Opi­oid ad­dic­tion cri­sis over­whelms states’ foster-care sys­tems

The Washington Post Sunday - - POLITICS & THE NATION - BY PERRY STEIN AND LIND­SEY BEVER

green­bush, maine — Deb McLaugh­lin’s 3-year-old grand­son climbed all over her, plead­ing to play trucks, rest­less as al­ways. Her 1-year-old foster daugh­ter, who had just wo­ken from a mid­day nap, sat in her lap, wear­ing a frilly dress and an ir­re­sistible smile. At least McLaugh­lin doesn’t have to worry about the daily shots of methadone any­more, at least th­ese ba­bies no longer scream and shake for the opioids to which they were born ad­dicted.

This isn’t what McLaugh­lin en­vi­sioned for her empty-nest years in ru­ral Maine, trad­ing camp­ing and four-wheel­ing trips for so­cial­worker check-ins, meet­ings with be­hav­ioral ther­a­pists and su­per­vised vis­its with the drug-ad­dicted bi­o­log­i­cal par­ents who had to give up th­ese chil­dren. McLaugh­lin’s daugh­ter, who once dreamed of be­ing a lawyer, is one of the mil­lions of Amer­i­cans ad­dicted to opioids and one of thou­sands of par­ents whom state gov­ern­ments have deemed un­fit to care for their own chil­dren.

“It’s heart­break­ing to watch a baby go through with­drawal, and then give that baby back to Mom,” McLaughin said as she pre­pared snacks in her blue mo­bile home out­side Old Town, along the Penob­scot River. “Be­cause she did that to her.”

More than 1,000 chil­dren are born ad­dicted to drugs in Maine each year, many of whom end up in foster care. The two chil­dren in McLaugh­lin’s home were among the more than 1,800 in foster care across the state in 2016, a nearly 45 per­cent in­crease in foster chil­dren here since 2011.

The trend in Maine is echoed in foster-care sys­tems through­out the coun­try, es­pe­cially in ru­ral ar­eas that have been hit hard by ad­dic­tion. Many are be­com­ing over­whelmed as the opi­oid cri­sis has forced more and more chil­dren into state cus­tody.

Mas­sachusetts ex­pe­ri­enced a 19 per­cent in­crease in chil­dren in foster care be­tween 2011 and 2015. Ohio’s foster pop­u­la­tion has gone up nearly 10 per­cent, with more than 60 per­cent of chil­dren in the sys­tem be­cause of parental drug abuse. The num­ber of North Dakota chil­dren in need of foster care has gone up more than 27 per­cent.

Foster-care ex­perts say that as the drug epi­demic has in­ten­si­fied dur­ing the past two years, an­other rush of chil­dren has en­tered the sys­tem. State bud­gets are stretched, so­cial work­ers are over­loaded, and not enough fam­i­lies are will­ing to pro­vide chil­dren with tem­po­rary homes.

Amer­i­can foster care, ex­perts say, is in cri­sis.

“It’s pretty much ev­ery state — ex­cept maybe four or five — that have seen an in­crease in the num­ber of chil­dren in foster care,” said John Scia­manna, vice pres­i­dent of public pol­icy at the Child Wel­fare League of Amer­ica. “What you are see­ing now is just a strain­ing of the sys­tem.”

The wide­spread and grow­ing abuse of opioids and metham­phetamine has played a sig­nif­i­cant role in re­vers­ing what had been a pos­i­tive trend in the num­ber of chil­dren need­ing foster homes. At its mod­ern low point in 2012, 397,000 U.S. chil­dren were in foster care, ac­cord­ing to data from the U.S. Depart­ment of Health and Hu­man Ser­vices. By 2015, that num­ber had risen 8 per­cent, to 428,000, and ex­perts say the past two years — the height of the opi­oid epi­demic — has in­creased that num­ber dra­mat­i­cally, al­though con­crete data is not yet avail­able.

