Snowball Effect of Opioids on Ohio’s Child Welfare System

Ohio’s child welfare system is in crisis, due chiefly to the opioid epidemic. The ability of child-serving agencies to provide essential services to vulnerable children – the innocent victims of this crisis – is at great risk.

In a ten-year period starting in 2002, Ohio’s state-supervised, county-administered system gradually and safely reduced the number of children in out-of-home placement. It led the nation, in fact, with a 42 percent decline in children in care.

But that number is rising again. The ravages of the Great Recession, followed by the scourge of the opioid epidemic, have led to an 11 percent increase in the number of children in foster care on any given day since 2010. That means an additional 1,336 Ohio children were living away from their homes on an average day in 2016 compared to just six years earlier.

The state leads the nation in heroin and synthetic drug overdoses. A survey my organization conducted showed that half of all children taken into custody in 2015 had parental drug use as a removal factor. Of those, more than half had parents using opioids, including heroin. That means 28 percent of children in custody that year were victims of the epidemic, and that number has almost certainly risen.

Maintaining these children in custody and addressing the trauma they experienced as a result of their parents’ neglect is increasingly expensive. Agencies spent $275 million in total placement costs in 2013; by 2016, costs had increased 20 percent to $331 million. The Ohio Department of Job and Family Services estimates that $138 million of these costs were for substance abuse-related cases.

Because parents who are addicted to opioids frequently relapse – some multiple times during their recovery process – their children linger in care. The length of time that children stay in temporary custody is up 19 percent, from 202 to 240 days, over four years.

If parents cannot demonstrate sobriety within the children services system’s timelines, or if they fall victim to an overdose, then children come into the permanent custody of an agency. Not surprisingly, the number of children awaiting adoption is up, a trend many agencies attribute to the epidemic.

The impact of opioids reverberates through every stage of the child welfare system and creates a snowball effect. It starts with more children placed in custody, staying longer because of relapsing parents, which in turn affects the availability of foster caregivers and places stress on kinship care providers struggling to meet the children’s needs with very little support.

The increased cost drains agency budgets, while caseworkers become frustrated with the lack of progress on cases, the long hours, and the secondary trauma of telling children that their parents have overdosed, ultimately leading to burnout and high turnover.

National intervention in the form of the Family First Prevention Services Act would have helped significantly, but the opportunity for real child welfare financing reform was lost. Meanwhile, public policy in Ohio has focused on expanding Medicaid to secure treatment services for addicts, prioritizing Medication-Assisted Treatment, limiting prescribing practices by physicians, and making naloxone available to first responders; all prudent steps.

Then, in March, Ohio’s Attorney General announced a $5 million grant to help children services agencies in 19 southern Ohio counties combat the opioid epidemic. Agencies will pilot a research-informed model for improving child safety, permanency, and well-being when parents are addicted to drugs, particularly opioids.

Called Ohio START (Sobriety, Treatment and Reducing Trauma), the program gives child welfare agencies resources to partner closely with behavioral health providers and juvenile courts to form teams that will provide necessary supports to addicted parents and their children. The pilot will study how effective these teams can be in the parents’ recovery by providing timely, accessible trauma-informed treatment, intensive case-management services, and recovery supports with certified peer specialists.

Research shows that more intensive casework is required to stabilize families suffering from opioid addiction and to reunify their children within federal timelines. But adding workers to reduce high caseloads and giving professionals the time they need to focus on these families is expensive.

Currently, a new statewide investment in child protection is being considered as part of Ohio’s biennial budget. Much more will be needed to address the $55 million increase in placement costs and the $24 million cost of caseworker turnover.

Sadly, Ohio has not yet reached the peak of this epidemic. Last in the nation for the state share of child welfare spending, Ohio must appropriate additional resources and supports for the children services system to adequately respond to the crisis created by the epidemic.

Excerpted from PCSAO Factbook 2017 (13^th Edition), available May 9 at www.pcsao.org/factbook.

Angela Sausser, MA, MSW, LSW, is executive director of Public Children Services Association of Ohio.