Are you a health care worker? We’d love to hear from you. Email editor at northcarolinahealthnews.org
By Taylor Knopf
As North Carolina’s opioid crisis deepens, a rising number of children are entering the foster care system as a result of their parents’ drug use.
In 2016, about 38 percent of children came to foster care due to parental drug use, that’s up from 31 percent in 2013. The majority of kids in foster care still end up there as the result of some sort of neglect. But the second major cause is parental drug use.
The total number of kids entering foster care is also increasing each year. In 2013, there were 5,198 kids in the system across the state. Last year, there were 5,721.
“We are seeing more severe situations in which children need to move to foster care placement and they remain in the foster care placement longer,” Susan Perry-Manning, deputy secretary of Human Services at the state Department of Health and Human Services, told lawmakers earlier this month.
Much of the increased substance abuse is due to opioids, explained DHHS Assistant Secretary Michael Becketts, who also spoke to the Joint Legislative Oversight Committee on Health and Human Services. On top of that, many kids are staying in foster care longer because addiction is a chronic, lifelong condition.
There is not a quick cure, Becketts explained in an interview with NC Health News. He pointed out that substance use is often an intergenerational problem. If mom and dad are affected, grandma might be also, so kids cannot always be placed with extended family.
Opioid deaths on the rise
Prescription drug overdose deaths in America have quadrupled since 1999, according to the Centers for Disease Control and Prevention. More than 183,000 people died in the U.S. from opioid overdoses between 1999 and 2015.
North Carolina has paralleled the nation, with overdose deaths climbing from 150 deaths in 1999 to 1,110 in 2015. A total of 11,072 North Carolinians died from opioid overdose during that time.
Becketts said he’s seen substance abuse in pockets across the state where there has been an increase of kids coming into foster care.
“It varies across the counties,” he said. “One county that comes to mind is New Hanover, which is not surprising with their ranking of opioid abuse nationwide. Almost every one of the children coming into foster care in that county last month was related to substance abuse.
“These things concern us,” Becketts added. “We want to strengthen families.”
Sen. Tamara Barringer (R-Cary) told DHHS staff that while the opioid crisis is a big problem, she wants to make sure attention to substance abuse doesn’t “take our eye off the ball.” She brought up the fact there’s a backlog of child death investigations at DHHS.
“I just want to make sure that there is still pressure, still encouragement, still enabling of investigations of all kinds of child protection, not just that of the drug situations,” Barringer said. “The drug situation is horrendous, but we have other situations these children are living in.”
Currently, the department has a backlog of 96 cases from the last three years requiring investigation. The majority — 51 cases — are from fiscal year 2015-16.
“I want to make sure you know we recognize the department did not meet its obligations in the past, particularly we’re behind reviewing these child fatalities,” DHHS Sec. Mandy Cohen told lawmakers during the presentation. “My goal is to clear all backlogs by July of next year.”
Becketts clarified that not all of the uninvestigated deaths are due to neglect or abuse. The department is mandated to investigate all deaths of children who had contact with the Department of Social Services within the 12 months prior to death. That could mean the child was in a foster care placement, or that there was simply a DSS report.
DHHS’ foster care death investigation protocol can be found here on their website.
Becketts said the purpose of the investigation is to help the local county DSS review what happened and look for opportunities to “mitigate risk in the future.”
“That’s what it’s about,” he said. “Not placing blame for who is at fault, but to do our best to put resources in place to prevent untimely death of another person.”
Becketts said the investigation backlog has been due to insufficient staffing in the past. Until about six months ago, the department had only one full-time person working on the investigations. After receiving additional funds from the General Assembly last year, Becketts said there are now five full-time employees solely focused on fatality reviews.
Working on improvements
It’s been well reported that the foster care system across the state is subpar. A federal review of the child welfare system released in 2016 found North Carolina’s system as a whole is failing children across the state.
The federal Children’s Bureau found that the state system did not meet standards in any of seven outcomes measures, such as children being protected from abuse or neglect. Also, North Carolina did not meet standards in any of seven systemic factors, such as quality assurance and staff training benchmarks.[sponsor]
In response to these troubling reports, DHHS partnered with the Children’s Bureau to create a Child and Family Services Performance Improvement Plan, which outlines specific improvement goals and strategies to meet them. For example, to improve safety outcomes, the plan calls for creating a better statewide communication platform and conducting a case study with 100 random cases from across the state.
Becketts said he thinks implementing the Family/ Child Protection and Accountability Act will also have “an enormous impact.”
The new law, signed by the governor in June, seeks to transform of the state’s system by establishing a “working group” of county commissioners, social services workers, court officials, attorneys and other concerned professionals who are tasked with re-organizing county social services.
The new plan will come back to lawmakers in 2018.
The bill also calls for outside help from national experts who have already been identified and will develop a plan for state supervision and accountability.