April 25, 2006

The Child Welfare League of America (CWLA),on behalf of its 900 public and private nonprofit, child-serving member agencies, thanks the U.S. Senate Finance for holding this hearing on the issue of methamphetamine (meth) use and its impact on the child welfare system. We appreciate that this Committee, through the leadership of Chairman Grassley and Senator Baucus has set aside time in the Committee’s very busy schedule to highlight the impact of meth use on communities across the country and on the child welfare systems that serve them. CWLA looks forward to future hearings and discussions on the range of child welfare issues that challenge this nation-including the reauthorization of the Promoting Safe ands Stable Families program.

CWLA also recognizes Chairman Grassley’s recent efforts concerning the implementation of regulations in regard to Medicaid’s targeted case management (TCM) and its availability to children in foster care. The Chairman’s letter dated April 5th to the Secretary of Health and Human Services, attempts to clarify how states can use TCM through Medicaid in light of recent legislative changes. Medicaid targeted case management serves as an important tool to ensure children in care gain access to clinical and medical services that are essential to their permanency. CWLA looks forward to working with your office and all members of the committee to ensure that any future regulations will aid, not hinder, such a goal.

The Issue of Parental Substance Abuse on Children

Any discussion concerning the manufacture, use, and addictive nature of meth and the child welfare system highlights a more general, but critical concern CWLA holds regarding a key strategy for improving the safety and well-being of children and the effectiveness of the nation’s child welfare system. Alcohol and other drug addictions devastate the lives of hundreds of thousands of American children and their families each year.

Among these families, those who are involved in the child welfare system often face additional difficulties with addictions and require access to appropriate substance abuse treatment. A common thread in child protection and foster care cases is the high percentage of children, their parents, or both who have a substance abuse problem. Substance abuse, a major factor in child abuse and neglect, is associated with the placement of at least half of the children in the custody of child welfare agencies. 1Some estimates indicate that substance abuse is a factor in nearly two-thirds of substantiated cases of child abuse and neglect, and in two-thirds of cases of children in foster care. 2 Furthermore, children whose parents use drugs or alcohol are three times more likely to be abused and four times more likely to suffer from neglect. 3As this Committee examines the impact that meth production and use play on child welfare systems, we should remember that substance abuse is a treatable public health problem with cost-effective solutions. Even meth-focused treatment is effective, despite claims to the contrary. Implementing a treatment strategy for meth addiction that is time appropriate and includes a cognitive behavioral approach and motivational interviewing can produce recovery rates for meth addiction similar to other substance addictions. 4 Congress should craft policies that recognize these interventions as important components of a comprehensive drug policy and as a key to effectively treating all substance abuse addictions.Good assessment, early intervention, and comprehensive treatment are key to determining when and if a child can safely stay at home or be reunited with his or her family. 5 SAMHSA data indicates that women who participate in comprehensive substance abuse treatment longer than three months are more likely to remain alcohol and drug free (68%) than are those who leave treatment within the first three months (48%). 6 SAMSHA data also shows that 75% of those women receiving comprehensive substance abuse treatment have physical custody of one or more children six months after treatment discharge.

In 1997, this Committee guided through to passage the Adoption and Safe Families Act (ASFA) (P.L. 105-89). ASFA was designed to promote the safety and permanence of children by expediting the timelines for decision-making in seeking a permanent home for children. ASFA requires that the courts review the plan for a child’s permanent living arrangement within 12 months of the date a child enters foster care. It also requires that if a child is in foster care for 15 of the most recent 22 months, that a petition to end a parent’s rights to the child must be filed, unless certain exceptions apply. To ensure permanency decisions can be made for children whose families face alcohol and drug addictions, special steps must be taken to begin services and treatment for the family immediately upon a child’s entry into foster care or after the family regains custody of their children.

Resources for substance abuse treatment for families are in chronically short supply. There is a national shortage in all types of publicly funded substance abuse treatment for those in need, especially for women with children. Even prior to the rapid spread of meth, all states reported long waiting lists. Alarmingly, over two-thirds of parents involved in the child welfare system need substance abuse treatment, but less than one-third gain needed treatment.

