proactive steps in addressing the misuse of opioids · 2018. 5. 25. · establishing a taskforce...
TRANSCRIPT
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The Infant/Toddler & School-Age Child Care Institute
Proactive Steps in Addressing
the Misuse of Opioids
Child Care State Capacity Building Center
National Center on Early Childhood Health and Wellness
National Center on Tribal Early Childhood Development
May 23, 2018
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Action Plan
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Let’s Get to Know You!
Please tell us your name, role and
interest in this topic.
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Outcomes of Today’s Session
Build awareness of the seriousness of
this epidemic in the United States.
Consider the impact of opioid misuse on
children and their caregivers.
Identify strategies to support children and
families.
Share resources and state examples.
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Connecting to CCDF Plans
Priority of HHS/ACF
Subsidy policy
Examples:
12 month eligibility for foster care/protective services
Increased caseloads for Family Care/Grandparents
Partnerships with other agencies
Professional development
High quality child care for low-income children
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Have you worked with a family or
child affected by opioid misuse?
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Source: U.S. Department of Health and Human Services. The opioid epidemic by the numbers. Retrieved April
11, 2018, from https://www.hhs.gov/opioids/about-the-epidemic/
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https://www.hhs.gov/opioids/about-the-epidemic/
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What We Know about the Opioid
Misuse
Roughly 21 percent to 29
percent of patients prescribed opioids
for chronic pain misuse them.
Between 8 percent and 12 percent
develop an opioid use disorder.
Approximately 80 percent of people who use heroin
first misused prescription
opioids.
National Institute on Drug Abuse, National Institutes of Health, U.S. Department of Health and Human Services.
(2018). Opioid overdose crisis [Web page]. Retrieved April 11, 2018, from https://www.drugabuse.gov/drugs-
abuse/opioids/opioid-overdose-crisis
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https://www.drugabuse.gov/drugs-abuse/opioids/opioid-overdose-crisis
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Source: National Institute on Drug Abuse, National Institutes of Health, U.S. Department of Health and Human Services. (2018). Opioid summaries by
state [Web page]. Retrieved April 11, 2018, from https://www.drugabuse.gov/drugs-abuse/opioids/opioid-summaries-by-state
1. Opioid overdose deaths are identified using underlying cause-of-death codes X40–X44, X60–X64, X85, and Y10–Y14. Opioid overdose deaths as
defined, that have T40.1 (Heroin), T40.2 (Other opioids), T40.3 (Methadone), T40.4 (Other synthetic narcotics), T40.6 (Other and unspecified
narcotics) as a contributing cause. Age-adjusted death rates were calculated as deaths per 100,000 population using the direct method and the 2000
standard population. Source: The Centers for Disease Control and Prevention, CDC WONDER.
2. Xponent, IMS Health, Plymouth Meeting, PA Copyright 2016 as published by the Medical Association of Georgia State and National Totals of Filled
Prescriptions-All Opioid Analgesics.
Opioid-Related Overdose Death Rates
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https://www.drugabuse.gov/drugs-abuse/opioids/opioid-summaries-by-statehttps://wonder.cdc.gov/controller/datarequest/D77;jsessionid=EEFE79AB3A44A9DAE45325C2A6B966A8https://www.mag.org/georgia/UploadedFiles/prescriptions-filled-chart.pdf
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Source: National Institute on Drug Abuse, National Institutes of Health, U.S. Department of Health and Human Services.
(2018). Opioid summaries by state [Web page]. Retrieved April 11, 2018, from https://www.drugabuse.gov/drugs-
abuse/opioids/opioid-summaries-by-state
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Opioid-Related Overdose Death Rates
https://www.drugabuse.gov/drugs-abuse/opioids/opioid-summaries-by-state
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What is neonatal abstinence
syndrome?
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Neonatal Abstinence Syndrome (NAS)
Every 15 minutes, a baby is
born suffering from NAS
Five times as many babies
were born with NAS in 2009
as in 2000.
