Who Cares:
A National Count of Foster Homes and Families

The Foster Care Surge Has Leveled Off. Has The Opioid Epidemic?

For five consecutive years, from 2012 to 2016, federal reports have shown a steady increase in the number of youth living in foster care. Sources within the federal agency tracking this number say that these increases will continue in the soon-to-come 2017 count. Also rising are overdose deaths related to opioids, a group of narcotics that include powerful prescription medications and heroin.

But both of those data sets lag behind the present day; for child welfare by two years, and for opioid deaths by a year.

The 2018 youth-in-care figures obtained by The Imprint from every state, except Maine, project that the number of youth in foster care has begun to decline and is nearly 4,000 children shy of our 2017 projection. Our analysis points to a total of 439,020 youth in foster care this year, which is 1,555 more than the 2016 total calculated by the federal Children’s Bureau.

The surge in foster youth has been tied, to some extent, to the rise of opioid abuse, according to statements from federal officials and child welfare administrators hardest hit by the epidemic. So could fewer kids in foster care suggest that the opioid epidemic is cresting?

The latest data from the Centers for Disease Control and Prevention (CDC) suggest that drug-related deaths overall are still trending up, largely due to synthetic opioids like fentanyl. In 2016 opioids were responsible for 42,000 deaths; that number jumped to 49,000 in 2017, based on CDC provisional data.

But there are some regional signs of hope. In Akron, Ohio, a region in the heart of one of the states most affected by the epidemic, opioid-related deaths plunged nearly two-thirds in the first eight months of 2018. And there were over 500 fewer prescription opioid-related deaths in the state in 2017, compared to the previous year.

In Massachusetts, opioid-related overdose deaths fell by more than 8 percent in 2017. Erie County, in New York, saw a decrease in opioid deaths in 2017 for the first time since 2013. In the southwest, New Mexico has seen declines now for three straight years.

The CDC’s recent surveillance report found that health care providers were writing almost 20 percent fewer opioid prescriptions in 2017 than they were in 2006. And a recent survey of high school students showed a declining interest in opiates, including prescription and synthetic varieties as well as heroin. These two indicators are a potential harbinger of hope for the coming generation of young parents.

Still, Carissa Denny, a Phoenix, Ariz.-based mom and peer recovery coach who could have lost her infant daughter to foster care if she hadn’t chosen to get sober three years ago, said she has yet to see a shift away from opioid abuse and overdoses on the front lines.

“I don’t think it’s gotten any better at all,” Denny said. “I think it’s gotten worse because there’s fentanyl now. The majority of stories I hear people started off with being prescribed something.”

According to Andrew Golub, a senior investigator for The Institute for Special Populations Research at the National Development and Research Institute, drug epidemics are “mesa-shaped,” with four distinct phases: incubation, expansion, plateau and decline.

Golub believes the U.S. has hit what he calls the “long plateau” of the opioid epidemic, but points out that it’s not like other drug epidemics for two reasons. First, a diverse range of people are opioid users: different races, and people of different socioeconomic status. Second, many people first access opioids through legal means. This makes it less predictable than previous epidemics.

Since the largest group of people misusing opioids is 20- and 30-year-olds – the decades in which most babies are born – child welfare and substance abuse have a direct relationship. And if the spike in opioid use contributed to the rise in kids in foster care, it stands to reason that lower rates of opioid use would result in fewer maltreatment investigations, reducing the load carried by child welfare systems.  

We asked several states whose reported point-in-time foster care totals for 2018 were lower than their federal 2016 data whether they were seeing a dip in parental substance abuse-related removals. Only a handful, including Colorado and Ohio, reported that the number of removals pegged to drug use had declined.

Colorado officials reported that the number of child removals wherein parental substance abuse was a factor declined by 19 percent from 2016 to 2018. Counties there now have the option to use state funds for substance abuse treatment of parents through what the state calls PA3, a prevention services program.

Though the state says its data “cannot be used to positively correlate a relationship between early prevention and a decrease of children in out-of-home care,” its PA3 program has expanded to 61 of Colorado’s 64 counties. PA3 served over 60 percent more kids during that 2016-2018 timeframe.

It’s also possible that, even where opioid use has not subsided, some child welfare agencies are trying to serve more parents without removing their children.

In Massachusetts, for example, substance abuse-related removals have held steady at about a third of removals overall for the past three years. But the state has doubled its investment in substance abuse specialist positions. Specialists are available to social workers and managers to provide consultation when substance use is impacting families and a parent’s ability to safely care for their children, according to Andrea Grossman, director of public affairs for the state’s Department of Children and Families.    

Oklahoma, which sees more meth-related child welfare investigations than those related to opioid use, rolled out two tiers of front-end services aimed at handling cases without using foster care, according to Casey White, communications manager for the Department of Human Services.

Oklahoma’s Intensive Support Services program, funded in part by a waiver from the federal Department of Health and Human Services, places behavioral health social workers in the home for up to 10 hours per week, working to support a case plan for family preservation. This program began in 2015, White said, after “we saw an enormous increase” in foster youth from 2011 to 2014.

The state served 767 children in the first three years of the program, and 80 percent have remained with their families, White said. She said the agency anticipates it will be able to continue the program under the new federal Family First Prevention Services Act, a major overhaul of child welfare financing.

These developments come a year before Family First is set to offer more dollars to help prevent the use of foster care in cases related to substance abuse, mental health and parenting.

Under the new federal law, states will now be able to use funds derived from Title IV-E of the Social Security Act – the entitlement that currently pays for foster care and adoption – for “time-limited” services aimed at preventing the use of foster care in maltreatment cases. This includes substance abuse treatment for parents of a child who is a “candidate for foster care,” which is defined as a child who would have to enter care but doesn’t as long as Family First Act services are made available.

Just in the past month, states have gotten millions of dollars to help keep families together through the Comprehensive Addiction and Recovery Act (CARA), a 2016 federal law authorizing $181 million each year for states to combat opioid addiction. CARA also helps states strengthen their ability to monitor opioid prescribing, expand evidence-based treatment and intervention programs, encourage use of naloxone to prevent overdose deaths and increase education and prevention efforts.  

Florida, for example, was awarded more than $50 million to allow its Department of Children and Families to provide treatment and recovery services for individuals struggling with opioids. Summit County, Ohio, home to Akron, also received a little more than half a million dollars under CARA.

Another $29 million was awarded across 27 states by the Department of Justice under its  “Enhancing Community Responses to the Opioid Crisis: Serving Our Youngest Crime Victims” program. West Virginia, the state with the highest opioid mortality rate and where 83 percent of open child abuse or neglect cases are parental substance abuse-related, got $2.3 million.

This year, more new funding will be available for child welfare services through the recently passed $8 billion opioid package called the SUPPORT for Patients and Communities Act. It includes assistance to build more evidence for family-focused substance abuse treatment, and development of safe care plans for moms returning home with opioid-exposed newborns.

Sara Tiano and John Kelly contributed to this story.