In recent years Senators Olympia Snowe and Jay Rockefeller, along with other cosponsors, have proposed legislation (Child Protection/Alcohol Drug Partnership Act) that would assist states in addressing this shortfall through a range of state activities to improve substance abuse treatment. These activities must be directed to families with substance abuse problems who come to the attention of the child welfare system. We urge the committee, as part of its review both of the current meth crisis and comprehensive child welfare reform, to examine this legislative proposal which was developed through a broad coalition of groups and experts.

The Impact of Methamphetamine Manufacture and Use on Child Welfare

In recent months several congressional committees have held hearings in Washington and around the country on the unique challenges and threats that meth imposes on all aspects of the community. Much of the initial focus centered on the law enforcement issues regarding meth use and production. CWLA restates earlier comments offered to Congressional committees that the Finance Committee may find useful:

Increasing use of meth has challenged the abilities of child welfare agencies (tribal, state, and private) to protect children. Child welfare agencies are forced to focus more of their time and resources on children impacted by meth and, as a result, essential child abuse and neglect prevention and support funds are diverted to providing foster care. In rural areas, where meth use and production has led to greater devastation, stresses on the child welfare system can also surface through the increased need for foster parents complicating the unique challenges rural areas already face in recruiting foster families. These challenges increase when caseworkers must find appropriate foster parents willing or having the ability to accept children removed from meth-involved families. Some potential caregivers may fear contamination or have concerns regarding some children’s behavioral problems that may require intensive therapy following removal.

Children face many hazards while living in meth labs and are often the victims of maltreatment. In homes where drug addiction is present, necessities such as food, water, supervision, shelter, and medical care may only be an afterthought. Children can also be exposed to dangerous chemicals and the risk of explosions. As of 2003, fires or explosions occurred in 15% of meth labs. 7Studies have shown that meth production environments produce immediate and long-term health risks. Exposure to the precursor chemicals used in the manufacturing of meth can result in pulmonary irritation and pulmonary edema; severe corneal irritation; upper respiratory tract damage resulting in permanent lung damage; and bronchospasm, vocal cord dysfunction, and lung fibrosis among healthy adults. 8 For children, these effects are multiplied. The complete and lasting long-term health effects for children exposed to meth environments are not fully known at this time, however, recent reports from physicians and psychologists reveal significant concerns about the physiological and psychological conditions of children exposed to these environments. 9Between 2000 and October 15, 2005, methamphetamine lab seizures by local or federal law enforcement affected 15,192 children. 10 Early reports reveal that nearly 3,800 children were exposed to toxic chemicals, 96 were injured, and 8 died because of meth labs. 11 This does not account for the other meth-affected children who entered foster care through reports of abuse or neglect, or those who were never reported to state officials. The figures are considered underreported, as many states are only beginning to collect data representing the presence of children in a lab site. While it is important to document the number of meth labs seized, they account for only a small level of meth available in communities. The passage of recent legislation aimed at preventing the home manufacturing of meth has resulted in fewer meth labs, but the National Drug Threat Assessment reports the increased production in and distribution from Mexico has easily offset this. 12Recent data indicates more than 80% of the nation’s meth supply is being imported to the U.S. 13

Child welfare workers report that the needs of children removed from meth labs are pronounced and extreme following prolonged periods of neglect. Outside of the immediate physical health concerns, these children may exhibit greater social, educational, emotional, and behavioral challenges than other children who enter foster care. 14 The lack of parental attention has not allowed the children to achieve appropriate levels of development and a child may face confusion and doubt in terms of whom they can trust. These children have difficulty associating with peers and lack guidance in their everyday actions. 15

The Impact of Methamphetamine on the Child Welfare Workforce

We urge the committee to pay special attention to the child welfare workforce when addressing meth. We feel it is always critical that any reforms or modifications aimed at improving child welfare pay special attention to the workforce that must be fully staffed, trained, and supervised. This also applies to the impact of meth. The exposure to the toxic mixture we list in this testimony is a risk not just to the families but also to the child protection and other child welfare personnel who come into these sites. Comprehensive solutions require addressing the need for training and protection for these workers.