The average hospital stay in
2012 for infants exposed to
substances was 16.9 days,
compared to an average of
2.1 days for an infant not
exposed to drugs
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Source: Winkelman, T.N., Villapiano, N., Kozhimannil, K.B.,
Davis, M.M., Patrick, S.W., Incidence & Costs of Neonatal
Abstinence Syndrome among Infants with Medicaid: 2004-
2014, Pediatrics published online: March 23, 2018 (doi:
10.1542/peds.2017-3520). Funded by NIDA K23DA038720.
http://pediatrics.aappublications.org/content/early/2018/03/21/p
eds.2017-3520
Retrieved May 8, 2018 from: https://www.vumc.org/nas/
http://pediatrics.aappublications.org/content/early/2018/03/21/peds.2017-3520https://www.vumc.org/nas/
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Symptoms of NAS
Body shakes (tremors), seizures (convulsions),
overactive reflexes (twitching) and tight muscle tone
Fussiness, excessive crying, or having a high-pitched cry
Poor feeding or sucking or slow weight gain
Breathing problems, including breathing really fast
Fever, sweating or blotchy skin
Trouble sleeping and lots of yawning
Diarrhea or throwing up
Stuffy nose or sneezing
Excerpted from March of Dimes. (2017). Neonatal abstinence syndrome [Web page]. Retrieved April
11, 2018, from https://www.marchofdimes.org/complications/neonatal-abstinence-syndrome-
(nas).aspx
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https://www.marchofdimes.org/complications/neonatal-abstinence-syndrome-(nas).aspx
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Possible Impact on the Development of Young
Children
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Summary of Effects of Prenatal
Exposure
Source: Adapted from Behnke, M., Smith, V. C., Committee on Substance Abuse, & Committee on Fetus
and Newborn. (2013). Prenatal substance abuse: Short- and long-term effects on the exposed fetus.
Pediatrics, 131(3), 1009–24. Retrieved from http://pediatrics.aappublications.org/content/131/3/e1009.full
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http://pediatrics.aappublications.org/content/131/3/e1009.full
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Potential Impact on 1–5 Year-Olds
A toddler or preschooler who has been exposed to opiates
may experience one or more of the following symptoms:
Mental and motor deficits
Cognitive delays
Hyperactivity
Impulsivity
Attention deficit disorder (ADD)
Behavior disorders
Aggressiveness
Less social responsivity or poor social engagement
Failure to thrive (socially)
Short stature
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Excerpted from Intervention IDEAs for infants, toddlers, children, and youth impacted by opioids.
Retrieved from https://osepideasthatwork.org/sites/default/files/IDEAslIssBrief-Opioids-508.pdf
https://osepideasthatwork.org/sites/default/files/IDEAslIssBrief-Opioids-508.pdf
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Potential Impact on School-Age Children (includes multiple substances, not just opioids)
Impaired verbal performance, reading, and
arithmetic skills
Poor mental and motor development
Memory and perception problems
Attention deficit hyperactivity disorder (ADHD)
Developmental delays
Impaired self-regulation
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Behnke, M., Smith, V. C., Committee on Substance Abuse, & Committee on Fetus and Newborn. (2013). Prenatal
substance abuse: Short- and long-term effects on the exposed fetus. Pediatrics, 131(3), e1009-e1024. Retrieved
from http://pediatrics.aappublications.org/content/131/3/e1009
http://pediatrics.aappublications.org/content/131/3/e1009
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School absence, failure
Low self-confidence
Depressive disorder
Substance use disorder
Speech problems
Language disorders
Potential Impact on School-Age Children (includes multiple substances, not just opioids)
Behnke, M., Smith, V. C., Committee on Substance Abuse, & Committee on Fetus and Newborn. (2013).
Prenatal substance abuse: Short- and long-term effects on the exposed fetus. Pediatrics, 131(3), e1009-
e1024. Retrieved from http://pediatrics.aappublications.org/content/131/3/e1009
http://pediatrics.aappublications.org/content/131/3/e1009
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What strategies can you use to support
caregivers in providing care for children
born substance exposed?
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What we can do:
Explore opportunities to
provide training on trauma-
informed care to providers
Explore resources in the
community for support in
trauma-informed care and
practices
Connect with coaches and
mentors to support providers
on an ongoing basis
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Working with Providers
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Using Relationship-Based Practices
Establishing strong relationships with and recognizing
strengths of the parent or primary caregiver:
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Primary caregiving: The care of each
infant or toddler is assigned to one
specific infant and toddler caregiver
who is principally responsible for that
child in the care setting
Individualized care: Being responsive
and adapting to the unique cues and
temperament of each child to support
a healthy sense of self and optimal
development
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Providing Care for Infants with NAS
Decrease environmental stimuli
Holding, swaddling
Feeding, non-nutritive sucking
Encourage breastfeeding
Caregiver wellness
Integration of sensory stimulation
Most important …
Be attuned to the infant and adjust to his or her responses to touch
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Partnering with your state on training
Accessing child care resource and referral agencies
for strategies and informed care
Collaborating with Indian Health Services and local
health services for training
What we can do
Support follow-up care
Policy and procedure changes
Case management
Mental health consultation
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Training for Providers
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Training on Screening and Surveillance
Observation—focused and attuned
Developmental screening tools and
protocols
Responsive practices for gathering family
information
Sensitive, strengths-based communication
with families
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Community Support
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How local and tribal communities address the opioid crisis by training together as a community
What we can do:
Engaging in strategic planning to address this crisis
Promoting community engagement and awareness
Establishing a taskforce
Providing mentoring programs for youth
Connecting to integrated behavioral health and substance use disorder services
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How can we support the families and
caregivers affected by opioids?
