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Substance use is driving children into foster care

If you need more evidence that substance use has a long-lasting and far-reaching impact, consider this heartbreaking data: The ongoing escalation of opioid use is driving a surge in children and youth entering foster care systems across the nation.

Even before COVID-19 upended global health, North Carolina’s foster care system was already experiencing “record levels of need” driven largely by opioid use. During the 2017-18 fiscal year, parental substance abuse was the primary reason children were removed from the household in nearly 40% of the cases.

In the wake of the pandemic, substance use has risen sharply and record numbers of opioid deaths have left even more families destabilized … and more children vulnerable.

This should be a call to action, not despair. Together, the health care industry, community organizations and community leaders can prevent overdose deaths. We can treat substance use disorder. We can help families reunite safely, and we can help children develop skills to cope with the trauma that family substance use can provoke.

All of this demands a broad strategic response, guided by the understanding that a whole-person, whole-community approach to prevention and treatment is the surest route to minimizing the impact substance use disorders (SUDs) have on families.

What works: a whole-person approach and a coalition of care

Investing in prevention and treatment benefits everyone, not just the families directly involved with SUDs. A holistic system of care that emphasizes positive outcomes in the form of family continuity and security helps build stronger communities.

A child’s safety and security should always be the top priority. But permanency of household and home have a significant long-term impact on health, well-being and success. Parental substance use and entry into the child welfare system are traumatic events for any person. Reinforcing a healthy family structure provides the best environment for healing from adverse childhood experiences. When the health care system and communities work together, we can put families in contact with the support and resources they need to manage substance use and become healthy, whole and functional once again.

This is one reason why it’s so important to place both primary care and mental health providers at the center of patient care.

It’s just as important to give patients and their families the right resources they need. Tools like ATLAS® – available through Shatterproof, a national nonprofit dedicated to reversing the addiction crisis in America – can help patients and their families make more informed treatment choices based on facility locations, standardized quality data and patient-reported feedback.

In addition, parents in recovery feel more empowered when they have the resources they need to meet non-medical needs. Barriers to employment, food security, housing, and transportation provoke the stress that often leads to substance use and other household traumas. Not surprisingly, research shows that when a parent gets support accessing these fundamental drivers of health, they are more likely to start and complete substance use treatment. Ultimately, this improves the odds of family reunification.

This is why Blue Cross and Blue Shield of North Carolina (Blue Cross NC) supports a wide range of community-based treatment and family-support programs, including:

  • Triangle Residential Options for Substance Abusers, Inc. (TROSA). TROSA is a multi-year residential and recovery program in Durham that provides education, jobs and ongoing care. Through work-based training at TROSA’s own companies—TROSA Moving, TROSA Lawn Care, and TROSA Thrift and Frame Store—men and women gain the skills they need to transition into the job market during recovery.
  • Home-based family trauma treatment services in Cumberland County. Healthy Blue, Blue Cross NC’s Medicaid program has collaborated with Thompson Child & Family Focus to launch an evidence-based model of family centered treatment in Cumberland County, which will provide long-term stabilization services to families with youth who may move between the child welfare and juvenile justice systems and who may be at-risk of unfavorable, potentially traumatic situations such as removal from the home. The program’s approach is extraordinarily effective: 90% of families who complete treatment maintain family placement, avoid out-of-home placement or are reunified with their families.
  • Youth Villages’ Intercept Program in Hanover County. When children are at high risk of entering the foster care system or a group home, Intercept helps change the family’s trajectory with intensive support, new parenting and communication skills and evidence- and strengths-based mental health intervention services. Family intervention specialists work with both the child and caregiver, meeting multiple times a week and providing around-the-clock on-call crisis support.

The high cost of inaction

Children and families shouldn’t face the challenges of substance use alone. Even when viewed solely through a cost/benefit lens, the failure to provide whole-person, community-based support for substance use disorder is extraordinarily expensive.

According to one study, between 2011 and 2016, nationally, opioid overuse contributed more than $2.8 billion in costs to the child welfare system. The bulk of that money – between $1.6 and $1.9 billion – was directed toward foster care. Costs related to child protective services (screening, assessment, investigation, and so on) totaled between $852 million and $900 million. Crucially, between $162 to $174 million went toward in-home treatment services.

By comparison, our nation spends a lot less on in-home services than we do on foster care, but these investments go a long, long way. They provide the sort of whole-person, whole-family approach to treatment that gets results: parental support and coaching; therapy; referrals for substance use and behavioral health treatments; support for job training; assistance with childcare, transportation and budgeting; and help addressing other drivers of health needs, such as food and housing security.

Of course, we can’t just use dollars and cents to measure the value of any investment in child welfare. Proactive interventions that keep families together – or which help them reunite – impact lives and make communities stronger. According to North Carolina Department of Health and Human Services data, more children aged 0 to 8 years old entered the foster care system in 2017 to 2019 than in previous years. That narrow window of time is a critical one in child development. By some estimates, 85% of a person’s brain has developed by the time they reach the age of five. This is the time when children form bonds with caretakers and develop indispensable cognitive skills. If physical, mental and emotional needs aren’t met, a child is more likely to face long-lasting effects on emotional intelligence, emotional development and social skills.

Substance use doesn’t determine any individual’s fate. Making the right investments at the right time can help households in recovery change course. Children are the living embodiment of North Carolina’s future. Everyone with a stake in community health owes it to them and to our state to think holistically about how we can help families overcome the challenges of SUDs.

Anuradha Rao-Patel, MD

Anuradha Rao-Patel, MD

Medical Director

Anuradha Rao-Patel, MD, is a medical director at Blue Cross NC. She 'ss responsible for the evaluation of the medical necessity, appropriateness and efficiency of the use of health care services, procedures, prescription drugs and facilities under the provisions of the applicable health benefits plan.

Before joining Blue Cross NC, she worked in a private practice doing acute and chronic pain management.

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