Elementary School Counselors’ Experiences Working With Children Affected by Parental Substance Use

Abstract

Despite widespread effects of parental substance use on children, little is known about the experiences of school counselors working with this student population. We examine the experiences of elementary school counselors working with school-aged children affected by parental substance use. Eight school counselors participated in semistructured interviews, which we analyzed using consensual qualitative research. Participants described significant contact with the population in question. Findings suggest that elementary school counselors utilize multitiered interventions but need additional training and job support to meet the prevalent needs of this student population. We provide implications for school counseling practice, research, and counselor training.

Keywords

school counseling parental substance use children consensual qualitative research counselor training

Introduction

Childhood exposure to abuse, violence, and substance use has detrimental impacts on development. Adverse childhood experiences (ACEs) are strongly related to negative health outcomes in later life (Felitti et al., 1998). Those with ACEs are more likely to experience issues such as depression, suicide risk, substance misuse, and overall poor physical and emotional health (Balistreri & Alvira-Hammond, 2016; Felitti et al., 1998). Of the ACEs categories, substance misuse in the home is among the most frequently documented (Balistreri & Alvira-Hammond, 2016; Felitti et al., 1998).

Parental substance use is increasingly problematic (Bullinger & Wing, 2019) and has serious and concerning consequences for children and families (Raitasalo & Holmila, 2016; Locke & Newcomb, 2003). This issue is not new, although the severe impacts of the opioid crisis have brought national attention to drug issues and policy. Discussion of this issue must consider the needs and impacts on children as one of the most vulnerable populations. Although school counselors are often the first line of intervention for these students and families, the school counseling literature in this area is surprisingly sparse. The purpose of this study was to investigate the experiences of elementary school counselors working with school-aged children affected by parental substance use. We first discuss the effects of parental substance use, then review the school counseling literature.

Effects of Parental Substance Use on Children: School Counselors Need to Know

Between 2009 and 2014, 8.7 million American school-aged children were living with at least one parent who had a substance use disorder (Lipari & Horn, 2017). Poison control services reported 188,469 cases of children with opioid exposure between 2000 and 2015 (Allen et al., 2017). Overdose deaths continue to increase in the United States (Centers for Disease Control and Prevention [CDC], n.d.), as does the number of children in foster care (Radel et al., 2018). Most children of parental substance use have a low-income status and are living with only one guardian (Conners et al., 2004). Violence in the home is increased by 4.5 times and family separation by 2.6 times when one or both parents have a substance use disorder (Christoffersen & Soothill, 2003). The chance of injury among children with parental substance use is higher and is further increased if both parents have a substance use disorder (Gandhi et al., 2021; Raitasalo & Holmila, 2016). Due to family separation, children in these situations are more likely to live with extended family, especially grandparents (Haight et al., 2005).

Among school-aged children with parental substance use, externalizing behaviors noteworthy for school counselors are prominent in several studies. Students are often “socialized to be very guarded in their communications and interactions with teachers and others so as not to incriminate the parents” (Haight et al., 2005, p. 959). Wilson et al. (2004) found that children of opiate-dependent parents were three times more likely to exhibit disruptive behavior compared to children whose parents were not dependent on opiates. Research by Haight et al. (2005) indicated that while in a school setting, students of parents addicted to methamphetamines had a difficult time following directions, understanding consequences, and fitting into social situations. They were also described as being isolated from their peers. Researchers have also found that children whose parents had an alcohol use disorder were more likely to drink as adolescents (Chassin et al., 1991; Roosa et al., 1988). According to Hussong et al. (2007), when both parents had an alcohol use disorder, children showed more externalizing symptoms than those with one affected parent. Conners et al. (2004) found that 18% of students with parental substance use were held back at least one grade level and 25% had an increase in negative behaviors.

Research has also shown an effect of parental substance use on the internalizing symptoms of children, such as anxiety and depression. Children whose fathers have substance use disorders have been found to demonstrate a higher rate of “conduct disorder, ADHD, major depressive disorder, and anxiety disorders” (Clark et al., 2004, p. 687). Children with parental substance use showed “twice as great a risk of displaying internalising symptoms, depression symptoms and socially deviant behaviour in the clinical range” (Christensen & Bilenberg, 1999, p. 223). Female students had generally higher rates of internalizing and depression scores than male students (Christensen & Bilenberg, 1999). Children with parents who used substances also reported higher binge eating and purging than those whose parents did not use substances (Boswell & Lydecker, 2021).

