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Nation's opioid crisis overwhelms foster-care system

Deb McLaughlin of Greenbush, Maine, swings a toddler and her 3-year-old grandson in her back yard on June 30. She and her husband foster their grandson, who was born addicted to drugs, along with a toddler from another family. Tristan Spinski/For The Washington Post1 / 3
Debbie McLaughlin, of Greenbush, Maine, guides a toddler in foster care into her backyard to play with her 3-year-old grandson on June 30, 2017. Tristan Spinski/For The Washington Post2 / 3
Debbie McLaughlin, of Greenbush, Maine, with her 3-year-old grandson in her bedroom on June 30, 2017. Tristan Spinski/For The Washington Post3 / 3

GREENBUSH, MAINE -- Deb McLaughlin's 3-year-old grandson climbed all over her, pleading to play trucks, restless as always. Her 1-year-old foster daughter, who had just woken from a midday nap, sat in her lap, wearing a frilly dress and an irresistible smile. At least McLaughlin doesn't have to worry about the daily shots of methadone anymore; at least these babies no longer scream and shake for the opioids to which they were born addicted.

This isn't what McLaughlin envisioned for her empty nest years in rural Maine, trading camping and four-wheeling trips for social-worker check-ins, meetings with behavioral therapists and supervised visits with the drug-addicted biological parents who had to give up these children. McLaughlin's daughter, who once dreamed of being a lawyer, is one of the millions of Americans addicted to opioids and one of thousands of parents whom state governments have deemed unfit to care for their own children.

"It's heartbreaking to watch a baby go through withdrawal, and then give that baby back to Mom," McLaughin said as she prepared snacks in her blue mobile home outside Old Town, along the Penobscot River. "Because she did that to her."

More than 1,000 children are born addicted to drugs in Maine each year, many of whom end up in foster care. The two children in McLaughlin's home were among the more than 1,800 in foster care statewide in 2016, a nearly 45 percent increase in foster children here since 2011.

The trend in Maine is echoed in foster-care systems throughout the country, especially in rural areas hit hard by addiction. Many are becoming overwhelmed as the opioid crisis has forced more and more children into state custody.

Massachusetts experienced a 19 percent increase in children in foster care between 2011 and 2015. Ohio's foster population has gone up nearly 10 percent, with more than 60 percent of children in the system because of parental drug abuse. The number of North Dakota children in need of foster care has gone up more than 27 percent.

Foster-care experts say that as the drug epidemic has intensified during the past two years, another rush of children has entered the system. State budgets are stretched, social workers are overloaded, and not enough families are willing to provide children with temporary homes.

American foster care, experts say, is in crisis.

"It's pretty much every state -- except maybe four or five -- that have seen an increase in the number of children in foster care," said John Sciamanna, vice president of public policy at the Child Welfare League of America. "What you are seeing now is just a straining of the system."

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The widespread and growing abuse of opioids and methamphetamines has played a significant role in reversing what had been a positive trend in the number of children needing foster homes. At its modern low point in 2012, 397,000 U.S. children were in foster care, according to data from the U.S. Department of Health and Human Services. By 2015, that number had risen 8 percent, to 428,000, and experts say the past two years -- the height of the opioid epidemic -- has increased that number dramatically, although concrete data is not yet available.

The progress in the early 2000s was linked to the implementation of laws meant to prevent children from languishing in foster care and providing financial subsidies as incentives to adopt, Sciamanna said, including President Bill Clinton's signing of the Adoption and Safe Families Act in 1999.

But as the increase in drug abuse affects many layers of society, it also is complicating the typical pathways to adoption. When children come from a violent home, for example, it's a relatively straightforward decision about whether to permanently terminate a parent's right to care for them. With drug addiction, which can be a hidden issue and can involve treatment, recovery and relapse, the decision to take a parent's children away can be difficult and take a very long time.

"You begin to look at all these various impacts across multiple systems, but I would say the child welfare system is really the canary in the coal mine of a growing crisis that's not going to go away anytime soon," said Wendy Ellis, a public health expert at George Washington University.

