How Substance Use Affects Child Welfare Systems

After more than a decade of sustained declines in the
national foster care caseload, the number of children
entering foster care began to rise in 2012. Between
2012 and 2016, the number of children in foster care
nationally rose by 10 percent, from 397,600 to
437,500. Although the experience of individual states
varied, more than two-thirds (36 states) experienced
caseload increases. Hardest hit have been six states
whose foster care populations rose by more than 50
percent over this four-year period[Alaska, Georgia, Indiana, Minnesota, Montana and New Hampshire].

Many in the child welfare field believe  that parental substance use-prescription drugs, alcohol, and especially opioids- has been the primary cause of the increase in foster care placements. So far, however, there is very little empirical evidence to support this view at the national level.

At face value, one can make such assumptions, but it is not usually that cut and dry. One factor in child care placements increase has to do with poverty. Poverty increase the likelihood of involvement with the child welfare system, accompanied by increased reports of maltreatment. Together, parental substance use disorders weren’t affecting foster care placement as in the methamphetamine crisis in the 90s or crack epidemic of the 80s.

When children were removed from homes, family members and community organizations shielded many children from some of the consequences of parental substance use. Grandparents topped the list of alternative placements, followed by other relatives. The foster care system was not as overloaded as today’s crisis situation. It seems that the current familial characteristics have shifted. Family members across generations are more frequently using substances themselves, leaving displaced children to the care and custody of the child welfare system.

Community institutions have been rendered less able to support families as earlier years. As opposed to the past, families are less likely to be involved in churches and communities aren’t bound together.

Additionally, drug epidemics of the past were limited in reach, and this opioid epidemic reaches across demographic groups. The greatest increases in heroin use that historically have had lower rates of heroin use- doubling among women and more than doubling among non-hispanic whites.

Although substance use is a serious problem, problems aren’t primarily an opioid crisis. Parents using substances have multiple issues. Families come with range of issues and needs. Some of these issues include domestic violence, mental illness, and long histories of traumatic experiences. Addressing substance use alone is less likely to be effective or successful in reunifying families or achieving desired outcomes.

For reunification to succeed, supportive services must address co-occurring problems to support both the parent’s
recovery and the child’s safety and well-being. These services could include, for example, family therapy, programs building parenting skills, child development services, and interventions addressing domestic violence. In addition, many community leaders and service providers view substance use, and the opioid epidemic in particular, as being rooted in diminished economic opportunities, unresolved emotional pain resulting from adverse experiences, and pervasive feelings of hopelessness from which substance use (at least initially) provides an escape.

Agencies and caseworkers are overwhelmed.
Caseworkers are overwhelmed by the volume of cases, the lack of treatment resources, and the sheer magnitude of the problem. These factors all lead to high stress, burnout, and turnover. While this consequence is not a new phenomenon in child welfare practice, community leaders see it as worse
now than in the past. Actual and threatened violence against caseworkers was also frequently cited.

There is certainly concern about coming into
contact with hazardous substances when investigating maltreatment in homes. While recruiting and retaining foster parents has always been challenging, many believe that the problem has intensified. Children are remaining in care longer, thus keeping existing foster homes full and unable to accept new placements. Children are often placed long distances from their parents, and placing large sibling groups together is difficult. Some multigenerational substance use has made it more difficult to identify viable kinship placements in their communities.

Cases involving serious substance misuse or disorders overwhelmingly require the removal of children from the home and are very likely to end in termination of parental rights. The strong inclination in many places is to remove children from the home in cases with significant parental substance use, often regardless of other factors. This view is particularly prevalent among judges, district attorneys, and court personnel, especially regarding substance-exposed newborns.

The practice of assessing substance use in child welfare cases is extremely inconsistent and in many places inadequate to successfully identify the extent of substance use. Assessment identifies the substances being used and how the use may affect the safety and well-being of children. Substance use by itself may not be a sufficient reason to remove children from the
home. However, substance use often underlies behaviors that place children at risk. Therefore, a thorough assessment of the family must be completed to determine if substance use is impairing a parent’s judgment and ability to provide a minimally safe level of care to the child. However, case plans are frequently created without solid clinical information about substance use or other important factors relevant to the family’s situation.

Child welfare agencies are not sure whether or
how to address reports of parental marijuana use. In part because of recent changes to federal child maltreatment laws that require health care providers to notify child protective services of all infants identified as affected by parental substance use, agencies are seeing families affected by substances, particularly marijuana, who in the past may not have come to an agency’s attention. Complicated is the marijuana debate since it has become legal for recreational use in many states. The reports of its use is now less frequent as its perception has been altered. Risks for maltreatment and child welfare agency involvement decrease unless marijuana use is accompanied by another substance, as well.

On the positive side, professionals across service systems widely recognize that substance use disorders are chronic diseases, not simply moral failures. Staff actively seek more and better treatment options for parents. In addition, justice system interventions such as family treatment drug courts actively engage judges and court personnel in supporting treatment, recovery, and family reunification.

While the misuse of drugs has always been part of the constellation of issues affecting parenting in families involved in the child welfare system, the current crisis has affected communities more broadly than past epidemics have. Child welfare agencies in many parts of the country are struggling to respond.

KEY TAKEAWAY:

 Caseloads: Nationally, rates of drug overdose deaths and drug-related hospitalizations have a statistical relationship with child welfare caseloads ( rates of child protective services reports, substantiated reports, and foster care placements). Generally, counties with higher overdose death and drug hospitalization rates have higher caseload rates. In addition, these substance use indicators correlate with rates of more complex and severe child welfare cases.
 Availability and use of substance use treatment: Several major challenges affect how child welfare agencies and families interact with substance use treatment options, including medication-assisted treatment for opioid use disorder. Family-friendly treatment options are limited, and caseworkers,
courts, and other providers often misunderstand how treatment works and lack guidelines on how to incorporate it into child welfare practice.
 System response: Child welfare agencies and their community partners are struggling to meet families’
needs. Haphazard substance use assessment practices, barriers to collaboration with substance use treatment providers and other stakeholders, and shortages of foster homes and trained staff undermine the effectiveness of agencies’ responses to families.