The rapid growth in opioid use and addiction over the past several years affects many individuals and their families.  But it also has had a significant impact on systems in our communities that support our well-being – including the foster care system and its traditional focus on reunification of foster children with their parents whenever possible.            

The Center for Disease Control and Prevention (CDC) recently reported that the number of infants born with neonatal abstinence syndrome (NAS) in the U.S. rose 300% from 1999 to 2013.  (NAS is a postnatal drug withdrawal syndrome primarily caused by in-utero exposure to opioids.) At the same time, the Pew Charitable Trust reported that foster care placements increased in 2013 after having declined steadily since 2010, as a result of a greater emphasis on placing children in kinship care (with a family member) as compared to foster care outside of the natural family. In the state of Vermont, for example, foster care placements rose 33% between 2014 and 2015.

Ken Olsen, executive director of KidsPeace Maine Services, said those trends reflect that people are substituting heroin for prescription opioids, either because of cost or inability to get a doctor’s prescription. Olsen acknowledges data that shows more children being born addicted to opioids, but he believes there is more to the story.

 “Some children are born with drugs in their system, but most of the reports are based upon the neglect of the child because the parent is using drugs,” Olsen said. “Parents with opiate addiction are often younger and going through their own emotional development, and many would benefit from learning stress management techniques.” 

During incidences where children are born drug-addicted, neglected or a combination, local agencies are called on to offer support to families to assure the safety of their children, link parents to community resources and provide expectations and guidelines promoting healthy parenting.  In Carbon County, Pennsylvania, for example, Children and Youth Services Supervisor Marianne Grabaritis said drug use is affecting her agency’s effectiveness in working with families towards permanency solutions. 

“There has been an increase in foster care placement over the past two years. Heroin, methadone and suboxone (used to treat opiate addiction) are the most frequent drugs babies are born addicted to. The drug use leads to other problematic behaviors among parents, such as stealing for money to buy drugs in order to support their habit,” she added.

As of August 2016, Carbon County (population 65,000) had29 children in placement through foster care and kinship care; of those cases, eight involve drug use and all except one of those children are residing with a family member. Grabaritis added, “Children and Youth Services is not waiting as long to move children to kinship care, based upon the needs of the situation. If everyone is in agreement, we try to make that happen as soon as we can.”

Elizabeth Lunney, LSW, is Pennsylvania state manager of KidsPeace Foster Care and Community Programs, and she has seen the challenges in reunifying families amid the spike in opioid use, especially in cases of groups of younger-aged siblings. “Groups of siblings often need to be separated from each other when placed outside of the home, because it can be difficult for certain foster families to accommodate more than one child.”

“Parents are required to provide basic care for reunification to occur,” she added. “The child welfare system is encouraged to work towards reunification, but when the circumstances impact the child’s life, the permanency goal is typically changed. Most systems are sensitive towards parents working through recovery and will act in favor of the parent through using the permanency rule liberally, as long as progress can be charted. However, we have to be realistic with how many chances to give parents before the goal is changed.”

The Pew report points out that there has been progress made towards a more unified and diverse approach to tackling this issue. 

  • Ohio has a pilot program helping pregnant women with opiate addiction get proper care in the early stages of the child’s development.
  • Maine is doing targeted recruitment for foster parents trained to parent drug-affected babies and infants.
  • There are more recovery programs, such as peer specialists which offer peer-to-peer support and community-based treatment centers which focus on life wellness.
  • So-called “drug courts” allow for more regular permanency court hearings, holding them as frequently as every two weeks instead of the current three-month requirement.
  • In some locations, professional drug and alcohol counselors are accompanying Children and Youth workers on reports of abuse and neglect where drug use is reported.
  • Finally, there is more emphasis on prescribing guidelines on the federal and state levels. In August 2016, U.S. Surgeon General Vivek Murthy issued new recommendations for prescribing opioids; practitioners now are urged to assess level of pain, potential risk factors and available alternative therapies before prescribing the medications, and are encouraged to develop treatment goals that work towards discontinuing the opioid when it is no longer needed.

In September 2016 Pennsylvania Governor Tom Wolf, calling the opioid epidemic “a plague,” announced the state would open an additional 25 opioid addiction Centers of Excellence by January 2017, building off of the 20 already in place. The Centers of Excellence will assist in coordinating mental health and physical health services for those with an opioid abuse disorder – reducing wait times and making more services available for those living in rural counties where there is no public transportation system.

Lunney noted that funding streams starting from the Federal level down to counties influence decisions child welfare agencies have to make in order to continue to try to reunite families while staying within their budgets. “Visitation requirements for parents overcoming addiction are increased in order to support quicker reunification efforts, but these efforts can be costly when they involve trips where children can travel up to 50 miles in some rural counties, 2-3 times a week to see their parents in the home setting. This is taxing for a child for having to travel that much during the week, especially during the school year.”

“An influx of children into the system directly impacts the budget and puts a strain on resources available – which limits the opportunities for funding other supplemental supports (staffing/training/additional support agencies),” Lunney added.

References

Cohen, E. (2016). US surgeon general sends warning letter to all doctors on opioid epidemic. CNN. http://www.cnn.com/2016/08/25/health/us-surgeon-general-letter-doctors-opioid-use/index.html

Ko J.Y., Patrick S.W., Tong V.T., Patel R., Lind J.N., Barfield W.D. Incidence    of Neonatal Abstinence Syndrome — 28 States, 1999–2013. MMWR Morb Mortal Wkly Rep 2016;65:799–802. DOI: http://dx.doi.org/10.15585/mmwr.mm6531a2

McGuire, P. (2016). Maine has the Second-Highest of Babies Born Addicted to Opioids. Portland Press Herald.  http://www.pressherald.com/2016/08/13/state-has-second-highest-rate-of-babies-born-addicted-to-opioids/

Olds, D. (2016). Pennsylvania To Expand Opioid Treatment by 2017. The Fix. https://www.thefix.com/pennsylvania-expand-opioid-treatment

Quinton, S. (2015). How Heroin is Hitting the Foster Care System. The Pew Charitable Trust. http://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2015/10/09/how-heroin-is-hitting-the-foster-care-system

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Jared Soto

Jared Soto

Jared Soto is an outpatient therapist for adults and children at The RedCo Group in Lehighton, Pennsylvania, and previously worked for Carbon County (PA) Children and Youth Services. He holds a bachelor’s degree in psychology from Penn State and a master’s degree from Grand Canyon University.