Most of the front door of Rachel Taylor’s little yellow house in White Sulphur Springs, W. Va., is pasted with paw prints where her dog struggled to get inside during the flood last month. He was too big to carry through the rising waters.

Across the street, nestled between two battered houses, an empty lot is marked by a cross with an array of flowers and photos — a small memorial for a family washed away by the torrent.

Taylor’s dog survived and is now with some of her family members in Kentucky. But those neighbors across the street, the Nicelys, were swept away when their house collapsed; they have since been confirmed dead.

“When I start feeling overwhelmed with this,” Taylor says from her front porch, “I just look across the street at that memorial and I think, there’s nothing that we have lost that can’t be replaced or mended.”

She and her husband spent seven years renovating this 1930s Craftsman house, room by room. They were just about done with renovations when their house flooded a few weeks ago. Today the living room is gutted.

“You know, the first couple of days it was very intense,” Taylor says. “It was kind of ‘crisis mode.’ Maybe that’s the way I would describe it, because you didn’t really have time to think about it and process it.”

But once the full extent of the damage set in, Taylor says, she developed severe nausea and carsickness to the point of not being able to drive.

A number of people, she says, have chalked up her symptoms to nerves. “You know, the stress level. You don’t realize your body is just having a response to this.”

Taylor worries that the houses in her neighborhood will remain abandoned and that she, her husband and her 14-year-old daughter won’t feel safe at home anymore. She plans to rebuild, but says her family will likely sell the house and move.

Rachel Taylor surveys the flood damage from her front porch in White Sulphur Springs, W.Va. Muddy paw prints on the front door still mark her dog’s panic as the waters rose. He survived, but others didn’t. Kara Lofton/West Virginia Public Broadcasting hide caption

toggle caption Kara Lofton/West Virginia Public Broadcasting

“The words we use when we talk about it are ‘I don’t know if I have it in me;’ ‘I’m not sure if I can do it again,’ ” she says. “Things like that. And then we just say, ‘Well, we’ll take it one day at a time.’ “

Psychologists say this kind of response is normal following natural disasters.

“It’s a physical aspect of the stress response — it will affect the body’s ability to concentrate, to rest and to be able to function,” says Marcie Vaughan, leader of the state-funded West Virginia Community Crisis Response Team. “Cognition is slowed and impaired,” she adds.

Vaughan’s team offers support, counseling and referrals for further mental health care at local behavioral health centers.

“From the behavioral health perspective, we find we are more in need after the tenth [or] twelfth day,” Vaughan says, “just because immediate needs of food, clothing and shelter take precedence.”

In the first few days following the flood, Vaughan’s team members split their time between helping people replace lost psychiatric medications and looking for signs of mental distress in people at shelters or feeding stations.

“We see fatigue, problems with cognition,” she says. “You have individuals who walk into a supply center and they have no idea what they need.”

A 2012 study published in the journal Social Psychiatry and Psychiatric Epidemiology found that while most people bounce back a few months after a disaster, if their ongoing stressors aren’t addressed — such as a lack of permanent shelter, financial challenges and repeated exposure to the trauma — affected residents will continue to struggle.

In addition to Vaughan’s team, church disaster-assistance teams and Hope Animal-Assisted Crisis Response — a support organization that uses trained therapy pets for comfort — stepped in to help.

“As the fatigue sets in and the frustration, we see an increased need for behavioral health intervention,” says Vaughan.

Unfortunately, that’s just when the work becomes hardest, Vaughan says, and it’s often after national organizations and media have lost interest. Very real, tough problems persist, though only local groups and neighbors remain to extend helping hands.

This story is part of NPR’s reporting partnership with West Virginia Public Broadcasting and Kaiser Health News.

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The Senate is set to approve a bill intended to change the way police and health care workers treat people struggling with opioid addictions.

The bill is an amalgam of more than a dozen proposals passed through the year in the House and Senate. And while it has lots of new policies and provisions — from creating a task force to study how best to treat pain, to encouraging states to create prescription drug monitoring programs — it doesn’t have much money to put them in place.

President Obama had requested $1.1 billion to help pay for more addiction treatment programs and other initiatives. But the version agreed to by House and Senate Republicans last week didn’t include all that money. In the end, it will probably get about half that much.

“It’s clear that efforts to prevent and treat the opioid epidemic will fall short without additional investments,” Sen. Patty Murray, D-Washington, said in a statement after House and Senate negotiators hammered out the final bill.

But Sen. Lamar Alexander, R-Tenn., argued that the money for treatment has been rising for three years.

“Our friends on the other side say, you have to fund it. We are funding it,” he said in a statement on the Senate floor Friday. “And they helped fund it. We’ve increased funding for opioids already by 542 percent.”

Still, Democrats are expected to support the bill even without the additional money.

And that’s a good thing, says Linda Rosenberg, president of the National Council for Behavioral Health, because the bill helps expand treatment in significant ways.

For example, it allows nurses and physician assistants to treat people with addictions using medications, which is considered the evidence-based standard.

“Treatment capacity is really a crisis. There just isn’t enough,” Rosenberg tells Shots. “But what this bill does to address that — it expands the kinds of people who can prescribe medications for addictions. And that’s a very big deal.”

She says that provision alone can help because nonprofit treatment centers will be able to use nurse practitioners and physician assistants rather than trying to hire doctors, who are both scarce and expensive.

