eastern shore substance abuse needs assessment · all substances – alcohol, heroin,...

EasternShoreSubstanceAbuseNeedsAssessment

Report Prepared by

December 2016

TABLE OF CONTENTS

I. INTRODUCTION AND BACKGROUND………………………… 2

A. Brief Description of Community and Project……..… 2 Community Coalition…….…………………………………….. 2 History of Substance Abuse Prevention Activities………… 3

B. Community Readiness for ATOD……………………… 4 Coalition Readiness Survey…………………………………… 4 Key Informant Interviews…………………………………….… 5 Focus Groups……………………………………………….…… 6

II. PURPOSE OF THE ASSESSMENT……………………………..…. 6

III. DATA COLLECTION...………………………………………...… 7

A. Methods Used……………………………………….…... 7 Key Informant Interviews…………………………………..….. 7 Focus Groups………………………………………………...…. 9 Quantitative Data………………………………………........... 15

B. Strengths and Limitations of the Data……………….. 15

IV. KEY FINDINGS…………………………………………….….… 16

A. Assessment of Indicators……………………….…...… 16 Socioeconomic Risk Factors………………………………… 16 Health Related Risk Factors………………………………….. 18 Demographics………………………………………………… 18 Standard Indicators…………………………………………... 19

B. Assessment of Resources……………………………... 30

V. RECOMMENDATIONS AND IMPLICATIONS FOR ACTION... 31

VI. CITATIONS AND APPENDICES ........………………………..… 34

A. Footnotes.......................................................................... 34

B. Standard Indicator Sources............................................ 35

C. Appendices...................................................................... 35

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1

The Eastern Shore of Virginia, geographically removed from the rest of Virginia, has had a unique history of settlement and development that can be attributed to agriculture, fishing, tourism and the Pennsylvania Railroad. Bounded by Maryland to the North, it is located at the southern tip of the Delmarva Peninsula. The Eastern Shore of Virginia stretches for 75 miles between the waters of the Chesapeake Bay on the west and the Atlantic Ocean on the east. It consists of two counties - Accomack and Northampton - and hosts a year-round population of 45,553 people (73% of whom live in Accomack County).1

The 23-mile long Chesapeake Bay Bridge-Tunnel spans the mouth of the Bay and connects the rural counties and towns of the Eastern Shore to the Hampton Roads metropolitan area and the rest of the state. Terrain is very flat throughout, and dominated by cotton, soybean, vegetable and truck farming, and large-scale chicken farms. At the northern end of the Atlantic side are the beach community of Chincoteague; and Wallops Flight Facility, a NASA space launch base. Economic development focuses around agriculture and aquaculture, tourism, new and existing businesses, education, and water quality.2 The Eastern Shore has become one of the few places on the East Coast that has preserved its pristine marine environment and shoreline eco-system. Residents struggle with balancing this way of life with the growing need to adapt, develop and remain economically relevant.

Community Coalition The Eastern Shore Community Services Board (ESCSB) plays a key leadership role of the Community Partners of the Eastern Shore (CPES). Made up of over 20 organizations, CPES works to solve regional human service issues by pooling resources, carrying out research and data projects to identify gaps in services, and obtain funding to address those needs. Community Partners of the Eastern Shore was originally founded in 1996 as an effort to assist the communities of the Eastern Shore of Virginia and its multiple service groups and

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organizations to work together collaboratively, cooperatively, and in a coordinated fashion to assess, develop, and deliver substance abuse prevention services. Since the first meeting in 1996, CPES has expanded its membership, written, supported and received grants, annually developed a community-based prevention plan, and provided training on the Social Development/Communities that Cares Model and other prevention initiatives. The Coalition has consistent representation from a diverse group of individuals and organizations, and functions by a democratic process.

The coalition currently has six standing committees, including a Family Wellness and Substance Abuse Prevention Advisory Council.

CPES is coordinated and sponsored by the Accomack-Northampton Planning District Commission while the Eastern Shore Community Services Board Office of Prevention holds the secretarial seat, a permanent position on the Executive Committee. Although several organizations take leadership roles in terms of financial and human resource support, all member organizations exercise equal decision-making power. CPES has functioning by-laws to specifically identify its functions and purposes.

It is through the diverse community membership body of the CPES that key functions of community planning, developing and implementation happen. CPES has a long history of successfully identifying needs, facilitating community discussions around issues, and implementing programs to affect change.

The Eastern Shore has become one of the few places on the East Coast that has preserved its pristine marine environment and shoreline eco-system. Residents struggle with balancing this way of life with the growing need to adapt, develop and remain economically relevant.

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Key stakeholders include:

• Accomack County Emergency Management• Accomack & Northampton Counties Departments of Social Services• Accomack & Northampton Counties Health Departments• Accomack-Northampton Regional Housing Authority• Accomack-Northampton Planning District Commission• Accomack & Northampton Counties Public Schools• Accomack & Northampton Counties Extension Services• Eastern Shore Area Agency on Aging – Community Action Agency• Eastern Shore of Virginia Housing Alliance• Eastern Shore Center for Independent Living• Eastern Shore Coalition against Domestic Violence• Eastern Shore Community College• Eastern Shore Community Services Board• Eastern Shore Literacy Council• Eastern Shore Rural Health• Foodbank of Southeastern VA and the Eastern Shore• Legal Aid Society of Eastern Virginia• The Salvation Army of Accomack County• U.S. Social Security Administration• Virginia Department of Veterans Services• Virginia Employment Commission

To assist with the data collection, analysis and reporting for this needs assessment, the ESCSB engaged The Planning Council, a nonprofit organization with whom the ESCSB has worked for 16 years. The Planning Council provided two evaluators with experience in health and human service planning programs, and ESCSB advised them throughout the process.

