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This is the fifth in a six-part series on mental health care and substance use in Columbus County, North Carolina. Earlier installments have traced how gaps in services have pushed people toward self-medication, and into jails and emergency rooms. Today, The News Reporter and Scalawag look at how the shortages in care affect the school system and young people more generally. The final installment next Thursday will consider how to move forward constructively from here.

Kim Ward, principle of Whiteville Primary School, is worried about a student she has not seen lately.

"It is not uncommon to see him and Mom walking up and down the street, bouncing from shelter to shelter," Ward says. "He has some very well-known, prominent family members in Whiteville. But they're just exhausted with this mother, and her history of drug abuse. Consistently late for picking him up, would not be at the bus stop, changing transportation and not calling to tell him the change."

"This kid was a mess most days. But the classroom that he got put in was with a great teacher, and she would work with him. I thought we were at a really good point."
"But then Mom had a relapse," Ward says. "The last I've heard, two weeks ago, they're missing. We have his Christmas presents here, we've tried to reach out to the family, but she's not been in contact."

This series has tracked worsening mental health care shortages and substance abuse in Columbus County, which have pushed those with behavioral health issues into jails and emergency rooms. Self-medication is on the rise, as the county's state-leading opioid rates attest.

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All of the tumult and social dislocation that results tumbles onto young people. Precarious life circumstances can be passed down like a family heirloom. With public services lacking, the institutions that do exist take on an outsize role. Along with those covered in the other parts of the series—religious institutions, law enforcement, and hospitals—schools and connected programs must scramble to account for issues that once fell further outside their purview.

In the last year, Whiteville City Schools has had to double their teachers for special needs students. These students, who bring to class everything from developmental delays to learning disabilities to behavioral issues, receive tailored educational attention. Each school in the district—primary, elementary, middle, and high—offered one special needs class a year ago. Now, each has two.

Unstable home lives can factor into the sort of misbehavior that lands students in these classes. Kenny Garland, superintendent of Whiteville City Schools, attributes the change to increasing rates of substance abuse—particularly of opioids—among parents. Mental illness, which often overlaps with substance use, can also contribute.

"Socioeconomic factors are not in play on this," Garland says. "We've dealt with poverty for years in public education. That's no problem. Now, we're seeing even children that do have higher socioeconomic status in the home, but the parents are just neglecting them. It's a poverty of neglect, is what it is."

The fallout is apparent even at the youngest ages, according to Ward. That means for an all-hands-on-deck approach to student wellbeing.

"I consider every one of my staff members to be counselors," Ward says.

Family Heritage

"When I was in school, there were two things that I was not taught," recalls Carol Caldwell. "One was how to handle my money, to be a financial wizard. And the other is how to be a good parent."

In 1991, Caldwell became the executive director of the Alcohol and Drug Prevention Council, to work against substance abuse in Columbus County. After a few years, the organization morphed. "The staff here began to realize that people were abusing substances, drugs and alcohol, for a myriad of reasons," she says. "And a lot of it dealt with people living in poverty. A lot of it dealt with a lack of education."

Accordingly, Caldwell's group moved and became the DREAM Center—an acronym for Developing Resilience through Empowerment, Awareness, and Motivation. The group takes a multi-faceted approach to young people's health. An afterschool program, supported by Whiteville City Schools, "works on the whole child," Caldwell says, by including outdoor exercise time and health and nutrition workshops alongside more traditional academic aid.

In addition to the afterschool offerings, the DREAM Center hosts parenting classes for those with children ages 6 to 11, and a "well births" course aimed at pregnant women of color in Columbus County, who have an especially high rate of infant mortality: African-American infants in the county die at more than twice the rate of white infants.

The sorts of intergenerational interventions that the DREAM center practices are a nod to the complex factors of children's health: early experiences, especially within the household, have an outsize impact on a person's health for a lifetime.

