The opioid problem has claimed the lives of many young people
The nation's opioid crisis is wreaking havoc on a particularly vulnerable group: the children of people who have substance use problems.
While many of these children are transferred to live with grandparents or other family members when a parent overdoses or exhibits other difficulties, an increasing number are placed in the foster-care system, which is struggling to keep up with demand in many states.
According to the Administration on Children and Families of the United States Department of Health and Human Services, the number of children in foster care increased by about 7% from 2013 to 2015, reaching approximately 429,000. In nearly 32% of all foster placements, parental substance abuse was mentioned as a cause, up 10% from 2005.
The rise in foster care need comes at a time when opioid-related deaths are on the rise. According to the Centers for Disease Control and Prevention, more than half a million individuals died of an overdose between 2000 and 2015, and 91 people die every day from overdoses of prescription or illegal opioids. Sadly, many children, who are the unintended victims of the crisis, are not receiving the attention and resources they require.
"This is a neglected group," says John Kelly, PhD, founder and head of the Recovery Research Institute at Massachusetts General Hospital and associate professor of psychiatry in addiction medicine at Harvard Medical School. "We haven't really been attending to other casualties, including youngsters, since we've been trying to put out the fire in terms of halting overdose deaths."
Psychologists are treating children in foster care in outpatient, inpatient, and residential therapy programs, as well as school-based mental health programs, to decrease the long-term consequences on them.
Taking care of foster children
Richard Ruth, PhD, an associate professor of clinical psychology at George Washington University in Washington, D.C., is one of several psychologists who have noticed a "staggering" rise in the number of foster children in the system, owing partly to the opioid crisis. Opioid deaths nearly doubled in Maryland between 2010 and 2016, prompting the governor to proclaim a state of emergency. Foster care placements in Baltimore increased by 30% between 2014 and 2017.
Ruth claims that he receives calls on a regular basis from people seeking help for themselves or loved ones who are addicted to opioids. Foster children are referred to him by agencies for difficulties such as parental substance abuse. Some of his patients are teenagers who have struggled with substance abuse.
Ruth has also helped patients through A Home Within, a volunteer counseling program for children in foster care. This national philanthropic organization recruits therapists to provide pro gratis care for one child for as long as it takes, with weekly visits that often last three years. According to Ruth, this type of high-quality, consistent care is in stark contrast to how foster children are normally treated. "Too often, foster children are sent to clinics that are underfunded and under-resourced, and the therapists are not wellsupported," he says. "Every few months, they get a new therapist."
Psychologist Anthony Mannarino, PhD, who runs Allegheny General Hospital's Center for Traumatic Stress in Children and Adolescents in Pittsburgh, has noticed an increase in the number of children placed in foster care as a result of a biological parent's opioid use problem. They may be subjected to a variety of traumas. "We've had youngsters who tracked down their parents after they overdosed and waited for responders," he says. "A parent may have died in certain situations, and the child is typically left wondering what he or she could have done to save the parent."
To assist these youngsters understand and heal from their traumatic experiences, the Institute employs TraumaFocused Cognitive Behavioral Therapy (TF-CBT). Mannarino claims that TF-CBT has been used widely to treat children in foster care. The therapy entails the development of coping skills so that children can learn to better regulate their post-traumatic feelings and ideas. Children also practice trauma narration and processing, which include expressing specifics about their trauma and how they reacted to it. Foster parents are frequently an important component of the therapeutic process.
"TF-CBT has had a very positive effect on foster children, with a significant reduction in trauma-related symptoms and behavioral difficulties," Mannarino explains. After participating in TF-CBT, foster children were considerably less likely to have their foster placement disrupted due to behavioral issues, according to one study (Children and Youth Services Review, Vol. 31, No. 11, 2009).
Mannarino claims that his two-year follow-ups show that the therapy is helping the children's mental health, and that there are many TF-CBT-trained therapists who can provide this evidence-based care to foster kids. However, he wonders how many youngsters who require assistance have yet to be found and brought in for treatment.
Other psychologists are offering outpatient or residential services that allow children to remain with their parents during treatment, resulting in a "much healthier, positive attachment," according to Hendrée Jones, PhD, executive director of the University of North Carolina at Chapel Hill's Horizons program. Despite the fact that Jones lacks comprehensive published data on the program's effectiveness, she claims that many of the children of opioid-addicted parents improve swiftly with treatment, going from being terrified or acting out to "coming up and hugging people" within 30 days.
According to new research, keeping families together during treatment is beneficial to both the parent and the child. The Ohio State University's Natasha Slesnick, PhD, discovered that when substance-abusing mothers and their children were treated together, both were less likely to use substances than if the moms were treated separately without their children's participation. Additionally, the youngsters were less likely to develop behavioral issues such as conduct disorders, as well as despair and anxiety (Family Process, published online, 2017).
More outreach is required.
Although there is a growing awareness of these children's mental health issues, many still have unmet needs, according to Mannarino. Shame and stigma frequently prevent families from seeking help.
Kelly proposes that practitioners assess children and teenage patients who present with anxiety, depression, or other mental health illnesses to see if they have developed their own substance use disorders. (He recommends the World Health Organization-developed ASSIST screening tool.) Psychologists can also assist these youngsters by communicating with policymakers about successful methods that can aid children with substance use disorders, according to Jones.
"I believe it is now more important than ever for psychologists to step up to the plate," she says. "We need to make our voices known in order to find solutions to the epidemic we're facing."