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Figure.  National Trends in Foster Care Entries Attributable to Parental Drug Use, 2000 to 2017
National Trends in Foster Care Entries Attributable to Parental Drug Use, 2000 to 2017

Adoption and Foster Care Analysis and Reporting System data for fiscal years 2000 to 2017. Fiscal years are from October 1 to September 30. Parental drug use was missing for 3.5% of the sample. Total foster care entries were stratified into removals for parental drug use (n = 1 162 668) and other reasons (n = 3 636 177). Logistic regression was performed to estimate a linear trend in the proportion of entries for parental drug use during the study period (coefficient, 1.07; P < .001).

Table.  Characteristics of Children Entering Foster Care Because of Parental Drug Use Removal vs Other Reasons, 2000 to 2017a
Characteristics of Children Entering Foster Care Because of Parental Drug Use Removal vs Other Reasons, 2000 to 2017a
1.
Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau. Trends in foster care and adoption: FY 2008–FY 2017. https://www.acf.hhs.gov/sites/default/files/cb/trends_fostercare_adoption_08thru17.pdf. Accessed January 29, 2019.
2.
Ghertner  R, Waters  A, Radel  L, Crouse  G.  The role of substance use in child welfare caseloads.  Child Youth Serv Rev. 2018;90:83-93. doi:10.1016/j.childyouth.2018.05.015Google ScholarCrossref
3.
Quast  T.  State-level variation in the relationship between child removals and opioid prescriptions.  Child Abuse Negl. 2018;86:306-313. doi:10.1016/j.chiabu.2018.10.001PubMedGoogle ScholarCrossref
4.
Felitti  VJ, Anda  RF, Nordenberg  D,  et al.  Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: the Adverse Childhood Experiences (ACE) study.  Am J Prev Med. 1998;14(4):245-258. doi:10.1016/S0749-3797(98)00017-8PubMedGoogle ScholarCrossref
5.
Lloyd  MH, Akin  BA, Brook  J.  Parental drug use and permanency for young children in foster care: a competing risks analysis of reunification, guardianship, and adoption.  Child Youth Serv Rev. 2017;77(C):177-187. doi:10.1016/j.childyouth.2017.04.016Google ScholarCrossref
6.
Humphreys  KL, Nelson  CA, Fox  NA, Zeanah  CH.  Signs of reactive attachment disorder and disinhibited social engagement disorder at age 12 years: effects of institutional care history and high-quality foster care.  Dev Psychopathol. 2017;29(2):675-684. doi:10.1017/S0954579417000256PubMedGoogle ScholarCrossref
Research Letter
July 15, 2019

Trends in Foster Care Entry Among Children Removed From Their Homes Because of Parental Drug Use, 2000 to 2017

Author Affiliations
  • 1Department of Healthcare Policy & Research, Weill Cornell Medical College, New York, New York
  • 2Department of Psychiatry, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
JAMA Pediatr. 2019;173(9):881-883. doi:10.1001/jamapediatrics.2019.1738

After more than a decade of declines in the foster care caseload in the United States, cases have risen steadily since 2012.1 Between 2012 and 2017, the number of children living in foster care and entering care increased by 12% and 8%, respectively.1 One proposed explanation for this recent growth is the opioid epidemic, but supporting evidence is scarce.2,3 In this exploratory study, we examine trends in the number of children entering foster care because of parental drug use and describe changes in their characteristics over time.

Methods

We analyzed data from the Adoption and Foster Care Analysis and Reporting System, a federally mandated data collection system that receives case-level information on all children in foster care in the United States. The database includes information on child demographic characteristics, health status, geographic area, and home removal reason (ie, physical/sexual abuse, neglect, child disability/behavior problems, child alcohol/drug use, parental alcohol/drug use, death, incarceration, inability to cope, abandonment, relinquishment, or inadequate housing). Data were deidentified, and this study did not meet Weill Cornell Medicine institutional review board’s definition of human subjects research.

We identified entries of children in foster care during fiscal years 2000 to 2017 and stratified the sample based on home removals attributable to parental drug use, defined as the principal caretaker’s recurrent and lasting use of drugs. The number of entries is not synonymous with the number of children because children may enter foster care more than once. We calculated national trends of the number and proportion of foster care entries because of parental drug use and reported children characteristics at different time intervals for this population. Characteristics of children entering care for other reasons were reported for comparison. Analyses were conducted using Stata version 15 (StataCorp).

Results

There were 4 972 911 foster care entries between fiscal years 2000 and 2017 (October 1, 1999, to September 30, 2017), 1 162 668 (23.38%) of which were home removals attributable to parental drug use. The number and proportion of entries attributable to parental drug use rose dramatically and steadily during this period, from 39 130 of 269 382 removals (14.53%) in 2000 to 96 672 of 266 583 removals (36.26%) in 2017 (Figure).

