In Harm’s Way: Children are drug epidemic’s innocent victims – Milwaukee Journal Sentinel
You can put numbers to the impact of the nation’s opioid epidemic. But harder to measure is the pain of shattered families and trauma of children who find themselves placed in harm’s way by the very people they love and count upon for protection.
The crisis that is the nation’s drug epidemic is often measured in deaths. It is a gruesome toll, without precedent.
More than 52,000 people died from accidental overdoses in 2015. In Milwaukee County, medical examiner’s office is braced for a record 400 deaths this year.
It is an epidemic driven by opioids, whose abuse shows no sign of abating. On an average day, according to the federal Department of Health & Human Services, nearly 4,000 people begin using prescription opioids for nonmedical reasons, 600 people begin using heroin and 80 people die from opioid-related overdoses.
Harder to measure is the pain of shattered families and trauma of children who find themselves placed in harm’s way by the very people they love and count upon for protection.
Perhaps begin here, at Meta House, a residential treatment facility for women and children located in the former convent of St. Casimir Church in Milwaukee’s Riverwest neighborhood.
On a recent afternoon, a 5-year-old boy, skinny, with hair the color of wet sand, is busy stuffing dolls into a toy house. A therapist watches.
The boy and his mother, Kelsey Olson, live at Meta House. Kelsey is recovering from a heroin addiction.
The boy, who has seen his mother overdose, who has seen police haul her from their house in the middle of the night, who after she and his father were evicted twice, went to live with one relative and then another, who now lives in a city 140 miles from what used to be home, is recovering from the trauma of her addiction.
The boy pulls the dolls out of the house, informs them that they are in trouble, and puts them in a toy jail. Then he takes them out of the jail, tells them they need to get well, and moves them to another house.
He is acting out the broad narrative of his life. And in doing so, he is also, again in broad terms, describing what has become our twin response to the epidemic itself:
They are two responses fraught with conflict, particularly for overwhelmed child protective services agencies which, working within the dynamic intimacies that exist between parent and child, must find ways to keep children safe without deepening their trauma by destroying their families.
The opioid crisis has a disproportionate impact on young children.
A study published in March in Pediatrics, the official journal of the American Academy of Pediatrics, examines pediatric opioid poisoning from the years 2000 through 2015.
Nearly 200,000 exposures to prescription opioids among children and teens under the age of 20 were reported to poison control centers across the United States, according to the study.
Most of the children — 60% — were 5 years old and younger.
Rates shot up at ages 1 and 2, then declined, increasing modestly among teenagers. Most young children were accidentally exposed to opioids, the result of their natural propensity to get into things and to stick objects in their mouths.
That is exactly, Milwaukee police say, what happened earlier this year to two-year-old James Vessell Jr.
James died after devouring oxycodone pills that he found in his mother’s purse, according to a criminal complaint charging the mother, Martis Dickerson, with second-degree recklessly endangering safety.
While his death was ruled accidental, details contained a medical examiner’s report suggest that it was an accident waiting to happen.
James and his 4-year-old brother lived in a filthy home that had neither a stove nor a refrigerator. Accustomed to fending for themselves, the boys had previously devoured an entire bottle of Dickerson’s vitamins as well as their own chewable vitamins.
Dickerson told investigators that she kept her oxycodone and other medications in her purse. Rather than capping the bottles with the lids in their child-proof position, she screwed the lids on for easy access. On the day James died, she had found her purse in the 4-year-old’s room. Investigators found four oxycodone pills on the bedroom floor.
The mother told investigators she had gone out the night before James died and had spent most of the day sleeping, drifting in and out of consciousness. She awoke around 3:30 p.m. and found James, not breathing and foaming at the mouth.
It is the mission of child protective services, which in Wisconsin are overseen by the Department of Children and Families, to step in when parents abuse their children or are unable to protect or care for them.
In any given situation, when abuse or neglect is found, protective service workers have two options.
They can decide to keep the children in the home and provide family support and counseling, or they can decide to place the children in out-of-home care until they can be safely reunified with their families. If reunification proves impossible, then the children are placed in an adoptive home and parental rights severed.
“The child’s safety is the top priority,” said Eloise Anderson, secretary of Children and Families.
“But we must also do all we can to keep families intact.”
