Adapting a Program to Protect Children Caught in the Middle of the Opioid Epidemic

ATHENS, Ohio — Children are the silent victims of America’s opioid abuse epidemic, often suffering neglect, abuse or trauma as one or both of their parents sink into the pit of addiction.

In one tragic example of this, the children of a couple in the southwest Ohio city of Centerville, found the dead bodies of their parents this past March after the mom and dad overdosed on the powerful opioid synthetic drug fentanyl.

Cases of children in Ohio calling 9-1-1 about the overdose of their parents were also reported in Cincinnati, Cleveland, Lorain and Dayton in March alone.

In January, in Berea, near Cleveland, an 8-year-old boy suffered a non-fatal overdose of heroin.

A new pilot program in 18 southern Ohio county governments, including Athens County, will seek to address the needs of all family members with a focus on children when parents become addicted and throw their families into crisis.

Ohio START—standing for Sobriety, Treatment and Reducing Trauma—is being launched this month by the office of state Attorney General Mike DeWine.

Origins of START

The START program originated in Cleveland before being brought to Kentucky in 2007, according to Anya Weber, a spokesperson for Kentucky Attorney General Andy Beshear.

In Kentucky, it has been implemented in Louisville, Covington, Lexington, Owensboro, Inez and Ashland, Weber said.

“START’s primary goal is child safety, which we seek to accomplish through parental sobriety by helping parents with substance use disorders obtain quick access to intensive child welfare and treatment services, which allows us to keep children in the home with their parents when safe and possible,” Weber said.

Families face a number of challenges including poverty and a lack of resources, co-occurring mental health disorders, trauma and domestic violence, overdose risks, stigma against people with substance use disorders, and limited treatment capacity along with long waits for assessment and treatment.

The START program employs people in long-term recovery as family mentors to engage parents and address stigma and enabling among family members, she said. The program provides intensive child welfare services to monitor child safety and provide support to the family, along side partnerships with behavioral health providers for quick access to holistic assessments and treatment.

“We educate our clients about overdose prevention and link them with overdose prevention kits,” Weber said. “We also link our participants with community resources as needed. We do a lot of community education.”

The program has led to improved outcomes for families, with mothers in START having roughly twice the rates of sobriety as those receiving services outside the program, and over 75 percent of children in START able to remain with their parents or reunified by the end of services.

Moreover, she said, the program is economical, with every dollar spent on START services offsetting $2.22 in foster care expenses.

How START Works

Immediately after a report is called into the Kentucky child protective services hotline and an investigator determines services are needed, it is referred to START, Weber said.

A family entering START is in the “crisis” period of having a new case open for child welfare, she said. A “Family Team Meeting” is called where START begins the process of shared decision making with the family.

“The family is encouraged to bring their supports with them, whoever they may be, and everyone present has a voice in the process of figuring out how the children can be safe and who can take care of them while the parents begin treatment,” Weber said. “The team is both supportive of the family in a non-judgmental way and transparent with the family about the issues that must be addressed.”

A family mentor and behavioral health clinician are present at the first meeting, conducting a full assessment of substance use and co-occurring mental health issues, she said. Treatment recommendations are made and shared with the family team so that parents can begin treatment within three days of the assessment, she said.

“The family mentor takes the parents to their first four treatment appointments to help them feel comfortable and not miss their treatment. The START worker and family mentor meet with the family at least weekly to monitor child safety, coach and support the parents to achieve sobriety, and help the family meet their basic needs,” Weber said.

Family mentors talk with participants about how to parent while sober and what is needed to stop using drugs/alcohol, she said.

“They might take the participants to recovery support meetings and teach them how to use the supports present there,” Weber said. “The family is very busy in the first few months of their case, but the team is there to walk them through the entire process.”

START cases last an average of 14 months, and the program continues to work with the family until child permanency is achieved, meaning that children remain with or are reunified with their parents, a relative is granted permanent custody, or parental rights are terminated.

“Not all families have to go to court, but when they do, the family mentor accompanies the parents and helps them navigate the process,” she said.

Participants have appreciated the assistance, as seen in some quotes Weber shared from participants that were gathered in a recent qualitative study.

“It’s hard to stay sober in a substance abusing community. The counselor helped me learn that addiction is a disease, and how to deal with the substance abusers around me,” one START participant said. “We relapsed several times, but they keep working with us and helping us stay sober longer.”