Also important is the internal experience of contradictory emotions that these children may experience (Wangensteen et al., 2019). Findings showed that children grapple with feelings such as fear of losing a parent, anger at a parent’s behavior, and desire for a relationship with the parent. Research also revealed the importance of having professional support to process these emotions and experiences (Wangensteen et al., 2019). A similar study by Maina et al. (2021) interviewed 12 adults who grew up in homes where substance use was prevalent and identified four themes: substance use at home and its impact on dependents, school environment influences on substance use, aggravating traumatic life experiences, and rebuilding a battered life. These themes included an increase in ACEs, disarrangement of the home and family, homelessness, and discontinuation of schooling and/or deterioration of academic performance (Maina et al., 2021).

School Counselor Intervention

Given the multitude of effects of parental substance use on school-aged children and the documented need for professional support (Wangensteen et al., 2019), identifying first lines of intervention is important. Schools are recognized as an integral component of a public health approach (Teasley, 2018). School counselors are ideally situated to identify and intervene with students affected by parental substance use because they understand the impact various ACEs can have on student success. The opioid epidemic has brought a greater sense of urgency to this issue, which has been noted as “the source of many behavioral health problems in schools, and …needs greater attention and planned intervention by school-based professionals” (Teasley, 2018, p. 195). Nevertheless, little is known about how school counselors are navigating this crisis.

According to the American School Counselor, 2019b, multitiered systems of support (MTSS) is an evidence-based framework that allows for school counselor intervention at tiered intensities to improve student functioning. MTSS principles emphasize that every student can achieve and learn with the implementation of a collaborative, evidence-based intervention that targets each student’s needs using collected data (Kemp & Poole, 2018). Tier 1 interventions include classroom instruction and school-wide programming and initiatives, Tier 2 interventions include small-group and individual counseling (as well as consultation and collaboration with internal stakeholders), and Tier 3 interventions include indirect services such as facilitation of referrals and consultation (Goodman-Scott et al., 2020; Ziomek-Daigle et al., 2016). Utilizing MTSS helps school counselors recognize and close the gaps among students while collaborating with stakeholders such as teachers, administrators, and family members (Kittelman et al., 2021; Weingarten et al., 2020).

School counselors have a documented need for additional training and support in the area of substance use disorders (Burrow-Sanchez & Lopez, 2009; Vail-Smith et al., 1995). Specifically lacking are research and guidance for elementary school counselors working with students impacted by parental substance use. Much of the existing school counseling literature focuses on students with a substance use disorder (Dunbar et al., 2019); the research that does address elementary school counselors and students impacted by parental substance use is limited and more than 10 years old (Knight, 1994; Vail-Smith et al., 1995). Vail-Smith et al. (1995) found that about 50% of elementary school counselors had not had a substance use course in their graduate program. This finding was later corroborated by a 2009 study of high school counselors by Burrow-Sanchez and Lopez. Both studies identified school counselors’ desire for more training on substance use (Burrow-Sanchez & Lopez, 2009; Vail-Smith et al., 1995). Given the continuing prevalence of substance use disorders, coupled with the severe impacts of the opioid epidemic on families and communities, improving research and support for school counselors working with children of parental substance use is essential. As part of these efforts, this study investigated the following research question: What are the professional experiences of elementary school counselors working with students affected by parental substance use?

Method

We utilized consensual qualitative research (CQR; Hill et al., 2005) for this study. CQR is an integration of multiple approaches such as grounded theory and phenomenology and uses a rigorous method of analysis focused on consensus for interpretation of data (Hays & Singh, 2012). CQR is particularly suited for studying both events and attitudes of participants who are close to and knowledgeable about a topic (Hays & Singh, 2012; Hill, 2012). This approach provides a rich framework for examining the perceptions, behaviors, and needs of elementary school counselors working with students affected by parental substance use.

Procedures

Participants

Participants in this study were certified elementary school counselors currently employed in the commonwealth of Kentucky with at least 1 year of professional experience. Eight school counselors contributed data to the present investigation. Seven participants chose to respond to the demographic questions; of these, six identified as female and one as male. Six participants identified as White/non-Hispanic; one participant identified as White/Pacific Islander. Participant ages ranged from 30 to 62 years. The number of years of experience practicing as a school counselor ranged in years from 1 to 24, with a mean of 11.57 years’ experience. Six participants reported receiving a master’s in school counseling since 2008, with the earliest in 1993 and the most recent in 2019.

