Children in New Hampshire are finding themselves caught in the front lines of the state’s heroin and opioid crisis.
Last month, first responders had to use Narcan to revive a 6-year-old Manchester boy. And last week, a 9-year-old was left unattended at a Manchester Dunkin' Donuts when his father overdosed in the bathroom.
Lara Quiroga is with the Manchester Community Health Center, and helped launch a program last summer that aims to ensure children who experience trauma, whether it's witnessing an overdose or being exposed to violence, get the services they need. She joined NHPR's Morning Edition.
In these situations where children are exposed to this epidemic, experiencing it first hand, what do we know about the impact that can have long-term?
The long-term impacts have the potential to be very serious. Adverse childhood experiences, and that includes exposure to household substance abuse and other traumatic events, can lead to very poor health outcomes in adults. For children who are living in a household that has substance use, they are two to four times more likely to become drug users themselves by the age of 14.
What is the magnitude of the problem? What are you seeing as far in terms of numbers?
I don't think that we have a full grasp on that. And I think that as much as we talk about being in a crisis right now, we could be facing something exponentially worse in 10 to 20 years if we don't do something now to mitigate the risks associated with substance use and other kinds of adverse childhood experiences in terms of numbers. We are seeing children exposed to all sorts of trauma certainly overdosing in the presence of an adult in their life. There's other trauma like domestic violence, abuse, neglect, parental incarceration, things that are often associated with substance misuse.
When a child is witnessing their parent overdose or is directly exposed in some way, what is happening after the fact for that child?
Typically, immediately of course the police are called and when a child is exposed DCYF is involved. So they'll take immediate steps to make sure that the child is safe in that moment and then work to find an appropriate placement for that child hopefully with a family member, if there's one that's close. Otherwise, they may be connected with the foster care system.
Is there a large difference in reaction to children based on age? I imagine a 4 year old witnessing this as opposed to say a 9 or 10 year old I imagine is very different.
For some children, you may see more immediate impacts, you may see immediate sort of mental health concerns, acting out. For other children, there may not be an immediate reaction beyond extreme sadness or even depression. But again those long-term effects can be pretty serious. What we know that what science tells us about young children and the way that their brain is developing the foundations that we're setting for them at an early age is extremely important. We're setting the foundation for young children for everything else that follows. So if we don't have a sturdy foundation for them, it's more difficult for them later on in terms of learning behavior and sort of higher order thinking skills that make them productive members of our society later on in life.
You are involved with launching ACERT in Manchester last summer, which stands for adverse childhood experiences response team. What was the impetus for that? And can you describe exactly what you do?
Sure. Back in the summer of 2015 actually Chief Nick Willard said to his lieutenants and sergeants what is going on with children that are exposed to things like domestic violence and overdose says. Initially we decided that we would get a child advocate in place at the Manchester Police Department to offer support to children exposed. Then we developed a release form that basically patrol officers take out with them they have it with them in their cars at all times and they ask families to give permission to give their contact information to one of the social service agencies that we partnered with; it’s just about that incident, only what happened so that that agency could reach back out to the family and try and connect them with a service that would be appropriate for whatever the incident was. In the first two weeks of doing that in September of 2015 we had 20 releases signed which was wonderful but we said we don't think this is enough. So we put our heads together and said what if we had a team: a police officer, a crisis services advocate from the YWCA, and a community health worker from the health center.
The idea is to really begin working with children right there in that moment.
Right. So when an officer responds to a scene and sees that a child has been exposed to some sort of trauma, once the scene is secure they can call that team and have them actually go to the scene and provide immediate support to the family and start building that relationship and helping them understand the importance of getting the children, even though they were not direct victims of violence or trauma, getting them the support that they need.
It's only been a year or so now since the program launched, but can you assess what's working and what the biggest challenges are?
Yes. The team has been deployed about 100 times since last year when we started this on July 7th, 2016. In the first nine months where we were just doing the release in 2015, we were able to refer a little over 50 children in the first nine months. After we started the team, we more than tripled the number of children that we were able to refer. So that personal connection with the family and really spending some time beyond what a responding officer can spend has really made a difference and now that we've been doing this a year we've referred over 250 children, which we think is pretty amazing considering our baseline is zero. None of this was happening before.
The important thing that we really try and stress for folks is as unique as ACERT is and as effective as it has been in terms of referring families to services, it doesn't exist in a vacuum. It only works if there are other pieces of the system in place to support families, so at some point we need to have a conversation about getting more mental health providers in our state so that there's not three- to six-month waiting lists to get into services. We need to make sure that providers are accepting insurance and Medicaid so that they're out-of-pocket expenses aren't a barrier to families so those other pieces of the system are really important.