In this analysis, we sought to begin to identify how the opioid crisis is affecting children in families touched by problem drug use; how parents or caregivers could be better supported; and how service providers and systems—and the policies underpinning them—could better support families affected by the crisis. To do so, we consulted with national experts in the field and conducted site visits to two Appalachian communities significantly affected by the epidemic. However, the two communities we visited do not represent the wide range of communities and local contexts relevant to this ongoing nationwide epidemic.

The study revealed wide-ranging unmet community needs and service system limitations, often tied to historical policy failures and/or regional economic challenges. People grappling with substance use disorders face limited access to treatment, as do their families, and child-serving systems are often not equipped to meet the complex needs of children and families touched by the epidemic. And though schools and early childhood care programs can be a critical resource for families, these service systems and settings are already overstretched and underfunded. Further, stigma, bias, and misinformation continue to impair efforts to address the epidemic.

Policymakers looking to support children and families and the service systems surrounding them, would do well to

• address long-standing systems-level challenges and misalignments,
• invest in community-based services and infrastructure,
• deliver trauma-informed care,
• family-proof public policies while also making them more adaptive and agile,
• and ensure policies in mainstream settings reflect best practices and research-based evidence.