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

Drug Overdose and Ohio’s Good Samaritan Law

Good Samaritan laws are meant to protect someone from legal liability when providing help to a person in distress. Ohio has had a Good Samaritan Law since 1977 to protect people from malpractice lawsuits when providing emergency medical and non-medical care to someone in need. This protection is not just for off-duty medical professionals but also for any citizen. This law does not protect someone who deliberately acts in a way that they know can cause further harm, or who accepts money, gifts, or any form or payment for helping.

Do you have to help someone in distress? Ohio does have a “duty to rescue” rule and requires you to help someone in distress if:

  • You are responsible for the welfare of a child. This includes parents, guardians, teachers, and any adult responsible for the child.
  • Your actions caused the danger.
  • You started to help – you must continue to help unless the situation changes to put you in danger.

In 2016, Ohio revised its Good Samaritan laws (Ohio Revised Code Section 2925.11) to encourage people to call 911 when they see someone who overdoses. What this law does is provide immunity for minor drug possession, amounts considered to be a misdemeanor or fifth-degree felony, to individuals who seek emergency help for themselves or another person during a drug overdose. The 911 operator receiving the overdose call can help explain this immunity if asked. You cannot be arrested or prosecuted if:

  • Law enforcement found the drugs as a result of seeking medical assistance for a drug overdose.
  • The person has a drug test and receives referral for treatment from an accredited addiction treatment program or professional within 30 days.
  • The person provides documentation, when requested by a prosecutor, verifying the date and time of the drug test and receiving the referral.

This immunity can be used twice and people on parole or probation are not eligible. The immunity is limited to possession of controlled substances. House Bill 205 is currently in the Ohio Legislature and, if approved, it will expand immunity to include drug paraphernalia.

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.

Introducing a New Needs Portal Staff Member

We are excited to announce a new Needs Portal staff member, Ian Murphy. Ian earned his MPH in Behavioral and Community Health Sciences from the University of Pittsburgh. He will be a liaison between Needs Portal users and the evaluation team. Ian will also be conducting Needs Portal training.

If you need to reach any of the Needs Portal staff, you can email us at needsportal@osu.edu.

Welcome to the team, Ian!

The OhioSTART Oct 2018 Interim Evaluation Report Reflects on Progress Made and Points to Future Directions

In early 2018, the OhioSTART intervention counties trained their employees on the new OhioSTART program and found partner agencies to implement the intervention. The purpose of the interim report is to evaluate OhioSTART thus far and confirm the project is in line with the long-term goals.

OhioSTART created a data use agreement with the Ohio Department of Jobs and Family Services to obtain SACWIS data and is in the process of analyzing that data. A plan for monitoring data fidelity is also in the development. The Needs Portal will be used for information management and data collection.

Front-line workers, supervisors, and administrators of OhioSTART were surveyed. The results of the survey showed there was an increase in collaboration between child welfare agencies and behavioral health agencies. The survey also found that family peer mentors bridged the gap between parents and child welfare agencies. When surveyed about OhioSTART training, some workers felt that they weren’t learning new information. OhioSTART parents were also surveyed. There was some difficulty getting the participants to respond, so it is necessary to continue to offer incentives.

The future for OhioSTART includes assessing the well-being of family peer mentors and the fidelity of interventions across sites, continue to encourage parents to participate in surveys, and monitor changes in child welfare outcomes – especially reunification.

You can find the full Oct 2018 report under “Publications” or click here.

OhioSTART Dashboard

OhioSTART is excited to announce that we now have a dashboard that gives you information on START cases in a way that’s easy to understand. You can find the Dashboard under the Evaluation menu or click here.

Information can be separated by county. Blue counties show data from Cohort 1 counties, orange shows Cohort 2 counties, and white counties are ones that are not a part of OhioSTART. Just click on the county you are interested in or choose one from the “Select County” drop-down menu, and the dashboard will only show data from that county. You can also hover over bar graphs for the exact number.

We will continue to add information to the Dashboard so that you can keep track of the cases and timelines. Feel free to contact us with the information you would like to see reflected in the Dashboard.

For more information, please refer to these two documents. The “Getting Started” document will help you start to navigate the Dashboard. The “Explaining the Numbers” document will help you better understand the data on the dashboard.

We are excited for you to see the progress OhioSTART is making!

 

NBC News Covers START in Fairfield County

“START targets the most at-risk kids in the county.”

“Fairfield County, Ohio’s Protective Workers used to almost automatically remove kids from the home if the parents were using drugs, but with 8 out of 10 cases of abuse and neglect, here, related to drugs (mainly opioids), and a severe shortage of foster care options, CPS workers in Ohio are trying a new approach to keep families together.” –NBC News

 (Click image to watch news story.)

image of a family with text "Program to Preserve Families in Opioid Ravaged Ohio"

People interviewed include:

  • Brittaney Pickerel – OhioSTART participant
  • Kitty Matson – Peer Supporter
  • Kristi Burre – Fairfield County Director of Child Protective Services

New! Needs Portal Training Videos

We know that many of you are already using the Needs Portal. We currently have 78 tickets logged by 9 different counties!

We hope that you are getting comfortable with the Needs Portal. To assist you, Elinam has just posted a set of videos guiding workers through the use of the Needs Portal. There are videos for caseworkers, family peer mentors, and service providers. In addition to the links below, you can access the videos from these two places:

  1. The Training Page of the this website
  2. The FAQ page available after you have logged into the Needs Portal.

For caseworkers

For Parent Mentors

For Service Providers

Please let us know of any additional training resources that would be helpful.

What Do Staff Think of OhioSTART?

During spring and summer 2018, the evaluation team conducted 16 interviews with various OhioSTART staff representing 6 counties, in order to assess perceptions of the program and guide further implementation.  Overall, the interviews reveal staff have positive perceptions of the OhioSTART model. While we are currently drafting a full report, we wanted to highlight some preliminary findings.

Bar Chart showing number and type of interview participants: 1 behavioral health provider, 4 child welfare caseworkers, 5 peer mentors, and 6 child welfare administrators.

OhioSTART is good for the child welfare system

  1. The model is influencing the child welfare system via an intensive, positive, and supportive approach to working with families experiencing substance use disorders and child welfare involvement.

“I think that it’s motivating for caseworkers to see that parents, some of which were involved with our agency, do recover. They’re able to get their children back.”

–Child Welfare Administrator

  1. Ohio START has resulted in increased and rapid communication and coordination of families’ services between child welfare staff and behavioral health providers.

“We are just having a lot more open communication with [AOD providers] than in the past and it is very helpful.”   

–Child Welfare Administrator

Peer Mentors are key to the success of the program

Peer Mentors are not only providing intensive and supportive services and modeling recovery for parents, but they are also a resource with experience of substance use disorders and a source of hope for child welfare staff.

“Having people who have walked that path (child welfare and substance disorder) for themselves as a model that it is possible to recover. It is possible to get your kids back. It is possible to have a healthy productive family life. It is possible. Recovery is possible and life is possible after. It’s not the end.”

–Behavioral Health Provider

Improvement can be made in services and implementation

  1. Interviewees also report additional service needs. For example, there is a reported shortage of inpatient behavioral health care for women, not enough housing in some communities and not enough child trauma services in some communities.
  2. Some interviewees note more of a planning period, as well as increased clarity on implementation and funding at the outset would have been helpful.
  3. Interviewees would like increased flexibility on when families can be included in OhioSTART.

Click here for a 2-page summary with more inspiring and helpful quotes.