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NEA Letter to Vice President Biden on Reducing Gun Violence

January 4, 2013

Vice President Joe Biden
The White House
1600 Pennsylvania Avenue NW
Washington, DC 20501

Dear Vice President Biden:

Thank you for the opportunity to offer policy ideas related to the Administration’s effort to respond to the tragic school shooting in Newtown, Connecticut. Sadly, public education employees across the country have been grappling with school safety and coping with the aftermath of school shootings for many years. From Paducah, Kentucky in 1997 to Newtown just last month, every member of the National Education Association grieves when students and educators are victims of horrific violence. We are a family, so we grieve for the parents who have lost children, and we grieve for the families of the educators who time and time again put themselves between bullets and their students. These memories never go away. They can be harkened back by a sound or a smell or a specific date on a calendar. Now, more than ever, we stand ready to speak out and mobilize to protect our students and communities from further pain and needless violence.

I also believe that vast numbers of Americans stand ready for this debate as well. The news has been dominated by a renewed conversation about gun violence prevention, due perhaps to the overwhelming public outrage about the mass killing of such young children (ages 6 and 7), as well as the fact that the shooter was yet again someone clearly mentally ill. This wasn’t a circumstance where there was carelessness on the part of the school or negligence or a lack of security systems and procedures. Sadly, school districts have had safety procedures in place due to the large number of mass shootings using weapons with high-capacity magazines.1

This letter is not intended to address every aspect of our culture or society that might contribute to gun-related deaths (such as regulation of video games and movies), but rather is intended to provide our overall guidance about some immediate federal policy solutions in the areas of gun violence prevention, mental health, and school safety and support that have the support of educators.

We strongly believe that a multi-pronged approach is needed and is urgent. As the President himself said, there is “no single piece of legislation that will solve this problem.” We agree. If Congress were to pass legislation requiring background checks for every gun purchase, the nation must still have enough mental health services and professionals making diagnoses about individuals (and states submitting those records to the National Instant Criminal Background Check System (NICS)) to make the background check system reliable and effective. Furthermore, since schools are often the places in which some of the first signs of mental health issues can be spotted and diagnosed, it is all the more important that there are adequate numbers of qualified school personnel to make these diagnoses and/or spot warning signs of potentially problematic or violent behavior. Complicating matters, there is a huge shortage of these types of professionals in our public education system (from pre-k through higher education), which impedes the ability of school personnel to ensure a learning environment that is safe, secure, respectful, and nurturing. We must focus on all three areas: common sense gun violence prevention, greater emphasis on mental health, and school safety and student support.

Recommendations for Immediate Federal Action

Gun Policy

These are commonsense measures that will rally broad community support, especially when coupled with a greater focus on mental health and safe, secure, and supportive school environments.

As for the recommendation made by some to place armed guards--including “volunteers” or “posse’s” from the community--in or around every school, that is a far cry from calling for more school resource officers in communities who need and want them. School resource officers are trained not only in the appropriate use of firearms in high-stress, rapid-response situations, but they also become integrated members of the school staff who also receive additional training in counseling and working in a school setting. We do not object to increased funding for school resource officers, but would like to see more emphasis placed upon school resource officers AND educators being trained together in bullying, school safety, cultural competence, positive behavioral supports, and appropriate classroom management.2 We are also mindful that school districts should not simply use the presence of a school resource officer to improperly substitute criminal justice-oriented treatment of students rather than appropriate implementation of effective school conduct codes and discipline policies. Furthermore, the decision about whether to place an SRO in a school building should be part of an overall community-developed plan to prevent violence against our children and ensure access to counseling, social services, and mental health services for any and all who need them. Sadly, the presence of a School Resource Officer alone—without any other policy solution being employed as well—will be entirely insufficient to prevent another Newtown. There was, for example, a school resource officer at Columbine High School and that didn’t prevent or stop the tragedy there. We cannot solve this problem with simplistic solutions.

