Opioid use increasing number of foster children around US
Public health officials say America is living through the worst drug crisis in its history — and children across the country suffer the repercussions
By Amanda Williamson
The Florida Times-Union
JACKSONVILLE, Fla. — The blond toddler pounced from the floor without warning and reached for a toy deep within Savannah Wood’s entertainment center.
She remained on the plush, beige carpet, her eyes following the toddler through the room. In attempt to rein in the child’s energy, Wood called him back to her side and asked him to name a smiling woman in the picture she held.
“Momma,” the two-year-old said. The photograph captured Wood and her wife, Carly.
“In class, they teach you to let the child call you whatever they feel comfortable with,” Wood said. “It may be upsetting for the biological parent, but the child has already been through so much.”
The boy, who she was fostering until he could be reunited with his parents, showed no delayed development, no abnormal behavior, and no signs of opioid addiction.
For Wood, it isn’t always like that.
At least one of the children she and her wife fostered over the last year arrived to their Northwest Jacksonville home dependent on opioids, medicine intended to relieve pain but instead was a remedy that hurled the nation into crisis.
Opioids killed more than 33,000 people last year — and tens of thousands more lived daily with the physical and mental side effects of opioid addiction. Communities now battle with an increased number of addicts, a lack of resources to treat them and the casualties associated with both.
Public health officials say America is living through the worst drug crisis in its history — and children across the country suffer the repercussions.
More than ever, substance abuse is the driving factor behind the removal of children from Duval County homes by the Florida Department of Children and Families.
According to the department, 62 percent of the removals so far in 2017 came about as a result of substance abuse — a percentage that, only four years ago, sat at 36 percent. As the numbers increase, the burden placed on foster homes sees a parallel increase.
“If the epidemic keeps growing and more kids come into care and we can’t recruit enough foster homes to handle that, then those kids will have to go into group care,” said Family Support Services Chief Financial Officer Bob Miller. “That’s the danger. If this epidemic continues, it will outstrip our capacity to take care of the kids.”
In Florida, some counties already lack enough families to meet the need.
In Duval County, the situation remains under control at the moment, but Miller attributes that success to the organization’s proactive approach.
Family Support Services of North Florida is the lead agency for foster care, adoption and family preservation in Duval and Nassau counties.
Just last year, it launched a campaign to recruit more foster families and attracted 75 new foster parents. This year, they are doing the campaign again. They also established a post-reunification unit to continue in-home help after the child returns to his or her parents. The organization works each year to spend a large chunk of the budget on prevention services.
The baby’s curdling screams startled Wood the first night the infant spent at her house.
Foster care officials didn’t tell her much about the child — and even less about her medical history. But, the symptoms seemed familiar, something she’d read about or heard of before.
High-pitched screams, tense muscles, feeding struggles — Wood knew exactly what she was seeing, even though her own child never displayed such behavior. She turned to the internet to confirm: opioid withdrawal.
Sure enough, when the child’s court documents arrived, it was outlined within the official texts. The child spent over a month in the neonatal intensive care unit for opioid dependency, and now, Wood would take over.
“You can’t protect them from that,” she said. “I feel for the parents. It’s not that they are choosing the drugs over their children. It’s that they have a disease.”
More than three out of five overdose deaths now involve an opioid, according to the Centers for Disease Control. The epidemic touches every state in the country and shows no discrimination. Deaths, the CDC reports, are up among men and women, of all ages and all races.
Last year, in Jacksonville, the fire and rescue department responded to 3,411 overdose calls, more than triple the number from 2014. On top of that, opioids accounted for 544 deaths. Even though opioid prescriptions are down in the state of Florida, those found illegally on the streets are more often than not being sliced with dangerous additives, like fentanyl, Miller said.
“Once people get hooked on it, they will do anything to keep from having to go through the withdrawal,” he added. “When they get to that point where they don’t value anything other than the drug, it just rips families apart. You can take away their children — and that still doesn’t get their attention.”
That’s where Family Support Services (FSS) steps in. The Florida Department of Children and Families investigate possible instances of child abuse or neglect, and then refer to FSS on an as-needed basis for fostering and adoption.
Recently, the foster-care organization has been getting more and more business.
This year, as of June 30, 217 children have been removed from Duval County families due to drug or alcohol-related issues. In all 2016, 363 children were removed for substance abuse and a total of 658 children were removed.
In 2013, when DCF first created a database on substance abuse removals, those numbers sat at 198 removals due to substances. That was only 36 percent of the 550 children removed from their families.
Christine Cauffield, executive director of LSF Health Systems, said she believes the almost 30 percent increase can be attributed to the opioids. “Parents are dying,” she said. “They are overdosing or children are finding their parents unconscious with needles in their arm. Even if the parents are revived, there’s usually removal.”
The average length of time a child must stay away from his or her home now exceeds its historical average, Miller said. After children enter the foster care system, they get placed with a relative, a foster care family or a state residential agency.
A 12-month time frame then begins.
