The Infant/Toddler & School-Age Child Care Institute

Proactive Steps in Addressing

the Misuse of Opioids

Child Care State Capacity Building Center

National Center on Early Childhood Health and Wellness

National Center on Tribal Early Childhood Development

May 23, 2018

Action Plan

2

Let’s Get to Know You!

Please tell us your name, role and

interest in this topic.

3

Outcomes of Today’s Session

Build awareness of the seriousness of

this epidemic in the United States.

Consider the impact of opioid misuse on

children and their caregivers.

Identify strategies to support children and

families.

Share resources and state examples.

4

Connecting to CCDF Plans

Priority of HHS/ACF

Subsidy policy

Examples:

12 month eligibility for foster care/protective services

Increased caseloads for Family Care/Grandparents

Partnerships with other agencies

Professional development

High quality child care for low-income children

4

Have you worked with a family or

child affected by opioid misuse?

6

Source: U.S. Department of Health and Human Services. The opioid epidemic by the numbers. Retrieved April

11, 2018, from https://www.hhs.gov/opioids/about-the-epidemic/

7

https://www.hhs.gov/opioids/about-the-epidemic/

What We Know about the Opioid

Misuse

Roughly 21 percent to 29

percent of patients prescribed opioids

for chronic pain misuse them.

Between 8 percent and 12 percent

develop an opioid use disorder.

Approximately 80 percent of people who use heroin

first misused prescription

opioids.

National Institute on Drug Abuse, National Institutes of Health, U.S. Department of Health and Human Services.

(2018). Opioid overdose crisis [Web page]. Retrieved April 11, 2018, from https://www.drugabuse.gov/drugs-

abuse/opioids/opioid-overdose-crisis

8

https://www.drugabuse.gov/drugs-abuse/opioids/opioid-overdose-crisis

Source: National Institute on Drug Abuse, National Institutes of Health, U.S. Department of Health and Human Services. (2018). Opioid summaries by

state [Web page]. Retrieved April 11, 2018, from https://www.drugabuse.gov/drugs-abuse/opioids/opioid-summaries-by-state

1. Opioid overdose deaths are identified using underlying cause-of-death codes X40–X44, X60–X64, X85, and Y10–Y14. Opioid overdose deaths as

defined, that have T40.1 (Heroin), T40.2 (Other opioids), T40.3 (Methadone), T40.4 (Other synthetic narcotics), T40.6 (Other and unspecified

narcotics) as a contributing cause. Age-adjusted death rates were calculated as deaths per 100,000 population using the direct method and the 2000

standard population. Source: The Centers for Disease Control and Prevention, CDC WONDER.

2. Xponent, IMS Health, Plymouth Meeting, PA Copyright 2016 as published by the Medical Association of Georgia State and National Totals of Filled

Prescriptions-All Opioid Analgesics.

Opioid-Related Overdose Death Rates

9

https://www.drugabuse.gov/drugs-abuse/opioids/opioid-summaries-by-statehttps://wonder.cdc.gov/controller/datarequest/D77;jsessionid=EEFE79AB3A44A9DAE45325C2A6B966A8https://www.mag.org/georgia/UploadedFiles/prescriptions-filled-chart.pdf

Source: National Institute on Drug Abuse, National Institutes of Health, U.S. Department of Health and Human Services.

(2018). Opioid summaries by state [Web page]. Retrieved April 11, 2018, from https://www.drugabuse.gov/drugs-

abuse/opioids/opioid-summaries-by-state

10

Opioid-Related Overdose Death Rates

https://www.drugabuse.gov/drugs-abuse/opioids/opioid-summaries-by-state

What is neonatal abstinence

syndrome?

11

Neonatal Abstinence Syndrome (NAS)

Every 15 minutes, a baby is

born suffering from NAS

Five times as many babies

were born with NAS in 2009

as in 2000.

