To even the most casual observer, the news media this summer gave the impression that a methamphetamine epidemic has created a child abuse problem that is overwhelming the nation’s child welfare system. Reports suggested that meth addicts are untreatable, that their children are irreparably damaged and that child-welfare agencies all over the country are being strained as never before.
“In every way, shape and form, this is the worst drug ever for child welfare,” Jay Wurscher, director of addiction services for Oregon’s child welfare agency, told The New York Times.
“We have so many in foster care, we’re running out of homes,” Joy Swing, a child protective services agent in Clermont County, Ohio, told “NBC Nightly News.”
While some child welfare agencies are struggling with growing caseloads and new challenges stemming from parental meth use, experts on meth addiction and child welfare say the recent coverage promulgated some myths: that meth-related child abuse is worse than it is, that meth addicts are harder to treat than they are, and that the nation’s child-welfare system is overwhelmed, when many agencies are coping well.
Many experts worry that the recent reporting on meth’s connection to child abuse may erode public support for drug treatment programs and family-strengthening services that can keep children out of foster care, just as hyped reporting on crack cocaine did in the 1980s and ’90s. In July, more than 90 leading physicians, scientists and treatment specialists urged that public policies on meth “be based on science, not presumption or prejudice.”
“We are concerned that policies based on false assumptions will result in punitive civil and child welfare interventions that are harmful to women, children and families, rather than in the ongoing research and improvement and provision of treatment services that are so clearly needed,” said a statement from the group, the National Advocates for Pregnant Women.
One of the signatories was Dr. Ira Chasnoff, the pediatrician who sounded the alarm in 1985 about what the media came to call “crack babies.” Chasnoff later said his research had been misinterpreted.
Meth is undeniably a nasty, dangerous drug, and a parent’s addiction can place a child in harm’s way. Some children need to go into foster care for their protection, and an upsurge in cases might overwhelm child welfare agencies in some localities. But here are some facts that got lost in the recent coverage:
• Despite claims that prenatal exposure to meth is creating a new class of disabled “meth babies,” there is little research on long-term effects, says Barry Lester, director of the Brown University Center for the Study of Children at Risk and the principal investigator for the first large-scale, long-term study of the prenatal effects of meth.
“I don’t want us to make the same mistake with meth that was made with cocaine,” he says. “We don’t know that meth-exposed babies are harmed, and if the meth effect is anything like the cocaine effect, it is mild and treatable.”
• Meth addicts are as treatable as cocaine addicts, says Richard A. Rawson, associate director of the UCLA Integrated Substance Abuse Programs. Rawson was the principal investigator for the Methamphetamine Treatment Project, the first large-scale, randomized clinical trial of eight types of behavioral therapies for meth addiction.
• Effective practice models exist for meth-related child abuse. “We know how to assess for child safety and risks, and those lessons and skills should be used with families across the spectrum of substance use, abuse and dependence,” says Nancy Young, director of Children and Family Futures in Irvine, Calif., which operates the National Center on Substance Abuse and Child Welfare for the federal government. “Those jurisdictions that have put effort into working across agency lines to address these issues seem fairly well prepared to work with families with methamphetamine use, abuse and dependence.”
• The foster care system as a whole has not been overwhelmed by meth-related admissions. Nationally, the foster care population has declined every year since 1999, when it peaked at 570,000. (In 2003, the latest year for which national data are available, it was 523,000.)
Without recent national data, it’s too soon to know whether increases reported by some jurisdictions are localized aberrations or predictors of more widespread increases to come. Tellingly, in California and Illinois, among the few states to report statistics for 2004 and early 2005, the foster care populations have continued to decline, despite entrenched meth problems in those states.
• Meth is not even close to being the most abused drug. Nationally, meth was the drug of choice for only 7 percent of people who sought treatment in 2003, according to a federal database published by the U.S. Substance Abuse and Mental Health Services Administration.
Alcohol abuse accounted for almost 42 percent of treatment admissions, opiates for almost 18 percent, marijuana for almost 16 percent and cocaine for almost 14 percent.
