Tag: Substance Abuse

Unrecognized Trauma

I came upon this article – LINK>The Unrecognized Developmental Trauma of Early Relinquishment in Adoption by Meggin Nam Holtz in Visible Magazine. The link was shared due to someone else’s interest in researching both the positive and negative effects of adoption and that resulted in someone pointing to this link as one they have found useful.

In response to the initial research interest, one adoptee noted – unfortunately I think it’s harder to find the studies and statistics because no one wants to crush the pretty package of “adoption is beautiful.” However, if you check out the statistics of children raised by their biological parents vs raised by unrelated people, the kids raised by unrelated people are more likely to be abused, suffer various issues and not have the greatest outcomes.

The challenge is – We can’t even fully use that research since as soon as the child is adopted, they no longer fall into the “unrelated” category. My personal opinion is that, if research was honest, we’d see a lot less “natural” parents and their children listed under abusers or abused, in the mental health statistics. But again, society doesn’t want to acknowledge that taking someone else’s child and claiming it as your own might not be so great for the kid in the long run.

Also, if using google to research, I’m fairly certain you will be pulling up what everyone else is, ultimately, it’s a matter of what you’re willing to accept. You can go pretty much anywhere in the internet world and see undeniable proof of the negative outcomes of adoption, I hope all of those lived experiences that adopted people are telling the world aren’t secondary in your mind, due to them not being the result of technical studies done.

In other words – a Google search will give you the rainbows and unicorns story most of the time.

The link above is from a paper used in a Master of Social Work graduate school professional seminar related to child trauma. She notes that she is a female adopted person who was adopted in infancy and a clinical social worker working with the adopted population. VISIBLE Magazine® is an online publication committed to making storytelling accessible and inclusive. The publication actively privileges the work of those whose voices have been intentionally ignored or suppressed by traditional media outlets.

Meggin Nam Holtz notes – Permanent physical separation between birthing mothers from their babies is commonly referred to as “relinquishment” in the context of adoption. This discussion article will explore developmental effects of relinquishment occurring at birth and in the early days of an infant’s life.  Examination of neurological, attachment, and developmentally positive outcomes attained through maintaining physical interactions between mothers and their infants during the first hours and days of infant life sheds light on what is missed if a separation occurs.  Contrary to conventional beliefs and attitudes that a baby will not remember or be affected by early life experiences, the neurological impacts of stress in very early life such as relinquishment should be re-framed, acknowledged, and understood as a form of developmental trauma.

She goes on to frame the issue (and cites papers & studies) – there is a misconception in conventional attitudes that young children cannot and will not remember traumas experienced in their first few years of life. It is commonly believed that children “removed at birth may be spared the impact of ACES” (Adverse Childhood Experiences) and although adoptions that take place at an earlier age are often associated with better outcomes, adoptees who experience relinquishment at all ages are vastly overrepresented in mental health and substance abuse clinics, are at higher risk for mood disorders, mental health issues, and are four times more likely to commit suicide than non-adoptees.  Adoptees are an unrecognized marginalized group deserving of specialized services that are currently lacking.  

She hopes that her article debunks the myth that when placed into the best of circumstances, adoptees separated from their birth mothers in early life, do not face challenges due to long lasting developmental, emotional, and behavioral effects. The truth from the adoptees themselves is otherwise.

From there, she shares some of the history of adoption – From 1937 to 1965, the number of adoptions in America grew from 8,000 to over 70,000 due to the fact that newborns, as opposed to older children, became available. [blogger’s note – Actually, my parents were born and adopted in the 1930s.] And then adds that in the present day, there is often no waiting period at all between the actual birth and placing a newborn into the arms of an adoptive family. [blogger’s note – My parents DID spend at least the first months of their lives with their birth mother before being given to unrelated persons to raise.] She indicates that denying a newborn the smells, tastes, movement, and sounds of its birth mother creates a stress response.

There is much more in her paper, and if you are at all interested, I would suggest reading it.

We Were Once A Family

You probably remember the horrific story – In March of 2018, an SUV carrying two adults and six children drove off a cliff along Pacific Coast Highway. It was deemed a murder-suicide at the hands of Jennifer and Sarah Hart, a white lesbian couple who adopted the Black children from two families in Texas children on board.

The above and what follows are thanks to a story online by LINK>WBUR about Roxanna Asgarian, author of the book who’s cover is above. When the Houston reporter sought out the birth families of those children, she discovered a flawed and over-burdened child welfare system that routinely mistreats Black families. What started as a newspaper assignment turned into Asgarian’s new book.

