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October 2021Vol. 22, No. 9Spotlight on National Substance Abuse Prevention Month

This issue of CBX spotlights the effects substance use, particularly opioid use, can have on the well-being of families involved with child welfare. We also feature a message from Associate Commissioner Aysha E. Schomburg about the long-term effects natural disasters can have on the lives of children and the importance of making sure we are meeting their needs even after the storm passes. This issue also includes valuable resources for professionals and the families they serve.

Issue Spotlight

  • The Intersection of Opioid Use and Child and Family Welfare

    The Intersection of Opioid Use and Child and Family Welfare

    The National Council on Family Relations published a brief that explores the intersection of opioid use and child and family welfare in three states: Indiana, Massachusetts, and North Carolina. While these states face different needs, all are dealing with the changing landscape of the intersection of the opioid epidemic and child welfare. States can look at these case studies to see how they can apply to their own unique situation instead of relying only on national level statistics and trends. The brief also covers relevant legislation these states have passed to stop the epidemic and enact potential policy responses.

    Indiana had a 271 percent increase in opioid related overdose deaths between 2010 and 2016. In 2017, its percentage of prenatally exposed infants exceeded the national average by 4 percentage points. Furthermore, more than half of all child removals in the state in 2017 were linked to parental substance use—again, far higher than the national average (35 percent). In response, Indiana passed legislation to limit opioid prescriptions and make opioid specific treatment options more accessible.

    In 2017, Massachusetts had an opioid related overdose death rate that was nearly twice the national average. From 2014 to 2018, the percentage of families investigated for potential maltreatment was also consistently higher than the national average. In 2016 and 2018, the state passed two proactive prevention focused bills to address the issue.  

    North Carolina experienced a 70 percent increase in opioid related overdose deaths between 2015 and 2017, and prenatal opioid exposure increased over 20 fold between 2000 and 2013. In 2017, the state had a higher percentage of children involved with child welfare than the national average. The state overhauled its child welfare system and passed multiple pieces of legislation to reduce the supply of opioids and increase public awareness and prevention efforts.

    The brief provides the following suggestions for future policy changes:

    • Invest in a two generational approach to substance use disorder prevention and treatment.
    • Optimize early detection and treatment of substance use disorders during pregnancy.
    • Expand access to medication assisted treatments.
    Read the full brief, Juggling Child Protection and the Opioid Epidemic: Lessons From Family Impact Seminars, for details about the policy implications and more information on the state case studies.

  • Providing Substance Use Disorder Treatment to Families in Rural Communities

    Providing Substance Use Disorder Treatment to Families in Rural Communities

    The Office of the Assistant Secretary for Planning and Evaluation (ASPE) within the U.S. Department of Health and Human Services published a brief that identifies, summarizes, and provides possible solutions for key challenges rural communities face in regards to the intersection of parental substance use and child welfare. The research team conducted a literature review, interviewed subject-matter experts (SMEs) from relevant fields, and reviewed relevant gray literature and articles recommended by SMEs and ASPE staff.

    Rural communities have a significantly higher per capita opioid overdose rate than urban areas as well as higher rates of methamphetamine use. Rural communities also have less capacity to treat substance use disorders, and treatment is further complicated by the increased rate of polysubstance use. Rates of poverty and unemployment are widespread in many rural areas, which increases the risk for both substance use and child maltreatment and further exacerbates the complexity and issues in providing successful treatment.

    This brief highlights the differences between rural and urban areas, key issues communities face, and potential strategies agencies can employ to improve their services to parents and families affected by substance use disorders. Some of the challenges included the following:

    • Limited resources to provide services, including fewer peer-recovery support and family-centered programs, workforce and provider shortages, and a lack of wraparound services
    • Limited insurance access and coverage of services
    • Rural economics, transportation, and technology limits
    • Difficulties with collaboration and information sharing due to informal practices
    • Stigma and misinformation compounding problems and willingness to access services

    The brief emphasizes the need for better access to services and provides the following potential solutions to offset the barriers rural communities face:

    • Increase the local service array to include more family-centered and in-patient treatment options.
    • Invest in workforce training and hiring to enhance existing services, including salary adjustments and student loan waivers.
    • Colocate services to alleviate transportation barriers and increase collaboration.
    • Implement family drug treatment courts to promote collaboration and improve family outcomes.
    • Provide guidance and training on how to share information across service providers.
    • Leverage flexible funding to increase parental access to treatment services.