Options for Longer Range Federal Action on Gun Violence Prevention Policy

Assuming the gun restrictions mentioned above can be passed quickly, the President or Vice President should host a major national summit about gun policy, inviting state and local lawmakers, law enforcement and military personnel, gun manufacturers and/or retailers, mental health providers, educators, parents, students, as well as high level staff from the Departments of Homeland Security, HHS, Education, and Justice. After the summit, the President could include items below in a budget proposal:

Mental Health Policy

  • Issue regulations related to mental health provisions of the ACA that expand access to mental health services.

The Affordable Care Act includes specific provisions that impact mental health care services including the establishment of home health care for individuals with mental illness and new educational training grants for the mental health workforce. The U. S. lacks both institutional and community-based mental health providers for children and adults, alike. Budget pressures at the federal and state levels have worsened this situation. We lack enough inpatient mental health beds to treat those who suffer. State and local governments continue to report shortages of key outpatient staff, especially psychiatrists. Regulations would move the implementation of the ACA’s mental health expansion.

The federal government has given states the authority to define the essential health benefits that will be offered on the state health care exchanges. States have an opportunity to ensure that their residents have access to comprehensive in-patient, out-patient, community-based services and prescription drug related mental health services.

State and local government self-insured employee group health plans have been able to opt-out of complying with two federal laws that require that health plan coverage for mental health and substance use disorders be on par with covered medical and surgical benefits. The federal laws are the Mental Health Parity Act of 1996 (P.L. 104-204) and the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Act of 2008 (P.L. 110-343). For the 2012 plan year, the opt-out provision has allowed almost 400 employers that sponsor state, county, municipal, school district, and other localities to ignore compliance with the federal mental health parity laws. This has resulted in reduced mental health and substance use disorder benefits for millions of teachers, education support professionals, police officers, firefighters, emergency medical service professionals and other first responders, and their families. These brave public service employees have a lower coverage of mental health benefits than the rest of Americans in group health plans and this must change.

The Affordable Care Act included funding for school-based health centers. That’s important, but not all school-based health centers have mental health providers. Additional funding should be provided to ensure that more mental health professionals trained to work in school settings are available. Outreach to parents and facilitating student engagement are among the other components necessary to more fully integrate mental health services into school settings. Last year, the House of Representatives voted to repeal ACA-related mandatory funding for the construction of school-based school health centers. These centers can be an important component of strengthening students’ mental health. Moving forward, the House must refrain from undermining school health initiatives.

The mental health parity laws prohibit large group health plans from raising copayments or limiting physician visits for mental health care. The parity requirements do not apply to small group plans with fewer than 50 employees. The Affordable Care Act (ACA) did not correct the small group health plan exemption. In fact, the ACA defines small employer to mean an employer who employed an average of 1, but not more than 100 employees. The parity exemption could actually apply to a wider range of employers. All health plans should provide coverage for mental health and substance use disorders at the same level as they cover medical and surgical benefits.

The Department of Health and Human Services needs to issue final rules enabling states to enforce the requirements of the Mental Health Parity and Addiction Act of 2008.

Greater federal oversight is required to ensure that group health plans and group insurance plans are in compliance with the requirements of the Mental Health Parity Act and the Mental Health Parity and Addiction Equity Act. Many group health plans are out of compliance with the parity law.

According to some analyses, fewer U.S. medical students have been choosing to specialize in psychiatry in recent years. The National Education Association calls on the federal government to develop and implement loan-relief programs for medical students who specialize in psychiatry and clinical psychology and practice in less affluent and less urban areas. In return, providers could be required to accept Medicaid patients for a given period of time.

Medicaid’s mandatory Early and Periodic Screening, Diagnosis and Treatment (EPSDT) benefit requires states to furnish all medically necessary services through a periodic screening for any Medicaid-eligible child under age 21. Under EPSTD the needs of children and youth with mental illness, are supposed to be identified, evaluated, and treated. However, many states have been found to have inadequate screening tools to identify mental health issues and have not provided adequate community-based services that would allow children with SED to remain with their families rather than being placed in a residential facility.