Interview Protocol

We developed a semistructured interview protocol to elicit responses in several areas relevant to the role of an elementary school counselor. Participants were asked to describe (a) the awareness of students affected by parental substance use; (b) previous training experiences and felt sense of preparedness for working effectively with this population; (c) intervention strategies in response to parental substance use; (d) how school counselors view their role in intervening with students affected by parental substance use; (e) available resources in and outside of their school; (f) if substance use within their communities has changed the school counselors’ Tier 1, 2, and 3 interventions; and (g) what supports school counselors feel they need that they do not have to help students affected by parental substance use.

Data Collection

Recruitment of participants took place using purposive convenience sampling. Over a period of 15 months, we sent more than 130 recruitment emails to elementary school counselors in counties across the commonwealth of Kentucky. Email addresses were identified by searching school district websites. Eight elementary school counselors consented to participate and be recorded for the interview. This sample size aligns with CQR recommendations of 8–15 participants for studies with one or two interviews (Hill et al., 2005). After obtaining consent, we scheduled phone interviews with participants and provided a copy of the semistructured interview questions we developed for this study. One researcher conducted each of the semistructured interviews to improve consistency in data collection. All interviews were conducted and audio recorded via telephone, and were completed within 30–45 minutes. The primary analysis team transcribed the audio-recorded interviews verbatim.

Reflexivity and Trustworthiness

Reflexivity in qualitative analysis requires self-awareness and transparency of potential biases (Patton, 2015). The first three authors are counselor educators in a school and mental health counseling program and have completed master’s and doctoral degrees in CACREP-accredited programs. All the authors identify as White, cisgender females. The first author has professional experience as a mental health counselor that includes working with children and adults for a variety of mental health concerns, including dual diagnosis. She grew up with a single parent who was proudly sober, and the author regularly went with her parent to Alcoholics Anonymous meetings. The second author worked as an elementary school-based clinical mental health counselor in Kentucky, and also had experience as a middle school counselor. The third author’s clinical and research foci have been in substance use and addictions counseling. She has also worked as a clinical supervisor in a school setting and provided counseling for children in community and private practice settings. This author has struggled with substance use issues of her own and has received treatment. The fourth author was a graduate student during this study. She has worked in both a clinical and school setting with children who have parents with substance use issues. She grew up with a parent who continues to struggle with substance use.

Trustworthiness in CQR is established through structured cross-analysis of the data, involvement of multiple team members, and use of an auditor (Hill et al., 2005), which we discuss in the Data Analysis section. At the beginning of the study, authors involved in the data analysis performed a bracketing exercise to record biases and expectations of the study prior to data collection. During the exercise and throughout the analysis, we noted how our professional and personal experiences could impact our interpretation of the data.

Data Analysis

Data was analyzed using CQR (Hill et al., 2005) with the aim of capturing the lived experiences of elementary school counselors providing support to students affected by parental substance use. Hill et al. (1997) outlined the following key components for conducting a CQR study: (a) data is gathered using a semistructured interview process with open-ended questions to allow participants ample opportunity to speak to their unique experiences; (b) words, narratives, and stories—rather than numerical data—are utilized to describe the phenomena; (c) a small number of cases are studied in great depth; (d) the holistic context of each case is used to understand specific parts of participant responses; (e) conclusions are built from the data itself using an inductive process; (f) team members examine the data independently and then come together to discuss ideas until all team members reach consensus on the best representation of the data; (g) an auditor reviews the team’s consensus judgments, providing additional feedback and reviewing to ensure that the team does not overlook important data; and (h) the research team continually returns to the raw data to ensure that the results and conclusions drawn by the others accurately reflect participant narratives. Our team members worked to gain consensus through the process of interpreting and classifying the data throughout the three steps of analysis. First, the team reviewed the data and identified a list of domains, which are broad topic areas found within the data. Second, we analyzed each domain to capture core ideas, and then cross-analyzed the data to reach consensus on the categories (and in some cases, subcategories) that comprised each domain. At the offset of Steps 1 and 2, one case was omitted from the initial analysis and later added to check for stability of findings. The auditor reviewed the work of the primary research team at each step to ensure the accuracy and integrity of the process. Finally, we assigned frequency labels to each category based on their observed frequency in the data, with a frequency of 7–8 cases being labeled as general, 5–6 cases as typical, 2–4 cases as variant, and 1 case as rare.

