PITTSBURGH — Every Friday afternoon, Pittsburgh Municipal Court hears family crimes, its plastic seats filling up largely with parents accused of endangering their children by injecting themselves with heroin or fentanyl.

Often the district judge tells the parent to leave the kids in the hands of a relative, get drug treatment and come back to court in a few months. Occasionally, the judge adds some grim parting advice:

“If you decide to relapse,” District Judge Anthony Ceoffe urged one young woman last month, “stay away from the kids.”

When opioids hijack a parent, there’s no proven playbook for getting the family back on course. Caseworkers have to decide whether to take the kids away, and policymakers are now trying to provide other options, including novel ones like whole-family rehab.

“Some addicts can care for their kids,” said Marc Cherna, director of Allegheny County’s Department of Human Services. “But odds are that you are neglecting your children. Odds are you’re not giving them what they need, because you’re chasing the drug.”

Removing children can do more harm than good, and there may not be enough foster homes to handle the kids of all of the parents now abusing narcotics. So Mr. Cherna is working to launch two new programs early next year — one in which the family would get help in its own home, and another in which parents and children would be housed together in a new rehab facility.

“It’s an investment,” he said in an interview last week, “but we think that this has a good chance of really reducing relapses and keeping families together.”

That’s less traumatic — and cheaper — than finding a foster home for the children.

Mr. Cherna’s efforts come as the state struggles with the child welfare problems created by the overdose epidemic, and as legislators consider whether to red-flag more families in which a parent uses illegal narcotics. Right now, no coherent strategy exists for addressing the flotsam of families hit by the opioid wave.

“What happens to the kids is kind of dependent on what the circumstances of that moment are, as opposed to a strategic, unified and motivated approach,” said Cathleen Palm, founder of the Center for Children’s Justice, based in Bernville, Pa., in Berks County. However, a heavy-handed approach “will freak out the parent who is now panicked at losing their child, and that may serve as a disincentive to get into recovery and treatment.”


BRING THE FAMILY

In Allegheny County, the number of child welfare cases in which the parent was alleged to have a drug problem has nearly doubled since mid-2015, and that trend is expected to continue for years, as people hooked on prescription drugs continue to progress to heroin and fentanyl, Mr. Cherna said. In early 2016, his caseworkers juggled an average of 12 families each. Now the average is 18.

These cases can be emotionally draining, added Jacki Hoover, assistant deputy director for the county’s Children Youth and Families unit.

“Our South Regional Office had several (client overdoses), I think over five in one month, resulting in a death,” she said. Caseworkers “go in the house that next day. Sometimes you’re wanted. Sometimes you’re not … We have had caseworkers help with funeral arrangements.”

Unlike crack cocaine or alcohol, opioids don’t typically make a parent violent, Mr. Cherna said.

“They certainly love their kids and want to keep their kids, the vast majority of the time,” he said.

As addiction deepens, though, the drug demands more time and money. Meanwhile, which parent can spare a week for crippling withdrawal, a month for inpatient rehab, or three mornings a week for outpatient counseling? Another day on heroin may seem the less disruptive option.

Mr. Cherna wondered: What if the whole family could go to rehab?

His department asked for proposals from vendors willing to create a facility for six to eight entire families. One or both parents would get drug rehab and parenting help, while the children would be cared for during the day and join their parents for dinner and evening family time. He hopes to choose a vendor shortly and start the program within the next few months.

Why treat the whole family?

“All of them are wounded. They all need help. They’ve lived in dysfunction. They have no idea what health is,” said Nick Reynolds, executive director of the 68-bed Dunklin Memorial Church rehab facility, in Okeechobee, Fla. The kids “have observed things that kids shouldn’t have to witness.”

Dunklin is one of the few models for whole-family drug rehabilitation. It offers men 10-month rehab with overnight family visits on weekends, and some stay another year during which they are joined by their families full time. Mr. Reynolds said roughly a third of clients “really grab a hold and see a change,” and that result is worth it.

“You get a healthy family and they go out there and live right,” he said.


OR LET US COME TO YOU

Allegheny County is also hiring Holy Family Institute to send rehab teams into the homes of families with drug-dependent parents and with children ages 2 or younger. They’ll use a plan called Family-Based Recovery, developed at Yale University and used in Connecticut for 10 years, but never before adopted by a county outside of that state.

The theory: Sometimes it’s too much to ask struggling parents to trek daily to an outpatient rehab office, often via public transit. In Yale’s strategy, a substance-use counselor visits the home twice a week, providing treatment, administering toxicology tests and, where necessary, making referrals to methadone or Suboxone prescribers. Once a week, a parent-child clinician comes by to teach mothering or fathering skills.

The child’s presence motivates the parent, of course, but benefits run the other way, too, said Karen E. Hanson, an assistant professor at the Yale Child Study Center.

“A newborn needs to be with their parent,” she said. “That attachment is critical for development” and sets the stage for all future relationships.

Some would argue for removing a child until the parent is clean for a few months, but in her view, “60-90 days for a child, an infant, is an eternity.”

In Connecticut, she said, half of the parents start the program with drugs in their veins, but after 20 weeks 86 percent of them test clean.

“We’re going to walk into a home, and there’s going to be lots of other issues,” said Sister Linda Yankoski, president and CEO of Holy Family Institute. “Sometimes, you visit a family with a new baby, and they don’t have a crib.”

Getting them a crib might be a first step toward their deeper problems.


SENDING UP FLARES

Everybody has seen the photos.

“There will be children in the car with the mom or dad slumped over,” said state Rep. Joanna E. McClinton, D-Philadelphia.

Most people assume that child welfare agencies swoop in, but that’s not necessarily the case. Right now, in some cases, she said, first responders “will not let anybody know,” because they are not legally required to do so.

Ms. McClinton is the prime sponsor of legislation introduced this month that might increase the number of cases reported to county agencies. Under her bill, when public safety professionals respond to an opioid overdose in a home that includes a child under 18, they would have to report it to the appropriate county agency, which would then “immediately see the child to determine if emergency protective custody is required.” Similarly, anytime a baby is born in withdrawal, unless the mother was taking opioids under medical supervision, the county would be alerted.

Gov. Tom Wolf’s administration hasn’t yet weighed in on the bill but has a stakeholder group looking at the issues of infants and children exposed to opioids.

What would happen if even more cases involving addicted parents flooded into the child welfare system?

“We’re reporting to the same system and we’re going to do the same things that we always do,” Ms. Palm, the Berks County child advocate, fears.

She worries that will mean “a traditional child welfare response, not enough tools in the toolbox, not enough resources … To what end?”


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Information from: Pittsburgh Post-Gazette, http://www.post-gazette.com