America’s opioid epidemic has seized the headlines. Every day brings a new count of the dead and addicted.
But what about the children left in their wake? Addiction is nothing new in the world of child protective services, but with opiates, getting the next fix can become the parent’s sole purpose in life, and it’s the children who suffer.
“Young children are left home alone for extended periods of time,” explains Jessica Laspino, executive director of Court Appointed Special Advocates (CASA) Lancaster. “You have children who are truant from school because their parents are unable to get them there. You have children who aren’t being fed or bathed properly because the disease becomes all-consuming.”
Throughout the Susquehanna region, county services are stepping up to care for kids and the families they love.
The child
It can start at birth. A baby suddenly deprived of the substances that a mother ingested is born with potentially deadly withdrawal symptoms. York County agencies and WellSpan are collaborating to alert OB-GYN offices and connect mothers with all the supports needed before and after delivery to improve the chances of a drug-free birth and to better equip the mother to raise her baby. Collaborating across services smooths out the bumps “so the mother is not overwhelmed at this stressful time of life,” says York-Adams Drug and Alcohol Commission administrator Audrey Gladfelter.
The children of the opioid crisis are showing up on the doorsteps of county agencies. Lancaster County Children & Youth has seen 20 to 30 more children a year entering because of parental addiction, a “pretty significant increase” of 10 to 15 percent, says director of quality assurance Amy Campbell.
Many come through calls from mandated reporters, such as teachers and doctors, or from concerned citizens.
“Someone’s using opioids or drugs, and they’re not able to care for the kids,” York County director of Children, Youth & Families Terry Clark will hear from calls. “The children are not being supervised properly. They’re not being fed. They’re wandering the neighborhood looking for food. They’re coming to school and they’re hungry.”
Their medical, emotional, and behavioral development is at risk, requiring therapy and treatment, says Pennsylvania deputy secretary of the Office of Children, Youth, and Families Cathy Utz, in the state Department of Human Services. Some children have suffered neglect. Some have seen parents overdose and be revived. Older children who care for younger siblings need guidance toward “becoming a child again and not being a parent,” she explains. Treatment must be customized “to each child and their particular circumstances.”
In Lancaster, CASA trains volunteers as advocates and mentors for abused and neglected children. The group serves about 400 children a year–up to 45 percent of children in Lancaster County foster care. All are assigned by judges who determine the need for help. In the past, many were older children who “needed that consistent adult to act as a bit of a mentor, but the tide seems to have shifted,” says Laspino. “My perception is it’s due in large part to the epidemic that we have more and more younger children being referred.”
The family
Children come with parents, grandparents, aunts, and uncles, which is why child services “look at families as an entire system,” says Campbell. “It’s not just a caseworker working with the child. It’s the caseworker working with the parents and the grandparents and all those other people who love that child and want to care for them.”
Unless a child is in immediate danger, the first step is mapping a plan to bring the parent to recovery and keep the family intact. In the breach, “family” takes on a broad meaning.
“In the families that we’re serving, we see grandparents stepping forward, and other relatives and kin are stepping forward to assist their family members in attempting to really overcome any challenges that led to their substance abuse disorder,” says Utz.
In Dauphin County, parental addiction is a “primary reason for placements” of children outside the home, says county commissioner George Hartwick. “The fallout has been devastating.” And the county, too, has seen a resurgence in “so many grandparents who raised kids, and now they may be grand-grands, where they are the primary caregivers in many of these cases.”
“Our primary goal is reunification,” adds Dauphin County Children & Youth administrator Annmarie Kaiser, “but there are instances where parents aren’t able to stabilize themselves.”
A “good number” of primary parents struggling with substance abuse are women, says Lancaster County Drug & Alcohol Commission director Rick Kastner. The responsibilities of single motherhood complicate the road to recovery.
“They’re providing the shelter and food and oversight,” he says. “If a mother is torn between going into a treatment program and doesn’t have other relatives or friends to watch the children for those one to four months, [some] women will choose not to go into treatment.” Some fear losing their parental rights if they leave their children with others.