The bill also allows the Department of Health and Human Services to give grants to states and community organizations for improving or expanding treatment and recovery programs. It has several provisions that would allow police departments to send people with addiction problems to treatment rather than to jail.

In one of the few areas of the bill that includes funding, lawmakers authorized the Department of Justice to spend $100 million a year for five years to find alternatives to jail for opioid abusers, and to allow prisons to use methadone or buprenorphine to treat inmates with opioid addictions.

Rosenberg says these measures help change the definition of addiction from a crime to a health problem.

“It’s a health care issue and not a moral failing issue,” she says. That’s a big reversal from the “war on drugs” campaigns of a few decades ago.

And the legislation allows more people to have access to naloxone, the drug that can reverse an opioid overdose, reducing the risk of death. Access would be expanded for people working in schools and community centers.

The bill encourage pharmacies to fill standing orders for the drug so that those likely to come in contact with someone suffering an overdose will have the drug on hand, according to Mike Kelly. He is the U.S. president of Adapt Pharma, which sells Narcan, a nasal spray version of naloxone.

“This bill addresses getting Narcan out into the community, outside of emergency and first responders,” Kelly says. “The big thing here is this will fund recovery.”

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Many babies born to mothers who are covered by Medicaid are automatically eligible for that health insurance coverage during their first year of life. In a handful of states, the same is true for babies born to women covered by the Children’s Health Insurance Program.

Yet, this approach is routinely undermined by another federal policy that requires babies’ eligibility for these programs to be re-evaluated on their first birthday. Although they’re likely still eligible for coverage, many of these toddlers don’t get it because of a tangle of red tape.

People often cycle in and out of Medicaid and CHIP, state/federal health programs for low-income residents, as their income or family circumstances change. Such churning is a long-recognized problem. The requirement that people renew their coverage annually may also cause hiccups.

“Many people lose Medicaid coverage for procedural reasons,” says Shelby Gonzales, a senior health policy analyst at the Center on Budget and Policy Priorities. “But there are all sorts of things that are unique about babies turning 1” that present extra challenges.

“You hate any baby to lose coverage,” says Jill Hanken, a lawyer with the Virginia Poverty Law Center who has worked on this issue. “A 1-year-old needs to have consistency with their health care and visits with the pediatrician.” Regular well-baby visits ensure kids are developing properly and get scheduled vaccines, among other things.

One potential snag in retaining toddlers’ coverage is that their first-year review is pegged to their date of birth, which is generally different from the annual renewal date for other family members’ coverage.

In other instances, states that don’t seek babies’ Social Security numbers until they turn 1 may have a tougher time getting the income and other data they need to process the renewal. And some states mistakenly ask for documentation proving the baby’s citizenship, which is not required if Medicaid or CHIP paid for the birth.

Antiquated computer systems sometimes automatically drop babies after their first birthday unless a renewal has been processed. This can be a problem in states that are behind in renewals, which is not uncommon, Gonzales says; some states have scrambled to implement the many requirements of the health law.

It’s hard to quantify the extent of the problem nationally. An analysis of data from the 2014 American Community Survey of 700,000 children found that children between the ages of 1 and 2 were less likely than infants to be covered by Medicaid or CHIP. That suggests “some children may be losing Medicaid/CHIP coverage at their first birthday,” says Genevieve Kenney, a co-director and senior fellow at the Urban Institute’s Health Policy Center.

The experience of the state of Connecticut offers a window on the problem. Connecticut Voices for Children, a policy research and advocacy organization, has tracked the issue closely for several years. In 2008 and 2009, 42 percent of babies who had been considered automatically eligible for Medicaid at birth lost their coverage at the end of the month they turned 1. That’s compared with roughly 6 percent of babies who were in other Medicaid coverage groups, such as those whose mothers had employer-sponsored insurance.

By 2013, when Connecticut Voices revisited coverage gaps, Medicaid and CHIP coverage retention when infants turned 1 had improved significantly. Still, nearly 23 percent of babies with guaranteed coverage for their first year were uninsured after their first birthday. That was true for less than 2 percent of other babies in the state.

During that time the state had revised confusing notices to families that, for example, announced that coverage was ending for infants because, “You are not the right age to be eligible for this program.” Advocates also played a role in improving the troubling statistics by working to alert pediatricians and community services providers about the problem.

Though coverage for 1-year-olds has improved, “the problem still persists,” says Mary Alice Lee, senior policy fellow at Connecticut Voices for Children. Advocates hope that a new eligibility management system, scheduled to roll out next year, will make a difference.

Elsewhere, advocates in Virginia are also awaiting a computer system fix so that infants who were guaranteed Medicaid coverage for the first year aren’t automatically canceled after their birthday. In the meantime, Hanken says, the state changed its policy so that the determination of a newborn’s Medicaid eligibility at 1 year of age is a streamlined renewal, instead of a totally new application for coverage.

“We’re about halfway to a solution,” Hanken says.

Outdated technology is no excuse for states not addressing this longstanding problem, says Tricia Brooks, a senior fellow at Georgetown University’s Center for Children and Families.

These newborns are easily identified, Brooks says, so “if nothing else, [state officials] could go in on a manual basis and trigger a review.”

Kaiser Health News is an editorially independent news service that is part of the nonpartisan Henry J. Kaiser Family Foundation. Michelle Andrews is on Twitter:@mandrews110.

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