Foster care case numbers continue to climb in NC, as opioid crisis affects families - North Carolina Health News

By Sarah Ovaska-Few 

North Carolina could use more people like Lisa Link, as the state grapples with record numbers of children entering and staying in the already stretched foster care system.

Link, an auto broker and owner of a small used-car lot in Charlotte, opted five years ago to become a foster parent after years of helping with family members’ children. She was single, in her early 40s, and wanted to help children coming out of difficult situations in need of a stable and loving home even if temporarily. More than 20 children have been under her care since, some for short stays of a few days or weeks and others for a year or more.

She cherishes being a dependable, caring presence for children who are often coming from chaotic or unpredictable households. She makes sure they get the childhood joys of playing at local parks or experiencing what might be new things such as eating out at a restaurant, a day at the nearby Carowinds amusement park, or going to museums.

“I’m going to take this a level up, where I can help children that needed help,” said Link, about her decision to become a foster parent. “That’s when I felt like this was my place and my calling.”

And something else happened she hadn’t expected or intended – she met her 6-year-old forever son, Latrell Ma’az Link, who has lived with Link since he was 3. Latrell ended up in the foster care system and Link’s home because of neglect. His adoption to Link was formalized last month.

“I’ve had him three years and wiped his little nose,” Link said.  “I couldn’t see him going anywhere else.”

The foster care system in North Carolina continues to experience record levels of need, the increases believed to be yet another aspect of the devastation from the opioid abuse epidemic.

As of mid-summer, there were 11,700 children and teens younger than 20 in the foster care system. According to the N.C Department of Health and Human Services, that’s a 20 percent jump from just five years ago. Some of those children are in family foster homes such as Link’s. Other children stay with non-parental relatives as part of the state’s focus on kinship care to lessen the trauma experienced by children entering the system.

Those numbers also include more than 800 older teenagers. Those young people can opt to continue receiving support services such as health care through the age of 21 if they are working or in school, one of a series of reforms passed in 2017 by the state legislature.

Prescription drugs, heroin abuse behind surge

Opioid misuse and addictions are the likely culprits behind the recent growth, say those that work in and around the foster care systems. The effects of pervasive poverty, untreated mental illness and domestic violence also continue to be significant factors driving increases in foster care.

Parental substance abuse was the primary reason for the removal of a child for nearly 40 percent of the cases during the 2017-18 fiscal year, up from 30 percent five years ago and from 25 percent a decade ago, according to data provided by DHHS.

The state and most counties don’t track what specific substances – drugs or alcohol – were at the root of a family’s troubles, however. The actual number of affected children may be higher, as each county categorizes information differently. Some counties, for instance, report no substance abuse-related removals of children from homes, an unlikely scenario given the pervasiveness of addiction and the current opioid crisis.

At the state level, the focus on children removed from homes because of substance abuse is the same as any other scenario – a desire to get them in a stable and safe situation. Ideally, these children would be reunified with their parents, said Erin Baluyot, the interim program manager for DHHS’ State Foster Care and Adoption Services. If reunification is not a safe option and parental rights are terminated, the goal is to find a child an adoptive home as soon as possible.

“We do business as usual; our goal is to achieve permanency for children no matter the reason for them coming into foster care,” Baluyot said.

Sadly, children can spend years in the foster care system before being reunified with family members, or being adopted, according to DHHS.

More kids, more time

Statistics kept by the DHHS show the median time a child spends in the system was 525 days in the 2018 fiscal year that ended in June. That’s up by nearly 20 percent from four years prior, when the median stay was 441 days. The state is intent on reducing the amount of time children dwell in foster care, whether they end up going back to family or being adopted. This is one of the measurable goals in the department’s ongoing early childhood action plan.

Several high-profile deaths of children in recent years, including the 2016 drowning death of 3-year-old Rylan Ott, led to the state legislature passing changes in 2017 restructuring how child abuse investigations are handled across the state. The law was named for 3-year-old Rylan Ott, who wandered away from his Carthage home and drowned in a nearby pond. He had been returned to his mother’s home shortly before his death by the Moore County Department of Social Services, despite the mother’s erratic behavior and over a court-appointed guardian’s objections.

Baluyot acknowledged those failings but also pointed out that there’s more to the system than tragic headlines.

“We always hear about the negative and bad things that happen, but a lot of good things happen too,” she said, pointing out that 1,300 to 1,400 children are adopted out of foster care each year. “It’s certainly a good thing. That’s 1,400 children we don’t have lingering in foster care.”

How to address the current influx of children in the foster care system is not a settled question.

A bill introduced last month in the state legislature is seeking to change how the state does business as usual. House Bill 918 would speed up the time to terminate parental rights to as little as nine months for children born with illicit drugs in their systems. The bill would also give a foster family nearly equal standing as biological family when deciding permanent placement for a child and also broadening the reasons why a child can be taken from a home.

The bill drew heated debate when it was heard in committee and has not progressed since late August.

Rising need across country 

This trend of rising numbers of children in the child welfare system isn’t isolated to North Carolina. The U.S. has seen foster care cases steadily rise since 2012, following decades in which the numbers dropped, according to research published in July in JAMA – Pediatrics. 

Parental drug abuse was a root cause of a child’s entry into foster care in 36 percent of cases in 2017. Young children – those under 5 – were most likely to be affected by removals because of substance abuse, according to the research. Young age is a particular concern given that those years are also when children form bonds with caretakers.