The opioid epidemic, Anderson said, combined with the still expanding use methamphetamine, threatens to overwhelm state and county resources. The department estimates that more than 80% of open cases are either driven by, or complicated by, drug and alcohol abuse.
“It is a crisis,” Anderson said. “It is a crisis here and across the nation.”
According to the December issue of Wisconsin Counties, referrals to child protective services increased 30% from 2007 through 2015, from 55,895 to 72,698.
Not only is the system stressed, but so are child welfare workers, the men and women whose judgments are critical in determining what course of action is in a child’s best interests.
“Walking into a home where young children are in reach of illicit drugs or crawling amongst needles is a horrifying sight,” Mark D. O’Connell, the executive director of the Wisconsin Counties Association, wrote in the magazine.
“Rising caseloads, coupled with high-intensity drug addiction cases, leads to a higher level of professional burnout, causing counties to lose highly trained, well-qualified social workers,” he wrote.
Caseworker turnover is a perennial problem among agencies providing protective services in Milwaukee County, resulting in investigative backlogs and injecting the system with an unpredictability that harms children, a Journal Sentinel investigation found.
The Department of Children and Families is still reviewing the death of 2-year-old James Vessell, but the Journal Sentinel found that his case has all the hallmarks of a systemic breakdown:
Although his mother and family had been reported to child protective services two dozen times, although she had lost custody of four of her six children, protective service workers were still in the most preliminary stages of investigating a 4-month-old report of neglect when he died.
Addiction is, in itself, not a crime.
“Addiction is an illness,” said John Schneider, executive medical director of the Milwaukee County Behavioral Health Division.
“It’s a brain illness. It’s not a moral failing. It’s not perversion. It’s not criminality. It’s a brain illness,” he said.
But it is an illness that may drive criminality, such as thievery. And it is an illness that may impair parents’ capacity to care for and nurture their children.
And it is chronic, which creates problems for child protection agencies, which by law and by design provide time-limited interventions.
Families, said Sue Conwell, executive director of Kids Matter Inc., are stepping into the breach, sometimes as formal kinship foster parents and sometimes informally, hoping to keep their families intact.
The problem, she said, “is that the state is asking families to solve serious child safety issues that already overwhelm child protective services, police and the courts.”
“Basically, we are asking 62-year-old grandmothers, who often don’t know heroin from OxyContin, to save drug-endangered children one at a time,” she said.
“There are a lot of grandparents out there battling an epidemic with love and few other tools. But a lot more children would be dying if it weren’t for their grandparents.”
“The issues are not easy,” said Christine Ullstrup, Meta House graduate and now its vice president of clinical services.
“They are not easy because we are human beings, and because we have human frailties, and because addiction is a disease.”
Roughly 30,000 women struggle with addiction in Milwaukee County alone. Those whose drugs of choice are opioids, such as Kelsey Olson, often follow the same path: They are prescribed an opioid to treat physical pain, then abuse prescription opioids to treat other types of pain — trauma perhaps, or loneliness, or depression.
In Olson’s case, she was prescribed medication for a toothache. Her boyfriend, for an injured shoulder. They began to use opioids recreationally. Olson was able to take care of her son, hold down a job, pay rent, meet car payments.
Then her younger sister committed suicide.
A few months later, while watching a Fourth of July fireworks display, she was offered heroin. It’s better, someone told her.
“And it was,” she says, sitting near a window at Meta House, not far from the room where her son had been playing.
It was stronger. And it was cheaper. Within a few weeks, both she and her boyfriend were addicted. But the heroin no longer made them particularly high. It just kept them functional. If they didn’t shoot up, they were sick, unable to get out of bed and take care of their son.
“I needed the drug to maintain normalcy,” she says. “You’re just trying to be normal again.”
But normalcy is a fluid concept. She and her boyfriend thought, even after the evictions, job losses, car repossession, that they were maintaining normalcy and taking care of their son. Even when Olson was hiding in the bathroom, tying off her arm with the commemorative wristband from her sister’s suicide, she believed she was maintaining normalcy.
But her son noticed.
After her arrest, after she had progressed far enough in her treatment, she and her son were reunified at Meta House.
He ran into her arms, she says.
“I’m so happy to see you’re not sick anymore,” he told her.
“You don’t look like yourself,” he said. “You look pretty.”