The nation’s opiate addiction crisis draws attention but less visible are the effects on addicts’ children, in school. Across the Puget Sound region, these kids are reeling, and their life outcomes are often dire. But schools could offer hope to stem a looming social crisis.

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EVERETT — The front office at Hawthorne Elementary School, built in 1952, was never imagined as a social-service referral hub, drug-counseling center or confessional. But that’s the role it has served for Tiffany Smith over the past two years, as she’s worked to rid herself of heroin addiction while raising three children.

Smith, who lives across the street from the school, regularly stops in to chat with the office staff and update Principal Celia O’Connor-Weaver on her progress in treatment. It wasn’t always such a cheery occasion. The first time she ventured inside, Smith, now 31, clutched a sheaf of paperwork from Child Protective Services. She needed to tell the principal that her children — taken into foster care months before — might still get visits from state social workers, even now that the kids were back home.


This article is part of a series looking at the fallout of the opioid epidemic on K-12 schools and the foster-care system, as well as promising solutions to help stem the crisis. It is made possible in part by support from the Annie E. Casey Foundation and Education Lab funders.
In this series

Explaining all of this to O’Connor-Weaver meant describing what had led to the boys’ removal, which meant confessing the words Smith hated saying aloud: She had been addicted to heroin for the better part of a decade. She had been living in her car, the kids staying at her grandmother’s house, until her grandmother finally called state authorities.

“I was afraid of the judgment — or that my children would get shunned,” Smith said. “But it wasn’t that way at all. They said they have a lot of parents that have gone through this and what can we do to help? It was not what I was expecting.”

In her six years at the elementary school, Principal O’Connor-Weaver has repeated this conversation more times than she cares to count. Children in Everett, an epicenter of the opioid crisis in Washington, were among the 525 Snohomish County kids removed from addicted parents in 2017 and placed into foster care. In King County, more than 1,000 children were removed.

And while public-health workers scramble to stem adult addictions, less visible have been the reverberations downstream — that is, on addicts’ children, in school. Across the region, educators and child-welfare workers report increased learning problems and behavioral outbursts from the kids of addicted parents. Research, too, suggests dire life-outcomes for these students. Yet the potential for school-based interventions has been, as yet, underutilized — even as public-health investigators say schools offer the most efficient hope for stemming a looming social crisis.

“This fallout has been coming for a few years, but we’ve seen it get progressively worse,” said O’Connor-Weaver, pointing toward increased tardiness, low attendance and “kids not being well taken care of.”

Evidence shows up during the most mundane moments, like recess, when teachers at Hawthorne watch 7- and 8-year-olds pretend to revive overdosed patients. Or in the principal’s office, when a parent freshly home from rehab confesses that they’ve relapsed.

“The focus of school, of course, is learning,” O’Connor-Weaver said. “But kids’ minds are not focused on that. They’re worried about their parents. They’re worried about their next meal and who’s going to be home to take care of them. When a parent goes into rehab, it puts a huge stress on the family.”

Drug users’ children flooding to foster care

In Tiffany Smith’s case, three years of methadone treatment have helped her regain solid enough footing to secure housing and begin working toward a GED, in hopes of becoming a drug and alcohol counselor. (She’d dropped out of Sedro-Woolley High School at 15.)

But her children are still reeling. Smith’s 6-year-old cannot stand to be apart from his mother and struggles with speech, cognitive and learning delays.

“He was talking fine before foster care,” Smith said. “But when he came out, he couldn’t pronounce some words. They said it was due to the trauma.”

Her older son, now 7, was born prematurely and spent his first two days of life trembling from heroin withdrawal as his mother watched, devastated.

“Seeing my baby shake from detoxing really hurt — I knew it was my fault,” she said.

This may be the most pressing, but largely hidden, toll of the opioid crisis in Washington. Though 10,000 high-school seniors said they’d used heroin or gotten high on opioid-derived painkillers in 2016, those numbers were about the same as two years prior. Foster care, however, is surging.

Between 2011 and 2017, the state took children from drug-abusing parents nearly 14,000 times. Last year’s rate was the highest for drug-related causes since 2010 — up 16 percent over 2015 — while state hospitals report a steady increase in substance-exposed newborns.

Child-welfare workers hear complaints about increasingly severe problems in school — more physical violence toward peers, or kids who need to be taught separately — from students whose parents are staggering through addiction, said Jenna Kiser, who oversees intake at the state Children’s Administration.

