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Across the nation, thousands of children are dramatically and adversely affected by opioid and other substance misuse at home, and often little support exists to help them cope. Partnering with Youth Workers to Address the Needs of Children Experiencing Opioid Misuse at Home is a program designed to help out-of-school time workers better understand and address the needs of these children, and includes in-person training, a computer-based resource, and an activity book for students. The program is a project by Heidi Kar, Kim Netter, Julie Riordan, and Gisela Rots, all public health, psychology, substance misuse, and violence prevention professionals at the Education Development Center.
Heidi Kar, PhD, is the lead for EDC’s violence and trauma team. She develops public health interventions to address the mental health needs of underserved communities. A licensed clinical psychologist and international/cross-cultural public health professional, her areas of expertise are prevention and treatment of trauma disorders, violent behavior, substance use disorders, and suicide.
Kim Netter is an experienced health communications specialist with extensive expertise in public health strategy implementation, medical marketing, and product development and dissemination. She has a special interest in early childhood mental health and wellness programs and develops violence prevention and mental health promotional materials for tribal, school-based, community-based, and substance abuse prevention federal grantees and community-based organizations.
Julie Riordan, PhD, studies the influence of policy on outcomes for students. Her research interests include teacher preparation, evaluation, and effectiveness; mathematics education; collaborative research models; and comprehensive school reform efforts. She specializes in quantitative methods, including multivariate analyses, implementation research, survey research, and utilization of national data sets.
Gisela Rots has more than 15 years of experience in the public health field, with a career focused on opioid and other substance misuse prevention programs. Her expertise includes integrating trauma-informed approaches into prevention, developing social marketing campaigns, managing award-winning training programs, providing training and technical assistance to state agencies and community coalitions, and developing cross-sector partnerships.
Zoe Dobuler: What are your backgrounds, and how did you all find your way to EDC and to this project?
Heidi Kar: My background is in clinical psychology and international public health. I started out doing violence prevention work in the developing world, and realized that a lot of violence-related projects weren’t taking early trauma into consideration, trauma that occurred in the lives of many perpetrators that wasn’t being addressed, and then was being manifested later as violence. So, that propelled me into clinical psychology. And I came to EDC after several years of working as a clinician to grow the violence and trauma areas at EDC and to specifically connect these issues of early trauma, violence perpetration, and substance use. While I was doing my clinical training, I realized of course that substance use is intimately tied to violence perpetration in many ways, and also to early trauma as well.
And this project is very close to my heart because it really brings together all of those pieces. In terms of thinking through how families who are impacted by substance use also, by virtue of the different aspects of substance use, often have higher rates of violence perpetration and child maltreatment and neglect, as well as domestic violence. And that early trauma that children experience, that early adversity, is really important for that child’s mental health, but also if we think down the road for violence perpetration for those children — it sets up a trajectory that we need to be aware of and intervene in.
Kim Netter: My path to EDC was a little different. I spent about 20 years in the pharmaceutical and medical device industry doing marketing, both domestically and internationally. Then, I went and changed careers and got a public health degree. So, instead of treating disorders and illnesses, I could prevent then or work on preventing them. And the area that I have been most particularly interested in is mental health — where mental health and public health come together has been a sweet spot for me.
And when we talk about the opioid crisis, one of the things we found in our research was that schools are dealing with a very large population of kids who were being affected by the opioid epidemic. And as Heidi was saying, the trauma that imparts on a child is showing up in the classroom. So, not only does it affect their behavior in the classroom, but it also affects others in the classroom, and most importantly, what we found was that the people in the schools in particular, and out-of-school time wanted to know what they could do to help these kids. And that was really the genesis of this toolkit that we were thinking about. How can we help adults help kids when they’re desperately in need of help?
Julie Riordan: My training, background, and interest is in public education, along the spectrum from pre-K to the K-12 experience and beyond, in both informal and formal settings. My training is in education policy, specifically evaluating policies that are intended to improve the outcomes for students, teachers and others in school or out-of-school settings.
