Educators, social workers and mental health professionals are sounding the alarm that Vermont's opiate problem is working its way into the schoolhouse as one factor driving an increase in students with emotional problems.
And although there is no proof of cause and effect, professionals predict the pressures of addiction and poverty on the school system are only going to deepen and lead to more children being identified as needing special education as a result.
One crucial response, professionals say, is to provide mental health services to schoolchildren at the youngest ages, as well as continue and perhaps expand anti-poverty programs in schools, such as free and reduced-price meals.
Special education is tied to both poverty and opiate addiction, according to legislative testimony from Sherrie Brunelle, a paralegal with the Disability Law Project at Vermont Legal Aid.
"Is it tied to opiate issues, is it tied to poverty? I think yes to both. Is it tied to the fact that we don't have in schools the mental health supports that educators and families need to address those issues early on (in preschool and early elementary)? Yes," Brunelle said.
Vermont has the highest in the nation, per-capita rate of students who receive special education services because of emotional disturbance, according to a January report by the agencies of Education and Human Services. A designation of emotional disturbance covers behavioral, emotional and psychological disorders.
School administrators and practitioners point to poverty, substance abuse, physical violence, homelessness and neglect — all of which are considered causes of what doctors call toxic stress, which in turn is tied to behavioral problems at school.
There is a clear connection between a significant increase in poverty in the early 1990s, when students were first being diagnosed with emotional disturbance, and the current situation in Vermont, according to Jo-Anne Unruh, executive director of the Vermont Council of Special Education Administrators.
"Poverty is certainly a stressor for families. Homelessness, unemployment, underemployment — all of those have increased in Vermont and contribute to family stress and to the stress placed on young children," Unruh said in an interview. "We are seeing an increase in the number of young children coming to school who have suffered a number of adverse experiences, and the more adverse experiences a child is exposed to the more likely that child is to have mental health issues later in life."
Unruh said that's why including mental health support services in preschool and early education is critically important.
The Education and Human Services report indicates that the effects of poverty and opiate addiction are intersecting in Vermont's schools. The report lays out progress on developing a plan requested as part of last year's Act 46 education law to maximize collaboration between the agencies on delivering social services to public school students.
Rebecca Holcombe, secretary of the Agency of Education, said school districts are seeing an influx of children with challenging behaviors.
"You can see that in the younger generation of our population we have a growing incidence of child trauma and children dealing with extreme circumstances and struggling to thrive," Holcombe told members of the State Board of Education this month.
William Mathis, a member of the state board, said he recently spoke with a school principal about how his school has changed over the last five years.
"He said the needs of the kids — we have emotionally disturbed kids, and kids with heavy needs that are much greater than it was," Mathis said.
The number of school-age children receiving special education services for emotional disturbance is growing, and younger children are also seeing an increase in emotional disturbance and other developmental disabilities, according to the report.
Children with the most extreme needs are in state custody, and the number of children under the age of 5 years old who are wards of the state has doubled. In 2013, 284 young children were in state custody; by the beginning of this year the number had nearly doubled to 532. In 2013, 194 children age 6 to 11 were in custody, versus 309 by 2016. Other age categories stayed largely steady.
"Clearly the issues the Department (for) Children and Families have faced, in terms of opiate addiction and young children coming into custody — all those issues impact all kids coming into school," Unruh said.
In 2014 nearly 16 percent of Vermont's children were living in households at or below the federal poverty level, which means a family of four makes $24,000 and a single parent with one child makes $16,317 a year, according to the state report. In 2008, the rate of children living in poverty was 13 percent.
"Because strategies to reduce the impacts of poverty are most effective when assistance is offered to very young children and their families, it is important that the state continues to support poverty prevention efforts at schools, afterschool and summer school programs and in community for those children not yet enrolled in formal K-12 school programs," according to the report.
Holcombe cited school meals as an example. "There are school systems that routinely feed kids three meals a day. It really feels safe, and I attribute that to the educators who learned and designed a system supportive of their kids," she said, adding, "I sense this is a more pervasive need."
While the report could not directly connect high rates of poverty and opiate addiction to the increase in children identified as needing special education because of emotional disturbance in Vermont, the data did show, however, an increase in family poverty, opiate abuse and death that is accompanied by an increase in the number of cases of emotional disturbance.
In 1989, 891 students were identified as needing special education because of an emotional disturbance. More than two times that number — 2,121 — had individualized learning plans because of emotional problems in 2014.
The report acknowledges that better identification of emotional troubled children or a change in the way emotional disturbance is defined could be factors in the more common diagnosis.
Act 46 instructed the agencies of Education and Human Services to work with school districts, supervisory unions, social service providers and other stakeholders to come up with a plan for coordinating the delivery of social services to public school students and their families.
As a result, the agencies have joined with the Department of Mental Health, the special educators council and others to create an interagency mechanism built on a foundation set up in the 1990s that had an interagency team with coordinated plans to deliver mental health services to schoolchildren, according to Unruh.
The state report identifies what it calls a policy weakness in the 1988 law that set up the system of coordinating services: It guarantees children the right to coordination but not necessarily to the services outlined in the plan.
"Given the current issues in terms of opiate addiction and more young children coming into state custody, we need to strengthen that care system based on 2016, not 1990," Unruh said.
In an effort to better understand how to target the children who need the most help, researchers studied the six supervisory districts or unions with the highest increases in emotional disturbance. They found that Winooski has consistently had a high rate of students identified as emotionally disturbed and it continues to rise, while Orange North has also seen a spike in the diagnosis. Researchers plan to look at the areas with the lowest emotionally disturbance rates as well.
Unruh wants to know what can be learned from these local experiences to create better practices and responses. "Schools are spending an enormous amount of money addressing the mental health needs of children," she said. "We have a real high incidence in the rate of children who are identified as ED, which speaks to the need of dealing with these issues earlier and well, in collaboration with the Department (for) Children and Families as well as mental health providers."
The Human Services and Education agencies say they want to bolster the good work that is already going on in many of the districts. "These districts are working hard; by coordinating state level support we hope to bolster ongoing local efforts to make sure all children are safe, healthy, engaged and appropriately challenged," says the report.
Holcombe said she wants to know the best way to incorporate support and services, especially mental health services for children, "so teachers can continue to do the phenomenal work to keep our education program going."
Unruh said that serving the children as early as possible with the right level of support is the answer. When this happens, she said, she has seen lives turned around and children successfully learning and thriving with their peers in school.