May 2021 Child Support Report
- Helping Others Starts with Taking Care of Ourselves
- Celebrating Moms Virtually
- Children’s Mental Health Care is Covered with Medicaid and CHIP
- Preventing Violence Against Native Americans Using a Public Health Framework
- Tribal Spotlight: Taking Steps to Protect Indigenous Women
- Success Story: Leveraging Retired Child Support Workers to Increase Collections
- Calling on States to Support Electronic Child Medical Support Notices
- Resource Alert: COVID-19 Funeral Assistance Program
COMMISSIONER'S VOICE: Helping Others Starts with Taking Care of Ourselves
Linda Boyer, Acting Commissioner, OCSE
May is Mental Health Awareness Month, and I know this past year has been challenging for all of us. Personally, many of our families have experienced economic hardship and personal heartache. Professionally, states and tribes are still struggling from effects on their programs, including lower paternity establishment performance, limited access to courts, and technology challenges.
Yet amid these ongoing struggles, I’m heartened by the resilience of the child support program and how we’ve helped struggling families during the pandemic. States and tribes adapted to unforeseeable changes to keep providing services. Many moved to virtual meetings and court hearings, provided outdoor genetic testing, and enhanced online services to safely work with our customers.
Not only did our programs have to shift, but so did we. We quickly had to balance home and work life, and many parents had to become teachers overnight. This naturally caused stress and mental health challenges for many Americans. According to the Kaiser Family Foundation Visit disclaimer page , over 41% of adults reported symptoms of anxiety and depressive disorder at the beginning of 2020, up from 10% in 2019. Stress from this pandemic has also caused Americans to have difficulty sleeping (36%), trouble eating (32%), and increased alcohol use and substance abuse (12%).
Mental health resources
You may have heard flight attendants advise passengers, “In the event of a change in cabin pressure, put on your own oxygen mask before helping others.” In order to be capable of helping others, we must ensure we are taking care of ourselves first. It’s important to acknowledge the stress we’re all under and to know when we need help. Here are several resources to consider when seeking mental health aid:
- National Institute of Mental Health Visit disclaimer page : Find free mental health resources, including how to cope with the stress of COVID-19.
- Substance Abuse and Mental Health Services Administration Visit disclaimer page : Find information on treatment centers and mental health services. You can search by location, language, youth treatment services, payment options, and more.
- National Suicide Prevention Lifeline Visit disclaimer page : If you or someone you know is struggling with depression or thoughts of suicide, call 1-800-273-TALK (1-800-273-8255) to speak with a professional 24/7 and learn about free mental health resources.
Celebrating Moms Virtually
While many of us are still isolated from family because of the pandemic, talking via phone or video can help us stay connected and relieve stress. As we celebrate Mother’s Day this month, I encourage you to take a special moment to reach out to moms and mother figures who have inspired, supported, and shaped you and your family. Expressing gratitude is another great way to lift each other up during these difficult times.
Children’s Mental Health Care is Covered with Medicaid and CHIP
Centers for Medicare & Medicaid Services
From school closures to limited social interaction, children have experienced unexpected changes to their daily lives during the public health emergency, impacting their well-being and mental health. The Connecting Kids to Coverage National Campaign Visit disclaimer page wants to remind you that kids and teens up to age 19 can receive free or low-cost health insurance through Medicaid and the Children’s Health Insurance Program (CHIP). These programs cover vital mental and behavioral health services Visit disclaimer page , including access to counseling services, prescriptions, and substance abuse programs.
Mental health and COVID-19
Mental health disorders can first arise in childhood Visit disclaimer page , causing serious changes in the way children typically learn, behave, or handle their emotions. This can lead to distress and problems getting through the day. Prior to the public health emergency, as many as 1 in 6 U.S. children between the ages of 6 and 17 Visit disclaimer page had a treatable mental health disorder. With additional stressors such as lack of a routine, there has been a surge of anxiety and depression Visit disclaimer page in young people since the start of the pandemic. Despite this surge, mental health services declined sharply among children age 18 and under Visit disclaimer page . Although telehealth visits have helped increase mental health services, these services have rebounded less than primary and preventive care services among Medicaid and CHIP beneficiaries.
Medicaid and CHIP help support children through early intervention and access to essential mental health services, both in person and virtually. As the public health emergency continues, it’s important to make sure children take advantage of these resources.
How to enroll in Medicaid and CHIP
Medicaid and CHIP enrollment is open year-round, allowing parents and caretakers to immediately sign-up and access benefits; coverage must be renewed annually. Eligibility varies by state and is based on household size and income, but professionals working with children can direct families to learn more through the “Find Coverage for Your Family” map on InsureKidsNow.gov Visit disclaimer page or by calling 1-877-KIDS-NOW (1-877-543-7669). The website has shareable materials like social media posts, graphics, and short informational videos for parents and caregivers. You can also access helpful resources like FAQs, print materials, and toolkits to share information about the programs across different channels.