I was afraid of the judgment — or that my children would get shunned.” - Tiffany Smith

“These numbers are very concerning,” said Jenny Heddin, a supervisor at the agency. “When children from these homes come into foster care, they can be very difficult to serve. Meanwhile, our foster-family system, too, is very stressed. So this is a bit of a perfect storm.”

Heddin and her staff represent one corner of a national wave. More than 37 states report unprecedented numbers of kids entering foster care, many of them for reasons related to a parent’s substance abuse, according to the federal Department of Education.

The fallout is evident nearly every day at Hawthorne Elementary.

“I don’t care about you!” shouted a child who had been muscled out of his behavior-intervention classroom on a Thursday morning in March, a teacher gripping each arm, bouncer-style. In the hallway outside, the boy covered his face with his hands. His father was no longer living at home, no one had any idea when he’d be back and the child was “a mess,” his teachers told Principal O’Connor-Weaver.

Smith has seen or heard of similar disruptions across the district.

“It’s pretty much everywhere,” she said. “People I’m in recovery with have their children all over Everett Public Schools. One time, I saw a woman nodding out, obviously high while waiting for her kid. She was going to get into her car. I hate to point fingers, but I told the school that’s definitely what’s going on.”

Damaging children’s futures

By the time Child Protective Services is knocking on someone’s door, the problem is already severe. And so far, efforts to respond might best be described as triage — focused more on addiction treatment than prevention, both in Washington and across the country.

“People are very early in their planning on how to make an impact on this,” Kiser said. “I’d love to hear that there’s a state doing awesome so we could follow suit, but I haven’t heard of anyone who’s been able to resolve this.”

Earlier this year, Gov. Jay Inslee proposed spending $20 million on a multipronged effort to combat opioid addiction. The bill never made it to the floor for a full vote, and it contained little funding for prevention. (But $1.7 million targeted for youth did get funding.)

We need to be doing a lot more for kids being parented by opiate-addicted parents — and we’re not.” - Caleb Banta-Green, principal research scientist, Alcohol and Drug Abuse Institute, University of Washington

Yet researchers warn that ignoring that aspect of the crisis virtually guarantees costly problems to come as the children of addicts grow into adulthood. Kevin Haggerty, a professor at the University of Washington who studies risk factors for drug abuse, authored one of the few peer-reviewed studies tracking life outcomes for these young people.

In the early 1990s, he identified 151 elementary and middle-school children in Washington who were growing up with heroin-addicted parents. Fifteen years later, as young adults, 33 percent had dropped out of high school. The vast majority were addicts themselves, and half had criminal records. Only 2 percent had made it through college. (Nationally, 33 percent of all kindergartners in 1992 grew up to earn a college degree.)

“The results are astounding at how poor the outcomes are, having a drug-addicted parent,” said Caleb Banta-Green, principal research scientist at the Alcohol and Drug Abuse Institute at the University of Washington’s School of Public Health.

“We need to be doing a lot more for kids being parented by opiate-addicted parents — and we’re not.”

A few East Coast states — particularly New Hampshire and Massachusetts — have been forced to confront the school-level effects because the scale of adult addiction in their communities has grown impossible to ignore.

“We’re getting that first big wave of kids who were born addicted — they’re kindergartners right now — and it’s not just medical issues. It’s neurodevelopment and behavioral issues,” said McKenzie Harrington-Bacote, who oversees special programs in the Laconia, New Hampshire, schools. “Their behavior is so off-the-charts and aggressive in ways we’re not accustomed to — it’s just a whole other world. The littlest guys in our building are the ones destroying the building.”

New Hampshire itself is relatively prosperous, with a high median household income and low unemployment. But its rural areas have pockets of severe poverty and, like Washington, the Granite State levies no income tax.

To address the need for kid-level interventions, Laconia has increased funding for school-based mental-health treatment by nearly 20 percent in the last three years. This, in turn, has forced layoffs elsewhere in the district. But the possibility that better trauma care now could head off ballooning special-education costs in the future has won the community’s support, Harrington-Bacote said.

Much like O’Connor-Weaver and her staff at Hawthorne Elementary in Everett, educators in Laconia find themselves pressed into service as ad hoc social workers almost every day.

Sometimes that means helping illiterate parents fill out Medicaid forms, or welfare paperwork, or job applications — nothing that teachers were told to expect in their master’s programs.

“Families literally bring their problems to our door now to help them navigate their lives,” Harrington-Bacote said. “Public schools are doing things that fall way outside of regular academic education. But if they don’t, it’s not going to get addressed at all.”