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Support for Families and Caregivers
What we know:
Increase of opioid misuse has significantly affected the child
welfare system
Infants are coming into protective custody at alarming rates
Grandparents are becoming primary caregivers for a second
time
What we can do:
Increase family engagement strategies
Provide family and peer-to-peer support opportunities
Connect with comprehensive services
Use infant–early childhood mental health consultation
Use language and communication that reduce stigma
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Foster Care
Source: Children’s Bureau, Administration on Children, Youth and Families, Administration for Children
and Families, U.S. Department of Health and Human Services. (2017). The AFCARS report. Retrieved
from https://www.acf.hhs.gov/sites/default/files/cb/afcarsreport24.pdf
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0
10,000
20,000
30,000
40,000
50,000
60,000
Lessthan 1year
1 year 2 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years 10 years
Children Entering Foster Care by Age (2016)
Children Entering Foster Care by Age (2016)
https://www.acf.hhs.gov/sites/default/files/cb/afcarsreport24.pdf
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Impact on Grandparents/Relative Care
Approximately 2.5 million children are being raised by
grandparents or are in kinship care with no birth parents in
the home.
This is 3 percent of all children.
Approximately 29 percent of children in foster care
(120,000+) are being raised by relatives.
Generations United. (2016). Raising the children of the opioid epidemic: Solutions and support for grandparents.
Retrieved from http://gu.org/Portals/0/documents/Reports/16-Report-State_of_Grandfamiles.pdf29
For every child in foster care with a
relative, there are 20 children being
raised by grandparents or family
members outside the foster care
system.
http://gu.org/Portals/0/documents/Reports/16-Report-State_of_Grandfamiles.pdf
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How We Can Support these Families and
Engage in Comprehensive Services
Strengthening Families
Medical homes
Recovery-oriented systems
Home visitation
Early Head Start
Early intervention
Community resources
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https://www.cssp.org/young-children-their-families/strengtheningfamilies
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Providing Comprehensive Mental Health
and Prevention Services
Infant and early childhood mental health care and consultation
services
Interventions that are attachment-based and focused on
caregiver-child relationships
Child-parent psychotherapy (CPP)
Parent-child interaction therapy (PCIT)
Caregiver skills training
Incredible Years training for parents
Promoting First Relationships
Brazelton Touchpoints
Trauma-informed care 31
http://www.incredibleyears.com/programs/parent/
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Parent, Family, and Community
Engagement Framework
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Source: Early Childhood Learning & Knowledge Center. (2017). Parent, family, and community
engagement framework: Head Start approach to school readiness. Retrieved from
https://eclkc.ohs.acf.hhs.gov/school-readiness/article/parent-family-community-engagement-framework
https://eclkc.ohs.acf.hhs.gov/school-readiness/article/parent-family-community-engagement-framework
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How are states working on this
issue?
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Massachusetts
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“Proactive Steps in Addressing the Opioid Crisis- Local and
Regional Initiatives”OCC Infant/Toddler School Age
Institute
Carol Nolan and Anne HemmerMay 23, 2018
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MA Head Start State Collaboration Director, Carol Nolan and the Region 1 Head Start Training and Technical Assistance Systems Specialist, Anne Hemmer, partnered with a Southeastern MA Head Start program to plan a ‘pilot opioid project’ – Fall 2016
Developed a framework for the pilot that included:
1. Grantee collaborate with community partners and ensure diverse community representation for the pilot
2. Support Head Start grantee management team with resources and best practices that can support their program staff to work with children and families impacted by the opioid crisis
3. Utilize strategies/community partnership building efforts developed by grantee to share with other MA Head Start programs
4. Partner with state agencies, National Centers and national organizations to review existing research and resources to share best practices
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Initial Opioid Pilot Project
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Ongoing meetings with Head Start Director and Management team to discuss current work/progress of priorities for the work to be undertaken.
