A Silent But Burning Problem

COVID-19 has all but decimated the familiar routines of life and school for students and teachers across the country and subjected millions to the stresses of illness, lost jobs, and social isolation. On top of this, Oregon and 9 other Western states, thousands of students, their parents and teachers are reeling from yet another layer of trauma: wildfires.

In some of these school districts, children who had been chomping on the bit to reconnect with their friends in school have been informed that they will be stuck at home learning on a computer, for the indefinite future. And in some places, schools have been completely shut down, unable to conduct remote instruction or distribute subsidized meals.

For some families, it is even worse, as the flames have threatened their homes and their safety. While some eventually returned to find their homes intact, others have only found ash and memories burnt to a crisp. And still, others live with the burning question of what to do.

When you add these fires to the pandemic’s disruption of any sense of normalcy, this fire-driven experience has many experts wondering how much stress young children can safely manage. Being removed from school goes far beyond the academic slide; it is challenging many children’s grip on their view of the world devoid of trauma.

“When it comes to trauma, the old saying, ‘What doesn’t kill you makes you stronger,’ isn’t true,” said Robin Gurwitch, a professor of psychology at Duke University who studies the effect of trauma on children. “It’s a cumulative impact.” The more trauma people experience, “the more at-risk they are for health and mental impacts.”

And yet for some children, the problem is further compounded by being cut off from sorely needed therapy, be it speech, language, or mental health. In those states impacted by the wildfires, local therapists are facing the same challenges as the children to whom they provide services, such as being driven from their homes and unable to conduct their lives in a normal fashion.

With so many therapists being unavailable, there aren’t enough therapists to go around. So from whom can these children hope to receive therapy?

Well, that would seem to be a no-brainer. Just pull in therapists from other states to compensate for the shortfall. They don’t need to travel to these fire-ravaged states. Let them deliver remote therapy. What could be simpler?

Nothing could be simpler but for one small detail. Therapists trained in remote therapy, fully qualified and credentialed are unable to deliver therapy to these needy children because while they are properly licensed in their states, they lack licensure in the state where they need to provide the services.

Obtaining that licensing in another state can take weeks or even months. And these children need to be served today! Every day of lost services further compounds the problem and trauma that these children face.

Drop the Regulations and Help the Children

So what is the solution? There seems to be no way around it. Either create reciprocity between states or sweep away these state licensing requirements and turn instead to a national standard.

This suggestion is not as novel as it may seem. Since the start of the COVID-19 Pandemic, various states have either rescinded, revised, or waived regulations in response to COVID-19, demonstrating that change is not only possible but can happen swiftly.

Take telehealth as an example. Once a minefield with regulations that varied from state to state, telehealth quickly became part of the new normal. The elimination of state-by-state variability has supported a more consistent approach to delivering telehealth care across many states.

What’s more, The Uniform Emergency Volunteer Health Practitioner Act (UEVHPA) is model legislation developed in 2006 by the Uniform Law Commission. The legislation allows any state that has enacted it to recognize out-of-state licenses for a variety of health practitioners during a state of a declared emergency. As of 2020, 18 states and the District of Columbia have enacted UEVHPA legislation.

And recently the Center for Medicare and Medicaid Services (CMS) issued a national emergency order to pay doctors for services rendered to patients in states in which they are not licensed to practice, so long as they hold an equivalent license in another state. This needs to be duplicated in the therapy realm as well.

An even quicker path to cross-state provision of medical care is the full waiver of state-specific licensure requirements. We have already seen this approach by CMS, which, for purposes of Medicare and Medicaid providers, temporarily waives requirements that out-of-state providers be licensed in the state where they are providing services, when they are licensed in another state.

We have all heard the infamous statement, “A crisis is a terrible thing to waste.” Important among the useful discoveries that many public officials have hit upon in managing the COVID-19 crisis has been the dissolution of the regulatory obstacles that have piled up over time, which cripple our system’s ability to respond to unexpected emergencies.

It is time to eliminate all regulatory obstacles that stand in the way of the children of Oregon and the other Western states that are being devastated by the wildfires from receiving the therapeutic services they so desperately need.