To: State, territorial, tribal, and local policymakers and administrators of systems, agencies, and programs responsible for children, youth, and family health and well-being Dear Colleagues, Thank you for the work you do each day to support children, youth, and families across the country. The Administration for Children and Families (ACF) would like to highlight the critical importance of timely, high-quality behavioral health crisis care and make sure you are aware of how these resources can be accessed in your communities. Too many people are experiencing suicidal crisis or mental health-related distress without the support and care they need, and this is particularly true for children, youth, and families. Trends in suicide attempts and deaths by suicide have been increasing among adolescents and remain a major public health concern. In 2023, 3.2 million adolescents aged 12 to 17 (12.3 percent) had serious thoughts of suicide in the past year, 1.5 million (5.6 percent) made suicide plans, and 856,000 (3.3 percent) attempted suicide. Vulnerable adolescent populations exposed to adverse childhood experiences are at particular risk of suicide and related behaviors. Someone to contact: The 988 Suicide & Crisis Lifeline 988 offers one-on-one, skilled, compassionate mental health and substance use support for anyone at any time. 988 counselors are trained to understand how an issue is affecting a person and share resources that may be helpful. People can call or text 988 or chat 988lifeline.org 24/7 for themselves or if they are worried about a loved one. The 988 dialing code is made up of a national network of more than 200 local crisis contact centers that are equipped to handle thousands of contacts each day. When someone calls 988, they first hear a greeting message. They are then given choices of who to connect with. The 988 Lifeline has specially trained counselors for veterans, Spanish speakers, LGBTQI+ youth and young adults, and Deaf and Hard of Hearing people. The 988 Lifeline uses Language Line Solutions to provide translations to callers in more than 240 additional languages, and is also working to ensure broad accessibility to make sure that all people can receive needed support, including those with intellectual and/or developmental disabilities, those with brain injury, and those with other disabilities. Since Congress designated 988 in 2020 and the three-digit number went live in 2022, there has been a significant investment of federal resources to scale up crisis centers across the country. 988 is an important step forward and offers an unprecedented opportunity to strengthen and transform behavioral health crisis care in our country. There are a number of other federally funded hotlines that offer critical support and intersect with topics related to emotional distress and crisis. Use your best judgment as to the most appropriate resource for the situation when directing the public to different hotline resources. For your convenience, a list of ACF- and select federally supported hotlines is included at the bottom of this letter (see Tables A, B). When suicide presents as a risk, please refer to 988. 911 should only be used for situations posing immediate physical danger, such as suicide attempts in progress, medical emergencies, or immediate threats to safety. Someone to respond and a safe place to go: The importance of trained face-to-face response The vast majority of those seeking help from the 988 Lifeline do not require any additional emergency interventions at that moment. However, there are instances when an in-person response is needed. The Substance Abuse and Mental Health Services Administration (SAMHSA) outlines two core components that every community should work to have in place when these instances arise: mobile crisis teams that can reach individuals where they are in the community, and crisis stabilization facilities that can provide observation and stabilization services in a

