Last fall when HHS released the new ACFARS Report Number 23, they pointed out that nearly three quarters of states reported an increase in the numbers of children entering foster care from 2014 to 2015. They went on to highlight that the five states with the largest increases were Florida, Indiana, Georgia, Arizona, and Minnesota; these five states were also among the states with the largest increases between 2013 and 2014.  But most significantly they also stated that “parental substance use may have contributed to the growth in the child welfare population. From 2012 to 2015, the percentage of removals where parental substance use was cited as a contributing factor increased 13 percent (from 28.5 percent in 2012 to 32.2 percent in 2015)—the largest percent increase compared to any other circumstance around removal.” Over that period foster care numbers have increased from just under 400,000 to 427,000 children and youth in care.

The role of substance use and mental health issues in not new to child welfare, foster care and removals.  CWLA has been referencing and raising it for years within its legislative agendas, publications and other work including last year’s conference, Advancing Excellence in Practice and Policy: What Works for Families Affected by Substance Use.  What is new however, is just when the nation is starting to address the need for more drug treatment and mental health services through the combination of mental health parity laws and the ACA, we could lose it.

As we stated before in this publication, the ACA provides more than $5.5 billion in substance use and mental health services. That figure is based on research by to health experts from NYU and Harvard recently published in the Capitol Hill publication, The Hill.  The Washington Post on Friday, March 10, doubled down on that research with an article, that said, “Medicaid pays for 49.5 percent of medication-assisted treatment in Ohio, 44.7 percent in West Virginia and 44 percent in Kentucky…” The reporters also went back to the two authors Richard Frank and Sherry Glied who pointed out that a full repeal of the ACA would result in a loss of coverage for 2.8 million people with 220,000 of those people having an opioid addiction.  Frank pointed out that substance use disorders is, “a disease that hits suddenly at various points in the life cycle and is a chronic-relapse disease…” with a need to go back on Medicaid. While Speaker Ryan’s plan would leave the “essential benefits” package as part of private health insurance it would repeal it under Medicaid.  That combined with the repeal of the Medicaid expansion and the inclusion of a per capita cap would, in many cases, cut off people and in other cases allow Medicaid but eliminate treatment coverage.

And all that effects foster care, child abuse and all of child welfare.  If health care is a complex issue as the President says, so is child welfare.  Children and families involved with child welfare don’t exist in a bubble funded solely by Title IV-E and IV-B. Last year’s Families First Act would have provided important substance use and mental health services for 12 months while last year’s drug package, the CARA Act, provides $500 million in new treatment dollars this year and next.  Both important steps but both dwarfed by the dramatic cut-backs that would happen under the current health care reform package.   A 2005 report,

A Review of Alcohol and Other Drug Issues in the States’ Child and Family Services Reviews and Program Improvement Plans concluded:

  • Parental substance abuse was reported as a factor in cases in 32 states.
  • It was identified as a factor that brought the child to the attention of the child welfare agency in 16 to 61 percent of cases
  • Parental substance abuse as a primary factor was reported in 34 states and was identified in 2 to 44 percent of cases
  • Substance abuse by the child was reported in seven states.
  • It was identified as a factor bringing the child to the child welfare agency’s attention in 2 to 48 percent of cases.

In addition to those statistic, the new AFCARS report for the first time included data on reasons for removal of the child.  In 32 percent of the cases it involved parental drug use, 6 percent alcohol, 14 percent parental inability to cope, and in 11 percent of the cases child behavioral issues were at least one of the reasons for removal.

If we are too make more lasting reductions in foster care and prevent child abuse and neglect and child fatalities, it can’t happen without a vigorous system of substance use and mental health services, it’s part of any child welfare finance reform.