The average hospital stay in

2012 for infants exposed to

substances was 16.9 days,

compared to an average of

2.1 days for an infant not

exposed to drugs

12

Source: Winkelman, T.N., Villapiano, N., Kozhimannil, K.B.,

Davis, M.M., Patrick, S.W., Incidence & Costs of Neonatal

Abstinence Syndrome among Infants with Medicaid: 2004-

2014, Pediatrics published online: March 23, 2018 (doi:

10.1542/peds.2017-3520). Funded by NIDA K23DA038720.

http://pediatrics.aappublications.org/content/early/2018/03/21/p

eds.2017-3520

Retrieved May 8, 2018 from: https://www.vumc.org/nas/

http://pediatrics.aappublications.org/content/early/2018/03/21/peds.2017-3520https://www.vumc.org/nas/

Symptoms of NAS

Body shakes (tremors), seizures (convulsions),

overactive reflexes (twitching) and tight muscle tone

Fussiness, excessive crying, or having a high-pitched cry

Poor feeding or sucking or slow weight gain

Breathing problems, including breathing really fast

Fever, sweating or blotchy skin

Trouble sleeping and lots of yawning

Diarrhea or throwing up

Stuffy nose or sneezing

Excerpted from March of Dimes. (2017). Neonatal abstinence syndrome [Web page]. Retrieved April

11, 2018, from https://www.marchofdimes.org/complications/neonatal-abstinence-syndrome-

(nas).aspx

13

https://www.marchofdimes.org/complications/neonatal-abstinence-syndrome-(nas).aspx

Possible Impact on the Development of Young

Children

Summary of Effects of Prenatal

Exposure

Source: Adapted from Behnke, M., Smith, V. C., Committee on Substance Abuse, & Committee on Fetus

and Newborn. (2013). Prenatal substance abuse: Short- and long-term effects on the exposed fetus.

Pediatrics, 131(3), 1009–24. Retrieved from http://pediatrics.aappublications.org/content/131/3/e1009.full

15

http://pediatrics.aappublications.org/content/131/3/e1009.full

Potential Impact on 1–5 Year-Olds

A toddler or preschooler who has been exposed to opiates

may experience one or more of the following symptoms:

Mental and motor deficits

Cognitive delays

Hyperactivity

Impulsivity

Attention deficit disorder (ADD)

Behavior disorders

Aggressiveness

Less social responsivity or poor social engagement

Failure to thrive (socially)

Short stature

16

Excerpted from Intervention IDEAs for infants, toddlers, children, and youth impacted by opioids.

Retrieved from https://osepideasthatwork.org/sites/default/files/IDEAslIssBrief-Opioids-508.pdf

https://osepideasthatwork.org/sites/default/files/IDEAslIssBrief-Opioids-508.pdf

Potential Impact on School-Age Children (includes multiple substances, not just opioids)

Impaired verbal performance, reading, and

arithmetic skills

Poor mental and motor development

Memory and perception problems

Attention deficit hyperactivity disorder (ADHD)

Developmental delays

Impaired self-regulation

17

Behnke, M., Smith, V. C., Committee on Substance Abuse, & Committee on Fetus and Newborn. (2013). Prenatal

substance abuse: Short- and long-term effects on the exposed fetus. Pediatrics, 131(3), e1009-e1024. Retrieved

from http://pediatrics.aappublications.org/content/131/3/e1009

http://pediatrics.aappublications.org/content/131/3/e1009

18

School absence, failure

Low self-confidence

Depressive disorder

Substance use disorder

Speech problems

Language disorders

Potential Impact on School-Age Children (includes multiple substances, not just opioids)

Behnke, M., Smith, V. C., Committee on Substance Abuse, & Committee on Fetus and Newborn. (2013).

Prenatal substance abuse: Short- and long-term effects on the exposed fetus. Pediatrics, 131(3), e1009-

e1024. Retrieved from http://pediatrics.aappublications.org/content/131/3/e1009

http://pediatrics.aappublications.org/content/131/3/e1009

What strategies can you use to support

caregivers in providing care for children

born substance exposed?