Results

Analysis of the eight semistructured interviews yielded seven domains and 44 categories. The seven identified domains are: School Counselor’s Perception of the Issue, Observed Effects on Students, School Counselor Interventions, Obstacles and Barriers to Successful Intervention with Students, Related Training Experiences, Third-Party Intervention, and Recommended Action. One domain, Observed Effects on Students, was further broken down into subcategories to capture participant responses more accurately. In the cross-analysis, we identified three categories as general, 10 as typical, 14 as variant, and 17 as rare. The full list of domains, categories, and subcategories is presented in Table 1.

Table 1.

Domains, Categories, Subcategories, Participants, and Frequency Labels.

Domains	Categories and subcategories	Participants	Label
School counselor’s perception of the issue	High prevalence of children affected by parental substance use	1, 2, 3, 4, 5, 6, 7, 8	General
	Negative perception and mistrust of parents	1, 2, 4, 6, 7	Typical
	The issue is complex and systemic	2, 4, 5, 6	Variant
	Intersectionality with low socioeconomic status	1, 2, 6, 8	Variant
	School counselor feels shocked and concerned	1, 4, 7	Variant
	Ineffective interventions and resources for ASU	3, 5, 6	Variant
	The issue has escalated/is more visible than it used to be	3, 5	Variant
	Negative effects on property value	8	Rare
	Positive perception of community resources for ASU	8	Rare
Observed effects on students	Adverse childhood experiences	1, 2, 3, 4, 6	Typical
	Parental overdose and death	1, 2, 3, 4	Variant
	Incarcerated parents	1, 3, 4	Variant
	Neglect/abuse	1, 3, 4	Variant
	Accidental overdose of student	3	Rare
	Behavioral effects	1, 3, 4, 6, 7, 8	Typical
	Lack of classroom readiness	1, 3, 4, 6, 7, 8	Typical
	Parentified behaviors/parentification	3, 6, 7, 8	Variant
	Disarrangement of home environment	1, 2, 3, 4, 5, 6, 7, 8	General
	Complicated housing situations	1, 2, 3, 4, 5, 8	Typical
	Living with relatives or in foster care	1, 2, 4, 5, 6, 7	Typical
	Social and emotional effects	1, 2, 3, 4, 6	Typical
	Emotional distress	2, 3, 4, 6	Variant
	Resiliency	1	Rare
	Relief with distance from using parent	1	Rare
	Biological effects from substance exposure in utero	1, 2, 3, 5, 8	Typical
School counselor intervention	Individual and small group	1, 2, 3, 4, 6, 7	Typical
	School-wide intervention	1, 2, 3, 6, 7	Typical
	Family intervention	1, 2, 3, 5, 8	Typical
	CPS reports	3, 5, 6	Variant
	Referral to higher level of care	5	Variant
Obstacles and barriers to successful intervention with students	Need for training	1, 2, 3, 5, 6, 7, 8	General
	Frustration with CPS	1, 2, 3	Variant
	Developmental considerations	1, 2, 3, 7	Variant
	Time limitations and logistical constraints	2, 6	Variant
	Frustration with local cabinet	1	Rare
Related training experiences	Trauma-informed care	1, 2, 4, 5, 7, 8	Typical
	Master’s level course on substance use	3, 7, 8	Variant
	Has received targeted training	5	Rare
	Grief training	4	Rare
	Credentialed as LCDC	7	Rare
Third-party intervention	School-based mental health counselors	2, 3, 4, 5, 7	Typical
	Family resource coordinator	1, 2, 3, 5, 6	Variant
	Student resource officer	4, 6, 7	Variant
	Law enforcement	1, 3	Variant
	Teachers	2	Rare
	Homeless coordinator	2	Rare
	District safe school coordinator	3	Rare
	School social worker	8	Rare
	School psychologist	8	Rare
	Youth services coordinator	8	Rare
Recommended action	Mentoring programs with high school and college students	6	Rare
	More school counselors	6	Rare
	Full-time mental health counselor at school	2	Rare
	Greater allocation of resources	7	Rare
	Guided curriculum	4	Rare