When children with mental health disorders get the support they need, they are better able to reach important developmental and emotional milestones. Together, we can promote enrollment in Medicaid and CHIP and encourage eligible families to take advantage of the mental and behavioral health coverage available to kids.
Preventing Violence Against Native Americans Using a Public Health Framework
Administration for Native Americans
Prompted by countless stories of missing or murdered relatives and friends, Indigenous communities across the U.S. and Canada raised an urgent call to action. Law enforcement, health and human service providers, and policymakers at every level of government began doing more—and doing better—to address Missing and Murdered Native Americans (MMNA). Led by the Commissioner of the Administration for Native Americans (ANA), the Administration for Children and Families (ACF) started conversations with tribal leaders and Native American communities in 2018 about possible actions to address the crisis.
Treating MMNA as a public health crisis
By mid-2019, ACF senior officials determined that the agency’s programs had a vital role to play in addressing increased risks for Native Americans and initiated a framework for collective action. With input from tribal leaders and consultations, ACF completed the Missing and Murdered Native Americans Framework which represents an important step towards responding to MMNA as a preventable public health crisis, instead of only responding to criminal acts. By focusing on strengthening protective factors, social determinants of health, and cultural well-being, the Framework proposes a proactive way forward.
A presidential Executive Order Visit disclaimer page also established the Operation Lady Justice Task Force and named the Attorney General and Secretary of the Interior as co-chairs. The EO also named the ANA Commissioner to the Task Force to bring a public health perspective, identify necessary health and human service supports for affected families, and improve prevention.
Understanding root causes of MMNA
Tackling a public health challenge requires understanding the root causes of the problem. For MMNA, that includes understanding the centuries of physical and cultural violence carried out through colonization and assimilation. This violence from outside forces continues today, with multiple studies showing that the majority of violence against Indigenous people is committed by non-Natives.
According to a 2016 report from the Department of Justice’s National Institute of Justice, 84% of Native American women and 81% of Native American men experience violence in their lifetime, the highest victimization rates of any race. Of those who experienced violence, 97% of women and 90% of men were victimized at least once in their lives by non-Natives.
ACF’s role in this framework
Because children are vulnerable to violence and families are crucial to violence prevention, every ACF program office can play a role in protecting Native American communities. ACF’s programs improve individual and community conditions and facilitate systems like child support enforcement that contribute to improved outcomes for children, youth, and families. To do so, ACF committed to thirteen strategic actions that include supporting MMNA activities through:
- Operating grant programs
- Enhancing technical assistance
- Targeting economic mobility grants
- Increasing Native American grantee engagement
- Holding community-centered cultural events
- Implementing a national awareness campaign
Among the important objectives of the Framework is improving the way ACF works collectively to address MMNA and promote better data analysis, prevention science, and community collaboration.
This work is not an abstract notion for ACF. Many of our staff come from Indigenous communities, and several have been directly affected by this issue. One staff member, Sonya Begay (Diné), shared her story during the Operation Lady Justice Virtual Tribal Consultation in September 2020:
“My son was Ruben Eppele. He was born in Tuba City, Arizona, on January 29, 1980. He was murdered on November 26, 2010 in Corinth, Kentucky, at the hands of an ex-felon. My son is buried in Rock Point, Arizona, next to his great grandmother and other relatives. Ruben was a master union millwright who resided and worked in Kentucky. He left behind three children who I am raising… It is not just the victim of the crime that suffers, but the loved ones left behind are just as vulnerable.”
To learn more, read ACF’s Public Health Framework on Missing and Murdered Native Americans.
Tribal Spotlight: Taking Steps to Protect Indigenous Women
Awendela Dana, Program Coordinator, Penobscot Nation Child Support Agency, and Patricia Graffam, Program Coordinator/Advocate, Penobscot Nation Domestic Violence & Sexual Assault Advocacy Center
Did you know that more than 4 out of 5 Native women Visit disclaimer page experience violence in their lifetimes? The murder rate for Native women is 10 times higher than the national average, according to a U.S. Department of Justice study. These disturbing statistics highlight the importance of the National Day of Awareness for Missing and Murdered Indigenous Women (MMIW) to bring a call for action that continues year-round.
Raising awareness in the Penobscot Nation
In Maine, the Penobscot Nation recognizes MMIW every year through a community walk to raise awareness about this issue and honor victims. Our Tribal Child Support Agency supports and participates in this walk organized by our Domestic Violence Advocacy Center. The domestic violence team meets regularly to plan the walk, secure funding from the Office of Violence Against Women, and coordinate marketing. They promote the event through social media, posters, and word of mouth.
