Taking a Toll: The Opioid Epidemic's Impact on N.H.'s Child Welfare System

Sep 17, 2018

Child Advocate Moira O'Neill
Credit Dan Tuohy / NHPR

On Morning Edition, NHPR is taking a look at how the opioid epidemic is taking a toll on children in New Hampshire.

One person who's charged with thinking about that every day is Moira O'Neill, the state's Child Advocate. Her office independently oversees the Division of Children, Youth and Families (DCYF), the state's child welfare system.

Morning Edition Host Rick Ganley met with O'Neill at her office in Concord to talk about why DCYF has struggled to meet the demands of the opioid epidemic, and how opioid use has complicated the separation and reunification process between children and their parents.

(Editor's note: this transcript has been edited lightly for clarity.)

A lot of the problems that DCYF is dealing with is not just opioid related. I mean, this was an agency that was really short staffed [and] short funded for a long time, and New Hampshire has had a problem with substance use disorders for a long time. It's not just opioids. The Opioid epidemic has absolutely exacerbated all of that. So we are seeing more problems, more work, more overload. It's really infiltrated everything about the child welfare system.

I wanted to get your thoughts personally on how you're feeling that, not only how DCYF is doing and their efforts, but how you see things going generally in the state. Do you feel like things are going in the right direction? Are people paying attention to what they need to?

We have mixed reviews on that. And you've heard in the news recently, you know, we just had a federal report that said that the child welfare system is failing. We've had a lot of issues that are reported publicly. We have lawsuits. So it does seem like it's a big mess, but it is a big mess that stems from you know 10 years ago when a lot of cuts were made. There are a lot of people who are really committed at DCYF. There's a whole new leadership team. We did a good job in the legislature last session getting started [with] money for voluntary services so that there was sort of start rebuilding that infrastructure and help families before they abuse and neglect kids. But it really was like just incremental in terms of what we need. You know, we need another 175 caseworkers. We got 33 last session. I mean that's huge. That's a huge amount of money.

Can you explain what the process is like when you have to go in and there has to be a separation of children from parents who are struggling with addiction?

What happens is if they're able to find very clear evidence a child is at risk of being or is being abused and neglected, they will remove the child. Within 12 months that child has to return to their family or they have to have some other family. So there's an understanding that children need permanency. They use the word permanency. So here's where the problem starts. Because by law, over this 12 months that a child is in care, the agency has to do every single thing they can to reunite the child with the family. And the sort of legal requirements, and the child development needs and recovery needs are all diabolically opposed to each other. It's really hard for people to just recover on a schedule like that. We know relapse is normal. We know we have a dearth of services for people to get into to help them with their recovery. We know that when people are involved with opioids there's a lot of other co-occurring problems like housing, employment, transportation. So all of those things sort of overwhelm a lot of parents.

And where we are so good intentioned on thinking we need to get this child to be visiting with parents and working towards reunification, and oh by the way maybe the parent is being asked to go to parenting classes, maybe go to see a therapist. So that's a really busy week. And another piece that surrounds all of this opioid use tends to be at times some level of criminality. I mean people who are really desperate with their addictions may be involved in illegal things that kids are exposed to.

So that while intended reunification process over those 12 months creates yet another imposed inconsistency in the child's life. The child is yanked back and forth. They have to go to these visits. The visits don't happen. Someone didn't show up. Someone had an outburst. You know people's behaviors are thus. And so even in that time where the child thinks, well I'm in this safe place in this foster home, but I'm still being exposed to these other things. So we're not giving the child the emotional safe place that they need over the long term.

So you have discussed I know that there's alternatives to this current separation and reunification process. What would those alternatives look like?

Well it's really a challenge, because I've never met a child who didn't want, regardless of the circumstances, to have some relationship with their biological parent. I mean in many years I've done this work, they all want to be connected. So you don't want to say like we're going to turn our backs on biological parents, but we do need to think about what is the healthiest thing for this child in their development, especially very young children whose brains are just developing.

So I think that we'll hope to see more what's called voluntary mediated adoptions, which are sort of a co-parenting model. So the foster parent maybe will adopt this child. There's still an avenue for the biological parent to have some role in that child's life once they've recovered. Some people use guardianship. A family member can become the guardian and then when the parent gets their recovery under control, then they can transfer the [guardianship] back to the parents.

Those are all sort of options that we're not really seeing a great deal of -- these sort of open adoptions for sharing the parenting. Those are difficult because if I adopt your child and you continue to have really problematic behaviors, I don't necessarily want you to show up here and disrupt this child's life all the time. It all comes down to permanency and consistency. Can we manage it?

So it really is individually based. We have to figure out what's going to work for each family. We have to have hard conversations about the capacity for someone to recover. Some people work really hard and they do what they can to continue to engage their children and be a good parent, and some people just have the cards stacked against them. It may be a long time before they're capable of really thinking about children and children's needs. So do we have other options? We should definitely be open to them. Is it going to work for everybody? Someone is going to have a loss at some point. As a child advocate, our obligation is to make sure the child's needs are met. Having a biological parent is one of those needs but not when that parent is really disrupting the development of that child.