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Learning From Each Other: State Efforts to Address the Opioid Epidemic and Its Consequences on Schools in Appalachia

December 19, 2018

SRI International
   Sarah Mehrotra, REL Appalachia
   Tali Klima, REL Appalachia

Both the prevalence and the devastating impact of the opioid epidemic are well documented. While the crisis in Appalachia has been gaining national attention, students, families, and teachers have been living with its effects every day. Opioid abuse encompasses misuse of prescription painkillers such as hydrocodone and oxycodone as well as illegal drugs like heroin and fentanyl. For several years, the rates of abuse of these substances in Appalachia have exceeded national averages.1 Several factors are thought to contribute to these unmatched rates of abuse and overdose, including a lack of access to healthcare or treatment and general economic decline.

Panel discussion regarding opioid epidemic in the Appalachian region

Tali Klima (right) moderates a panel discussion on how states are addressing the opioid epidemic in the Appalachian region with (from left) Susan Beck, West Virginia Department of Education (WVDE); Rebecca King, WVDE; and Vestena Robbins, Kentucky Department of Behavioral Health, Development & Intellectual Disabilities.

The greatest percentage of opioid users are not teenagers but rather young adults (ages 18–25),2 and opioid deaths are highest among middle-aged adults (ages 25–54). The users thus are typically not students but their parents, grandparents, and other adults in their communities.3 Living with adult family members and community members who misuse opioids exposes students to acute and chronic stressors (among them parental neglect, domestic violence, criminal activity, parents' severe physical/mental deterioration, compromised home environment, foster care placement) and, potentially, psychological trauma.

In October 2018 the REL Appalachia (REL AP) Governing Board explored how the education system is supporting Appalachian students, teachers, communities, and families in the midst of this crisis.

Trauma-informed care

Students who live in communities affected by opioid addiction may experience the stress or trauma from unmet basic needs (lack of sleep or food, instability in housing), as well as psychological difficulties from their experiences. Students in these circumstances are likely to have a hard time concentrating on schoolwork, engaging in the school environment, and learning new material. In schools where teachers are already overburdened, school leaders and administrators must find ways to provide students with adequate care to address basic needs and psychological supports to cope with the stress. Some schools in Appalachia are implementing trauma-informed practices. Trauma-informed practices can be embedded in a wide range of school practices, from curriculum or educating school staff on trauma to discipline policies offering restorative justice as an alternative to suspension or expulsion.4 For example, the Kentucky Department of Education is helping schools implement practices that are trauma sensitive and optimize the use of mental health referrals and resources.5 Virginia recently received a grant to implement Virginia Tiered System of Supports, which supports the alignment of academic, behavioral, and social-emotional wellness in schools most impacted by the opioid crisis. The grant will help schools develop curriculum and training materials for teachers to support students who have experienced trauma.

For more information and resources on student trauma and the opioid crisis, see Community Opioid Abuse and Student Trauma: New Challenges for Educators.

Collaborating to support schools

REL Governing Board members agreed that a common challenge is coordination and collaboration among schools, local and state agencies, and community organizations charged with supporting students during the opioid crisis. Some collaborations suggest potential. For example, the Kentucky Family Resource and Youth Services Centers (FRYSCs) are social service agencies that operate in schools and aim to eliminate nonacademic barriers to learning. Such barriers are especially pronounced for students who are experiencing opioid abuse in their homes or immediate communities. FRYSCs provide peer mentors, tutors, and resources for transition to college or careers. By being physically located in schools, FRYSCs are a readily accessible resource for students (and their educators).

West Virginia's Handle with Care program recognizes the important link between traumatic events that may occur outside school and the impact of those events on students during the school day. Handle with Care is a partnership between local law enforcement and schools. A law enforcement officer can contact school personnel through an app to let them know that one of their students was involved in a serious event that involved law enforcement the previous day (perhaps a parent was incarcerated or overdosed). In this way, administrators and teachers are better prepared to make the necessary adjustments to support the student in school the next day, such as by accommodating the school schedule, providing counseling, or contacting external service agencies.

State task forces can also be powerful in addressing the opioid crisis, both on a systems level and in schools. Tennessee, for example, assembled the seven-member Ad Hoc Task Force on Opioid Abuse and used the expertise of doctors, judicial branch representatives, and law enforcement agencies to form solutions. This task force partnered with the Tennessee General Assembly in TN Together, a comprehensive plan to aggressively end the opioid epidemic in Tennessee. Part of this plan is to increase prevention education in elementary and secondary schools.

Early childhood and special education

Neonatal abstinence syndrome is a growing concern for educators in Appalachian states. Tens of thousands of babies are born each year to mothers who abused opioids when they were pregnant.6 Infants with neonatal abstinence syndrome are significantly more likely to be referred for a disability evaluation, meet criteria for a disability, and to require classroom therapy or services.7 The REL AP Governing Board members expressed concern about how they can prepare schools to give this incoming group of students the supports they need. It will be critical in the coming years for state agencies that serve young children (such as early-intervention services and Head Start) to raise awareness of this issue and come together to create solutions.

Learn more about the opioid crisis in Appalachia and state efforts and collaborations

These materials were created by Tali Klima, Kaily Yee and Jennifer Nakamura.

  • Trauma Support for Schools. This website from REL Appalachia's Cross-State Collaborative to Support Schools in the Opioid Crisis (CCSSOC) includes extensive resources including mindfulness videos, training modules, factsheets, blogposts and much more for diverse stakeholders committed to supporting students and educators experiencing trauma.
  • The Handle With Care Resources. REL Appalachia developed educator resources to support educators in examining data related to implementing the Handle With Care (HWC) program, which supports children exposed to trauma through collaboration between school and emergency response systems.



1Moody, L., Satterwhite, E., & Bickel, W. K. (2017). Substance use in rural central Appalachia: Current status and treatment considerations. Rural Mental Health, 41(2), 123–135.

2Ahrnsbrak, R., Bose, J., Hedden, S. L., Lipari, R. N., & Park-Lee, E. (2017). Key substance use and mental health indicators in the United States: Results from the 2016 National Survey on Drug Use and Health. Retrieved from .

3Walsh Center for Rural Health Analysis. (2017). Final report: Appalachian diseases of despair. Retrieved from .

4Christina, S. A. (2018, September 17). Opioid epidemic raising special education concerns. Education Week. Retrieved from

5Commonwealth of Kentucky. (2017). 2017 Combined annual report: Kentucky Office of Drug Control Policy and Kentucky Agency for Substance Abuse Policy. Retrieved from

6Christina, 2018.

7Fill, M. A., Miller, A. M., Wilkinson, R. H., Warren, M. D., Dunn, J. R., Schaffner, W., & Jones, T. F. (2018). Education disabilities among children born with neonatal abstinence syndrome. Pediatrics, 142(3). Retrieved from