The birth mother of three of the six children was battling drug addiction. Her children were cared for by their aunt and a father figure, who was not related to them. They were removed by Child Protective Services when the aunt asked their birth mother to babysit one day because she could not find any other childcare. The other three were removed from their birth family for reasons of supposed medical neglect. Actually, one of the children was bitten by ants at a birthday party. Their birth mother had not been able to find a ride for them to the hospital.

The adoptive mothers, the Harts, had been investigated multiple times for abuse and mistreatment. Even so, the children were never removed from their care, even when they displayed bruises and malnourishment. Asgarian says, “I knew immediately when I was let into the homes of the birth family of three of the kids that this was a child welfare story. It seemed increasingly clear as time went on that the systemic part of the story was being totally overlooked.”

You can read an excerpt of her book at the link above.

Foster Care Reform

Discussion topic from my all things adoption (and foster care because they are very much intertwined) – Being a foster caregiver means you are contributing to a flawed and broken system. It makes you part of the problem.

Foster carers don’t like to hear that, they prefer to feel they are saviors. They will use terms like they are a “soft place for these kids to land while their parents work on the issues that got them there” or they just want to be a “place these kids feel safe and loved”. They want to “make a difference” in these kids lives because that feels all warm and cozy and is the perfect look at me social media moment.

Lovely sentiments..I’ll say good intentions as well, but they are only that..lovely sentiments that mean nothing when you have a corrupt, controlling, biased system watching over you. Your hands are tied.

How can you better help kids other than being a foster caregiver and taking your instructions from a corrupt system? What specific changes need to be made in child welfare for it to even be remotely something someone should consider aligning themselves with?

Some of the thoughts on this –

Becoming a CASA advocate. It’s free, and the classes are typically offered 2-3 times a year. Connecting with kids through programs like Boys and Girls Club, Big Brother Big Sister. Reaching out to vulnerable families and offering help directly to them.

The biggest change is that the resources given to fosterers need to be redirected to families in need and family preservation as a whole. Poverty should never be a cause for removal.

One notes – the system needs to look for more kin. This idea that only the next of kin can take children supports the system not putting any effort into keeping kids with family. Half the time they don’t even look for family. They say they do, but they don’t.

It should go without saying but still it must be emphasized that nobody wants kids in an unsafe situation (even though Child Protective Services regularly leaves children in awful situations). And I’m sure there are instances where a trained non-relative’s residence is the best place to support the child. But those services must be disconnected from the foster system as we know it.

From a social worker in the field of family preservation – the continued participation of foster parents is propping up the system. I work in a system with many examples of how easy it is to eliminate the need for fostering. Kinship care is one – here, kinship is defined according to Indigenous cultures, which is any person involved in the child’s life, culture, or community. Family preservation programming is another, either through social supports coming into the home or the family moving into a residential facility with all needed supports in place. Another option is supported living placements for youth; they live independently in their own apartment with support workers and services integrated as needed.

Stop viewing being poor as a moral fault or think it automatically makes you a bad parent.

A former foster parent writes – I stopped being a foster parent when I realized how little support and care the parents received. I think it was actually a social worker than made me realize it when she said you and every other foster parent are no different than the parents. You could easily be in their same situation. I think more foster parents need to realize they are no different and start thinking about what they would want if they were in the same situation.

Personally if my kids were removed I would want full access to them, their healthcare, their school records and sports. I would want for them to be returned as quickly possible. That being said I am clueless and ignorant on how to help and how to support these families. I feel like the biggest problem in our area is drugs. Other than carrying Narcan, I don’t know how else to support help these families staying together. To which, someone else suggested – You can get involved with your local women’s shelter, Domestic Violence Shelters, etc – that is a start.

Yet another notes – there are some areas that are beginning amazing programs that foster whole families, either in home or out of home. LINK>Saving Our Sisters is a great place to start, volunteering as a sister on the ground. I love that you understand and empathize with parents. That’s rare and appreciated.

Another option is helping with food pantries and clothing pantries. Personally, I refuse to have anything to do with goodwill or salvation army because they are beyond problematic. LINK>The Trevor Project is another wonderful organization to get involved with to help at risk LGBTQ youth. Churches are also a great place to reach out to. Many of them have programs that help the community, but always need help.

There are courses you can take through Red Cross that offer Infant CPR and Child Care Certifications. Go into online community pages and explain that you are a former fosterer and you have infant CPR training (basically put out your credentials) and offer to help with child care.

