Report: Response to Opioid Epidemic Needs Sharper Focus on Children

The deadliness of the opioid crisis for its direct victims has left policy-makers nationally in a constant crisis mode, with too little attention given to the children and families who are suffering devastating consequences of their own. A report from the United Hospital Fund and the Milbank Memorial Fund that draws this conclusion suggests that governments at all levels must work harder to build on the comparatively few existing programs that are addressing the “ripple effects” of the epidemic.

“There's a basis for acting now—it's not as if we're starting at ground zero,” Suzanne Brundage, director of the United Hospital Fund's Children's Health Initiative and co-author of the newly released report, tells Behavioral Healthcare Executive.

The Ripple Effect: The Impact of the Opioid Epidemic on Children and Families offers a series of policy recommendations that grew out of a two-day meeting of policy-makers, researchers and clinicians hosted by the New York-based United Hospital Fund last October. Some of the themes that participants focused on as part of their strategies for decisive action to help families include breaking down silos in government and health care, as well as emulating past efforts to stamp out stigma that once stalled responses to cancer and HIV/AIDS.

As with those health crises, “We need people telling their stories and humanizing their experience, which would make the disease something that is OK to talk about,” Carol Levine, co-author of the report and director of the United Hospital Fund's Families and Health Care Project, tells Behavioral Healthcare Executive.

Hidden tragedies

Both of the report's co-authors had involvement in responses to the HIV crisis earlier in their careers. As they watched the opioid epidemic unfold, they mutually decided, “We have to do something—nobody is looking at how this epidemic is unfolding in the lives of children, and in the lives of family members caring for these children,” Brundage recounts.

The numbers are compelling, such as 8 million U.S. children who lived with at least one parent with a substance use disorder between 2009 and 2014, and the incidence of neonatal abstinence syndrome tripling between 2003 and 2014. A deeper dive into the problems facing children and families reveals some less expected and disturbing truths, such as grandparents suddenly thrust into parenting roles, and even children and teens who have to take on caregiving responsibilities when the usual caregiver in the household succumbs to an addiction.

Around all of this can be an atmosphere of distrust around working with authority figures, over fear that bringing attention to problems in the home could lead to consequences such as forced separation of families.

“Children, they know exactly what's going on,” Levine says. “But they often won't want to talk about it because they're afraid of being removed from the home.”

Major recommendations

With no one sector solely responsible for serving children and families, the report recommends that state and local governments take the lead but also engage community leaders, persons in recovery and family members affected by the crisis. The report's recommendations are divided into four categories:

• Reduce stigma and misunderstanding of opioid use and treatment. Goverment leaders should promote the use of nonjudgmental language in addiction. Leaders also should take a lesson from how stigma was reduced for cancer and HIV/AIDS. Brundage says the emergence of treatments that worked was one of the pivotal factors in reducing stigma toward HIV. Certainly the wider use of evidence-based medication-assisted treatment (MAT) for opioid dependence could help lead to the same result.

• Make investing in a response to the ripple effect a priority. “Effective programs that can help children affected by, or at risk for, substance use disorder have not been scaled to the scope of the problem,” the report states. Policy-makers should encourage the integration of services for parents and children into one setting. Also, efforts should be made to close geographic and racial disparities in service delivery. Currently, “The door the family first goes through determines what happens to them,” Levine says.

• Ensure that government and private agencies work as a team. One priority here should be for leaders to establish a coordinated prenatal care system that links to substance use disorder treatment providers and that seeks to prevent foster care placement.

• Identify children at risk as early as possible. Adults who regularly interact with children need assistance in recognizing the signs of childhood trauma and connecting children to trauma-informed care. Levine says earlier identification of problems emerged as a common theme in last fall's meeting of experts.

Examples of innovation

The report also featured examples of programs that have achieved results in some communities and could merit replication elsewhere. One such program cited by the authors in speaking with Behavioral Healthcare Executive was Handle With Care, a collaborative effort between law enforcement and schools in West Virginia.

The program seeks to ensure that when children witness a traumatic event such as a parent's overdose or arrest, they receive appropriate interventions to boost their ability to succeed in school. Law enforcement officers at the scene notify the child's school that an incident has occurred, and school personnel who have received trauma-sensitive training engage with the child in a supportive and not punitive fashion.

“A big, collaborative, successful effort to reach children in the crosshairs of the opioid crisis will require as much compassion as coordination,” the report concludes.