My work at EDC currently focuses on schools and districts and early childhood sectors, working with program providers and with school and district and state education agencies to research, provide evaluation of educational policies and programs such as those that are being implemented now around social-emotional learning, with the intent of improving educational experiences for the whole child, in school and after school. And one of the things that we have learned in talking with our partners in states within this region, and in other areas in Appalachia, is that there is really an increase in teachers and administrators interacting with students who are having to deal with secondary trauma relating specifically with the opioid crisis. Teachers are asking for tools, both to identify and to help children cope. And with the opioid crisis it feels like something that could use some specific tailoring and customization of the kind of tools and support that teachers and administrators, coaches could benefit from. So, that’s my entry into this group and thinking about how we can address those needs in schools.
Gisela Rots: I have a background in substance misuse prevention. But beforehand, I worked on HIV prevention in a number of different settings and ended up working on a couple of substance use disorder research studies. I got a little frustrated with how behind the eight ball we were, and ended up working in prevention efforts in a couple of communities in Massachusetts, and, starting in 2008, worked on a grant that was designed to address the emerging overdose situation.
For so long things focused only on the person who was overdosing and their immediate adult bystander support systems. And I came to EDC to work on a project that was more national in scope in providing training and technical assistance on substance misuse prevention. And I’d been doing that since I joined EDC in early 2012, at which point a lot of states were starting to think about overdose prevention and what that means. We were all starting to feel like we’re all talking about treatment, talking about the adults, but what we’re not talking about is the sheer number of children being impacted. In some communities, you saw a situation where 10–11 years ago, you’d have one member of the family overdose, and everybody would be shocked. Fast forward a few years and you’re seeing siblings in the same family, you’re seeing cohorts of young people starting to overdose. So, recognizing that if we’re really going to get ahead of this issue, we need to start thinking about the children being impacted and thinking strategically about what opportunities we have to support them.
So, short story long, I ended up with these guys talking about what is it that we can do to look at school systems and after-school systems and other places where children are in the community where the community can provide some support, because we can’t fully rely on the parents. It does take a village to raise a child, and so, especially if the family is being impacted, we need to help and support the families, and we need to help and support the children where we see them on a daily basis.
ZD: Can you tell me a bit about the program and how it works? What problems is it designed to address, and how does it put that mission into action?
JR: In terms of the scope of the problem of opioid use and children who are living in homes where there is substance use, the magnitude of the issue is stunning. You’ve got one in eight kids living in a home where at least one parent has a substance misuse problem. And 2 million kids are living in a home where there is illicit drug use, like opioids. So when you think about 2 million kids, it just reinforces the need to support them in schools and in out of school settings.
GR: And to build on that, we know that something like 2/3 of people who suffer from a substance use disorder have experienced earlier trauma or witnessed violence. So not doing anything was just not an option.
Our project initially came about via EDC’s innovation challenge that they hosted for their 60th anniversary, and simultaneously we had this opportunity to apply for a foundation grant that was funding opioid prevention opportunities. We opted to, for this particular opportunity, hone in on the after-school time component of this equation. And in order to do that, recognize that there had to be an additional piece, because the out-of-school program staff are also in need of resources: They’re not credentialed, and they don’t have formalized training like a lot of school-based settings do. There are a lot of other benefits of out-of-school time— they’re informal, the adults have opportunities to build really great relationships with the kids, et cetera. So we decided to hone in on the out-of-school time component and think about a tool that those program staff could use. This led to the decision-adventure component of the program.
The activity, or decision-adventure-based workbook, is targeted at the children. It’s coupled with a day-long training for out-of-school time program staff, with the idea that in order for them to be able to use the tools, they actually need to get a little bit more training in what it is and how they can identify children who may be impacted by opioid use disorder in the home. The reality is that a lot of them already know if families are being impacted. But, really helping them identify some of the behaviors, identify the challenges that the kids might be facing, and how they, as out-of-school time staff who have often flexibility in their programming, can support the kids.
