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Foster Care Is Straining Under the Opioid Crisis and Other Drug Abuse
By ALLEGRA ABRAMO|April 9, 2018
States hard-hit by the opioid crisis face severe shortages of foster homes.
Michał Parzuchowski Unsplash
Quick Takeaway
  • A 10 percent rise in a county's overdose death rate correlates with a 4.4 percent increase in the rate at which its children enter foster care
  • In New Hampshire, the number of children in foster care has doubled since 2015, with substance abuse a factor in two-thirds of new placements.
  • Children have been warehoused in hotels, motels, and state office buildings.

A federal study published last month corroborates what voices on the ground have been reporting for some time.

“Increased levels of substance abuse, including but not limited to opioids, have devastated many American families, and the child welfare system has felt the effects,” concludes a report by five researchers with the Office of the Assistant Secretary for Planning and Education (ASPE) of the U.S. Department of Health and Human Services.

The study, which employed both statistical analyses and interviews with 188 child welfare professionals, found that, on average, a 10 percent increase in a county’s overdose death rate corresponded with a 4.4 percent increase in the rate at which children entered the foster care system.

Similarly, a 10 percent increase in a county’s drug-related hospitalization rate was associated with a 2.9 percent increase in new entries into the foster care system.

A second briefing paper, stemming from the same study, observed that substance abuse tended to correlate with “more complex and severe child welfare cases,” meaning, for instance, “higher degrees of child neglect” and “maltreatment.”

In such cases, caseworkers reported finding it more difficult to get parents “to comply with court orders” or to find “family to care for children because in many cases multiple members are misusing opioids.”

Though the study brings scientific rigor to the topic, the gist of its key findings were widely assumed. In states hard-hit by the opioid epidemic, children have been pouring into foster care at rates not seen in many years.

  • In West Virginia, about 80 percent of children in foster care come from homes with substance abuse, and the drug epidemic is “the driving force in [the] child welfare crisis,” the state’s Department of Health and Human Resources said in a statement in February.
  • In Ohio, a parent’s drug abuse was a factor in at least half the state’s foster placements, according to the Public Children Services Association of Ohio. In a dozen counties, parental drug abuse was involved in 75 percent or more of cases.
  • In New Hampshire, where the number of children in foster care has more than doubled since 2015, parents’ substance abuse was a risk factor for two-thirds of children who entered foster care last year.
  • Georgia’s foster care population is up 76 percent in the past five years, according to a 2017 report by the Chronicle of Social Change.
  • Kentucky has seen a 23 percent increase in the number of foster children since 2012, and 71 percent are there as a result of substance abuse, according to the same report.

For children, the result is often more instability in their already-chaotic lives. Many states face severe shortages of licensed foster homes, group homes, and programs to help parents struggling with addiction keep or regain custody of their kids. Child welfare agencies across the country have resorted to warehousing children in hotels and state offices. Oregon, for example, kept 213 children in hotels for at least one night last year, and in February settled a lawsuit brought on behalf of foster children placed in hotels and offices. A private foster care agency in Florida was recently reported to be keeping some hard-to-place youth in cars.

“Because we have had such an increase in a short time, our foster care system was not prepared,” says Angela Sausser, executive director of the Public Children Services Association of Ohio. “So our agencies are struggling every single day to find an available, appropriate home for a child.”

While children languish in hotels, the costs to taxpayers mount. After slashing child welfare budgets in the wake of the Great Recession, states are now adding back hundreds of millions of dollars to their child protection budgets. Nationwide, the opioid epidemic is costing child assistance programs $6.1 billion annually, according to a recent estimate by Altarum, a nonprofit health research and consulting firm. Costs are only expected to rise.

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“In those states that have been most affected by the opioid crisis, they are really, really struggling” to cope with the influx of children, says Sandy Santana, executive director of Children’s Rights, which has won lawsuits on behalf of foster kids in several states. “Their foster care systems are reeling.”

Statistics Likely Understate the Role of Drug Abuse

It’s often not possible to pinpoint the precise role that opioids play in rising foster care caseloads. States are not consistent in whether they track parental drug abuse as a factor in children’s removal. When they do, they don’t specifically identify whether opioids or other drugs were involved.

Still, “the correlation is definitely there,” Santana says. “When you talk to people on the ground and child welfare providers, they’ll tell you that this is a big issue and that it’s overwhelming them.”

At the same time, the key drugs involved varied geographically. “Drugs other than opioids (e.g., methamphetamine) are the primary concern in many places,” according to one of the ASPE briefing reports, whose lead author is Laura Radel. “Polysubstance abuse—use of multiple substances by the same individual,” she adds, “is a significant issue and the norm in most places studied.”

