A generation ago, infants born of drug-addicted mothers were known as “crack babies.”
Now, social workers and health care professionals are having to set up treatment plans for newborns who are beset by maternal opioid addiction from heroin and related substances.
The problem affects children of all ages. Of Washington County’s 316 children in foster care last year, “64 percent of the kids came due to parental substance abuse,” said Kimberly Rogers, Washington County Children and Youth Services agency administrator. “It was 68 percent just a couple of months ago. You have to have programs. Kids are in foster care to ensure their safety due to the impact of opioids in our community.”
In Greene County, the number of children entering foster care has also gone up. According to Stacey Courtwright, director of Greene County Children and Youth Services, 23 of the 49 children in foster care right now are there because their parents have a drug problem. She said of those 23, most are under five-years-old.
“It’s the highest it’s been in a while,” she said.
Courtwright said caseworkers try to place children with family members before putting them in foster care, but when it comes to this drug epidemic, that’s become a challenge.
“It’s hard to find a family member or a kinship person who can also pass a drug test, because it’s usually a family issue,” she said.
Parental substance abuse leads to the largest number of children in foster care, followed by sexual abuse and neglect, Rogers said.
“We don’t want children to be in homes where they’re watching their parents die or overdose, or be sexually assaulted or neglected,” she said.
An infant living with his or her heroin-addicted mother or father would invite disaster unless the parent is also treated. Prenatal exposure to opioids means an infant will experience withdrawal symptoms, and it can impair a baby’s ability to suck and swallow. Some of the babies require feeding tubes, which requires additional medical support.
In fact, parental drug use has spawned a new category of statistical record-keeping at Washington County CYS.
“In 2015 we had 39 (infants) who had been prenatally exposed to or tested positive for one or more drugs,” Rogers said
“In 2016 it was 36 babies of that type. And so far, just in 2017, there have been 17.
“We just started collecting the information on that in the last couple years. We didn’t do that previously.
With mid-year approaching, Rogers updated the latest figures reflecting an unfortunate recent trend.
“As of May 31, we had 313 children in placement, and 70 percent of those children in placement were removed due to parental substance abuse,” Rogers said.
“That number has gone up. It went from 64 percent, a couple months later to 68 percent and now, we’re at 70 percent.”
To help infants cope with opioid addiction inflicted upon them in utero, Washington County CYS, with taxpayer dollars since Jan. 1, has had a contract with the Care Coordination for Babies Born Drug-Exposed program offered through the Children’s Institute of Pittsburgh, which has received 13 referrals.
It is a voluntary program, which begins with a phone call or a visit from a care coordinator.
According to Stacey Vaccaro, chief operating officer of the Children’s Institute of Pittsburgh, Washington County has the capacity to contract with the institute to accept 20 to 30 children annually. “A family can elect to participate or not,” she said. “It’s usually about 50 percent. Seven families are enrolled in services, and six declined.”
Approximately two years ago, the Children’s Institute, with West Penn Hospital, began an inpatient neonatal abstinence program for drug weaning as an alternative to neonatal intensive care units, which are likely too noisy for infants requiring calm.
“Since July 1, 2016, we have served six infants in our inpatient program for babies with neonatal abstinence syndrome,” Vaccaro said. “None of the referrals were received directly from Washington County CYS. These referrals typically come from acute hospitals that have labor and delivery services.”
The Children’s Institute wants to monitor the progress of babies who have gone through the abstinence program as outpatients through at least age 3 through voluntary care coordination from a developmental perspective.
The heroin scourge is occurring in Pennsylvania at a time when the state is financially strapped, and the current budget is set to expire June 30, but Rogers said her funding source for the neonatal program is secure through Dec. 31 of this year.
“The state is not funding that program for us,” Rogers said. “Don’t be surprised when we appeal the budget for 2017-18.”
The majority of the CYS budget comes from the commonwealth, although there is a possibility that some of the babies might qualify for federal funding.
The Washington County CYS annual budget was $29 million in 2016-17, but for 2017-18, funding is projected to drop to $26 million. The state House has passed a budget for the coming fiscal year, and it is awaiting action by the state Senate as the state looks at a $1.2 billion shortfall.
Appealing a state budget allocation, or lack thereof, does not mean initiating a court case. Rather, it means filing a letter that state officials then review. But a tight budget likely means funding for foster parents will be frozen despite cost increases.
“How am I supposed to retain foster parents to care for children?” she asked.
Rogers refuses to discontinue referring addicted moms and babies who would benefit from care coordination.
“We’re keeping it. I’ll find a way,” she asserted. “We’re going to do at the end of the day what we believe is right for families and children. My job is to find the money. I haven’t been over budget yet.”
Not all local infants born addicted to opiates go through the Children’s Institute programs. Sometimes, a relative moves into the baby’s home to help.
But the goal for CYS is the same: to develop a safe plan of care, Rogers said, answering the question, “How do we keep kids safe while mothers are getting the help and support they need?”
Courtwright said that in Greene County, much of the focus of treatment programs has shifted from the mother to the babies. She said babies are typically referred to them from a hospital.
“Where we struggle is when a mother has a prescription for Suboxone, and the baby still tests positive,” Courtwright said. “A lot of times our hands may be tied if the mother has a legal prescription. Depending on the hospital policy on how they report things, there may be a child out there who needs service, but we never got a report.”
When a report does come in, the baby is most likely to be referred to the county’s Early Intervention Program, which gives at-risk infants and children an assessment to see if exposure to drugs has cause a delay in their development. If specialists discover a delay, they will recommend a type of therapy or treatment.
Lauren Chambers, the director of the Early Intervention program, said it is free to anyone regardless of income, as long as a developmental delay is discovered.
“The past five to six years, we’ve seen a lot more babies that are born addicted,” she said. “Our goal is to not just provide services to the child, but to the whole family and to enhance the family’s capacity to stimulate the child’s growth.”