The Opioid Crisis and the Nation's Youth-Strategies and Solutions to Serve Our Youngest Victims - BJA/OVC Grantee Meeting - United for Youth
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The Opioid Crisis and the Nation's Youth—
Strategies and Solutions to Serve Our
Youngest Victims
BJA/OVC Grantee Meeting
Alexandria, Virginia | December 4-5, 2019
Pillars of Culturally Responsive Programming Hocking County, Ohio
Upon completion, participants will be able to: • Understand that culturally relevant practices which are incorporated in all systems and services are beneficial to all adults and children. • Eliminate cultural barriers that interfere with service delivery.
Hocking County, Ohio • Appalachian Ohio • Population 28,385 (2018) • Between Columbus and Parkersburg, West Virginia • Home to Hocking Hills State Park, biggest tourist destination “you’ve never heard of” (8 million visitors each year) • County seat: Logan, 4.9 square mile city (7,069 pop.)
• Wealthy cabin and resort owners and retirees (second homes), but little industry beyond tourism • Ash Cave (left) • Conkle’s Hollow
Hocking County, Ohio • Biggest employers are local government (school district, county government) (HC-CIC) • Median household income is $48,073, 12% less than Ohio’s $54,021 (U.S. Census) • 96% white, 1.4% two or more races, 1.1% Hispanic or Latino, .7% African- American, .4% American Indian or Alaska Native, .4% Asian • 89% graduation rate (diploma/GED), 14% with bachelor’s degree or higher
Pillars of Culturally Responsive
Programming
• Knowing the Culture
• Respecting the values and
beliefs
• Meeting people where
they are
Traditional Appalachian Identity ❑Extended kinship networks: No other large geographic region in the United States has so many family members who live their lives in proximity to their birthplaces. ❑ Children learn from parents and extended family members. ❑ Family surname can identify persons and link them to a kinship network. ❑Fierce protection of self and family, I can talk about my family, but you can not!
Characteristics of Appalachian Culture
Hard Working
Community Proud Family
“Community pulled together to help” Polite Independent
Comparison of Rural America with Appalachia
Rural America Appalachia
• Oriented to progress • Oriented to existence
• Separation of husband and wife tasks
• Home tasks shared by husband and wife
• Suspicion and fear of outside world and change
• Acceptance of world, and change
• Fear of doctors, hospitals, those in authority, the
• Cooperation with doctors, hospitals, and well-educated
outsiders
• Shows hostility toward government and law
enforcement.
• Use of government and law to achieve goalsNegative Images about Appalachian culture • Welfare type people • Hillbillies, people not really intelligent • Poverty, barefoot children, shanty houses • Oppressed, bypassed • House trailers • People who think differently • Trash and junk in the creeks
Positive Images about Appalachian culture
Community
• Honest, hard-working service
workers
• Strong family values, close-knit families help
beautify
• Friendly Hocking
• Big-hearted, generous County
• MusicalService Delivery within Appalachian Culture • Trust and respect must be earned. • Conflict • Suspicious of “superficial” • Often will talk to a mutual friend friendliness • Offending one member can impact • Must be “down-to-earth” the whole family • Maintaining appointments • Humor • Your priority may not be their • Humor is often used to cover up priority pain, disappointment, or fear • Something more important may • Literacy – education (view of) come up
Service Delivery Challenges
• Be patient
• Emphasize the family
• “Will the Circle Be Unbroken”
• Do not impose your ideas on them
• Accept the fact that you may never know “why”
• Earn their trust and respect
People don’t care how much you know until they know how
much you care!Children in Poverty • 49 percent of children live at or below 200% poverty (Ohio average 44%) (USDA, 2018) • 62% of students are eligible for free/reduced lunch (Ohio average 16%, Nation 13%). Every child receives free breakfast and lunch, through other grant funding. • 21% were enrolled to receive Supplemental Nutrition Assistance Program (SNAP) benefits in 2016. Hocking is ranked first in Southeast Ohio for receiving SNAP benefits, at $2.8 million each month.
Behavioral Health • Hopewell: Behavioral health and substance abuse counseling; case management for children and adults; help with housing/homelessness; and MAT • Integrated Services: Behavioral/mental health, case management, group art therapy; help with housing; and MAT • TASC of Southeast Ohio: Substance abuse counseling (individual and group), including music therapy • Ratio of behavioral health providers to the general population is 1,920:1 (Ohio average 700:1) (CMS/NPI, 2018)
How does the Opioid Crisis affect the Community? • Grandparents are raising grandchildren • Community outlook • Homelessness • Mental health • Community resources • Flooding ERs and EMS services • Overwhelming the court system • Overflowing correctional facilities • Hepatitis A tripled from 2014 to 2016
Hocking County Overdoses
• Unintentional drug mortality rate is 27.9
higher than 18.2 statewide (Ohio
Attorney General Report, 2017)
• From 2015 to 2018, there were 18
unintentional drug poisoning deaths
• 178 doses of Narcan distributed by
emergency personnel in the same time
period; overdoses may have been higher
otherwise
• 62 people experienced non-fatal
overdoses in 2018 • 73% of child removals are
• 88% of child removals are from homes
with parental drug use, while the directly caused by opiate use,
statewide average is 50% (2016) and the state average is 28%
(2016)Hocking County Overdoses • Rate of overdose deaths as a percent of all drug overdose deaths in Ohio (83%) was 26 percent higher than the nation (66%) making it the leader for the highest number of opioid overdoses in the nation in 2016. • Ohio surpassed New York, Florida, Pennsylvania, California and Massachusetts for the number of opioid overdose deaths in 2016 with 4,329. West Virginia (just 60 miles away) became number one in 2017.