Compared with children entering care for other reasons, children entering because of parental drug use were more likely to be 5 years or younger (1 441 741 of 3 635 362 removals [39.65%] vs 699 340 of 1 162 448 removals [60.16%]), white (1 597 066 of 3 524 011 removals [45.32%] vs 616 153 of 1 131 294 removals [54.46%]), and from the southern region of the United States (1 119 679 of 3 636 177 removals [30.79%] vs 519 988 of 1 162 668 removals [44.72%]) (Table). The characteristics of children entering care because of parental drug use changed over time. Notably, between fiscal years 2000 to 2005 and 2012 to 2017, the proportion of children who were white (2000-2005, 148 780 of 291 017 removals [51.12%] vs 2012-2017, 276 296 of 480 012 removals [57.56%]), from the Midwest (2000-2005, 56 734 of 300 633 removals [18.87%] vs 2012-2017, 124 535 of 492 209 removals [25.30%]), and in nonmetropolitan areas (2000-2005, 30 971 of 169 132 removals [18.31%] vs 2012-2017, 120 984 of 492 195 removals [24.58%]) increased. These patterns were not observed among children entering care for other reasons.

Discussion

The number of foster care entries attributable to parental drug use increased substantially from 2000 to 2017 (from 39 130 to 96 672 removals, an increase of 57 542 removals [147.05%]), even when entries for other removal reasons mostly declined. These findings suggest that greater parental drug use has contributed to increases in foster care caseloads and coincide with increasing trends in opioid use and overdose deaths nationwide during this period.

Foster care placement generally implies that a child has faced abuse or neglect. Adverse childhood experiences, such as abuse, neglect, or having a parent who uses drugs, increase the risk of chronic health conditions and other poor outcomes across the lifespan.4 Additionally, when children enter foster care because of parental drug use, episode duration is longer and less likely to result in reunification with the parent.5 This is of special concern because of the large proportion of children experiencing entry before age 5 years, a critical period for forming stable attachments.

Limitations of this study include potential reporting inconsistencies in parental drug use. Moreover, it is possible that factors other than drug use influenced entries for parental drug use.

Policy makers must ensure that the needs of this new wave of children entering foster care because of parental drug use are being met though high-quality foster care interventions. These have been shown to mitigate some of the adverse effects of early childhood deprivation and disruptions in attachment.6

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Article Information

Corresponding Author: Angélica Meinhofer, PhD, Department of Healthcare Policy & Research, Weill Cornell Medical College, 425 E 61st St, Ste 301, New York, NY 10065 (anm4001@med.cornell.edu).

Published Online: July 15, 2019. doi:10.1001/jamapediatrics.2019.1738

Correction: This article was corrected on August 19, 2019, to fix 2 labels switched in the Figure. The label “Entries owing to parental drug use” was positioned over the line that indicated the proportion of foster care entries owing to parental drug use, and the label “Proportion of entries owing to parental drug use” was positioned over the line indicating the total number of foster care entries owing to parental drug use. The labels have been moved to the correct positions.

Author Contributions: Dr Meinhofer had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Meinhofer.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: All authors.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Meinhofer.

Obtained funding: Meinhofer.

Administrative, technical, or material support: Meinhofer.

Supervision: Meinhofer.

Conflict of Interest Disclosures: None reported.

Funding/Support: This work was supported by the National Institute of Mental Health (grant T32MH073553).

Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

References
1.
Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau. Trends in foster care and adoption: FY 2008–FY 2017. https://www.acf.hhs.gov/sites/default/files/cb/trends_fostercare_adoption_08thru17.pdf. Accessed January 29, 2019.
2.
Ghertner  R, Waters  A, Radel  L, Crouse  G.  The role of substance use in child welfare caseloads.  Child Youth Serv Rev. 2018;90:83-93. doi:10.1016/j.childyouth.2018.05.015Google ScholarCrossref
3.
Quast  T.  State-level variation in the relationship between child removals and opioid prescriptions.  Child Abuse Negl. 2018;86:306-313. doi:10.1016/j.chiabu.2018.10.001PubMedGoogle ScholarCrossref
4.
Felitti  VJ, Anda  RF, Nordenberg  D,  et al.  Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: the Adverse Childhood Experiences (ACE) study.  Am J Prev Med. 1998;14(4):245-258. doi:10.1016/S0749-3797(98)00017-8PubMedGoogle ScholarCrossref
5.
Lloyd  MH, Akin  BA, Brook  J.  Parental drug use and permanency for young children in foster care: a competing risks analysis of reunification, guardianship, and adoption.  Child Youth Serv Rev. 2017;77(C):177-187. doi:10.1016/j.childyouth.2017.04.016Google ScholarCrossref
6.
Humphreys  KL, Nelson  CA, Fox  NA, Zeanah  CH.  Signs of reactive attachment disorder and disinhibited social engagement disorder at age 12 years: effects of institutional care history and high-quality foster care.  Dev Psychopathol. 2017;29(2):675-684. doi:10.1017/S0954579417000256PubMedGoogle ScholarCrossref
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