Sub­stance abuse, men­tal ill­ness add to Ok­la­homa’s fos­ter care chal­lenges

The Oklahoman (Sunday) - - FRONT PAGE - BY RANDY EL­LIS Staff Writer rel­lis@ok­la­homan.com

Ok­la­homa has been plagued for years by high rates of abuse and ne­glect of chil­dren — sta­tis­tics driven in large mea­sure by the state’s high level of metham­phetamine ad­dic­tion, of­fi­cials say.

Opi­oid ad­dic­tion has added to that cri­sis in re­cent years.

Now state child wel­fare and sub­stance abuse ex­perts are won­der­ing what im­pact the state vote to ap­prove med­i­cal mar­i­juana will have on Ok­la­homa’s fos­ter care sys­tem.

“I have no way of know­ing or spec­u­lat­ing how many more peo­ple might be us­ing mar­i­juana be­cause this statute passed, ver­sus peo­ple who are al­ready us­ing it any­way,” said Ed Lake, di­rec­tor of the Ok­la­homa Depart­ment of Hu­man Ser­vices.

One thing Ok­la­homa’s child wel­fare ex­perts do know is that drug abuse has his­tor­i­cally been a huge prob­lem in Ok­la­homa and it has had a dra­matic im­pact on the state’s fos­ter care sys­tem.

Ten out of ev­ery 1,000 Ok­la­homa chil­dren were in fos­ter care in 2016, the most re­cent year for which fed­eral sta­tis­tics are avail­able. That rate was tied with Kansas and Ari­zona and was higher than all but five other states — Ver­mont, In­di­ana, Alaska, Mon­tana and West Vir­ginia.

Ok­la­homa child wel­fare work­ers con­firmed 15,289 cases of abuse and ne­glect in fis­cal year 2017 alone.

When they looked into the abuse cases, they found sub­stance abuse was a con­tribut­ing fac­tor im­pact­ing the safety of the child more than 82 per­cent of the time.

Metham­phetamine abuse was the big­gest cul­prit, iden­ti­fied as the drug in­volved in a lit­tle over 40 per­cent of cases where sub­stance abuse was sub­stan­ti­ated last fis­cal year, Lake said.

“Mar­i­juana was about 26 per­cent, al­co­hol a lit­tle over 10 per­cent,” he said.

“The con­cern there is, gen­er­ally speak­ing, the use of metham­phetamine is go­ing to be more danger­ous to the child, pose more po­ten­tial risk,” Lake said. “Be­cause of the im­pact on the per­son and their abil­ity to func­tion — much less as a par­ent — is much more im­paired, I think, with meth abuse than it would be with mar­i­juana.”

Opi­oid ad­dic­tion

Opi­oid ad­dic­tion has joined metham­phetamine ad­dic­tion as a sig­nif­i­cant threat to fam­i­lies in re­cent years, “es­pe­cially in terms of ne­glect,” said Carrie Slat­ton-Hodges, deputy com­mis­sioner of the Ok­la­homa Depart­ment of Men­tal Health and Sub­stance Abuse Ser­vices.

“When some­body is abus­ing an opi­ate, their abil­ity to care for a child goes way down,” Slat­tonHodges said. “Now that’s un­treated sub­stance abuse. If we can get a per­son into treat­ment, that makes a big dif­fer­ence.”

The state has made progress in that area, she said.

“We have a num­ber of lo­ca­tions where women can go to treat­ment with their chil­dren and that’s re­ally, re­ally great,” she said. “DHS tries to work with us on that. If they’ve got some­body who is will­ing to ac­tively go into treat­ment with their child, then that can be a real de­ter­rent to re­moval be­cause they know ev­ery­body is go­ing to be safe­and mom’s on the path to re­cov­ery.”

The state of­fers var­i­ous lev­els of out­pa­tient and res­i­den­tial treat­ment care, although there is a need for more res­i­den­tial treat­ment beds.

Treat­ment needed

“On any given day, we have be­tween 500 and 600 peo­ple wait­ing for a res­i­den­tial treat­ment bed,” she said.

Treat­ment beds for men are par­tic­u­larly hard to find.

“The in­vest­ment that has been made over the past 10 to 12 years has been on the women’s side,” she said. “We do bet­ter at getting you a bed if you’re a fe­male . ... If you’re a male and are need­ing res­i­den­tial sub­stance abuse treat­ment, you’re pretty much not go­ing to get that level of care.”

In­stead, out­pa­tient ser­vices are likely to be of­fered, she said.

“That’s ei­ther go­ing to be suc­cess­ful, or chances are you are no longer mo­ti­vated for re­cov­ery by the time a bed is go­ing to come open for you,” she said. “So, it’s very, very chal­leng­ing. And the frus­trat­ing thing is those in­di­vid­u­als are likely to end up in prison, and we could have di­verted them and helped them have a bet­ter life.”

Slat­ton-Hodges said it is im­por­tant to as­sess clients for men­tal health as well as sub­stance abuse is­sues when they first seek help, be­cause the two prob­lems are fre­quently linked.

“If you’re go­ing to treat some­body for their ad­dic­tion is­sues, but not en­sure there’s not a co-oc­cur­ring men­tal ill­ness go­ing along

with it, then you could be set­ting some­one up for fail­ure,” she said. “We want to make sure we as­sess that and treat for both so peo­ple can have the best pos­si­ble out­come.”

Men­tal ill­ness

“At least 50 per­cent of the per­sons in our sys­tem have co-oc­cur­ring — both men­tal ill­ness and ad­dic­tion is­sues,” she said.

As state child wel­fare work­ers con­tinue to deal with the metham­phetamine, opi­oid and men­tal ill­ness is­sues that have made their jobs more dif­fi­cult for years, they now also won­der how med­i­cal mar­i­juana may change things.

Lake said DHS of­fi­cials are scur­ry­ing to check with other states that have med­i­cal mar­i­juana laws to see how they han­dled it and the im­pact it had on their fos­ter care sys­tems.

It’s dif­fi­cult to pre­dict, how­ever, be­cause each state’s laws are a lit­tle dif­fer­ent.

For ex­am­ple, it’s pos­si­ble that med­i­cal mar­i­juana that has a low THC com­po­nent might have lit­tle im­pact at all, while recre­ational mar­i­juana could have a greater im­pact, he said.

So far, DHS of­fi­cials haven’t made any rec­om­men­da­tions to the state Health Depart­ment re­gard­ing rec­om­mended med­i­cal mar­i­juana reg­u­la­tions, he said.

“What we don’t need is more sub­stance abuse and se­vere im­pacts on parental func­tion­ing,” Lake said. “That’s the last thing we need or Ok­la­homa needs.”

If you’re go­ing to treat some­body for their ad­dic­tion is­sues, but not en­sure there’s not a co-oc­cur­ring men­tal ill­ness go­ing along with it, then you could be set­ting some­one up for fail­ure. We want to make sure we as­sess that and treat for both so peo­ple can have the best pos­si­ble out­come.” Carrie Slat­ton-Hodges, deputy com­mis­sioner of the Ok­la­homa Depart­ment of Men­tal Health and Sub­stance Abuse Ser­vices

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