19

What we can do:

Explore opportunities to

provide training on trauma-

informed care to providers

Explore resources in the

community for support in

trauma-informed care and

practices

Connect with coaches and

mentors to support providers

on an ongoing basis

20

Working with Providers

Using Relationship-Based Practices

Establishing strong relationships with and recognizing

strengths of the parent or primary caregiver:

21

Primary caregiving: The care of each

infant or toddler is assigned to one

specific infant and toddler caregiver

who is principally responsible for that

child in the care setting

Individualized care: Being responsive

and adapting to the unique cues and

temperament of each child to support

a healthy sense of self and optimal

development

Providing Care for Infants with NAS

Decrease environmental stimuli

Holding, swaddling

Feeding, non-nutritive sucking

Encourage breastfeeding

Caregiver wellness

Integration of sensory stimulation

Most important …

Be attuned to the infant and adjust to his or her responses to touch

22

Partnering with your state on training

Accessing child care resource and referral agencies

for strategies and informed care

Collaborating with Indian Health Services and local

health services for training

What we can do

Support follow-up care

Policy and procedure changes

Case management

Mental health consultation

23

Training for Providers

Training on Screening and Surveillance

Observation—focused and attuned

Developmental screening tools and

protocols

Responsive practices for gathering family

information

Sensitive, strengths-based communication

with families

24

Community Support

25

How local and tribal communities address the opioid crisis by training together as a community

What we can do:

Engaging in strategic planning to address this crisis

Promoting community engagement and awareness

Establishing a taskforce

Providing mentoring programs for youth

Connecting to integrated behavioral health and substance use disorder services

How can we support the families and

caregivers affected by opioids?

26

Support for Families and Caregivers

What we know:

Increase of opioid misuse has significantly affected the child

welfare system

Infants are coming into protective custody at alarming rates

Grandparents are becoming primary caregivers for a second

time

What we can do:

Increase family engagement strategies

Provide family and peer-to-peer support opportunities

Connect with comprehensive services

Use infant–early childhood mental health consultation

Use language and communication that reduce stigma

27

Foster Care

Source: Children’s Bureau, Administration on Children, Youth and Families, Administration for Children

and Families, U.S. Department of Health and Human Services. (2017). The AFCARS report. Retrieved

from https://www.acf.hhs.gov/sites/default/files/cb/afcarsreport24.pdf

28

0

10,000

20,000

30,000

40,000

50,000

60,000

Lessthan 1year

1 year 2 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years 10 years

Children Entering Foster Care by Age (2016)

Children Entering Foster Care by Age (2016)

https://www.acf.hhs.gov/sites/default/files/cb/afcarsreport24.pdf

Impact on Grandparents/Relative Care

Approximately 2.5 million children are being raised by

grandparents or are in kinship care with no birth parents in

the home.

This is 3 percent of all children.

Approximately 29 percent of children in foster care

(120,000+) are being raised by relatives.

Generations United. (2016). Raising the children of the opioid epidemic: Solutions and support for grandparents.

Retrieved from http://gu.org/Portals/0/documents/Reports/16-Report-State_of_Grandfamiles.pdf29

For every child in foster care with a

relative, there are 20 children being

raised by grandparents or family

members outside the foster care

system.

http://gu.org/Portals/0/documents/Reports/16-Report-State_of_Grandfamiles.pdf

How We Can Support these Families and

Engage in Comprehensive Services

Strengthening Families

Medical homes

Recovery-oriented systems

Home visitation

Early Head Start

Early intervention

Community resources

30

https://www.cssp.org/young-children-their-families/strengtheningfamilies

Providing Comprehensive Mental Health

and Prevention Services

Infant and early childhood mental health care and consultation

services

Interventions that are attachment-based and focused on

caregiver-child relationships

Child-parent psychotherapy (CPP)

Parent-child interaction therapy (PCIT)

