In October, Texans Care for Children began a three-part discussion series, “Substance Use Among Youth and Families: What are the Big Issues and What is Texas Doing about It” because substance use affects children and children’s policy in so many ways, including the high cost in terms of health, human potential, and state resources.

We have posted some of the materials from our first two discussions, including Powerpoints for our October discussion and November discussion as well as the Prevention Funding Map and Treatment Funding Map that we distributed at our last discussion.

This blog highlights what we learned at our second discussion in November, which focused specifically on youth substance use, and closes with a few data points presented by our staff at our first discussion in October. Our November speakers were:

Eric Niedermayer, the CEO of the Recovery Resource Council in Fort Worth,
Judge Michael Schneider of the 315th Juvenile Court in Harris County,
Andrea Richardson, the Executive Director of Bluebonnet Trails Community Services, and
Tymothy Belseth, a research coordinator with the Texas Institute for Child and Family Wellbeing.

In examining challenges related to youth substance use prevention and treatment, two themes emerged. First, effective youth substance use prevention and recovery efforts address trauma and help youth build resilience. Second, there are serious gaps in data and cross-system alignment that make it difficult to understand the scope of the problem, measure the unmet need for substance use treatment and prevention, and determine whether the state is adequately investing in effective services.

Effective Substance Use Prevention and Recovery Efforts in Texas Address Trauma and Build Relationships

Speakers highlighted that positive and negative childhood experiences affect lifelong health and opportunity, including the risk of youth substance use, especially when appropriate support is not provided after negative experiences. For example, young children’s exposure to abuse, neglect, household stress, and other family challenges — often referred to as Adverse Childhood Experiences (ACEs) — have been linked to later risky health behaviors including substance use, chronic health conditions, school failure, and early death. As the number of ACEs increases, so does the risk of negative outcomes including substance use. Similar studies have shown other types of trauma and toxic stress in early childhood yield similar outcomes. Research also shows that the negative effects of trauma, toxic stress, and ACEs may be mitigated through trauma-informed care, mental health supports when appropriate, and building resilience through meaningful, supportive relationships.

To underscore this point, Andrea Richardson of Bluebonnet Trails Community Services shared a story about a 14-year-old who benefited from Bluebonnet’s support services. This child was born exposed to cocaine, tested positive for meth as a youth, was removed from his home and placed in foster care, and was involved with the justice system. He’s now in treatment and continues to experience challenges, including damage to his foster family’s house during Hurricane Harvey and the tragic death of his aunt, who was a victim of gun violence.

Thanks to the support he is now getting, he is showing signs of resilience and is making progress. His response to these most recent tragedies has been a desire to help provide respite for other families who are struggling. He wants to help because he has been helped. This is the kind of resilience that effective treatment and strong relationships can build.

Eric Niedermayer discussed another example of how effective supports for children who have experienced trauma and ACEs can prevent and reduce substance use. The Recovery Resource Center run by Niedermayer focuses on relationship-building. For example, their “Kids Connection” program, otherwise known as the Sunshine Club, focuses on children ages 6-12 who have experienced trauma or other risk factors for substance use as identified by teachers or other school personnel. They created this club as an in-school intervention that focuses on building social-emotional confidence, improving school achievement, developing coping strategies, improving decision-making, and reframing challenges. The key is creating a safe space to talk and build relationships.

Harris County’s Judge Schneider spearheaded a Juvenile Drug Court in Houston in 2010 after traveling around the country exploring overcrowding issues in juvenile lock-up and learning about effective court models. He noted that while many youth in the juvenile justice system would benefit from community-based substance use treatment, which, if more readily available, would reduce the flow of youth into the juveniles justice system.

To be part of the Harris County juvenile drug court, youth must be eligible for lock-up, have a substance use disorder, and have one adult willing to shepherd them through the process. These eligibility criteria recognize the importance of relationships. The court may recommend Multi-Systemic Family Therapy and other best practices that work with children in their home environment to reduce triggers that may have contributed to drug use.

Tymothy Belseth has seen many foster youth who are drawn to substance use because of placement instability, social isolation, and childhood trauma. Too often, Belseth explained, rather than helping foster youth feel more empowered in their life decisions and building healthy relationships, treatment is often in the form of psychotropic medication that fails to address underlying social isolation and trauma. Again, promoting resiliency and normalcy (i.e. the opportunity to participate in typical youth activities, which are often out of reach of youth in foster care) can go a long way to reduce the likelihood of youth substance use.

Gaps in Data and Lack of Collaboration

All the panelists stressed the value of good data and the need for better data collection at the state and local level. Better data would help policymakers and community providers assess the cost-effectiveness of various substance use prevention and treatment models as compared to the expense of detox or medication-assisted treatment.

