More heroin is coming into Vermont than ever, state officials say, and the ripple effects are disturbing. Families are facing tough choices as their loved-ones descend into addiction, and communities working to respond to the effects of addiction, including increased crime.
But Vermont's opiate epidemic also has a huge impact on the children who are living through the crisis.
In Brattleboro, Academy School Principal Andy Paciulli tries to greet each student in the morning. He welcomes kids who are homeless and who are hungry to the elementary school.
There are kids who are dealing with mental illness, and who are coming from homes of extreme poverty or violence.
And increasingly, Pacciulli says, he's seeing students dealing with the effects of heroin use at home.
"We're seeing more kids come to school who aren't ready," Paciulli says. "We see kids who are having trouble functioning in a school environment, and much of that we attribute to this level of dysfunction in so many families, which I think is also related to substance abuse."
Vermont's heroin crisis plays out every day in the headlines that are reported across the state.
The overdoses, crime, and desperation that stem from addiction can be tracked in the stories of adult Vermonters caught up in the epidemic.
Paciulli says kids get caught up in that world too and confront those severe situations at home. And then the schools are left to help them process and try to move beyond the trauma.
"It makes it very difficult to be engaged with 17 other kids in the classroom, and listen to directions, and focus and concentrate on learning math and literacy and science when something has happened at home that's had a significant impact on you," Paciulli says.
Lori Schreiner is a clinical supervisor at Health Care and Rehabilitation Services, the state's designated mental health agency in southeastern Vermont.
She says children who are exposed to the violence and neglect that often come along with addiction can suffer long-term effects.
"I think we know neglect and abuse and trauma impact mental health of children, and health of children," says Schreiner. "So when substance abuse makes a parent unavailable, it becomes neglect or abuse, and it impacts a child."
And trying to serve these kids and families can be especially challenging, according to Liz Mueller, an HCRS clinician.
She says it can be hard to get parental or guardian consent for treatment when families are deep into addiction, and parents who are using often don't follow through or show up for appointments.
"It makes it really difficult, with families that are actively using, to continue with those services," Mueller says. "It makes it hard to maybe make up for what wasn't there earlier on, to try to build the skills for the kids, and for the parents."
Vermont's schools and mental health agencies are overwhelmed with the fallout from the opiate crisis, but the state might be dealing with the impact for a long time.
Abigail Crocker, an assistant professor at UVM, is setting up a long term study with the Agency of Education to track the effects on children who are exposed to opioids during pregnancy.
Crocker says the University of Vermont Medical Center puts resources into making sure babies who are born to opioid-dependent women get a good start on life.
But there's very little known on how those children do going forward.
Crocker says UVM and the Agency of Education are setting up a confidential data tracking program to see how these children perform and behave as they go through school.
"We'll be using data on babies who had an opioid exposure during pregnancy," says Crocker. "And we'll be able to look and see what's happening in the education realm with those kids three to five to 10 years later."
Schools across Vermont are seeing more families that are battling addiction, and the education agency recognizes the need to develop a long term strategy, says Wendy Geller of the Agency of Education.
"There's not a lot that we actually know in the scientific community about what happens for kids who are born of opioid-addicted moms," Geller says.
Education and mental health officials all say the crisis is growing, and they say they are being asked to do this work at a time when funding is hard to come by and when more coordinated services are needed.