History of Substance Use Prevention Activities

The Office of Prevention Services at ESCSB has been offering community programs, outreach, treatment and educational activities since 1996. With a current staff of 6, the Office of Prevention implements six research-based prevention strategies in all of its work:

1. Education2. Alternatives3. Problem Identification & Referral4. Community-Based Process5. Information Dissemination6. Environmental

Involving families, service providers and policymakers in the activities around substance use prevention, the ESCSB coordinates - and collaborates with - a variety of programs, such as:

• Dare to Be You• Suicide Prevention Task Force• Counter Tools Project• Mental Health First Aid• Tobacco Access Project• Nurse Family Partnership• Al’s Pals

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By applying these interventions within the schools and the community, ESCSB staff is able to identify and address the risk factors facing the residents of the Eastern Shore, including isolation, poverty, single and teen parenting, low literacy and domestic violence.

poverty, homelessness, and a lack of the community’s ability to thrive,

Thirty-seven CPES members completed surveys. The surveys were distributed and respondents were allowed about fifteen minutes to complete them.

On the 4-point scale, the overall score is 3.5, which seems to indicate a fairly high degree of readiness and coordination to plan and implement goals around youth substance use. The chart at the right shows the results of the survey for each dimension. See Appendix B for Coalition Readiness Assessment Form.

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Group Position Education Adult Career Coach, Eastern Shore Community College

Nurse Supervisor, Accomack Public Schools

Faith Community Pastor, Maranatha Baptist Church Pastor, United Methodist Church

Public Health Director, Eastern Shore Health District Program Assistant, Virginia Cooperative Extension Family Nutrition

Substance Use Provider Emergency Services, Eastern Shore CSB Employment Admissions Counselor, Job Corps Domestic Violence/Homeless Provider Board Director, Eastern Shore Coalition Against Domestic Violence Social Services Director, Northampton Department of Social Services * One of these key informants was selected partially due to a prior personal experience with substance abuse and

recovery

What is working well • Dedication to the mission

• Strong leadership

• Well informed leaders with experience intheir fields and with the Eastern Shorecommunity

• Well attended, well organized andconsistent membership meetings

• Excellent communication amongmembers

• Professionalism of partners

Recommendations for improvement • Increase awareness of coalition and its

efforts in the community

• Create additional leadershipopportunities for member agencies

• Increase membership by inviting businesspartners and local government leaders

Reasons for participating

• To facilitate access to services forclients

• To serve as a bridge between CPES andthe community

• To work toward common goals

• To identify needs/gaps and developgoals to meet those needs

• To improve my community

How to improve Coalition participation • Create greater community awareness

• Recruit new member agencies

• Report results/successes to countyleaders

In addition to the numerical scores, the open-ended questions indicate that the coalition has the following strengths:

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5

It is recommended to use the data contained in this report to:

• Evaluate and implement service improvements;• Raise awareness of community issues;

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6

• Educate the general public and local government of challenges such as existing resources,barriers and gaps in services, changes in perception, and successes;

• Identify trends that will affect how services are delivered, where, to whom and the quantity;• Target and seek additional funding to expand, enhance or adjust the service delivery system.

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• EMT / Paramedics• Fire Department• Sheriff’s Department• Probation: Adult & Juvenile• Magistrate• Clinical service providers• Dept. Juvenile Services• Hospital Emergency Department• Police Crisis Intervention Team (CIT)• Corrections/Jails• Commonwealth Attorney’s Office• High School student• High School Teacher• Community College Student• Eastern Shore Community Services Board• Eastern Shore Coalition Against Domestic Violence• Virginia State Police• Eastern Shore Community Services Board• Physical Therapist

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Focus Group Question Law Enforcement General Population How many of you encounter youth ages 14-24 using substances on ES?

Everyone raised their hands. Everyone raised their hands.

Which substances do you know that are being misused on the ES?

All substances – alcohol, heroin, prescriptions, pot

Heroin on the rise due to cheap price

Juvenile probation: Marijuana off charts, Not heroin yet, but soon. Users getting younger and younger, also Prescriptions

Adult probation: seeing lots of heroin use

ER: Many withdrawals in ER, youth in mid 20s; 8-9 deaths heroin OD 18-24 yr. olds

Alcohol

Marijuana

Crack

Tobacco

Cocaine

Prescription drugs Adderall

Heroin

Psychotropic drugs

Locally distilled moonshine

DAB (wax THC)

Marijuana eye drops.

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Focus Group Question Law Enforcement General Population What are some factors specific to this community that lead people to misuse substances?

No recreation, kids use to enjoy themselves

Lack of employment

Escapism

Geographically – ES is on the trade route between VB and MD

ES has poorest counties in Virginia. Poverty has lot to do with misuse.

Dysfunctional family units – single moms, grandparents raising families.

Kids having kids at young age are now adults. Generational patterns of dysfunction.

No prevention services – only CSB which isn’t enough. No detox facilities.

Misuse is getting worse and worse.

One senior high school class has 80% kids smoking pot

Kids come from poor homes, kids use for different reasons, pot doesn’t seem bad

Touches all families, rich, poor,

Some CSB programs in schools to find kids at risk.

Accessibility changed – with social media and cell phones, kids get substances easily

Youth use as a coping mechanism. Numbing, etc.

What services can help kids get help? Stigma to get those services

Transportation to services is limited and difficult to arrange

Idea that prescriptions are safe -- Xanax is freely shared

Boredom, perceptions safe vs fun, value system, lack of recreational options.

Crummy home life, escapism, lack of maturity.

