Foster care system struggles to keep pace with opioid epidemic

The Dayton Daily News' Path Forward project is seeking solutions to the region's biggest challenges, including how we recover from the opioid crisis. This story digs into how children have been hurt and examines potential solutions to make sure we don't lose a generation of kids to addiction.

Our investigation found that Montgomery, Greene, Warren and Miami counties saw the total number of kids removed from homes increase nearly 20 percent from 2013 to 2017. Removals dropped last year, just as overdose deaths peaked in 2017 and then declined in 2018.

We also found the total costs in those four counties increased by 14 percent from 2013 to 2016.

“Here’s our war,” said Helen Jones-Kelley, executive director of Montgomery County’s addiction services board. “We are succeeding in bringing the number of overdoses down and saving lives, certainly, but we’re not succeeding in terms of the trauma, the carnage that’s left when this wrecks a family’s life.”

Traumatic experiences such as seeing a parent overdose, or living through a long foster-care stay, increase the likelihood that children will face a future of unemployment, homelessness, addiction or criminal activity, said Scott Britton, assistant director of the Public Children Services Association of Ohio.

One proposal calls for improving the quality of training for foster parents, so they can better help children recover. The state also wants to recruit more foster parents.

Children services agencies also are looking at more collaboration between addiction treatment providers, the courts, the faith community and others to create an all-hands-on-deck approach. That’s the same tactic local leaders say they used to reduce the number of fatal overdoses.

Locally that includes programs like family treatment court, where other parents who have successfully gone through the system help separated families. The Ohio Sobriety, Treatment and Reducing Trauma (START) intervention program also provides intensive trauma counseling to children in the system.

“We continue to try to find new practices — promising practices, evidence-based practices that work,” Britton said. “We know that a lot of these families just need to be connected to resources.”

Foster parents needed

Child welfare officials describe the opioid epidemic as a double whammy — not only are there more children entering foster care, but those children have more costly needs.

Ohio has seen a 28 percent increase in the number of children in state custody in five years and the cost to care for them has gone up 34 percent, according a December PCSAO report.

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Ideally, children would be placed with family members, a situation known as kinship care.

But placing children with kin has become more difficult because of multi-generational family addiction, according to a May 2018 report by the state's Foster Care Advisory Group.

“We are not keeping pace in terms of recruiting enough foster homes to house these children,” Britton said.

Without enough local foster homes, children are sent to other counties or even other states. Montgomery County currently has seven children placed outside of Ohio.

The county recently bought cots in case a child needs to spend the night at the children services office, said Jewell Good, children services director.

“Montgomery County Children Services is experiencing a crisis as it relates to the cost of placing children,” Good said.

The number of children being placed in group homes and residential facilities has increased, leading to a more than 20 percent jump in placement costs in the last year, she said. Those facilities cost more than placement in a foster or kinship home.

Some of those children have nowhere else to go because a foster family can’t be located, officials said, but mostly the rise in group-home or residential placements is due to an increase in behavioral problems.

“What we’re hearing across the board is, these kids are more traumatized, more challenged from a behavioral perspective and as a result, more expensive to place,” Britton said.

‘Out of control’

Children of parents with a substance-abuse disorder are three times more likely to be abused and four times more likely to be neglected than their peers, according to a 2016 report by the American Academy of Pediatrics.

These children are also at greater risk of serious medical conditions and mental-health problems including anxiety, attention-deficit/hyperactivity, depression and oppositional defiant disorder.

“We have a lot of young people in the community who are experiencing their caregivers’ addiction in ways we’ve not seen before,” Jones-Kelley said. “This is an epidemic that is going to influence their lives and their ability to navigate success through their education, employment.”

RELATED: Convicted 12 times, mom turns life '180 degrees' after drug court

Worsening behavioral issues have impacted agencies’ ability to recruit and retain foster parents.

“We have children who are behaviorally and psychologically out of control,” Good said. “They are literally tearing people’s houses up. They are frequently running away … they are physically fighting with caregivers.”

It’s to the point where regular foster parents and those who run group homes are saying “we can’t do this,” she said.

Foster parent Cyndi Swafford hasn’t given up yet, but she and her husband, Jesse, have seen the challenging behavior for themselves.

