When heroin invades a home, the biggest victims are children, many of them too young to know why their bodies are screaming in pain.
Three-month-old C.J. was born addicted to heroin and spent his first month in a Neonatal Intensive Care Unit at Miami Valley Hospital. The infant was on a morphine drip for that first month.
His foster parents, Elizabeth and Daniel Schreier of Fairborn, are doing their best to nurse him through his withdrawals, but he cries a lot and his limbs are stiff and uncomfortable.
“He wants to see your face at all times,” said Elizabeth, who with her husband has fostered four children for two years. “He wants to hear you talking at all times … otherwise, he’s just screaming non-stop.”
Foster parents, like the Schreiers and Kim Fore of Butler County, are on the front line of an ever-growing problem: how to handle the children displaced and harmed by the heroin problem that is ravaging homes in the Miami Valley and statewide.
Between 2009 and 2013, there were 25,052 cases in Ohio where heroin was cited as a reason for action in child protective services cases, according to the latest data from Ohio Job and Family Services and Ohio Mental Health and Addiction Services.
During the same period, Montgomery County, for example, saw a 131.9 percent jump in child welfare cases where heroin was mentioned.
There appears to be no slowing down the tide of children who are trapped in drug-plagued environments entering the foster care system.
“It seems that the majority of the kids that are coming into (foster care) custody are definitely drug-related cases,” Fore said.
About six years ago, Fore took foster daughter Jennifer into her Fairfield Twp. home when she was six months old. Jennifer’s mother was a used heroin, among other drugs, Fore said.
For a time, the infant split time between her birth mother and Fore before she was permanently removed from the birth mother’s home. Today, the mother is incarcerated in the Ohio Reformatory for Women in Marysville, Fore said.
After visits with her mother, the infant “would be almost in a catatonic state,” said Fore, who has fostered six children in nearly seven years.
Last week, Fore confirmed she has adopted the child, who is now 6 years old. Jennifer and her brother — now 4 and living with his grandmother — both saw far too much involving drug addition.
“He knows how to put a needle in his arm,” Fore said of the brother. “They know way too much. They know more stuff than I know.”
When removed from homes where drug use is rampant, lucky children find a place with relatives, if heroin abuse isn’t a family affair and if those relatives are local, child services professionals say.
But sometimes children are placed in foster homes — surrounded by well-meaning strangers in strange communities.
Increasingly, heroin is the reason why.
A worsening problem
In 2009, heroin was mentioned 144 times in Montgomery County child protective services case files. By 2013, that number had jumped to 334 times, according to the state.
“That wouldn’t surprise me,” said Dayton police Sgt. Monica Evans, a member of the special victims unit. “Heroin is easy to buy on the streets, and it seems to be the drug of choice. With any addiction like that, your priorities are changed.”
That includes the priority of child care.
“Everything else seems to fall apart,” Evans said.
It’s not just a city problem. The drug and its effects are felt across Southwestern Ohio.
“The drugs seem to have a hold of them more than their kids do,” said Sue Gregory, a Fairfield resident who, with her husband Chester, has fostered more than 100 children in nearly 24 years.
The Gregorys adopted two foster children who were born addicted to crack. All too often today, she said, babies are born addicted to another drug.
“It’s not crack any more,” said Gregory, who is president of a foster and adoptive parental support group in Butler County. “It’s heroin.”
In Butler County, the number of times heroin is mentioned in child welfare case files has skyrocketed, from 179 mentions in 2009 to 503 mentions in 2013 — an increase of 181 percent.
In Clark County, heroin mentions rose from 61 to 79 from 2009 to 2013, an increase of almost 30 percent.
Pam Meermans, deputy director at Clark County Job and Family Services, sees the increase.
“The real drug that’s going on is opiates,” Meermans said.
Montgomery County Sheriff Phil Plummer has watched heroin become a monster in Dayton and beyond. He agrees that children can’t escape the problem.
“We’re seeing more and more children in the homes on drug raids then we used to,” Plummer said.
The county jail — which Plummer’s office oversees — once saw a jail inmate population of about 120 women on a daily average, he said. Today, the daily average is closer to 180, he said.
Many of those women inmates are mothers with drug addictions.
“It’s all related to heroin,” Plummer said. “Our jail population has exploded, which creates housing difficulties. We have to transition people to more cells and beds.”
Ten years ago, when Brittany Robertson started working for Montgomery County Children’s Services case worker, dirty homes and parental use of cocaine were often reasons for separating children from parents, she said.
“Now it’s pretty much heroin,” Robertson said.
“Our investigators are going out into the unknown, really,” said Scott Britton, assistant director of Columbus-based Public Children’s Services Association of Ohio. “They’re knocking on doors and they don’t what they will find inside those homes.”