So, building those healthy relationships, helping the children find their best coping skills. And then the tool itself will be a series of decision-adventures, based on the theme of a detective story. It focuses specifically on kids ages 6–10, because that seems to be the big gap. We know there’s stuff happening for younger children and older children, but that 6–10 age group seems to have a gap. So, we are creating a series of decision-adventures that can help the kids identify some of those emotions, then start to think about how they can manage them and express them. And then think about how can they approach other adults for support; that’s part of what we want to do, we want to give the kids and the adults to opportunity to engage in those conversations and those opportunities to bond and build attachments, which we know is especially important for these children. And then, also start to identify those things that they can do proactively on their own to be able to cope with these things. Whether its joining a basketball team or sitting and listening to music. Then the activity book will help support those different pieces.
ZD: You mentioned that your project is targeted for an age group that’s not getting much attention now with regard to these issues. What does the landscape of these kinds of programs look like right now?
KN: The research we did showed that there really wasn’t anything for this group. What there has been is what we call in public health a universal approach to risk and resilience factors. Which, theoretically, could be part and parcel of the support that kids need. But I think that this is one of the first — if not the first program — that specifically targets kids who are affected by the opioid crisis.
JR: And I think teachers might be, especially in high risk or historically disadvantaged districts, accustomed to having referrals made for mental health specialists who come to the school. But the fact is that the children are with the teachers for those 6+ hours a day, and to have teachers or those program staff in out-of-school settings with more expertise in identifying and helping children cope, is really what we know the field is asking for, what educators are asking for. And I think that’s why there’s this gap: There’s a habit of bringing services in—which are quite necessary, you need expert mental health folks there—but in my view, from my school perspective, raising the level of information and competency of the educators is also key.
GR: It’s changing the environment. That’s what we know now about working with children who face these early adversities. It’s not just about giving them one place or one hour a week where they’re supported. It’s how do we change the environment that they walk into every day? Whether it’s at school, out of school, in a faith-based community — how can we help support those environmental or climate changes? Because we know that one of the things that will help build their resilience is feeling connected to the community, to their schools, and feeling safe and secure in these spaces. And if we can help teachers and the other adults in these settings understand that and understand what they can do, and translate that into action, then we’ve got the best opportunity we could have to provide support to the kids.
HK: Building off of that, one of the common pushback factors sometimes, when you’re talking about new interventions, or taking new to-do’s to school systems, is the idea that teachers have so much to do, that school staff are already doing so much. And, I think it’s important to point out, that with these ideas, you have to be considering all of those realistic, practical factors.
But as we have thought about the long-term opportunities for supporting children within school systems and out-of-school settings, there’s very good research that shows that teachers and other professionals feel that they have something to offer. If they feel that they know what to do about a problem they’re encountering, they’re actually happier, even if they’re doing more work. Even if it’s an added responsibility, they’re happier, they’re more resilient, they’re more well-adjusted. And I think that’s very important because a lot of people could look at this and say, “Oh no, another thing for teachers to do, throw it out, they’re doing too much already.” But that research has been done over and over in many different settings all over the world, and that sense of agency that comes from ok, my kids are suffering, what can I do to help? This is something I’ve seen that can help them, something that will keep them safe, something I can offer — that’s really powerful for teachers and out-of-school staff.
ZD: What’s in store for the future of the project? Where do you see it going from here?
GR: Step one is rolling out the work for the foundation grant, which we’ll be doing, and piloting both in Worcester, MA and Montgomery County, Indiana. We’re right now working on getting focus groups and key stakeholder interviews done to inform the development of both the tool and the training, and we’ll be doing that for the next couple weeks. Then we’ll be hoping to start the actual development, piloting by the end of the summer, and making some adaptations. We’re really hoping that by piloting this in one urban and one rural community, we can get a sense of how else we can build it out in the future. I know there’s a group of funders that have expressed interest in this in the longer term, and looking forward to thinking about how else we can further it along.
This Change Maker interview was originally published May 2019 on the HubWeek blog.
The HubWeek Change Maker series showcases the most innovative minds in art, science, and technology making an impact in Boston and around the world. Know a change maker you think should be interviewed for this series? Nominate them here.