The Opioid Epidemic and Foster Care: The Opioid Epidemic’s Forgotten Victims

The opioid epidemic has continued to make a devastating impact across the United States. In 2010, officials reported 21,088 opioid related deaths. By 2018, this number had risen to 46,802. The next four years saw an even larger increase, with 68,630 opioid related deaths reported in 2022. Despite public conversation and consistent news coverage of the individuals affected by the opioid epidemic, there remains a large segment of society that is often overlooked: children and youth in foster care.

The history of the opioid epidemic and foster care connection

The increase of children entering foster care due to the substance-use and opioid epidemic is not new in American history. Near the end of the Vietnam War, heroin use reached epidemic levels, creating a death rate that was about one per 100,000 people. The crack-cocaine epidemic of the 1980s lead to a death rate that was about two per 100,000 people. In each of those periods, the child welfare system saw a significant increase in the number of children moved into foster care.

During these past epidemics, the child welfare and foster care systems became completely overwhelmed. Parents who struggled with addiction were often criminalized, and there were few resources available to assist their children and other family members. Foster children were often placed in unsafe environments, and once they aged out of the child welfare system, they had insufficient resources helping them effectively transition to adult independence.

According to the latest data, the U.S. Department of Health and Human Services found that a 10% increase in opioid-related overdose deaths directly corresponded with a 4.4% increase in the rate of children entering the foster care system. Additionally, a 10% increase in opioid-related hospitalizations was associated with a 2.9% increase in children entering foster care.

Hope in the form of new federal legislation

The nation is now seeing a similar connection between parental substance use and foster care placement. In fact, it is the fastest-growing reason for removing children from the home of their caregiver. In 2016, parental drug abuse was a factor in the removal of a child from the home in 34% of cases – a 6.5% increase from 2012. This connection between the opioid epidemic and foster care rates leaves children in a precarious situation, and it leaves child welfare workers under-resourced, overwhelmed, and burned out.

However, there is some hope in the form of federal assistance for the child welfare system. In February 2018, Congress passed the bipartisan Family First Prevention Services Act, which allows states to spend federal child welfare dollars on preventative services to help keep families together. It also limits funds for placing foster youth into large congregate care placements, including group homes. It is the largest change to federal child welfare finance in almost 40 years.

Some highlights of the Family First Prevention Services Act include:

1. Services to prevent foster care

These services help reduce the need for foster care in the first place. They include services to address mental health disorders, substance use disorders treatment and in-home parent skill-based programs.

2. Limiting support for congregate foster care

The monies available to be reimbursed for group home placements will be limited to only two weeks, encouraging child welfare agencies to place children with next-of-kin or in foster family homes. It holds an exception for qualified residential treatment programs, which must include a trauma-informed treatment model.

3. Adoption, foster home recruitment, and reunification services

The act provides 8 million dollars in competitive grants to support the recruitment and retention of highly qualified foster families. It also eliminates the time limit for family reunification services and reauthorizes incentives to states to promote adoption and legal guardianship.

This law provides much-needed resources to the struggling children, families and child welfare systems affected by the opioid crisis. Yet, it is difficult to determine if it will be enough. The ramifications of the epidemic and its effect on foster care youth can yield intergenerational trauma, as seen in previous drug epidemics. It took more than 25 years for the foster care system to stabilize after the cocaine epidemic of the 1980s.

Helping children and caregivers work toward normalcy

Thanks to the legislation discussed above, foster care parents can more than house the children under their care. They can enroll children in after-school activities and more to help promote a sense of normalcy in a tumultuous time.

Activities that promote normalcy for youth in foster care are hugely beneficial to their ongoing development and can give them a foundation for success in adulthood. Many youths in foster care have lived lives that most cannot imagine. They have seen, heard, and experienced things way beyond their years. Providing them with opportunities to engage in developmentally or age-appropriate activities allows them to be like their peers who are not in the foster care system and can reduce feelings of isolation or otherness. This can improve a child’s self-esteem, mood, and functioning.

As an organization, you should work to incorporate training for foster parents and caregivers related to their child’s experiences. These can include:

• Typical childhood and adolescent development
• Milestones of growth and development,
• The impact of trauma on development, emotions, and behavior

This type of training will allow foster parents to make informed decisions using the reasonable and prudent parent standard.