10.28.19

Addiction and Child Welfare Policy: Ensuring Healthier Outcomes for Families

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This post was written by Regina LaBelle, Shelly Weizman, and Somer Brown

Megan Webbley, a mother of four, died of a drug overdose on September 29, 2019 in Vermont. Her grieving father wrote the following in her obituary:

“To editorialize, I am hoping that the Department for Children and Families rethinks its mission to be the punisher of addicted mothers, the separator of families and the arbiter of children’s futures, and instead embraces a mission of enhanced rehabilitation. We, as a state, are overwhelmed by addiction. We have almost nowhere to turn. I encourage enhanced funding for treatment in general and using DCF as a gateway for mothers with addiction to get help. Because, as one would guess, once the mother is separated from her children, desperation sets in, even with the brightest and most determined of mothers — and Megan Angelina Webbley was that bright and determined mother … with a fatal disease and a dearth of treatment options.”

Unfortunately, Megan Webbley’s story is not unique. Punitive responses to parents with substance use disorders have been the norm for many years, both during the current surge in opioid involved deaths, the crack epidemic of the 1980s, and before. As stated in the obituary, child welfare systems can provide another intervention point for families, but are often hemmed in by siloed systems, a lack of treatment programs that are family-centered, and the stigma attached to people with substance use disorder.

Another individual with experience in the child welfare system is Elizabeth Brico, an author, advocate, and a mom in recovery struggling to regain custody of her children.

In an open letter to the child welfare agency handling her case, Elizabeth writes:

“I would do anything for my little girls, and my only goal is to reunify with them and be the best mama I can be. I am so lucky to have such sweet, wonderful little children, because they share that wish with me. I am asking only that our combined wish can be granted… This case is not about malice or abuse; it is about treatable medical conditions, and a family in need of healing. My request is simply a measure of understanding, acknowledgment of the shared importance of my bond with my daughters, and the chance to continue to be a mother.”

A few trends:

  • The number of pregnant women with opioid use disorder (OUD) presenting to hospital labor/delivery departments quadrupled between 1999 and 2014.
  • Between 2012 and 2016, the number of children in foster care nationally rose 10%.

Child welfare experts believe that parental substance use is the primary driver of the increase in placements. In the hardest-hit states, including Georgia, Minnesota, Indiana, and Montana, foster care populations rose by more than 50% between 2012 and 2016.

In the face of increasing rates of foster care, communities have begun implementing a range of responses, including increasing programs to retain families or encourage family unification to prevent long-term negative outcomes. Removal of a child from their parent’s home puts the child at risk for adverse outcomes, including substance use disorder.

New program models focused on integrated services and supports show promise.

For example, in the Sobriety Treatment and Recovery Team (START) model, researchers found that clients with a history of opioid use who received a year of treatment using medication for opioid use disorder (M-OUD) increased the odds of retaining custody of their children by 120% compared with those who did not receive M-OUD. Mothers recovering from OUD are more likely to succeed in family reunification when comprehensive services that are matched to their individual, specific needs are provided and when recovery management and other social and family supports are integrated into the treatment plan.

Still, barriers and challenges persist. For mothers in recovery from addiction, finding support can be difficult, and caseworkers, courts, and other providers often misunderstand how treatment works and lack guidelines on incorporating it into child welfare practice.136 Despite the success of M-OUD as a treatment modality, parents enrolled in such programs often face serious limits on treatment availability, due to a misunderstanding of M-OUD and limited interaction between child welfare agencies and health care providers.

To promote policies that improve outcomes for families interacting with the child welfare system due to parental substance use, the O’Neill Institute has drafted a report highlighting legal and policy strategies. Applying the Evidence seeks to address gaps in access to M-OUD and features the work of advocates with lived experiences. This report includes recommendations for policymakers and child welfare agencies to implement evidence-based treatment in coordination with other agencies.

One example of successful implementation of evidence-based practices is the Family Treatment Court in Tompkins County, New York. This court institutes a milestone-based approach that embraces evidence-based practices, connections with public health nurses trained in SafeCare, child and parent psychotherapy, and connecting parents with M-OUD in low-barrier clinics in the area.

“The ‘us versus them’ mentality has to shift,” said Judge John Rowley of the Tompkins County Family Treatment Court. “We are seeing success now that we’ve gotten away from re-traumatizing people like we were in the weekly court appearances where you get called up to the podium. We are doing better with engaging. We are embracing peer support and are now hosting monthly sober event for families to create an atmosphere where families can feel normal. We aren’t even tracking clean dates any more, the focus is on actions and behaviors. It’s not really about the numbers in the end, it’s about finding a more human way to support families.”

Amplifying the voices of those who have been affected by substance use disorders and the child welfare system will help build systems that are more responsive to the needs of the entire family, while also creating healthier outcomes for communities and our nation.

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The views reflected in this blog are those of the individual authors and do not necessarily represent those of the O’Neill Institute for National and Global Health Law or Georgetown University. This blog is solely informational in nature, and not intended as a substitute for competent legal advice from a licensed and retained attorney in your state or country.

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