Caregiver skills training

Incredible Years training for parents

Promoting First Relationships

Brazelton Touchpoints

Trauma-informed care 31

http://www.incredibleyears.com/programs/parent/

Parent, Family, and Community

Engagement Framework

32

Source: Early Childhood Learning & Knowledge Center. (2017). Parent, family, and community

engagement framework: Head Start approach to school readiness. Retrieved from

https://eclkc.ohs.acf.hhs.gov/school-readiness/article/parent-family-community-engagement-framework

https://eclkc.ohs.acf.hhs.gov/school-readiness/article/parent-family-community-engagement-framework

How are states working on this

issue?

33

Massachusetts

34

“Proactive Steps in Addressing the Opioid Crisis- Local and

Regional Initiatives”OCC Infant/Toddler School Age

Institute

Carol Nolan and Anne HemmerMay 23, 2018

MA Head Start State Collaboration Director, Carol Nolan and the Region 1 Head Start Training and Technical Assistance Systems Specialist, Anne Hemmer, partnered with a Southeastern MA Head Start program to plan a ‘pilot opioid project’ – Fall 2016

Developed a framework for the pilot that included:

1. Grantee collaborate with community partners and ensure diverse community representation for the pilot

2. Support Head Start grantee management team with resources and best practices that can support their program staff to work with children and families impacted by the opioid crisis

3. Utilize strategies/community partnership building efforts developed by grantee to share with other MA Head Start programs

4. Partner with state agencies, National Centers and national organizations to review existing research and resources to share best practices

36

Initial Opioid Pilot Project

•

•

•

•

•

•

Ongoing meetings with Head Start Director and Management team to discuss current work/progress of priorities for the work to be undertaken.

The program chose to do some of the following activities:

Conduct a staff survey to assess type of resources, trainings and supports they would find helpful in addressing the opioid epidemic

Assess availability of agencies/resources in community involved in this work and develop collaborations

Develop a toolkit of practices and resources/trainings specific to their community/state

Promote process to continue support to frontline staff with use of a coach/mentor/support groups to enhance sustainability

37

Opioid Pilot Project 2016-2017

RESOURCE and TRAINING NEEDS: Information from Head Start Grantees

•

•

•

Head Start Collaboration Directors and Head Start State Associations were asked by the OHS to reach out to the grantees in their state regarding the opioid crisis.

Responses from many grantees reflected the need for resources and training for staff working with children and families in their community affected by opioid/substance use issues.

Many grantees expressed the need for staff training on how to recognize when families are affected and how to support those families.

38

OHS Region 1 needs

39

Opioid Addiction

Finding 2: Programs reported that staff were less confident in identifying children and families impacted by opioid addiction than other areas.

(scale- not to little to somewhat to very confident)

0 1 2 3 4

Identifying children andfamilies impacted by opioid

addiction.

Making referrals to servicesthat support children and

families impacted by opioidaddiction.

Helping families navigateservices for children and

families impacted by opioidaddiction.

Partnering with communityhealth agencies on

addressing issues of opioidaddiction.

MA HSSCO Needs Assessment 2016

40

Opioid Addiction

Finding 4: Programs desired to be connected to community resources, or provided toolkits that could assist them in dealing with issues surrounding opioid addiction.

(scale- prioritize least to most important)

0 1 2 3 4

Learning about otherinitiatives in statewideor national programs

that address the opioidcrisis (not Head Start).

Learning about otherinitiatives in Head StartPrograms that address

the opioid crisis.

Developingresources/toolkits to

support program staff indealing with the opioid

crisis.

Connecting programs tocommunity resources

that address the opioidcrisis.