Behind the Scare
Many of the summer’s meth stories were pegged to the release in July of surveys of county law enforcement and child welfare officials that were commissioned by the National Association of Counties (NACo). “Many children are being grossly neglected by their addicted parents, and these same children are being exposed to the harmful side effects of the production of the drug, if they live in close proximity to a lab,” the association said in a report on the surveys.
Most media accounts adopted NACo’s alarmist tone, reporting that 40 percent of child welfare officials claimed an increase in meth-related out-of-home placements in the past year. But that also means that 60 percent reported no increase.
News outlets also commonly reported that 71 percent of the responding counties in California claimed an increase in meth-related out-of-home placements, but didn’t note that only seven of California’s 58 counties were surveyed.
The survey seemed designed to provide context for the announcement several weeks later by NACo’s new president, Bill Hansell of Umatilla County, Ore., that one of his three initiatives would be to gain more federal funding for counties’ meth-fighting efforts. The association backs four meth-related bills pending in Congress.
Also in July, Valerie Brown, a county supervisor from Sonoma County, Calif., testified before Congress that the Bush administration’s proposal to eliminate $804 million from the Justice Assistance Grant Program would jeopardize counties’ meth enforcement, treatment and prevention efforts. She also expressed the association’s opposition to the administration’s proposal to transform foster care from open-ended entitlement to a capped allocation.
“If the counties that are experiencing an increase in foster care caseloads because of methamphetamine use had been operating under a capped allocation, they would not have had the resources to respond quickly,” she testified before the House subcommittee on criminal justice, drug policy, and human resources.
Richard Wexler, executive director of the National Coalition for Child Protection Reform in Alexandria, Va., believes that fear of losing the foster care entitlement underlies much of the hyperbole about meth. “That’s a huge threat to child welfare agencies that exist on endless per-diem payments for endless foster care,” says Wexler, who advocates for more family preservation efforts and less use of foster care.
Michael Arsham, executive director of the Child Welfare Organizing Project in New York City, agrees. Annual admissions to foster care in New York City have fallen by one-third since 2000. Nevertheless, Arsham says, private foster care agencies are pressing the city’s child welfare agency to maintain foster care slots in case there’s an upsurge in parental meth use.
“If they are concerned about the well-being of children, the questions they should be asking are whether there are effective treatment models that have been developed elsewhere in the country, or whether we should be looking more at kinship and guardian arrangements, “ says Arsham, whose project is a partnership of parents and professionals dedicated to child welfare reform.
Some Areas Hit Hard
To be sure, some child welfare agencies have good reason to be alarmed by meth.
Although meth abuse has been a problem in the West for years, it is spreading to other regions, creating challenges for child welfare systems whose experience with substance abuse has been limited largely to marijuana and alcohol. Even a small upsurge in meth-related child abuse can have a disproportionately large impact in rural areas and small towns, where substance treatment programs, social service providers and foster homes are scarce or stretched thin.
“We find that workers leave the agency because of personal risks, the nature of these cases and the challenges of working with these families,” Freida Baker, deputy director of Alabama Family and Children’s Services, said at the House subcommittee hearing in July. “We find that an already strained child welfare work force of young, inexperienced staff is further burdened with the complex dynamics of crystal meth.”
In Vigo County, Ind., which includes Terre Haute, a child-welfare official told the Louisville Courier-Journal this summer that about 70 percent of children entering foster care had parents who abused meth. In Oklahoma, state officials say meth is a major reason that the foster care population is up 16 percent from a year ago. Even in relatively resource-rich Tulsa, The New York Times reported in July that siblings in child protection cases were forced to share beds in an emergency shelter because meth cases had pushed the shelter’s population to double its licensed capacity.
Probably the major reason for the alarm over meth is that it can be produced in home kitchens, which may expose children – and abuse and neglect investigators – to toxic chemicals and the risk of burns. From 2000 to 2003, the U.S. Drug Enforcement Administration (DEA) says, eight children died and 96 were injured through home meth production.