They sometimes find meth labs, abuse, neglect — and worse, he said.
“There’s a lot of vicarious trauma that leads to burnout very early,” Britton said.
Children in strange homes
For children, the experience can be worse.
Even if they’re moving into a more nurturing, stable environment, children find the foster experience disorienting. Separation from a parent — even a parent who uses drugs — is never easy, said Amanda Bush, foster care manager at Choices Inc., a non-profit foster care agency that has its own network of foster homes and works with Montgomery County and other government agencies.
“The move from your birth family to a foster home is traumatic,” Bush said.”It’s a completely different environment. It might be a completely different community, as well.”
Foster parents may find children pulled from neglectful homes sometimes hoard food because they’re used to a home where the next meal is uncertain at best, she said.
“The parents work with them, to help them understand, we’re still having dinner at five o’clock,” Bush said.
Neglect may vary from family to family. But when parents are no longer spending money on food, rent, power and water, the homes start to looking depressingly similar, said Lesley Keown, district manager for Montgomery County Children’s Services.
Focus falls away from everything but drugs, Keown said. Kids lack clean clothes. Parents perhaps have sold furniture, including kids’ children’s beds. Income will be directed to buying drugs. That may mean a lack of food.
“This is when they are pretty far into the addiction,” Keown said. “The problem sometimes becomes when they think they can manage it. And the process of addiction gets worse.”
Caseworkers primarily need lower case loads so they can focus on families, said Britton, whose agency is an advocate for the 85 children services agencies operate in Ohio’s 88 counties.
Caseloads vary from location to location and season to season, but Britton said the Child Welfare League of America — a national advocate for private and public child-care agencies — recommends a ratio of about 12 families per case worker.
Caseworkers spend about 75 percent of their time on just 35 percent of their case load, he said. That leaves just a quarter of a caseworker’s time for the remaining 65 percent, he noted.
“What we’re struggling with in Ohio is a system that’s underfunded, that sees a tremendous amount of turnover and has a lot of trouble retaining caseworkers,” he said. “As soon as we train them, we lose them.”
It’s becoming less usual for caseworkers and investigators to stay on the job for a full year, he said. If they manage to stay on the job for two years, they’re considered “veterans.”
Once the recession ended, caseworkers moved on to different jobs, he said.
“They move on to jobs where they’re not kind of in the line of fire the way they are in our system,” Britton said.
In a September 2014 white paper, Britton’s association argued for more drug courts as well an intervention model that works with child protection service agencies and courts. Medication-assisted treatment — helping addicts wean themselves off heroin with other drugs, essentially — is controversial but still has promising research behind it, he said.
Further, parents of children already in the foster system should be prioritized for treatment — an imperative Britton said is already enshrined in law but not always acted upon.
Because of Medicaid expansion, more people are able to access treatment services. He credits Gov. John Kasich’s administration for that change.
“Unfortunately we have just not seen the next step we would like to see, which is more of a focus on the children who suffer as a result of their parents’ addictions,” he said.
Heroin and other opiates tend to be particularly insidious. Addicts to those drugs suffer a higher rate of relapse, making reunifying children with families more difficult.
“They go into treatment one day or a couple of hours, and they’re right back out,” Robertson said.
Helen Jones-Kelley, executive director of the Montgomery County Alcohol, Drug Addiction and Mental Health Services Board, has long warned of the dangers of heroin. But she says that of Montgomery County’s 225 total available treatment beds at rehab facilities, many are going unused.
“We have plenty of treatment facilities,” she said. “But until a person is ready to work a program … people will walk away.”
‘When they’re high on heroin, you can tell’
Montgomery County Children’s Services officials do not yet track cases so that “heroin use among parents” can be quickly identified as a reason for placing a child in the foster care system.
That type of detail is often found in case notes, said Kevin Lavoie, a spokesman for the office. He added: “It’s not in a scientific quantifiable means that we can sift through our system as yet.”
“Neglect” or “abuse” may be identified as reasons for placing a child in foster care, as can physical abuse. And those reasons may be traced back to drug use, officials said.
“When we get out, we sometimes find it’s related to substance abuse,” Keown said.
Robertson said case workers get calls from neighbors or schools concerned about children being left alone or without adequate food or clothing.
Initial visits are often simply an attempt to give the parents information about local resources, as well as assessing the safety of a child or children in a home.
“You’re finding drug paraphernalia, parents under the influence,” Robertson said. “Usually when they’re high on heroin, you can tell pretty clearly.”
Sometimes children themselves are able to verbalize that parents are using drugs, she said.
“I do know that we’re getting an increase in the number of referrals that we’re getting that are related to heroin use,” Keown said.