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Windows into Health Care - A Conversation with Secretary Bill Crouch

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In the next episode of Window's into Health Care - our occasional series talking with health experts from around the state - health reporter Kara Lofton sits down with  Department of Health and Human Resources Cabinet Secretary Bill Crouch to talk about his work and what he feels are the biggest health issues the state is facing.

In the transcript below, Crouch talks about how the DHHR is dealing with the opioid crisis, concerns about the state's growing foster care crisis and how chronic conditions like diabetes and obesity impact West Virginia. 

The biggest problem is drugs and it's affecting virtually every department in DHHR. We have 80 percent of our children in foster homes [that] are from families who have had drug problems - either the overdoses by the mother or addiction by the mother. We have a large number of NAS babies - neonatal abstinence syndrome. These babies need special care. So, the problems are affected a lot by drugs. That's not our only problem. We have obesity in West Virginia - we are number one in obesity, we're number one in cardiovascular disease, number one in diabetes. So, there are a lot of health problems that are difficult to tackle because they require changing behavior and changing people's behavior is one of the toughest things to do in health care.

One of the things that I'm hearing from health professionals who are dealing with the addiction problem that is in this state is: not only how do we help change the behavior of existing users, but how do we prevent future users and how do we impact West Virginia's youth? I mean, what is the DHHR's approach to that?

You know, our death rate in West Virginia to opioids and drugs is over twice the national average. We have a problem that I believe is a community problem. This has to happen from the bottom up -- not the top down. I can speak all day long and Dr. Gupta - our public health officer - can speak, Jim [Johnson], our new director of the Office of Drug Control Policy, who was in the same position as city of Huntington for the past several years - can speak. It doesn't change things. We have to have change at the local level. So we're working on an approach that involves folks at the local level helping to tackle this problem. We need an intervention early on for these issues.

So when you say approaching from the local level and from a community approach, those are pretty broad terms. Can you describe more specifically what you mean by that?

Well, that's what I've charged this department with - this office with  developing. But it could include a social worker. It could include a professional from the local behavioral mental health program. It could include someone from the local health department. It could include someone from emergency medical services. It needs to be a team of individuals who really are charged with going out and developing an intervention with an individual. A good example of what has happened in the past is in Huntington. In August of last year, 2016, we had 26 individuals overdose within a few hours. Our Department of Public Health was contacted a few days later and asked to do an epidemiological study to determine the outcome of that and determine any factors that might help prohibit that in the future. That report was done - I believe it was completed in January - and it showed not one of those individuals went for treatment. So what that tells me is we need a local team at the local level to contact those folks immediately and see if we can get people into treatment sooner and convince them that that is the way to go. They have to change that lifestyle. If nothing is done - in fact, we have a number of individuals who overdosed two or three times a day. And so, we have to have some intervention at a local level to have an impact on that.

West Virginia is a poor state and we struggle with our economy. So when we're looking at interventions, which can be quite expensive, how does money and lack of money impact our ability to spread resources to those who might need them?

That's a great question. We started out last year's budget, as you probably know, with a $500 million deficit. It looks like we're going to we're going to start out the next fiscal year with $250-280 million deficit. So we don't have a lot of money. The legislature played a great role in the last session in passing a bill called the Ryan Brown fund, in which settlement money from the pharmaceutical companies was placed into an account called the Ryan Brown account to be used to develop treatment beds in West Virginia. That is one of the areas that we're lacking. We don't have enough treatment beds in West Virginia for folks that need those treatment beds - even when you convince them that they need treatment. We have to have a place to place those individuals. So that was a big help. But we're struggling with the cost of this public health problem in West Virginia. We will get funds from the federal government from time to time and we look for every grant we can get to try to provide funds down at the local level to combat this problem. But it's a barrier to fixing the problem.

Let's come back around to what you do as Secretary and some of the things that you encounter. What are the biggest challenges of your job?

The biggest is probably the responsibility for the children that DHHR is responsible for caring for through the foster care program and other residential programs. I really had no idea of the amount of responsibility that that involves. So. that's been a little eyeopener to me.

Foster care and caring for children is something you've mentioned a couple of times. So let's talk about this a little bit. What's happening with West Virginia's children?

We have a large number of children who are there because of the drug problem. We have more than doubled the number of children in foster care in the last 10 years. We do not have enough foster families, where many of our children now end up going to extended families - their grandparents, aunts, uncles. We're trying to recruit more foster families. But that's difficult. It's a large responsibility. It's a huge burden. But it's amazing, the number of folks who have stepped up and who are trying to help children. It is not an easy thing to do. We seem to have a lack of placement in a lot of the areas that we're responsible for. We are examining that right now to look and see if there is more we can do in that area.

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