Keeping families affected by substances together as they heal
pediatricians have seen children affected by parental substance use disorders.
We’ve all taken care of children in foster care or state custody, and
we’ve seen the trauma that can result. Foster care is supposed to be the
safety net for kids in imminent danger, but what is the safety net to prevent the need for
foster care in the first place? And what if foster care is not in the best interest of the
child, in which case it only adds to their trauma?
Many people assume that most foster care placements are due to abuse. The reality is that the majority (roughly 75%) of kids in foster care are there because of neglect, which often stems from issues such as parental substance use or unmet mental health needs. I am seeing many more substance-exposed babies admitted to the NICU, and many more placed in foster care.
Kansas and neighboring Missouri, where I practice, are among many states seeing a rise in children being placed in foster care. Parental substance use was a factor in 46% of foster care placements in Kansas and over 50% of placements in Missouri, according to the most recent statistics.
More than half of children placed in foster care return to their families at some point. So what happens to their parents during this time? Do they get the resources and treatment they need to address the root of the problem?
More importantly, what happens to the children during this time before they return to their family? If only there was a way to get families the care they need while keeping them together, putting the priority on family, first.
“Foster care is supposed to be the safety net for kids in imminent danger, but what is the safety net to prevent the need for foster care in the first place? And what if foster care is not in the best interest of the child, in which case it only adds to their trauma?”
Making landmark reform a reality for families
The Family First Prevention Services Act is bipartisan, AAP championed legislation
that was signed into law in 2018 and has the power to transform child
welfare throughout the United States. This policy allows states to use
federal funds previously limited to paying for foster care to prevent
the need for foster care placement. By providing access to in-home
services including substance use disorder treatment, mental health
services (for parents and children), and intensive parenting education,
families can heal together.
Prevention is at
the heart of what pediatricians do. Through Family First, scientific,
evidence-based interventions can be used to help avoid further trauma
and the need for foster care while improving outcomes. Pediatricians
know the potential effects of foster placement on child health and
development. We’ve seen the long-lasting trauma of separation to both
children and parents. Keeping families safely together while parents
get treatment for substance use disorder and children receive
trauma-informed care to address the impact of parental substance use represents the best evidence-backed approach. It can increase the likelihood of recovery for everyone.
The opioid epidemic adds urgency to the tenets of Family First, spotlighting mental health and the need to treat disorders of the brain like any other organ. It gives us the opportunity to discuss the importance of trauma-informed pediatric care. Most importantly, it highlights the importance of strong families in optimizing growth and development of children. Family First incorporates the best scientific evidence on child trauma, development, and attachment and offers states the tools to provide families in crisis the services they need.
However, while Family First has been signed into federal law, states have to act and allocate matching funds to implement it. Children need pediatricians to educate state legislators on why these changes in child welfare policy will benefit the health and well-being of the children and families you care for in your state. Without state action, children in your state will not benefit from these policies.
I've worked with my chapter here in Kansas to organize successful advocacy to encourage our state to implement this critical law. I am excited that in recognition of National Foster Care Month in May, AAP has developed a Family First Advocacy Toolkit and a May 1 advocacy day of action so that pediatricians can share their stories about why these policies matter for child health.
Family First is a landmark reform of federal child welfare law with the opportunity for states to better serve vulnerable children and families. As pediatricians, we have the power, responsibility and privilege to help ensure this needed reform is put into action.
* The views expressed in this article are those of the author, and not necessarily those of the American Academy of Pediatrics.
Dena K. Hubbard, MD, FAAP, serves on the Kansas American Academy of Pediatrics (AAP) Board of Directors and Chair of the chapter’s Public Policy Committee. She is also an active member of AAP’s Section on Neonatal-Perinatal Medicine. Dr. Hubbard, works as a neonatologist at Children's Mercy Kansas City.