Photo shows an arrangement of pills of the opioid oxycodone-acetaminophen.
David Cox is the superintendent in Allegany County in western Maryland. For the past five years, Cox and his staff have been responding to an opioid epidemic that has ravaged their community, leaving in its wake orphaned children and others facing emotional trauma. “We have kids who have lost their parents, and, unfortunately, there have been situations where the parents have overdosed with the kids watching,” he said.
Cox testified before Congress this month, and spoke to Education Week’s Denisa R. Superville about what his district of 74,000 students needs to deal with the crisis. The conversation has been edited for clarity and length.
When did you first start noticing the impacts of the opioid epidemic in Allegany County Schools?
COX: About five years ago, our principals started talking to me about their concerns with attendance. We’ve had, historically, a very high elementary attendance rate—something like 96 or 97 percent. The number of kids who began to develop more chronic absenteeism was one of the first signs. We have positions that are called PPW—Pupil Personnel Workers—who work with the schools and with the counselors and make home visits whenever there are [attendance] issues.
In establishing contacts with some of our families, some of the principals learned that we had an increasing number of parents who were addicted to opioids and were using opioids. They noticed that the chronic attendance issues were linked to parents’ use of opioids: parents were not able to get up in the morning and get the kids ready, to get them on the bus, and to bring them to school. It was not just absenteeism. It was also the rise in tardiness—kids who were brought in well after the school day had started.
When you realized that you dealing with this, what steps did you take?
COX: We worked closely with a lot of community agencies, and the department of social services. In some cases, you had social workers who would work with the families and try to help the parents get help for the addiction issues. About that time, the sheriff became very involved in doing community forums and educating the general population about what addiction is. It’s one of the things that I think people did not understand.
Has the problem escalated?
COX: It has. Just the sheer number of overdoses in the county, and overdose deaths. I think it hit an apex last year. If I am remembering correctly, there were 59 [drug-related] deaths in the county that included opioid [deaths], but were not just opioids. But this year, [we] already [have] 26 opioid-related deaths. The other thing that began to impact our kids severely was the number of parents who had actually died due to overdoses. In many cases, because of that, [children] have to live with somebody else, and in many cases that’s with grandparents. [W]e have an elementary-age student who is being raised by an 85-year-old great-grandmother. In many cases, they were living with just one parent, not with two parents. A lot of kids are in the foster system. And that means in some cases they had to change schools.
Our counselors do a really great job of making kids feel welcome when they transfer schools. I would say a big shout out to our teachers, who are just very empathetic to our very young children. I don’t mean to say, though, that it’s not impactful on older children, because any time a student loses a parent or has these family issues it’s impactful.
Were teachers and principals ready or equipped to deal with the impacts of the opioid epidemic?
COX: Teachers have asked for additional training around the whole opioid issue, dealing with kids [who are impacted]. Another thing they specifically have asked about is help in dealing with some of the behavioral issues with young children. About 18 percent of all the children born in the county hospital are born drug-affected, and that does not include the number of kids who may have also been affected by prenatal alcohol exposure. Sometimes it’s both. Those kinds of issues create lifetime problems for kids, and we have seen a huge increase in children who come to us in preschool, who have very severe behavioral issues. I have only one behavioral specialist for 13 elementary schools. That’s one of the needs that we have—people who have expertise in helping to develop behavioral plans for children to be successful.
You’ve also said that special education placements have increased.
COX: It’s also increased the services we need to deliver to kids under IDEA. We have more kids, as a result, with [individualized education plans].
How would you describe the response from both federal and state levels to help you get your arms around this?
COX: I would have to say that the state of Maryland has been very forthcoming. Gov. [Larry] Hogan has provided funds in his budget to help with the issue, not necessarily for the services to children, but to help educate the children. Lt. Gov. Boyd Rutherford came to a meeting of all the superintendents to listen to our concerns. That’s one of his initiatives—not just helping with the educational aspect, he specifically wants to reach out to superintendents. The legislature also passed laws this year in Maryland so we [have] Naloxone (a drug used to reverse the effects of opioid overdoses) in all of our schools, and we are training all staff. The resources in our state have been really good. We have a number of community initiatives and people who are helping, especially bringing awareness to the unmet mental health needs of our children. … We need more response from the federal government.
You talked about the flexibility in funding, in what other areas do you need assistance on the federal level?
COX: We need more funding. Yes, we need the flexibility [in federal Title IV funds which can be spent on a range of academic supports], but we also need more funding. Special ed., or IDEA, is not fully funded by the government. But the number of children who require special services is increasing as a result of this. I am very concerned about the Children’s Health Insurance Program or CHIP. Congress has not yet reauthorized it. That has historically been a bipartisan effort to provide health insurance for our poorest children in my district. And, certainly, any cuts to Medicaid would be further devastating.
President Trump recently declared the opioid epidemic a public health emergency. Are you optimistic that this declaration will lead to more resources?
COX: I am very happy that President Trump has declared [the opioid epidemic] a national public health [emergency]. But I think we need to have some response in terms of additional funding to help us take care of it. This is happening at a time when the bar has been raised in terms of more rigorous curriculum and more rigorous assessments, and then we also have these issues [like the opioid epidemic] that affect a good number of our students.
It puts a lot of pressure on our teachers. In our county, we have experienced local funding cuts, that’s resulted in larger class sizes. So teachers have more kids in the class, with more needs. But they work really hard.
The good news is that if you walk into a school, every one of my principals can say ‘you see that kid over there, when he or she first came, they didn’t speak or they couldn’t sit still.’ And they would tell me about the successes that they have had that day, and over time, that [the student has] been in the school. So if we can get kids in and get them a program, they can learn.
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