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Rethinking the Removal of Kids From Moms Struggling With Addiction

State efforts reflect a shift in child welfare policy toward family preservation and the well-being of both parents and children.

By Hannah Ditzenberger  |  May 15, 2024

Two statistics spell trouble for the nation’s already burdened child welfare system. More Americans died from overdose in 2023 than ever before, and parental substance use is a leading cause for the removal of newborns, infants and toddlers from their homes.

Addiction is so prevalent and the effects so severe that child welfare agencies are struggling to find enough foster families to care for substance-exposed infants. Children under age 5 are the fastest-growing age group entering foster care, and about half of those kids enter out-of-home care because of parental substance use.

Amid the crisis, state governments are finding ways to support the comprehensive needs of mothers in recovery while keeping their infants and young children safe. These state efforts reflect a shift in greater child welfare policy toward family preservation, the well-being of both parents and children, and collaboration between child welfare, health and early childhood systems. 

Louisiana Sen. Beth Mizell (R) sponsored legislation (SB 268, 2022) that requires certain substance use disorder facilities to provide pregnant women access to at least one form of opioid agonist treatment approved by the Food and Drug Administration.

“We weren’t really treating the pregnant mother who had a drug problem in a way that was conducive to her well-being and the well-being of her infant,” Mizell says in an NCSL Town Hall. To promote recovery and keep families together, some states have implemented policies and allocated funds to improve access to family-based treatment, child care and other resources throughout treatment and recovery.

Maine Rep. Laura Supica (D) sponsored bipartisan legislation meant to support parents through recovery by addressing the challenge of finding housing and other resources.

“Somebody might get their children back, but if the recovery home doesn’t allow kids in the house, they are plunged into this situation where they can’t afford housing anywhere, and their recovery is in jeopardy,” she says.

Family-Based Treatment and Recovery

Family-based residential treatment centers allow parents and their children to remain together while the parent participates in treatment. In these homes, parents receive wraparound services to support recovery and strengthen family relationships.

When mothers and children enter treatment together, parent-child bonds are maintained. Research shows women who enter residential treatment programs with their children are more likely to complete the program and maintain custody of their children.

At least eight states—Kentucky, Nebraska, Maine, New Jersey, North Carolina, Oregon, Pennsylvania and Wisconsin—have created initiatives to support family-based treatment. Maine (H 163, 2023) allocated funds to create family-based recovery residencies in rural parts of the state. The recovery homes are designed to allow parents to stay with their children or, if the children have been removed, to work toward reunification.

“When somebody experiences having their children taken away from them, even for really good reasons, there are all these hurdles you have to go through to get your children back,” Supica says. “I get why we do that—we need to keep kids safe—but it also creates an economic divide. People who don’t have as much money, who don’t have access to as many resources, then the hurdles they have to jump over are higher.”

The Family First Prevention Services Act of 2018 allows states to use Title IV-E foster care funds to place children with their parent in a licensed residential family-based treatment facility. Some states, including Minnesota, modified their laws to take advantage of the federal provision and place children in family-based facilities.

Child Care When Mom Is in Treatment

Difficulty obtaining child care is a stronger predictor of reports of maternal neglect than the severity of the substance use disorder. In fact, mothers entering substance use treatment who report difficulty finding child care are 82% more likely to self-report child neglect compared with mothers entering treatment who have access to child care.

Because lack of child care is a common stumbling block for mothers in recovery, the federal Child Abuse and Prevention Treatment Act requires states that receive CAPTA funds to have plans of safe care. The plans must address the health and safety of substance-exposed infants and their caregivers and may include child care as a service to parents.

In addition, the Administration for Children and Families’ Office of Child Care recommends states include substance use treatment as an eligible activity for Child Care and Development Fund dollars, which states use to fund child care assistance to low-income families. Child care subsidies enable low-income parents to work and help meet their family’s economic needs. For many parents with substance use disorders, affordable child care is essential to completing outpatient treatment programs.

Recognizing the need for child care for parents in treatment, Colorado (HB 1193, 2019) allocated $500,000 in general funds for a pilot program to serve mothers receiving substance use treatment. One of the grants funds a mobile child care classroom for children from birth to age 5 parked outside their parents’ treatment facilities.

Voluntary Home Visiting Programs

Parents in or recently out of treatment facilities or programs can also benefit from home visiting programs, in which a trained professional visits a pregnant woman or new parent to provide support related to maternal health, child development and parent-child bonds. Evidence-based home visiting programs are considered an effective strategy to support nurturing and responsive child-parent relationships, and they can be more accessible than out-of-home options for some parents.

A parent-child assistance program is a home visiting model that helps mothers with substance use disorders begin or maintain recovery, build parent-child relationships and prevent prenatal exposure to substances. Washington is one of five states that has implemented the model. Washington funds the program through client fees and a dedicated marijuana tax revenue account (SB 693). Kansas included a parent-child assistance program in its five-year Title IV-E prevention plan. In Kansas, the program is funded through the Kansas Children’s Cabinet Community-Based Child Abuse Prevention grant and the city of Topeka Special Alcohol and Drug Tax Fund. California, Nevada and Oklahoma also use the PCAP model.

Despite these state efforts to curtail its effects, the opioid epidemic persists in rupturing family stability. To combat this, NCSL supports state efforts to enact creative policies and allocate funds to mitigate the impact on infants, toddlers and moms and to strengthen comprehensive prenatal-to-3 systems that prioritize family well-being and child safety. NCSL offers Opioid Policy Fellows and Child Welfare Fellows programs for legislators and legislative staff to help them continue this work.

Hannah Ditzenberger is a policy associate in NCSL’s Children and Families Program.

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