The recovery plan, supervised by the courts, requires documented steps before a parent canregain custody. Complicating the situation is that real-world recovery doesn’t comply with manmade timelines. Many addicts need to attend seven to 10 programs “until they finally find the one that keeps them clean,” but federal law calls for termination of parental rights if a child has been in care 15 of the previous 22 months, explains Clark.“If that’s the case and we’re terminating parental rights by a certain date, that might not be enough time,” he says.
Recovery, Utz agrees, “is a lifelong process, and one of the things we have to plan for is relapse.” She compared it to the natural human inclination to backslide from New Year’s resolutions.
“We have to come back and refocus and reenergize,” she says. “That’s exactly what occurs as part of the substance abuse recovery process. How do we make sure that people are connected to supports, so once the formal process goes away, there’s an informal support network in place?”
The solutions
At the state level, 45 Centers of Excellence are serving as hubs for all the services needed to untangle the intertwined aspects of addiction. In a sign of their effectiveness, 71 percent of people seen by a COE in 2017 engaged in treatment.
At the local level, counties are also taking multi-faceted approaches.
York County: Often, addicted parents—especially mothers, but fathers, too—don’t go to treatment because they can’t leave their children. In York County, agencies and York Day Nursery came up with an innovative, one-stop solution, to be pilot-tested by fall 2018. Parents can come to the centrally located York Day Nursery for outpatient treatment or parenting education, while their young children get free child care in York Day’s 4 Keystone Stars, NAEYC-accredited early learning center.
“It’s a nice collaboration that eliminates barriers,” says Gladfelter.
York County has also contracted with equine therapists, transporting kids to farms to work with horses and animals. “It can change a child for the time they’re working in those programs,” Clark says.
If children reach the point of adoption, the county works with SWAN, the Statewide Adoption Network, to prepare them for the change and help make the perfect match.
Lancaster County: Targeting moms is a priority here, too. One residential recovery program under development will allow moms to bring up to two children. “Mom receives treatment, the children receive prevention and education programs, and hopefully, we get everybody back onto their feet into clean and sober living,” says Kastner. Another approach is expected to offer “three-quarter housing,” at that transition step after halfway houses, assuring clean and sober living on the way to full independence.
Dauphin County: Dauphin County strives for action before the situation becomes critical.
“You can always address addiction before it becomes a crime, and it’s better to do it proactively before a child is neglected, hurt, abused, or left in a life-or-death situation,” says Hartwick. “It’s okay to ask for help.”
Though there are “obviously never enough resources,” the county has expanded detox beds, promoted “warm handoffs” of overdose patients to treatment, offered the receptor-blocking Vivitrol to imprisoned addicts, and trained community recovery support specialists who help people coming out of recovery find stability when they’re back home, he says.
It’s not solely about treatment but also helping those in recovery connect with community services, explains Kaiser. Childcare, housing costs, employment—someone can help, and “we try to make sure that folks are aware of it.”
The opioid epidemic is swamping children and youth agencies in the wake of another tsunami—skyrocketing child abuse reports in the post-Sandusky era. “You can’t point to one thing and say, ‘This is why we’re getting calls,’” says Utz. “We recognize that it’s complex.”
“It takes the community working together to alleviate these issues,” she says. “If they were easy, we would have fixed them by now. It’s taking that collective wisdom in communities and saying, ‘What can we do differently?’”
How can you help?
Get educated: Attend town halls. Read up. Attend an open 12-step meeting. “Help prevent addiction from taking hold, and reduce stigma in the community, so if someone needs treatment, they seek it out because the community is accepting,” says Gladfelter.
Speak up: If you suspect someone has an issue, have an honest conversation with them. Offer to help with daily tasks or even caring for the kids while the parent gets treatment. Contact your local children and youth agency.
Volunteer: In the midst of an epidemic, community services need help. Being a CASA advocate is “not for the faint of heart,” says Laspino, but its 150 volunteers find fulfillment (casalancaster.org). And of course, CASA and other nonprofits always welcome donations.
Foster or adopt: The process can be grueling, and agencies will probe into every corner of your life, but the #meetthekids videos on YouTube offer a glimpse into children seeking homes and the satisfaction of adopting or fostering. SWAN is “a network of agencies working to ensure that we’re providing permanency for children” through adoption and caregiver supports, says Utz. “The reason you do something is probably as unique as you are as an individual. It requires patience. It requires building trust. It requires being able to work with the birth family. Anybody can ask.”