- Associated Press - Saturday, September 30, 2017

YAKIMA, Wash. (AP) - Every morning, Ryan Alonzo listens to a voicemail he saved from his little girl, telling him how much she loves him and misses him.

He hasn’t seen his three young children - a daughter and two sons - in a year. But he’s always thinking of them, and the idea of reuniting with them and being a good father again is what drives him to stay clean instead of falling back into drug addiction.

“I was at the brink of either suicide or going into treatment, and I just thought about leaving my kids like that … And the thought crossed my mind, like, ‘Why not just get better for them?’” Alonzo, 30.

“The whole time, I’ve been fighting for them, and to just give up just because it’s hard - I couldn’t accept that.”

Nationwide, annual overdose deaths from opioids such as heroin and prescription painkillers have soared in recent years, topping 33,000 in 2015, according to the Centers for Disease Control and Prevention. In Yakima County last year, five of the 26 overdose deaths involved heroin, according to the county coroner.

But the opioid epidemic doesn’t just affect the lives of those addicted. It hurts families, leading to developmental and behavioral problems in kids, splitting children from parents, and straining the nation’s foster care system.

While the Yakima Valley has not seen the scale of opioid deaths currently ravaging states such as West Virginia and Ohio, the epidemic is still taking its toll on local families and social services.

“Drugs don’t discriminate,” Alonzo said. “They don’t care who you are.”

‘THEY WANT TO BE WITH THEM’

The Children’s Administration, under the Department of Social and Health Services, manages the state’s foster care network and works with parents who are required to go through drug treatment before being reunified with their kids. In cases where parents don’t have insurance, the department may pay for treatment or connect parents with other resources, and it also pays for urinalysis drug tests.

However, the department doesn’t track the number of parents receiving drug treatment by specific drug, so there are no figures on how many children are in foster care as a direct result of opioid abuse.

But anecdotally, “We have certainly seen an increase in intakes that mention opiates,” and opioid-related drug overdoses, said Jenna Kiser, the intake and safety program manager.

Statewide, the number of children in foster care has grown from 7,833 in 2012 to 9,358 this year, according to DSHS. Yakima County has seen an average of 432 children during that time frame, reaching a five-year high of 459 in 2016 before dropping back to 413 this year.

Foster parents who care for drug-affected kids need extra support, including training in how to address their special needs, and social workers are supposed to help direct them to those resources, Kiser said.

There also are independent support groups for foster parents, such as the five that operate within the south-central region of the state through Fostering WA, a program from Eastern Washington University that contracts with the state to recruit and support foster parents.

Recruitment coordinator Tyann Whitworth, who facilitates the peer-led support groups in this region, said she’s definitely seen an increase in need for foster homes in the last couple of years, while it seems existing foster parents are leaving - largely due to feeling unsupported by the system.

“I feel like the need is greater all the time and we just can’t fill it,” she said.

An investigative series by InvestigateWest last year found that the state lost almost 1 in 5 licensed foster homes between 2008 and 2015, with the total number of homes dropping to roughly 4,600 in 2015, about 1,000 less than normal.

Whitworth has fostered more than 50 kids herself, including some whose parents were in drug treatment. She’s seen both ends of the spectrum: parents who work really hard in treatment, have good visits with their kids and are ultimately successfully reunited; and parents who are still struggling with addiction, whose visits become sporadic.

It’s when children are around 8 years old and can understand and be hurt by those inconsistent visits, Whitworth said, that behavior problems start to come out. They may regress into younger behaviors, such as wetting their pants or sucking their thumb, or they may act out aggressively as they struggle to understand the emotions they’re feeling.

“From what I’ve seen with kids, it doesn’t really matter what the parents have done, in a sense, or what they’ve been exposed to,” Whitworth said. “It’s their parents, and they want to be with them.”

DRUG-AFFECTED

Among those in need of foster homes are children born drug-affected because their mothers used drugs during pregnancy.

Drug-affected children may have behavioral challenges including increased aggression or hyperactivity, which can appear immediately after birth or might not become apparent until kids reach school-age.

Hospitals have policies for testing babies medical staff suspect of being drug-affected, to determine if an infant is going through withdrawals from an opioid such as heroin and needs medical care.

Any record of drug use or concern in a mother’s medical records from prenatal visits would factor into those suspicions, and hospital staff may send the umbilical cord for a toxicology screen in addition to a urinalysis on the mother, said Dr. Jennifer Myszewski, a pediatric hospitalist at Virginia Mason Memorial hospital.