“[W]hen children enter foster care because of parental drug use, episode duration is longer and less likely to result in reunification with the parent,” wrote journal authors Angelica Meinhofer, a Cornell University researcher, and Yohanis Anglero-Diaz, a psychiatrist with Boston Children’s Hospital and Harvard Medical School.

Those trends are reflected in North Carolina, where more children 0 to 8 years old entered the foster care system last year than in previous years, according to DHHS data.

That creates a unique challenge for social workers, foster parents, teachers and other caregivers, given that those are critical ages in a child’s development.

Taking trauma into consideration

Entry into foster care, in addition to the circumstances that bring a child to the attention of child welfare workers, are considered traumatic events that carry long-term psychological and health effects. Public health researchers found in landmark research conducted two decades ago that adverse childhood experiences (ACES), events such as living in a household with domestic violence or substance abuse, can lead to a lifetime of both mental health and even physical health challenges.

Public health experts have in turn emphasized having more trauma-informed care in many settings, in hopes of lessening the impact of childhood trauma.

In the past, the number of foster care cases has decreased when the economy is doing well. That reduction is a sign that parents are able to find work and have fewer financial stressors to trigger abusive or neglectful behavior, said Ken Maxwell, head of Seven Homes, a privately run High Point nonprofit foster care placement and adoption agency that he co-founded in the mid-1990s.

That’s not what’s happening now, Maxwell said. North Carolina’s foster care system has continuing to swell to record numbers despite the overall strength of the economy and historically low unemployment rates.

“We’re not seeing the numbers decline, we’re seeing the numbers increase,” he said. “The numbers are staying high because of substance abuse or opioid abuse.”

He also said that many of the birth families haven’t had interaction with the foster care system before, a departure from what he’s seen in other illicit drug crises. To him, it’s an indication of how quickly opioid addiction can overtake a person’s ability to maintain the regular rhythms and responsibilities of their lives.

“This sneaks up on families and they don’t realize it until they’re at risk of losing their kids,” Maxwell said. He has seen higher reunification rates, though, with children eventually being able to go back to their parents or with other family members.

Many of the children coming to Seven Homes needing temporary placements are young infants, and Maxwell has had difficulty finding enough foster families with the ability to take in newborns in need of around-the-clock care.

Though the rising numbers are not what anyone wants to see, Baluyot maintains the state currently has enough foster homes, though there’s always a need to recruit more.

Children with complex needs due to disabilities, mental health or behavioral issues as a result of sustained trauma or sibling groups may, however, end up facing longer waits for suitable homes, she said.

“We do have a lot of foster homes, it’s not like we’re in a crisis where we desperately need more,” she said.

How children fare at epicenter of opioid crisis 

One county keeping track of the precise reasons why children enter foster care is New Hanover, home to Wilmington and among the most affected in the state and country by opioid misuse.

In 2013-14, 10 percent of the 189 children who entered the foster care system did so because of their caretakers’ heroin or opioid addictions. Substance use was a factor in 36 percent of cases overall, according to statistics provided by the New Hanover Department of Social Services.

Just four years later, nearly half of the 205 children entering the system came from homes where substance use was a factor, with opioids or heroin involved in 23 percent of the cases, according to 2017-18 data collected by New Hanover DSS.

The county also experienced an unexpected surge of need in 2016, when 280 children entered the foster care system. Their current living situations were deemed unsafe or babies born exposed to substances were unable to safely leave the hospitals with their mothers, said Mary Beth Rubright, the assistant director of social work for New Hanover Department of Social Services.

Children aren’t automatically or permanently taken away if there’s someone using drugs in the home, Rubright said. Instead, child protective services workers evaluate whether the home is safe and whether a family member can step in and provide stability if the current situation isn’t tenable.

Social workers are also steering parents toward resources for treating addiction, if applicable, and the courts often include it as a condition of being reunified with children.

“If they’re in recovery and in a program, it makes our job a whole lot easier,” she said.

Hospitals take a bigger role

There have been more babies born in the Wilmington area with opiates or other substances in their system than in the past, with social services getting involved with families in the first days, or even hours, of a child’s life, Rubright said.

In 2016, New Hanover DSS workers were notified of 54 babies born drug-positive, a term that includes both drugs being abused and those prescribed as a part of opiate recovery treatments. That went up by a startling 89 percent within two years, with 102 babies born drug-positive in 2018, Rubright said.

A big part of the increase is due to the county child welfare workers reaching out to local hospitals and making sure hospital staff were properly flagging them about children born drug-positive, a requirement under federal regulations. Reasons for notification include exposure to illicit drugs as well as to drugs such as buprenorphine or methadone that may be prescribed as part of an addiction treatment plan.

Hospital staff wasn’t consistently contacting DSS in those situations in the past, Rubright said.

To help those families, the county launched an intensive support program for mothers who give birth to children with drugs in their system. The goal: having the baby back in their mother’s care within 60 to 90 days, provided the household is assessed as safe by social workers.

The social worker running this program only has three cases at a time, down from the former average caseload of 15. This allows for more visits with the family to offer parenting support, to check in on the mother’s progress with substance abuse recovery programs and to help locate housing or other assistance, if needed.

It’s an expensive program for DSS to administer, at a cost of about $100,000 to pay for the single social worker assigned to the program and the related therapies and programs for affected parents. But the goal is to try and ensure the household is safe for a baby while setting up both mother and baby for longer-term success.

“It’s critical that you give [mothers] opportunities to bond with her children,” Rubright said. “The truth is that in the end, it’s a lot less expensive to pour those resources in on the front end.”