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

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

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.

The Children at Risk (CAR) Program was a comprehensive, neighborhood-based strategy for preventing drug use, delinquency, and other problem behaviors among high-risk youth living in severely distressed neighborhoods. The goal of this research project was to evaluate the long-term impact of the CAR program using experimental and quasi-experimental group comparisons. Experimental comparisons of the treatment and control groups selected within target neighborhoods examined the impact of CAR services on individual youths and their families. These services included intensive case management, family services, mentoring, and incentives. Quasi-experimental comparisons were needed in each city because control group youths in the CAR sites were exposed to the effects of neighborhood interventions, such as enhanced community policing and enforcement activities and some expanded court services, and may have taken part in some of the recreational activities after school. CAR programs in five cities -- Austin, TX, Bridgeport, CT, Memphis, TN, Seattle, WA, and Savannah, GA -- took part in this evaluation. In the CAR target areas, juveniles were identified by case managers who contacted schools and the courts to identify youths known to be at risk. Random assignment to the treatment or control group was made at the level of the family so that siblings would be assigned to the same group. A quasi-experimental group of juveniles who met the CAR eligibility risk requirements, but lived in other severely distressed neighborhoods, was selected during the second year of the evaluation in cities that continued intake of new CAR participants into the second year. In these comparison neighborhoods, youths eligible for the quasi-experimental sample were identified either by CAR staff, cooperating agencies, or the staff of the middle schools they attended. Baseline interviews with youths and caretakers were conducted between January 1993 and May 1994, during the month following recruitment. The end-of-program interviews were conducted approximately two years later, between December 1994 and May 1996. The follow-up interviews with youths were conducted one year after the program period ended, between December 1995 and May 1997. Once each year, records were collected from the police, courts, and schools. Part 1 provides demographic data on each youth, including age at intake, gender, ethnicity, relationship of caretaker to youth, and youth's risk factors for poor school performance, poor school behavior, family problems, or personal problems. Additional variables provide information on household size, including number and type of children in the household, and number and type of adults in the household. Part 2 provides data from all three youth interviews (baseline, end-of-program, and follow-up). Questions were asked about the youth's attitudes toward school and amount of homework, participation in various activities (school activities, team sports, clubs or groups, other organized activities, religious services, odd jobs or household chores), curfews and bedtimes, who assisted the youth with various tasks, attitudes about the future, seriousness of various problems the youth might have had over the past year and who he or she turned to for help, number of times the youth's household had moved, how long the youth had lived with the caretaker, various criminal activities in the neighborhood and the youth's concerns about victimization, opinions on various statements about the police, occasions of skipping school and why, if the youth thought he or she would be promoted to the next grade, would graduate from high school, or would go to college, knowledge of children engaging in various problem activities and if the youth was pressured to join them, and experiences with and attitudes toward consumption of cigarettes, alcohol, and various drugs. Three sections of the questionnaire were completed by the youths. Section A asked questions about the youth's

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