Child Welfare Needs the Three Rs to Combat Opioid Impact

To improve the lives of children and families affected by the opioid epidemic, we have to go back to those fundamental elements of success, the “3Rs”: results, resources and relationships.


Child welfare agencies cannot accomplish their mission without resources and support from other family-serving systems. This is especially true in serving families challenged by substance use disorders, mental illness, family violence and trauma, and inadequate housing.

Over the past 20 years, federal, tribal, state and county agencies and forward-thinking foundations have supported projects that break down existing agency silos. Exemplary programs in California, Arizona, New York and Kentucky, among others, have achieved reunification at rates substantially better than the “business as usual” system, using a family-centered approach and drawing on collaborative partnerships. They have also supported parents’ recovery at much higher rates than conventional approaches, and demonstrated rates of re-entry into the child welfare system at a third of standard services.


The child welfare system spends approximately $30 billion annually keeping children safe and families together. The federal government alone allocates over $470 billion annually on programs that benefit children. Just last week, the omnibus spending bill passed by Congress allocated $112 million to the Centers for Disease Control and Prevention and $150 million for the Substance Abuse and Mental Health Services Administration to combat opioid use disorders.

It also appropriated the funding levels authorized by last summer’s 21st Century Cures Act, which included money for community-based coalitions, access to overdose treatment, building communities of recovery and improving treatment for pregnant and post-partum women. These resources could help families in which opioid use disorders may result in foster care removals.

But here’s a critical question: Were any child welfare agencies included in the planning for new federal allocations? Were child welfare-involved families given any priority for this funding? And how much have home visiting and other programs with sizable funding streams focused on child welfare-involved families?

These are compelling questions for policymakers, advocates and other stakeholders who are committed to ensuring that federal funds are directed to the children and families who need them the most.


To justify current and future federal investments, policymakers will need to be convinced that increased funding will lead to results. More often than not, effective results can only be achieved if two or more systems work effectively together. Trust and alignment of values are the active ingredients of successful partnerships, but they only come as relationships and collaboration deepen over time.

In the case of the opioid crisis, child welfare agencies often lack relationships of trust with the substance use treatment providers, health and mental health agencies, and other providers. As a result, some parents don’t have access to the services they need in order to be reunited with their children, while others lack the treatment and recovery resources to keep their children safe.

Both federal requirements and collaborative efforts on the ground in local communities can drive new and stronger relationships between agencies. A convergence of these two drivers has emerged in recent policy responses to the prenatal exposure of thousands of babies to opioids.

For example, new opportunities for collaboration have come from the guidance issued under the Child Abuse Prevention and Treatment Act (CAPTA) for Plans of Safe Care for all infants  that are drug- or alcohol-affected, experience withdrawal symptoms or identified with a fetal alcohol spectrum disorder at birth.

We can no longer say that we don’t know what to do when it comes to prevention, treatment and support. The good news is that we now have the results we need to make the case for critical increases in government investments. As more children go into foster care, we must ensure the availability of appropriate resources to serve child welfare-involved children and their parents. And through the success of dozens of innovative programs across the country, we also know that relationships between agencies are critical to help families solve complex problems.

Child welfare agencies need and deserve help from the treatment and other agencies that are also funded to help children and families. Accomplishing this will require a new level of collaboration, support and trust from other agencies they do not control — but whose help they desperately need.

Mary Bissell is a partner at ChildFocus, a national child welfare policy consulting firm.

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