The opioid crisis comes to the classroom as soaring numbers of children born in drug withdrawal reach school age

LACONIA, N.H. — With its historic Main Street and wealth of lakeside vacation homes, this small New England community long took pride in an image straight out of Norman Rockwell paintings. But alongside that picturesque world, in rooming houses and alleyways, young adults were overdosing by the score, bringing Laconia, population 16,000, unwanted attention as an epicenter in the national opioid crisis.

The results have been particularly acute at Woodland Heights elementary school, where the sound of screaming children and running teachers used to hit visitors the moment they walked into the open-concept building. Five years ago, there were tiny kids throwing chairs, 7-year-olds actually climbing the walls, and costly Special Education services gobbling up ever more of the school’s budget, as the children of addicted parents increasingly filled Woodland Heights’ classrooms.

But in 2018, after an annual drumbeat of dismal outcomes in math, science and writing, teachers saw something that they hadn’t for years: academic growth.

The key was not a novel approach to instruction — it wasn’t even strictly academic. The secret, said Principal Eric Johnson, was overhauling his school’s approach to students’ emotional well-being by weaving extra support into the fabric of each day. Some kids might require 5-minute check-ins every morning. Others, a weekly group meeting. And all now get lessons in relaxation and mindfulness. Teachers say these small but significant changes have transformed their working environment.

On the front lines, Johnson deploys a full-time social worker, two behavior specialists, a guidance counselor and part-time psychologist dedicated to figuring out just what is going on with these kids, and whether they need special education — even without a diagnosis of autism or ADHD.

During fetal development, “the neurological connections are getting messed up, so their executive functioning is messed up,” said Christina Flanders, who conducts educational testing at Woodland Heights. “They’re not autistic. They’re just these damaged little brains that are not psychologically ready to learn.”

Amid the ongoing national discussion about opioids, the grim tracking of overdose trends and debates over treatment, the story of Woodland Heights illuminates a looming problem that receives far less attention. But it could shape public education for a generation.

From Washington to West Virginia, the number of children born in withdrawal from opioids and other drugs has skyrocketed, and those babies — now elementary-school students — present challenges that teachers say they have never encountered at such a scale.

Expected to sit quietly, memorize lessons and manage the basic frustrations of learning, these children, suffering cognitive and developmental problems, instead tend to lash out with explosive physical aggression and wild mood swings. An elementary school in Everett designates a teacher and three aides to handle one classroom of just a dozen special-needs students exhibiting extreme behaviors.

Beyond toxicity in utero, the lives of children who grow up with drug-abusing parents are marked frequently by the presence of police, the constant fear of a mother or father’s incarceration and the likelihood of sudden death by overdose — all traumas shown to impede brain development and learning. The disruptive behavior that results can affect entire classrooms.

Despite these hurdles, 58% of Woodland Heights’ students improved on state language arts tests in 2018, 42% did better in math, and so far this year disciplinary problems are down 79% from where they were in 2013.

The change is notable enough that other schools in the rural New England district — even those with fewer low-income kids and less extreme problems — are clamoring for their own behavioral-health teams. Researchers at Antioch University New England have taken notice too, highlighting Woodland Heights’ success (though without naming the school) in a report published earlier this year by the New Hampshire Department of Education.

“Before we had our behavior specialists and social worker, it was really hard to teach,” said Ashley Black, a second grade teacher at Woodland Heights. “We were faced with behaviors beyond what we were capable of dealing with in the classroom. It was really bad — I just couldn’t meet the kids’ needs.”

Daily check-ins

In her office with comfy beanbag chairs and low lights, school social worker Rachele Cote meets three times a day with a fifth grade boy, talking in the morning about how the night before had gone and setting goals for the day. At a recent lunchtime meeting, the boy was sketching as they spoke. Cote nudged him to talk about his father (imprisoned for dealing drugs), his hopes for the future (becoming a police detective) and the best thing about school (math team).

Worn out afterward, the boy rubbed his arm across his eyes and forehead, inadvertently revealing a large red bruise. Cote showed no shock or alarm. The 11-year-old routinely struggles with self-harm, she explained later, hitting his head against the frame of the bed where — abandoned by his mother — he lives with a friend of his incarcerated dad. This summer, because the Woodland Heights guidance counselor applied on his behalf, the boy will spend weeks in the country at a nature camp designed to help kids improve their self-esteem.

His session with Cote wrapping up, the boy looked down at his drawing — a cylinder shape topped with a fluffy-looking cloud — and grimaced.

“I was trying to draw a nuclear bomb,” he muttered. “But it came out looking like a tree.”

