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Nobel Lett (R), who suffers from Prader-Willi Syndrome and is treated under the Children's Health Insurance Program (CHIP), eats a snack with his family after school in his home in Columbus, Ohio, U.S. January 17, 2018.   REUTERS/Maddie McGarvey - RC14BB847C60
Up Front

The foster care system was unprepared for the last drug epidemic—let’s not repeat history

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“It turned out that I did have a lot of talent. I wouldn’t have known it if she didn’t bring it out of me. I wouldn’t have played alto-saxophone, I wouldn’t have learned to play the drums, I wouldn’t have learned how to draw, I wouldn’t have been that person, that artistic person who has a crazy knowledge for science. She’s supportive of me. She believes that I can do it. And she never stopped doing that.”
 
Quijai (Jay) Johnson speaking of her foster mother at the 2017 California Quality Parenting Initiative conference.

An estimated 500,000 children and youth are living in foster care in the United States today. A disproportionate number of them are poor and/or minorities. Foster care is intended to be a temporary safe haven until a child can be reunited with their family or until another permanent placement can be found. Being removed from one’s family and placed into foster care often results in life-changing trauma for a child, making the role of foster parents critically important to the child’s ability to cope and recover from trauma. The nurturing, guidance, and skilled parenting that foster families provide children and youth can make the difference in whether their trauma is exacerbated or they can grow and flourish. Indeed, foster parents are the child welfare system’s primary intervention for helping children. Unfortunately, current policies and practices do not adequately promote quality parenting in all foster care settings.

This is a problem we aim to fix.

CHAMPS is a new national policy campaign to improve outcomes for children in foster care. CHAMPS, which stands for CHildren Need AMazing ParentS, prioritizes the most powerful intervention for children in foster care: foster parents like Quijai Johnson’s who recognize their children’s gifts and do their best to encourage the development of their talents and happiness with love, support and guidance. The CHAMPS Policy Playbook offers policy ideas based on research that shows loving, supportive families – whether birth, kin, foster or adoptive – are critical to the healthy development of all children.

The opioid epidemic is pushing more children into foster care

Although quality of care has long been an issue, the current opioid problem brings much urgency to the need for quality foster parenting in communities across the country.  Local and state child welfare systems are on the front lines of the national response, helping families and children affected by the devastating epidemic. For months, media has reported that increasing numbers of children are coming into foster care in many areas as a result of parental drug addiction, particularly to opioids. These reports are consistent with the most recent federal data on the number of children in foster care which shows three consecutive years of increasing numbers of children entering foster care. Reports by federal and state public agencies responsible for foster care services indicate that the rise in parental substance use, including opioids, and the limited availability of other alternative responses, is likely a key driver in the uptick in the number of children entering foster care.

What’s more, the recently issued final report by the President’s Commission on Combating Drug Addiction and the Opioid Crisis called attention not only to the increasing demand for foster care, but also to the limited resources to support drug treatment or parenting classes and community-based support for these children. While foster care may not be the appropriate intervention for all these children and families, the numbers indicate that across the country more children are coming into care.

As long as the current trend continues, there will be continued pressure on child welfare systems to provide timely and appropriate services to children and families. Having more children in foster care will intensify what is already a problem in many states; namely, recruiting and retaining enough good foster homes for children who have been removed from their families. States should now be intensifying their efforts to find and train foster parents and to ensure state and county child welfare agencies have policies and practices that support foster parents, including kin, in providing quality parenting.

The CHAMPS initiative is convinced that over the next five-to-ten years we can, along with our partners, improve the nation’s foster care system by promoting quality parenting, including the supports and services to birth, kin, foster and adoptive parents.

As state leaders continue to respond to the devastating consequences of the opioid epidemic, we urge them to avoid past mistakes. We now know that responses to earlier drug epidemics made too little investment in strategies that could ensure safety and preserve families and which could have helped more children avoid the trauma of separation from parents. We also know that many child welfare systems, having become overwhelmed by the drug epidemic, too often lowered standards and failed to provide children in foster care with the intervention of quality foster parenting.

CHAMPS offers today’s leaders sound policy options that acknowledge lessons learned and leverage current innovations. The CHAMPS framework is one that raises expectations of foster parents while at the same time ensuring they receive the critical support they need to provide high quality care. Child development research, along with the experiences of children and families, show us that supporting quality foster parenting is the foundation of better outcomes for children in foster care. Quality foster parenting helps children heal from trauma, keep siblings together, increase stability and well-being, and ensure that children achieve permanency and consistent, loving care through reunification with birth families, placement with relatives, or adoption.

Why is CHAMPS needed?

The National Center for Health Statistics reported that overdose deaths reached a record in 2016, the steepest annual increase in a decade in the United States. Few of us are surprised by these reports; we have faced drug epidemics before, but according to David Patterson Silver Wolf, associate professor at Washington University, St. Louis, today’s epidemic is different: “The first was a heroin epidemic during the closing years of the Vietnam War. The death rate during that epidemic was about 1 per 100,000 people. Our second occurred in the early 1980s during the crack epidemic. The death rate during this epidemic was about 2 per 100,000. Our current opioid overdose epidemic’s death rate is about 10 per 100,000.”

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In each epidemic, the negative impact on family life has been exponential, and unfortunately, intergenerational. This intergenerational impact is seen in the children and sometimes the grandchildren. During the crack cocaine epidemic that ravaged poor urban communities in the 1980s, many children impacted were removed into foster care. Far too little investment was made in strategies that might ensure safety and preserve families, such as family residential substance abuse treatment. Instead, thousands of children were simply removed from their families and communities. Parents struggling with substance abuse often were criminalized, rather than provided access to the recovery programs, resources and supports that might have helped them remain intact as families or reunite with their children. Child welfare systems were overwhelmed, and often failed to provide children the safety, stability or parenting that would provide positive short- and long-term outcomes.

