Carol Levine and Suzanne C. Brundage
While the United States struggles to manage the devastating COVID-19 pandemic, the opioid epidemic continues to ravage individuals, families, and communities. There is a critical point of convergence between them, however: grandparents, most vulnerable to coronavirus, and the children in their care because of parental opioid use.
A recent report by United Hospital Fund and Boston Consulting Group estimates that 2.2 million children and adolescents had a parent with opioid use disorder in 2017, or misused opioids themselves. Some 325,000 of these children were in foster care or living with a relative, usually a grandparent, because their parents either could not care for them or had died, often of an overdose.
These children are already dealing with the “ripple effect” of the opioid epidemic—devastating short- and long-term physical and behavioral health consequences stemming from trauma and stress. The coronavirus pandemic is creating extraordinary new pressures on them, their families, and the public health and social services agencies that serve them. Children can flourish even in adverse circumstances, but they need family resilience and connection to do so. Those factors are sorely tested in both epidemics.
The grandparents in charge of many of these children may be overwhelmed by their care and neglect their own health and fail to follow COVID-19 prevention methods. That means the children who have experienced the trauma of losing a parent may now experience a second trauma if Grandma or Grandpa become ill. Moreover, recent reports of a rare but serious new COVID-19-related childhood illness called Multi-System Inflammatory Syndrome (MIS-C) means that kids who are exposed to the virus are not immune.
Even if their caregivers remain healthy, they, like all children, are coping with restrictions on socializing, outdoor games, erratic schooling, and other stresses. But they may not have access to private yards, Wi-Fi, or activities to ease the isolation. And just when schools are gaining experience in supporting children dealing with adverse childhood experiences, these children have been cut off from what may be their primary source of assistance, or even basic needs such as food. Even before the COVID-19 epidemic and when the opioid epidemic was still little known, the negative impact of adverse childhood experiences on health and school engagement was apparent.
Since many informal kinship arrangements do not involve child welfare agencies, these ad-hoc families also may not have been getting support services and funds before the pandemic. Now they need such help more than ever.
Federal and state agencies must enhance support of existing programs that support these children and their kinship caregivers and add appropriate COVID-19 services. There are several federal funding sources—such as the 2018 Families First Prevention Services Act, designed to keep children with their families instead of being placed in foster care—while the newly enacted Families First Coronavirus Response Act provides some support for free testing, paid sick leave, expanded unemployment benefits, and nutrition assistance during the pandemic. State kinship navigator programs also provide information and referrals on legal, financial, and emotional issues.
The federal Administration for Community Living’s Advisory Council to Support Grandparents Raising Grandchildren ideally will address both COVID-19 and the opioid epidemic in its recommendations for action and funding. Generations United, a national organization serving “grandfamilies” and multigenerational families, has an online coronavirus Fact Sheet that includes sources of accurate information and tips on practicing good hygiene, accessing food and medication, using technology, and talking with kids about the pandemic.
Meanwhile, it is more critical than ever that community services organizations continue to serve these at-risk children, despite the challenges of operating during a pandemic. Some are moving their services online to keep clients connected and reduce isolation, but such a transition requires training and adjustment on the part of clinicians and clients alike. These agencies will surely need financial support if they are to keep doing their essential work. In New York, the Mayor’s Office for Contract Services maintains website with lists of potential funding for nonprofit agencies. The New York State Attorney General’s Charities Bureau has guidance and resources.
As the country addresses COVID-19, it is important for policymakers, child welfare agencies, and health care and social service providers to remember that the opioid epidemic is still ongoing. Their efforts to reduce stigma, provide treatment, work closely together, and meet children’s and families’ needs are more critical than ever.
Turning the now-familiar COVID-19 prevention advice on its head, we must not put on masks that shield us from seeing the ongoing suffering of America’s children and families.
Carol Levine, an expert on family caregiving and a MacArthur Fellow, is a senior fellow at United Hospital Fund. Suzanne C. Brundage is director of United Hospital Fund’s Children’s Health Initiative.
United Hospital Fund has a long history of bringing together diverse perspectives to address critical challenges in health care in New York. In the current crisis, it’s more important than ever to hear from all parts of the health care system. Today’s commentary from Carol Levine and Suzanne C. Brundage looks at how the convergence of the COVID-19 crisis and the opioid epidemic is affecting grandparents and the children in their care. – UHF President Tony Shih