The Nadeaus live on Cape Cod, which has some of the highest numbers of deaths due to opioid overdoses in Massachusetts. It's also where a growing number of schools are hiring treatment counselors to work with teachers and their students whose families are battling addiction. The counselors work at the schools but are employed by Gosnold, the largest provider of addiction services on the Cape.
In October, Congress authorized $50 million a year for the next five years to fund mental health services to help school districts treat students who have experienced trauma due to the opioid epidemic.
And an increasing number of school districts across the country are starting not only to screen and treat at-risk kids for opioid addiction, but also access mental health counseling specifically for students whose families and communities are consumed by opioid abuse.
"Schools have more kids who cannot access the learning environment," says Sharon Hoover, co-director of The National Center for School Mental Health at the University of Maryland School of Medicine. Children are "suffering from family substance abuse and schools are feeling the burden."
Hoover says bringing counselors and psychiatrists into the schools is an effective approach.
"This is considered a preferable model of care," she says. "The kids show up for treatment services because they're not relying on a family member to take them somewhere in the community."
These programs are new, but data shows that school counseling for kids at risk for substance abuse leads to less absenteeism and better school performance.
In Massachusetts, the schools using the Gosnold counselors report that their students are doing better academically and emotionally.
Sarah Nadeau says that has been the case for both Maddy and her older sister, who are leading more stable lives since they began seeing the Gosnold counselors at school every week.
"Their day runs smoother. They can get out their anxiety while they're in school instead of bottling it up, and then go back to class and continue learning," she says.
K'yan Kelly is a Gosnold counselor who works at Lawrence Middle School in Falmouth, Mass. She sees Maddy Nadeau at least once a week.
She recently increased the number of days she works at the school because she says so many children are experiencing the chaos of addiction, including the fear that their parents might not survive an overdose.
"The unknown of whether a parent will live is a certain kind of trauma," says Kelly. Also, "if you are a child who has experienced trauma, school itself can have a lot of demands."
The counselors are also there to support the teachers, who must navigate how to educate kids whose families are consumed by addiction.
"It's a lot. You're dealing with addiction, you're dealing with trauma, you're dealing with loss and that's what they're up against, a lot of these kids," says Carolyn Alves. Alves has been teaching for 17 years, most of them at Lawrence Middle School.
She has seen an increasing number of students who are living in foster care or have moved in with other family members because their parents are dead, in jail, or struggling with active addiction.
"You know that what they need is a lot bigger than what you can give to them as their teachers," she says.
Each school pays Gosnold a fee for its counselors. Private insurance covers the student's individual sessions. If insurance won't cover the therapy, Gosnold will absorb the cost. Last year, 17 schools on Cape Cod used Gosnold counselors, this year there are more than 50 schools offering these services to students throughout Massachusetts.
"I wish that more schools offered it because the epidemic is everywhere," says Sarah Nadeau. "For a lot of these kids, school is the only place that is stable. They get their lunch here, they get their education here, so why not give them their support while they're here at the school?"