The program chose to do some of the following activities:
Conduct a staff survey to assess type of resources, trainings and supports they would find helpful in addressing the opioid epidemic
Assess availability of agencies/resources in community involved in this work and develop collaborations
Develop a toolkit of practices and resources/trainings specific to their community/state
Promote process to continue support to frontline staff with use of a coach/mentor/support groups to enhance sustainability
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Opioid Pilot Project 2016-2017
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RESOURCE and TRAINING NEEDS: Information from Head Start Grantees
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Head Start Collaboration Directors and Head Start State Associations were asked by the OHS to reach out to the grantees in their state regarding the opioid crisis.
Responses from many grantees reflected the need for resources and training for staff working with children and families in their community affected by opioid/substance use issues.
Many grantees expressed the need for staff training on how to recognize when families are affected and how to support those families.
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OHS Region 1 needs
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Opioid Addiction
Finding 2: Programs reported that staff were less confident in identifying children and families impacted by opioid addiction than other areas.
(scale- not to little to somewhat to very confident)
0 1 2 3 4
Identifying children andfamilies impacted by opioid
addiction.
Making referrals to servicesthat support children and
families impacted by opioidaddiction.
Helping families navigateservices for children and
families impacted by opioidaddiction.
Partnering with communityhealth agencies on
addressing issues of opioidaddiction.
MA HSSCO Needs Assessment 2016
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Opioid Addiction
Finding 4: Programs desired to be connected to community resources, or provided toolkits that could assist them in dealing with issues surrounding opioid addiction.
(scale- prioritize least to most important)
0 1 2 3 4
Learning about otherinitiatives in statewideor national programs
that address the opioidcrisis (not Head Start).
Learning about otherinitiatives in Head StartPrograms that address
the opioid crisis.
Developingresources/toolkits to
support program staff indealing with the opioid
crisis.
Connecting programs tocommunity resources
that address the opioidcrisis.
MA HSSCO Needs Assessment 2016
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Attended “Improving the Care of Mothers, Infants and Families Impacted by Perinatal Opioid Use in Massachusetts: A Statewide Initiative” September 2017 (PN QIN)
National Center on Health and Wellness- calls with Amy Hunter to update progress and share information of MA opioid/substance use projects
Presented OCC New England Health and Wellness call – September 2017
Attended “Improving Outcomes for Women, Infants, and Children Affected by Opioids” November 2017 (Southcoast Health )
Presented at Region 1 OHS, T/TA Network and Collaboration Directors and EEC’s Regional Directors meeting - December 2017
Convened Head Start Grantees Focus Groups: with Early Intervention, MHVI, DPH,EEC Coordinated Family Community Engagement (CFCE), ECMH, Learn to Cope -Winter/Spring 2018
Attended Washington Post Event : “Addiction in America” Boston - Winter 2018
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Trainings and Collaborations
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September 2017- Met with MA EI/MHVI/DPH/EEC to discuss program needs
October 2017- Met with EEC Regional Directors to plan trainings
Fall 2017- Share staff survey results with National Center on Health and Wellness-conduct bi-monthly calls to share ongoing work/resources
Two MA Focus groups Western MA December 2017 and Southeastern MA January 2018 - Head Start/Early Head Start grantees, state partners and community agencies to share challenges, success and resources
April 3rd “Kick-off training” with Lt. Governor, OHS & OCC-“Supporting Families and Young Children affected by Opioid and Substance Use: Bridging Systems and Services”
March- May 2018 - Conduct 6 MA trainings for HS management/social service/EI/MHVI/CFCE grantees
Spring 2018 Presentation at NEHSA conference
Continue to gather resources/training information and share successful efforts-local/regional/national
Ongoing Related Work
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Carol Nolan, MA Head Start State Collaboration Director
[email protected] 617 988-7816
Anne Hemmer, Systems Specialist, NE Head Start T/TA Network
[email protected] 617 413-2399
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Contact Information
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Frequently asked questions (FAQs)
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Training
How do we access training for staff working with
children and families affected by opioid issues?
Baseline training on effective communication
and appropriate language to use
Recovery-oriented support training
Recognizing the signs and symptoms of opioid
misuse and substance use disorders
Recognizing and addressing the social and
behavioral impact of opioid misuse and
substance use disorders on children and
families 45
FAQs
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Support
How do we provide long-term support for
families throughout the treatment and recovery
process?
What are effective program policies related to
involving law enforcement and child protective
services regarding children placed at significant
risk by opioid misuse or substance use
disorders?
