Helping Substance-exposed Youngsters

Substance Abuse

New $3.9 million social services project to improve the well-being and safety of the youngest victims of substance abuse

In Penobscot and Piscataquis counties, children ages 5 and under whose families are struggling with substance abuse will have improved well-being and safety, and a better chance of staying in or returning to their own homes rather than remaining in foster care under a five-year, $3.9 million project led by the Bangor-based Families And Children Together (F.A.C.T.), the University of Maine School of Social Work, and a coalition of community organizations and agencies.

The Penquis Regional Linking Project: Building Quality Services for Rural and Frontier Communities will receive $797,405 annually for five years from the Administration for Children and Families, Children’s Bureau’s Promoting Safe and Stable Families program. The effort will involve at least 25 area service agencies, led by F.A.C.T. and Beverly Daniels, the executive director of F.A.C.T. Jennifer Middleton, a UMaine assistant professor of social work, is the lead researcher on the project and co-director of evaluation.

“I am especially excited about this project because it is an exciting step toward establishing important community-university partnerships and addressing an issue of paramount importance to our region of the state,” says Middleton, who joined the UMaine School of Social Work faculty in 2011.

“Through the implementation of a trauma-informed system of care and the utilization of other evidence-based practices, this project has the potential to strengthen the system of care for families affected by substance abuse, helping parents and caregivers access important resources and reducing the isolation and stigma often experienced by these families,” says Middleton, who will team in the project’s evaluation with Len Kaye, a UMaine professor of social work and director of the Center on Aging.

The project will address a particularly critical need in the Penquis region of the state — Penobscot and Piscataquis counties, and the Penobscot Nation, say the project coordinators. Maine has the highest opiate addiction rate per capita in the country at 386 per 100,000, compared to 45 per 100,000 for the U.S. and 131 for New England, according to Middleton. In addition, a recent and growing problem is the use of bath salts; of the state’s 152 bath salts overdoses in 2011, 30 percent were in Penobscot County.

The high opiate rate has resulted in a sharp increase in the number of babies born with intrauterine exposure to drugs, note the researchers. The statewide number has jumped from 165 babies affected in 2005 to 667 in 2011. Of those, 173 were opiate-exposed. At Eastern Maine Medical Center, the primary birthing hospital in the Penquis region, a third of all drug-exposed infants in Maine — 195 substance-affected newborns — were treated in 2011. And the numbers continue to climb significantly in the Penquis region: The first two quarters of 2012 statistics regarding substance-exposed infants at EMMC show a 20 percent projected increase for this year, compared to 2011, Middleton says.

The newly funded Penquis Regional Linking Project is a “community engaged” research project and one of the first of its kind in the nation to implement and evaluate a trauma-informed system of care for substance-exposed infants and their families.

A program, agency or system that is trauma-informed is aware of the widespread impact of trauma and understands potential paths for healing. It recognizes the signs of trauma in clients, staff and others touched by the system, and responds by integrating knowledge about trauma into policies, procedures and practices. Specifically, a trauma-informed approach reflects a cultural change among service providers, reflected in the shift of asking, “What happened to you?” rather than “What’s wrong with you?” The principles of trauma-informed care are especially applicable when working with families struggling with substance abuse, as a large majority of these families have a history of trauma and adverse childhood experiences.

In the Linking Project, a specially trained “navigator” will partner with families dealing with substance abuse issues to assess their strengths and needs, build formal and informal supports, and reduce barriers to accessing resources. Services will include individualized and group prenatal and parenting education, access to substance abuse screening, and assistance with transportation.

With such services in place, the youngest children in families struggling with substance abuse will not only be safer, but have a better chance of staying with their families and reducing their foster care system involvement, according to the project coordinators. Initially, an estimated 500 children up to age 5 and their parents or caregivers will receive navigator services, outreach and referral services, parenting education and trauma-informed family support.