Unemployment, peer pressure, group mentality, self-medicate the bad stuff, using it for late night or intense study.

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Focus Group Question Law Enforcement General Population How do most people on the ES view using prescription opioids to get high?

Awareness coming to light with Chasing the Dragon video. I was shocked and impressed at how many community members showed up to see video. They may be seeing the seriousness of the heroin issue.

In the ER, docs can access a patient’s prescription profile – people asking for too much pain meds will be flagged in an Electronic Record System so they can’t obtain/sell excess prescriptions on street. There are notices in the ER that profiles will be electronically checked.

All kids must be seen in person to get any prescription. Docs won’t prescribe over phone or automatically anymore.

Not so much prescription. There tends to be a trend from what is available in their home medicine cabinet.

What about heroin?

Opiate pills seem socially acceptable while heroin seems “dark alley.”

Inmates in the Correctional system are moving to heroin because it’s more available and affordable – this is a new trend, we never used to see such use. Pills were entry drug.

Cocaine is still in use on Eastern Shore. No change in Corrections from 80s to now. Even “good kids” are using cocaine (seems safe like pot was before).

One high school kid was taken out of school after being jumped for walking into restroom during a drug sale. Schools are not good environments and there is a common understanding not to go into bathrooms between classes. Kids know who’s doing what drug. Pot is in regular use.

Should have been more school personnel at Chasing the Dragon. Change comes from the top. We need to start talking in community – we see obituaries for young kids but the cause of death isn’t listed - people only know it was drug related reason after the fact– we need to talk early. This is everyone’s problem, not just law enforcement and clinical providers. We need to get the community interested in issue through awareness and education. Parents aren’t interested in their kids’ education – How can we get them involved in kids’ lives.

30% use on the ES according to SP because of its availability. After being cut off from pain killers they seek street drugs. Heroin is readily available and cheaper. Reasonably easy to find. Usually is the last drug after marijuana and others. The use comes from feeding the addiction not the desire to use heroin, which is highly addictive.

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Focus Group Question Law Enforcement General Population What role does law enforcement play in terms of opioid misuse?

Probation is reactive – kids already have substance issues, have gone through the courts, and have already impacted the community.

We get calls to drug test people who seem at risk or are already in trouble.

If a family reaches out, the Magistrate can start the process.

Law enforcement is often the first line of contact. Sometimes getting charged is the only way to get treatment. There is a vicious cycle of getting arrested and getting clean, then being released and using again.

If a person is jailed for non-substance issue but staff sees withdrawal, staff can’t mandate treatment. Once the person is released he/she goes back to using and sometimes die.

Seek out the offenders, arrest and prosecute. Tasks forces to combat. Offenders do not detect the police as a presence in the community.

Virginia State Police does not want to harass someone that needs help. Would like to be trained to provide medical help while waiting for first responders.

What about in overdose situations?

Once released from jail, go back to using. Accomack is looking into having cops carry Narcan. Some people know Narcan is available and rely on it.

Police Departments are putting an “After incident review” in place for overdoses.

Securing the area, requesting emergency responders. SP feels there is no role. Would like to have Narcan

What roles would you like law enforcement to play?

We need detox and substance use rehab on ES. There are many AA meetings on shore, but only one NA. NA doesn’t have a good reputation – some providers refer clients to Celebrate Recovery, which is better program.

Key is support system– this is an isolated area, families have cut ties with users and they have no supports.

We need support and education for families so they know what to expect, how to support the user in their family. They need to realize that relapse is part of recovery so they don’t give up. CSB SU Prevention has family programs – need awareness of resources available. Law Enforcement can give Pocket Resource guides.

More medical intervention. (Narcan)

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Focus Group Question Law Enforcement General Population

What are someone’s chances of getting caught while using?

Chances of getting caught are high. It’s getting harder for cops to be proactive – laws keep changing, civil rights laws inhibit investigating drug users and/or distribution. DUI needs search warrant to draw blood, used to be implied consent. Going to Magistrate for warrant within time frame and getting blood draw is nearly impossible. Laws are working against cops on street.

First time distributors are only “slapped on wrist.” Cops think “why waste time” if distributors are not charged.

Media posts light sentencing and reversals, and dealers see no consequences.

Some people are able to work while using – then begin to steal, so this impacts all community prices, etc.

Very miniscule. Only if they are careless, this is a rural area there are plenty places to hide. Informants.

How do people obtain prescription opioids?

We have their names but won’t mention. There are well-known people over- prescribing. People doctor shop and cross state lines for prescriptions. For example, people go to the Pain Management Clinic and the ER for chronic back pain – they can get 90 pills at a time, but renew every 2 weeks. Docs are starting to put a halt to that.

Asking their doctors. Getting large prescriptions filled. Party houses where the adults give it to their kids and sell it. Kids stealing their parents prescribed medication.

What trends are you seeing with prescription opioid and heroin use on ES?

Use is going up. It spiked 1.5 years ago. Indigent care is where we’ve seen the highest number of prescriptions for pain meds.

Adult Probation – Seeing a decrease in prescription meds and an increase in heroin.

Juvenile probation – not seeing heroin yet.

In the courts Pill cases are decreasing. Heroin has leveled off possibly due to the task force caseload.

CSB sees an increase in heroin. Recovery groups are getting bigger. More marijuana and alcohol. Heroin is used more by Caucasian population. DV shelter sees more addicts with children. They are not equipped to service. More this summer than ever before.

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9

B.

