The view from Ground Zero: Q&A on the opioid crisis

By Nila Cobb.

Welcome to the first of a two-part question-and-answer session with Nila Cobb, healthy lifestyles specialist and assistant director of the West Virginia Statewide Afterschool Network. In the first part, Nila describes the earliest signs of the opioid crisis impacting her community and her view on the role of afterschool in supporting children through the epidemic. Read part two here.

What were the first signs of the opioid crisis in your community?

I was aware in 1997 that a crisis was brewing. I worked as a medical social worker at both the Veteran’s Affairs Medical Center and a private hospital. I saw the damage opioids were causing when patients arrived at the hospitals with drug-seeking behaviors and I watched as they were often provided with prescriptions they would either abuse or sell. Unfortunately, I also saw an extremely personal side of the crisis as my then-19-year-old daughter became addicted through prescriptions. As a family, we have been through many traumatic experiences as she went through the spiral of addiction and then fought back through recovery.

How have you seen the public health crisis impact school-age children and their families?

The main problem is that parents are unable to parent when they are actively addicted. There are immediate emergency issues that include lack of resources in housing, food, and child care.

In 2005, the AARP reported that 4.5 million children nationwide were living in grandparent-headed households (6.3 percent of all children under age 18). This represented a 30 percent increase from 1990 to 2000. By May of 2017, the number had grown to more than 10 percent of children under 18 living in homes where householders are grandparents or other relatives.

During this time, I have raised my grandson. I’ve witnessed the trauma he has suffered. Although he has been cared for in a home that does not lack resources, his high Adverse Childhood Experiences (ACEs) score has directly impacted his health. According to the emerging research, childhood experiences, both positive and negative, have a tremendous impact on future violence victimization and perpetration, lifelong health, and opportunity.

Many of the children and families we encounter in our mostly rural area are the collateral damage of the drug epidemic. Cabell County, W.V., with a population of just under 100,000, is often referred to as Ground Zero for the drug epidemic. It is still among the highest in the nation for overdoses.

However, the pace at which non-fatal overdoses are suffered in Cabell County is gradually slowing, according to records logged by Cabell County EMS, marking a now five-month downward trend into 2018. In January, 113 overdoses, or 3.6 per day, were reported in Cabell County. By comparison, the county averaged 152 overdoses per month, or 5.2 per day, through 2017 — amassing a record-shattering 1,831 for the year. It goes unknown how many of these overdoses are accidental and how many are “deaths of despair.”

According to the findings of the 2016 National Survey of Children’s Health and an analysis conducted by the Child and Adolescent Health Measurement Initiative at the Johns Hopkins Bloomberg School of Public Health, more than 46 percent of U. S. youth have had at least one ACE or Adverse Childhood Experience.

In West Virginia, 52.4 percent of children under age 18 have had at least one adverse childhood experience, a rate significantly higher than the national average. Moreover, 26 percent have had two or more experiences, such as the death or incarceration of a parent, witnessing or being a victim of violence, or living with someone who is suicidal or has a drug or alcohol problem.

Addressing this childhood trauma is critical to providing positive youth development for the children impacted by this crisis. There is an emerging body of work around this topic which indicates that, with appropriate supports and interventions, people can overcome traumatic experiences.

How can – and should – afterschool play a role in intervening in the crisis?

Afterschool was the catalyst that helped me step in as a grandparent and rescue my grandson from a deteriorating circumstance.

I interviewed the program director of a local afterschool program about her views on afterschool’s role. She said that afterschool has access to build a relationship with the child’s family. When a parent comes in to pick up a child at afterschool, they usually have to go in and sign the child out. This is an opportunity for the staff to observe the parent and witness parent/child interaction, which is not always possible during the school day. The program director also adds how she has had to provide her staff specialized training around the steps that must be taken when a parent/guardian shows up intoxicated.

Afterschool is also an opportunity to help fragile families access needed resources. Front line providers tell of the emergency placement of children in foster families and kinship families being an area where afterschool can provide a community-wide ecosystem of both prevention and family support. Offering hot suppers and homework help along with consistently caring staff can make a tremendous difference in the chaotic lives of children and families experiencing the crisis.

Finally, it is imperative youth serving organizations be prepared to understand the relationship between working with children with trauma and striving to help them heal and thrive in the face of adversity. This can be accomplished when utilizing a Trauma Informed Care approach. By using the six key principles of the trauma-informed approach, afterschool programs can address the needs of children of trauma as outlined by SAMSHA:

1. Safety
2. Trustworthiness and Transparency
3. Peer Support
4. Collaboration and Mutuality
5. Empowerment, Voice, and Choice
6. Cultural, Historical, and Gender Issues

The desired goal is to build a framework that helps systems “talk” to each other, to understand better the connections between trauma and behavioral health issues, and to guide systems to become trauma-informed.