School Counselor’s Perception of the Issue

All the school counselors interviewed for this study indicated that they have experienced a high volume of students affected by parental substance use in their schools. One participant described this prevalence saying, “There is not a classroom in this entire building that doesn’t have a kiddo that’s been impacted by drug abuse in their family.” Participants shared feeling a sense of mistrust for parents they thought were using substances and had negative perceptions of this parent group. Several described challenges getting accurate information about a student’s home life when talking to parents they suspect are using substances. As one participant summarized: “So it’s like a little game, you know, where you can’t really let them know that you’re on to them, because then they think that you are calling the cops and calling [child protective services].”

Although the school counselors conceptualized the issue in ways that diverged moderately, responses were generally rooted in a sense of concern for the growth of parental substance use. Several participants noted the issue of substance misuse within their communities feels more visible than in previous years and expressed feelings of shock and concern for their students. Many participants described the issue as complex and systemic. For example, half of the participants noted connections between high levels of low socioeconomic status within their communities as a complicating factor to the issue. One participant commented:

But it’s a very powerful thing, it’s hard.…I mean we’ll have people have success, and like I said, this one call I made this morning, apparently, it’s a kindergarten student so I haven’t known these people for a long time but, you know, apparently they were sober for 3 years. And now everything is just …both mom and dad are using again. And you know, that they had such success. They turned their lives around apparently. And now they are going down this path again. So, you know, it’s heartbreaking.

Observed Effects on Students

Participants had the highest rates of consistency in terms of their observed effects of parental substance use on students. To better describe what school counselors have observed among their students, we further broke down the categories in this domain to subcategories (see Table 1).

All the participants mentioned high rates of disarrangement in the home environment. Within this general category, two prominent themes emerged. First, participants noted that parental substance use caused students to endure a variety of complicated home environments, such as having to adjust when parents are in and out of jail (and thus in and out of their home life). The participants also observed that students affected by parental substance use are often forced to live with other relatives or in foster care settings. According to participants, this student population experienced notable rates of ACEs, with the most common ACEs reported being neglect and abuse in the home, incarcerated parents, and parental overdose and death. One participant mentioned having a grief group for students who had lost parents to drug use. Another noted the high rates of neglect among this student population: “It is kind of like [these elementary students] are raising themselves.” School counselors observed behavioral effects impacting classroom readiness, and several noticed a theme of parentified behaviors among some students. Participants observed social and emotional effects on students as a result of parental substance use, with emotional distress being the most common effect. One participant shared:

We also see a lot of kids feeling like they are not enough. Because if they were good enough, or if they were enough, their parents wouldn’t feel that they would need to abuse the drugs. So, you know they always feel like they’re not being chosen because the parents are choosing the drug over them. So, it’s kind of that, you know, sense of …I don’t really belong. I don’t belong anywhere and I must not be good enough.

Biological effects of substance use in utero was another a concern noted by participants. One participant shared: “We have some students that are born addicted…. A lot of them are then diagnosed with ADHD or some sort of developmental delay due to [fetal alcohol syndrome].” Another stated:

And then we have the more severe cases where kids, a lot of kids that were born addicted to meth and heroin…. I don’t even think we’ve scratched the surface of what that’s doing to our little ones’ brains.

School Counselor Intervention

The school counselors interviewed for this study reported using a wide range of multitiered interventions to target this issue, with most participants utilizing individual and small-group counseling, school-wide programs, and family interventions. Notable interventions included counseling groups (including grief groups) for students with similar experiences, referral to the school counselor based on results of a district-wide needs assessment (e.g., resiliency poll, to assess anxiety and depression) and Red Ribbon Week school-wide activities for substance awareness. In discussing individual and small-group interventions, several participants noted their desire to create a safe space for students who may not feel safe at home. Others commented on the need to educate students about what behaviors they should and should not expect from their parents. As one participant said,

I talk to the kids about, you know, when you go home you should have an adult there who is taking care of you. That means making your dinner, making sure you have clean clothes, like making sure that you are taken care of. It doesn’t mean that you can’t help …but that should not be your job and your job alone.