I could go on and on but there is always another way to address social problems beyond tearing genetically related, biological families apart.

Kid’s Count

Someone noted – Foster Care causes 61% of All Child Abuse in America. So I went looking and found this, at The Annie E Casey Foundation – LINK>Child Welfare and Foster Care Statistics. KIDS COUNT is a robust source of the best avail­able data on child well-being in the nation. This includes state-by-state data on child abuse and neglect and chil­dren liv­ing in out-of-home care from the Nation­al Child Abuse and Neglect Data Sys­tem, the fed­er­al Adop­tion and Fos­ter Care Analy­sis and Report­ing Sys­tem, and the Nation­al Youth in Tran­si­tion Data­base. These data help our Foun­da­tion and lead­ers across the coun­try to mon­i­tor trends, assess the child wel­fare sys­tem, and advance poli­cies and prac­tices to improve out­comes for chil­dren, youth and fam­i­lies — par­tic­u­lar­ly for children of color who are overrepresented in the system and more like­ly to expe­ri­ence neg­a­tive outcomes.

KIDS COUNT offers more than 60 mea­sures of child wel­fare, encom­pass­ing how many chil­dren and youth are in the sys­tem, the rates at which they enter it, their demo­graph­ic char­ac­ter­is­tics (includ­ing race and eth­nic­i­ty when avail­able) and their expe­ri­ences in fos­ter care, exit­ing care, being adopt­ed when applic­a­ble, aging out of the sys­tem and more. In addi­tion to child wel­fare sta­tis­tics at the nation­al and state lev­els, KIDS COUNT also pro­vides data by ter­ri­to­ry, when pos­si­ble. Pol­i­cy­mak­ers, child wel­fare agen­cies and oth­ers have used these data for decades to under­stand how well the sys­tem is meet­ing the needs of vul­ner­a­ble chil­dren, youth and fam­i­lies, and how it can be strength­ened so that all abused and neglect­ed chil­dren can heal and grow up with safe, sta­ble families.

Chil­dren and youth who expe­ri­ence trau­ma, includ­ing abuse or neglect, are at increased risk for long-term emo­tion­al, behav­ioral and phys­i­cal health prob­lems, among oth­er chal­lenges. The data measures high-risk behav­ior, such as juve­nile jus­tice sys­tem involve­ment and sub­stance abuse, dif­fi­cul­ties with men­tal health, phys­i­cal health and aca­d­e­m­ic per­for­mance. The con­se­quences of child mal­treat­ment can be mit­i­gat­ed with equi­table access to trau­ma-informed ser­vices and nur­tur­ing, last­ing fam­i­ly rela­tion­ships and support.

Fos­ter care is meant to pro­vide safe, tem­po­rary liv­ing arrange­ments and sup­port ser­vices for chil­dren who have been removed from their fam­i­lies due to mal­treat­ment, lack of safe­ty or inad­e­quate care. The rate of children entering foster care has hov­ered at 3 or 4 per 1,000 for two decades. Kids ages 1 to 5 make up the largest share (29% in 2021) of chil­dren enter­ing care. Nation­al data also show that Black and Amer­i­can Indi­an and Alas­ka Native chil­dren con­tin­ue to be over­rep­re­sent­ed among those enter­ing fos­ter care. The rea­sons for this are com­plex, and efforts to improve racial equi­ty in child wel­fare have been under­way for many years.

In encour­ag­ing news, placements with relatives increased from 25% to 35% dur­ing 2000–2021, while place­ments in group homes or oth­er facil­i­ties were cut in half, from 18% to 9%. Few­er chil­dren are placed in pre-adop­tive homes (4% in 2021) or have tri­al home vis­its (5%), and some old­er youth live inde­pen­dent­ly with super­vi­sion (2%). Over a third of fos­ter chil­dren and youth expe­ri­ence more than two place­ments each year, mean­ing their liv­ing arrange­ments change at least three times a year.  Child wel­fare agen­cies are work­ing to min­i­mize these moves, as they are dis­rup­tive, stress­ful and often trau­ma­tiz­ing. Sta­ble rela­tion­ships and home envi­ron­ments are crit­i­cal for healthy child and youth development.

