A few miles outside Athens, Ohio, on one of the Appalachian area’s hairpin roads, sits Bassett House: an unassuming building with a gravel parking lot, small basketball court, and secured doors. Wildflowers and woods dot the grounds. In the middle of the property stands a memorial rose garden planted by staff. There are currently about 20 rose bushes, each originally planted to represent one child lost to drugs. But Nancy Baur, clinical coordinator of Bassett House, one of southeastern Ohio’s only drug and rehabilitation centers for children ages 13-18, says some of those rose bushes now stand for more than one child.

Baur, who began her career as a special education teacher, saw the opioid epidemic hit southeastern Ohio around 2011 as she was completing her counselor training. “Something that was once secret or taboo was now out in the open. Everyone was doing drugs—vets, rural kids coming to college for the first time, and members of the LGBTQ community. In [counseling] sessions, everyone was talking about drug use,” Baur said. In 2012, Baur joined the staff of Bassett House, and during the past five years she says she has seen the average age of when someone first tried an illegal substance drop to 8 to 11 years old.

Children and teens are coming into contact with drugs earlier and more frequently, and as a result, addictive tendencies are developing in ever-younger populations. The National Survey on Drug Use and Health (NSDUH) performed by the Substance Abuse and Mental Health Services Administration (SAMHSA) claimed: “Slightly more than 2.3 million adolescents aged 12 to 17 in 2014 were current users of illicit drugs, which represents 9.4 percent of adolescents.” In 2015, the National Institute on Drug Abuse for Teens said that more than 4,200 drug-related U.S. deaths were children and young adults age 15-24.

While depictions of overdosing adults saturate current media coverage, the rising use of drugs among children and teens is rarely discussed. Less, not more, is being done to curb the drug epidemic in Ohio, where changes in treatment services, thanks to a new set of rules called the Behavioral Health Redesign (BHR), which began August 1, alarm drug treatment providers like Bassett House with new fears of cuts to spending and budgets.

For the past three years, under Republican Gov. John Kasich, Ohio has been working on the BHR. In a statement from the Ohio Department of Medicaid, policy designers claim the BHR will “bring the behavioral health codes and practices up to National Correct Coding Initiative (NCCI) standards.” If you are a patient receiving medical treatment, each service that is provided to you has a unique identifying number attached to it. When you or your insurance company is billed, these numbers establish the amount owed. According to the statement about the BHR, changing the way behavioral health treatments and services are coded—or rather, identified and ultimately billed—will result in a “wider array of services [becoming] available to be more fully reimbursed than under the current system.”

But even before the launch of the BHR, providers warned that, at facilities affected by the BHR, treatment options would become limited—and patients would suffer. In a June interview for WCMH-TV Columbus, Lori Criss with the Ohio Council of Behavioral Health and Family Services Providers told reporters that “if the redesign goes live July 1, we will see a significant drop in access and capacity for mental health and addiction services.” Facing mounting pressure, the redesign was delayed by one month to allow behavioral health facilities to continue upgrading their systems.

The BHR has hit treatment facilities such as Bassett House particularly hard. The majority of its client base pays for treatment through Medicaid, and more and more of its clients come directly from southeastern Ohio, an area noted for high levels of poverty and a region that originally benefited from Ohio’s Medicaid Expansion.

This is significant because under the BHR, the new coding and billing requirements for residential facilities lower the Medicaid billing cap. One provider who wished to remain anonymous told Rewire the drop for in-patient addiction treatment is from approximately $400 per day per client to $200, while in the “Medicaid Behavioral Health State Plan Services Reimbursement Manual,” published on June 16, 2017, the per diem rate for “Clinically Managed Residential Withdrawal Management” shows a rate of around $250 under the new BHR. This drop will result in a substantial loss of the funding that keeps drug treatment providers fully staffed.

