The Drug Enforcement Administration calls fentanyl the greatest threat to Americans today, and now the potent synthetic opioid is forcing Clark County foster care to take action.

Here to explain how and expand upon the impact of substance abuse on foster care are Wonswayla Mackey, also known as "Sway," Deputy Director of the Clark County Department of Family Services; Leah Dodds, Director of Programs at Foster Kinship; and Katie Krikorian, a foster parent and foster parent advocate through the Clark County Department of Family Services.

Ladies, thank you for joining us today.

Sway, I'm going to start with you, and I have several questions.

First off, what sparked my interest in this topic was an article that I read on elkodaily.com.

The first line reads, quote, An emergency exists for abused and neglected children because of a continued lack of foster homes in Elko County, and fentanyl use by parents is worsening the problem, according to Brandy Holbrook of the Elko office of the Nevada Division of Child and Family Services, end quote.

And so I wondered, if fentanyl abuse by parents is straining the Elko County foster care system, is the same happening here in Clark County?

When I spoke with you on the phone, your answer was...?

(Wonswayla Mackey) Well, fentanyl use is so new and explosive here in Clark County.

However, we can't-- There's not enough data for us to really say that fentanyl in and of itself is bringing children into foster care.

What we can say is substance abuse and substance exposure is bringing children into foster care.

Now, we don't know if that is methamphetamine, if that's marijuana use, and if that's co-occurring use with fentanyl.

So that's really the impact that we can say is that there is a high substance use that's bringing children into care.

-But the impact that it has had is that you are now testing for it, correct?

-Yes.

We recently just added fentanyl as a standard testing panel on drug testing when we test parents for drug and substance use.

-And if a parent tests positive for fentanyl, does that mean that child is automatically removed from the home?

-Well, it doesn't mean that that child is automatically removed from the home.

We are always looking for the least restrictive measures to keep children safe.

So that means that if we have relatives, other fictive kin, individuals who are able to keep the child safe, then we're always looking to keep a child in their atmosphere in the environment that they are familiar with before we remove them from the home.

-Okay.

That is a little bit alarming to me that a parent can test positive for fentanyl and still retain a child.

-Well, what we do is we try to look at the safety threats that are occurring for a child that has to be removed.

So we're looking at the present danger situation, and we're also looking at the impending danger situation.

So present danger, for example, would be we go out to a home, we see a child with the parent, that child-- that parent is under the influence, that child is in a safety situation because the parent can't care for that child, and now we would see that as what we consider present danger that may cause that child to be removed from the home.

However, we're looking immediately to place that child with someone who is familiar or someone who can move into the child's home to care for them in their own home setting.

-As we talked about on the phone, there are certain drugs in which a parent is using, and you know they're using and kids are still in the home.

-Yes.

Because we have a safety plan that we can wrap those families with to keep the child in the home.

We look at the fact that every time we remove a child from a home, it causes a significant trauma to the child.

So we're trying to minimize the trauma to the child as well.

And if we can bring an individual that the child is familiar with into the home who can understand the family dynamics in the home, know what's going on, and keep the child safe in their current living environment, then that's what we look at.

We call it an in-home safety plan.

-And I saw you nodding your head, Katie, when she talked about the importance of keeping a child with a parent, the trauma that can be caused by that removal.

You are a foster care parent.

-I am.

-I would think you might be advocating for the removal, but you're nodding your head.

(Katie Krikorian) No.

The goal of foster care is always reunification.

And if we don't have to reunify because we didn't take them away in the first place, then that would be ideal.

-Okay.

-Kids thrive when they're with their family.

-Is this something you can attest to as well, Leah?

You are working with families who are stepping in to fill in for a parent who is unable to take care of the child.

(Leah Dodds) Most definitely.

The impact on parental separation on a child, I mean, it is really great.

That trauma in itself can cause much emotional and behavioral needs in that child.

And so if we can keep kids-- if they can't be with their parents, the next best option is going to be with their family to increase those cultural connections, to increase comfortability, because they know that child.

If I was removed from my parents, I would want to be with my grandma because that would be my safe place.

I think we could all think about, if we were children, where we would want to be, and it would probably be with a family member or fictive kin, like Sway said, which is just a close emotional bond or somebody who has a close emotional bond to that child.

-Let's say-- We're talking about heroin, meth.

These are drugs that parents are using, and the children are still staying in the house but with a safety plan.

What would that safety plan look like?

-So we're always trying to understand what the safety threat looks like in the home.

So for example, if we have a school-aged child that's at school from 7 a.m. to 3 p.m. or 8 a.m. to 3 p.m., then that child is outside and they're in what we can consider a safe environment in their school.

So we're trying to figure out when does the threat occur in the home, and what time frames do we need to plan to keep that child safe in the home.

