Better Than Punishment

From an editorial by Dr Ruchi Fitzgerald in LINK>The Hill – It is unimaginable to think that seeking medical care could lead to losing custody of their children, yet this devastating predicament is all too real for pregnant women with addiction in the United States.

In our nation, the systems that aim to protect children from the negative effects of parental substance use often prioritize punitive approaches over proven public health strategies. Fear of being imprisoned, stigmatized, or having their children removed makes many pregnant women with substance use disorder (SUD) afraid to seek medical care, contributing to poor maternal health outcomes. Some state laws, including the law in Illinois where I practice medicine, even mandate that health care professionals report cases of detected controlled substances in a newborn infant as evidence of child neglect. While the federal Child Abuse Prevention and Treatment Act (CAPTA) has no such requirement, CAPTA’s overall approach has led to significant variation in how states, counties, and health care institutions implement its reporting requirements when substance use is involved during pregnancy.

Threatening child removal from a birthing parent with SUD without a risk assessment or evidence of danger to the child is not ultimately improving outcomes for children. Research has long shown that children affected by the trauma of family separation tend to experience worse long-term outcomes on a wide variety of indicators, including education, health, housing, employment, substance use, and involvement with the criminal legal system. With over 400,000 children in foster care across the US, the trauma of separation is widespread.

Forced separation also brings unimaginable pain to new families – triggering in some parents such despair that it deters them from seeking or continuing medical care, including treatment for their SUD. Study after study shows child removal is associated with parental overdose, mental illness, post-traumatic stress disorder, and return to substance use. Public health-oriented policies that can result in better outcomes for families are part of the solution.

As an addiction specialist physician, I am involved with the medical care of pregnant people with SUD, and I have seen counterproductive child welfare and criminal investigations launched after a newborn infant tests positive for a controlled substance. Too often, parents become hopeless about recovery once their children are gone.

Current policies and practices related to substance use during pregnancy also result in serious health inequities. Pregnant and parenting people of color are much more likely to be impacted by forced separation than their white counterparts. Black parents are more likely than white parents to be reported for substance use to the child protection system at their child’s delivery despite similar rates of drug use, while Black and Native American children are overrepresented in foster care relative to white children in the setting of parental substance use.

Meanwhile, health outcomes are unnecessarily worse for mothers of color. Since 80% of maternal deaths are due to overdose or suicide, we can save lives with policies and practices that encourage treatment, not punish pregnant women with SUD for seeking it. Policymakers need to remove controlled substance reporting requirements that overreach and contribute to the current punitive approach.

The American Society of Addiction Medicine (ASAM) encourages child protective services agencies not to use evidence of substance use, alone, to sanction parents—especially with child removal; supports eliminating in-utero substance exposure language in child abuse and neglect statutes, and supports policies that extend social services benefits and financial support to families in need.

The US Senate will contemplate reauthorizing and reforming CAPTA this year. Health care professionals who treat pregnant people with medications for addiction, like methadone or buprenorphine for opioid use disorder, do not need to involve child protective services for that reason.

Recovery is possible with the right medical care and support. A pregnant person with addiction seeking medical care deserves a chance to heal and recover with her children. If we want pregnant and parenting people with addiction to access the evidence-based treatment they need, our decision-makers must embrace public health over punitive policies.

Victims of Adoption ?

There is currently some upset about birth mothers on TikTok (which I’m not on). An adoptee frustrated with birth moms who have large social media platforms of 30K+ subscribers. Adoptees whose voices should be elevated above birth moms not getting nearly as many views. These birth moms think they know it all when it comes to adoption, and that couldn’t be farther from the truth. Adoptees are the experts. Period.

At the same time admitting that it’s great they want to help reform the system, but they are part of the problem. They participated and benefited from the system. They signed on the dotted line. But there are first moms out there that are using their platform to profit. A few advise hopeful adoptive parents about how to attract expectant mothers to choose them, in exchange for a fee. They are dangerous and should not be held in such high regard (for example, being asked to speak at paid events).

Another adoptee writes – First mothers who use social media platforms to center themselves as the victims of adoption. In doing so, they focus the attention on their own self, putting themselves out there as the experts in adoption, when the people who should be receiving the attention for lived experience, the true experts in the post-natal trauma of adoption, are the infant adoptees. I am a domestic infant adoptee. I am also a mother of loss to Child Protective Services. I was given very little choice but to sacrifice my parental rights to the machine. I am not the victim of the system: My *children* are the victims. They are the ones who will live every moment of every day of their lives with the consequences of decisions I made, forced or not. If I was to center myself, I would create a vacuum in which there is no room for my children’s experience, and so, I choose to step back and allow them to be the experts regarding their experience — even when it hurts me. The problem with these “loud” mothers of loss is that they cannot comprehend that it really isn’t about them at all: it’s about the person they gave away. And as much as I feel for Baby Scoop Era moms…. I stand by this perspective, even with those mothers.