Child protection workers are often among the first to investigate potential meth labs based on reports of neglect or abuse filed by schools, neighbors, or others. Child protection workers who perform investigations face extreme risk of physical safety due to users’ heightened sense of paranoia, which can result in assaults against workers. Also, unknowing workers are at risk of chemical contamination as they enter the home. As a result, several state legislatures have enacted provisions within the past year that set strict protocols for child protection workers to follow if they suspect a meth lab is present. For example, a responder who suspects a meth lab should immediately leave the area, without informing potential suspects, and inform law enforcement of the situation.

The Impact of Methamphetamine in Select Communities

The social and economic impact of meth has spread from a few rural areas to a majority of states. Meth has filtered into a significant portion of the communities represented by members of this committee, as the following chart reflects. Of the 17 states that the committee members represent, 4,739 children were directly impacted from federal or state meth lab seizures from 2000-2005. 16 This represents nearly one-third of all the children nationwide who were impacted over the same period. Again, these numbers are only a fraction of the children who enter into out-of-home care due to parental meth use.

Children affected by meth lab seizures for 2000-2005* 17

2000 2001 2002 2003 2004 2005 Total
AR 53 120 207 230 173 57 840
AZ 57 59 60 82 44 20 322
IA 37 61 91 115 103 25 432
ID 14 16 14 21 10 4 79
KY 33 34 42 55 79 67 310
MA NA 2 NA 2 0 NA 4
ME NA 0 NA NA 6 0 6
MS 18 44 104 80 63 19 328
MT 5 17 37 20 7 2 88
NM 7 27 43 64 18 6 165
ND 5 52 57 18 14 1 147
OR 117 225 133 99 82 19 675
PA 0 1 2 8 5 7 23
TN 59 160 224 296 287 41 1067
UT 17 23 29 17 22 0 108
WV 0 10 8 20 37 31 106
WY 3 2 19 9 4 2 39
Totals 425 853 1070 1136 954 301 4739

*Totals reflect reports as of 10/15/05

Even with recent trends documenting that “mom and pop” meth lab operations are decreasing as because state and federal legislative action are limiting the sale of precursor chemicals, meth use is not fading away. Substance abuse treatment admission rates for meth increased 420% between 1992 and 2002. 18 The most recent available treatment rates reveal significant portions for meth treatment in each of the committee members’ states.

2003 State Admission Rates with methamphetamine/amphetamine as primary substance of abuse 19

Total of All Admissions Meth/Amphetamine admissions
US 1,841,522 135,737
AR 13,369 2,958
AZ 15,879 1,625
IA 27,197 5,330
ID 3,122 818
KY 31,149 696
MA 52,202 101
ME 13,057 51
MS 9,140 561
MT 7,234 1,040
NM 3,835 155
ND 2,045 240
OR 45,461 7,548
PA 63,992 254
TN 7,796 301
UT 13,226 3,430
WV 1,247 21
WY 5,816 891
Totals 315,767 26,020

The Impact of Methamphetamine in Tribal Communities

On April 5th, the Senate Committee on Indian Affairs held a hearing on meth use and its impact on Indian country. Members of the Finance Committee represent sizable tribal populations, we emphasize that solutions need to include tribal governments.. CWLA mentions this not only because many of these tribes are your constituents, but also because we believe this country must make a more diligent and concentrated effort to provide tribal governments greater access to vital child welfare services.

Existing data on meth use affecting tribal communities is startling. The National Survey on Drug Use and Health shows that 1.7% of the American Indian/Alaska Native population reported meth use in the past year. 20 This rate is only behind that of Native Hawaiians (1.9%) and those of two or more races (1.9%). 21 Less than 1% of White, non-Hispanics reported using meth in the past year 22, even though they account for 72.7% of those entering treatment with meth as a primary focus. 23 Native Americans represented only 2.2% of those entering treatment due to meth use. 24

