Stimulant Summit | Trauma-Informed Approach Key for Children Hurt by Parents’ Addiction

As progress is made in the development of resources and treatment modalities for substance use disorders, leaders at Cayuga Counseling Services in the rural Finger Lakes region of upstate New York have turned their attention to a sometimes-overlooked group: child victims of crime stemming from the substance use epidemic.

In a presentation delivered Saturday during the Cocaine, Meth & Stimulant Summit, associate director Sarah VanDoren and victims services program coordinator Emily Hitchcock, LMHC, walked attendees through Cayuga Counseling Services’ Children Affected by Substance Abuse (CASA) program, which was launched in 2018 and is funded by the state’s Office of Victims Services.

Cayuga County has consistently reported higher rates of overdose-involved deaths and emergency room visits compared with other New York counties in both rural and urban areas. In 2017, Cayuga’s rates were nearly double those of counties similar in size, VanDoren said. Substance use was identified as a primary reason that children in the area were being placed into foster care, she said, adding that 95% of Article 10 placements—placements with relatives—were a direct result of substance use in the home.

In recent years, Cayuga County has added expanded access to naloxone to reverse opioid overdoses and redesigned residential services to better serve individuals early in recovery, but a gap remained for services focused on children, prompting Cayuga Counseling to develop its CASA program. Since it began offering direct services in May 2019, the CASA program has served 170 individuals, 109 of which are children.

“The CASA program’s goal was to identify and execute a multidisciplinary coordinated response to children who are victims of their caregivers’ substance abuse…with the creation of services for children and youth up to age 18 and their non-offending caregivers,” VanDoren said.

CASA is structured to include a program coordinator, therapists, and a case manager. Advocacy and case management are provided to family and offered from the point of program enrollment. CASA offers specialized individual and group therapy, and staff members are currently being trained in parent–child interaction therapy, VanDoren said. CASA uses trauma-focused cognitive behavioral therapy and eye movement desensitizing and reprocessing therapy.

Hitchcock said in developing the program, a great deal of thought was put into facility design to create a supportive atmosphere for young people.

“It was really important for us that when children walk through the door, that they’re greeted in a child-friendly, trauma-informed environment,” Hitchcock said. “We have snacks. We have Netflix®. We have games and crafts for them. We have stuffed animals that they are welcome to go home with.”

That attention to detail carried over to intake assessments, during which staff are mindful of minimizing retraumatization. Intakes begin with a meeting with caregivers alone while an advocate waits in a separate room with the child. "We did this intentionally to allow for a space where the caregiver can speak freely about what the child has experienced,” she said. “The children, they’ve already lived to this. They don’t need to rehear their story in that first initial meeting.” Children are then brought into the discussion to provide “a complete, holistic picture of the needs of the family,” Hitchcock said.

Several assessments are included at intake, including an adverse childhood experience (ACE) screening, child posttraumatic stress disorder (PTSD) symptom scale (CPSS) to assess severity of PTSD in children between the ages of 8 and 18, an adult CPSS assessment, and a Columbia Suicide Severity Scale.

The variety of assessments help inform therapists of the psychoeducation that will need to be provided to both the child and his/her caregiver, Hitchcock said.

Seeing high ACE scores, Hitchcock said that it became clear that trauma-informed practices were a must, hence the implementation of trauma-focused cognitive behavioral therapy (TF-CBT).

“This is an evidence-based therapy practice that aims at addressing the needs of children and adolescents with post-traumatic stress disorder and have experiencing difficulties related to traumatic life events,” Hitchcock explained. “I want to be clear: Our children don’t have to be diagnosed with PTSD to benefit from TF-CBT, but absolutely, if they have that diagnosis, this is an approach we’re utilizing.”

“It’s a structured intervention where the child and caregiver can learn new and better ways to handle their difficult feelings.”

Research has shown that children who have completed the TF-CBT approach have reported “a statistically significant lower number of PTSD and depressive symptoms compared to children in a control group,” Hitchcock said.

Hitchcock shared 2 other notable findings from CASA:

At the outset of group, 20% of participants believed many children dealt with addiction within their family. By the end, that number increased to 100%. “It really highlights that children maybe felt isolated and alone at the beginning, that they were the only ones potentially experiencing this,” Hitchcock said. “At the end of the group, thankfully they didn’t feel as alone.”

Also at the beginning, 50% of children answered that they agreed with the statement: “You caused most of your parent’s addiction problems.” By the end, 100% responded that they did not agree with the statement.

Reference

VanDoren S, Hitchcock E. Children affected by substance abuse: a multidisciplinary approach to serving the epidemic’s most vulnerable victims. Presented at: Cocaine, Meth & Stimulant Summit; October 14-16, 2021; Virtual.