1. Contributors Physical abuse Sexual abuse Neglect Domestic violence Poverty Homelessness Medical trauma Natural disasters School violence/bullying Refugee and war zone trauma Leading to Mental health issues Substance abuse Chronic health conditions Overeating disorders Criminal justice involvement Physical symptoms Emotional and psychological symptoms

2. What we know... Medical care for opioid-addicted newborn $27,000-$352,000 30-day outpatient treatment program for women $45.0 million * [* Does not include personnel such as counselors, caseworkers, healthcare providers] 2011 public children services expenditures $846,029,363 Ohio residents receiving nutritional assistance between January 2005 and January 2012 71% increase Addressing the Needs of Ohio’s Drug Addicted Women, Ohio Women’s Network PCSAO Fact Book: 11 th Edition, 2013-2014, Public Children Services Association of Ohio

3. Women admitted for drug treatment services 2007 24,262 Approximate number of women in criminal justice system in 2010 4,000 Persons Served by Ohio’s Mental Health System in SFY 2013 Adults with mental illness 244,118 With serious mental illness (Ohio definition) 109,034 Children with emotional disturbances 137,740 With serious emotional disturbances (Ohio definition) 57,977 OhioMHAS Regional Psychiatric Hospital average daily census 1,000 Admits per year 7,000+ Addressing the Needs of Ohio’s Drug Addicted Women, Ohio Women’s Network Persons Served, OhioMHAS, Liz Gitter OhioMHAS RPH census – NCTIC TA Application, Mark Hurst

4. The number of children insured by Medicaid INCREASED 17% between SFY2005 and SFY2011 Children using behavioral healthcare represented ten percent of the overall Medicaid child population, but an estimated thirty eight percent total spending for children in Medicaid Children in foster care and those on SSI/disability together represented one-third of the Medicaid child population using behavioral health care, but 56 percent of total behavioral health service cost Almost 50 percent of children in Medicaid who were prescribed psychotropic medications received no identifiable accompanying behavioral health treatment Identifying Opportunities to Improve Children’s Behavioral Health Care, Center for Health Care Strategies, December 2013

5. Ohio population under age 18 2,730,751 Ohio children living in poverty in 2012 619,354 Ohio teens births age 15-19 in 2011, 13,505 Ohio’s teen birth rate 33.5/1,000 National teen birth rate 34.3/1,000 January 1, 2012 children in custody 12,804 Grandparents raising grandchildren 93,831 Ohio youth, 0-21, receiving treatment services from the Community Mental Health System in 2011 148,360 2011, new reports of child abuse and neglect 100,804 Physical abuse 27,542 Neglect 29,553 Sexual abuse 10,581 Emotional maltreatment 1,804 Multiple allegations abuse/neglect 12,128 Family in need of services/dependency/other 19,196 PCSAO Fact Book: 11 th Edition, 2013-2014, Public Children Services Association of Ohio

6. What we know... ODYS male population is on mental health caseload 52 percent Average age of youth in ODYS facilities 17 yrs 7 mos Almost all of the females are on the mental health caseload Many of the youth have multiple disorders that began in childhood and will last into adulthood Youth with a diagnosed substance abuse disorder 75 percent In need of special education 61 percent Medicaid eligible youth at arrival 65 percent A significant number of youth with trauma histories come into contact with the juvenile justice system and ODYS These youth typically also have known severe emotional disturbances and histories of multiple system involvement January 2014 Fact Sheet, Ohio Department of Youth Services

7. What we know... Ohio 2011 infant mortality rate 7.87/1,000 live births National rate of 6.05/1,000 live births Black infant mortality rate was 15.8/1,000 live births White infant mortality rate of 6.3/1,000 live births In 2011, the last year for which national statistics are availableOhio ranked #47 Non-medical contributors: Poverty Low education levels Under-resourced neighborhoods Poor nutrition Racism Ohio’s Commitment to Prevent Infant Mortality, Ohio Department of Health, 2013

8. What we know... In central Ohio, it is estimated that 88% of human trafficking involves sex slavery; 75% are female; and, 84% are American born citizens 91% of girls trafficked experienced some form of abuse in the home 77% trafficked as a young girl continue into adult prostitution 77 % had been involved with county children services 64% living in home with one or both parents abusing drugs (*) 2,500 Ohio schools were not in compliance with the requirements of state law regarding safety and floor plans on February 27, 2012; 725 never filed plans at all and 1,813 had failed to update their plans. Also on this day, six students were shot in the Chardon High School cafeteria; three of the students died. (**) Recommendations to Governor Kasich, June 2012, Ohio Human Trafficking Task Force School Safety Task Force: Report and Recommendations, Ohio Attorney General, Mike DeWine

9. What we know... During state fiscal year 2012, 2.9 million visits to food pantries were made by children and more than 1.2 million visits to food pantries were made by those older than 60 years of age. Ohio is 11th in the nation for high food insecurity rates, with 15.5% of Ohioans considered food insecure in 2011. Ohio’s food insecurity rate is higher than nearly all surrounding states as well as the U.S. average. 31.8% of Ohioans were at or below 200% FPL in 2012. Ohio’s unemployment rate for November 2013 was 7.4% compared to 6.8% in November 2012. Food insecurity among children may result in: More frequent nurses visits at school Higher rates of depression and anxiety Higher rates of diabetes and other chronic conditions Higher rates of internalized behavior problems Increased likelihood of needing to repeat a grade at school Lower math scores More likely to be at developmental risk More likely to have colds as preschool children More likely to have iron deficiency anemia as infants or toddlers Hunger in Ohio, Ohio Association of Foodbanks and Promedica Nord, M. (2009). Food Insecurity in Households with Children: Prevalence, Severity, and Household Characteristics. Economic Research Service, United States Department of Agriculture. Ohio Labor Market Information, OhioMeansJobs.com

10. What we know... According to the Attorney General’s Office, in 2012, law enforcement responded to 68,277 domestic violence calls that involved 56,146 reported victims; 41,053 arrests were made for domestic violence offenses; there were 38 victim fatalities. Barbara Warner Committee on Workplace Domestic Violence -2013 Report, Ohio Department of Health Ohio Domestic Violence Statistics, 2012, Ohio Domestic Violence Network