In anticipation of the BHR rollout, Bassett House was forced to reduce their staff. In the interest of cutting costs, they also moved from being a co-ed facility capable of caring for 26 boys and girls to a boys-only facility with a client maximum of 18. This switch significantly affects Ohio families. With already limited treatment options in this part of Appalachia, young girls in need of residential treatment must now travel elsewhere. One of the closest locations where girls are still welcomed is Talbert House in Cincinnati—about a three-hour drive from Athens. That drive could be insurmountable for families: a barrier to getting a child placed at the center, or for family to visit.

Dorothy McIntosh Shuemake of Middletown, Ohio, knows the urgency of drug treatment for children and teens firsthand. Two years ago, her daughter, Alison Shuemake, died from a heroin overdose at age 18. “For at least the first six months after Alison’s death, almost every single day someone would tell me about their loved one who had also died from a drug overdose or was struggling with [Substance Use Disorder] or was in treatment or recovery,” Shuemake said.

Ohio deaths related to opioids, which include heroin, synthetic drugs like fentanyl, and prescribed medications such as oxycodone, jumped 775 percent from 2003-2015. Losing funding and staff for residential drug treatment centers for Ohio children hurts an especially vulnerable population.

Alison was 17 when her family first sought treatment for her. Shuemake said, “We were only vaguely familiar with two in-patient treatment facilities in the area. Her counselor strongly recommended a treatment facility in Indianapolis, Indiana .… It was a two-hour trip when traffic was good.”

As of July 1, the date the BHR was supposed to take effect, Bassett House can’t afford to staff weekend family visits. Now parents must make an appointment to visit their children during standard business hours Monday-Friday, which is prohibitive for many working families. For other Appalachian families, it could be as simple as not having access to a telephone to make an appointment to arrange a visit. The weekend visits provided open-access for a set time on Saturdays and Sundays, and while visiting their children, parents also had the option of engaging in family counseling sessions.

Baur noted these counseling sessions fill a crucial role in a child’s recovery: “Children can feel supported by a network and the parents can get clear instruction from staff about what their child needs when they complete treatment and come home.” Without these visits or the ability to communicate a recovering child’s needs, families may struggle to create a stable network of support and education, a network that can significantly reduce the chances of relapse.

A similar hurdle facing families in recovery is the stigma and silence of drug use. Shuemake challenged this mindset when she stated unequivocally in her daughter’s obituary that Alison had died of a heroin overdose. Shuemake hoped that by doing so, it might help others struggling. In the nearly two years since Alison’s death, Shuemake has seen more people break their silence: “The stigma is still awfully powerful, but the more we talk, the less power it holds.”

Between Ohio’s Behavioral Health Redesign and possible major changes in state and national health coverage, Ohio providers of addiction services are bracing for an increase in drug overdoses. Baur is adamant that “we’re going to see a lot of dead children before this changes.” And antipathy is growing toward those with addiction issues, as evidenced in comments made in June by Ohio politician Dan Picard of the Middletown City Council, when he suggested simply doing nothing when police receive reports of overdosing: “Is there a law that says we have to go out?”

While news on the drug epidemic continues to be bleak, a Women’s Recovery House plans to open in Athens later this year. The recovery house hopes to provide a safe space for women “where they can have the support they need in their recovery, a place to help with their integration back into their community after a life of addiction.”

No word on whether services would be offered to young women under the age of 18.

For parents struggling to help their children with addiction issues, Shuemake offers this message: “No matter what boundaries you set and no matter what your son or daughter does, be sure that you are expressing love in your actions and your words. That may be what leads them to recovery. That may be what makes them feel better during the worst time in their lives. That may be the last thing you will have said or done for them in this lifetime. So take them a hot meal, answer every call.”

Baur wants people to remember: “They are kids. Their brains are not developed yet. If you put something in front of an impulsive kid, they are going to do it. I want everyone to know—they are children. They are not evil and they are not bad. It’s not their fault. I don’t care how awful you think these kids are, they are kids.”

Note: The writer’s husband currently works for HRS, Bassett House’s parent company, but did not contribute to this story.