CWLA’S Recommendations

CWLA strongly recommends federal legislation that is focused on the growing meth dangers in this country and the impact of parental meth use on children. Much of the recent focus and attention on the meth problem has focused on the law enforcement response and action. Legislation is needed to strengthen the capacity of child welfare agencies to protect children from abuse and neglect where meth is involved, enhance services for children removed from these homes, and increase prevention efforts for abuse and neglect. Congress can address these issues in several ways:

  • Pass the Child Protection/Alcohol and Drug Partnership Act with new resources for states and tribes to provide the substance abuse treatment.The Child Protection/Alcohol and Drug Partnership Act would provide new resources for a range of state activities to improve substance abuse treatment for families in the child welfare system. State child welfare and substance abuse agencies, working together, would have the flexibility to decide how best to use these new funds to enhance treatment and services. This bipartisan legislation, sponsored in previous sessions by Senators Olympia Snowe and Jay Rockefeller and others from both parties, would enhance efforts to address substance abuse treatment as it affects child welfare systems. As part of this, Congress must ensure that tribal communities are partners in this effort in both planning and funding.
  • Reauthorize Promoting Safe and Stable Families with enhanced funding.We urge Congress to reauthorize the Promoting Safe and Stable Families program before it expires at the end of this fiscal year. We appreciate the increase in mandatory funding and continue to work toward restoring this important program’s full funding, which was set at $505 million in 2001. The need for increased funding for family reunification, family preservation, family support, and adoption support is great and the challenges of meth use only increase this need.
  • Preserve access and support for Medicaid Targeted Case Management and other services. We commend Chairman Grassley’s efforts to preserve access to targeted case management for children in foster care. We call on all of Congress to preserve this service and reject any proposal that would reduce the matching rate. In addition, CWLA urges Congress to reject any legislative or regulatory changes that would deny access to children in the child welfare system to needed rehabilitative services provided through Medicaid.
  • Maintain, strengthen, and broaden the access to Title IV-E training funds.As the challenge of parental substance abuse increases in many parts of the country, child welfare workers (including tribal, public, and private agency workers) need to be well prepared. A small but important source of child welfare training is provided through Title IV-E Training dollars. Currently, federal funds cannot be used to provide training for private agency workers or court personnel who are involved in providing services and making decisions for abused and neglected children. Neither is this funding directly available to tribal programs, as emphasized earlier. This source of funding could enhance worker training if Congress were to amend the law as some recent legislative proposals have suggested, increase the appropriations available in response to the current epidemic, and expand the access to include all governmental and non-governmental agency staff that are required to intervene.
  • Pass the Indian and Alaska Native Foster Care and Adoption Services Amendments to provide tribal access to Title IV-E funds. Legislation currently before the Senate, S. 672 the Indian and Alaska Native Foster Care and Adoption Services Amendments of 2005, introduced by Senator Gordon Smith and co-sponsored by other members of this Committee, would allow tribal governments direct access to Title IV-E Foster Care and Adoption Assistance. While not specific to the substance abuse problem, these federal funds are the single largest federal source of support to our nation’s child welfare system. The Senate Finance Committee actually passed this legislation in 2005, but the vehicle it was attached to did not pass. These funds subsidize foster care placements and adoption assistance. Tribes currently do not have access unless they can work out mutual agreements with state governments. The child welfare systems of tribal communities are massively underfunded, and this issue needs urgent Congressional action.

Conclusion

CWLA commends the Committee for its focus on addressing the impact meth plays on children, their families and the agencies that serve them. The dangers of meth to children and its social and economic impact on the child welfare system are such that it demands the immediate Congressional attention. As Congress acts on the overall impact of meth manufacture and use, it must also incorporate child welfare concerns in its legislative efforts. A real solution must establish enhanced treatment programs, allowing individuals to receive the help needed. Effective practice modalities must be established for child welfare workers that protect their safety. Education efforts must begin for our children, youth, and tribal communities that detail the dangers associated with meth and seek to curb future use. These efforts must also be targeted at those areas that are not currently experiencing a problem. Above all else, services and protection for the children removed from meth homes must be secured and strengthened. CWLA looks forward to working closely with this Committee to further promote the safety and security of the nation’s children.

