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Foster Care, Kinship Care and the Opioid Epidemic

By: Dr. Marsha Raulerson, M.Ed. MD FAAP, Pediatrician in Brewton, AL and Vice
Chairman, Children First Foundation Board of Directors

This week in Alabama a committee will begin discussing how Alabama’s opioid settlement money will be used. My hope is that they will remember the children.

An often-forgotten consequence of the opioid epidemic is its impact on children and their
caregivers. Children of addicted parents frequently end up in foster care or are taken in by
relatives—usually grandparents. These children have suffered from neglect, if not frank abuse,and arrive in their new home traumatized, scared, and with challenging behaviors.

Children in kinship care are likely to experience fewer home changes than foster children and are more likely to have a “forever home.” For every one child raised by kin in foster care, there are 85 being raised by kin outside of that system. ( State Fact Sheet 2021).

But children living with relatives are often ineligible for the social supports from state and city governments that standard foster care families receive. In some cases, this includes financial support, and in others can include social services, therapy, education, and other critical resources.

Grandparents or other relatives can provide a safe, nurturing, and structured home for children whose lives have been turned upside down by their parent’s addiction. Unfortunately, food insecurity, crowded living spaces, and the caregiver’s loss of freedom are frequently associated with the arrival of this sudden responsibility.

One family I see have been caring for two grandchildren for seven years with no government
assistance other than Medicaid insurance for the children (not the grandparents, who are too
young for Medicare). The younger child has multiple handicapping conditions secondary to an
emergency delivery and premature birth resulting from his mother’s addiction. Several months
ago, these grandparents took on the responsibility of three more children who are victims of
parental drug addiction. They asked for DHR help, and are training as kinship foster parents, but have received no financial help in five months. They live in a small three-bedroom home, have an older vehicle that cannot accommodate seven people, can’t afford childcare for the youngest children, and were turned down for SNAP. Just feeding the kids has been a challenge. Getting to church or the grocery store requires significant planning and help from friends.

Kinship care takes its toll on these heroic relatives. They must jump through many hoops to
qualify for foster parents—usually at their own expense. They must put aside their retirement plans, often neglect their own physical and mental health—but they do it with joy. They are oftenalso motivated by a sense of their own perceived failure in preventing their own children’s drug abuse.

Over a period of nine years, another couple, in their mid-seventies, had five grandchildren placed in their care. For a short time, they received a little financial assistance—but receive none now. They have struggled financially despite having good jobs. Their life savings are depleted. Emergency car repairs almost pushed them over the edge. Although four of the children have Medicaid insurance, it does not pay for braces for their teeth, extra funds for school, gas for doctor visits, or out-of-home activities. They cannot afford family vacations. To make ends meet, the grandfather still works full time. The grandmother states: “All five of the children have mental health issues due to their parent’s drug use and the trauma that was inflicted on them while living with drug addicts.” The oldest child has aged out of Medicaid but still needs mental health services and has been incapable of working. This wonderful grandmother also said: “in kinship placement, very little if any financial assistance is provided—not even for food.

There are so many of us grandparents struggling to support these children because it is best for children to stay together with family that loves them. As we age that becomes more and more difficult. The system pushes to place children with their families and then just forgets them.”

I know what she says is true. I have tried over many years to care for another family with six children. They were removed from their parents because of repeated drug abuse and physical violence. The case was closed when the children were divided among three family members. Only one of those kids remains with the original placement. Has anyone checked on them? NO.

Another family with two boys I care for, recently got temporary custody of their two nieces, ages 3 and 7. The girls’ parents, who are abusing drugs, abandoned them in a motel. The seven-year- old is on the autism spectrum and is nonverbal. The aunt told me: “it is hard to keep food in the house with only one parent working. Plus, there is the cost for gas for doctor and dentist appointments. Clothes, medicine, anything the kids need is on us. Everything is expensive now. Plus, school just started with the added expense of supplies, lunch and snack money, gas to take them to school or daycare. Just keeping the kid’s clothes and bedding washed and clean getsexpensive.”

Alabama’s foster care system is seeing a rising number of children in DHR custody due to
parental drug abuse. The fate of these children is much more dire than those in kinship care. A child living with a relative usually has at least one caring adult whose love can help him overcome the trauma and adverse experiences he endured because of his parent’s substance abuse. But the foster child may never receive trauma-informed care or experience unconditional love from anyone.

Children in foster care face the constant risk of being moved. They have only a fifty percent chance of graduating high school. They are significantly more likely to become homeless, incarcerated, and unemployed than their peers not in foster care. If trauma-informed mental health services were readily available and consistently provided for these children and their foster parents, we would see a better outcome for them.

Several years ago, I cared for a high school senior who had spent most of her life in foster
homes. She planned to attend her high school prom and picked out the perfect dress. When her foster mother brought home a second-hand dress, she had a severe melt down that led to her
immediate removal from that home.

Another teen patient of mine was picked out from a computer site and adopted by a couple in
another state. They declined my offer to meet with them, stopped her medication and did not
have her records sent to a pediatrician where they lived. A few months later they called her DHR social worker and said: “Come and get her.” She is now in a group home in Alabama and will soon age out of the system.

Opioid settlement funds should, of course, provide treatment including medications for patients suffering from substance disorders, including many who are incarcerated. But we must not forget to care for the children impacted by this epidemic—for they are our future.
Children First is a non-profit, non-partisan organization dedicated to improving the lives of Alabama’s children and families through advocacy, awareness, and accountability on legislative issues that directly impact their daily lives. Children First has been one of, if not the, leading advocate for the well-being of children in the state of Alabama. Children First was formed because our states’ leaders and child advocates saw a need to advocate for children in the halls of Alabama’s legislature. For more information, please visit

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