Hocking Overdose Partnership
Endeavor (HOPE)Partners with HOPE Goal: Provide trauma-informed care and recovery support services to families who are victims of overdose by meeting them in their homes and school. ▫ Law Enforcement: Hocking County Sheriff’s Office, Hocking County Prosecutor’s Office ▫ Alcohol Drug Addiction & Mental Health Board: 317 Board ▫ Healthcare: Hocking County Health Department, Hopewell Health Centers, TASC of Southeast Ohio, Hocking Valley Community Hospital, Emergency Medical Service ▫ Social Services/Case Management: Logan-Hocking School District, South Central Job & Family Services, Integrated Services, Hocking County Help Me Grow
Other Individual Drugs of Choice Reported
HOPE QR Team 5%
by HOPE Clients
Alcohol
5%
▫ Quick Response Team: Team of 3 or 4 who Suboxone Heroin
11%
visit homes of overdose victims from the Prescription
26%
previous week. Team consists of law Opioids
17% Meth
enforcement, health department, and 36%
substance/mental health providers. Goal is
Heroin Meth
harm-reduction, health, safety, and Prescription Opioids Suboxone
treatment. Alcohol Other
Individual Drugs of Choice Reported by HOPE Clients
From January-October, 52 of 62 unique 25
individuals have been successfully 20
contacted, 24 Narcan kits distributed, 22 15
referred to detox/initial counseling, 28
10
people referred to long-term treatment;
and Narcan used 7 times during an 5
overdose event. 0
Heroin Meth Prescription Suboxone Alcohol OtherSTART Program
(Sobriety, Treatment and Reducing Trauma)
• South Central Job & Family Services (SCJFS)/Integrated Services Partnership
▫ Case worker and peer mentor work closely together to provide recovery
services for parents and families and protective supervision of the children.
• Goal: To keep the children in a drug-free environment with their family.
• Referrals and collaboration with other service providers
• Quick response
▫ Barriers to Service: Transportation, homelessness, lack of inpatient facility, distrustful
culture
• Sex Crimes: Selling children for drugs, leaving children with strangers, exposing
them to sexual interactions.
• Success Story: 44-year-old woman with alcohol and substance misuse who is now
nine months sober.
• Of 19 families referred, 10 currently in program, 3 successful completions, 1
moved to drug court, 1 did not participate, and 4 did not complete program
successfully.COAP Project Overview
▫ START (Sobriety, Treatment and Reducing Trauma) Program: • Transportation barrier is
Partnership between South Central Ohio Job & Family eliminated by visiting families
Services and Integrated Services that provides counseling and
peer recovery support services to families with a history of
in their homes, children at
opioid misuse that are involved with children services. school.
▫ Better Birth Outcomes/Help Me Grow: Case workers visit • Challenging getting to other
homes of new families with infants on weekly basis, and appointments
provide supportive services for the first three years of the
child’s life. • Families served have history
▫ Logan-Hocking School District: Full-time counselor is available of opioid misuse
to students in middle and high schools who have been
affected by parental/familial overdose or substance misuse.
Fun fact: Nine student walk-ins the first week on the job.
Superintendent thinks four more counselors are needed to
meet the demand. 4,000 students in total district.
Three high school students overdosed
at school in the 2017-2018 school year• Evidenced-based home visiting model • Healthy Families America (HFA) • Nationally-recognized • Works with overburdened families who are at-risk for adverse childhood experiences, including child maltreatment. • Prevent Child Abuse America • Early Intervention Services Success Story
Hocking County Health Department • Family Navigator • NARCAN distribution / Needle Exchange • Other services: Immunizations, Screening for Hepatitis, HIV, and other communicable diseases. • WIC • Breastfeeding Support • Sanitarians • Tobacco Cessation • Birth/Death records
Future Goals January 2020: • Two deputies who specialize in mental health will be stationed at Hocking Valley Community Hospital to assist with security, and respond to mental health calls within the county. Talks are underway with HVCH to add two detox beds in 2020. • Renovated jail facility that houses a substance abuse treatment agency on the first floor will tentatively open in 2021.
Questions & Answers
Contact Information Misty Tigner: Hocking County Help Me Grow, mtigner@hockingdd.org Natalee Andrews: Hocking County Help Me Grow, nandrews@hockingdd.org Marni Tucker: Children Services Caseworker, marni.tucker@jfs.ohio.gov Steve Caruthers: Family Mentor, Integrated Services, rcaruthers@integratedservice.org Ashley Standall: Community Health Worker/CDCA, Hocking County Health Department, astandallhchd@gmail.com
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