Behind the Story: Healing the Youngest Victims of the Opioid Crisis

By Emily Tate Sullivan and Jeffrey R. Young Mar 4, 2020

This story is part of an EdSurge Research series about the early childhood education workforce.

Today on a bonus episode of the EdSurge Podcast we’re talking about the youngest victims of the opioid crisis.

They’re preschoolers whose parents or caregivers misuse painkillers; some have become addicted to heroin or other street drugs as a result. One expert called these kids “America’s lost children.” Of course, educators haven’t given up on them. But they recognize teaching these kids brings unique challenges.

EdSurge reporter Emily Tate spent the past couple of months exploring this subject, to produce the longform feature we published today, “Inside a Preschool That Treats the Youngest Victims of the Opioid Crisis.”

The EdSurge Podcast sat down with Emily to find out what she learned, and to go behind the story of her trip to classrooms at the heart of the opioid crisis.

EdSurge: Emily, where did you end up going for your reporting for this?

Never gonna give you up. Never gonna let you down. Messed up article for you.

Tate: I went to Ohio [a hotspot of the opioid crisis] and visited the Therapeutic Interagency Preschool Program, also known as TIP. And TIP serves three, four and five-year-olds in Ohio who have experienced severe childhood trauma. And it helps them work through those experiences through one-on-one counseling services, a targeted social-emotional learning curriculum, and small class sizes. So there are fewer children for every teacher than is normally seen in a preschool.

The TIP program was founded about 30 years ago in 1989 by two women at the Cincinnati Children’s Hospital. It’s still available there, but it’s also now being used in two other counties in Ohio. And I visited Butler County, which is in southwest Ohio. In particular, I spent three days in Hamilton, a small city of about 60,000 people.

There’s some language to learn to understand how these educators are measuring the trauma these kids have gone through. One of the terms you encountered is apparently adverse childhood experiences, or ACEs. What are those?

I’m glad you brought this up because this is really important to understand not only what these children have been through, but how to measure it. The Adverse Childhood Experiences Study was a study done in the 1990s by the Centers for Disease Control and Prevention and Kaiser Permanente. It was a groundbreaking study that looked at how adverse childhood experiences, or put simply childhood trauma, affects a person over time. And what it found is that the more adverse childhood experiences someone has… the smaller their chances of staying on track in life and living a full and healthy life.

People who have more experiences with trauma early in their lives are more likely to be incarcerated, to have a substance abuse problem, to suffer from toxic stress, to commit violence or to live in poverty. The numbers are really astounding. And since that study was published, a lot of people have used it, especially with young children. And it’s been boiled down to about 10 ACEs questions, which look at things like: Did a person experience emotional abuse before the age of 18? Did they witness domestic violence? Did they experience sexual abuse? Were they in a household with someone with a mental illness? Was a parent ever incarcerated? Did they have a single parent?

The CDC, which originally performed that study, estimates that 36% of Americans have never experienced an ACE, and just 12% have had four or more of the ten ACEs. The children in this TIP program that I visited have an average of seven.

What does this program look like? What does the classroom approach that you saw look like?

It’s still a preschool classroom. The kids are still there to learn and develop. So, if you were just stepping in for a few minutes, you might not think anything was different. But over the course of a few days and many interviews, I really got to peel back the layers of the onion and understand the bolstered services that are helping these kids get back on track.

For an average Head Start classroom across the country, there’s going to be two teachers and 17 kids. But because the needs of these children in TIP are so great, they actually have a much lower ratio. So, it’s three teachers for every 12 to 14 children. And that goes a long way because if one child is throwing toys or acting out, then that diverts one of the teacher’s attention and the other two are able to work with the other kids.

One of the things that I thought was most remarkable is the one-on-one mental health services that the children get. The TIP program has a licensed professional counselor on staff. Her name is Jennifer Minnick, and she has actually been with the program for 10 years, and she knows how to work with these children and how to help them work through what they’ve seen and experienced and then move on from it.

She has this office where the kids go, one at a time. They’re pulled out from class and they go with her into her office. It’s bathed in cool colors and has a sandbox, a doll house and lots of squishy toys—things that are very sensory. But there are also a lot of things that help them articulate their feelings, which they may not understand very well at that age and may not have a name for.

So, she helps them tell her where it hurts when they talk about something that’s difficult. Maybe they haven’t seen dad in a few months, or maybe they saw mom or dad get taken away by police. And these are real things that they shared with me. That the staff shared with me. So, she gets to ask them questions like: Where do you feel that and what does that feel like? And help give them names for things.

Things like the doll houses are helpful because she can just play with these children, and through that, learn more about what they’ve experienced and help all of the staff understand their backgrounds and what they’ve been through. As awful as it sounds, sometimes it’s acting out a drug deal, or hiding next to the bed. And this is all being done through dollhouse.

What is it like for the teachers in these classrooms?

This is something I went in being really curious about because over the last few months I’ve been writing about the early childhood workforce, and all of the challenges that professionals in that workforce face. They face many, but this is a whole different ball game.

In each of my interviews with teachers, I asked them what it’s like for them to carry the stories of these children after class ends. How do they cope? How do they deal with this? Because frankly, even just being there for a couple of days, it really weighed on me. And at first some of them shrugged it off, [taking the mindset that] they’re just kids and we’re just trying to give everybody the same education.

But digging a little bit deeper, they struggle. This is really hard work. Experiencing the secondary trauma of being around these children who have been through so much and hearing their stories and having to sometimes be subpoenaed and appear before court in one of their custody cases, it’s a lot. And several of the teachers mentioned the strategies that they’ve developed to cope with this. As one person put it, she cries it out when she has to. Another person says she goes home and colors.

So, how are things going with the TIP program? Are they getting results?

Yeah, the program really works. The staff use several different assessments to measure the children’s progress over the course of a year. One of them, which measures their social emotional development, is used three different times throughout the year. And that informs the different strategies they use with each child and counseling and in class.

But another thing they use is the Trauma Symptom Checklist for Young Children, and they conduct that at the very beginning of the year and at the very end. These trauma symptoms include anxiety, anger and aggression, post-traumatic stress disorder and depression.

On average, children’s symptoms are reduced by half over the course of one school year, and that’s pretty remarkable because reducing those symptoms means that they’re going to be more prepared to focus in school and in their academic learning when it comes to kindergarten. And that they’re going to be better with attachment and relationships. They’re going to be better at self-regulating. It really goes a long way.

But another thing about this program that I would add is that they do a lot to engage families. And a lot of times these are foster families or relatives outside of the nuclear family. That’s just the reality of children in this situation. But they work with families that have custody of these children to make sure that they know how to take the strategies home and use them there, so that a kid doesn’t have a super peaceful environment at school and then go home at night and everything is chaos. You want to keep that consistency.

When I visited a mother and her four-year-old, I noticed that she was doing some of the things that they do in class. And that means when he gets overly excited, she knew to squat down to his level and look him in the eyes and take some deep breaths so that he could mimic her.

And there’s some momentum that this program is being used in other states and areas?

That’s right. The folks at the TIP program in Butler County present on their approach in different counties throughout Ohio, in different cities in the Midwest. And they’ve gotten a lot of interest.

Recently the TIP program and other programs like it have caught the attention of Congress. In December, Congress appropriated $250 million to support programs that are either establishing or expanding services like trauma-informed care, which is what the TIP program uses.