (E)

(A) American Academy of Pediatrics president: Trump family separation policy is ‘child abuse’, by JUSTIN WISE, http://thehill.com/latino/392790-american-academy-of-pediatrics-president-trumps-family-separation-policy-is-child
(B) Toxic effects of stress on children separated from parents, by DEBORAH GROSS, ELLEN OLSHANSKY AND SARAH OERTHER, http://thehill.com/opinion/immigration/392724-toxic-effects-of-stress-on-children-separated-from-parents
(C) An Immigration Attorney on What It’s Like to Represent Small Children Taken from Their Parents, by Alexandra Schwartz, https://www.newyorker.com/news/as-told-to/an-immigration-attorney-on-what-its-like-to-represent-small-children-taken-from-their-parents
(D) The past 72 hours in outrage over Trump’s immigrant family separation policy, explained, by Emily Stewart, https://www.vox.com/2018/6/18/17475292/family-separation-border-immigration-policy-trump
(E) Separating families at the border isn’t just bad policy — it’s horrible for children’s health, by OSCAR J. BENAVIDEZ, https://www.statnews.com/2018/06/19/separating-families-border-children-health/?utm_source=STAT+Newsletters&utm_campaign=641b1008a8-Daily_Recap&utm_medium=email&utm_term=0_8cab1d7961-641b1008a8-149527969

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