Scott County has struggled with substance use, misuse and addictions for many years. There are many presumed causes of this struggle. Certainly, a culture of poverty, a culture that has not readily seen the value of education have all contributed to these problems. From data, anecdotal stories and evidence, we recognize that Scott County has a high rate of child substantiated abuse and neglect cases. In fact, we currently have the highest rate in the state. Scott County CASA Director, Kelly Shelhamer, states that 90% of the abuse and neglect cases are due to parental substance misuse. As we have learned more about our community and sought root causes, we have come to understand that the people in our community also have high ACE (Adverse Child Experiences) scores. We are currently undertaking a survey process to identify the community’s ACE score. Preliminary results show that many people in our community have experienced high levels of trauma as children. We now understand the science that suggests high levels of trauma without developing strong resilience skills leads to many problems including substance misuse. Scott County has long held high rates of alcohol and tobacco usage. However, the use of marijuana, methamphetamines, and the misuse of prescription medications grew significantly in the past two decades. More recently, the use of e-cigs and vaping has skyrocketed in our community. 

Alcohol and tobacco continue to have the highest reported use among our youth. Twenty-four percent of Scott County 12th graders reported use of cigarettes or smokeless tobacco in the past 30 days. Twenty-two percent reported use of electronic vapes in the past thirty days. Alcohol use remains high with 18.6% of 12th graders reporting past 30 day use (INYS, 2018). We have seen a downward trend of use of alcohol, tobacco and marijuana since collection of data in 2013, however the mean age of onset has decreased, meaning youth are starting to use substances at a younger age. The highest mean of age of onset for alcohol was in 2016 at 15.3 years old. In 2018, the mean age of onset was 14.42 years old (INYS, 2018). We also want to increase perception of risk of harm among our youth. Since 2018, only 29% of our 12th grade students have reported there is a “great risk” when using marijuana once or twice a week.  

Community Assessment Social Indicator Data for Scott County indicate the following:

  • Per Capita Personal Income – $36,397 (2017) 87th in the State of Indiana (Rural IN Statistics)
  • Scott County reports 20.5% poverty rate among children 0-17 years. 23rd ranking in Indiana.   (IYI Kids Count, 2018)
  • 16.1% of adults have less than a high school education. (2018 Stats IN)
  • 11.9% of adults have a Bachelor’s degree or higher. (2018 Stats IN)
  • Child abuse & neglect rate in the county is 45.6. 3rd highest in the state. (2018 Kids Count)
  • # of CHINS cases 71.3 of 1000 children. HIGHEST in the state. (2018 IYI Kids Count)
  • Teen birth rate per 1,000, ages 15-17 – 39.5. 8th in the state. (2018 IYI Kids Count)

Our past prevention efforts targeted primarily middle-school students and work with families overall. We employed the use of some environmental strategies that have touched all ages and demographics of people. Now, we would like to fill-out the continuum by targeting high school students with this proposal. We’ve worked closely with both school districts and their guidance departments to provide the services they believe could benefit their students the most. 

Community Risk & Protective Factors

Our priority determinants are low commitment to school, community laws and norms relating to substance abuse, social access, perceived risk of harm of substance abuse and involvement of prosocial activities with positive peers. These contributing risk and protective factors were prioritized by a Determinant Assessment Workgroup, along with the Grant Writing Team, from the analysis of our data from the Indiana Youth Survey and took into consideration the overall picture of Scott County. 

In order to select priority risk and protective factors for individuals in grades 6-12, the Determinant Assessment Workgroup examined graphs and narratives using survey results from the 2018 Indiana Youth Survey and archival data. These statistics are reported as risk factors, that increase the risk of substance use, or protective factors which decrease the risk of substance use. Scores are shown as youth have high risk – meaning increased risk of drug use, delinquency, teen pregnancy, etc, or low protection – demonstrating a need for an increase of supports to help buffer against the negative influences in a youth’s life. In order to help increase prevention for substance use among our youth, we want to decrease low commitment to school, retail availability, and social access. We will work towards increasing perceived risk of harm, and understanding community norms relating to substance abuse. We have also prioritized increasing rewards for prosocial involvement and work to increase interactions with prosocial peers. 