A recent but burgeoning body of research on adverse childhood experiences (ACEs) has shown that abuse, neglect, and trauma in the first 18 years of life increase the likelihood of poor health in manifold ways later on: Depression, substance abuse, and suicide attempts are more likely, but also heart and liver disease, risk of domestic violence, and financial instability.

Mental illness and drug abuse in the household—the focuses of this series—are two of the ten criteria used to measure a person's ACEs score. They can also contribute to physical and emotional neglect, two other criteria, in which a child either is not provided for or feels alone and unsupported at home. As the ACEs score adds up, people become more likely to see their health later in life deteriorate.

To hear it from Patches McQueen, Child Protective Services Supervisor at the Columbus County Department of Social Services, those ACE-inducing forces have been on the rise of late. "When I started 13 years ago, there were drugs, but the drugs were not as bad as what we're seeing now—as far as the types of drugs, and the population that is on drugs," McQueen says.

"Mental illness has increased dramatically. There's not many reports that we receive that do not include either substance abuse or mental health. Even if a report is called in about a dirty house, once we get in there, and start investigating, and asking questions and finding out—either the parents have issues with mental health, or they have a substance use issue."

Each of those behaviors then becomes more likely to be repeated in the next generation, contributing to an intergenerational cycle of trauma. A 2003 study by the American Academy of Pediatrics showed a strong correlation between ACEs and earlier onset of substance abuse. Adults who had five or more adverse experiences were seven to 10 times more likely to report addiction and other problems with illicit drugs than adults who had experienced no ACEs. In other words, people who grew up in houses with substance abuse—and other trauma—are more likely to abuse substances themselves.

The same pattern is true of mental illness. "It's a vicious cycle," says McQueen.
But she also stresses that does not mean that everyone with mental health issues or who uses drugs is dooming their kids. "People think because people use drugs they cannot care for their child. That's not true," she says. "If their substance abuse is not affecting the child and their way of taking care of the child, then there's not a safety concern."

"We have functioning alcoholics, and we have functioning drug addicts, that can take care of their children all the time."

Changing Pedagogies

Schools are adapting to face new non-academic challenges. "A lot of it is trying to meet the student's behavior and emotional needs before we can meet the academic needs. We have to take care of that component before we can even think about taking care of the academic component," says superintendent Garland.

"One of my biggest concerns when we send them home on Friday afternoons is: Monday morning is our best participation in our breakfast program," Garland says. "And that is common—they've not had anything worthwhile to eat all weekend."

That neglect, he believes, come from twisted priorities. "Somebody that's addicted to opioids, they will do whatever is possible at any point to get that addiction fixed. And the neglect of their child, depriving their child of things, they will do it."

How could students learn if they have not eaten? Like many school systems in North Carolina, the Whiteville and Columbus County systems are adopting a "multi-tiered system of support" to work with students more holistically.

Heather Wing, director of student services for the Columbus County School system, couches the issue in terms of a hierarchy of needs. "If things at home, as far as basic requirements like food and shelter are not addressed, if they are not available to that child for whatever reason, then in the school setting it cross-walks over and makes the challenges of education difficult."

Principal Ward, meanwhile, had her staff read "Teaching with Poverty in Mind" this year, in which author Eric Jensen discusses neurological responses to growing up in poverty and how to take those effects into account in the classroom.

The book is obviously tailored more precisely to poor students than to those with behavioral health issues in their families, but there is overlap. "A good portion of it looks at toxic stress, and how things affect the brain when the brain is in early development stages," Ward says.

Toxic stress occurs when the normal human fight or flight response to perceived threats lasts over too prolonged a period. The chemicals that the body releases in such situations become destructive, and can gradually impair normal development of the brain.

"For me, my concern is we're supposed to be building foundations for the kids to progressively move on to elementary, to middle school," says Ward. "But we're having to backtrack now, we're having to do a whole lot more before we can even build foundations."

"Our job is to prepare the kids for college and/or career success," Garland adds. "And we're just trying to prepare them for public education now."

