Call to Order and Roll Call
The Program Review and Investigations Committee met on Thursday, September 8, 2016, at 10:00 AM, in Room 131 of the Capitol Annex. Senator Danny Carroll, Chair, called the meeting to order. He led the committee and audience in the Pledge of Allegiance and a prayer. The secretary called the roll.
Present were:
Members: Senator Danny Carroll, Co-Chair; Representative Terry Mills, Co-Chair; Senators Julie Raque Adams, Perry B. Clark, Dan “Malano” Seum, Reginald Thomas, and Stephen West; Representatives David Meade, Rick Rand, Arnold Simpson, Chuck Tackett, and Jeff Taylor.
Legislative Guest: Representative Derrick Graham.
Guests: Van Ingram, Executive Director, Heather Wainscott, Branch Manager, and Amy Andrews, Program Coordinator, Kentucky Agency for Substance Abuse Policy, Kentucky Office of Drug Control Policy; Trooper Kendra Wilson, State D.A.R.E. Coordinator, Kentucky State Police; Bruce Owen, Retired D.A.R.E. Coordinator, Civilian Instructor-Kentucky State Police Academy; and Phyllis Millspaugh, Manager, Behavioral Health Prevention and Promotion Branch, Department for Behavioral Health, Developmental and Intellectual Disabilities.
LRC Staff: Greg Hager, Committee Staff Administrator; Chris Hall; Colleen Kennedy; Jean Ann Myatt; Chris Riley; William Spears; Joel Thomas; and Kate Talley, Committee Assistant.
Senator Carroll welcomed Senator Reginald Thomas as a new committee member replacing Senator Dorsey Ridley. Representative Derrick Graham was welcomed as a guest.
Minutes for August 12, 2016
Upon motion by Representative Simpson and second by Senator West, the minutes of the August 12, 2016, meeting were approved by voice vote, without objection.
Drug Abuse Prevention Programs in K-12 Schools
Senator Carroll explained that a factor in the choice of today’s topic is the overwhelming heroin epidemic in the state. Prevention programs in the school system seem to be missing from newspaper headlines and reports.
Mr. Ingram said the state is in the middle of the worst drug crisis it has seen. Kentucky’s drug problem has changed; the greatest exposure to substance abuse is now from opioids. The conversation should be broader than just schools. Federal research organizations such as the Centers for Disease Control now recommend increased knowledge of how addiction works and research on chronic, non-cancer pain. For most chronic conditions, opioids are not truly effective. Greater education with regard to drugs is needed.
Prevention education is needed from kindergarten through high school (K-12). The Kentucky Office of Drug Control Policy (ODCP) tries to reach minors by buying time at movie theaters for public service announcements and by working with church groups, but schools are still the best place to reach children. A program called Too Good for Drugs was funded in previous years to be taught in 50 elementary schools in eastern Kentucky. Adolescents’ use of drugs declined during the program, but the program is not taught as much now due to funding issues.
Ms. Andrews reported on a survey conducted by the Kentucky Agency for Substance Abuse Policy (ASAP). The Too Good for Drugs program for K-12 was mentioned most often as effective. “Class Action,” for middle and high school students, and “Project Northland,” for elementary students, were also considered effective. These are 10-week, peer-to-peer programs. Schools, however, find it difficult to create the necessary time in the curriculum to incorporate these programs.
In response to questions from Representative Simpson, Mr. Ingram said no money is allotted for these programs to schools by the state. ODCP allots some money to each county and some school districts apply for federal grants. Programs are taught based on each county’s interest.
Representative Graham commented that perhaps as the curriculum is developed, ODCP could collaborate with the commissioner of education and the education community to incorporate the programs into existing subject areas, especially in middle and high schools.
Mr. Ingram said his office would welcome a collaboration with the Department of Education and that ODCP working with the department to provide Narcan to all schools.
Representative Graham noted that he would like to hear about how to integrate successful programs into the curriculum. Part of being career ready is not failing a drug test for employment.
Ms. Andrews said Kentucky Family Resource & Youth Services Centers (FRYSC) officers are used in most schools. The required curriculum includes this as a component, but it is a small program. Some schools incorporate it by having someone from the guidance office come into class.
In response to a question from Representative Graham, Ms. Andrews said that the FRYSC program is schoolwide and all students receive it.
Representative West commented that he knows the schools are trying, but the drug problem is escalating. The current approach seems to be scattered, primarily due to funding.