MA HSSCO Needs Assessment 2016

•

•

•

•

•

•

•

Attended “Improving the Care of Mothers, Infants and Families Impacted by Perinatal Opioid Use in Massachusetts: A Statewide Initiative” September 2017 (PN QIN)

National Center on Health and Wellness- calls with Amy Hunter to update progress and share information of MA opioid/substance use projects

Presented OCC New England Health and Wellness call – September 2017

Attended “Improving Outcomes for Women, Infants, and Children Affected by Opioids” November 2017 (Southcoast Health )

Presented at Region 1 OHS, T/TA Network and Collaboration Directors and EEC’s Regional Directors meeting - December 2017

Convened Head Start Grantees Focus Groups: with Early Intervention, MHVI, DPH,EEC Coordinated Family Community Engagement (CFCE), ECMH, Learn to Cope -Winter/Spring 2018

Attended Washington Post Event : “Addiction in America” Boston - Winter 2018

41

Trainings and Collaborations

42

••

•

•

•

•

•

•

September 2017- Met with MA EI/MHVI/DPH/EEC to discuss program needs

October 2017- Met with EEC Regional Directors to plan trainings

Fall 2017- Share staff survey results with National Center on Health and Wellness-conduct bi-monthly calls to share ongoing work/resources

Two MA Focus groups Western MA December 2017 and Southeastern MA January 2018 - Head Start/Early Head Start grantees, state partners and community agencies to share challenges, success and resources

April 3rd “Kick-off training” with Lt. Governor, OHS & OCC-“Supporting Families and Young Children affected by Opioid and Substance Use: Bridging Systems and Services”

March- May 2018 - Conduct 6 MA trainings for HS management/social service/EI/MHVI/CFCE grantees

Spring 2018 Presentation at NEHSA conference

Continue to gather resources/training information and share successful efforts-local/regional/national

Ongoing Related Work

Carol Nolan, MA Head Start State Collaboration Director

Carol.Nolan@state.ma.us 617 988-7816

Anne Hemmer, Systems Specialist, NE Head Start T/TA Network

ahemmer@Donahue.umassp.edu 617 413-2399

43

Contact Information

mailto:Carol.Nolan@state.ma.usmailto:ahemmer@Donahue.umassp.edu

Frequently asked questions (FAQs)

44

Training

How do we access training for staff working with

children and families affected by opioid issues?

Baseline training on effective communication

and appropriate language to use

Recovery-oriented support training

Recognizing the signs and symptoms of opioid

misuse and substance use disorders

Recognizing and addressing the social and

behavioral impact of opioid misuse and

substance use disorders on children and

families 45

FAQs

Support

How do we provide long-term support for

families throughout the treatment and recovery

process?

What are effective program policies related to

involving law enforcement and child protective

services regarding children placed at significant

risk by opioid misuse or substance use

disorders?

46

FAQs

Substance Abuse and Mental Health

Services Administration (SAMHSA) Opioid

Treatment Program Directory

47

Substance Abuse and Mental Health Services Administration (SAMHSA), Division of Pharmacologic

Therapies. (n.d.). Opioid treatment program directory [Online tool]. Retrieved from

http://dpt2.samhsa.gov/treatment/directory.aspx

http://dpt2.samhsa.gov/treatment/directory.aspx

What resources are available?

48

What are the resources in my state?

49

Principles of Substance Abuse Prevention

for Early Childhood

“Research supports the value of

interventions that reduce risk

factors, promote protective factors,

and increase access to resources

(e.g., school- and community-

based family support services) in

the lives of young children and

those closest to them.”

50

National Institute on Drug Abuse, National Institutes of Health. (n.d.). Principles of substance abuse prevention

for early childhood [Web page, last updated March 2016]. Retrieved May 7, 2018, from

https://www.drugabuse.gov/publications/principles-substance-abuse-prevention-early-childhood/index

https://www.drugabuse.gov/publications/principles-substance-abuse-prevention-early-childhood/index

Principle 1: Intervening early in childhood can

alter the life course trajectory in a positive

direction.

Principle 2: Intervening early in childhood can

both increase protective factors and reduce risk

factors.

Principle 3: Intervening early in childhood can

have positive long-term effects.