    A forthcoming brief will feature promising models for addressing the needs of parents with substance use issues who are engaged in the child welfare system and live in rural communities.

    To learn more, read Challenges in Providing Substance Use Disorder Treatment to Child Welfare Clients in Rural Communities.



  • The Invisible Injury: When the Hurricane Comes and Stays

    The Invisible Injury: When the Hurricane Comes and Stays

    Written by Associate Commissioner Aysha E. Schomburg

    I can't stop thinking about the children whose lives have been upended by Hurricane Ida. As I write this, I know that there are children in many parts of this country who should be getting ready for school tomorrow, but instead they are trying to figure out when or even if they will return to school. They may even be trying to figure out where they will sleep or where their family will live in the coming days. If they are in a shelter, they may wonder if that shelter will be safe for them and provide them with the resources they need. I can't stop thinking about the trauma their small brains are experiencing and whether they-or the adults around them-are even aware of it. The child victims of Ida are not unlike the child victims of Hurricanes Katrina, Sandy, or Maria. They are not unlike the child victims of the wildfires that have devastated the western states of this nation. 

    According to the 2015 National Report Card on Protecting Children in Disasters, after Katrina, more than 300,000 children were forced to enroll in new schools around the country. By some accounts, settling in new schools wasn't safe for evacuees; they were treated as outsiders and accused of soaking up resources that were designated for resident families. Superstorm Sandy ripped through the northeast and left children homeless or without heat and power. Many schools were practically destroyed, and students were required to squeeze into otherwise already overcrowded schools. According to one study regarding youth in Puerto Rico, 32 percent of youth experienced shortages of food and water in the aftermath of Maria. Natural disasters have left children without homes, without schools, without power, and without enough food and water. To make matters worse, I've read recently that long-term exposure to smoke from the wildfires is especially damaging to a child's lungs. That same article pointed out that "it matters whether your family can afford an air purifier." Recovery economics is an issue. 

    I'm worried about the children who survive the disaster but can't defeat the posttraumatic stress. Not surprisingly, those most impacted are children in underserved communities-Black and Brown children living in poverty with insecure housing. We rush to provide them with basic necessities during the first few weeks, then the news cycle moves on. I still wonder if they truly have access to all that they need. For so many children, after the temporary wind and the rain, what remains is the permanent tornado within. There is stifling trauma that suffocates their ability to succeed. When the water dries and debris removed from the streets, are we tending to the wounds left behind that only they can feel? Are we acutely aware of the lingering invisible injury? Are we fully invested in disaster recovery when the hurricane comes and stays? I'm not sure we are doing enough. 

  • Opioid Overdose Events and Child Maltreatment Indicators

    Opioid Overdose Events and Child Maltreatment Indicators

    A 2020 article in Children and Youth Services Review explores the potential correlation between opioid overdose events and child maltreatment. The authors posited that conducting research that encompasses broader aspects of the opioid epidemic and child maltreatment can lead to a better understanding of the link between the two and better inform policy and practice decisions that improve child outcomes. Opioid overdose mortality rates have increased nearly six times since 1999, and there have also been significant increases in the number of children born with neonatal abstinence syndrome (NAS) and the percentage of home removals attributed to parental drug use. Many researchers have prioritized better understanding the specific impact of the opioid crisis on the child welfare system.

    This study examined the link between county-level opioid overdose event rates and child maltreatment indicators (e.g., intake, substantiation, placement rates). The study also included additional county-level variables and characteristics. Data were obtained from 39 Washington state counties from 2005 through 2017 to model predictors of child protective services (CPS) outcomes over time.

    The study did not identify any significant trends for CPS indicators as counties experienced increased opioid overdose events, which contrasts with previous findings of positive relationships between the epidemic and NAS. The data revealed the relationship to be more complex and requires the incorporation of macro-level contextual factors to better understand the link. 

    To learn more, read "Opioid Overdose Events and Child Maltreatment Indicators: Differential County-Level Associations."


  • How Opioid Use Affects Child Well-Being

    How Opioid Use Affects Child Well-Being

    Understanding the relationship between the opioid epidemic and child welfare --particularly how children are indirectly affected by the increase in opioid misuse—continues to be a priority. An article published in Contemporary Economic Policy found that increases in opioid related mortality and emergency department visits were associated with increased foster care entry, but there was no significant relationship between legal opioid distribution quantities and home removals. The article, "What About the Children? How Opioid Use Affects Child Well Being," explores the relationships between opioid use and child well being and between opioid related public policies and child welfare outcomes.