Because of the special dangers that meth production poses both to children and first responders such as police and child abuse investigators, the White House Office of National Drug Control Policy has pressed states and counties to establish multidisciplinary Drug Endangered Children (DEC) teams. So far, 25 states or regions have established teams, and 5,500 professionals from law enforcement, child protection, public health and other public agencies have been trained, the drug control office says.
“Collaboration is the key to success,” says Ronald Mullins, training coordinator for the San Diego-based National Alliance for Drug-Endangered Children. “If you develop standardized protocols and make those agreements in your community, the children get the medical attention they need, the psychosocial attention they need and the placement they need.”
The alliance’s protocols allow only specially trained law-enforcement officials to enter homes where meth is produced. Children must be washed at the site and immediately taken for medical examinations, including tests for exposure to chemicals.
Although the alliance’s focus is on children threatened by meth production, the numbers are fairly low. Young, of the National Center on Substance Abuse and Child Welfare, says federal data show that from 2000 through 2003, about 10,000 children were “affected” by meth manufacturing, including 4,662 who lived in homes where meth was produced. Some 2,881 of them entered foster care, Young says – less than one-third of 1 percent of all the children who entered foster care during that same period.
Learning from Others
Rather than feeling overwhelmed, experts say, child welfare agencies that are experiencing increases in meth-related child abuse and neglect can find guidance from jurisdictions with experience.
Many social service agencies in California have been dealing with meth-related abuse or neglect since the early 1990s and have learned how to intervene effectively. “Addiction is addiction,” says Toni Moore, administrator of the Alcohol and Drug Services Division for Sacramento County, where more than half of those who enter treatment cite meth as their drug of choice. “Although there may be some difference in how you approach someone who uses meth and someone who uses cocaine, the basic problem is addiction.”
UCLA researchers have found that traditional 12-step programs are not as effective with meth users as with marijuana and alcohol abusers, which means that treatment professionals may need additional training. Research has shown that meth abusers respond similarly to behavioral and cognitive-behavioral treatment strategies that work with cocaine abusers, says Rawson of UCLA.
The National Center on Substance Abuse and Child Welfare provides technical assistance to states and counties that are struggling with meth-related child abuse. Young, the center’s director, says the most effective strategies include stationing staff with substance abuse expertise in child welfare offices and courts; giving parents who face abuse charges priority for treatment; using facilitators to help parents access treatment, and setting up a dependency drug court to monitor parents’ compliance with treatment plans.
Because most mothers entering substance abuse treatment have experienced domestic violence and abuse or neglect as children, Young says, it’s important that they also get help for those problems. In addition, she notes, “We learned during the cocaine epidemic that mothers in treatment with all of their children had the best outcomes.”
The crack cocaine epidemic of the 1980s and early ’90s produced lessons that many experts say are highly relevant today. Research has found that most problems that had initially been attributed to prenatal exposure to crack resulted from poverty, that a childhood spent in foster care can be more harmful than the parental behavior that prompted the child’s removal, and that prenatally exposed infants who stay with their mothers achieve developmental milestones earlier than those who go into foster care.
Says Lester, the Brown University researcher: “If we overreact to meth, the effect will be, as with cocaine, flooding an already overburdened foster care system, breaking up families and having kids bouncing around from foster home to foster home during the first few years, when they need to develop strong attachment relationships. These children may wind up with behavior problems, not because of the drugs, but because they were improperly socialized.
“We need to move toward more of an understanding of drug abuse as a treatable mental health disease, not a crime against the child or society.”
Martha Shirk, based in Palo Alto, Calif., is an author and freelance journalist specializing in child and family issues. firstname.lastname@example.org.
A Model for Helping the Children of Drug Abusers
In Sacramento County, Calif., about 80 percent of child abuse cases involve parents with alcohol or drug problems, and more than half of these parents cite meth as their drug of choice. Nevertheless, child welfare workers there have trouble understanding why media reports say meth has paralyzed the nation’s child welfare system.
“We’ve got big meth issues in Sacramento County, but they’re not paralyzing anybody,” says Martha Haas, a program planner who has also worked as an investigator, intake worker and supervisor during 10 years with the county’s Child Protective Services division.