The data provided in this report were collected through a model utilizing community-wide participation that involved citizen input from various geographic areas and backgrounds across the Eastern Shore. For any community plan to be realistically implemented, it must be developed through broad participation by persons who share the commitment and have a role in the community’s health and well-being. Uses of this data can benefit the human service delivery system as a whole as well as the individual organizations, depending on the opportunities taken with the resources available to incorporate the results into practice or policy. Publicizing the report through media channels, at least in summary, is important to recognize the initiative taken by the service providers to identify the bigger community needs so as to develop and implement improvements wherever possible.

Weaknesses of interviews and focus group questions must also be noted, such as cost and the skills required to interpret data, as well as social influences on certain groups of respondents or language barriers. Another drawback is that respondents may not have experience with or know enough about the topics to provide quality responses to the questions. However implemented, the reports represent the perception of the individual responding to the questions and offering feedback and should be viewed as such. Qualitative data responses work best when they complement other forms of citizen participation.

To this end, the Eastern Shore needs assessment results were not only widely distributed at a public event – the Gallery Walk - but also collected related data (social determinants and risk factors) that demonstrate other gaps and barriers in the existing human services delivery system, including schools, medical care and more.

Interpreting the results and implementing change become the biggest challenge to end users of the data. Service evaluation is critical to monitor challenges and for focusing efforts and resources where failures are identified. However, national best practices demonstrate that the nurturing and development of strong community consensus regarding the needs of the service delivery system can be a springboard for future collective action.

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Socioeconomic Risk Factors

Source: Data is from 2016 Virginia County Health Ranking, except where noted.

According to youth.gov, substance abuse risk factors include poverty, lack of parental supervision, academic problems, anxiety and depression, consistent behavioral problems, dropping out of school and not attending college. 11

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Socioeconomic Risk Factors

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Unemployment on the Eastern Shore is higher than across the state, and can indicate that people are unable to earn a living, thus living in a fragile situation. Between 2011 and 2014, youth unemployment (ages 16-24) on the Eastern Shore has increased by 66% while only increasing at the state by 14% during the same time period. 15

Unemployment combined with not being in college can pose an increasingly negative environment for youth on the Eastern Shore. Thus, literacy remains a fundamental barrier for many families living on the Shore.

Educational Risk Factors: The dropout rate on the Eastern Shore is higher than for the state. Further, the percent of adults without a high school degree is nearly double the state rate, and a smaller percentage of adults have attended at least some college than adults across the state.

The State Council for Higher Education in Virginia reports that over the past five years, undergraduate enrollment of youth from the Eastern Shore has decreased by 26% while only decreasing 5% at the state level.16 In addition, the number of undergraduate degrees awarded to students from the Eastern Shore has decreased by 36% while increasing 10% at the state.17 Further reflecting the decline in education, enrollment at the Eastern Shore Community College has decreased by 28% over the past five year, compared to a 10% decrease at all public two-year institutions. 18

Between 2011 and 2014, youth unemployment (ages 16-24) on the Eastern Shore has increased by 66% while only increasing at the state by 14%, indicating an increasingly negative situation for youth who are not in college.19

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Health Related Risk Factors

Source: 2016 Virginia County Health Rankings

Both Accomack and Northampton Counties rank near the bottom in the 2016 Virginia County Health Ranking for Health Outcomes and Quality of Life. Because health influences all aspects of life, these are important risk factors to consider when addressing the root causes of dysfunction on the Eastern Shore.

The Eastern Shore has a slightly higher percentage of Non-Hispanic African Americans than the state, and a significantly higher percentage of citizens over the age of 65. Both counties are 100% rural.

Demographics

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Standard Indicators

a. Youth Receiving Substance Abuse or Mental Health Services at Eastern Shore CSB

420

430

440

450

460

470

480

490

500

2012 2013 2014 2015 2016

Num

be

r of Y

out

h 16

-24

Number of Youth Ages 16-24 Receiving Substance Abuse or Mental Health Services at

Eastern Shore CSB

Number of Persons Ages 16-24 Receiving CSB Mental Health or Substance Abuse Services by Year

Service Received 2012 2013 2014 2015 2016

Substance Abuse Case Management 11 13 9 13 18

Substance Abuse Outpatient 87 80 60 58 40

Mental Health Case Management 55 60 56 55 62

Mental Health Outpatient 312 295 256 189 162

Medical Psychiatric Services na na 80 179 209

Number Persons Ages 16-24 Receiving Services 465 448 461 494 491

b. Number of Opiate Clients at Eastern Shore CSB

47

90

0

20

40

60

80

100

2015 2016

Num

be

r

Increase in Opiate Clients at Eastern Shore CSB 2015-2016

Eastern Shore CSB

Number of Opiate Clients Eastern Shore Community Services Board

2015 2016

January 3 8

February 3 8

March 4 9

April 5 11

May 4 10

June 2 14

July 6 10

August 2 8

September 3 8

October 3 4

November 5 Not available

December 7 Not available

Total 47 90

Source: Eastern Shore Community Services Board; US Drug Enforcement Administration, National Heroin Threat Assessment Summary-Update.

The number of youth ages 16-24 receiving substance abuse or mental health services at the Eastern Shore Community Services Board has increased over the past five years.