Thinking things through

Substance abuse is finding its way into the classroom in other ways, as well. Adrienne Evans, a science teacher at the early college high school at Southeastern Community College, is teaching her honors biology class a unit on addiction.

"I found out that addiction was a disease, and I was blown away," Evans says.
Her students describe being plenty aware of opioid use around them, but seem less troubled than the older generation.

Why are they learning about this in school? "Parents don't want to talk to their kids about it," said senior Patrick Nunnery. He chalked that reluctance up to "social awkwardness and anxiety."

Of course, high schoolers deal with anxiety as well. Aaliyah Cawley describes the pressures that she feels to be successful. "I hear stories every day about people who weren't smart enough to succeed and they fell down into poverty, and lost their house. And we come to school, and it's 'get an A, get an A, get an A.' And if you don't, you won't succeed, you won't get ahead, you won't get a job and be able to raise a family."

To that, the whole class nods in assent. It is an honors class, after all.

But the pressure goes beyond the academic, says Andrea Galdeano. "People have to find a way to be their own motivation. They feel so stressed trying to be a certain way."

In the meantime, reminders of the perils of slip-ups hover. Many students in the class know peers, or know of peers, who have taken their own lives. One student casually mentions a "drug deal area" near his house, but says that it does not worry him.
"We have a gun," he explains.

Connections

Wing thinks of the social work side of the school system as its heartbeat, alongside teaching. "Sometimes we have to change our gameplan to better support, and acknowledge, that there are things that will maybe take a front-burner on education," she says.

The multi-tiered system of support model, Wing thinks, is a step in that direction. Human connection is another. "Teachers now find that more than just giving out a piece of technology, it's critical that you are able to talk the students' language, and to build and establish a level of rapport and relationship."

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The students in Ms. Evans' biology class agree. The opposite of addiction, Nunnery believes, is connection.

The research that has shown the ill effects of adverse childhood experiences has also focused on the possibility of building resiliency. Part of that means developing coping strategies, which Ward says many children in the school system from difficult backgrounds lack. But certain life events have been shown to help mitigate the effects of ACEs, as well: postsecondary education helps. So do supportive romantic relationships.

In the second installment of this series, The News Reporter and Scalawag spoke with Darren Mills, who overcame his addiction, breaking his family's cycle of dependence. His daughter remained sober, and her daughter did too. Another man, Michael—the family was given pseudonyms to protect their identity—spoke of a daughter introduced to opioids by her mother. She ended up out of school, trading sexual favors for drugs and giving birth to children in tattered circumstances. Eventually, though, Michael's grandkids found stable living situations with other family members, and are now thriving.

Intergenerational cycles of trauma can be broken in any number of ways. Carol Caldwell of the DREAM Center notes that, in the absence of parenting advice, "We learn from our parents, or what we see on television."

But thinking through parenting and its effects can allow for new possibilities. Physical violence, like substance abuse, factors into the ACEs scale.

"We had a single father who was in one of our earlier classes," Caldwell says. "This was last year. We were in a totally different meeting, had nothing to do with parenting at all, but we were going around the room and we had to answer a question."

"One of the questions was 'I will never…' so everybody had to complete that sentence. When it came his time, he said, 'as the result of taking the parenting class at the DREAM center, I will never beat my son again.'"

"Chills just kind of went up and down my spine."

Previous installments on mental health and substance use in Columbus County:

  1. Mental health care failing, the economy and opioids deal a crushing blow to many
  2. To battle opioids, county turns to better policy and hope
  3. Law enforcement scrambles to offset mental health shortfalls 
  4. Ensuring Crisis: Health System Pushes Mentally Ill towards Emergency Treatment

CORRECTION: The first version of this article incorrectly identified Carol Caldwell as the founder of the DREAM Center. She is not; she is the Center's executive director.

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Sammy Feldblum

Sammy Feldblum studies geography at UCLA and reports across the southern half of the United States.