She was first roused awake at 2:30 a.m. by a call seeking an emergency placement for a child. Ninety minutes later, it was a storm of texts telling of a problem at a foster home. Now, after a fitful night and a morning spent furiously juggling 15 foster cases, Rachael Stark is splashed with coffee and running late for a meeting when her phone rings with yet another request.
A child welfare worker is on the line telling of three siblings in need of a foster family. Without a pause, Stark offers a familiar line sapped with resignation.
"I've got no one," she says somberly.
Across the U.S., soaring use of heroin and other opioids has sent tens of thousands of kids flooding into the foster care system — creating a generation of children abandoned by addicted parents, orphaned by fatal overdoses and torn from families by authorities fearful of leaving them in drug-addled chaos.
New foster care cases involving parents who are using drugs have hit the highest point in more than three decades of record-keeping, accounting for 92,000 children entering the system in 2016, according to just-released data by the U.S. Department of Health and Human Services.
The crisis is so severe — with a 32 percent spike in drug-related cases from 2012 to 2016 — it reversed a trend that had the foster care system shrinking in size over the preceding decade. All told, about 274,000 children entered foster care in the U.S. last year. A total of 437,000 children were in the system as of Sept. 30, 2016.
Among the states with the biggest one-year increases in their foster care population were Georgia, West Virginia and Indiana.
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"This isn't a trickle. This isn't a wave. It's a tsunami," says Judge Marilyn Moores, who leads the juvenile court in Indianapolis and faces a crush of drug-related cases.
Though substance abuse has long been an issue for child welfare officials, this is the most prolific wave of children affected by addiction since crack cocaine use surged in the 1980s, and experts said opioid-use is driving the increase. In Indiana, drug-related foster cases have shot up more than sixfold since 2000.
When Stephanie Shene started as a case manager at the state Department of Child Services in 2003, use of opioids was a virtual non-issue. Now it's a constant. She's increasingly vigilant looking for shaking, fidgety parents or needle marks on their arms, behind ears and between fingers.
Her agency has added more than 1,200 workers in four years and its budget went from $793 million to more than $1 billion. Caseloads remain a challenge, though, and turnover is high.
Stark has spent the past 13 years as a case manager for The Villages, the largest private foster care and adoption agency in Indiana, which contracts with the state to find children homes. All but a few of her cases involve drugs and of those that do, about half are opioid-related.
The Villages is receiving 30 to 40 percent more referrals than it had been accustomed to, creating a "crisis state," says its president, Sharon Pierce. The agency used to see about 60 percent of children return to their birth families. Today it's around half that. Successful foster parents sometimes adopt, but then that limits the family's ability to take on another foster child, creating the need for even more homes. "So then we jump back on the treadmill," Pierce says.
Stark crisscrosses farm-lined stretches of Grant County on a day that is a series of home visits and a blur of calls and texts interrupted by sighs and talk of "imperfect solutions."
Her third stop this afternoon is emblematic of the cases inundating the system.
Two sisters, 9 and 10, landed in foster care because their mother got hooked on painkillers. There was no family to turn to, with their grandmother also addicted. Their mother's parental rights already have been rescinded, and foster parents Justin and Kristen Lovell hope to adopt.
"They had their choice," Justin Lovell says of the girls' parents, "and they didn't choose their children."
There is no simple assessment of the impact of all of this on kids. Some wind up in loving foster homes until their birth parents get clean. At the other extreme are children whose parents' addictions have led to their own, or who hop from foster family to foster family or live in a group home.
Anxiety can amass, academic performance can plunge, feelings of abandonment can run rampant, and the ability to trust can be strained. Says Maria Cancian, a social work professor at the University of Wisconsin-Madison: "When people ask me, 'Is foster care good or bad?' the first thing I say is, 'Compared to what?'"
Shawnee Wilson has been on both sides of the system. She was 13 when she was removed her from her home because of her parents' drug use. Now 26, she's fighting to regain custody of a little boy born just over a year ago; it took a month for doctors to wean him off the heroin she exposed him to. He's in foster care, and Wilson's been clean several months now, but she says it's hard to explain what compels someone to keep using even when it can cost them their children.
When she's been high, "I can't see the consequences," she says, "because all I want is to feel that drug."
Sedensky, an AP national writer, reported from Indiana. Data journalist Hoyer reported from Washington. Data journalist Hoyer reported from Washington.