Richardson also explained that good data is key to assuring treatment providers are accountable for the investment in their work. They are currently evaluating the effect of some of their youth substance use treatment services and plan to leverage those results to improve their services and share their lessons with other community providers.

Richardson noted that wraparound services should be interconnected across systems. The child protection, juvenile justice, and education systems too often operate in silos, which gives us a disjointed, narrow picture of the challenges facing our state and our children. For example, her program works within schools but those partnerships have taken time to develop. Most of the 12 schools districts they collaborate with brought them in due to a tragedy, such as a student’s suicide or overdose. Her hope is that schools will recognize before tragedy strikes that intervention and treatment will help promote student achievement and success.

Judge Schneider noted the significant gaps in data that could help improve care and treatment for kids in the foster care system. He and others have requested key data from the state, including:

What percentage of youth in foster care misuse substances or have a substance use disorder?
For which substances are youth in foster care receiving treatment?
How often are children in foster care prescribed opioids or other addictive prescription medications?
What are the ages of youth in care who are referred to substance use services?
What are the outcomes for youth in care with substance use disorders or who receive substance use treatment?

It is currently unclear whether any of the above data is being tracked at the state level.

Belseth had answers to some of those questions. He shared preliminary data on substance use from his longitudinal study on permanency (i.e. finding a safe, permanent, and stable home for a child in foster care through family reunification, guardianship from a kinship caregiver, adoption, or other means). The data indicated the prevalence of drug and alcohol use among foster youth may be higher than expected based on other studies. For alcohol, his research has found 15 percent of former foster youth in Texas surveyed had never tried it, 27 percent started drinking at 10 years of age or younger, and 58 percent used alcohol starting at 11 years of age or older. With regard to illicit drugs, 25 percent of the foster youth surveyed had never tried them, 25 percent started at 10 years of age or younger, and 50 percent started at 11 years of age or older. Other studies, like this survey by the National Youth in Transition Database, show lower levels of prevalence for the foster youth population. If the data Belseth presented is accurate, then it would also seem substance use prevalence is underreported in IMPACT, the data system that Texas uses to track characteristics of children in foster care. But these data highlight the need for a better understanding of the scope of the youth substance use problem, both in and out of the foster care system.

Key Data Points

Despite the gaps, a number of key data points about youth substance use were presented at the first of our three substance use discussions:

An estimated 182,000 youth in Texas have substance use disorders, but only five percent of kids who need treatment actually received treatment through the public behavioral health system (an unknown number may receive treatment elsewhere in Texas).
Alcohol is the drug of choice for Texas youth. According to the 2016 Texas School Survey of Drug and Alcohol Use for grades 7-12, 53 percent (1 million students) used alcohol at some point in their lives and 24 percent (470,000) used alcohol in the previous month.
Marijuana is the most frequent illicit substance used. The survey showed that 21 percent (400,000) of youth reported using it in their lifetime and 13 percent (148,000) used marijuana in the past month. Nearly 1 in 5 (19 percent) have used prescription drugs not prescribed to them. Five percent reported misuse of opioids.
Teenagers are not the only youth who struggle with substance use. A surprisingly high number of Texas students report first using a substance at 8 years or younger:
Alcohol: 97,000
Marijuana: 87,000
Inhalants: 13,200
Methamphetamine: 2,000
Cocaine: 560
Crack: 413
Heroin: 1,230

We also know that youth substance use contributes to school discipline and involvement in the juvenile justice system:

In 2015, Texas schools took mandatory disciplinary action against 26,693 students for drug or alcohol use. Not all these incidences at school result in arrest.
In 2016, 7,186 Texas children were arrested for drug and alcohol offenses, including 80 percent for drug possession, 14 percent for alcohol-related offenses, and 6 percent for drug sales/manufacturing. Seventy-eight percent of arrests for possession were for marijuana (5,600 arrests) while six percent of arrests for possession were for opium, cocaine, morphine, heroin, and codeine.

Conclusion

These discussions were a fruitful start to a much-needed conversation on youth substance use, their treatment needs, and system responses. Going forward, we need a better understanding of treatment capacity for various youth populations, both in the community and juvenile justice system. We need better data on the scope of youth substance use across systems, across age groups, and regional differences. There was agreement that state policy should focus on promoting prevention services and treatment services that build resilience through relationships and improving collaboration across systems.

Our next discussion on December 12, 2017 will focus on parental substance use disorders, its effect on children, current programs and treatment options, and system responses. Please join us to learn and share knowledge on how Texas can better address substance use and its effects on the health and well-being of Texas parents and children.