Parental drug use and racial and ethnic disproportionality in the U.S. foster care system.

BACKGROUND AND AIMS

Following nearly a decade of entry declines, foster care entries in the United States began to rise steadily since 2012, largely because of dramatic increases in home removals involving parental drug use (PDU). America's ongoing opioid crisis and recent changes in drug policies have been associated with the growth in PDU entries. The extent to which these and other recent factors have affected historical racial/ethnic differences in the foster care system is unknown. We explored the prevalence of racial/ethnic disproportionality and disparity in PDU entries and described children characteristics across racial/ethnic populations.

DESIGN

Secondary data analysis of the universe of foster care entries in 2008-2017, obtained from the Adoption and Foster Care Analysis and Reporting System.

SETTING

Children ages 0-17 entering foster care in the United States.

CASES

A total of 2,489,423 foster care entries, 29% (N=714,085) designated as involving PDU.

MEASUREMENTS

The rate of PDU entries was measured as the number of foster care entries involving PDU per 1,000 children ages 0-17 in the general population, by racial/ethnic group. Disproportionality in PDU entries was measured as the proportion of a racial/ethnic group among PDU entries over their proportion among the general population.

FINDINGS

From 2008-2017, the rate of PDU entries increased 71% in the general population and across all racial/ethnic groups. Native American children displayed the highest level and fastest growth in PDU entry rates (139%; 1.74 in 2008 to 4.15 in 2017), followed by non-Hispanic White children (112%; 0.70 in 2008 to 1.49 in 2017). Native American children also displayed the highest level of disproportionality in foster care entries, with a representation in PDU entries and other entries about 3.23 and 2.56 times their representation in the general population.

CONCLUSIONS

Foster care entries involving PDU increased considerably across all racial/ethnic populations. Growth in PDU entries was greatest among Native American children, exacerbating existing disproportionalities in the foster care system for this vulnerable population.