In 2016, 43% of 10th graders were at high risk for low commitment to school, which increased to 49% in 2018. From the qualitative data we know that generational poverty and family history of low school achievement is rampant in our community, leading us to believe that this increase of low commitment continues to be passed from generation to generation. We believe by continuing to prioritize education in Scott County that we will begin to decrease the low commitment to school in both Scott County School Districts. For community laws and norms related to substance abuse and retail accessibility, numbers have trended down over the past years. In 2015 retail and social access, or perceived availability of drugs was 25% of 12th graders at high risk.  In 2016, when both school districts participated in the INYS, that  number dropped to 22.2%. However, in 2018, the number rose to 31.6% of Scott County 12th graders being at high risk, flagging the Determinant Workgroup to again focus on this risk factor. Community rewards for prosocial involvement continue to show a high need to increase supports. In 2016, 66.1% of Scott County 10th graders had low protection. In 2018, the number remains the same at 66.7%. We will also continue to target the risk factor for understanding the dangers of substance abuse.  From 2016 to 2018, the number of 12th graders at high risk decreased from 61.1% to 58.6%. However, we would like to see more of an increase among our students. This is why our goal is to add more universal and indicated prevention programs in our high schools, along with maintaining the prevention programming in the middle schools funded through our local Community Foundation. 

Sub-populations/Diverse populations

Children of Incarcerated Parents

Scott County’s CHINS ranking, as stated above is the highest in the state. We know from our CASA program that most of these children have parents struggling with substance abuse disorder. Further, a high percentage of the parents are incarcerated. Our county jail is full to overflowing. According to law enforcement, most of those in jail are there because of consequences directly related to substance abuse disorder. According to the Annie E. Casey Foundation, “Incarceration breaks up families, the building blocks of our communities and nation,” the AECF report states. “It creates an unstable environment for kids that can have lasting effects on their development and well-being.” The effects of parental incarceration are so strong, the report points out, that they equal abuse, domestic violence, or divorce in terms of the impact on children. Many of Scott County’s children end up living with relative placements, or in alternative placements such as foster care further disrupting the family and causing greater instability. We intend to reach out to this population through the referral of guidance counselors at school and with our mental health partners. 

Low Socio-economic status

Scott County has long struggled with high rates of poverty and all the subsequent cultural problems that often accompany poverty-stricken areas. From the statistics above, it is clear we continue to struggle with poverty. People from low socioeconomic backgrounds are much more likely to develop substance use disorders and/or suffer from mental health disorders. Brittany Combs, Scott County Public Health Nurse, said the reason these two groups suffer health disparities is because of the “burden of disease.” The poverty they experience means they often do not have access to nutritious food at reasonable costs near their homes. In the city of Austin, Indiana, there is no grocery store only the three convenience store/gas stations within the community. The nearest grocery store is five miles which is a difficult distance for those that have no or limited transportation. Additionally, people in poverty are unable to access health care because of lack of knowledge or understanding of the health care system. Limited transportation resources is an additional barrier to accessing the healthcare system. Taking care of one’s health for the future is not something people in poverty generally consider. People in poverty are more concerned with daily survival. People in poverty are not afforded the luxury of being able to “plan for the future.” They live in the tyranny of the moment just trying to survive from day to day.

LGBTQ population

LGBTQ populations – According to “True Colors United”, 40% of homeless youth identify as LGBTQ, and up to 7% of the general youth population identify as LGBTQ.  In Scott County, we have no known measurement of the number of youth who identify as LGBTQ. However, the Scott County Partnership conducts a weekly support/mentoring group in both high schools called Conquer the CHAOS. Both of these groups average 10-12 students in each group. Nearly half of the participants have stated their struggle identifying as LGBTQ. In our small, rural, very Bible-based community, it is difficult for these students to receive the supports they need. We are identifying this health disparate population as one we wish to continue to support through intensive small group mentoring efforts such as Conquer the CHAOS. We know that students who struggle with this identity are also more likely to develop substance abuse issues, depression, and/or mental health problems. 

Cultural Adjustments Needed

Scott County, located in the farthest southeastern part of the state, is often viewed as an extension of Appalachia. If one reviews the obituaries in the weekly newspaper, especially those from Austin, Indiana were born in Eastern Kentucky. Many of the targeted population migrated to Scott County from Eastern Kentucky in the early 1900s to work in local factories. They maintain strong roots to Appalachia and in many ways have perpetuated cultural norms that are “frozen in time” as they have created an isolated community. The kinds of social problems we experience are much the same as the social problems of Appalachia. The times we are most successful in any type of social engagement is when we recognize and make adjustments for the Appalachian culture and heritage in our community. Whatever we do, we must make the needed changes that will most effectively reach our audience to produce the results we seek.