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FAQs
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Substance Abuse and Mental Health
Services Administration (SAMHSA) Opioid
Treatment Program Directory
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Substance Abuse and Mental Health Services Administration (SAMHSA), Division of Pharmacologic
Therapies. (n.d.). Opioid treatment program directory [Online tool]. Retrieved from
http://dpt2.samhsa.gov/treatment/directory.aspx
http://dpt2.samhsa.gov/treatment/directory.aspx
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What resources are available?
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What are the resources in my state?
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Principles of Substance Abuse Prevention
for Early Childhood
“Research supports the value of
interventions that reduce risk
factors, promote protective factors,
and increase access to resources
(e.g., school- and community-
based family support services) in
the lives of young children and
those closest to them.”
50
National Institute on Drug Abuse, National Institutes of Health. (n.d.). Principles of substance abuse prevention
for early childhood [Web page, last updated March 2016]. Retrieved May 7, 2018, from
https://www.drugabuse.gov/publications/principles-substance-abuse-prevention-early-childhood/index
https://www.drugabuse.gov/publications/principles-substance-abuse-prevention-early-childhood/index
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Principle 1: Intervening early in childhood can
alter the life course trajectory in a positive
direction.
Principle 2: Intervening early in childhood can
both increase protective factors and reduce risk
factors.
Principle 3: Intervening early in childhood can
have positive long-term effects.
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Principles of Substance Abuse Prevention
for Early Childhood
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Principle 4: Intervening in early childhood can
have effects on a wide array of behaviors.
Principle 5: Early childhood interventions can
positively affect children’s biological
functioning.
Principle 6: Early childhood prevention
interventions should target the proximal
environments of the child.
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Principles of Substance Abuse Prevention
for Early Childhood
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Principle 7: Positively affecting a child’s behavior
through early intervention can elicit positive
behaviors in adult caregivers and in other
children, improving the overall social
environment.
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Principles of Substance Abuse Prevention
for Early Childhood
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Opioid education resources
Available in English and Spanish
Resources intended to assist schools in addressing
the opioid issue
Elementary school
Digital lesson
Educator guide
Activities
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Prevention First. (n.d.). Opioid education resources [Online tool]. Retrieved from
https://www.prevention.org/Professional-Resources/Opioid-Education-Resources/
https://www.prevention.org/Professional-Resources/Opioid-Education-Resources/
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Classroom resources to help combat the
opioid crisis.
Operation Prevention’s mission is to educate
students about the true impacts of opioids and
kick-start lifesaving conversations in the home
and classroom. They offer resources you can
use in your district or classroom, and at home.
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Discovery Education. (n.d.). Classroom resources to help combat the opioid crisis [Online tool]. Retrieved from
http://blog.discoveryeducation.com/blog/2017/10/27/classroom-resources-to-help-combat-the-opioid-crisis/
https://www.operationprevention.com/http://blog.discoveryeducation.com/blog/2017/10/27/classroom-resources-to-help-combat-the-opioid-crisis/
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Preventing or Reducing Opioid Abuse and
Overdose: Selected Resources
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Resources
Center for the Application of Prevention Technologies, Substance Abuse and Mental Health Services Administration.
