The Opioid Crisis: What Can Be Done for the Children The Opioid Crisis: What Can Be Done for the Children? Treating the children and the mother together Evette Horton, Ph.D., NCC, LPCS, RPTS Assistant Professor, UNC School of Medicine Director of Child Clinical Services UNC Horizons Program www.unchorizons.org This panel will discuss the explosion in the number of children needing foster care due to the current opioid crisis, with the caseload in many areas doubling in the last five years, and will examine what the 1980’s drug epidemic can teach us about how best to help these children and their families. Panel , “The Opioid Crisis: What Can Be Done for the Children.”

Impact of the Opioid Epidemic on Families Grief Extended families stretched and stressed Increase in adverse experiences in the children Increased involvement with social services and legal system

Impact of the Opioid Epidemic on Children - Infants Infants born to mothers with substance use disorders: Higher risk of prenatal exposure to teratogens, poor prenatal care, low birth weight At risk for NAS symptomology, such as irritability, crying, Hypertonia, tremors, poor/uncoordinated sucking, etc. which can make mothers feel rejected. May have developmental delays.

Impact of the Opioid Epidemic on Children – Older Children At a higher risk for child maltreatment Display both internalizing and externalizing behaviors Have higher rates of insecure/disorganized attachments Have often been exposed to multiple traumatic events/adverse experiences

Impact of the Opioid Epidemic on Mothers with Substance Use Disorders Have significant trauma histories Report more irritable babies Are less sensitive in interactions Are less emotionally engaged Are less attentive Have less positive affect

Impact of substance abuse on the adult brain Volkow et al., 2004

What if we could treat the mother’s substance use disorder and help the children heal from this family disease at the same time?

Recovery to the adult brain takes time Volkow, 2001

Horizons’ Model of Care Trauma and Addiction Treatment Childcare and Transportation Residential and Outpatient Care Medical Care OB/GYN Psychiatry Vocational Rehabilitation http://www.unchorizons.org/ ParentEducation Infant/Children Mental Health Early Intervention 9

Evidence-Based Mental Health Interventions for Infants and Children Available at Horizons Circle of Security-Parenting Attachment and Bio-behavioral Catchup (ABC) Child Parent Psychotherapy (CPP) Parent Child Interaction Therapy (PCIT) Trauma Focused CBT (TF-CBT)

Outcome of Comprehensive Prenatal Care

CURES act obama ncpoep.org

Questions?

References Dozier, M., Peloso, E., Lindhiem, O., Gordon, M. K., Manni, M., Sepulveda, S., … Levine, S. (2006). Developing evidence-based interventions for foster children: An example of a randomized clinical trial with infants and toddlers. Journal of Social Issues, 62(4), 767–785. Felitti, V. J., & Anda, R. F. (2010). The relationship of adverse childhood experiences to adult health, well-being, social function, and healthcare. Horton, E., & Murray, C. (2015). A quantitative exploratory evaluation of the Circle of Security‐Parenting Program with mothers in residential substance‐abuse treatment. Infant mental health journal, 36(3), 320-336. Lieberman, A. F. (2005). Child Parent Psychotherapy: Treating Parent-Infant Relationship Problems: Strategies for Intervention, 97. Lieberman, A. F., Padrón, E., Van Horn, P., & Harris, W. W. (2005). Angels in the nursery: The intergenerational transmission of benevolent parental influences. Infant Mental Health Journal, 26(6), 504–520. Otero, C., & Archer, A. (2013). Substance use disorders and trauma among parents involved in the child welfare system. Powell, B., Cooper, G., Hoffman, K., & Marvin, B. (2013). The circle of security intervention: Enhancing attachment in early parent-child relationships. Guilford Publications. Volkow, N. D., Chang, L., Wang, G. J., Fowler, J. S., Franceschi, D., Sedler, M., ... & Logan, J. (2001). Loss of dopamine transporters in methamphetamine abusers recovers with protracted abstinence. Journal of Neuroscience, 21(23), 9414-9418. VOLKOW, N., FOWLER, J., WANG, G. J., & SWANSON, J. (2004). Dopamine in drug abuse and addiction: results from imaging studies and treatment implications. Molecular psychiatry, 9(6), 557-569.