In response to a question from Senator West, Mr. Ingram said he does not know how much it would cost to streamline all the schools’ approaches at the state level, but he can research it. It comes down to whether it is best for the state to do this or for local communities to decide what they need. He favors the local approach, since many of the current programs have begun there.
Senator West commented that the state has have reached a point in which it must make time for this education. The state cannot afford not to do this since it affects the ability to get a skilled workforce.
Senator Carroll said he agrees that it must be a coordinated effort between the state and local communities. Perhaps it could be a more centralized depository of information upon which schools can draw.
Mr. Ingram said it cost about $500,000 for the Too Good for Drugs program for which federal funds had been awarded for 50 elementary schools in previous years before funding ended.
Trooper Wilson said the D.A.R.E. program began in the 1980s and has been altered over the years to fit changing conditions. Reinventing the wheel by instituting a new program might not be the best approach. D.A.R.E teaches children how to respect themselves, how to communicate with others, and empowers them to do the right thing. It results in drug abuse prevention by teaching children how to resist. The D.A.R.E. program is now called Keeping It Real. It is a 10 week program in which students develop plans to make the right choices.
She described an example of a small girl who angrily resisted the class. She noticed the girl was not at school for a few weeks and found out it was because she had been in rehabilitation for heroin. When she came back to school, she said she had been clean for 4 weeks. The younger children have a different attitude from the older children; they want a D.A.R.E. officer there to teach them. She read an email from a woman whose son died of an overdose. The woman commended the state police for their work in educating the public of the dangers of substance abuse.
Trooper Wilson said that she gets calls weekly from schools across the state wanting a D.A.R.E officer. The Substance Abuse and Mental Health Services Administration’s (SAMHSA) National Registry of Evidence Based Programs and Practices now recognizes D.A.R.E as a viable education program. The program is funded by schools paying officers to come in to teach. It costs between $7,000 and $10,000 to hold a training session for officers entering D.A.R.E. Funding for that training is no longer available.
Senator Carroll commented that D.A.R.E is more than just the educational program. It is the relationships built between D.A.R.E officers and the students. Children return years later to tell officers how much the program meant to them.
In response to a question from Senator Carroll, Mr. Owen said since D.A.R.E’s introduction in Los Angeles in 1983, it has grown and been modified. Around 2003, an evidence-based program called Keeping It Real was integrated with D.A.R.E, and now the entire program is evidence-based.
Representative Rand described his own experience with outpatient surgery for which he was given a 30-day prescription for an opioid, when he only needed it for a day and a half. He said he has heard that people can become addicted in 30 days. He added that although he commends the ODCP and its programs, he wanted to point out that the General Assembly makes these choices. These are the programs affected because of budget cuts. This administration did not fund $4.6 million, which meant programs like D.A.R.E were either lost or underfunded. He described his experience mentoring a boy who had disrespected a D.A.R.E. officer. He is now doing very well and has started his own business but had needed help to keep him on the right track.
Trooper Wilson said the choices the legislature and government make choices that affect these children and their ability to have productive lives. Many children say they swing toward drugs because they feel alone. It takes the full 10 weeks in D.A.R.E. to get children to understand what “do the right thing” means. Teachers later comment on the change in those children's behavior.
Senator Carroll commented that these programs are a priority to this administration, but as a legislature is dealing with the consequences of previous administration’s decisions. The legislature has invested in treatment programs, and members agree that programs like D.A.R.E need investment. The private sector loves to get involved in sponsoring programs like D.A.R.E.
In response to a question from Representative Simpson, Trooper Wilson said state troopers do not provide D.A.R.E. in urban areas as often as rural unless requested because urban areas tend to have their own local police presence.
Representative Simpson commented that nothing is more important to Kentucky than its children. He represents an urban area in northern Kentucky, and the drug problem there is very serious. It seems as if there are a number of small programs that are not coordinated.
In response to a question from Representative Simpson, Trooper Wilson said some schools pay for D.A.R.E. books or supplies from drug court fines. The program is happy to work with all agencies. Lexington Metro is preparing to revamp its D.A.R.E program and her office will do a lot of training and work there. There is a major resurgence in schools and law enforcement for D.A.R.E.
Representative Taylor commented that what gets measured gets done. It would help to have more measurables. One of his constituents says 80 percent of his job applicants fail the drug test. It would be nice to know how many students are reached and how many reacted positively to the intervention. There needs to be an attempt to measure supply and demand for these drugs, whether provided by a doctor or street gang.