Notes

  1. Child Welfare League of America. (1997). Alcohol and Other Drug Survey of State Child Welfare Agencies. Available online. Washington, DC: Author. 
  2. U.S. House of Representatives, Committee on Ways and Means. (2004). Substance Abuse, Section 11. In 2004 Green Book. Washington, DC: U.S. Government Printing Office. 
  3. Wells, K. & Wright, W. (2004, Sept. 14). Medical Summit. Presented at Idaho’s Second Annual Drug Endangered Children Conference, Post Falls, Idaho. Available online. 
  4. Rawson, R. (2005). Methamphetamine addiction: cause for concern-hope for the future. Presentation to Congressional luncheon, June 29, 2005, Washington, DC. 
  5. Physician Leadership on National Drug Policy. (1998). Major new study finds drug treatment as good as treatments for diabetes, asthma, etc., and better and cheaper than prison. (Press release of a study sponsored by Physician Leadership on National Drug Policy). Available online. Providence, RI: Author. 
  6. Center for Substance Abuse Treatment. (2001). Benefits of residential substance abuse treatment for pregnant and parenting women: Highlights from a study of 50 Center for Substance Abuse Treatment demonstration programs. Rockville, MD: SAMHSA. 
  7. Swetlow, K. (2003). Children at clandestine methamphetamine labs: Helping meth’s youngest victims. OVC Bulletin. U.S. Department of Justice, Office of Justice Programs, Office for Victims of Crime. 
  8. Martyny, J.W., Arbuckle, S.L., McCammon, C.S., & Erb, N. (2004). Chemical exposures associated with clandestine methamphetamine laboratories using the anhydrous ammonia method of production.Available online. New York: National Jewish Medical and Research Center. 
  9. Martyny, J.W. (2005). Congressional testimony to the U. S. House of Representatives Committee on Science. Available online. 
  10. United States Department of Justice. Drug Enforcement Administration. (Unpublished report, November 2005). (Report generated by El Paso Intelligence Center’s National Clandestine Laboratory Seizure System and made available through the Freedom of Information Act). Washington, DC: Author. 
  11. Office of National Drug Control Policy (2005). Drug endangered children (DEC). Available online. 
  12. U. S. Department of Justice. National Drug Intelligence Center. (2006). National drug threat assessment 2006. DOJ publication No. 2006-Q0317-001. Available online. Washington, DC: Author. 
  13. Ibid. 
  14. Hohman, M., Oliver, R., & Wright, W. (2004). Methamphetamine abuse and manufacture: the child welfare response. Social Work, 49, 373-381. 
  15. Swetlow, K. (2003). Children at clandestine methamphetamine labs: Helping meth’s youngest victims. OVC Bulletin. U.S. Department of Justice, Office of Justice Programs, Office for Victims of Crime. 
  16. United States Department of Justice. Drug Enforcement Administration. (Unpublished report, November 2005). (Report generated by El Paso Intelligence Center’s National Clandestine Laboratory Seizure System). Washington, DC: Author. 
  17. Ibid. 
  18. Substance Abuse and Mental Health Services Administration. (2004). The DASIS Report. Primary methamphetamine/amphetamine treatment admissions: 1992-2002. Retrieved online. 
  19. Substance Abuse and Mental Health Services Administration. (2005). Treatment Episode Data Set (TEDS). Highlights – 2003. National admissions to substance abuse treatment services, DASIS Series: S-27, DHHS Publication No. (SMA) 05-4043, Rockville, MD. Available online. 
  20. Substance Abuse and Mental Health Services Administration, Office of Applied Sciences. (2005).Methamphetamine use, abuse and dependence: 2002, 2003, and 2004. (National Survey on Drug Use and Health Report). Available online. Washington, DC.: Author. 
  21. Ibid. 
  22. Ibid. 
  23. Substance Abuse and Mental Health Services Administration. (2005). Treatment Episode Data Set (TEDS). Highlights – 2003. National admissions to substance abuse treatment services. (DASIS Series: S-27, DHHS Publication No. (SMA) 05-4043). Available online. Rockville, MD: SAMHSA. 
  24. Ibid.