Across the country, people are recognizing the profound impact of trauma on individuals, families and society, according to the researchers. The largest and most widely recognized epidemiological study on the prevalence of childhood trauma and its impacts on health and well-being over the life span is the Adverse Childhood Experiences (ACE) study conducted jointly by the Centers for Disease Control and Kaiser Permanente. More than 17,000 Kaiser HMO members completed a confidential survey, reporting surprising high levels of adverse childhood experiences: Physical abuse (28 percent); sexual abuse (22 percent); emotional abuse (11 percent); living with a person who is depressed, suicidal, or diagnosed with a mental illness (17 percent); having a drug addicted or alcoholic family member (27 percent); witnessing domestic violence against the mother (13 percent); loss of a parent to death or abandonment, including divorce (23 percent); incarceration of a family member (6 percent); and physical (19 percent) and emotional (15 percent) neglect. Their “ACE scores” were then correlated with a wide range of physical health, behavioral health and social conditions.

There were two major findings of the ACE study. First, ACEs are very common: 70 percent of subjects had one or more ACE, 25 percent had two or more, and one in six had four or more. Second, the impact of ACEs is cumulative: There is a significant positive relationship between adverse childhood experiences and a very wide range of adverse outcomes, including depression, hallucinations, panic and anxiety, flashbacks and dissociation, multiple somatic problems, sleep problems, impaired memory, smoking, obesity, suicide, self-injury, alcoholism and drug use, eating disorders, heart disease, autoimmune disease, lung cancer, chronic obstructive pulmonary disease, asthma, liver disease, skeletal fractures, sexually transmitted diseases, HIV/AIDS, and early death. The correlations between ACE scores and health and social problems in adulthood are very strong. Adverse childhood experiences affect adult health and well-being in two ways: They have a direct impact on the neurological development of the child, and they pre-dispose the individual to the use of coping strategies or behavioral adaptations that can cause physical and emotional problems.

The Linking Project will dovetail into the existing Penquis District Linking Partnership to build a family-focused, integrated trauma-informed service system to mitigate the negative effects that substance abuse has on children and families. The Linking Partnership was created approximately one and a half years ago as a regional network of healthcare organizations, child welfare organizations, social service agencies, kinship care service providers, substance abuse treatment providers, public health agencies, institutions of higher learning including UMaine and the University of New England, and three offices in the Maine Department of Health and Human Services: Substance Abuse, Child and Family Services and the Family Drug Court Project.

The Linking Project will enhance the partnership by collaborating with the Sanctuary Institute, a national agency based in Yonkers, N.Y., that helps organizations implement the trauma-informed, whole-system organizational approach known as the Sanctuary Model. Furthermore, the Linking Project will be informed by a national trauma advisory council, consisting of key trauma experts from across the country, selected by project coordinators for their unique expertise regarding trauma-informed care, participatory action and qualitative research methods, and measurement of trauma-informed systems change. All service delivery implementation and project evaluation efforts will also be informed by consumers, namely parents and kinship providers of substance exposed infants in the Penquis Region.

In addition to UMaine and F.A.C.T., other partnering agencies in the Linking Project include: Eastern Maine Medical Center; the Penobscot Nation; Wellspring Substance Abuse and Mental Health Services, Bangor Public Health Nurses; Maine Department of Health and Human Services, Office of Child and Family Services; Maine Department of Health and Human Services, Office of Substance Abuse; Maine Academy of Pediatrics; Maine Families; Maine Touchpoints Project; Helping Hands with Heart; Charlotte White Center; Acadia Hospital; Children’s Developmental Services; Children’s Growth Council; and WINGS.

Grants by the Administration for Children and Families, Children’s Bureau’s Promoting Safe and Stable Families program were awarded to regional partnerships that provide, through interagency collaboration and integration of programs and services, activities and services designed to increase the well-being of, improve permanency outcomes for, and enhance the safety of children who are in out-of-home placements or are at risk of being placed in out-of-home placements as a result of a parent’s or caretaker’s substance abuse. The National Child and Family Services Improvement and Innovation Act (Pub. L. 112-34) includes a new targeted grants program (section 437(f) of the Act), that directs the Secretary of Health and Human Services to reserve a specified portion of the appropriation for regional partnership grants to improve the well-being of children affected by substance abuse.

Contact: Jennifer Middleton, (207) 581-2408; Beverly Daniels, (207) 941-2347