51

Principles of Substance Abuse Prevention

for Early Childhood

Principle 4: Intervening in early childhood can

have effects on a wide array of behaviors.

Principle 5: Early childhood interventions can

positively affect children’s biological

functioning.

Principle 6: Early childhood prevention

interventions should target the proximal

environments of the child.

52

Principles of Substance Abuse Prevention

for Early Childhood

Principle 7: Positively affecting a child’s behavior

through early intervention can elicit positive

behaviors in adult caregivers and in other

children, improving the overall social

environment.

53

Principles of Substance Abuse Prevention

for Early Childhood

Opioid education resources

Available in English and Spanish

Resources intended to assist schools in addressing

the opioid issue

Elementary school

Digital lesson

Educator guide

Activities

54

Prevention First. (n.d.). Opioid education resources [Online tool]. Retrieved from

https://www.prevention.org/Professional-Resources/Opioid-Education-Resources/

https://www.prevention.org/Professional-Resources/Opioid-Education-Resources/

Classroom resources to help combat the

opioid crisis.

Operation Prevention’s mission is to educate

students about the true impacts of opioids and

kick-start lifesaving conversations in the home

and classroom. They offer resources you can

use in your district or classroom, and at home.

55

Discovery Education. (n.d.). Classroom resources to help combat the opioid crisis [Online tool]. Retrieved from

http://blog.discoveryeducation.com/blog/2017/10/27/classroom-resources-to-help-combat-the-opioid-crisis/

https://www.operationprevention.com/http://blog.discoveryeducation.com/blog/2017/10/27/classroom-resources-to-help-combat-the-opioid-crisis/

Preventing or Reducing Opioid Abuse and

Overdose: Selected Resources

56

Resources

Center for the Application of Prevention Technologies, Substance Abuse and Mental Health Services Administration.

(n.d.). Preventing or Reducing Opioid Abuse and Overdose: Selected Resources [PDF resource]. Retrieved from

https://www.samhsa.gov/capt/sites/default/files/resources/preventing-reducing-opioid-abuse-overdose.pdf

https://www.samhsa.gov/capt/sites/default/files/resources/preventing-reducing-opioid-abuse-overdose.pdf

Resources

Early Childhood Learning and Knowledge Center, Substance Abuse,

https://eclkc.ohs.acf.hhs.gov/mental-health/article/substance-misuse

HealthReach’s low-literacy patient materials about opioids, opioid addiction, and

opioid treatment (includes documents, videos, and audio),

https://healthreach.nlm.nih.gov/patient-material-

results?keywords=opioids&btnsearch=Search&author=&language=&format=&user=&

records=10

The National Center on Substance Abuse and Child Welfare web page Infants with

Prenatal Substance Exposure, https://ncsacw.samhsa.gov/resources/substance-

exposed-infants.aspx

The National Center on Substance Abuse and Child Welfare web page Neonatal

Abstinence Syndrome, https://ncsacw.samhsa.gov/resources/opioid-use-disorders-

and-medication-assisted-treatment/neonatal-abstinence-syndrome.aspx

The SAMHSA Center for the Application of Prevention Technologies’ CAPT

Resources to Prevent the Non-Medical Use of Prescription Drugs, Opioid Misuse,

and Opioid Overdose, https://www.samhsa.gov/capt/tools-capt-learning-

resources/capt-resources-support-opioid-misuse-overdose-prevention

The U.S. Office of Special Education’s Programs Intervention IDEAs for Infants,

Toddlers, Children, and Youth Impacted by Opioids,

https://osepideasthatwork.org/sites/default/files/IDEAslIssBrief-Opioids-508.pdf57