Several school counselors described interventions aimed at helping the parent or family system, such as doing home visits, sending supportive notes to parents in recovery, and providing referrals to parents for services ranging from care closets to mental health services and medical providers. A few school counselors shared that they view reports to child protective services (CPS) as one intervention in their tool belt. One noted higher frequency of reports made following targeted school-wide interventions: “I’m sure any counselor will tell you they file more CPS reports during Red Ribbon Week.”

Obstacles and Barriers to Successful Intervention With Students

All of the participants noted significant barriers or obstacles to successful intervention with their students. Participants expressed that they need more training on substance misuse and intervention with students affected by parental substance use, with many sharing they had received no education related to intervening with students in this population. While some of the participants had received drug- and alcohol-related training in graduate school or beyond, several remarked that trainings were not specific to their needs in working with elementary school students. Participants shared unique difficulties working with elementary school students on this topic due to developmental considerations. As one participant stated: “I guess there’s kind of different philosophies on what age do you start, is it too early to do substance abuse education?” Another noted the difficulties of talking to young children about parent substance use: “Because, you know it’s that, well, ‘Mom told me this is a secret.’ And [the students] not being able to fully distinguish between good secret, bad secret, and thinking they are going to get in trouble for that.” Several also noted significant frustration with CPS, with frustrations ranging from not feeling believed to feeling that CPS was nonresponsive. Two participants bemoaned feeling they have too many responsibilities or too little time to effectively intervene with their students affected by parental substance use.

Related Training Experiences

Although all the participants expressed a desire for more training on the issue, most of the participants identified having some training that they drew from in working with this population issue. Six of the participants explicitly noted their utilization of trauma-informed care approaches. As shared by one participant:

What we have been receiving that is helpful is there is a big push for trauma-informed schools. And a lot of trauma training which kind of lumps a lot of things together. But that has been helpful. That’s probably the biggest push that we have received…. But it’s more broad-based trauma that we are receiving right now.

Three of the participants recalled some substance use training in a master’s level course, although some participants noted limitations in this content, as previously discussed. One participant disclosed previous work history as a licensed chemical dependency counselor, but described dissonance in applying their previous work experiences to their role as an elementary school counselor.

Third-Party Intervention

All the participants described utilizing third-party interventionists to assist them in working with this population on this issue, although the job titles of third-party partners varied greatly. Five of the participants highlighted the usefulness of school-based mental health counselors in helping to support elementary students affected by parental substance use. As one participant shared, school-based mental health counselors help reduce barriers to mental health care for students: “We have an in-school therapist with [mental health facility]. So that sometimes helps because parents can’t always drive their kids to therapy. And with this they don’t have to, it happens right here at school.” Family resource coordinators (FRCs) and student resource officers (SROs) were the second and third most listed third-party interventionists with whom the participants frequently collaborated. School counselors noted the usefulness of FRCs in providing needed referrals to outside resources. As one said, “Our FRC is amazing. I feel like she knows a lot of the answers that I don’t know the answer to about outside resources. So, if I have questions, I go to her.” Others noted a strong partnership with their FRC: “I have a wonderful FRC director that I do a lot of things with. We do a lot of go-see and see where the kids are actually living to see the actual circumstance.” Regarding SROs, participants felt that SRO school-wide programming on substance use (e.g., DARE and STAND) was beneficial to their students. For a full list of other third-party interventionists, see Table 1. These results underscore the need for strong interprofessional collaboration between the various professionals that have a stake in reducing the negative effects of parental substance use on school-aged children.

Recommended Action

Although each of the categories within this domain was unique (labeled rare), the recommended actions generated by participants in this study seem useful. Two participants suggested the need for more school counselors and more full-time, in-school mental health counselors to meet the needs of students. One participant noted that, in addition to more training, they would like to see the development of a guided curriculum. All of these recommended actions align with the broader context of the interviews: Schools have a high prevalence of school-aged children affected by parental substance use and great need for school counseling intervention, but not enough training, staff, or resources to currently meet those needs.

Discussion

The current investigation sought to clarify the experiences of elementary school counselors working with students with parental substance use. About one in eight American children grows up in a home with parental substance use (Tye et al., 2021). Consistent with these statistics, all the school counselors interviewed for this study described high prevalence of elementary students being affected by parental substance use in their school. As previously stated, school counselors endeavor to intervene with all students through multitiered systems of support: individually, in small groups, and through school-wide programming (American School Counselor, 2021b). This holistic focus on the needs within a student body places school counselors in a frontline position to be informed student advocates and practitioners.