Each May, approximately 30 to 50 people show up for the walk and help elevate this important issue. Everyone wears red, the official color of MMIW, and a local artist makes red dress earrings for attendees to wear. The event begins with a prayer, traditional drumming, and reading the names of missing and murdered Indigenous women. We are fortunate to not have any names from our tribe on the list, but we read names from other tribes to stand in solidarity with other communities. Then, step by step, we start our two-mile community walk around the reservation with banners to educate our neighbors.
In May 2020, social distancing and health guidelines prevented a community walk, but this did not stop our efforts. We turned the walk into a community caravan and continued to raise awareness.
Advocates call for better data collection
While the statistics are alarming, we unfortunately still do not know the full magnitude of the problem. Advocates say underreporting of missing and murdered Indigenous women Visit disclaimer page is likely due to varied data collection at the state and federal level, poor recordkeeping, and racial misclassification. The Wabanaki Women’s Coalition, a group of advocates from all five Native tribes in Maine, leverage the energy from MMIW and travel to the Maine State House to raise awareness. The coalition hopes new laws will better coordinate data collection and information sharing between law enforcement agencies to protect Indigenous women.
These conversations and efforts at the tribal and state level are helping to elevate this issue in the national conversation. Through continued efforts, we are working to ensure our communities are safe for all Indigenous women.
Success Story: Leveraging Retired Child Support Workers to Increase Collections
Louisiana Child Support Enforcement
Between 2010 and 2011, Louisiana Child Support Enforcement experienced a 25% reduction in staff. Needing to still meet collection goals, it was crucial for us to find a way to collect on stalled arrears cases and to give some relief to the field staff. The Division of Family Services and our office decided to secure a vendor that could work the low-priority stalled cases and collect payments. We outsourced the Arrears Collections Unit through April 2016. During its five-year run, the vendor successfully collected an average of over $946,000 per month.
During the final year, the Department looked at streamlining the program and processes. We decided to let the contract expire instead of renewing it. In May 2016, we brought arrears collection back in-house and created a new unit with one manager and three full-time employees. We also brought back 10 retired child support employees to work 20-24 hours a week from locations throughout the state.
The move from vendor to in-house workers proved cost effective. Between May 2016 and December 2020, the Arrears Collections Unit collected over $73 million, which averages to $1.3 million per month. We credit part of this enhancement to leveraging our retired child support workforce. These former employees are already knowledgeable about the child support system and strategies that can secure support for families. They also have a passion for helping children and families that is invaluable and important to our work.
For more information about this program, contact Donna Clayton, CSE Manager, Donna.Clayton.DCFS@LA.GOV.
Calling on States to Support Electronic Child Medical Support Notices
Alice P. Jacobsohn, Esq., Government Relations, American Payroll Association
Child support agencies send the National Medical Support Notice (NMSN) to employers to order health insurance coverage for an employee’s children when it’s available and ordered by a court. Soon, OCSE will launch the electronic NMSN (e-NMSN) to allow states and employers to transmit these current paper forms electronically. Like the e-IWO, the e-NMSN will create efficiencies to support children and families.
The COVID-19 health and safety stay-at-home orders have made electronic communication critical for state child support agencies and employers. The “new normal” will not reverse the virtual communication trend; if anything, it will make virtual communication even more vital.
Cost, security, and efficiency benefits
Development efforts and priorities may impact states’ abilities to implement the e‑NMSN, but the reduction in administration, printing, and postage will help offset these costs. The standard NMSN is generally 10 full pages. With copies included, a state easily spends $0.70 to $1.00 to mail a single NMSN. Sending those same 10 pages electronically would provide considerable savings.
Using e-NMSNs will also bring an additional level of security. States and employers will no longer have to send personally identifiable information via mail. The e-NMSN allows for secure two-way communication between child support agencies and employers.
And perhaps the most important benefit to using the e-NMSN is the speed in processing these official forms. Being able to receive and respond to the form electronically is an efficiency not only for states and employers but also for families waiting for the medical support to be implemented. This means that eligible children will be enrolled in employer-sponsored health plans sooner.
Please keep an eye out for news about the launch of the e-NMSN in the coming months. For more information, contact OCSE’s Employer Services team at email@example.com.
About Child Support Report
Child Support Report is published monthly by the Office of Child Support Enforcement. We welcome articles and high-quality digital photos to consider for publication. We reserve the right to edit for style, content and length, or not accept an article. OCSE does not endorse the practices or individuals in this newsletter. You may reprint an article in its entirety (or contact the author or editor for permission to excerpt); please identify Child Support Report as the source.
Acting Director, Division of Customer Communications