In response to a question from Representative Taylor, Trooper Wilson said D.A.R.E does not measure whether participants are on drugs. The training D.A.R.E. provides is not just about drugs, but about how to make good decisions. She does not know that there is a good way to measure that quantitatively.
Representative Taylor said he believes programs like D.A.R.E. would be more likely to be funded by both the General Assembly and private companies if results could be quantified.
Representative Mills said programs like D.A.R.E., drug courts, and health care are pro-life issues and he supports funding for them.
In response to a question from Representative Mills, Trooper Wilson said D.A.R.E. has a component for preschoolers. It is picture-based and shorter. Presenters do not talk about drugs. They address what it means to do right or wrong and teach that even though something may be legal, it still might not be good for us.
In response to a question from Representative Mills, Mr. Ingram said he is not aware of any programs directed toward child care facilities. Representative Mills commented that this is something that should be looked at. Senator Carroll said he agreed. He said he runs a child care program and, as soon as children are old enough to communicate, they are taught that there are ramifications for their actions. This is common in child development centers.
Mr. Ingram said Massachusetts and Connecticut have limited opioid prescriptions to 7 days for patients undergoing minor procedures, which might be something the General Assembly could consider.
Ms. Millspaugh said the Behavioral Health Prevention and Promotion Branch focuses on prevention and represents the state at national meetings. It funds partners that do primary prevention, which is a population-based approach. The branch funds the state’s 14 community mental health centers. Within each is a regional prevention center that provides planning for substance abuse prevention work. The branch analyzes data to decide which approaches should be taken. The strategic prevention framework starts with collecting data, then building the community’s capacity to fill in the deficits. As a condition of receiving funding from SAMHSA, the branch then evaluates the program. The branch uses the data to establish state priorities. The biggest issues are non-medical use of prescription drugs; opioids/heroin; underage drinking; service members, veterans and family; and suicide prevention and post-vention. Opioids are present in every community within the state. There are shared risk factors in suicide prevention and drug abuse prevention. The branch looks at the shared, underlying factors for both.
After identifying state priorities, the Behavioral Health Prevention and Promotion Branch asks communities to collect data on these issues and identify their priorities to create a plan. SAMHSA encourages them to use six evidence-based strategies: environmental; information dissemination; alternative activities that exclude alcohol, tobacco, and other drug use; education; community-based processes; and problem identification and referral. The regional prevention centers work with local communities to implement the strategies. Developing a comprehensive strategy is important. Individual efforts must be part of a bigger plan to create a social ecology in a community. Research indicates that prevention works differently from treatment. Prevention involves chipping away at community norms and is a long-term process to create shifts in the way a person thinks. The branch uses surveys of school children to identify trends.
In response to questions from Senator Carroll, Ms. Millspaugh said a lack of communication among entities is part of the problem. If someone in the school recognizes a potential problem, intervention must extend to the child's family life. It is not just about the child, it is about the messages a child receives at home and everywhere. It is unfair to put all the blame on children. It is also important that the school sends the message that it does not support these choices and behaviors.
Mr. Ingram said ODCP fosters cooperation with local ASAP groups using money set aside for opioid prevention. People from the community help them ensure a coordinated strategy is being followed rather than relying on a piecemeal approach.
In response to questions from Senator Thomas, Mr. Ingram said the opioid problem is found among all societal classes, ethnicities, and income levels. Methamphetamines are largely used by white males. Cocaine is used more often in African American communities. But overall, the drug problem crosses all races and classes. One difference is that if you are in poverty, it is harder to stop drug abuse. Ms. Millspaugh said substance abuse is driven by the community and is primarily an issue of access and opportunity. Trooper Wilson said when she asks children if they know where to get pot or heroin they usually know, no matter the demographic. They know where drugs are in their homes. Mr. Ingram said research indicates that a high percentage of women have had a trauma in childhood. If one could lower trauma levels, one could lower substance addiction. Ms. Millspaugh said that is why work needs to be coordinated. It is an epidemic and a crisis. The level of media awareness on how dangerous the substance abuse problem is can help. It creates an opportunity to work collaboratively.
Senator Clark commented that there is a greater danger of substance abuse when experiences such as trauma and assault accumulate. Often the main problem is the person's experience, not the drug.
Mr. Ingram agreed, saying his office is working on this as a larger problem that includes the other areas mentioned, such as trauma.
Senator Carroll announced that the next meeting will be held on October 13, 2016.
The meeting was adjourned at 11:56 a.m.