Has the opioid crisis affected foster care? It’s a matter of debate

The number of Durham County children in foster care has risen at the same time that opioid deaths have skyrocketed, but local officials say abuse and neglect — not opioids — are driving the increase.

“The primary reason for their coming into [the foster care system] is not substance abuse,” said Jovetta Whitfield, assistant director of child and family services at Durham County’s Department of Social Services.

The severity of foster cases the county is investigating has increased, according to documents Whitfield provided. The number of cases of neglect, physical abuse, and sexual abuse has increased, the documents state.

The county also has seen a significant rise in families with more than one generation of children needing foster care, and of families with criminal involvement, the county reported.

“We have been very well aware of this. We have been tracking these numbers every month,” said Wendy Jacobs, chairwoman of the Durham’s Board of County Commissioners, who also sits on the Social Services Board.

The county is trying to increase the number of foster-care homes, and residents are stepping up, Jacobs said. “We are well aware of this problem and we agree it is a crisis, and that’s why we’ve had a robust foster-care campaign,” Jacobs said.

Because social services departments have not had to keep numbers related to foster care and opioid use, Jacobs said it’s difficult to pin down exactly why Durham’s foster numbers are high.

In January 2012, Durham County had 177 children in foster care. By January 2017, it had 255, and by June, 283.

“There are things we can assume,” she said. “Number one, we see families that are under stress. This can be related to state policies.” Jacobs cited “an erosion of support for policies that keep people out of poverty,” such as the legislature’s decision not to extend unemployment insurance and Medicaid. “Some of the accompanying things like mental health issues, substance abuse, they’re all intertwined with poverty.”

The County Commissioners plan a community meeting soon to gather information about what can be done to curb opioid abuse, Jacobs said.

The N.C. Department of Health and Human Services reported a 41 percent increase in children entering foster care because of parents’ drug use since 2012.

Gov. Roy Cooper’s plan to fight opioid abuse cited that figure as evidence that the opioid crisis is “devastating our families.”

Monthly numbers from the UNC School of Social Work show that Durham County had an increase in children in foster care for that same period.

In January 2012, Durham County had 177 foster care cases. That number remained fairly steady until January of 2016, when the county had 243 cases. The county had 255 cases in January 2017, and 283 as of June.

Foster care numbers for Orange and Wake counties did not follow a similar pattern.

Orange County had 102 cases in 2012, and 91 as of June 2017. Wake County had 556 cases in January 2012. Wake had 764 children in foster care in January 2016. That number fell to 675 in January 2017, and to 646 in June.

Fewer state resources

The increases come at a time when the General Assembly has cut funding for mental health services this fiscal year by $178 million, leaving health care professionals and local officials trying to make up the difference.

“At this point we haven’t seen an uptick in therapeutic foster care due to opioids but I think we will …. Over time you will have a certain percent of those kids who will need more support,” said Beth Melcher, executive vice president for care management at Alliance Behavioral Healthcare. Alliance is a managed care organization that offers mental health and substance abuse services for the uninsured, underinsured, and Medicaid patients in Durham, Wake, Cumberland and Johnston counties.

At this point we haven’t seen an uptick in therapeutic foster care due to opioids but I think we will.

Beth Melcher, Alliance Behavioral Healthcare.

Therapeutic care refers to foster families with more experience and training in helping children. “A good number of those kids will have significant trauma issues,” and many will likely receive services from Alliance, Melcher said.

Budget cuts also have affected the ability of mental health agencies to address the opioid crisis. “I think the challenge we have had is many of the individuals we have with an opioid addiction do not qualify for Medicaid,” Melcher said. Medicaid has been repeatedly cut and the resources to address those patients have been limited.

Those cuts “are going to have a very big impact on us locally,” said Jacobs.

Looking for solutions

Alliance is teaming with the social services departments in Durham, Wake, Cumberland and Johnston to identify children needing therapeutic foster care.

The School of Social Work’s figures show that in June, of the 283 foster care children in Durham County, 116 were placed in foster homes, 51 were living with a relative, and 64 were in a therapeutic foster home.

North Carolina has received a $31 million federal grant, spread out over two years, to battle opioid addiction. It is part of Cooper’s plan to fight opioid abuse.

Durham’s portion of that $31 million “will give us some additional resources” but will not make up for the General Assembly’s cuts in mental health care, Melcher said. Alliance hopes to use its portion of the grant to help patients who do not have income or insurance, she said.

Currently, social services departments do not track foster care cases related to opioids, but last week local departments had to start reporting the number of infants born to parents with substance-abuse problems. The new regulations require that doctors report those cases to social services agencies. Social services departments also must report numbers for placement of those children in protective services.

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