Hospital staff calls Child Protective Services on most cases where drugs are a concern, even if the mother is going through the correct treatment programs, she said. It’s CPS and the courts, not medical providers, that decide whether babies go home with their parents.

Hospital staff monitor every baby that may have been exposed to drugs, but Memorial’s most detailed care plan is for babies who are opioid-affected, Myszewski said.

For opioids, Memorial staff score babies on several symptoms: if they’re jittery; have a high-pitched cry; if they’re able to sleep or feed appropriately. Based on those scores, taken every three hours, they may start the baby on a low dose of morphine and wean it down gradually.

Different kinds of opioids cause symptoms to show up at different points. With heroin, symptoms of withdrawal appear within 24 hours, Myszewski said; methadone and suboxone, which are often used as treatment for people who are addicted to other opioids, can take five to seven days to appear.

Memorial keeps drug-affected babies in the hospital five days, she said, not just to provide treatment, but because babies going through withdrawals tend to be fussy and inconsolable, which creates additional strain on new parents and puts the baby at risk of abuse.

Nearly 3,000 babies are born at Memorial every year. In calendar-year 2016, 36 were born opioid-affected; between August 2016 and July 2017, there were 54, said Jessalynn Jones, manager of Memorial’s Neonatal Intensive Care Unit and Pediatrics.

Myszewski said the hospital is definitely seeing an increase, but it’s also partly due to staff being more aware and better at identifying symptoms than before, she said. Some of the indications of exposure to other drugs are the same, such as breathing problems or possible seizures, but meth-exposed babies, for example, are less active and less interested in feeding.

If withdrawal symptoms are not caught and babies go home without treatment, she said, “It doesn’t make for an easy first couple of weeks of life.”

Babies will have difficulty eating and may have diarrhea, putting them at risk of dehydration; they’ll cry, have tremors and struggle to sleep; they’re at risk of fever and temperature instability; and significant withdrawals can even cause seizures.

However distressing opioid withdrawals are, Myszewski said, the most damaging and most common substance abused by mothers during pregnancy is still alcohol. Though CDC studies have struggled to pin down an exact number, estimates indicate as many as 9 children per every 1,000 nationwide are affected by fetal alcohol syndrome, which can cause facial structure abnormalities and growth problems, along with central nervous system issues such as developmental delays, motor function deficits and hyperactivity.

In the Lower Valley, Sunnyside Community Hospital pediatrician Dr. Ana Garcia said most drug-affected babies seen there are exposed to meth, not opioids.

Sunnyside staff call CPS anytime a baby tests positive for any drugs, she said, and keep babies for monitoring for four to five days.

“Thank goodness it’s not very common. But we could say probably one or two a month,” out of around 40 births per month at the hospital, Garcia said. “I just hope the opioids don’t get this way (to Sunnyside).”

ONGOING CHALLENGES

After withdrawals, drug-affected kids can display a range of neurological symptoms, including developmental delays and behavioral problems, depending on the extent of the mother’s drug use during pregnancy.

“At 3, 4, 5, you’re going to see very hyperactive kids; might have learning disabilities, ADHD, might be disruptive,” Garcia said. “They’re just going to be different, and it can be pretty hard for parents to cope with that.”

Jessica Hanna of Ellensburg, who’s been a foster parent for 11 years and has adopted four of her foster kids, said she’s also seen some sensory-development issues.

“We’re still working through things; my one son started running into walls, and cracking his head open and bleeding, and not crying because he didn’t feel it,” she said.

She says there still needs to be more support available when kids have special needs such as a parental history of drug use, because often children are adopted at younger ages, then reach school and start displaying challenging behaviors, causing parents to feel overwhelmed. She said parents often worry that they will be blamed and even criminally charged if they reach out to DSHS about a child’s violent behaviors, when what they really need is more training and perhaps respite foster care options to help both the child and the family setting be healthy and safe.

In a broader sense, Hanna hopes to see greater empathy and collaboration between the different pieces of the system - biological parents, foster parents, adoptive parents and DSHS - so that everyone can succeed.

“We need to build a program where people aren’t afraid to take on a challenging child because they know that there’s a safety net,” Hanna said.

She sees the lack of trust and understanding between the different players as detrimental to the ultimate goal of finding each child a permanent placement in a healthy home.

“The ideal foster care model is when everybody is on the same team, that we take away these barriers of fear,” she said.

___

Information from: Yakima Herald-Republic, https://www.yakimaherald.com

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