1. 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
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.”

2. 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

3. 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.

4. 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

5. 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

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

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

8. Recovery to the adult brain takes time
Volkow, 2001

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

10. 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)

11. Outcome of Comprehensive Prenatal Care

12. CURES act obama
ncpoep.org

13. Questions?

14. 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),
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),
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),