Baby Scoop Era. Took place during the period of approximately 1945 thru 1974. A time when single mothers–along with and by US society generally–were brainwashed into believing that single mothers could not raise, on their own, a child, and thus large numbers of white babies (mostly, due to demand) were made available to adoption agencies and through them to adoptive parents to “grab”.

Also at the end of the day, it is the children who are the victims. They are the ones *most* hurt by being denied access to their parents, and when their parents aren’t helped as much as possible, it is the children’s loss. Nobody gives a shit about the mothers. For most mothers of loss, they are just vessels for the baby the hopeful adoptive parents want. For those of us who lost ours to the machine, we’re the monsters who abused or neglected our children. It doesn’t matter how loudly we advocate for ourselves or one another, there is still a LARGE contingent of society who is going to see us that way. We’re abusers. Neglecters. Terrible people who hurt children. We’re lying because we have a blood in this game. Believe me – NOBODY CARES.

When we flip that narrative and talk about the children, knowing that the system was MADE for them, to protect them. Then, when we point out that the system designed to protect them is failing them, by exposing them to new trauma by removing them in the first place, then placing them with stranger caregivers who are often more abusive than their families were in the first place, now we have people listening. I’ve been in this fight for long enough to know that as a mother of loss, I’m easily dismissed. But the moment I talk about what my loved ones are experiencing in the care of their kinship caregiver, people start to listen. Better services for families is better for the kids. But we have to put the children of loss center stage, if we’re ever going to make a difference. Because it is the adoptees and the foster care youth who are the ones who really matter.

Kinship Caregivers

On December 29, 2020 – Ohio Governor Mike DeWine signed Senate Bill 310 which authorizes payments from the Ohio Dept of Job and Family Services to pay kinship caregivers. This is a big deal and hopefully other states will now follow suit. The governor noted that in Ohio alone, there are 2,600 kinship caregivers providing safe and loving homes to nearly 4,000 children registered in a children services agency.

The governor ordered the development of a system to pay kinship cargivers by June 1, 2021 and that payments to caregivers should be caught up retroactively to the date the bill was signed – December 29, 2020.

Across the United States, 4% of all children (more than 2.65 million) are in kinship care. In this arrangement, relatives raise kids when their parents cannot care for them. This is an effort to keep families together.

There are three general and sometimes overlapping categories of kinship care. These categories are: 1) private or informal care, where families make arrangements with or without legal recognition of a caregiver’s status; 2) diversion kinship care, where children who have come to the attention of child welfare agencies end up living with a relative or close friend of the family. and 3) licensed or unlicensed kinship care, where kids live with relatives but remain in legal custody of the state.

There are many reasons that a parent may be unwilling or unable to care for their child, including death, incarceration, illness, substance abuse and financial instability.

Kinship caregivers may be grandparents, great-grandparents, siblings, aunts, uncles, or family friends of the children in their care. Caregivers often feel responsible for extended family members and prefer to care personally for relative children who may otherwise end up in non-relative foster care. In many cases, grandparents and other relatives have not planned for the addition of children to the home, and may have problems accessing social and educational services that have changed drastically since they raised their own children. Some caregivers experience feelings of guilt and social isolation resulting from fear of the perception that one failed in raising one’s own child. Caregivers may be hesitant to pursue legal custody of children in their care if they want to maintain relationships with the child’s biological parent, or if they view the arrangement as temporary.

Grandfamilies face obstacles not encountered by biological parents such as obtaining medical and educational services for the children in their care and securing affordable housing in which they can live with the children. Many of the public assistance benefits available to birth parents and foster families are not available to kinship caregivers even if the child was receiving assistance in the parent’s home. Some states offer “subsidized guardianship” payments for kinship families with children placed through children services agencies or foster care agencies, although these payments are substantially less than payments that non-relative foster families receive.

Financial issues are common for many older grandparents and great-grandparents who are living on fixed incomes, Social Security or disability payments, who did not plan to raise children late in life, or who are raising children with demanding educational or medical needs. The prevalence of these financial issues has led to a high rate of food insecurity, job loss and home foreclosure in families who support additional children without adequate financial and service assistance. The obstacles can be even greater in “informal” care arrangements, where the relative caregiver lacks a legal relationship (such as legal custody or guardianship) with the child.