Grandparents Raising Grandchildren: Opioid Prescribing Rate Matters

Research from the U.S. Census Bureau has found that states with higher opioid prescribing rates have higher numbers of grandparents raising grandchildren, even after taking into account other socio-economic factors such as poverty. Data from the 2012-2016 American Community Survey allowed researchers to study the relationship between opioid prescription rates at the state and county level and the number of grandparents raising grandchildren. The study found that opioid misuse was involved in 46% of cases where grandparents are caring for grandchildren in rural areas, compared to 32% in urban areas. Nationally, 32% of children in foster care are being raised by relatives with many more are being raised by relatives outside of the foster care system. Currently, 2.7 million grandparents are raising grandchildren. According to the Public Children Services Association of Ohio, about 100,000 grandparents are currently raising their grandchildren in Ohio.

Ohio is making progress in reducing its opioid prescribing rates, but rates are still high. Since 2010, Ohio’s overall opioid prescribing rate has dropped from 102.4 to 63.5 per 100 persons, which is still higher than the national rate of 58.7. Cuyahoga is the only urban county, at 50.1 per 100 persons, have an opioid prescribing rate lower than the national rate. In rural counties, the prescribing rate ranges from Nobel the lowest (17.8) to Jackson the highest (112.5). Ohio continues to be challenged by the misuse of opioids with the second-highest opioid overdose death rate of 39.2 deaths per 100,000 persons.

Grandparents raising grandchildren face many special challenges including mental health concerns for themselves and their grandchildren due to the death or temporary loss of their grandchild’s parent (their son or daughter), financial obligations, navigating the school system, and building networks of social and other supports. To respond to the impact of the opioid crisis on grandparents, the federal government enacted The Supporting Grandparents Raising Grandchildren Act in July of 2019. The act created a federal task force to identify and share information to help grandparents raising grandchildren.

Anderson, L. (2019). The opioid prescribing rate and grandparents raising grandchildren: State and county-level analysis. Retrieved from https://www.census.gov/content/dam/Census/library/working-papers/2019/demo/sehsd-wp2019-04.pdf

Centers for Disease Control and Prevention. (2017). U.S. Opioid Prescribing Rate Maps | Drug Overdose | CDC Injury Center. Retrieved May 31, 2019, from https://www.cdc.gov/drugoverdose/maps/rxrate-maps.html

Cole, P. E., Clausen, K. A., Cook, L., Johanson, M., Cunliffe, J., Associate, R., Rostan, M. (2016). 2016 state of poverty: A portrait of Ohio families. Retrieved from www.oacaa.orgwww.researchpartners.org

National Institute on Drug Abuse (NIDA). (2019). Opioid summaries by state. Retrieved May 31, 2019, from https://www.drugabuse.gov/drugs-abuse/opioids/opioid-summaries-by-state

Public Children Services Association of Ohio. (2019). PCSAO – Factbook. Retrieved May 31, 2019, from http://www.pcsao.org/factbook

Take Home Naloxone Programs for Family Members

Learn to Cope is a support group based in Massachusetts for family members of people who primarily use opioids. The goals of this group are to increase knowledge about overdoses, conduct prevention trainings, and provide naloxone rescue kits (OEN). The objective of this study was to describe the benefits and motivations of family members who receive OEN and specify the frequency of naloxone used during an overdose rescue.

OEN began in 2007 and soon became one of the first organizations to offer OEN training. OEN training lasts about 20 minutes and includes education on how to recognize and respond to an overdose. The program emphasizes the importance of involvement from family members and provides potential opportunities to save lives.

The cross-sectional study provided OEN training at eight different sites. Participants completed a survey at the end of the 20 minute training to assess experience with overdose and motivation to receive OEN.

Among the 126 individuals with complete survey data, 52% financially supported their loved one and 50% reported daily contact. Those who received the OEN training were more likely to be a parent, apply to court-mandated treatment, attend more meetings, and witness an overdose. 72% of trainees reported wanting to have a naloxone kit in the household, and 57% heard about the benefits from other Learn to Cope members.

Trainees reported a greater sense of security, improved confidence to handle an overdose, and a greater understanding of overdose prevention and management. 22% of participants did not want OEN due to believing the training was not necessary or that they would not use the kit. Thirty-seven participants reported they had witnessed an overdose, and five participants administered naloxone to a family member or stranger after being trained through Learn to Cope. Due to the use of the naloxone kit, 4 of 5 overdoses restored breathing and individuals were responsive until an ambulance arrived.

Policymakers should consider mobilizing family members as part of the response to the opioid overdose epidemic and make efforts to empower family members who might feel stigmatized and isolated. OEN programs at support groups should be considered a part of an overdose prevention public health strategy. Programs such as these have the potential to provide education which could lead in an increase in confidence, and reduce the likelihood of fatal opioid overdoses.