NEA would support a commission to expand the scope of the Protect Our Kids Act to focus on all child deaths. The issues are all complicated and worthy of on-going analysis and attention -- transcending typical congressional committee jurisdiction.

There is tremendous variation in Medicaid eligibility levels, mental health services that are covered, the limits placed on those services and coordination and management of services. These and other issues leave many people without mental health benefits or without access to services. States should expand Medicaid eligibility up to 100% of the Federal poverty line.

Medicaid provider reimbursement rates tend to be lower than both Medicare and private market levels and this impacts the number of mental health providers who are willing to participate in Medicaid. States must make a commitment to funding and improving access to mental health services at the community level.

The Medicaid expansion under ACA for people with incomes up to 138% of the federal poverty level is optional for each state. By expanding Medicaid there will be an expansion of insurance. These expansions will result in new populations accessing behavioral health services through Medicaid.

Safe, Secure Schools and Student Supports

School Facilities: Ensure resources available and technical assistance from emergency preparedness experts to retro-fit or make school entrances and facilities safer.

School Personnel: More resources for school counselors, social workers, nurses, and school psychologists, as well as training for school personnel in not just school safety, but in diagnostic training to spot warning signs for mental health issues and/or potential for students to engage in high-risk or anti-social behavior.

School Resource Officers: Request funding for this program, but condition receipt of money upon several factors designed to ensure community support, appropriate training for the officers and school personnel, and protect against inappropriate uses of the criminal justice system in place of more effective classroom management and school discipline.

Student Supports: In addition to more school personnel to help address the emotional and mental health needs of students, students also need access to programs themselves that will teach them conflict management, an appreciation of diversity, and strategies for being a part of a school community

Specific policy recommendations:

Background: Adequate staffing by a range of health, mental health, social services, and counseling professionals ensures that students in need will receive the attention and services they need. It also allows these professionals to work collaboratively between school, students’ homes, and the broader community to assess students’ needs, provide early intervention services, and coordinate treatment referrals.

The National Education Association has supported—and continues to support—the Increased Student Achievement Through Increased Student Support Act. If enacted, it would increase the recruitment and retention of school counselors, school social workers, and school psychologists by low-income local educational agencies. We urge the House Committee on Education and Workforce to move this bill forward.

To help prevent future tragedies and to help the school community heal after a crisis, NEA also supports employee assistance programs for school staff and crisis prevention and response plans (like the plan outlined in NEA HIN’s Crisis Guide) for the entire school community.

We have in the past supported funding for school resource officers, but, as stated above, we recommend more emphasis placed upon school resource officers AND educators being trained together about bullying, school safety, cultural competence, positive behavioral supports, and appropriate classroom management.3 We would like to reiterate our view that school districts should not simply use the presence of a school resource officer to improperly substitute criminal justice-oriented treatment of students rather than appropriate implementation of effective school conduct codes and discipline policies. The decision about whether to place an SRO—who is from the community and wanted by the community--in a school building should be part of an overall community-developed plan to prevent violence against our children and ensure access to counseling and mental health services for any and all who need them. Again, the presence of a School Resource Officer alone—without any other policy solution being employed as well—will be entirely insufficient to prevent another Newtown. We must respond in a multi-faceted way.

States across the country have been eliminating inpatient psychiatric hospital beds, community-based care such as adult day treatment centers, outpatient counseling, medications, and family support services for people with mental health issues. This has resulted in law enforcement officers, educators and others have ending up on the "front line" of the U.S. mental health system. While crisis intervention programs for police, educators and others are crucial, we must find money for states and local governments to continue these necessary services for those with mental illness. In addition, patients must have reasonable access to providers who accept their insurance and who are accessible through public transportation.