En Español (PDF) Supporting the behavioral health of children, families, and youth is an essential priority for the Administration for Children and Families (ACF). We see youth and families facing mental health challenges, substance use struggles, and high levels of stress. In partnership with federal, state, tribal, territorial, and local partners, as well as youth and families themselves, we have — through prioritizing actions and investments — further integrated behavioral health support and services into existing supports for youth and families. This enables us to promote behavioral health, foster recovery, cultivate resilience, and strengthen overall well-being among individuals and communities across the country. I’m proud of the work ACF has done — and will continue to do — in partnership with all of you to address the President’s Strategy to Address our National Mental Health Crisis and the HHS Roadmap for Behavioral Health Integration . I’d like to highlight in this email some of our work and accomplishments to improve behavioral health for children, youth, and families. ACF is committed to centering and partnering with youth, families, and communities and learning from their experiences and expertise as we transform behavioral health in this country. The ACF team and I have regularly listened to, engaged with, and co-developed several behavioral health resources. These engagements have informed behavioral health activities, policy, and communications to better reach and serve children, youth, parents, and caregivers. A few examples of ACF’s engagements include: As part of this commitment, we recently launched our ACF and Behavioral Health webpage to expand access to resources for communities, parents and caregivers, teens and young adults, tribes, grantees, and service providers. Included online are resources to support the prevention, treatment, and recovery from behavioral health conditions; recognize, manage, and support children’s mental health needs; and address substance use during pregnancy. We have also dedicated a webpage specifically for early childhood behavioral health resources. I encourage you to share these resources within your networks and to note that near the top center of the webpage is a tool to translate the information into a variety of languages; ACF is committed to promoting language access. In the coming months, we will be making additional changes and adding new resources, including several Spanish language resources. We are working with partners across the federal government to increase access to culturally and linguistically relevant support for youth and families served by ACF programs. A few examples of ACF’s efforts to improve access to culturally and linguistically relevant resources include: ACF has been a partner in launching the first-ever HHS Children and Youth Resilience Challenge , which is investing in innovative, community-led solutions to advance the mental health of children and youth. Later this month, ACF will be announcing finalists for Phase 1 of the Challenge to support the mental health of children. Last year, we partnered with Instituto del Desarrollo de la Juventud and the U.S. Census Bureau to develop new solutions to enhance children’s resilience to adversity in Puerto Rico (PDF). The collaborative process led by The Opportunity Project brought together youth, tech, academic, and community partners to address the challenge by building public-facing products informed by open federal data. ACF values and welcomes your partnership to support behavioral health of children, youth, and families. We are in this work together. With thanks for your leadership, January Contreras Assistant Secretary Metadata-only record linking to the original dataset. Open original dataset below.

To: State, territorial, tribal, and local policymakers and administrators of agencies and programs focused on child, youth, and family health and well-being Dear Colleagues, Thank you for your work to support children, youth, and families. Populations served by Administration for Children and Families (ACF)-funded programs — including victims of trafficking or violence, those who are unhoused, and young people and families involved in the child welfare system — are often at particularly high risk for substance use and overdose. A variety of efforts are underway at the federal, state, and local levels to reduce overdose deaths. These efforts focus on stopping drugs from entering communities, providing life-saving resources, and preventing drug use before it starts. Initiatives across the country are already saving lives: the overdose death rate has declined over the past year but remains too high at 32.6 per 100,000 individuals. Fentanyl, a powerful synthetic opioid, raises the risk of overdose deaths because even a tiny amount can be deadly. Young people are particularly at risk for fentanyl exposure, driven in part by widespread availability of counterfeit pills containing fentanyl that are marketed to youth through social media. While overdose deaths among teens have recently begun to decline, there were 6,696 deaths among adolescents and young adults in 2022 (the latest year with data available)[1], making unintentional drug overdose the second leading cause of death for youth ages 15—19 and the first leading cause of death among young adults ages 20-24.[2] Often these deaths happen with others nearby and can be prevented when opioid overdose reversal medications, like naloxone, are administered in time. CDC’s State Unintentional Drug Overdose Reporting System dashboard shows that in all 30 jurisdictions with available data, 64.7% of drug overdose deaths had at least one potential opportunity for intervention.[3] Naloxone rapidly reverses an overdose and should be given to any person who shows signs of an opioid overdose or when an overdose is suspected. It can be given as a nasal spray. Studies show that naloxone administration reduces death rates and does not cause harm if used on a person who is not overdosing on opioids. States have different policies and regulations regarding naloxone distribution and administration. Forty-nine states and the District of Columbia have Good Samaritan laws protecting bystanders who aid at the scene of an overdose.[4] ACF grant recipients and partners can play a critical role in reducing overdose deaths by taking the following actions: Stop Overdose Now (U.S. Centers for Disease Control and Prevention) Integrating Harm Reduction Strategies into Services and Supports for Young Adults Experiencing Homelessness (PDF) (ACF) Thank you for your dedication and partnership. If you have any questions, please contact your local public health department or state behavioral health agency. Together, we can meaningfully reduce overdose deaths in every community. /s/ Meg Sullivan Principal Deputy Assistant Secretary [1] Products - Data Briefs - Number 491 - March 2024 [2] WISQARS Leading Causes of Death Visualization Tool [3] SUDORS Dashboard: Fatal Drug Overdose Data | Overdose Prevention | CDC [4] Based on 2024 report from the Legislative Analysis and Public Policy Association (PDF). Note that the state of Kansas adopted protections as well following the publication of this report. Metadata-only record linking to the original dataset. Open original dataset below.