Bagley, S. M., Peterson, J., Cheng, D. M., Jose, C., Quinn, E., O’Connor, P. G., & Walley, A. Y. (2015). Overdose Education and Naloxone Rescue Kits for Family Members of Individuals Who Use Opioids: Characteristics, Motivations, and Naloxone Use. Substance abuse36(2), 149–154. doi:10.1080/08897077.2014.989352

Examining Child Trauma Knowledge Among Kinship Caregiver

Kinship care placements have become an important part of the child welfare system due to the lack of adequate foster care homes for maltreated youth. Kinship care is generally defined as providing full-time nurturing and protected care to a child by relatives or those who have “family-like” relationships with a child. These relationships are often categorized into formal or informal arrangements. Formal arrangements involve public child welfare agencies arranging legal custody of children, while informal arrangements exclude government involvement.

In recent years, more research has studied the lasting effects of trauma for maltreated youth. As a result, the Substance Abuse and Mental Health Services Administration (SAMHSA) has made efforts to develop models of trauma-informed care. Also, child welfare agencies have been offering trauma-informed parenting programs. Unfortunately, there have been few programs specific for kinship caregivers, leaving questions about what kinship caregivers know about childhood trauma. A recent study examined three research questions: 1) “How do kinship caregivers perceive their knowledge and the knowledge of other kinship caregivers about child trauma?”, 2) “What are the relationships between kinship caregivers’ knowledge about child trauma, reported demographic characteristics, and background training in child trauma?”, and 3) “Is there a difference in kinship caregivers’ perceived knowledge and actual knowledge about child trauma?”.

In the study, researchers collected data from 130 kinship caregivers through online surveys that included the definition of child trauma, training about child trauma and its effectiveness, and both perceived and actual knowledge of child trauma. The vast majority of the caregivers were grandparents (n= 111), while 19 identified as an aunt or uncle to the child. To assess how helpful the training was in understanding child trauma, participants were asked to rank on a Likert-type scale as 1=” Very Unhelpful and 5=” Very Helpful”. Results showed that participants rated their self-knowledge and perceived knowledge of child trauma higher after given more exposure to child trauma training.

Most of the participants in the study were White (95.4%) and about 87% were married. Descriptive findings also indicated that on average, participants had been in a kinship care-giving role for nearly five years. The study suggests that most kinship caregivers (90%) receive some training about child trauma, and that many caregivers knew more about trauma than they thought. However, some groups of kinship caregivers knew more than others, caregivers who were more educated knew more about child trauma.

Agencies are considering mandating trauma assessments to children entering kinship care to ensure a minimum level of understanding. This study, one of the first to focus on this important topic, suggests that these trainings can be helpful for kinship caregivers’ knowledge about trauma, which may improve the lives of the children that they care for.

Reference:

Miller, J., Koh, E., Niu, C., Bode, M., & Moody, S. (2019). Examining child trauma knowledge among kin caregivers: Implications for practice, policy, and research. Children and Youth Services Review, 100, 112-118.

Peer Recovery Support Services: Helping Child Welfare Families with Substance Use Disorder

Parents involved with child welfare that have substance use (SUD) are often engaged with multiple systems including child welfare, SUD treatment, and the courts. To help families navigate these services and requirements, they can be assigned a Family Peer Mentor (FPMs). What is an FPM, what do they do, and are they helping families with parental SUD stay together?

An FPM is someone in long-term SUD recovery1 who also has experience with the child welfare system. They also complete a certification training program1 to learn how to apply their own experiences to help other families. The FPM is the family advocate, connecting the family to needed services and as emotional support promoting sober parenting. The relationship between the FPM and the family is collaborative with the shared goal of achieving parental sobriety and family safety and stability. FPMs are uniquely positioned not only to help families navigate the child welfare system, but also to provide the hope and motivation needed to achieve and maintain sobriety.

To better understand how FPMs help child welfare involved families, a study2 was conducted of the services and outcomes of 28 FPMs involved in the Sobriety Treatment and Recovery Teams (START) in Kentucky. Each FPM was partnered with one child welfare caseworker, and this FPM/caseworker team served 12-15 families. This study shows the importance of FPMs in promoting family unification and parent sobriety:

FPM Study ResultsThe study also highlights the importance of supporting FPMs’ own sobriety as they transition from child welfare client to an employee supporting families through a very stressful situation. Of the 28 FPMs, 10 had a relapse or other ethical/policy violation that resulted in their removal; however, the remaining 18 FPMs realized stability and growth either with the child welfare agency or with other, more advanced positions.

With the goal of parental sobriety and family unification, the use of FPMs shows excellent promise. Kentucky START and programs using FPMs or peer supporters are not only helping families; these programs are keeping more children from entering out-of-home care while also giving individuals in recovery an opportunity for steady, full-time employment that appreciates their child welfare and SUD experience to help others.

1Click here for more information on The Ohio Department of Mental Health and Addiction Services (OhioMHAS) certification for Peer Recovery Supporters in Ohio: (https://workforce.mha.ohio.gov/Workforce-Development/Job-Seekers/Peer-Supporter-Certification).

2Huebner, R. A., Hall, M. T., Smead, E., Willauer, T., & Posze, L. (2018). Peer mentoring services opportunities and outcomes Huebner 2018.pdf. Children & Society, 84, 239–246.