Of the more than 54,000 kids adopt­ed out of the child wel­fare sys­tem in 2021, over half were young kids ages 1 to 5, con­sis­tent with pre­vi­ous years. Most of these adop­tions are by the fos­ter par­ents (either rel­a­tives or non-rel­a­tives), who cared for the chil­dren while in fos­ter care. Unfor­tu­nate­ly, the medi­an amount of time in fos­ter care has increased over the last decade — from 13.2 months in 2011 to 17.5 months in 2021, based on chil­dren who exit­ed care in each year. How­ev­er, the per­cent­age of kids who spent 5+ years in care declined slight­ly from 7% to 5% in the same time peri­od. Among chil­dren who exit­ed fos­ter care in 2021, about a third (35%) were there less than a year, while near­ly half (48%) spent 1 to 3 years in care and 12% stayed in fos­ter care 3+ years.

More than 19,000 youth left fos­ter care in 2021 with­out reunit­ing with their par­ents or hav­ing anoth­er per­ma­nent fam­i­ly home. Thankfully, this fig­ure has declined since peak­ing at near­ly 30,000 in 2008. The tran­si­tion to adult­hood is a sig­nif­i­cant and chal­leng­ing devel­op­men­tal phase of life for all young peo­ple, but youth aging out of fos­ter care on their own must face this with­out the sup­port of a sta­ble, lov­ing fam­i­ly. Many also lose access to ser­vices and sup­ports that were offered to them through the fos­ter care sys­tem. Not sur­pris­ing­ly, these youth and young adults are more like­ly to expe­ri­ence behav­ioral, men­tal and phys­i­cal health issues, hous­ing prob­lems and home­less­ness, employ­ment and aca­d­e­m­ic dif­fi­cul­ties, ear­ly par­ent­hood, incar­cer­a­tion and oth­er poten­tial­ly life­long adver­si­ties. In line with the racial inequities not­ed ear­li­er, youth of col­or are more like­ly to expe­ri­ence these chal­lenges. The tra­jec­to­ries of these young peo­ple are not unavoidable. They can be pos­i­tive­ly influ­enced by poli­cies and prac­tices that ensure these vul­ner­a­ble youths receive cul­­tur­al­­ly-respon­­sive, trau­­ma-informed tran­si­tion ser­vices and sup­port to nav­i­gate the steps to adult­hood, achieve sta­bil­i­ty and reach their full potential.

None of This is OK

And yet, there seems to be no other choice in today’s story. Everything this person tried to do – failed. The kids are now 3 and 1. Mom was incarcerated, but has since been released. She contacted this woman 7 months ago and asked her to adopt the children. She tried to convince her that her kids need her. She went into social worker mode and asked her what her barriers to parenting were. She talked to the mom about substance abuse treatment options, housing support, financial support, etc. She told her that the best place for her kids is with her. She repeatedly reassured the mom that she on her team and wanted to help her. She told the mom that she has rights and that this case is not over yet – don’t give up. She tried everything she could think of to convince the mom to come back (she’s left the state). The mom called her from an unlisted number and wasn’t in an emotional space to hear all she tried to say. She was asked to call me back in a week (this woman was hoping maybe they could then continue the conversation) but the mom has gone no contact.

The permanency hearing is now coming up in 2 weeks. Because mom hasn’t been in contact with the Div of Child and Family Services (DCFS) now for 8 months, the Guardian Ad Litem is asking for reunification efforts to cease and the goal changed to adoption. This woman has woken up to the problems in the system and previously said she was unwilling to adopt them because she didn’t want to add further trauma to their lives – she sincerely wanted them to go back with their mom or be placed with relatives but a search for family on the mom’s side has been unsuccessful.

Now she is conflicted because she loves these kids but to be honest her feeling is that adopting just isn’t ethical at this point. She even decided to close her foster care license because she no longer wants to be involved in a system that tears families apart. She told herself that she’d just see this last case through. The problem is that these kids are going to be placed for adoption, no matter what she does. If she says no, then DCFS is going to start calling other foster homes in the region and find someone who will adopt them. Another home would be strangers, as she once was. But they also may not be the same ethnicity (the kids are Mexican and so is she). The 3 year old is established in her preschool and she has formed a relationship with her therapist. More to the point – this woman does love these children, cares deeply about their needs and tries her best to be trauma-informed and listen to adoptive voices. Realistically, she knows that she can never take their mom’s place. She knows that they will likely always have a gaping wound.

She knows that simply loving them is never going to be enough. That going will be hard, lifelong work on her part. She is honestly conflicted because she doesn’t want to be a further part of a system that is actively hurting them. But not adopting them feels like a cop-out. And the very idea of passing them onto a stranger feels devastating. None of this is okay. However, she got herself into this and she is going to do whatever she has to do on their behalf.