“The clock starts ticking,” Miller said. “Lots of times, even though we try to keep them bonded to the child, these parents say, ‘Oh, this is great. Now I don’t need to pay attention to anybody. I can just go on my merry drug way.’ ”
FSS provides parents with a case plan and services in hopes they will change any behavior that contributed to a child’s removal.
“If you look at classic addiction treatment, they don’t treat people until they are ready to be treated,” Miller said. “Then, eight months goes by, nine months goes by, 10 months, and they haven’t even engaged in trying to get their children back. They are still using. That’s why these drugs being so powerful compound the issue.”
It stretches the whole process out, he added.
If parents don’t actively engage in recovery, the child can stay in a foster home until a court determines the child should leave. That can mean the termination of parental rights, Miller said. If a parent decides to pursue treatment, the process starts anew.
“At Family Support Services, we have this belief: Every child that can safely remain in their home should do so,” Miller said. “As good as foster parents are, and they are fantastic about taking kids in and loving them, in order to cure trauma, those kids need a forever bond.”
Impact on county, children
As Duval County fire and rescue units stock medication to counteract overdoses, as morgues overflow with the opioid casualties, children of drug users watch these scenarios unfold.
Often, women who engage in high-risk behaviors such as opioid use have a higher chance of becoming pregnant, experts say. As their child ages, if he or she isn’t removed, then the child must deal with an addicted parent.
A large portion of the children pulled from home dues to substance abuse are under 5 years old.
“Those children are the most vulnerable. They are non-verbal. They can’t care for themselves,” Miller said. “So, if the mother is using, you have no idea how to make that child safe. Say the mother passes out. If she is passed out for long periods of time, no one is taking care of the child.”
Evidence shows parents — at a much higher rate — are using drugs around their children. It could be at home or in a vehicle or at a friend’s house. Regardless, if the parent dies or becomes unconscious, no one is around to care for the child.
Placing those in the under 5 group tends to be easier for FSS than placing teens.
“By the time a child enters the foster-care system, they’ve already seen an great amount of trauma,” said Angela Mann, a professor in child psychology. “Not only are we going to see an increase in the number of children coming into the foster care, which will strain the system, but they are also coming with quite a bit of need.”
That creates a generation of children who will be at risk for mental-health issues, behavioral issues and even physical health concerns.
What happens, Mann asked, when the children go to school? They might have trouble controlling their behavior. They might fall behind. They will struggle to make friends, to stay motivated.
“To think about those numbers growing, it is unclear to me how we are going to meet the need,” Mann said.
For many, treatment may ultimately be found only in prison, she added. When mental health issues are not addressed, the cycle starts again.
Miller agreed. When something happens to a young girl or boy that isn’t treated, they grow up vulnerable. They may start using to self-medicate, he said. Then, they have children and they can’t parent because they were never taught how to. So, their children get raised in the same unhealthy environment.
“That’s where we are really trying to break the chain,” he added. “It’s not what’s wrong with them. It’s what happened to them. They aren’t programmed like they would be mentally if they’d been in a supportive family from the beginning.”
Prevention is key
Because of that mindset, FSS spends more on prevention than any other foster-care agency in the state, Miller said. According to FSS staff, it spends approximately 15 to 20 percent on prevention and family preservation services.
Those prevention services result in FSS maintaining the third lowest rate of removal in the state. Much of this, said Miller, can be traced to the organization’s FAST program. The program grew from the recognition that pulling children from their families increases trauma. So, FSS focuses on implementing services in the home to protect and treat the child, while empowering parents.
“We had 1,000 children in our FAST program last year,” Miller added. “If not for FAST, those children would have come into foster care.”
The opioid epidemic may shake up that program — as it’s harder to care in-home when parents are unconscious or overdosing.
In situations where removal is unavoidable, foster parents can access services to improve the quality of a child’s care. FSS offers several different training opportunities, including therapeutic and medical options.
Currently, in its pilot phase, a post-reunification unit works to ensure a smooth transition for the child and parent after time in the foster-care system. That program, launched in March, provides a secondary caseworker for the family for six months.
Though the program is under evaluation, Miller said, it was created as a result of the opioid epidemic. “We are doing that because substance abuse is so difficult, it’s recalcitrant. It’s hard to overcome,” he said.
Enter Bethany Moore, a 27-year-old teacher who has been a foster parent for over a year.
Because she sees the need daily in her classrooms, Moore plans to pursue certification to increase the number of children she can foster at one time. For her, the classes provided by FSS were like foster-care bootcamp.
The information, she said, was vital. Knowing the current situation, Moore pursued classes specifically to help her understand children born with drugs in their system.
For over a year, Moore fostered a little boy who came to her just after turning 1 year old. The child was born early due to his mother’s drug use.
She sees the signs even now. She constantly works with him on his speech, on his walking. She takes him to counseling.
“He is making so much progress because of the home he is in,” Moore said. “Two months after being a foster mom, I knew I could be his mom. … If I can do this, anybody can.”
Moore plans to adopt her foster son this month.
Copyright 2017 The Florida Times-Union