Better Data Needed to Identify Opioid-Related Child Removals

When Cyndi and Jesse Swafford decided to be foster parents a decade ago, they were told it would take up to three years before their name would come up for a newborn. But a rapid, nationwide increase in opioid drug use put their services very much in demand.

Since then, the Dayton, Ohio, couple has taken in 15 children. They have taken two babies home from the hospital in just the past three years. In addition to their one biological child, the couple now has three adopted children and one foster child. Their adopted and foster children were all born addicted to opioids.

While various levels of government, law enforcement and the medical community develop strategies to reduce opioid use, families’ lives are in the balance. The number of children in foster care was shrinking as recently as 2012. But the crisis has ravaged communities across the country, creating shortages of foster parents and prompting public officials to plead for people to open their homes to displaced children.

“While there is this increase of babies coming home from the hospital exposed and addicted to opioids, there is also a significant need — at least in our area — of some of the older kids of opioid users who are coming into care as a result of neglect and parental dependency,” Cyndi Swafford said in an interview.

The couple’s goal is to reunite a foster child with their family. But the pull of addiction is often too strong, and parents are not able to raise their children. The Swaffords are prepared for those times. They have never taken in a child to whom they were unwilling to make a lifetime commitment.

Many Kids, Many Needs

Not every family may be as equipped for the job as the Swaffords. Children exposed to opioids in utero are likely to suffer from a range of health challenges. They may be at risk for developmental delays or learning difficulties. Older children who suffered neglect can be angry, detached — even dangerous.

“Among newborns, we see irritability, they have GI [gastrointestinal] issues, they have difficulty feeding, difficulty sleeping,” Cyndi Swafford said. “They often have a ‘failure to thrive’ type situation, so they’re not gaining weight and growing appropriately.”

Social workers can provide vital support systems and be advocates for the parents, children and foster families involved in these situations.

Stephanie Russell, an alumna of the University of Denver’s Graduate School of Social Work (GSSW), said the demand on the foster care system has led to a national push to recruit and retain foster parents. But both foster parents and biological parents need support systems to achieve the ultimate goal of family reunification. 

Amy S. He, an assistant professor at GSSW with a focus on child welfare, described a tightrope walk for social workers. On one side, there is the need to keep the child safe and secure — and minimize chaos. On the other side, there is a need to help families torn apart by substance use maintain nurturing bonds as they heal. She said the system has begun to embrace the concept that an entire family is being cared for — including the parents struggling with substance use — and not just the child. And that means including as many people as possible in a network to support a child while parents are unable to provide care.

“It’s important for all kids to be with their families when that’s possible,” she said. “You can spend a lifetime in recovery and still be able to parent a child adequately and safely.”

— Stephanie Russell, an alumna of the University of Denver’s Graduate School of Social Work (GSSW) 

“Just because the mother has addiction issues doesn’t mean she loves the baby any less,” she said. “We also want a parent to have bonding opportunities and attachment at that age, if possible.”

Russell, who is also an evaluator for the Colorado Department of Human Services, agreed emphatically.

“It’s important for all kids to be with their families when that’s possible,” she said. “You can spend a lifetime in recovery and still be able to parent a child adequately and safely.”

It’s often a grandparent or another family member who has to take charge, He said.

Donna Beckham knows that well. A day after her grandson Aaron’s birth in April 2016, she received a call from her son begging her to take the baby, who had tested positive for opioids and was being sent to foster care. She was shocked to learn her son and his girlfriend were using heroin. After the baby spent a week at a stranger’s home, she was able to bring the baby to her house outside St. Louis.

Beckham said Aaron’s mother has had two other babies who were born addicted to heroin. Her son is in jail for failure to pay child support. Suddenly, she is a mom again, raising another child instead of pursuing her dream to operate a food truck.

“Parenting again isn’t easy, but we have a big support system in this family,” she said. “We all chip in and do our part.”

Aaron overcame his withdrawal symptoms and appears to be doing well, she said. But the lack of attachment to his parents could be his next hurdle.

Despite the obvious ties between the opioid crisis and foster care, the nation lacks any meaningful data to show how the trends connect.

The Administration for Children and Families requires states to specify the reasons children are removed from parents’ custody. A November 2017 report found that parental drug use contributed to more than 92,000 removals in fiscal year 2016 — 34 percent of the nation’s total. That was up 2 percentage points from the previous year, but there was no analysis indicating how many of those 92,000 removals were due to opioid use as opposed to other substances. Current reporting standards do not capture information about the substance type that was involved in the reason for removal.

That’s a serious problem, said He, because the plan for a family battling opioid use may be different from one facing alcohol use. And without having a clear picture of the nature of problems facing a community, policymakers are left to guess how to direct precious resources.

Data may be piecemeal, but they do point to a link between the spikes in opioid use and in children placed in foster care. In St. Louis, clinicians at Cardinal Glennon Children’s Medical Center’s Fostering Healthy Children medical clinic see nearly all the children who enter foster care in the region; about a third of some 900 children they served in the center’s first two years have been opioid addicted.

Some of the best available research pointing to the opioid crisis’ effect on children may be specific to Missouri. Researchers from the Hospital Industry Data Institute found the growth in opioid use in the state tracked with an increase in newborns with neonatal abstinence syndrome, or NAS. The researchers reviewed hospital diagnostic codes for all Missouri births between 2006 and 2016, and found a 538 percent increase in codes related to newborns with withdrawal symptoms stemming from maternal drug use.

Late last year, an Associated Press investigation found perhaps the strongest link yet — a correlation between counties with higher levels of opioid prescribing and opioid death and those with higher shares of foster cases linked to drugs.

“Collecting better data is going to help child welfare workers better direct their services,” said Russell. The problem is too great for the system to base its response on anecdotal evidence.

Resources for Foster Parents and Parents Interested in Fostering Children

National Center on Substance Abuse and Child Welfare

National Foster Parent Association

National Conference of State Legislatures: Substance Use and Child Welfare Resources

Child Information Gateway: Parental Substance Use and the Child Welfare System Bulletin

Court Appointed Special Advocates (CASA) for Children: Addiction/Substance Use Resources

CASA in Colorado

Colorado State Foster Parent Association 

Colorado Department of Human Services: Adoption, Foster Care, and Kinship

Colorado Child Abuse and Neglect Awareness Campaign

Denver Human Services: Foster Care, Adoption and Kinship Care

Citation for this content: MSW@Denver, the Online Master of Social Work from the University of Denver.