(n.d.). Preventing or Reducing Opioid Abuse and Overdose: Selected Resources [PDF resource]. Retrieved from
https://www.samhsa.gov/capt/sites/default/files/resources/preventing-reducing-opioid-abuse-overdose.pdf
https://www.samhsa.gov/capt/sites/default/files/resources/preventing-reducing-opioid-abuse-overdose.pdf
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Resources
Early Childhood Learning and Knowledge Center, Substance Abuse,
https://eclkc.ohs.acf.hhs.gov/mental-health/article/substance-misuse
HealthReach’s low-literacy patient materials about opioids, opioid addiction, and
opioid treatment (includes documents, videos, and audio),
https://healthreach.nlm.nih.gov/patient-material-
results?keywords=opioids&btnsearch=Search&author=&language=&format=&user=&
records=10
The National Center on Substance Abuse and Child Welfare web page Infants with
Prenatal Substance Exposure, https://ncsacw.samhsa.gov/resources/substance-
exposed-infants.aspx
The National Center on Substance Abuse and Child Welfare web page Neonatal
Abstinence Syndrome, https://ncsacw.samhsa.gov/resources/opioid-use-disorders-
and-medication-assisted-treatment/neonatal-abstinence-syndrome.aspx
The SAMHSA Center for the Application of Prevention Technologies’ CAPT
Resources to Prevent the Non-Medical Use of Prescription Drugs, Opioid Misuse,
and Opioid Overdose, https://www.samhsa.gov/capt/tools-capt-learning-
resources/capt-resources-support-opioid-misuse-overdose-prevention
The U.S. Office of Special Education’s Programs Intervention IDEAs for Infants,
Toddlers, Children, and Youth Impacted by Opioids,
https://osepideasthatwork.org/sites/default/files/IDEAslIssBrief-Opioids-508.pdf57
https://na01.safelinks.protection.outlook.com/?url=https://eclkc.ohs.acf.hhs.gov/mental-health/article/substance-misuse&data=02|01|[email protected]|f721343f0efe460319a408d5bcf6e069|686a5effab4f4bad8f3a22a2632445b9|0|0|636622690872066700&sdata=xvWtrKAQSTqyYDMYW7Qd%2BI7qdOJ50OFXdwvkQCyLqaA%3D&reserved=0https://healthreach.nlm.nih.gov/patient-material-results?keywords=opioids&btnsearch=Search&author=&language=&format=&user=&records=10https://ncsacw.samhsa.gov/resources/substance-exposed-infants.aspxhttps://ncsacw.samhsa.gov/resources/opioid-use-disorders-and-medication-assisted-treatment/neonatal-abstinence-syndrome.aspxhttps://www.samhsa.gov/capt/tools-capt-learning-resources/capt-resources-support-opioid-misuse-overdose-preventionhttps://osepideasthatwork.org/sites/default/files/IDEAslIssBrief-Opioids-508.pdf
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Infant/Toddler Resource Guide
Child Care State Capacity Building Center, a service of the Office of Child Care, Administration for Children and
Families (ACF), U.S. Department of Health and Human Services. (n.d.). Infant/toddler resource guide [Webpage].
Retrieved from https://childcareta.acf.hhs.gov/infant-toddler-resource-guide
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https://childcareta.acf.hhs.gov/infant-toddler-resource-guide
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Questions and Next Steps
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Presenter Contact Information
Shana Bellow
Barbara Buckshot-Jock
Jeanne VanOrsdal
mailto:[email protected]:[email protected]:[email protected]
Proactive Steps in Addressing the Misuse of OpioidsProactive Steps in Addressing the Misuse of OpioidsAction PlanLet’s Get to Know You! Outcomes of Today’s Session Connecting to CCDF PlansHave you worked with a family or child affected by opioid misuse? The Opioid Epidemic by NumbersWhat We Know about the Opioid MisuseOpioid-Related Overdose Death RatesOpioid-Related Overdose Death RatesWhat is neonatal abstinence syndrome? Neonatal Abstinence Syndrome (NAS)Symptoms of NAS Possible Impact on the Development of Young ChildrenSummary of Effects of Prenatal ExposurePotential Impact on 1–5 Year-OldsPotential Impact on School-Age Children (includes multiple substances, not just opioids) Potential Impact on School-Age Children (includes multiple substances, not just opioids) What strategies can you use to support caregivers in providing care for children born substance exposed? Working with ProvidersUsing Relationship-Based PracticesProviding Care for Infants with NASTraining for ProvidersTraining on Screening and Surveillance Community SupportHow can we support the families and caregivers affected by opioids? Support for Families and CaregiversFoster CareImpact on Grandparents/Relative CareHow We Can Support these Families and Engage in Comprehensive ServicesProviding Comprehensive Mental Health and Prevention ServicesParent, Family, and Community Engagement FrameworkHow are states working on this issue? Massachusetts “Proactive Steps in Addressing the Opioid Crisis-Local and Regional Initiatives”OCC Infant/Toddler School Age InstituteInitial Opioid Pilot ProjectOpioid Pilot Project 2016-2017OHS Region 1 needsOpioid Addiction Opioid Addiction Trainings and CollaborationsOngoing Related WorkContact InformationFrequently asked questions (FAQs)FAQsFAQsSubstance Abuse and Mental Health Services Administration (SAMHSA) Opioid Treatment Program DirectoryWhat resources are available? What are the resources in my state?Principles of Substance Abuse Prevention for Early ChildhoodPrinciples of Substance Abuse Prevention for Early ChildhoodPrinciples of Substance Abuse Prevention for Early ChildhoodPrinciples of Substance Abuse Prevention for Early ChildhoodPrevention First ResourcesDiscoverty Education ResourcesResourcesResourcesInfant/Toddler Resource Guide Questions and Next StepsPresenter Contact Information