Messy Complicated and Beautiful

The joy and heartache of friendships. We love our friends and they can break our hearts – just being the messy, complicated and beautiful human beings we all are. That said, some lives are much more challenging than ours. And when our dear friend has such a life, out of love, we do our best with the reality. This is one such story.

I’ve adopted two little girls from a childhood friend. They are ages 5 and 3. The five year old, I brought home when she was born, her mom was very ill at that time. The 3 year old came to me through the foster care system, when she was 9 months old at her mom’s request. My friend had stage 4 cirrhosis during both of the pregnancies, as well as substance abuse and varying illnesses and had been homeless most of her life, was suicidal and with a history of violent behavior. She was in and out of jail. She passed unexpectedly in December two years ago.

I knew the girls had 3 older sisters who were adopted out by the state years ago. I had promised their mom I would look for them but today, they found me. They are 16, 18 and 19. They were looking for their mom. They asked me point blank if their mom was still alive. I answered that and a few questions. I did let them know that she loved them and missed them and thought of them every day and wondered how they were doing. She had hoped to connect with them again. I let them know they had little sisters We exchanged photos.

I just don’t know how to navigate this. I don’t want to give them a negative image of their mom. I’m thinking of just letting them know that she had had a lot of trauma that led to her addictions and illnesses, kind of a negative spiral she got caught up in but that she was a beautiful, amazing person with a big heart and a brilliant mind who was funny and creative and one of a kind….

Some responses to this sad story about life’s more difficult realities.

You tell those sisters that she was a human being that battled a war. With her self, her world, and still loved her children. Even while she fought. There’s something terribly strong and loving about that.

Let them know the truth as much as age appropriate for them to grasp. The real truth is people are messy & complicated & beautiful all at the same time, and that’s something they can grasp at any age, regardless of depth of details.

Please tell the older girls everything – the good, the bad, the ugly. They can handle it and it’ll be valuable information as they navigate their own trauma and mental health issues (and questions about their lives).

The woman replied – I’ve talked to two of the older girls and answered their questions. I sent them videos of their mom telling her life story, about her paintings and stuff.

Not A “New” Life

This comment came up in a discussion about how adoptive parents change the name of their adoptee when the adoption is finalized. One woman commented – “Nothing wrong with that, we started using his new name too to get him used to it. New life, new name.” She was quickly corrected – “I need you to fucking not. Adoption isn’t a “new life”, it’s a continuation of the life they are already living. This comment is insensitive at best.” This one had started new childcare job. She is a domestic infant adoptee. One child in her class is in the process of being adopted and that X is their legal name and Y is the name the adoptive parents have chosen to change it to. This child isn’t an infant, so the childcare workers are basically having to train the child to respond to a new name.

I will admit, I did a little sleuthing into the one who made the insensitive comment but could find nothing definite except that she is relatively new in the all things adoption group. There are some interesting photos but nothing certain as to her status in adoptionland but her comment seems to indicate an adoption there.

Lacking that, I looked for some context and found this recent (Oct 2022) article in The Atlantic LINK>Adoption Is Not a Fairy-Tale Ending, with the subtitle – It’s a complicated beginning. While maybe not perfectly what I was looking for, I did see how it begins – In America, popular narratives about adoption tend to focus on happy endings. Poor mothers who were predestined to give their children away for a “better life”; unwanted kids turned into chosen ones; made-for-television reunions years later. Since childhood, these story lines about the industry of infant adoptions had gradually seeped into my subconscious from movies, books, and the news.

The author, Erika Hayasaki, notes – researching a book on identical twins raised in radically different circumstances, the reality of adoption is far more complicated than some might think—and, as many adoptees and scholars have argued, deserving of a more clear-eyed appraisal across American culture. Her book, Somewhere Sisters, chronicles identical twins Isabella and Hà were born in Vietnam in 1998, and their mother struggled to care for them. Isabella (born Loan) was adopted by a wealthy, white American family that gave her a new name and raised her in the suburbs of Chicago. Hà was adopted by a biological aunt and her partner, and grew up in a rural village in Vietnam with sporadic electricity and frequent monsoons.

Twins have always fascinated me. I was born a Gemini and have always wondered what happened to my twin. When I was a child, my 13 month younger sister and I were often dressed alike and sometimes people thought we were twins. When my daughter was preschool age, she used to claim we were twins. I suppose I’ve had at least two surrogate twins in my life. I digress.