The progress in the early 2000s was linked to the im­ple­men­ta­tion of laws meant to pre­vent chil­dren from lan­guish­ing in foster care and pro­vid­ing fi­nan­cial sub­si­dies as in­cen­tives to adopt, Scia­manna said, in­clud­ing Pres­i­dent Bill Clin­ton’s sign­ing of the Adop­tion and Safe Fam­i­lies Act in 1999.

But as the in­crease in drug abuse af­fects many lay­ers of so­ci­ety, it also is com­pli­cat­ing the typ­i­cal path­ways to adop­tion. When chil­dren come from a vi­o­lent home, for ex­am­ple, it’s a rel­a­tively straight­for­ward de­ci­sion about whether to per­ma­nently ter­mi­nate a parent’s right to care for them. With drug ad­dic­tion, which can be a hid­den is­sue and can in­volve treat­ment, re­cov­ery and re­lapse, the de­ci­sion to take a parent’s chil­dren away can be dif­fi­cult and slow.

“You be­gin to look at all th­ese var­i­ous im­pacts across mul­ti­ple sys­tems, but I would say the child wel­fare sys­tem is re­ally the ca­nary in the coal mine of a grow­ing cri­sis that’s not go­ing to go away any­time soon,” said Wendy El­lis, a public health ex­pert at Ge­orge Wash­ing­ton Univer­sity.

Danylle Car­son, a lawyer who rep­re­sents chil­dren in foster care and who grew up in Maine state cus­tody her­self, said the ul­ti­mate goal is to re­unite foster chil­dren with their bi­o­log­i­cal par­ents. But that is of­ten a lofty — and unattain­able — goal.

She has worked with chil­dren in ru­ral Maine who were plucked from their schools and moved to a foster fam­ily hours away be­cause there were no closer op­tions. So­cial work­ers have been stay­ing with chil­dren in ho­tels overnight be­cause they can’t find a foster home. Cases have been de­layed be­cause so­cial work­ers are too over­worked to make all their re­quired vis­its.

“There are not enough case­work­ers, and there is not enough fund­ing,” Car­son said as she worked in­side a Lewis­ton court­house, ar­gu­ing that pro­pos­als to cut $140 mil­lion from the state’s Health and Hu­man Ser­vices bud­get could have ter­ri­ble ef­fects across Maine. “Th­ese are signs of a sys­tem crash­ing.”

Add to that the opi­oid prob­lem. Med­i­cal re­search, in­clud­ing a 2015 study from the Na­tional In­sti­tutes of Health, has found that chil­dren ex­posed to opi­ates dur­ing preg­nancy suf­fer from be­hav­ior and at­ten­tion prob­lems. Such chil­dren re­quire ther­apy and of­ten spe­cially li­censed and trained foster fam­i­lies, and states say they are strug­gling to re­cruit foster fam­i­lies to house them.

The lit­tle girl whom McLaughin fos­ters and hopes to adopt suf­fers from hep­ati­tis C and se­vere asthma. McLaugh­lin, who works at a ther­a­peu­tic foster cen­ter, de­scribes her grand­son — who likes morn­ing snug­gle ses­sions and gig­gles with de­light when his foster sis­ter wakes from naps — as an “adren­a­line junkie.”

In­stead of drugs, the tod­dler seeks out pain. He has a sen­sory pro­cess­ing dis­or­der, his lit­tle body cov­ered in bruises and scabs and his bed­room floor cov­ered in pad­ding be­cause, as an in­fant, he would bang his feet so hard against the floor they bled. He some­times turns vi­o­lent and is no longer in group day care be­cause he has tried to hurt his class­mates.

“It’s hard to see, es­pe­cially your grand­child,” McLaugh­lin said. “It’s hard to see him go through th­ese emo­tional melt­downs when he’s in­con­solable. I have seen my hus­band near tears be­cause his grand­son is in such an emo­tional state.”

Other foster par­ents sim­i­larly de­scribed host­ing chil­dren who had sen­sory dis­or­ders, speech de­lays, and sleep anx­i­eties that de­vel­oped while the chil­dren were liv­ing with their drug-ad­dicted par­ents.

