Tag: The Hill

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.

Privatizing Foster Care

A woman in my all things adoption group encountered this business (and by that I do mean for profit) at a pop up market. I had to go looking for a definition of that. Pop-up retail, also known as pop-up store or flash retailing, is a trend of opening short-term sales spaces that last for days to weeks before closing down, often to catch onto a fad or scheduled event.

She shares her experience thus – Today I did a pop up market and after I was fully set up I walked around. One of the other vendors that were there was this one (First Home Care). They claim to be there to help children in the foster care system. Ok, cool. I asked what they did for the community as I’d love to be able to help local families… The good ends there… After talking to the lady for less than 5 mins, She starts talking about how much money you can make as a foster parent. My jaw hit the floor. I was like are you a not for profit or a for-profit company? They are for profit… Not unification… Wtf… I told her she should be ashamed of herself and walked away… Is this common? I feel like a complete noob. I had no idea that there were foster companies for profit. Like I know there’s adoption companies for profit, but foster companies…

To which someone else posted a link to an article in The Hill – “Privatization of foster care has been a disaster for children.” The article highlights an abusive system, where corporations profit from and victimize vulnerable people: foster care for children.

Twenty-eight states allow some degree of for-profit contracting of foster care services. The private companies that make money off foster children would have us believe that they are providing quality service at affordable rates — as is often the selling point of privatization made to the general public. But evidence has shown that some of these for-profit services are rife with mismanagement and abuse.

One woman, who aged out at 18, describes her last (of 3 placements) in Utah – “It was the worst of them all. I still have bad dreams. My sleep was monitored; I wound up banished to the basement, alone for days. They listened in on my phone calls, read my mail. I was told the sexual abuse I had lived through was my fault. The meds they put me on threw my moods all over the place. I wanted to kill myself. I feel lucky I made it out alive.”  She had entered foster care when her mother died after being severely abused by her father.

Privatizing the core functions of the foster care system makes it harder for the public to exercise the necessary oversight over the activities of companies that are entrusted with the safety and well-being of vulnerable children. Of course, the for-profit foster care industry argues that abuse claims are nothing but isolated cases — bad apples in an otherwise pristine crop.

Foster care contractors benefit from a steady flow of children into the foster system, just as private prison contractors rely on the persistence of steady rates of crime and incarceration. A bipartisan congressional report released in 2017 by former Sen. Orrin Hatch (R-Utah) and Sen. Ron Wyden (D-Ore.) found that, by and large, “children who are under the legal authority of their state, yet receive services from private for-profit agencies, have been abused, neglected and denied services. The very agencies charged with and paid to keep foster children safe too often failed to provide even the most basic protections, or to take the steps to prevent the occurrence of tragedies.”