Another said that prior to START, resources just weren’t available and the family mentor has been a big help.

“I get help with mental health counseling that I have no money to pay for. I had a lot of trauma and need help,” the participant said. “I get counseling, drug tests, and lots of support. The mentor is good and down to earth and blunt. She doesn’t try to hide anything. She’ll tell you what she really thinks without being mean.”

Others Look to Replicate Kentucky’s Success

As Kentucky has seen success, state and local governments elsewhere are looking to replicate, including Bloomington and Terre Haute in Indiana and Asheville, North Carolina.

Ohio’s pilot program is launching this month. It will coordinate between the court system, drug-addiction treatment facilities and child-welfare agencies, explained LeAnn Cornyn, a representative from DeWine’s office.

Cornyn, who serves as director of children’s initiatives for the Ohio AG’s Office, was among multiple presenters at a recent conference hosted by the Athens, Ohio-based nonprofit organization IPAC (Integrating Professionals for Appalachian Children).

The conference brought together physicians, child-welfare workers, drug-addiction specialists, and professionals from a wide array of agencies and organizations working to address the opioid crisis and its impact on Ohio families.

Ohio is ranked No. 1 in the nation for number of heroin deaths, with a 19 percent increase in children entering foster care since 2015 and 50 percent of those cases due to parental drug addiction, according to stats presented by Cornyn.

Dr. Joe Gay of Health Recovery Services in Athens estimated during his own presentation that in Athens County one out of every five to 10 children have one or more parents who abuse prescription opioids or heroin.

He said his guess is that between 10 percent and 20 percent of adult Athens County residents suffer from some sort of opiate-related problem.

“It astounds me, and worries me, a lot,” he said.

Catherine Hill, director of Athens County Children Services, one of the agencies that will oversee the Ohio START program, said that her agency’s caseload has gone up significantly due to the rise in opioid abuse.

“Like many communities in Appalachia, Athens County has been hit very hard by the addiction epidemic,” she said.

Placements of children into the agency have increased significantly over the last few years, she said, with 20 percent more children in custody.

“We have younger children in care. They are staying in care longer. And the parents’ problems are very difficult to treat,” she said.

Placement costs for the agency have gone up 35 percent in three years, she added.

“We’re going to have intensive case management and wraparound services for children and families who are traumatized by substance abuse in our community,” she said. “We really do need to bring more resources and expertise to the region to address this terrible crisis for our children and families.”

Gay emphasized the important role that the federally funded, state-managed Medicaid program provides in paying for addiction treatment. He encouraged attendees of the conference to stress to their representatives in Congress the crucial role that Medicaid expansion under the Affordable Care Act has played in helping to address the opioid crisis.

The money used for addiction treatment will play a key role in the Ohio START program, funding specialists to oversee family cases.

Cornyn from the AG’s Office said that figures show that opiate addiction and drug addiction in general track alongside increases in child-welfare cases.

Funding for the Ohio START program will come from the statewide Victims Assistance Fund, she said.

Cornyn showed a slide photo from law enforcement of a little boy sitting in the backseat of a vehicle where both of his parents are slumped and passed out from drug abuse in the front seat.

“I don’t think anyone can look at this picture and try to say that this child is not a victim,” she said. “These children have suffered very severe trauma.”

The Ohio START program is therefore designed to serve the children first and foremost, she said.

“Our goal is to provide them with the trauma services and mental-health services that they need to deal with the trauma they have experienced,” she said.

It’s state of Ohio policy that children are best suited to live with their parents, she said, so in order that parents and children can be reunited, the parents must also deal with their own trauma and the often-resulting drug addiction.

The pilot program will last for two years, Cornyn said, which coincides with the time DeWine has left in office as AG through 2018.

Over the past six months, she said, the Ohio START program has been getting set-up. This has included training for involved professionals, trauma screening, cross-discipline training, creating and signing memorandums of understanding, and community education and outreach.

“We will be serving families with co-occurring child maltreatment and adult substance-abuse issues,” she said. “We’ll be integrating courts, child welfare and drug-addiction treatment.”

Courts and child-welfare agencies have a history of working together but adding in the drug-addiction treatment component is expected to add a positive result, she said.