Opioid crisis strains Minnesota's child protection system

The opioid epidemic that has ravaged communities across Minnesota is also wreaking havoc on the lives of hundreds of children whose parents abuse drugs.

New data from the Minnesota Department of Human Services (DHS) show that, as the opioid crisis tightened its grip on the Upper Midwest, the number of children being removed from their homes because of parental drug abuse has more than doubled since 2012.

For the first time, parental drug abuse has eclipsed neglect as the number one reason why Minnesota children are being taken from their birth parents and placed in state custody.

"We have never seen anything remotely like this," said Dennis Frazier, a child protection worker in St. Louis County in northeast Minnesota. "The opioid crisis moved so fast, like a sonic boom, and we were caught unprepared."

Even before the epidemic, Minnesota's child protection system was straining to shield children from abuse and neglect. Faced with additional children needing care, county social workers say they are working harder than ever to find stable homes and families for them.

DHS has responded with an ambitious strategy that would tighten its grip on Minnesota's fragmented child protection system, and by rolling out a more rigorous review of child maltreatment cases at the county level. The reforms also aim to reduce chronically high turnover among child protection workers, who say they feel emotionally drained by surging caseloads and the difficulty of reunifying families torn apart by addiction.

"We absolutely need to take a more proactive approach," said Human Services Commissioner Emily Piper.

The latest numbers are stark. In 2012, parental drug abuse accounted for fewer than 1 in 7 children being removed from their homes. That share has increased in each of the past five years, and in 2016 the number was just over 1 in 4. Overall, the number of such cases has risen from 881 in 2012 to nearly 2,100 in 2016, according to DHS.

The state has also recorded an alarming increase in newborns exposed to opioids in utero. More than 1,300 newborns were prenatally exposed to drugs and alcohol in 2016, up from 624 in 2012, according to a recent DHS report. Newborns exposed to drugs are at a high risk of long-term behavioral and developmental problems, and are among the hardest to place in permanent homes, researchers have found.

Amy Langenfeld has witnessed the crisis firsthand. As a nurse midwife for the Minneapolis Indian Health Board, she finds that her patients have been particularly hard hit by the opioid epidemic. Last summer, she began carrying a supply of Narcan, a drug that can reverse the effects of an overdose, in her purse, because so many addicts were at the edge of survival.

"You can't save someone who is dead," said Langenfeld, who estimates that 20 percent of her patients are addicted to opioids.

The trend presents unique challenges for social workers. Parents who abuse drugs often resist getting help, because many treatment programs involve separating them from their children, social workers say. In many cases, mothers who stay clean of opioids during their pregnancies relapse after giving birth — after they fall off the radar of clinicians and social workers.

"As soon as that baby is born, the risk of relapse is off the charts," Langenfeld said.

Making matters worse, parents who abuse drugs often lead nomadic lives, jumping from house to house, making them hard to find, said Frazier, the child protection worker in St. Louis County, which has been particularly hard hit by opioids. "It's difficult to reunify a family when you can't find the parents," he said.

Frazier said he has spent much of the past month searching a broad swath of the Iron Range, from Duluth to the Canadian border, for a drug-addicted mother who abandoned her teenage son and has a warrant out for her arrest. The boy, who is living with friends, insists he wants to stay with his mother, but she keeps changing her phone and address, Frazier said.

Last week, Frazier drove an hour through the snow in his old Ford Mercury on a tip that the mother was hiding in an apartment in Virginia, Minn. But when he arrived, she was nowhere to be found.

"It's heartbreaking," said Frazier, who is also president of AFSCME Local 66 in Duluth. "The family doesn't want the kid to become a ward of the state, but the one person who can prevent that from happening — his own mother — has disappeared."

The surge in parental drug abuse has swelled already overwhelming caseloads for many social workers. In some Minnesota counties, the average caseload has reached 30 per child-protection worker — three times the standard set by Gov. Mark Dayton's 2015 task force on child protection. "The workload has become almost unmanageable," said Traci LaLiberte, executive director of the University of Minnesota's Center for Advanced Studies in Child Welfare.

In addition, state officials said the turmoil caused by opioid abuse is one reason Minnesota has struggled to find stable homes for the children. In a widely used measure of the system's performance, the share of Minnesota children who bounce back into foster care after being returned to their parents (known as the "re-entry rate") has increased steadily for four years.

In 2016, 18.3 percent of foster care children in Minnesota were returned to care within a year after being reunited with their families, up from 16.5 percent in 2013, according to the state's online child welfare dashboard. The federal benchmark is 8.3 percent or less. "That's ... unacceptable," said James Koppel, assistant commissioner for children and family services at DHS.

Spurred by these trends, the Dayton administration and some large counties are stepping up efforts on abuse prevention. Both Hennepin and Olmsted counties, for instance, now team up child protection workers with "peer recovery" coaches, who can guide parents through treatment and rehabilitation. DHS has also moved to include peer recovery support among the list of benefits covered by Medical Assistance, the state's version of Medicaid.

The state is also working more closely with counties to prevent child deaths from maltreatment. In the past, the state's tracking of child deaths and their causes was inconsistent. The reviews often took years to complete — and sometimes would not occur at all, according to a 2014 Star Tribune investigation. However, outrage over the brutal murder of 4-year-old Eric Dean, after more than a dozen ignored reports of suspected abuse, prompted the state to adopt a more rigorous, uniform process for reviewing these deaths and their circumstances.

About 1,400 county workers have been trained on the new system since last spring. DHS officials hope the new process will detect patterns and help explain why deaths from maltreatment continue to climb. All told, 26 Minnesota children died from maltreatment in 2016, up from just 9 in 2012.

"We can now have consistent, clear outcomes on what happened," Koppel said. "And secondly, we can figure out what we're going to do about it."

Chris Serres • 612-673-4308 Twitter: @chrisserres