Suggestions for Local School Districts

Medicaid’s mandatory Early and Periodic Screening, Diagnosis and Treatment (EPSDT) benefit requires states to furnish all medically necessary services through a periodic screening for any Medicaid-eligible child under age 21. Under EPSTD the needs of children and youth with mental illness, are supposed to be identified, evaluated, and treated. However, many states have been found to have inadequate screening tools to identify mental health issues and have not provided adequate community-based services that would allow children with SED to remain with their families rather than being placed in a residential facility.

The Department of Health and Human Services should continue to strongly encourage state and local governments and school districts to devise plans for how they intend to improve their enrollment rates. There are 4.4 million children (up to age 21) who are currently eligible for but not enrolled in Medicaid. If more families knew their children were eligible for Medicaid, they might be less worried about the cost of mental health services and more apt to seek services for their children. The Department of Health and Human Services should create a Blue Ribbon Award program to publicly recognize and honor states that achieve 100% enrollment, as well as states that have the greatest increase in enrollment.

Finally, I would be remiss if I failed to mention that NEA’s school safety efforts go well beyond policy proposals. We have professional development for our members in school safety, bullying, bias/harassment, and cultural competence. We are running a Bullyfree: It Starts with Me campaign to ensure educators have the tools they need to identify and prevent bullying, which is frequently a source of isolation and depression for students and which can be a precursor to violent behavior. We have a world-class school crisis guide and several state affiliates have crisis response teams that are frequently deployed to help in tragic circumstances. In fact, our Ohio Education Association crisis response team was just on the ground in Newtown counseling families and educators and helping to manage the immediate aftermath of the crisis. The team is preparing to return to Newtown to provide more training to educators about some of the issues educators must look for as students return to school and re-engage in school life. Our state affiliate, the Connecticut Education Association (CEA) loaned building space and other infrastructure to our sisters and brothers of the American Federation of Teachers, whose members taught at Sandy Hook Elementary School, to use as a staging area for the crisis management. CEA has also started a scholarship

NEA’s members and NEA’s Health Information Network staff and Board have worked closely with foundations and other partners to strengthen gun policy, increase school supports, and to provide greater access to mental health services, professional training for educators, greater security measures around public schools, and more. We will continue to work on all of these issues with the passion and dedication of our members — not just to prevent another Newtown, but to honor all the students and educators who have lost their lives or have been injured over the years.

Thank you again for the opportunity to provide ideas and input into the important discussions you will lead in the coming weeks. We have complete faith that your commitment to America’s children and to the safety of our communities will be as steadfast as it has been throughout your public service career. If you have questions, please do not hesitate to contact Kim Anderson (kanderson@nea.org) or Jennie Young (jyoung@nea.org).

Sincerely,

Dennis Van Roekel
President
National Education Association


 

[1] By far the worst school shootings in terms of deaths and injuries have been Paducah KY (1997), Jonesboro AR (1998), Springfield OR (1998), Littleton CO (Columbine — 1999), Santee CA (2001), Tuscon AZ (2002), Red Lake Indian Reservation MN (2005), Nickel Mines PA (2006), Blacksburg VA (VA Tech 2007), DeKalb IL (Northern Illinois Univ 2008), Huntsville AL (Univ of AL 2010), Chardon OH (2012), and now Newtown CT (2012). When the shooters have been students, press accounts gravitate toward two different phenomena in their lives: mental health issues (including anger management/revenge-oriented behavior), as well as access to and use of violent video games. In most if not all of these cases, the guns used by the student shooters were owned by someone else. When the shooters have been adults, issues of mental health have arisen, but so too have conversations about our nation’s gun laws. Link to the Brady Campaign’s 41-page listing of major school shootings or gun-related events: http://www.bradycampaign.org/xshare/pdf/school-shootings.pdf.

[2] See this ACLU report for cautions about the SRO program, “Hard Lessons: School Resource Officer Programs and School-Based Arrests in Three Connecticut Towns,” November 2008, http://www.aclu.org/pdfs/racialjustice/hardlessons_november2008.pdf.

[3] Ibid