The number of opiate clients (all ages) nearly doubled between 2015 and 2016. This dramatic increase mirrors the nation's rise in heroin and opioid use, particularly in rural areas, according to the US Drug Enforcement Administration.20

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Standard Indicators

c. CSB Services: Substance Abuse Program, All Substances

0.0

100.0

200.0

300.0

400.0

500.0

600.0

2011 2012 2013 2014 2015

Rate

Pe

r 10,

000

Pop

ula

tion

CSB Substance Abuse and Mental Health Services Per 10,000 Population

Eastern Shore Virginia

CSB Services: All Programs, All Substances, Rate Per 10,000 Population

2011 2012 2013 2014 2015

Eastern Shore CSB 437.4 467.6 468.9 471.2 499.5

Virginia 255.4 262.8 253.4 250.1 256.3

CSB Services: Substance Abuse Program Services, All Substances,Rate Per 10,000 Population

2011 2012 2013 2014 2015

Eastern Shore CSB 99.1 120.1 112.4 85.9 89.7

Virginia 86.4 85.9 79.4 74.3 74.4

0.0

20.0

40.0

60.0

80.0

100.0

120.0

140.0

2011 2012 2013 2014 2015 Rate

pe

r 10,

000

Pop

ula

tion

CSB Substance Abuse ServicesRate Per 10,000 Population

Eastern Shore CSB Virginia

This indicator shows how the Eastern Shore compares to the state regarding the rate of services needed for substance abuse. From 2011 to 2015, the rate of substance abuse services remained higher than that of the state, indicating a higher proportion of residents on the Eastern Shore need these services.

This indicator includes mental health programs and substance abuse program in which a client needs substance abuse services. Again, from 2011 to 2015, the rate of substance abuse services remained higher than that of the state, indicating a higher proportion of residents on the Eastern Shore need these services.

Source: Virginia Social Indicator Dashboard

d. CSB Services: Substance Abuse Program, All Substances


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Standard Indicators

e. Fatal Drug Overdoses

Source: Virginia Social Indicator Dashboard; WDBJ7 News, Virginia declares public health emergency because of opioid addiction crisis.

Between 2008-10 and 2012-14, the rate of fatal drug overdoses on the Eastern Shore increased steadily, from 2.9 to 11.78 while the state increased slightly from 6.87 to 8.55 per 100,000. This reflects a much faster increase on the Eastern Shore than at the state level during the same time period.

0.00

2.00

4.00

6.00

8.00

10.00

12.00

14.00

2008-2010 2009-2011 2010-2012 2011-2013 2012-2014

Rate

Pe

r 100

,000

Po

pul

atio

n

Fatal Overdoses, Rate Per 100,000 Population


Fatal Drug Overdoses per 100,000 Population

2008-2010 2009-2011 2010-2012 2011-2013 2012-2014

# Rate # Rate # Rate # Rate # Rate

Accomack 3 2.90 6 6.01 9 9.02 10 10.04 13 13.08

Northampton 1 2.67 0 0.00 0 0.00 2 5.44 3 8.23

Eastern Shore 4 2.90 6 4.37 9 6.58 12 8.80 16 11.78

Virginia 6.87 7.08 7.26 7.93 8.55

Due to the rise in drug overdoses in Virginia, especially from heroin and synthetic opioids, the Governor and State Health Commissioner recently declared a Public Health Emergency, reporting that: 21

• On average, three Virginians die of a drug overdose and over two dozen are treated inemergency departments for drug overdose each day.

• The number of emergency department visits due to heroin overdose has increased 89% for thefirst 9 months of the year compared to 2015.

• During the first half of this year fatal drug overdoses increased 35% when compared to thesame period in 2015

• By the end of 2016, the number of fatal opioid overdoses is expected to increase by 77%compared to five years ago.

• In addition, our Department of Forensic Sciences just this month identified the presence ofCarfentanil in Virginia. This synthetic opioid is 10,000 times more potent than morphine and 100times more potent than fentanyl and, given its presence in Virginia, could significantly increasethe death rate trends from opioid overdoses.

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Juvenile Justice System Narcotic Intakes, Rate Per Population Under Age 21

2011 2012 2013 2014 2015


Eastern Shore 11 91.22 13 119.58 20 189.95 19 180.47 16 151.97

Virginia 3,854 174.45 4,097 185.24 3,706 167.36 3,433 155.20 3,273 147.96

f. Juvenile Justice System Narcotics Related Intakes

Between 2011 and 2015, the rate of juvenile narcotics related intakes increased significantly on the Eastern Shore, from 91.22 to 151.97 per 100,000 juveniles. At the end of 2015, the Eastern Shore exceeded the state in juvenile intakes that were related to narcotics.

Source: Virginia Social Indicators Dashboard

0

50

100

150

200

2011 2012 2013 2014 2015

Rate

Pe

r 100

,000

Po

pul

atio

n U

nde

21

Juvenile Justice System Narcotics Related Intakes, Rate Per 100,000 Population Under Age 21


Standard Indicators

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g. Drug Cases Submitted to the Department of Forensic Sciences, By Substance

Source: Virginia Social Indicator Dashboard; US Drug Enforcement Administration, National Heroin Threat Assessment Summary-Update

0

10

20

30

40

50

60

70

80

2010 2013 2015

Nu

mb

er

of D

rug

Ca

ses

Number of Drug Cases on the Eastern Shore By Substance

Cocaine Marijuana Prescription Opioids Heroin

Between 2010 and 2015, the Eastern Shore mirrored the statewide trend of a decrease in marijuana and cocaine drug cases, and increases in both heroin and prescription opioids. The US Drug Enforcement Administration has documented similar trends at the national level since 2007.22

Number of Drug Cases on the Eastern Shore By Substance

2010 2013 2015

Cocaine 55 69 49

Marijuana 36 46 14

Prescription Opioids 4 4 17

Heroin 0 3 8

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

2010 2013 2015

Num

be

r of D

rug

Ca

ses

Number of Drug Cases In Virginia by Substance

Cocaine Marijuana Prescription Opioids Heroin

Number of Drug Cases In Virginia By Substance

2010 2013 2015

Cocaine 8,808 7,350 6,910

Marijuana 13,117 13,342 6,304

Prescription Opioids 5,605 6,525 5,762

Heroin 2,056 3,878 4,999

Standard Indicators

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Standard Indicators

i. Virginia Youth Survey: Behavioral Health Indicators


Percent of Respondents Reporting Any Lifetime Use of

Prescription Drugs

Percent

Eastern 18.2

Northwest 16.8

Central 16.8 Southwest 15.9

14.5

15

15.5

16

16.5

17

17.5

18

18.5

Eastern Northwest Central Southwest

Perc

ent

of S

tud

ent

s

Percent of High School Students Reporting Lifetime Use of Prescription Drugs, 2013