Consistent with previous research (Haight et al., 2005; Maina et al., 2021; Wangensteen et al., 2019), school counselors in this study reported a wide range of noticeable effects on this student population, including unstable and ever-changing home environments, emotional distress, and difficulties with various classroom readiness skills such as attentiveness, social appropriateness, and academic success. Results of this study are consistent with earlier findings that suggested children affected by parental substance use are more likely to live in foster care or with other relatives (Haight et al., 2005; Radel et al., 2018), and are more likely to experience negative internalizing symptoms, for example, emotional distress (Christensen & Bilenberg, 1999), and externalizing behaviors, for example, guarded communication with nonparental adults, disruptive classroom behaviors, parentification, etc. (Haight et al., 2005; Wilson et al., 2004).

More concerning, school counselors reported observing high prevalence of ACEs among this student population. Hughes et al. (2016) found that individuals exposed to two or more ACEs are more likely to have a family history of alcohol problems than individuals with no ACEs. Participants in the current investigation noted ACEs such as parental overdose and death, incarcerated parents, and increased potential for neglect in these complicated home environments. One participant shared having a student accidentally overdose as a result of ingesting substances found in the home. The current reports of consequences on children where parental substance use is present mirror the themes of impact of substance use at home on children and aggravating traumatic life experiences described by Maina et al. (2021), particularly regarding the observed increased number of ACEs. Clearly, students affected by parental substance use should be considered a high-priority population requiring sensitive and specialized intervention.

Implications for School Counselors

Findings from the current study highlight the need for evidence-based practices such as MTSS within the school environment. Participants reported performing multitiered interventions consistent with the ASCA National Model (American School Counselor, 2019a) and ASCA Professional Standards and Competencies (American School Counselor, 2019b), emphasizing a reliance on interventions such as providing small groups to foster a sense of normalcy, creating a safe space within their school environment, and finding opportunities to intervene in individually responsive ways. Recommended interventions for school counselors, such as conducting home visits, sending supportive notes to parents, providing access to family resource center supports, and making outside referrals, were some of the most beneficial and commonly reported.

To help meet the needs of this student population, elementary school counselors should also be intentional and active in their Tier 3 engagement with third-party referrals. Current findings suggest that school counselors utilize school-based mental health counselors, FRCs, and SROs as primary and preferred third-party supports for referral, consultation, and collaboration. Although access to third-party providers (such as school-based mental health counselors) may vary, school counselors serve as an important catalyst for building professional support networks to meet the needs of students affected by parental substance use.

Trauma-informed care approaches, obtained mostly through recent continuing education, appear to have bolstered elementary school counselors’ sense of efficacy in working with this population and have provided a foundation for understanding the complex nature of addiction and its impact on family systems. Results from the current study suggest that an improved global understanding of children’s response to trauma has allowed elementary school counselors to develop a new perspective for conceptualizing student behavior and intervening with this population, specifically by recognizing the signs and symptoms of trauma, promoting stable and nurturing relationships, and providing a safe, connected school community (Tiers 1 and 2). Our results also suggest that teachers’ improved knowledge of trauma helps when referring students to the school counselor, further enhancing collaboration and better enabling the school counselor to intervene earlier with this population across tiers. A greater understanding of how school counselors are using trauma-informed care to improve service delivery and intervention with the specific types of ACEs associated with parental substance use would be a helpful line of inquiry.

Increased education and training on substance use is paramount for the school counseling profession. Participants in the current study reported limited or no training on substance use in their graduate program, and none of the participants reported receiving training specific to children and how to recognize signs of parental substance use. According to the Council for the Accreditation of Counseling and Related Education Programs (CACREP) 2016 Standards, school counseling students are to have course curriculum instruction into the “signs and symptoms of substance abuse in children and adolescents as well as the signs and symptoms of living in a home where substance abuse occurs” (5.G.2.i). The specifics of this are to be interpreted, which encourages graduate programs to integrate this content in ways that are responsive to their curriculum development. Given the high level of need among students affected by parental substance use, our results suggest that counselor educators should earnestly incorporate evidence-based training on substance use, with an emphasis on school counselor interventions and developmental and systemic effects on the child. Dunbar et al. (2021) suggested the importance of training school counselors with up-to-date resources that include current addiction terminology and definitions as one means of reducing stigma and confusion around this issue. Similarly, the current study supports the use of trauma-informed care approaches with students affected by parental substance use, although more research on trauma-informed care with this population is recommended. The current findings emphasize a need for school counselor training on parental substance use to be offered in non-university settings such as via conferences, faculty and staff development/in-services, and other continuing education and professional development opportunities.