High-profile child deaths and more reporting by hospitals of newborns affected by prenatal drug exposure could also be driving more investigations by child protective services. 

Nationwide, parental drug abuse was a factor in 34 percent of child removals in 2016, up from 28.5 percent in 2012, according to figures compiled by the U.S. Department of Health and Human Services. Of the 15 reasons for removal that states can report to HHS, parental drug abuse has grown the fastest. Neglect remains the most commonly cited factor, but child welfare experts say parents’ drug use often underlies neglect, even if it isn’t always checked off in state data systems.

The true number of children entering foster care due to parental drug abuse is likely much higher than federal data suggest, child welfare agencies and advocates assert.

“Not a single state believes these data accurately reflect their experience,” asserted Nancy K. Young, executive director of the nonprofit Children and Family Futures, in written testimony before the Senate Finance Committee last year. States “tell us that these numbers greatly understate that the vast majority of cases in which a child is placed in protective custody are related to parental substance use disorders,” she wrote.

That’s the case in Ohio, which is among the states with the fastest increases in death rates from heroin and fentanyl.

There, says Angela Sausser, of the Public Children Services Association of Ohio, child protection agencies “have tried to place [children] with relatives, but struggled as they would find grandmother, grandfather, aunt, uncle, etc., were all addicted to opioids or other substances.”

The number of foster children there grew 23 percent between 2013 and 2017, and could rise another 33 percent by 2020 if the opioid epidemic continues at its current pace, according to Sausser’s association. If that happens, county child protection agencies would require an extra $220 million — a 67 percent increase over 2016 expenditures.

Ohio today has twice as many children in foster care — about 15,500 — as it has licensed foster parents, says Sausser. “What are we going to do when we have over 20,000 kids in foster care? Where are they going to go?”

Parents’ opioid addiction also appears to be linked to kids staying in foster care longer, which also adds to caseloads. “Oftentimes, we’re working very closely with the families, and we believe reunification is going to occur, and then the parent relapses,” Sausser says. Many children wind up cycling in and out of care for years, causing them further trauma and making them harder and harder to place.

Across the country, the number of children entering foster care began rising in 2012, after many years of declines. Since 2012 the total number of children in foster care has risen 10 percent, from 397,600 to 437,500 in 2016, the most current year for which we have nationwide statistics.

The 2016 number is actually lower than it was in 1999, however, at the peak of an earlier epidemic of crack cocaine and methamphetamine use. As the current opioid epidemic first began to build, total foster care numbers continued to drop. One of the ASPE briefing reports, whose lead author is Robin Ghertner, attributes that decline to “efforts across the country to reduce unnecessary foster care placements and to identify permanent placements . . . through reunification, guardianship, and adoption.”

Foster care numbers began to climb again in 2012, the report notes, at about the same time that the pace of drug overdose deaths nationally—which had been rising at about 2.7 percent per year—suddenly began accelerating.

“The opioid epidemic is serious and has had devastating effects on possibly a fourth or fifth of states,” says Dee Wilson, a former child welfare administrator and researcher in Washington who now writes about child protection issues, “but it’s not in the same league as what happened in the late 1980s and 90s.” Based on past cycles of rising and falling foster care numbers, Wilson predicts that the country is about halfway through the current epidemic.

“The Real Solutions Are at the Front End”

Leadership at the federal level offers some hope for stemming the flow of children into foster care, says Santana, of Children’s Rights. The Family First Prevention Services Act, passed in February, will allow states to spend federal child welfare dollars on preventive efforts to keep families together, such as substance abuse and mental health treatment programs.

“The real solutions are actually at the front end,” says Santana, “by wrapping mental health and drug treatment services around families with children at risk of entering the child welfare system.” The Family First Act is “a bold and needed step in that direction,” he says.

Even with more federal dollars for prevention, states will have to increase their spending to adequately care for the ongoing surge of kids entering foster care, Santana and other child advocates say. That includes hiring more case workers and expanding residential treatment options for children who have experienced extreme trauma and whose behavior prevents them from being placed in regular foster homes. But ramping up services will take time and major infusions of public dollars that not all states may be willing or able to invest.

In the longer term, states and municipalities hope that some of the hundreds of lawsuits they have filed against opioid manufacturers and distributors will result in substantial reimbursements for a multitude of epidemic-related expenditures, including child welfare services. But the cases are at an early stage, the defendants deny wrongdoing, and settlements, if any, are not imminent.

In the meantime, more and more children and their parents will be drawn into child welfare systems that were already under-resourced and functioning poorly before the opioid epidemic took hold.

Contributor Allegra Abramo can be reached at her Twitter address: @allegamo.

Filed under: Addiction/ Families