Opioid crisis gives rise to new caregivers who need assistance

Repeating a pattern that has tended to emerge in periods of widespread drug crisis, sudden increases in the number of children in foster care are being attributed to the surge in opioid abuse. A new report urges policy leaders to address the needs of children being raised by non-parent relatives as a result of parental substance use, whether within or outside the foster care system.

Generations United's Raising the Children of the Opioid Epidemic: Solutions and Support for Grandfamilies reinforces the research-backed point that children raised by grandparents or other relatives can have good outcomes, but that both the child and the caregiver need significant support. When a parent cannot fulfill the parenting role because of an addiction, and a grandparent steps in, both the child and the grandparent will experience mental health needs that will have to be addressed.

“Both will be experiencing loss,” Generations United executive director Donna Butts tells Addiction Professional. As the report states, “Caregivers may suffer from their own mental health issues, stemming from feelings of shame, loss or guilt about their adult child's inability to parent due to their substance use disorder.”

A look at the numbers

The overall number of U.S. children in foster care has begun to increase after years of decline, and experts are citing the opioid epidemic as the primary cause, the report states. Grandfamilies, in which a grandparent assumes primary responsibility to raise a child, tend to form first and foremost because of parental substance use, according to the report

In 2009, 22.1% of children entering foster care had parental substance use listed as a reason for the placement. In 2014, the percentage had increased to 29.7%.

Similar patterns emerged during the steep increases in crack cocaine use in the 1980s and 1990s. The report states that the foster care system cared for 468,000 children in 1994, compared with 276,000 children in 1985.

Caregiving responsibility among relatives cuts across all economic lines, indicative of the effects of a disease that does not discriminate. Yet Butts says all relative caregivers share a commonality of needing information and guidance.

“Because they haven't parented for some time, they may not be aware of [the Children's Health Insurance Program], or that the child may qualify for [Temporary Assistance for Needy Families],” says Butts. “They may not know what an [Individualized Education Plan] looks like.”

Kinship navigator programs are seen as a potentially invaluable resource for these families. Navigators offer a single source for information about health services, financial and legal assistance and other aid available to the family. Several states have navigator programs, Butts said, and the Family First Prevention Services Act that is now under consideration in the U.S. Senate would expand their use by making federal reimbursement to states available for the services. The legislation has cleared the House.

The report quotes grandparent caregiver Chris Mathews as saying, “I would have lost my mind without the Kinship Program. They helped me navigate the court process, secure Social Security for the children, and connect to support groups. When my grandson got into trouble they helped me fight to keep him out of a juvenile justice facility and get him the treatment he needed. Now he is working full time and recently graduated cum laude.”

Recommendations

For substance use treatment providers working with parents, Butts says it is important to consider the transitional planning that will be required to help all family members adjust to changed roles post-treatment. “It's really important in any treatment plan that it looks at the whole family,” she says.

The report states, “It is time to improve supports and services for all families impacted by substance use disorders, so that family-serving systems will be more poised to respond to the next epidemic.” Among its policy recommendations, Generations United (which among its efforts established the National Center on Grandfamilies) calls for:

• Allowing states to use federal child welfare funds for trauma-informed prevention services for families of eligible children in grandfamily situations.

• Prioritization of a relative's home as the best possible option for children whose parents cannot raise them because of a substance use disorder.

• Expediting grandparent caregivers' process for applying for and receiving federal financial assistance.

• Helping relatives understand the potential benefits of each of the options available to them under the child welfare system.