During the height of the cocaine epidemic, the number of children in foster care who had been prenatally exposed to drugs and alcohol increased from one quarter (1986) to nearly two-thirds (1991). The numbers of children in foster care rose dramatically from 400,000 in 1990 to an all-time high of 567,000 in 1999. Finally, in 2012, we saw a decrease, down to 5.4 per 1,000 children, but that was more than 25 years after the cocaine epidemic captured national attention. For far too many children, a system that was supposed to be a temporary safe haven became their permanent childhood. Those traumatic years in foster care were met with more trauma and hardship for thousands who aged out of the system at age 18 to begin adulthood without a place of belonging and without the confidence, supports or resources to navigate the real world.

New York City is a case in point. The city was totally unprepared for the crack epidemic. As The New York Times reported on March 15, 1987, very young children were languishing in residential care institutions and worse, being bounced from one institution to another. Some Family Court judges simply sent children home to “bad circumstances,” because these judges saw foster care placement as a “terrible alternative.” The article continued, “Abandoned babies live in hospital cribs and learn to walk while holding a nurse’s hand. A pregnant 13-year-old has been sleeping for weeks on a couch in a recreation room at a group home where 25 children live in space meant for 18. Troubled teenagers languish for months in chaotic observation centers where, according to workers and legal advocates, physical abuse of children by other children has become a daily occurrence”.

Learning from the Past

Is the history of the cocaine epidemic now repeating itself with the opioid crisis?  Though there is disagreement about the exact reasons, many states are now reporting a rise in foster care placements. Decreases in supportive service availability, and changes in removal policies have been suggested as possible reasons. Nonetheless, most jurisdictions are reporting that increased removals are a response to the opioid epidemic. On August 8, 2017, Mike DeWine, Ohio’s Attorney General, reported that “50 percent of the kids who are in foster care in Ohio are there because one or both parents are in fact drug addicts”. Ohio is not alone:  States from North Dakota and Oregon, through the Midwest and into the South, are reporting increases in foster care placements attributed to the opioid crisis. The eastern states and California are not exempt.

Foster care is an imperfect system, often criticized for its failures, bureaucratic inefficiencies, and poverty and racial bias, leading to the harmful and unnecessary removal of children from their homes, disproportionately from homes of poor families of color. Nevertheless, foster care can be a lifesaving intervention as a system of last resort that we depend on to ensure the safety of the most endangered children. As we face the third drug epidemic in recent decades that threatens to overwhelm some state foster care systems, we have an opportunity to learn from the crack epidemic of the 1980s.

Many of today’s legitimate complaints and general frustration about a foster care system that continues to allow more than  23,000 children to age out without safety, family, or a home, can be traced to the system failures that emerged during the crack cocaine epidemic. 

Between a Rock and a Hard Place

The child welfare system and the professionals and families working to keep children safe are now squarely between a rock and a hard place. We have more families that need supports and services, but have not made the investment in the substance abuse, mental health, or poverty safety net supports needed. There’s a growing recognition that removing children from their homes is, in itself, traumatic for children and that the services provided to families – including birth, kin, and foster – fall short of what’s needed to promote quality parenting.

As the research arm of CHAMPS, the Brookings Institution plays a key role in the national movement to make foster care more effective for children and families. The Brookings Center on Children and Families (CCF) is reviewing research on the quality of foster care offered by states, focusing on how the quality of foster care can best be measured and on the relationship between quality and children’s development and behavior. A special focus of CCF’s research will be on determining how to adapt or expand existing evidence-based treatment programs that have been proven to successfully treat the types of serious emotional and behavioral problems that affect many of the parents and children who wind up in foster care. This research will help the field know more about these intervention programs and how to implement them with foster parents who play the most important role in improving the success of children in foster care.

CHAMPS supports a network of collaborating organizations that encourage policymakers to adopt policies based on promising approaches that are grounded in evidence. We know that prioritizing parenting in our policy and practice and changing child welfare organizational culture is possible because states and local jurisdictions across the country are engaged in this important work through the Quality Parenting Initiative (QPI), the Youth Law Center’s effort to strengthen foster care by realigning policy, practice, and culture around excellent parenting as the highest priority.

QPI’s core value is that every child, every day deserves excellent parenting in foster care. QPI engages public and private agencies, courts, foster and birth families, youth and community partners in identifying problems and developing, implementing and sharing results-based solutions that align the system to support excellent parenting for every child and youth in care. QPI was initially adopted by three pilot sites in 2008, but has grown to sites in 10 states and over 70 sites. It is the statewide approach in four states. By working together as a community to support parenting, child welfare agencies have been able to achieve results such as more quality families, more effective birth and foster parent teams, improved decision making and team work, higher skill levels and more long term relationships for children. A major objective of QPI – and now CHAMPS –  is increasing the number of committed families, including kin, who can provide excellent parenting to children in care, in a manner that supports excellent practice and strives to ensure that every family can and does meet the child’s needs. Working with a coalition of national partners, including the Youth Law Center), CHAMPS is building on the success and momentum of QPI. Its focus is to encourage action by further elevating the understanding of policymakers and the public about the importance of quality foster parenting to children in communities across the U.S.

The current opioid crisis creates an urgent need for state and local leaders to ensure that every child who is removed and placed in foster care has the parenting they need and deserve. Quality foster parenting is a critical, ever-present need. It is our hope that decision makers will leverage the lessons learned from history and put policies and practices in place that reflect a clear priority on what children need most to heal, grow and develop: quality parenting.

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