Sacramento County (population: 1.3 million) has been widely lauded for developing effective interventions for families in which parents abuse drugs and abuse or neglect their children. The National Center on Addiction and Substance Abuse, the federal Treatment Improvement Exchange, the Child Welfare League of America and the National Center on Substance Abuse and Child Welfare have all cited the county for implementing systems changes that have increased parents’ access to treatment and decreased children’s stays in foster care.
Here are the key elements to Sacramento’s success:
More training, treatment: Meth abuse, along with alcohol and cocaine abuse, was already a big problem in 1994, when the county got a two-year, $200,000 grant from the Annie E. Casey Foundation to better serve children who were being abused or neglected by parents with drug or alcohol problems.
“We realized that alcohol and drug use were a major driving factor for many of our health and social problems, and we wanted to increase the likelihood that people who were abusing drugs and alcohol would get treatment,” says Toni Moore, who served as project director for the Alcohol and Other Drug Treatment Initiative.
The initiative began by providing intensive training in alcohol and substance abuse assessment to child welfare workers, public health nurses and community service providers. Some 7,000 have been trained so far. Then the county gave treatment priority to parents with substance abuse problems who were involved with child protective services.
“If you don’t have an organized system where you give some sort of priority to specific groups, it’s typically going to be the most motivated client who gets in, or the one who knocks the loudest, and that may not be the one who needs it the most,” explains Moore, administrator of the county’s Alcohol and Drug Services Division.
Through a creative melding of funds from about a dozen federal and state programs, the county came up with $32 million a year for treatment.
Remove barriers: The county also added three early intervention specialists to make sure logistical problems don’t keep parents from accessing treatment. Two of them work in the courthouse. “When families come into the system, the service comes to them,” Moore says. “That immediate linkage happens.”
Monitor progress: To help keep parents on track, the county got money from the state’s tobacco litigation settlement to fund STARS (Specialized Treatment and Recovery Services), which deploys recovery specialists – some of them recovered drug abusers – to monitor and support parents in treatment. “I’m convinced that it’s those relationships that families build with STARS workers that are crucial to success,” says Haas of Child Protective Services. “When parents are in crisis, it’s the STARS worker who responds and motivates them.”
Special court: In 2001, the county added the final element of its cross-agency approach: a dependency drug court, which monitors the treatment progress of substance-abusing parents accused of abuse or neglect. Parents must appear there every month for at least three months to report on their treatment progress. In many other jurisdictions, they would be lucky to reach the top of a waiting list for treatment in that amount of time.
“These hearings are something between a revival and an Alcoholics Anonymous meeting,” says Laurie Slothower, a spokeswoman for the Sacramento County Department of Health and Human Services. “People show up in their best suits, and they’re crying and thanking their CPS worker and their case manager. The judge tells them what a good job they’re doing and gives them these little rocks that say ‘Hope’ or ‘Faith.’ Coming from a judge, that carries a lot of weight.”
Results: Sacramento’s approach is being evaluated by researchers at Children and Family Futures, a nonprofit policy research firm in Irvine, Calif. So far, the evaluation has found that 86 percent of parents referred to Dependency Drug Court entered treatment, compared with about half of a comparison group. Of those who entered treatment, two-thirds completed it. On average, their children spent far less time in out-of-home care than the comparison group.
Besides reunifying families more quickly, the evaluation found, the strategy saved the county nearly $3 million in out-of-home care costs over two years.
“Our approach has made a difference in our families,” Haas says. “I’m hoping that in a few more years, we’ll see more families getting hooked up with services in their neighborhoods before their kids need to come into care.”
Nancy Young, Director
Children and Family Futures
Richard A. Rawson, Associate Director
UCLA Integrated Substance Abuse Programs
(310) 445-0874, ext. 311
Barry Lester, Director
Brown University Center for the Study of Children at Risk
(401) 453-7640, Barry_Lester@Brown.edu
Toni Moore, Administrator
Alcohol and Drug Services Division
Sacramento County Department of Health and Human Services
Informational website sponsored by federal agencies.