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Introduction

The opioid crisis affecting countless families throughout the United States has caught the attention of groups spanning the sectors of health care, education, social services, criminal justice, and even business and labor. According to the Centers for Disease Control and Prevention (2018), from 1999 to 2017, more than 700,000 people died from a drug overdose. On average, 130 people die every day from an opioid overdose in the United States.¹ Within these average numbers, certain populations are being affected more than others. According to the National Institute for Children’s Health Quality (n.d.):

Children are one of the most vulnerable populations caught in this public health crisis, as a growing number are sent to live with other relatives or placed in foster care following the death of a parent or a parent’s inability to continue as a primary caretaker while in recovery (Collier, 2018). Additionally, health care systems around the country have seen a dramatic increase in babies who are born with neonatal abstinence syndrome: there were 32,000 such births in 2014—five times higher than the number in

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¹ See CDC-WONDER (wide-ranging online data for epidemiologic research); see http://wonder.cdc.gov.

2004 (National Institute on Drug Abuse, 2019). All children affected by the opioid crisis, whether born with withdrawal symptoms or struggling as an older child surrounded by uncertainty, need dedicated attention, likely including specialized services, to achieve optimal levels of health and well-being. Unfortunately, because so many resources directed to the crises have been dedicated to the immediate and long-term needs of people who have overdosed, children often become a forgotten population.

In response to this need, the Forum for Children’s Well-Being convened a workshop in June 2019 on Fostering Children’s Physical, Developmental and Social/Behavioral Health in the Face of the Opioid Crisis. The goals of the workshop were to explore multigenerational approaches and policy strategies to promote health and well-being, using the opioid crisis as a case study.

The planning committee chose this case study not only because of the urgency of the crisis, but also because the members believe it provides insight into how to approach similar crises. While opioid misuse is a public health concern today, other substance use may be of concern in the future. Multigenerational approaches and policy strategies that are successful in fostering children’s health in this crisis may be adaptable in the future, and the planning committee recognized that learning best practices now can help to better prepare practitioners and policy leaders.

The workshop featured two speaker panels, the first on approaches to prevent and mitigate adverse childhood outcomes related to parental substance abuse disorder and the second on policies aimed at preventing opioid misuse. The workshop had three main objectives:

1. Identify and describe innovative prevention and intervention programs that incorporate multisector and multigenerational approaches to promote the well-being of children and youth affected by the opioid crises and the treatment and recovery of their families.
2. Identify and describe policy approaches at the local, state, tribal, and federal levels that address the well-being of children, youth, and families affected by the opioid crisis throughout the life course.
3. Broaden the conversation and policy options to include intentional prevention, early intervention, and recovery in light of the nation’s opioid crisis.

Following the panel presentations, many Forum members and those in the audience commended the work being done both at the local and community levels, as well as work at the national policy level, in undertaking multifaceted efforts to mitigate the negative outcomes associated with opioid misuse.

ORGANIZATION OF THIS PROCEEDINGS

This proceedings document is organized into four chapters. Following this introduction, Chapter 2 highlights the examples of work being done on the ground, described by speakers across the federal, state, county, and tribal and community levels. Chapter 3 summarizes several of the various drivers for change discussed during the workshop, either through examples of programs already in place or suggestions for future consideration. Finally, Chapter 4 brings together takeaways for both the Forum and related partners to consider as potential future directions for supporting families in the face of the opioid crisis, as well as future focus areas for the Forum to consider in relation to the well-being of children and families. All of the presentations at the workshop except one, as well as the ensuing discussions, are summarized in this proceedings. The presentation of Judy Tan is not included because tribal rules do not permit publication of her materials in any way.²

This proceedings has been prepared by the workshop rapporteur as a factual summary of what occurred at the workshop. The planning committee’s role was limited to planning and convening the workshop. The views contained in the proceedings are those of individual workshop participants and do not necessarily represent the views of all workshop participants, the planning committee, or the National Academies of Sciences, Engineering, and Medicine.

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² Copies of the speakers’ slides, as well as archived recordings of the workshop, are available on the Forum website. See http://sites.nationalacademies.org/DBASSE/ccab/DBASSE_192648. For information on Judy Tan’s presentation, contact the speaker directly.

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