The author discovered that when reunions with birth families do happen, they aren’t always happy; they can be painful, confusing, or traumatic. Adoptees who are parents, lawyers, educators, or activists are challenging the rosy image of adoption that stubbornly persists in our culture. Children are not offered up for adoption in a vacuum. Many of them “are available because of certain, very strategic political policies.” Often the reasons for removing children from their parents comes under the heading of “neglect.” Throughout adoption history, this broad category has encompassed homelessness, poor hygiene, absent parents, and drug abuse in some instances, or simply leaving a child with caregivers outside the nuclear family.

A happily ever story after adoption often comes at the cost of forsaking everything that came before. The process, known in the adoptee community as coming out of the fog, refers to when an adoptee starts to see beyond the narrative about fate and question their true feelings about the adoption system, and how it has impacted their relationships, personalities, and identity formation. As the child of two adoptees, I also had my moment of coming out of the fog because adoption had seemed like the most natural thing to me until I was over 50, both of my parents had died and I began to discover my families true origins.

For me, coming out of the fog was, and continues to be, a process that involves simultaneously holding my adoptive grandparent’s love and good intentions in my heart’s memories alongside all the ways that adoption robbed me of what, for most people, is almost an unconsidered common reality. There are all of these contradictory realities within one’s experience of belonging to a family created by adoptions. The duality of that space can be hard for those without such a background to reasonably understand.

A Mother’s Trauma

In learning my parent’s origins stories (they were both adoptees), I have learned a lot about trauma. So much so that I can now recognize it in my own self. Some thoughts from Psychology Today – LINK>How a Legacy of Trauma Affects Parent-Child Relationships.

In the 1998 Adverse Childhood Events study, in a sample of approx 10,000 individuals, over half of all the people surveyed experienced at least one traumatic childhood event, and one-quarter experienced multiple. Experiencing these traumatic childhood events increased the risk for mental and physical health problems. The more traumatic the events, the higher the likelihood of poor outcomes as an adult. These poor outcomes include substance abuse, depression, risky sexual behavior, obesity, heart disease, cancer, lung disease, and others.

Childhood trauma can be transmitted across generations. When a mother experiences childhood trauma, that can go on to influence her bond with her own child. In effect, the trauma reaches forward to disrupt the normal back-and-forth engagement of mothers with their newborns. Having more adverse childhood events can predict a mother’s stress and mental health before she delivers. Women with more childhood trauma had more depression (before childbirth), more family stress, more daily hassles, more economic hardships, and experienced more negative life events. Stress and depression before childbirth are associated with postpartum depression having worse symptoms. In effect, childhood trauma sets mothers up to fail. They are in a worse situation when they are about to have a child, and that appears to make their postpartum depression worse.

This is how childhood trauma is passed forward to the next generation –

  1. A woman experiences trauma as a child.
  2. This trauma leads the woman to experience more stress and depression and to be at risk for other health problems.
  3. When this woman becomes pregnant, these stressors affect how she will respond to childbirth.
  4. Because she has more stress, the woman is more likely to experience postpartum depression.
  5. This postpartum depression disrupts the bond she is trying to form with her child. She is less able to engage fully and positively with her child.
  6. The poorer interaction and bonding end up harming both mother and child. The child is more likely to be stressed and have behavioral problems, and the mother is more likely to be depressed.

Evidence shows is that maternal mental health is not something that’s isolated from the rest of the family. It’s something that influences the entire family system, including the bond formed between mother and child. Healing needs to occur.

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.

NOT A Gotcha Argument

Whether this statistic is accurate or not, it is an issue close to my own heart and personal experience in life. That said, just passing this along as a kind of public service announcement from one such adoptee.

I am an adoptee whose birth mom was a drug and alcohol addicted teenager, who repeatedly abandoned me, abused me, and exposed me to abuse including child sexual abuse.

STOP USING ME AND PEOPLE LIKE ME AS A “GOTCHA” ARGUMENT FOR ADOPTION.

I couldn’t be more sick of reading, over and over, “what about the kids who actually do have abusive or neglectful birth parents, don’t they deserve adoption?”

No. There are still better ways. One of the biggest ways to prevent sad stories like mine is to fight for abortion rights, and fight against the societal narrative that vilifies aborting an unwanted child and glorifies adoption.

But most importantly, if you’re not one of us, you don’t get to use our existence as a talking point in your agenda.

(With my own apologies for making this my blog today but I thought it was important.)