As our country responds to and recovers from the pandemic, mental health and wellness have emerged as ongoing concerns. Parents and child care providers alike must be equipped to support their own mental health and wellness needs in addition to those of the children they love and care for. The entire early care and education workforce—regardless of setting and including those who provide out-of-school time and summer enrichment—must also have the resources and supports they need. A collection of resources to support the mental health and wellness of children, their families, and the workforce are listed below. These resources are organized into two categories: (1) materials designed for families and (2) materials designed for child care providers. Some resources may benefit both audiences. According to the Centers for Disease Control and Prevention, “Mental health includes our emotional, psychological, and social well-being. It affects how we think, feel, and act. It also helps determine how we handle stress, relate to others, and make choices. Mental health is important at every stage of life, from childhood and adolescence through adulthood" (2021). Centers for Disease Control and Prevention. (2021). About mental health. U.S. Department of Health and Human Services. A Resource Guide for Developing Integrated Strategies to Support the Social and Emotional Wellness of Children This Resource Guide highlights promising strategies and provides information about how some Child Care and Development Fund grantees have already leveraged partnerships and funding to support implementation success. Asian American, Native Hawaiian, and Pacific Islander Self-Care and Healing This roundtable focuses on the importance of self-care and family care. The discussion asks three questions: 1) Why are self-care and healing so important yet so difficult? 2) What are culturally responsive strategies to support well-being? 3) What are key approaches for self-care during this period of the COVID pandemic and increasing anti-Asian hate crimes and incidents? Being Brave: Grounding Ourselves in Our Ancestors' Resilience The recording of Being Brave: Grounding Ourselves in Our Ancestors' Resilience is a workshop that will guide you through some grounding techniques that tap into the strength and resilience of American Indian / Alaska Native communities. You'll work through exercises that you can adapt for any age to activate mindfulness into your programming. Be prepared to write and reflect, so bring a pen/pencil and something to write on. CDC: Helping Children Cope with Emergencies A web page addressing the signs of distress in children of different ages, and strategies to support these children. Available in Spanish Early Childhood Learning and Knowledge Center: Children’s Response to Crises and Tragic Events This tip sheet can enhance adults' understanding of children’s responses to a crisis. Early Head Start National Resource Center@ Zero To Three: Pathways to Prevention (PDF) A comprehensive guide for supporting infant and toddler mental health, that includes definitions, strategies, and challenges. Healthy Ways to Handle Life’s Stressors This short article by the American Psychological Association has 12 evidence-based tools proven to tackle stress. Native Spirituality: Creating Time and Space for Trauma Recovery and Wellness Native people define spirituality as central to their culture and traditions. Spirituality, culture, and healing ceremonies not only reinforce the core beliefs of tribal life but also restore personal balance when life stressors threaten to overwhelm. The COVID-19 pandemic added enormous anxiety and fear into many tribal communities. This discussion with Native spiritual and cultural leaders provides an opportunity to applaud the bravery of our health care providers and community members, and to discuss how Native spirituality can support our ab

A presentation on the use of Washoe County's SAFE-Family Connections intervention with families with children determined to be unsafe, part of the Nevada Initiative to Reduce Long-Term Foster Care / Permanency Innovations Initiative (PII). Metadata-only record linking to the original dataset. Open original dataset below.