So we're always looking and trying to understand when does the threat exist so that we can safety plan specifically around the threat.

Now, at the same time that we're trying to keep the child safe, we're also working with the family to try to ensure that the parent or the person, the caregiver who is using the substance, that they're getting the services that they need as well.

-To try and get off that drug.

-Absolutely.

-Give me an example of a safety plan.

Let's say a parent is out using between 1 a.m. and 4 a.m. That is an example you gave me on the phone.

-Mm-hmm.

-What are you doing?

-So now we know that-- First of all, we try to understand what substance is the parent using and what is the behaviors that is associated with that substance.

And now, once we understand what the substance is, what the behaviors are, now we can figure out, okay, a parent is out.

You know, they may be caring for the child all day long, but then leaving the child at home, either alone or with someone throughout the early morning, midnight hours.

So we're just trying to make sure that we have someone who can provide safe and adequate care for that child through those hours.

But at the same time, it's not just those hours that we're looking at, we're also looking at when that parent comes back to the home, what is the parent's behaviors once they come back.

We know that sometimes parents use drugs and they're on a high and they may be functioning on that high.

It's the time that when they're coming down now that that threat may exist.

So even though they're home, the high is over.

They're coming down from the high.

It may be that they're sleeping all day, they're not caring for the child, they're not feeding the child because they're coming down from that high, which hinders their ability to care for the child.

-That seems like a really hard equation to figure out.

-Yes.

-But you have, based on what you've learned on certain drugs, heroin has these characteristics, meth has these, you are learning to find out what about fentanyl?

-And that's what we're trying to figure out.

Because fentanyl is so new, you know, we're still trying to understand what those behaviors from fentanyl look like.

We're still trying to understand how it impacts the care that they can give to a child.

We're still trying to understand the total dynamic that fentanyl has on the entire family, to include the relatives as well.

-Including the impact that it would have on an unborn baby if used while in the womb?

-Yes.

-Okay.

So that is where I will bring in you, Katie.

You are taking care of infants who have been substance exposed?

-That's correct.

-What kind of information do you get from Clark County about what substances these babies have been exposed to?

-A lot of time, we don't, we don't get a lot of information at placement or when they call us initially.

They do try to contact someone.

These babies are usually in the NICU, and they do try to find a family before they're released.

It's ideal that we can go visit them ahead of time so they're not alone at the hospital.

And at that point, they don't have a lot of information.

Even the hospital doesn't have a lot of information.

Some of the testing that they do can take a while to have conclusive results.

So they know, based on the child's symptoms, that they're going through withdrawals of some kind.

They can guess.

But until we take them to the pediatrician and discuss it with them, we don't really have a lot of information.

-And the pediatrician will get the results of drug tests done at the hospital?

-Yes.

-Okay.

I did reach out to UMC.

They are not testing for fentanyl at this moment on their standard drug testing panel.

I want to bring in you now, Leah.

We had talked on the phone about the importance of knowing whether, for example, an infant has fetal alcohol syndrome.

Will you explain why.

-Yeah, so I think substance use in utero can have detrimental effects on infants, right, especially as they grow and develop into children, into teenagers, and into adulthood.

I think especially with FASD, it can cause a great impact on a child and adult's life.

I think having that diagnosis can be incredibly important in terms of how you treat that FASD.

However, that diagnosis can take years to come about.

It can take two, three, four, or five years old, if you can even get an assessment for that because it can be really hard to find providers that are, one, competent in that, but can actually diagnose it.

And you really need a full picture too.

Like you need to know Mom was using alcohol in utero to even diagnose that.

You could have all the other features, but you need to know that specific information as well.

And I think, yes, it can be helpful to know if a child was born exposed, but really, we need to treat the symptoms that that's causing.

And exposure to substances in utero can also kind of mimic the effects of parental separation.

Maybe that infant is grieving, right?

It might be a combination of that.

If it's an infant that you can't calm down, that maybe seems colicky, right, that could be the grief from just not being with Mom or the parents.

-What kind of information would you like to have, Katie, from Clark County regarding substance exposure.

-I think they do a pretty good job of providing us with information as far as what they can.

We can't violate, you know, the medical rights of the parents.

It would be great if we had additional training on dealing with infant drug exposure, just so that we were more prepared.

I get a lot of phone calls as a foster parent champion from new foster parents that are having a hard time soothing a baby, and they feel like they're doing something wrong.

-Have you over the years learned to differentiate a baby's response?

Well, then this baby may have been exposed to this based on how they're behaving versus-- -To some extent, but it's not always as simple as this baby was exposed to this one thing.

Sometimes it's a combination of drugs.

There's also a lack of prenatal care that happens when parents are using.

And babies who are exposed to some drugs are often born prematurely.