Indicator Accomack

County Northampton

County Total Eastern

Shore Virginia Total

# % # % # % # %

High School Youth (age 14-19, #) 2,227 766 2,993 656,868 Alcohol (age 14-19, 1+ drinks in past month, #) 644 29% 217 28% 861 29% 194,401 30% Sad or Hopeless (age 14-19 consistently for 2+ weeks, #) 556 25% 191 25% 747 25% 163,653 25% Tobacco (age 14-19, 1+ days in past month, #) 440 20% 146 19% 586 20% 133,498 20% Driving While Intoxicated (age 14-19 who rode with intoxicated driver, #) 435 20% 146 19% 581 19% 129,216 20%

Source: Virginia Health Atlas

h. Virginia Youth Survey: High School Students Reporting Use of Prescription Drugs

Youth in the Eastern Region, which includes the Eastern Shore, report the highest percentage in the state for any use of prescription drugs.

High school students on the Eastern Shore reported similar behavioral health responses as students across the state regarding drinks in the past month, feeling sad or hopeless, using tobacco and driving while intoxicated.

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Standard Indicators

Between 2014 and 2015, the number of alcohol impaired driving deaths slightly decreased at all levels, and then in the following year increased in both counties on the Eastern Shore while remaining the same across Virginia.

Percentage of Alcohol Impaired Driving Deaths

2014 2015 2016

Accomack 41 35 39

Northampton 14 11 14 Virginia 35 31 31

j. Alcohol Impaired Driving Deaths

Source: 2016 Virginia County Health Rankings

0.00

0.50

1.00

1.50

2.00

2.50

3.00

2010 2013 2015

Rate

pe

r 1,0

00 D

rive

rs

Alcohol Related Crashes Per 1,000 Licensed Drivers


k. Alcohol Related Crashes

Source: Virginia Department of Motor Vehicles, Virginia Traffic Crash Facts

Alcohol Related Crash Rate per 1,000 Licensed Drivers

2010 2013 2015

Accomack 2.58 2.29 1.83

Northampton 3.35 3.11 1.90

Eastern Shore 2.78 2.50 1.85

Virginia 1.51 1.40 1.27

Although the number of alcohol related crashes between 2010 and 2015 decreased on the Eastern Shore and Virginia, the rate per 1,000 drivers is higher on the Eastern Shore.

0.0 5.0

10.0 15.0 20.0 25.0 30.0 35.0 40.0 45.0

2014 2015 2016

Perc

ent

Percent of Alcohol Impaired Driving Deaths

Northampton Accomack Virginia

26

Standard Indicators

Between 2010 and 2015, the rate of adult DUIs decreased at the state and national levels, and in Accomack County. However, the rate slightly increased in Northampton County.

l. Adult DUIs

Source: Virginia State Police, Crime in Virginia; Federal Bureau of Investigation, Crime in the US

Adult DUI Rate per 100,000 Population Age 18 and Over

2010 2011 2012 2013 2014 2015 # Rate # Rate # Rate # Rate # Rate # Rate

Accomack 94 358.5 65 247.9 89 339.4 83 286.0 75 286.0 83 316.5

Northampton 24 243.6 19 192.8 32 324.7 26 294.3 31 314.6 26 263.9

Eastern Shore 118 327.1 84 232.8 121 335.4 109 288.3 106 293.8 109 302.1

Virginia 462.2 469.4 454.7 417.0 377.3 336.3

US 448.80 385.9 403.4 371.3 346.4 335.6

0.0

100.0

200.0

300.0

400.0

500.0

2010 2015

Rate

Pe

r 100

,000

Ad

ults

Ove

r Ag

e 1

8

Adult DUI Rates Per 100,000 Population Age 18 and Over

Accomack Northampton Virginia US

27

Standard Indicators

Between 2010 and 2015, the rate of DUIs for juveniles under the age of 18 decreased at the state and national levels. During this time period, there were four juvenile DUIs on the Eastern Shore: One in 2011, two in 2013 and one in 2014.

m. Juvenile DUIs

Juvenile DUI Rate per 100,000 Population Under Age 18

2010 2011 2012 2013 2014 2015

# Rate # Rate # Rate # Rate # Rate # Rate

Accomack 0 0.0 1 14.4 0 0.0 1 14.4 1 14.4 0 0.0

Northampton 0 0.0 0 0.0 0 0.0 1 41.7 0 0.0 0 0.0

Eastern Shore 0 0.0 1 10.7 0 0.0 2 21.4 1 10.7 0 0.0

Virginia 165 19.8 177 21.3 145 17.4 115 13.8 104 12.5 116 13.9

US 12.7 10.5 9.8 8.1 7.4 6.9

0.0

5.0

10.0

15.0

20.0

25.0

2010 2011 2012 2013 2014 2015

Rate

Pe

r 100

,000

Po

pul

atio

n U

nde

r Ag

e 1

8

Juvenile DUIs, Rate Per 100,000 Population Under Age 18

Eastern Shore Virginia US

Source: Virginia State Police, Crime in Virginia; Federal Bureau of Investigation, Crime in the US