    Results of the study show that there is a strong need for policies that mitigate the harmful—and sometimes indirect—effects the opioid epidemic has on children. It also notes that policies should focus less on reducing the amount of legal opioids available and instead focus on improving how we can predict prescription abuse risk and reduce illicit opioid use. Findings also suggest that reducing the impact of the opioid epidemic on children can lead to a substantial amount of public savings. 

    To learn more, read "What About the Children? How Opioid Use Affects Child Well Being."

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News From the Children's Bureau

In this section, find the latest news, resources, and publications from the Administration for Children and Families, the Children's Bureau, and other offices within the U.S. Department of Health and Human Services as well as a brief listing of the latest additions to the Children's Bureau website.

Training and Technical Assistance Update

This section features resources and updates from the Children's Bureau's technical assistance partners to support practices and systems that improve the lives of children and families.

Child Welfare Research

In this section, we highlight recent studies, literature reviews, and other research on child welfare topics.

  • The Families Actively Improving Relationships Program Reduces Parental Substance Use

    The Families Actively Improving Relationships Program Reduces Parental Substance Use

    A study that examined the effectiveness of the Families Actively Improving Relationships (FAIR) program found that program participation resulted in significant reductions in parental opioid and methamphetamine use, mental health symptoms, and parenting risk.

    The FAIR program was developed to address the needs of families with parental opioid and methamphetamine use who are involved in the child welfare system. FAIR is an intensive, community outpatient program that involves four major treatment components: substance use treatment, mental health treatment, parent management training, and resource building and services receipt. 

    A key component of the program is the FAIR store. Parents are awarded "FAIR bucks" for positive treatment gains, such as negative drug tests and the use of positive parenting strategies, that they can spend on items to support their individual and parenting goals. The donated store items range from clothing, games, and toiletries to passes for swimming lessons and scholarships for camps. FAIR bucks are awarded liberally to positively reinforce incremental gains.

    The study recruited 99 parents. Of the 86 participants who engaged in services, 72 percent completed their treatment. The average length of treatment was 8.7 months, with a 24-month follow-up period. Outcomes showed statistically and clinically significant reductions in parental substance use, mental health symptoms, and parenting risk, as well as improvements in stability. Many participants maintained improvements in their substance use, mental health symptoms, and parenting risk throughout the follow-up period. The researchers concluded that there is a need for policies that support funding intensive, family-based programs.

    For more information, read "Meeting the Needs of Families Involved in the Child Welfare System for Parental Substance Abuse: Outcomes From an Effectiveness Trial of the Families Actively Improving Relationships Program." 

  • How Concrete and Economic Supports Can Improve Child and Family Well-Being

    How Concrete and Economic Supports Can Improve Child and Family Well-Being

    Improving outcomes for children and families and preventing child maltreatment requires transformation across the entire human services system. A recent policy brief from Chapin Hall at the University of Chicago explores how various human services agencies can provide concrete and economic supports to ensure families have what they need to keep children safe and healthy.

    According to the brief, economic need and disparity is the root cause of child maltreatment, particularly neglect, for many families. The brief outlines key steps to understanding the relationship between economic risk and well-being outcomes and increasing the use of economic and concrete supports. The following are the four areas for system transformation outlined in the brief, as well as their core strategies:

    • Policy: Implement policies that stabilize rather than separate families, such as developing cross-agency integrated solutions or reframing the role of mandatory child maltreatment reporters from surveillance to support. 
    • Program: Expand programmatic capacity and create new pathways for families to access supports.
    • Data: Analyze data to understand what drives service needs and develop an analytic framework that measures economic risk. 
    • People: Authentically engage families and youth with lived experience, as well as communities and provider organizations, in system transformation efforts. 
    For an indepth look at each of the four areas in which to leverage economic supports, see System Transformation to Support Child & Family Well-Being: The Central Role of Economic & Concrete Supports. In addition, Chapin Hall plans to publish a series of subsequent policy briefs exploring each of the four categories.

Strategies and Tools for Practice

This section of CBX offers publications, articles, reports, toolkits, and other resources that provide evidence-based strategies or other concrete help to child welfare and related professionals.

