Pennsylvania focuses on helping opioid-addicted parents kick habit, keep their children
Bailey Noll hid her heroin addiction from her young son's curious eyes.
“I never let Paxton be around when I was using,” she said.
She would lock herself in her North Huntingdon bedroom to inject the drug.
One day in January last year, she didn't come out.
Her mother picked the lock with a wire hanger and found her unconscious. As she started CPR, Paxton was in the next room.
“She told him to go stand in the kitchen, stay there,” Noll said, her voice going quiet. “And he listened, thank God.”
Paramedics came. Then the police showed up.
Officers called the Westmoreland County Children's Bureau.
“I had avoided it up to that point,” Noll said.
The hard reality was that her drug use could cost her custody of her child.
Was it worth it?
Hundreds of parents are faced with that question in Westmoreland County and across Pennsylvania, where parental substance abuse accounted for 8,423 valid child abuse allegations — 19 percent of the total, according to a 2015 report from the state Department of Human Services.
In the three previous years, substance abuse contributed to 14 percent of valid abuse cases, according to the annual reports. The number may not be exact because counties were not required to provide that information from 2012-14, officials said.
While substance abuse isn't a new problem for caseworkers, the ongoing opioid epidemic will take community partnerships and coordination between state agencies to solve, said Cathy Utz, deputy secretary of the Office of Children, Youth and Families.
“It's not an easy issue; it's complex,” she said. “The journey to recovery isn't something that happens overnight for these individuals.”
The Westmoreland County Children's Bureau has taken more abuse reports in recent years, though it doesn't track the number related to drugs, said Director Shara Saveikis. She believes it's the result of more parents with substance abuse problems as well as a law revised in 2015 that requires people who work closely with children, such as teachers and police, to report suspected abuse to the state's 24-hour ChildLine service, she said.
In fiscal year 2013-14, the bureau assessed 5,544 children and opened 336 new cases. In 2015-16, the number jumped to 6,617 children and 418 new cases. Its budget swelled from $23 million in 2015 to about $26.2 million by the end of 2016. Officials budgeted $25.9 million for 2017.
While officials in other states plead for more foster parents amid the drug epidemic, the number of Westmoreland children placed into foster care because of substance abuse in the home dropped from 57 two years ago to 37 last year.
Assistant Director Jason Slocenski said two factors have helped keep parents and children together: The bureau lowered the toxicity threshold on drug tests to better monitor clients, and it started referring families to services more quickly. During 2015-16, 47 people were referred to a family decision-making class, up from 34 referrals two years before.
“It's really engaging and emphasizing the family” while “preventing the initial addiction from occurring,” Saveikis said.
As of September, 15,618 Pennsylvania children were in foster care because of a parent's substance abuse problems, a 10 percent increase from March 2013, state figures show.
A parent's substance abuse results in loss of custody in 30 to 40 percent of cases, Utz said. Many children are placed with relatives or in a familylike setting and some eventually rejoin their parents, she said.
State officials hope that more than $40 million directed to specific treatment centers and more options like those for the uninsured and underinsured can get help to parents, said Jason Snyder, special assistant to the secretary of the Department of Human Services.
“We need to be treating those parents effectively ... so that we can eventually put them back with their children,” he said.
Noll's addiction story is a familiar one.
At age 25 and after a flurry of tough times, she started abusing painkillers she had been prescribed for years for a medical condition. Then she moved to heroin.
She didn't abuse drugs while pregnant and managed to get clean several times — twice celebrating her birthday in rehab — only to get hooked again.
Paxton was born in January 2014.
“I didn't even leave the hospital before I started using again,” Noll recalled. “He wasn't out 48 hours before I started up.”
For months, Noll struggled to form a bond with the baby.
It wasn't the life she had planned.
“Who I was becoming was a very, very ugly, disgusting person,” she said. “I destroyed so many things in my life. I have hurt too many people. I have said and done things that I can't take back.”
She hit rock bottom with the overdose last year. Caseworker Paula Cerra determined that because Noll's mother and grandmother lived in the same house, Paxton wasn't in danger. Noll was allowed to keep custody.
A child living with a parent abusing drugs or alcohol isn't automatically removed from the home, officials said. Though a caseworker can seek a court order to take custody after any type of abuse is alleged, the threshold is high.
Caseworkers assess a child's safety, immediate needs and the potential for harm, among other criteria. They may develop a safety plan and start in-home services for the family or allow another family member to care for a child.
After detailed assessments, caseworkers can develop a plan that may include random drug testing, referring the caretaker to treatment and closely monitoring the situation. Their last resort is asking a judge for custody.
“It's not necessarily these substances that's the immediate concern. It's the parent's intoxication or the parent's inability to care for the children,” Slocenski said. “If one of the caretakers has concerns, that doesn't necessarily mean that the child is unsafe.”
The bureau's ultimate goal is to keep the family unit together — or reunify families with children in foster care — in a safe environment while helping parents build their skills, Saveikis said.
While it's difficult to get specific data from county bureaus, Pennsylvania children have been neglected or even died after a parent or caretaker died of an overdose or fell unconscious, said Cathleen Palm, founder of The Center for Children's Justice. Palm is concerned that there is no “systematic statewide review” of such incidents.
For a system already swamped with the expanded mandated abuse reporting law, the opiate epidemic “couldn't be happening at a worse time,” Palm said. With no easy fix to protect at-risk children, the center has called for a state task force to examine the problem.
“We can't be punitive to parents; we have to figure out how to move parents from treatment into recovery,” Palm said.
Some county agencies have reported moving a child more than once in foster homes after finding substance abuse in the family, she said.
“In some situations, there's a family generational thing that's happening” with addiction, Palm said. “It's reaching deep into some kids' lives.”
Rebuilding a life
Cerra saw something in Noll immediately — honesty.
“That's something that's not always common, just getting that up-front honesty,” said Cerra, a caseworker for eight years. “That was something that I felt was going to help her in the long run.”
Cerra provided Noll with resources and a counselor, and she conducted random drug tests. At one point, Noll slipped and got high even though she knew she risked losing Paxton.
Cerra took her for an hours-long car ride to talk after that relapse. Noll spent all of 2016 working with the children's bureau.
Cerra knew she could have closed the case earlier — Paxton wasn't in danger. But part of her job is to keep families together.
“I just had this feeling, if I closed it ... I knew that something bad would happen to Bailey,” Cerra recalled. “I didn't want her to give up.”
Later, Noll wrote a letter to Cerra thanking the caseworker for saving her life.
“I felt so happy when I read that letter,” Saveikis said, noting a caseworker's job can be thankless. “That reflects what our caseworkers do every single day.”
Though Noll's case is closed, Cerra sometimes stops by. Noll knows her family can call if life goes off track.
Cerra typically doesn't keep close relationships with past clients, but she saw something good in Noll.
“I just had a soft spot for Bailey,” Cerra said.
Noll will celebrate one year of sobriety on Wednesday.
“Child services is the reason why I am clean and have this little man as my best friend,” Noll said. “I got very lucky because Paula cared.”
One day in February, as energetic Paxton, 3, scampered around the house imitating animals, Noll said having him close made a difference in her recovery. She plans to go back to school to become an addiction counselor. But it's a tough road every day to mend broken relationships and herself.
“It takes a very long time to put your life back together when you have destroyed everything — literally everything,” Noll said. “Things don't all go back to normal. You're someone new. You've been through too much.”
Renatta Signorini is a Tribune-Review staff writer. Reach her at 724-837-5374 or firstname.lastname@example.org.