28

Standard Indicators

n. Suicide

o. Suicide With a Substance Abuse Problem

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

2006-08 2007-09 2008-10 2009-11 2010-12

Rate

pe

r 100

,000

Suicide With Substance Abuse ProblemRate Per 100,000 Population


Suicide With Substance Abuse Problem Rate Per 100,000 Population

2006-08 2007-09 2008-10 2009-11 2010-12


Eastern Shore 4 2.8 5 3.6 4 2.9 5 3.7 3 2.2

Virginia 1.6 1.6 1.7 1.9 2.0

Suicide Rate Per 100,000 Population

2006-08 2007-09 2008-10 2009-11 2010-12


Eastern Shore 10 7.1 10 7.16 13 9.42 21 15.31 18 13.15

Virginia 11.47 11.71 12,05 12.33 12.5

0.0 2.0 4.0 6.0 8.0

10.0 12.0 14.0 16.0 18.0

2006-08 2007-09 2008-10 2009-11 2010-12

Suicide Rate Per 100,000 Population




The rate of suicides on the Eastern Shore was lower than the state in 2006-08 but began to exceed the state rate in 2009.

Since 2006, the rate of suicides with a substance abuse problem remained higher than that of the state.

29

Standard Indicators

Number of Adults and Children Receiving Domestic Violence Services

FY 2012 FY 2013 FY 2014 FY 2015 FY 2016

Adults Age 18-29 38 30 27 46 43

Children 13-18 6 9 10 8 7

0

10

20

30

40

50

FY 2012 FY 2013 FY 2014 FY 2015 FY 2016

Num

be

r

Number of Adults and Children Receiving Domestic Violence Shelter/Services

Children 13-18 Adults 18-29

p. Number of Adults and Children Receiving Domestic Violence Shelter and Services

Source: Eastern Shore Coalition Against Domestic Violence

The Eastern Shore Coalition Against Domestic Violence (ESCADV) continues to shelter families and children, despite the community denial that this and other social problems exist on the Shore.

In FY 2016, the ESCADV served 43 adults and 7 children. According to the Centers for Disease Control and Prevention, substance abuse is linked to all forms of violence that families can experience, including child maltreatment, teen dating violence, intimate partner violence, sexual violence, youth violence, bullying, suicide and elder maltreatment. 20 Combined with potential poverty and other social or health risk factors, families experiencing violence may have greatly increased chances of experiencing substance abuse.23

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B. Assessment of Resources

The Community Partners of the Eastern Shore keeps an updated Pocket Pal (resource guide) brochure that widely distributed among all community partner agencies, at community events, and in electronic form on the coalitions’ website: www.cpesva.org. The Pocket Pal with available community resources is found in Attachment D. There are a variety of human services resources available for those in need, yet there is just one organization, the Eastern Shore Community Services Board, providing substance abuse and mental health services. All interview and focus group respondents commented on the critical need for more resources and capacity to address the increasing need for these services.

The Coalition Readiness Assessment resulted in an overall score of 3.5. Based on these results, the Community Partners of the Eastern Shore (CPES) has the leadership, dedication and strength to build the necessary bridges and additional partnerships to obtain resources needed to decrease the use and negative consequences of youth substance abuse. By addressing youth substance abuse and its underlying causes, CPES hopes to create a community where families and their children can thrive and live healthy and connected lives.

While the CPES scored high in readiness, the key informant interviews indicate some opportunities to bring the general community to a place of similar readiness. The most frequent theme among key informants was the need to raise the awareness of this issue among the general population, many of whom are in denial that substance abuse occurs on the Eastern Shore. By raising public awareness of the issue, CPES hopes to make it easier for people to seek services without stigma; to better understand the issue so they can have a positive impact on those they serve. Key informant results also suggest the need to continue working with law enforcement and schools to education students and their parents about the risk and protective factors associated with substance abuse. Finally, key informants noted that finding a local leader to champion these efforts will garner community interest and support for interventions.

Causes: There seems to be a clear link between the recent significant increase in youth substance abuse on the Eastern Shore and the multiple socioeconomic and health disparities that exist in its poor, rural areas. Poverty, combined with negative family patterns (high rate of teen births, single parent households, and homelessness) combined with a higher dropout rate and low educational attainment may play key roles in the increased rates of fatal overdoses, juvenile narcotics arrests, suicides and the increased use of CSB substance abuse services.

Dimension Score Indication of Score Coalition Context 3.7 The Coalition works very collaboratively to determine key issues and

to have a positive impact on resolving them. Coalition Structure 3.6 The Coalition includes key stakeholders, and most have a agreed

upon structures and communications methods to achieve goals. Coalition Members 3.3 The Coalition is cohesive and active, and members are learning to

communicate effectively and work toward improvement. Coalition Process 3.5 Most members trust the leadership and other members; the

decision-making process may be continually refined. Coalition Results 3.5 The Coalition recognizes the importance of focusing on its goals,

and continues to develop measures and milestones to track success.

Average 3.5

http://www.cpesva.org

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11

Regarding the significant increase in heroin and opioid use on the Eastern Shore, the US Drug Enforcement Administration (DEA) reports that heroin use has also dramatically increased across the nation, but especially in Mid-Atlantic suburban and rural areas. 21 The DEA reports that the causes for this increase include 1) larger quantities being trafficked in suburbs and rural counties because there is a greater ability to conceal these activities; 2) people using prescription painkillers are turning to heroin because it is cheaper and more easily available than physician prescribed medications.

This trend follows the national trends of consumption by these substances.

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12

The existing coalition, made up of key service providers (governmental and non-governmental) should take the following steps in order to make the best use of the data:

1. Review and analyze the summary of responses contained in this report along with other socialindicators that demonstrate community-wide issues.