Revised (initially published October 25, 2024) To: State, territorial, tribal, and local policymakers and administrators of systems, agencies, and programs responsible for children, youth, and family health and well-being Dear Colleagues, Quality and accessible health care is critical to support the children, families, and communities we serve. We know that state Medicaid and the Children’s Health Insurance Program (CHIP) agencies are essential partners in this important work. I am excited to share that the Centers for Medicare & Medicaid (CMS) recently released new guidance regarding coverage requirements for eligible children and youth enrolled in Medicaid and CHIP. The new guidance, in the form of a State Health Official letter entitled, Best Practices for Adhering to Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Requirements,[1] is intended to support states as they work to strengthen their implementation of EPSDT requirements to help ensure improved health outcomes for children and youth enrolled in Medicaid and CHIP. Nearly 80 million individuals are enrolled in Medicaid and CHIP, including nearly half of all children and youth in the United States. Many of the individuals served through the Administration for Children and Families (ACF) funded programs are enrolled or eligible for Medicaid or CHIP. Medicaid and CHIP are jointly financed by the federal government and states, and they are administered by states within broad federal guidelines. Though each state may take a tailored approach, EPSDT requires that comprehensive and preventative health care services (medical, dental, mental health, and specialty services) for children under age 21 who are enrolled in Medicaid or CHIP be provided. There are many services that states can elect to include as part of the EPSDT benefit to address risk factors for adverse experiences such as child welfare involvement and youth homelessness. These risk factors often directly intersect with the work of ACF grantees. A few examples included in the new guidance are highlighted below: Care coordination or care management, depending on a child’s needs States have integrated primary care settings, Certified Community Behavioral Health Centers, or other settings where the range of services includes coverage for services that support children and their parents, family members, and caregivers. Some parent-facing services can be paid for through the child’s Medicaid benefit if the service is provided for the direct benefit of the child. Non-Emergency Medical Transportation (NEMT) While doing so is not required under EPSDT, states also may develop approaches to cover services in addition to those covered under section 1905(a), with the goal of maintaining children with disabilities or other complex health needs in integrated home and community-based settings or helping them return to their community.[3] The CMS guidance contains specifics about how states might use other authorities to cover services beyond what is required under EPSDT. ACF grantees can be valuable thought partners to their Medicaid counterparts in thinking through the advantages of specific Medicaid services across systems. If your organization has the capacity to do so, we strongly encourage you to work closely with your state Medicaid and CHIP agencies to help strengthen access to care for children and youth. For ACF grantees eager to engage in these conversations, I suggest you take the following actions: We hope that you find this guidance helpful in supporting children, youth, and their families in receiving the health coverage services they need and may be entitled to under federal Medicaid law. Thank you for your dedication and partnership. If you have any questions, please contact your state Medicaid agency. Together, we can ensure that all children and youth have the health care, services, and supports necessary to thrive. /s/ Meg Sullivan Principal Deputy Assistant Secretary [1] SH

The Administration for Children and Families (ACF) is committed to promoting the economic and social well-being of children, youth, families, individuals, and communities. As part of our work, we support the HHS Overdose Prevention Strategy (OPS) to ensure individuals with a substance use disorder (SUD) are supported and connected to substance use treatment, human services, and other necessary resources. Harm reduction , an evidence-based approach critical to engaging with people who use drugs and equipping them with life-saving tools and information, is one of the four priority areas in the agency’s overdose prevention strategy. This brief provides information and resources about harm reduction services for young adults experiencing homelessness. Metadata-only record linking to the original dataset. Open original dataset below.

Location: Statewide Home Visiting Program Selected: Paraprofessional home visiting model Home Visiting Target Population: Families with multiple, malleable risks for maltreatment of newborns Project Overview: The State of Hawaii's Department of Health, working collaboratively with State and community-level agencies and councils, community-based organizations, academic institutions and families, will develop and implement a detailed plan to enhance the Healthy Start Program, the State's paraprofessional home visiting model that was the prototype for Healthy Families America. The project, Enhancing Hawaii's Statewide Home Visiting Program to Improve Fidelity and Effectiveness, has a project goal to assure that children in the most vulnerable families receive the most appropriate, most effective, and least intrusive home visiting services to promote healthy family functioning, prevent child maltreatment, and promote child health and development. Through the project, Hawaii will address five existing challenges related to fidelity, effectiveness and sustainability: 1) improve the implementation system to assure staff competence; 2) build capacity for continuous quality improvement; 3) refining the selection of families who receive home visiting; 4) enhance Hawaii's Healthy Start program model; and 5) resolve incongruities between funding stream requirements and the home visiting model. The project builds on the longstanding history of the Healthy Start program in Hawaii. The planned evaluation involves process, outcome, and economic cost analyses. Metadata-only record linking to the original dataset. Open original dataset below.

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