Opioid intervention teams in Maryland that include school district superintendents, philanthropic funding for drug abuse prevention in Indiana schools and an opioid intervention court in Buffalo, New York, are a few examples of cross-sector partnerships working to address the impact of opioid abuse on children and families.

“Educators too often don’t have the tools, the resources, the supports, the training that they need to support children who are the victims of this epidemic,” Glen Harvey, CEO of WestEd, a San Francisco-based research and service organization, said during a recent live-streamed discussion on the topic. “No one sector can provide all the supports that these children need to survive.”

Dr. Rahul Gupta, the senior vice president and chief medical and health officer for the March of Dimes, said opioid addiction among mothers is leading to high pre-term birth rates and children being born with neonatal opioid withdrawal syndrome.  

“These kids are now entering the school system. They are having problems with impulse control,” said Gupta, who served in two administrations as West Virginia’s public health commissioner. He added that some of these children are being misdiagnosed with attention deficit disorder and being prescribed drugs, which can sometimes lead to later substance use problems. “We’re almost creating the problem for the next generation because we don’t understand the problem, and we are lagging behind.”

The opioid epidemic is also contributing to increases in children being placed into the foster care system at a time when schools are now responsible under the Every Student Succeeds Act for monitoring and reporting outcomes among students in foster care, Troy Quast, an associate professor of public health and the University of South Florida — and also a foster parent — found increases in opioid prescription rates were strongly associated with child removal rates. Because educational outcomes among children in foster care are often poor, the epidemic is “really harming the country going forward.”

In Maryland, Reginald Burke, who directs the Maryland State Department of Education’s (MSDE) Youth Development Branch, described the Opioid Operational Command Center, a multi-agency collaborative effort that has contributed to schools finding additional financial resources to respond to the effects of opioids and district leaders having “real-time” information from health and law enforcement agencies.

Superintendents from each of the state’s 24 districts are also involved in intervention teams that share resources and knowledge of effective programs. “What we try not to do at the state is dictate what programs are going to work in particular counties,” Burke said. Innovative approaches, however, are developing, such as students in high school drama departments addressing substance use in school productions and presenting the plays to younger students. “The message is being shared by students,” he said.

Because many schools don’t have health or physical education teachers who can teach students about drug prevention, Burke said, MSDE is also partnering with the state health agency to make an online training module available to teachers so they can address the topic in their classrooms.

Links to social-emotional learning

In Indiana, when leaders at Richard M. Fairbanks Foundation in Indianapolis surveyed 150 school social workers and school leaders, they learned that only 11% of schools in Indianapolis even had drug prevention programs. And if they had one, they often weren’t using evidence-based programs, said Ellen Quigley, the vice president of programs at the foundation. A 9th-grade class, for example, might be using a 1st-grade curriculum.   

The foundation compiled a list of 25 rigorously evaluated prevention programs and worked to connect them to state academic standards. The foundation also created a grant program to support planning and implementation of the programs, which will reach over 180 schools and over 81,000 students, Quigley said.

Teachers, especially at the elementary and middle school levels, often said they didn’t have drug issues in their classrooms. But then the foundation connected the prevention programs to social-emotional learning, which educators are now expected to blend more intentionally into their teaching.

“They realized that these are the kinds of programs that they need — both to address academic performance but also long term — to help [students] to become adults that are able to reduce the kinds of pressures that lead them to substance use disorder,” Quigley said.

A few of the speakers addressed the needs of older adults raising grandchildren who have been removed from parents with addiction problems, as Quast noted. In Indiana, Quigley said former school leaders are volunteering to work as child advocates. “Having a school voice is really helpful because it helps [child protective services] do a better job at what they are charged to do,” she said.

Tara Kunkel, a principal court management consultant with the National Center for State Courts, added that programs such as Buffalo’s Opioid Intervention Court, a model that is now spreading to other counties in the region, are thinking about the whole family when working with someone who has experienced a non-fatal overdose. Judges handing out sentences such as free family memberships to the YMCA is one example, she said.

Concerns about liability

Some representatives from the healthcare field, however, say they still encounter barriers when trying to work with schools. Chris Stock, a pharmacist and the co-chair of the Colorado Harm Reduction Work Group — part of the Colorado Consortium for Prescription Drug Abuse Prevention — said he has reached out to educators and school nurses but that they are not well represented on any of the consortium’s work groups.

School nurses, he said, would like to have access to Naloxone, the drug that reverses an overdose, but because the state’s law doesn’t explicitly say that school employees can administer the drug, there is still uncertainty about liability. “They have to convince administrators that the current law is sufficient,” he said.

Dianne Harris, the director of health services for Friendship Public Charter School in Washington — who attended the event — echoed the concerns Stock mentioned. “In the situation of education, people just want to educate,” Harris said, adding that non-medical staff members are being put “in the position that they may have to save someone’s life.” 

Other questions from attendees focused on how to launch collaborative efforts similar to the ones the presenters mentioned. If school and district leaders are “ready and willing” to convene representatives from other sectors in their communities, they should, Kunkel said. “Invite your local justice system players to the table.”