2. Identify trends, gaps, barriers and successes within the bigger issues discussed in this report.

3. Develop a realistic action plan that includesa. a goalb. at least one objectivec. very specific activities around each issued. person(s) or organization(s) responsible for each activitye. short-term and long-term timelines

The action plan should be developed over a succession of meetings within a limited time period, such as six months, while the motivation around implementing change is elevated. It should be flexible to include changing policies, funding and other factors. It should also be aligned with continued efforts by the local or state officials to address substance use.

The action plan should be used as a guiding document over the next 3-5 years and reviewed and updated annually. The action plan, along with a summary of the key results from this report, should be incorporated into the annual or strategic plan of every agency within the human service delivery system to ensure consistency of efforts.

33

13

Those within the CPES that have the expertise and incentive to seek additional funding and resources should make appointments with local governmental leadership as well as private funding organizations to announce the action plan undertaken by the service providers. Through these personal exchanges and supporting documentation, priorities can be identified for allocating resources where additional assistance is needed to affect change. Determining strengths and weaknesses within the current system while matching needs with assets is the cornerstone of any successful strategy for community-wide improvement.

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14

1 U.S. Census Bureau, population data, 2010.

2 Eastern Shore of Virginia Comprehensive Economic Development Strategy, June 2011.

3 US Census Bureau, American Community Survey, 2009-2014 5-Year Estimate, Table S1701

4 US Census Bureau, American Community Survey, 2009-2014 5-Year Estimate, Table S1701

5 US Census Bureau, American Community Survey, 2015 1-Year Estimate, Table S0901

6 Centers for Disease Control and Prevention, Teen Pregnancy In the United States, Retrieved December 10, 2016 from http://www.cdc.gov/teenpregnancy/about/

7 Virginia Project HOPE, Homeless Student Count; Welden Cooper Center, Population Estimates for Virginia School Divisions

8 Virginia Department of Education, Graduation, Completion, Dropout and Postsecondary Data, Virginia Cohort Reports

9 US Census Bureau, American Community Survey, 2009-2014 5-Year Estimates, Table S1701

10 US Census Bureau, American Community Survey, 2015 1-Year Estimate, Tables S1701, PEP2015 PEPAGAESEX

11 Youth.gov website, Youth Topics/Substance Abuse Prevention/Risk and Protective Factors, Retrieved November 30, 2016 from http://youth.gov/youth-topics/substance-abuse/risk-and-protective-factors- substance-use-abuse-and-dependence

12 ChildTrends. (2015). “Family Structure: Indicators on Children and Youth.” Retrieved December 10, 2016 from

http://www.childtrends.org/wp-content/uploads/2015/03/59_Family_Structure.pdf

13 National Campaign to Prevent Teen and Unplanned Pregnancy. (2014). “Teen Pregnancy: Why It Matters.” Retrieved December 10, 2016 from https://thenationalcampaign.org/why-it-matters/teen-pregnancy

14National Center of Family Homelessness. (2011). The Characteristics and Needs of Homeless Families Experiencing Homelessness Retrieved December 10, 2016 from http://nationalhomeless.org/references/ publications/

15 US Census Bureau, American Community Survey 2009-2014 5 Year Estimate, Table B23001

16 State Council of Higher Education for Virginia, Undergraduate Enrollment By Student's Location of Origin, Table E12RA

17 State Council of Higher Education for Virginia, Total Degrees Awarded by Student Origin, Table LD05

18 State Council of Higher Education for Virginia, Change in Enrollment, Table E41

19 US Census Bureau, American Community Survey 2009-2014 5 Year Estimate, Table B23001

20 US Drug Enforcement Administration. (2016). National Heroin Threat Assessment Summary - Updated. Retrieved December 11, 2016 from https://www.dea.gov/divisions/hq/2016/hq062716_attach.pdf21 WDBJ7 TV, November 21, 2016. Virginia declares public health emergency because of opioid addiction crisis. Retrieved December 11, 2016 from http://www.wdbj7.com/content/news/Virginia-declares-public- health-emergency-because-of-opioid-addiction-crisis-402263566.html

22 US Drug Enforcement Administration. (2016). National Heroin Threat Assessment Summary - Updated. Retrieved December 11, 2016 from https://www.dea.gov/divisions/hq/2016/hq062716_attach.pdf

23 Centers for Disease Control and Prevention. (2014). Connecting the Dots: An Overview of the Links

Among Multiple Forms of Violence. Retrieved November 30, 2016 from https:www.cdc.gov/ violenceprevention/pdf/connecting_the_dots-a.pdf

CITATIONS AND APPENDICES

35

15

Virginia State Police, Crime in Virginia, Retrieved on September 12, 2016 from http://www.vsp.state.va.us/Crime_in_Virginia.shtm

Federal Bureau of Investigation, Crime in the US, Retrieved September 12, 2016 from https://ucr.fbi.gov/crime-in-the-u.s

Eastern Shore Community Services Board, Planning and Prevention Services

Eastern Shore Coalition Against Domestic Violence

Domestic Violence and Youth

Impact: ES

Appendix A: Gallery Walk Photos

Complete DUI Data Station with 3D Data and

Activities

3D Representation of DUI Fatality

and Injury Data for ES

Opioid Use for ES Youth

Parental Involvement and Regular Communication

Parental Monitoring Station: 3D Representation of Risk Factors

Homeless Map for ES Youth

Homeless ES Youth Station

Complete Station for Youth Marijuana Use 3D Data Representation of Marijuana Use and

Station Activity

Poverty Data Station

Data Reveal Meeting ES

Coalition Members Visiting Data Stations and Discussing

eastern shore substance abuse needs assessment · all substances – alcohol, heroin,...

Documents