https://na01.safelinks.protection.outlook.com/?url=https://eclkc.ohs.acf.hhs.gov/mental-health/article/substance-misuse&data=02|01|apowell@aap.org|f721343f0efe460319a408d5bcf6e069|686a5effab4f4bad8f3a22a2632445b9|0|0|636622690872066700&sdata=xvWtrKAQSTqyYDMYW7Qd%2BI7qdOJ50OFXdwvkQCyLqaA%3D&reserved=0https://healthreach.nlm.nih.gov/patient-material-results?keywords=opioids&btnsearch=Search&author=&language=&format=&user=&records=10https://ncsacw.samhsa.gov/resources/substance-exposed-infants.aspxhttps://ncsacw.samhsa.gov/resources/opioid-use-disorders-and-medication-assisted-treatment/neonatal-abstinence-syndrome.aspxhttps://www.samhsa.gov/capt/tools-capt-learning-resources/capt-resources-support-opioid-misuse-overdose-preventionhttps://osepideasthatwork.org/sites/default/files/IDEAslIssBrief-Opioids-508.pdf

Infant/Toddler Resource Guide

Child Care State Capacity Building Center, a service of the Office of Child Care, Administration for Children and

Families (ACF), U.S. Department of Health and Human Services. (n.d.). Infant/toddler resource guide [Webpage].

Retrieved from https://childcareta.acf.hhs.gov/infant-toddler-resource-guide

58

https://childcareta.acf.hhs.gov/infant-toddler-resource-guide

Questions and Next Steps

59

Presenter Contact Information

Shana Bellow

shana.bellow@georgetown.edu

Barbara Buckshot-Jock

barbara.buckshot-jock@icf.com

Jeanne VanOrsdal

jeanne.vanorsdal@icf.com

mailto:shana.bellow@georgetown.edumailto:barbara.buckshot-jock@icf.commailto:jeanne.vanorsdal@icf.com

Proactive Steps in Addressing the Misuse of OpioidsProactive Steps in Addressing the Misuse of OpioidsAction PlanLet’s Get to Know You! Outcomes of Today’s Session Connecting to CCDF PlansHave you worked with a family or child affected by opioid misuse? The Opioid Epidemic by NumbersWhat We Know about the Opioid MisuseOpioid-Related Overdose Death RatesOpioid-Related Overdose Death RatesWhat is neonatal abstinence syndrome? Neonatal Abstinence Syndrome (NAS)Symptoms of NAS Possible Impact on the Development of Young ChildrenSummary of Effects of Prenatal ExposurePotential Impact on 1–5 Year-OldsPotential Impact on School-Age Children (includes multiple substances, not just opioids) Potential Impact on School-Age Children (includes multiple substances, not just opioids) What strategies can you use to support caregivers in providing care for children born substance exposed? Working with ProvidersUsing Relationship-Based PracticesProviding Care for Infants with NASTraining for ProvidersTraining on Screening and Surveillance Community SupportHow can we support the families and caregivers affected by opioids? Support for Families and CaregiversFoster CareImpact on Grandparents/Relative CareHow We Can Support these Families and Engage in Comprehensive ServicesProviding Comprehensive Mental Health and Prevention ServicesParent, Family, and Community Engagement FrameworkHow are states working on this issue? Massachusetts “Proactive Steps in Addressing the Opioid Crisis-Local and Regional Initiatives”OCC Infant/Toddler School Age InstituteInitial Opioid Pilot ProjectOpioid Pilot Project 2016-2017OHS Region 1 needsOpioid Addiction Opioid Addiction Trainings and CollaborationsOngoing Related WorkContact InformationFrequently asked questions (FAQs)FAQsFAQsSubstance Abuse and Mental Health Services Administration (SAMHSA) Opioid Treatment Program DirectoryWhat resources are available? What are the resources in my state?Principles of Substance Abuse Prevention for Early ChildhoodPrinciples of Substance Abuse Prevention for Early ChildhoodPrinciples of Substance Abuse Prevention for Early ChildhoodPrinciples of Substance Abuse Prevention for Early ChildhoodPrevention First ResourcesDiscoverty Education ResourcesResourcesResourcesInfant/Toddler Resource Guide Questions and Next StepsPresenter Contact Information