Cote’s day starts with a series of these student check-ins. She’ll then make phone calls to various parents, trying to track down chronically absent kids, or connect a family with community-based therapy. She might drive a mom to the pharmacy for medication, or to a food pantry. She’s helped parents who can’t read or write get their kids signed up for summer programs, and she’s made phone calls to foster care — parents weeping at her side. Cote is available to any student in the school but works closely with about a third of Woodland Heights’ 390 kids. By the end of the day, she often has a line of teachers waiting to alert her to the next day’s red flags.

Yet when Cote started at Woodland Heights, “social worker” was a dirty word among some on the school board, said Marcy Kelley, who oversees student support at the school.

“There used to not be a whole lot of connection between home and school — it was, the school does math, reading and science and your home life is your own business,” said Cote. “We still have some hard-core critics who think school should just be reading, writing and math, but they’ve never set foot in an elementary school — at least not in the last 20 years. They have no idea what kids are going home to today.”

Others question the wisdom of throwing resources at families led by parents who decide every day to put a needle in their arm. Cote, whose husband successfully overcame heroin addiction 16 years ago, is well acquainted with this line of thinking. She is also the daughter of a neighboring town’s police chief.

“It’s not the kids’ choice,” she reminds critics. “And if they grow up to be unemployable because they’ve never learned how to deal with their anger, they’re not going to contribute much to society.”

Skepticism at the district office meant that, initially, Cote’s salary and that of many other behavioral-health staff in Laconia were not part of the regular budget. Instead, they were paid for with federal substance-abuse, mental-health and justice department grants. McKenzie Harrington-Bacote, who directs Laconia’s Office of School Wellness, makes it her business to find them. In the past five years, she has brought $4.4 million into the district.

“It doesn’t matter how great the teaching staff is if the kids can’t focus on learning,” Harrington-Bacote says, thinking about the little girl who came to Woodland Heights with dog feces smeared on her clothes. And the kids who showed up so hungry they were unable to wait for lunch because they’d eaten no dinner the night before. And the boy who, on the day he turned six, dozed off on his father’s lap and awoke to discover his dad had overdosed. The child’s birthday is now a source of annual trauma.

Troubling forecast

Only a handful of studies have attempted to quantify the education outcomes of children born to opioid-addicted parents. One, published in the journal Pediatrics last year, tracked 7,256 Tennessee students between 2008 and 2011, and found that those born in drug withdrawal — a condition known as neonatal abstinence syndrome (NAS) — were 15% more likely than their peers to be diagnosed with a disability requiring special education.

In Washington, rates for NAS — seen in newborns wracked with tremors, labored breathing, digestive and developmental problems — surged more than sixfold between 2000 and 2017 — forecasting a potential flood of special-needs students in coming years. The same trend has troubling implications for states across the country dealing with fallout from the opioid crisis.

At New Hampshire’s Woodland Heights, the results have already shown up in preschool, where at least 26% of current 3- and 4-year-olds were born to or are living with opioid-addicted parents. Nearly all are in line to receive special-education services, which increased 33% districtwide between 2013 and 2018, though many do not have a traditional diagnosis.

“Behavior is beginning to be a route to special education for kids now, rather than academic or learning disabilities — it’s a real shift for us,” said Kelley.

It’s a serious concern for a small district where schools are funded almost entirely by local property taxes, which are capped.

‘Just give us a social worker’

Woodland Heights did not turn the corner all at once. In fact, its initial investments in student mental health did almost nothing.

“It was like Groundhog Day,” Kelley recalled, describing a cycle of student outbursts and quiet counseling sessions that repeated day after day because kids kept going home to the source of their trauma. Not until Woodland Heights connected with parents, grandparents and community agencies did the school begin to see progress.

That message has reverberated. Across town, at Pleasant Street School, the staff have begun to survey incoming parents with a series of questions assessing the prevalence of drug use, divorce, parental death or incarceration in their homes — all recognized as Adverse Childhood Experiences that can impede learning.

And while some parents may resent the intrusion, their children drink in the attention. All morning long, tiny kids walk into Principal David Levesque’s office — by 8 a.m., a third-grader has already set up cribbage on the principal’s desk; at 11 a.m., a second grader whose father is in prison for dealing methamphetamine is doing puzzles on the floor. These are mini timeouts that the students have been taught to seek when they feel unable to concentrate or about to blow up.

Pleasant Street also slots its children into biweekly groups, depending on their emotional needs, for discussions on friendship, self-advocacy and communication. Known as “We Connect,” these 45-minute periods are the only time block on the entire school calendar without a single disciplinary referral, Levesque said.

In many ways, Levesque is an old-fashioned educator — a former high school guidance counselor turned principal, who reminisces about the old days when the worst he encountered was marijuana and a knife in some teenager’s pocket.

But six years at the helm of an elementary school have turned him into an evangelist for this new, more holistic way of working with kids. He is determined to continue, even in the face of $2.5 million in budget cuts to Laconia schools during the past three years, clinging to a new mantra:

“The only thing we need is a social worker — we don’t want any other teachers or anything, just give us a social worker.”