  • California "Roadmap for Resilience" Provides Framework for Preventing ACEs and Toxic Stress

    California "Roadmap for Resilience" Provides Framework for Preventing ACEs and Toxic Stress

    The Office of the California Surgeon General published a report detailing how adverse childhood experiences (ACEs) and toxic stress are threats to public health that can be mitigated. The report, Roadmap for Resilience: The California Surgeon General's Report on Adverse Childhood Experiences, Toxic Stress, and Health, provides a framework for a cross-sector response to these challenges.

    The report is intended for a wide audience, including professionals, families, community organizations, researchers, and advocates. It proposes enhanced coordination in addressing ACEs and toxic stress from various human services sectors, including health care, public health, social services, early childhood, education, and justice. Children and youth involved with child welfare often have ACEs and deal with the stress and trauma related to those experiences. This report can help child welfare professionals understand how ACEs and toxic stress have affected the families they serve and provide ways they can take a collaborative approach to easing this strain on families' well-being and improving outcomes.

    The roadmap outlined in the report is split into four parts: 

    • The science, scope, and impacts of ACEs and toxic stress
    • The public health approach for cutting ACEs and toxic stress in half within a generation
    • California's response to ACEs and toxic stress
    • What lies ahead
    While there is an intergenerational cycle of toxic stress and ACEs, the global experts who contributed to the report determined that toxic stress is treatable, requiring a coordinated, cross-sector approach that includes prevention, early detection, and evidence-based interventions. Interrupting and treating the toxic stress response may break this intergenerational cycle of stress and promote a new cycle of health.  


  • Online Tool Provides Practice Tips for Working With Adolescents At Risk of Substance Use

    Online Tool Provides Practice Tips for Working With Adolescents At Risk of Substance Use

    The National Center on Substance Abuse and Child Welfare (NCSACW) developed a new technical assistance tool to provide information to child welfare professionals, substance use treatment providers, health-care professionals, and other child-serving community agencies about working with adolescents who are at risk of misusing or abusing substances.

    The tool, Working With Adolescents: Practice Tips and Resource Guide, provides information on adolescent development, as well as tips and best practices professionals can utilize when working with at-risk youth. Topics discussed include the five Cs of positive youth development (competence, confidence, connections, character, and caring); the role of parents and caregivers in adolescent development; and the co-occurrence of trauma, abuse, neglect, and substance use in adolescents. Many children and youth involved with child welfare have experienced trauma, increasing their risk for substance use.

    In addition to providing tips for practice, the guide links to additional resources for professionals on substance use prevention, intervention, treatment, and recovery.


  • Integrated Disaster Planning to Increase Preparedness

    Integrated Disaster Planning to Increase Preparedness

    Written by the Capacity Building Center for States

    Integrating disaster planning into regular agency strategic planning, reporting, and continuous quality improvement (CQI) efforts is critically important in helping ensure that agency services for children and families can continue during a disaster. While we don't know exactly when and where the next flood, fire, shooting, or health crisis will occur, integration ensures that disaster planning remains a visible agency priority and that sufficient resources and staff are allocated to allow agencies to advance their plans for achieving desired outcomes, even during a disaster.

    Although disaster planning is already part of the Child and Family Services Plan (CFSP) and Annual Progress and Services Report (APSR) process, in practice it often is not closely linked with other agency work. By better integrating disaster planning with other processes, such as strategic planning, reporting, and CQI tasks, agencies can do the following (Capacity Building Center for States, 2021):

    • Align priorities between disaster planning and other strategic-planning, reporting, and CQI activities to ensure sufficient resource allocation and staffing
    • Share information and data among teams to inform coordinated action
    • Find connections between disaster planning and other processes to avoid work duplication
    The following considerations can help agencies determine the best ways to align disaster planning with other agency processes.
    Align Goals and Priorities Among All Planning and Review Activities
    Because disasters aren't everyday occurrences, it can be easy to relegate disaster planning to the back burner and not fully think through the connections that disaster planning may have to other planning and review tasks. Disaster planning can be aligned with other tasks in several ways:
    • Members of a disaster-planning team (including youth and families) can also serve on other planning and review teams to facilitate communication (Capacity Building Center for States, 2018).
    • Leads of various planning teams can review plans as a group to ensure that goals and priorities align.
    • Disaster planning can be integrated into prevention plans by aligning the agency's disaster plan with those of community organizations (Capacity Building Center for States, 2021).
    • A disaster-readiness assessment can be integrated into an agency's broader CQI process (Capacity Building Center for States, 2021).
    Share Information and Data at All Stages
    To implement an integrated approach to planning, review, and change-management processes, agency administrators and program leads must put in place a communication network that facilitates regular, timely data and information sharing among the various teams working on these initiatives. 
    For example, the CFSPs, APSRs, and Child and Family Services Reviews all include an assessment of or update on the child welfare system's performance on child and family outcomes and systemic factors. These assessments are also useful for evaluating an agency's readiness to manage a disaster (e.g., assessing levels of youth and family engagement in agency disaster planning work). A weekly or biweekly check-in among data leads is one strategy that can help ensure that this information is regularly shared among teams.