Efforts to improve training and education in this arena must take into account the many barriers to intervention school counselors often navigate. In addition to improved training, the participants all expressed a need for more time, resources, and personnel to adequately serve students with parental substance use. ASCA (n.d.) recommends that school counselors spend 80% of their time in direct services with students and have a student-to-school-counselor ratio of 250:1. Currently practicing school counselors in all grade levels are recommended to conduct the ASCA School Counseling Program Assessment (American School Counselor, 2021a) to collect and present use-of-time data and other needs assessment data to advocate for an increase in human and financial resources. An influx of school counselors and other school-based mental health personnel would be of significant benefit for students with parental substance use.

The body of literature on school counseling and parental substance use remains scant, with even fewer studies into the efficacy of early school counselor intervention with this population. An increased research focus into the specific outcomes of early school counselor intervention on academic performance and social/emotional development in students with parental substance use would be beneficial. One participant noted a desire for a developed guided curriculum, which is consistent with a recent report of elementary school counselors’ preference for using evidence-based practice and established curriculum (Mullens et al., 2019). Future researchers could consider establishing a developmentally responsive, substance-use-specific guided curriculum and comparing this curriculum to other forms of intervention with students in grades K–12.

Limitations

Results from this qualitative investigation offer insight into the daily experiences of elementary school counselors working with students affected by parental substance use. Nevertheless, every study has limitations. Although the purposive convenience sample was appropriate given the nature of CQR analysis (a homogenous sample is preferred; Hill et al., 2005), nonrandom sampling is always limited by the characteristics of the participant sample and may therefore be limited in its generalizability. All the participants in this study are school counselors in the commonwealth of Kentucky, and as such may be more affected than school counselors in other states due to the high prevalence of substance use and overdose deaths in the region (CDC, n.d.). Nevertheless, substance use and opioid misuse specifically is of national concern, with a 35% increase in drug overdose deaths since the start of the COVID-19 pandemic (National Institute on Drug Abuse, 2023). Finally, although we included several procedures to reduce researcher bias (e.g., bracketing exercises, the use of consensus gathering in interpretation, frequently going back to raw data, utilizing an auditor), eliminating the risk of bias is impossible in qualitative research.

Conclusion

As rates of parental substance use continue to rise (e.g., Bullinger & Wing, 2019), school counselors at all grade levels will invariably encounter students who are affected by the direct and indirect outcomes of parental substance use. Although all the participants in this study indicated having a substantial population of elementary students affected by parental substance use, most participants felt underprepared and uncertain about how to conceptualize and intervene in these cases. School counselors will greatly benefit from increased training at the graduate level and from continuing education opportunities to receive up-to-date knowledge and skills on substance use and addictions.

Supplemental Material

Supplemental Material - Elementary School Counselors’ Experiences Working With Children Affected by Parental Substance Use

Supplemental Material for Elementary School Counselors’ Experiences Working With Children Affected by Parental Substance Use by Hallie M. Sylvestro, Dorea E. Glance, Dana Ripley, and Rachel Stephenson in Professional School Counseling.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Hallie M. Sylvestro

Supplemental Material

Supplemental material for this article is available online.

Author Biographies

Dr. Hallie Sylvestro is an assistant professor and counselor educator at Northern Kentucky University. She is passionate about evidence-based practice and research related to integrated care, wellness, grief issues, and substance use. She has clinical experience working in community mental health and integrated care settings.

Dr. Dorea Glance is an Associate Professor and director of the school counseling program at Northern Kentucky University. She also serves as Vice President for Post-Secondary Schools for the Kentucky School Counseling Assocation.

Dr. Dana Ripley is a counselor educator, with a research focus in addictions. She has experience working in community mental health and treating substance use and addiction issues.

Rachel Stephenson received a Master of Arts in School Counseling and a Masters of Science in Clinical Mental Health Counseling from Northern Kentucky University. She currently works at a high school as a school counselor while also counseling children and adolescents at a private practice.

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