Bette Hoxie, ex­ec­u­tive di­rec­tor of Adop­tive and Foster Fam­i­lies for Maine, said far more in­fants are en­ter­ing the foster sys­tem now, in large part be­cause of a state law that re­quires in­fants to be tested for drugs at birth if their mother is sus­pected of us­ing them while preg­nant, Hoxie said.

Hoxie’s or­ga­ni­za­tion, which has a con­tract with the state, pro­vides sup­port and train­ing to foster fam­i­lies, and they’ve had to boost their staffing to try to meet the grow­ing de­mand; she said they field about 900 calls for help each month.

Hoxie lost a son to drug ad­dic­tion two years ago, and she has fos­tered more than 100 chil­dren in her Ban­gor home, in­clud­ing a 2-year-old who lives with her now. She also is host­ing an adopted son — who is suf­fer­ing from ad­dic­tion — and his wife. They are work­ing to re­gain cus­tody of their young child.

“I don’t think there’s been a con­ver­sa­tion in the last year about foster fam­i­lies or kin­ship fam­i­lies that didn’t al­lude to sub­stance abuse,” Hoxie said.

The dra­matic in­crease in the need for foster care has states scram­bling.

Mas­sachusetts hired 15 peo­ple last year to re­cruit new foster fam­i­lies, ac­cord­ing to a spokesman from the state’s Depart­ment of Chil­dren and Fam­i­lies. Ver­mont of­fi­cials have be­gun col­lect­ing car seats for the state’s foster par­ents be­cause there are so many in­fants and tod­dlers seek­ing refuge there. Texas passed leg­is­la­tion al­low­ing re­li­gious adop­tion and foster-care agen­cies to refuse to place chil­dren in the homes of gay or trans­gen­der fam­i­lies in part to en­cour­age those or­ga­ni­za­tions to re­main in­volved in fos­ter­ing.

And Sen. Heidi Heitkamp (D-N.D.) in­tro­duced bi­par­ti­san leg­is­la­tion that would ad­dress and study the ef­fects of trauma on chil­dren in an ef­fort to pre­vent an­other gen­er­a­tion of dru­gad­dicted par­ents. The num­ber of chil­dren liv­ing in state cus­tody in North Dakota has soared be­cause of drug ad­dic­tion, a cri­sis that she said has hit their Na­tive Amer­i­can pop­u­la­tion par­tic­u­larly hard.

“When we look at peo­ple who have been trau­ma­tized as chil­dren, they have a much higher rate of ad­dic­tion as an adult,” Heitkamp said. To break the cy­cle, Heitkamp said, the na­tion must ad­dress the drug prob­lem as early in life as pos­si­ble.

Part of that so­lu­tion rests in the na­tion’s foster-care sys­tems, which are seek­ing more fam­i­lies like McLaughin’s.

McLaughin and her hus­band, a for­mer fire chief, orig­i­nally wanted to be­come foster par­ents af­ter their two daugh­ters left the house, say­ing they still had en­ergy and love to give chil­dren. They mostly took in teenagers, whose por­traits still adorn their walls. But when their daugh­ter be­came ad­dicted to opioids and other drugs, they de­cided to care for her young son.

Then Maine, des­per­ate for help with young chil­dren, asked the cou­ple whether they could care for an­other. They obliged, wel­com­ing the baby girl into their fam­ily.

“We def­i­nitely feel we are blessed. It’s hard work, it’s tir­ing work, but we feel we are blessed,” McLaughin said. “They keep us young, and we couldn’t imag­ine our lives with­out lit­tle ones run­ning around.”

TRIS­TAN SPINSKI FOR THE WASH­ING­TON POST

Deb McLaugh­lin of Green­bush, Maine, is car­ing for her grand­son, 3, and a 1-year-old foster daugh­ter. Both chil­dren were born to drug-ad­dicted par­ents who were un­able to keep them. More than 1,000 chil­dren are born ad­dicted to drugs in Maine each year.

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