    Coordinate Improvement Plans
    Child welfare agencies develop plans for improvement in response to findings from performance assessments and CQI efforts. Using a coordinated approach to implementing improvement changes, team leads and agency leaders can work together to establish goals, objectives, interventions, and action steps for implementation that align across planning and improvement processes. 
    For example, when working to improve their technology knowledge and access, agencies should also consider how this intersects with identified technology needs in the agency disaster plan (e.g., access to smartphones, laptops, tablets, quality broadband). Together, teams can outline measurement plans and identify performance indicators, measures, and benchmarks, as well as describe roles, responsibilities, and timeframes in establishing the joint plans for improvement across the agency. 
    Once disaster planning is well integrated with other agency planning, review, and improvement processes, it can become a more regular and meaningful part of planning for the future well-being of children, youth, and families.
    The following Capacity Building Center for States resources can help your agency plan for a disaster and align disaster planning with other agency processes:
    Capacity Building Center for States. (2018). Strategic planning in child welfare: Integrating efforts for systems improvement.
    Capacity Building Center for States. (2021). Coping with disasters and strengthening systems guide. 


This section of CBX presents interesting resources, such as websites, videos, journals, funding or scholarship opportunities, or other materials that can be used in the field or with families.

  • Protecting Children Online: Tips for Caregivers

    Protecting Children Online: Tips for Caregivers

    A blog post from AdoptUSKids discusses why spending time on the internet can be a dangerous pastime for children, particularly those in foster care; the associated risks; and considerations and strategies for parents and caregivers to keep kids safe online.

    Excessive online screen time, a problem compounded by COVID-19, can threaten personal safety; lead to deteriorating mental health, including feelings of social isolation, depression, and low self esteem; and open the door to unauthorized or unhealthy connections with their birth family and others.

    The following tips are some of the ways parents can limit screen time and mitigate safety concerns:

    • Focus on prevention. Begin conversations about appropriate internet usage when children are young, before they get online.
    • Discuss "netiquette" with your child. Talk with them about what information is safe and not safe to share online and appropriate ways to communicate with trusted friends and adults.
    • Model healthy relationships with technology. Establish agreed upon rules that apply to everyone such as no phones in private areas (e.g., bathrooms) and, if appropriate, include the child's birth family to encourage shared understanding.
    • Use parental controls. A variety of tools exist that allow parents to monitor internet usage and content and track children's online activities and location. However, do not spy on your child; instead, involve them as partners in their online safety.
    Finally, a collection of helpful resources, such as the National Center for Missing and Exploited Children and its Netsmartz online safety education program, is provided for interested readers.

  • Updated Guide to Understanding the Adoption Tax Credit

    Updated Guide to Understanding the Adoption Tax Credit

    The National Council for Adoption (NCFA) has provided an updated guide to understanding the adoption tax credit (ATC). The guide includes sections discussing the following:

    • The legislative history of the ATC
    • Eligibility criteria and restrictions
    • How the tax credit works
    • Internal Revenue Service guidelines regarding the official documentation needed for tax filing 
    • Advocacy efforts, particularly the ATC Refundability Act
    • Frequently asked questions and additional resources
    The resource also includes a real-life story of a family who adopted a child from China with special medical needs to highlight the financial challenges many families face and the difficulties that could be ameliorated with the passage of the ATC Refundability Act. 
    For more information, download the issue of NCFA's Adoption Advocate newsletter dedicated to the updated ATC guide. 

Training and Conferences

Find trainings, workshops, webinars, and other opportunities for professionals and families to learn about how to improve the lives of children and youth as well as a listing of upcoming events and conferences.