Danylle Carson, a lawyer who represents children in foster care and who grew up in Maine state custody herself, said the ultimate goal is to reunite foster children with their biological parents. But that is often a lofty -- and unattainable -- goal.

She has worked with children in rural Maine who were plucked from their schools and moved to a foster family hours away because there were no closer options. Social workers have been staying with children in hotels overnight because they can't find a foster home. Cases have been delayed because social workers are too overworked to make all their required visits.

"There are not enough caseworkers, and there is not enough funding," Carson said as she worked inside a Lewiston courthouse, arguing that proposals to cut $140 million from the state's Health and Human Services budget could have terrible effects across Maine. "These are signs of a system crashing."

Add to that the opioid problem. Medical research, including a 2015 study from the National Institutes of Health, has found that children exposed to opiates during pregnancy suffer from behavior and attention problems. Such children require therapy and often specially licensed and trained foster families, and states say they are struggling to recruit foster families to house them.

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The little girl whom McLaughin fosters and hopes to adopt suffers from hepatitis C and severe asthma. McLaughlin, who works at a therapeutic foster center, describes her 3-year-old grandson -- who likes morning snuggle sessions and giggles with delight when his foster sister wakes from naps -- as an "adrenaline junkie."

Instead of drugs, the toddler seeks out pain. He has a sensory-processing disorder, his little body covered in bruises and scabs and his bedroom floor covered in padding because, as an infant, he would bang his feet so hard against the floor they bled. He sometimes turns violent and is no longer in group day care because he has tried to hurt his classmates.

"It's hard to see, especially your grandchild," McLaughlin said. "It's hard to see him go through these emotional meltdowns when he's inconsolable. I have seen my husband near tears because his grandson is in such an emotional state."

Other foster parents similarly described hosting children who had sensory disorders, speech delays, and sleep anxieties that developed while the children were living with their drug-addicted parents.

Bette Hoxie, executive director of Adoptive and Foster Families for Maine, said far more infants are entering the foster system now, in large part because of a state law that requires infants to be tested for drugs at birth if their mother is suspected of using them while pregnant.

Hoxie's organization, which has a contract with the state, provides support and training to foster families. It has had to boost staffing to try to meet the growing demand, about 900 calls for help each month, she said.

Hoxie lost a son to drug addiction two years ago, and she has fostered more than 100 children in her Bangor home, including a 2-year-old who lives with her now. She also is hosting an adopted son, who suffers from addiction, and his wife. They are working to regain custody of their young child.

"I don't think there's been a conversation in the last year about foster families or kinship families that didn't allude to substance abuse," Hoxie said.

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The dramatic increase in the need for foster care has states scrambling.

Massachusetts hired 15 people last year to recruit new foster families, according to a spokesman from the state's Department of Children and Families. Vermont officials have begun collecting car seats for the state's foster parents because there are so many infants and toddlers seeking refuge there. Texas passed legislation allowing religious adoption and foster-care agencies to refuse to place children in the homes of gay or transgender families in part to encourage those organizations to remain involved in fostering.

Sen. Heidi Heitkamp, D-North Dakota, introduced bipartisan legislation that would address and study the impacts of trauma on children in an effort to prevent another generation of drug-addicted parents. The number of children living in state custody in North Dakota has soared because of drug addiction, a crisis that she said has hit their Native American population particularly hard.

"When we look at people who have been traumatized as children, they have a much higher rate of addiction as an adult," Heitkamp said. To break the cycle, Heitkamp said, the nation must address the drug problem as early in life as possible.

Part of that solution rests in the nation's foster-care systems, which are seeking more families like McLaughin's.

McLaughin and her husband, a former fire chief, originally wanted to become foster parents after their two daughters left the house, saying they still had energy and love to give children. They mostly took in teenagers, whose portraits still adorn their walls. But when their daughter became addicted to opioids and other drugs, they decided to care for her young son.

Then Maine, desperate for help with young children, asked the couple whether they could care for another child. They obliged, welcoming the young girl into their family.

"We definitely feel we are blessed. It's hard work, it's tiring work, but we feel we are blessed," McLaughin said. "They keep us young, and we couldn't imagine our lives without little ones running around."

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