Is U.S. Opioid Crisis Straining State Child Welfare Systems?

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Time is running out for the U.S. Senate to pass a bipartisan bill that could spare children the trauma of being removed from their homes because of parental substance abuse. In an editorial Sept. 5 in The Washington Post, the sponsors of the Family First Prevention Services Act argued for a different, “better” approach that would keep families together while parents with a drug problem undergo treatment. The legislation comes as some state officials point to soaring prescription opioids and heroin abuse as a contributor to their increasing foster care caseloads.

Overdoses up, along with child removals

In 2012, more than 2.1 million adults in the nation were abusing prescription opioid painkillers, according to the National Institute on Drug Abuse, and an estimated 467,000 were addicted to heroin. The epidemic’s toll is rising: Overdose deaths involving prescription opioids have quadrupled since 1999, according to the Centers for Disease Control and Prevention.

While this opioid crisis rages, the number of children in foster care has increased to more than 415,000 nationwide, the highest number since 2009, according to the national Adoption and Foster Care Analysis and Reporting System (AFCARS). Parental substance abuse was cited as a reason for removal in about one-third of all cases. Is this more than a coincidence?

Child welfare and drug abuse officials are cautious, for now, about drawing a definitive link between the two trends. “Both things are true, that we are seeing a spike in opioid use disorders and we’re seeing an increase in foster care placements,” said Sharon Amatetti, MPH, a chief at the Center for Substance Abuse Treatment at SAMHSA, the Substance Abuse and Mental Health Services Administration. “But we can’t say that one is directly causing the other. We don’t have the data for that.”

At least, there’s no solid national data linking opioid abuse with increased child removals. “It is anecdotal,” said Rricha Mathur, a senior policy advisor for child welfare and child rights at First Focus, an advocacy organization in Washington, D.C. “There is some city-level data and state-level data, but there isn’t really a comprehensive national look yet at the opioid numbers.”

That’s partly because the severity of the opioid crisis has only recently shown up as dysfunction within families. Opioid abuse is also more difficult to document, said Mathur, since it often begins with legal prescription medications. “There hasn’t been good incentives or funding for this level of data collection,” she said.

Moreover, national data linking the opioid epidemic to rising child removals is hard to come by because of the way child welfare agencies record foster care referrals. “There is great variation among states in the way cases are classified,” said SAMHSA’s Amatetti. “A case might be recorded as abuse or neglect but they don’t dive deeper, they might not actually check the box or make a notation that says it’s substance use related, or they might not even know [it is related] when they first open the case.”

Opioids just one factor in growing caseloads

Los Angeles County, home to the nation’s largest child welfare agency, is a good example. Foster care referrals don’t specify whether opioid abuse is a factor in opening a case, said Laura Luna, a supervising children’s social worker for the Department of Children & Family Services.

“Our referrals, when they’re generated for any kind of substance abuse, are just categorized under general neglect.” At a later date, after child welfare workers have investigated a family’s plight, they might document a child’s drug exposure as a reason for a removal. However, “that’s not information that is easily retrieved through our database,” said Luna.

It’s the same thing at the Washington State Department of Social and Health Services, where “we don’t have a formal data collection process for substance exposure,” said media relations manager Norah West, adding, “law does not require us to.”

Even if a state’s data collection system does specify drug exposure as a factor in child removals, it’s not clear that opioids are the only culprit. Take the case of Indiana, where 6,223 children were removed from their homes due to parental substance abuse over one year ending in June — a 22 percent spike from the prior year.

James Wide, deputy communications director for the Indiana Department of Child Services, said the state added more than 300 family case managers over a two-year period to cope with the increased caseload. But Wide said, there was no one reason for the spike. “Opioid abuse is a factor, but so is cocaine, methamphetamine and mental health issues,” he said.

The takeaway for some child advocates is that the opioid crisis has grown so quickly and is now so prevalent that the metrics linking it to foster care simply haven’t caught up. But for child welfare workers in the trenches, “it’s very very clear that it’s happening,” said Adam Pertman, president of the National Center on Adoption and Permanency. “The consequences of addiction are abuse and neglect — the things the child welfare system was built to react to,” said Pertman.

States rely on a complicated mix of federal, state and local sources to fund an array of services to preserve families and protect children’s safety and well-being. It’s no surprise, said Pertman, that following years of declines in the foster care population, budgets and staff allocations in child welfare systems are now feeling the strain. “More kids are going into the system,” said Pertman. “You cannot serve more people with the same or fewer resources.”

Yet states are faced with doing just that, as overall spending on child welfare has fallen for the first time in two decades, according to a report by Child Trends, a Washington, D.C.-based nonprofit research center. It found that total child welfare expenditures from federal, state and local sources decreased by 8 percent between 2010 and 2012. Child Trends also found that federal spending on child welfare had declined to its lowest level since 1998.

With tighter budgets, child welfare agencies need to target their resources to address the specific reasons parents are struggling, said Pertman. He and other child advocates say they would welcome better data to determine what those reasons are. “Wouldn’t it be good to know more of what’s really going on?” asked SAMHSA’s Amatetti. “With better information, we can put better services in place for families and use resources more effectively,” she said.