As a result, they have all these comorbidities like low birth weight, and they can have heart problems and respiratory issues.

And they might not be directly linked to the drug itself.

-You had told me that you're seeing an influx of babies right now into foster care.

What do you believe is behind that?

-I think, obviously, drug use is a problem.

And I think that that's happening now.

But I also think that there's a lack of support in the community for these parents who are struggling to control their use.

Las Vegas is a very transient place, and I think very few people who move here have that multigenerational support system that many people in other parts of the country do.

-In our community, there is a lack of support.

I think we are trying to get better, and I think Clark County Department of Family Services has done a wonderful job in when children have to be separated from their parents, getting them with family members.

I think close to half of their, quote/unquote, placements are with relatives right now, which is amazing.

And across the country, numbers aren't that high in other jurisdictions.

So that's really great, but we do need support and to stabilize these families to help form connections so they can build their own informal support system.

You know, just having friends who can babysit is so helpful, or having friends that their kids can get together with.

Sometimes our relatives lack that.

And so at Foster Kinship, we're trying to give them formal supports as well as informal supports to really build up that community.

-You want to add something?

-Yeah.

I would also add that we also need to look at the mental health crisis that's happening here in Clark County.

You know, sometimes there are coexisting problems.

You know, parents have mental health issues, and then they're trying to, you know, self medicate using those substances, you know, which is also bringing those children into care.

So, the coexisting mental health, you know, sometimes that leads to domestic violence.

Sometimes that leads to substance use.

So there are so many co-occurring issues that are happening that are also bringing children into care.

-And when you are made aware of a parent in this situation, are you offering help?

-Yes, we do try to offer resources to parents.

We give them a case plan, a safety plan, so that they can receive services through therapy, counseling, treatment homes, shelter services for domestic violence.

We give the parents a variety of resources and try to help them walk through those things.

Because again, like she said, our goal is always reunification for a child, because children thrive with their parents.

If they can't be with their parents, they thrive in their families.

So we try to keep children connected with the family network.

-So then a foster care parent becomes the third option.

And that is where you come in, Katie.

Katie, what is it like to take care of a substance-exposed infant?

-It can be a struggle, for sure.

They tend to cry more.

And there's a very specific high pitched cry that you hear a lot with babies that are drug exposed.

They're harder to comfort, so we use a lot of affection and attachment and skin time and holding.

I joke that I pick a baby up from the hospital, and I set them down when they turn one.

-They need that much contact?

-They do.

And as parents, we, with our own biological children, we hear a lot that you can spoil them and that you shouldn't, you know, pick them up every time they fuss.

And that's not the case at all with these kids.

They need that attachment.

They crave that attachment because they're missing their family.

-And perhaps missing the substance?

-As well, yes.

-There is one fact I want to get in here.

According to the Nevada Department of Health and Human Services, in 2020, 1,892 infants were reported with substance exposure.

This number has tripled since 2012.

What do you think is behind that, Sway?

-Well, you know, we've had so many things that have changed: The workforce--parents, you know, are struggling to find jobs.

Just generational changes and the thought process of the various generations.

Again, the mental health crises.

We've just recently come out of COVID, where people were struggling with substance use, mental health.

So there's just a variety of things that has caused that increase.

And we are aware of that as a department, so we're trying to make sure that we're, when we're assessing families, we're looking at the totality of the family dynamic, not just one thing.

So we may go in and look at a family who is dealing with substance use, but we're also assessing for other things.

What is the relationships like in the family?

What is the work history like in the family?

You know, what are your living conditions?

Are you able to pay your bills month to month?

You know, what are the other stressors that are causing...

So we're looking at basically trying to get to the root cause as to why there are concerns in the household and, as a department, how can we help mitigate some of those root causes.

-It is Foster Care Awareness Month.

Katie, what would you tell someone considering becoming a foster care parent.

There are 3,000 children in the Clark County foster care system right now.

-If not you, who?

You don't have to be special to be a foster parent.

You just have to be dedicated.

And if you open your heart and your home, then you can figure out the rest.

-Do you have to have a lot of free time?

Can you hold down a regular job?

-Absolutely.

There's a lot of working foster parents.

We help with daycare services, as well.

Most of them are not stay-at-home moms.

That's part of the reason we have issues placing newborns.

-Oh, that makes sense.

And, Sway, last thing: 3,000 kids in the system right now in Clark County, is that a lot?

Is that average?

What's the need?

-It's a significant number.

And what I would tell foster, people considering, is that we need you.

We need the foster homes.

Children should place-- They should be placed in a home setting to where they are in a loving environment, whether it be with a relative or a fictive kin or a foster parent.

Children thrive in a home setting.

So we need you, you know?

We would ask that if you're considering that, to give us a call at the department and we can walk you through that.

-Thank you all for your time.