“It’s really isolating sometimes to try to explain to someone who has no experience with dealing with behavioral problems,” she said. “There’s definitely secondary trauma (to the foster family).”

The Englewood couple was recognized by President Donald Trump in 2017 during a speech where he declared the opioid crisis a national public-health emergency.

They’ve fostered 22 children since 2007 and adopted three. Many of their foster kids came from homes with addicted parents, including babies exposed to drugs in the womb and suffering from neonatal abstinence syndrome.

Their 3-year-old adopted son was in the hospital for 30 days and on methadone to wean him off opioids for 27 days.

“He was a significant case,” Cyndi Swafford said.

In her experience, these babies can do really well through their toddler years, but as they get older the gap widens in terms of their social-emotional development.

“They process things differently,” she said.

Creating the next generation

Childrens’ trauma as they enter the system is being compounded by longer and more frequent stays in custody, according to child welfare experts.

Since 2012, Ohio’s foster care reentry rates have remained at 14 to 15 percent, which is higher than the national standard of 8.3 percent.

Between 2010 and 2016 there was a 19 percent increase in the median number of days that Ohio children spent in temporary custody — from 202 days to 240 days.

“That’s a whole extra month in foster care that we just weren’t seeing back before this epidemic took hold,” Britton said.

RELATED: Program examines if fentanyl test strips reduce overdoses, save lives

The longer children linger in foster care, the more likely they are to face adverse effects like unemployment, early pregnancy and criminal justice system involvement, he said. “All kinds of negative outcomes that impact not only them but impact all of society down the road.”

Good with Montgomery County Children Services said kids moving in and out of foster care lack someone to rely on and trust.

“We know that unless we can teach these teenagers that connection, we are creating the next generation of families that children services is going to have to deal with,” she said.

More family support recommended

Ohio’s Foster Care Advisory Group was created in 2017 to help the state recruit more foster parents and support existing foster families.

Ohio currently requires 36 hours of pre-service training for foster parents — more than any other state. But more training doesn’t necessarily equal better foster parents, according to federal data, as Ohio had more children maltreated in foster care than 33 other states.

One of the group’s recommendations is to decrease the number of training hours to become a foster parent, but offer more specialized training, professional coaching and mentorship opportunities for foster parents who work with drug-impacted children.

RELATED: DeWine kicks off addiction listening tour in Dayton

Several states have successfully increased the number of foster homes available as demand has risen.

Arkansas partnered with a faith-based non-profit to recruit foster families from church communities, according to a 2018 report by the Chronicle of Social Change on the national foster care housing crisis.

Kentucky increased its foster capacity by 50 percent through a similar faith-based effort and more partnerships with private foster agencies.

Montgomery County launched its Family Treatment Court in 2016 and reunited its first families in March 2018. The program pairs drug and mental-health treatment with extensive counseling to help reunify families separated by drug addiction as quickly as possible.

RELATED: Treatment court reunites parents, kids

Some children have even been able to stay out of foster care altogether through customized case plans that include home visits and drug testing for the addicted parents, according to the court.

Launched in 2017 in 14 southern Ohio counties, the START program brings together child protective services, peer mentors, the courts, and behavioral health and treatment providers to work closely with families whose children have been abused or neglected because of parental addiction.

Both parents and children can get mental-health and trauma counseling, while parents get expedited entry into addiction treatment. The family gets weekly visits from a caseworker and peer mentor for six months.

In 2018 the program expanded to a total of 34 counties, including Butler. It is funded by Victim of Crime Act grants from the Ohio Attorney General’s Office.

START is based on a Kentucky program that over a decade saw 66 percent of participating mothers achieve sobriety compared to 36 percent in the normal child-welfare system. START children in Kentucky were 50 percent less likely to be removed from their homes and participating counties saved $2.22 for every $1 invested in the program, according to the Ohio Attorney General's office.

Staff writers Chris Stewart and Kate Bartley contributed to this report.

ABOUT THE PATH FORWARD

Like all of you, we care deeply about our community, and want it to be the best it can be. We have formed a team to dig into the most pressing issues facing the Miami Valley. The Path Forward project, with your help and that of a 16-member community advisory board, seeks solutions to issues readers told us they were most concerned about.

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