Kicking the Habit

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One evening in 1981, a friend offered Robin Wiley a new drug called cook-up. She didn’t know anything about it. All Wiley knew was that cook-up gave her a rush she did not want to stop. Over the next few years, it became the “in” thing in Harlem. Wiley stood in line waiting to buy it from proliferating dealers. She smoked it in apartments stripped bare by addicts who sold all their belongings for the drug. And she called it by its new name: crack.

Wiley’s addiction did not lower her to the depths she saw many other women reach. Some friends suggested she use her disability to beg for money; a year before she began smoking crack, Wiley had been hit by a car. Her hip and leg had shattered, and she walked with a cane and a pronounced limp. Wiley did not beg, sell drugs, resort to prostitution or abandon her two small children. For the most part, she just smoked up her welfare check and then waited for the next one, using food pantries and handouts from family to get through the month.

At times Wiley prayed to get off crack. “God, let me lose the taste for this drug,” she begged. That was not easy in Harlem in the late 1980s. Wiley lived in the projects, and she knew apartments on nearly every floor where she could get high. Friends leaned out of windows, calling, “Come on up and hang out, Robin.” And crack offered her respite from a life she did not want to live. “I didn’t want to kill myself, but sometimes I did want to die,” Wiley says now.

Wiley grew up with hardworking, loving parents, but she also got beaten with a belt or anything else handy. And for three years, starting when she was 11, Wiley was sexually abused. When she got pregnant at 16, Wiley believed her boyfriend would marry her, but that didn’t happen. Her parents ended up raising her son. Wiley’s next boyfriend didn’t marry her either, and he beat her, much to her shame.

Wiley’s life was being shaped by forces she didn’t understand; in the 1970s, as factories left the city and black men lost their jobs, the number of black single mothers doubled. But Wiley believed there was something wrong with her, that no man would marry her. Wiley’s accident left her disabled and in physical pain; life’s disappointments had left her deeply depressed.

For 10 years, Wiley used crack steadily, but not disastrously. In 1991, however, she gave birth to a child who had a “positive tox”: traces of crack in his blood. He went straight into foster care, since city policy at the time was to remove from its mother any newborn with a positive tox. Wiley still had her two older children at home. The next year, a caseworker showed up at her door, saying, “We have a report that you’re selling drugs from this apartment.”

“What? I’ve never sold drugs,” Wiley responded. “You getting high?” they asked. “Look, I get high, but I never sold drugs,” she told them.

All of Wiley’s children ended up in foster care. Within a year, Wiley had smoked herself into a shelter.

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In the mid-1980s, as crack took hold of poor neighborhoods and reports of abuse and neglect skyrocketed, parents like Robin Wiley confounded child welfare agencies. A decade earlier, when crack was still unheard of, New York City child protection officials had begun trying to keep kids at home instead of sending them to foster care, which frequently was proving abusive and psychologically damaging to children. If troubled parents could get preventive services, the thinking went, it would be safer for their children to stay at home than to leave. That idea was buttressed by the state legislature’s 1979 Child Welfare Reform Act, which provided the first funding for preventive services aimed at keeping families intact. In late 1977, almost 24,000 children were in foster care in New York City. By 1985, the number had dropped to only 16,200.

But as crack spread and the number of children in foster care skyrocketed–by 10,000 annually between 1987 and 1989–officials who had once been hopeful began to think that trying to rehabilitate crack addicts was just throwing money at a lost cause. “Rather than expand prevention, there was a loss of faith,” says Eric Brettschneider, who was director of Special Services for Children, the city’s child welfare agency, in the early 1980s. Yet there were not enough foster homes for all the children being removed from crack-addicted parents. And though child welfare’s primary function is caring for children, not their parents, suddenly the system realized it was going to have to deal with more and more addicted mothers and fathers.

At first, the child protection professionals didn’t know how to help these parents. Caseworkers sent them to treatment programs that usually had long waiting lists, or told them to get clean on their own. If parents failed to enter treatment or stick with it, many caseworkers shrugged. Society in general reviled crack addicts, and child protection workers saw how they left their children at home for days without food and turned their apartments into crack dens. It was easy to conclude that these drug addicts were beyond hope.

Sometimes, parents like Robin Wiley would get clean after years of addiction, and their children would return to mothers they barely knew. Other addicts simply never recovered and never got their kids back; many of the teens now in foster care came from such homes.

These days, much has changed. The crack epidemic has subsided, and the child welfare system has returned to its earlier focus on keeping kids in their homes. As a result, the number of children in foster care has declined, from 49,000 in 1991 to 22,800 today.

Yet drug addiction remains a major reason for removing children from their homes. According to estimates by the Administration for Children’s Services (ACS, New York City’s child welfare agency), four out of five kids now entering foster care have a parent who uses illegal drugs.

ACS knows what can help. In the early 1990s, faced with masses of children whose parents had drug problems, the agency pioneered an effective, nationally recognized program, dubbed the Family Rehabilitation Program (FRP), which gave drug-addicted mothers treatment while their kids stayed with them, instead of going into foster care. This combination of treatment and nurturing makes FRPs surprisingly successful at keeping moms off drugs and kids out of care. A 1999 study by the National Drug Rehabilitation Institute found that FRPs had higher success rates than traditional treatment and that few children–less than 5 percent at one typical agency–ended up in foster care.

Despite its success, the model is still so tiny and obscure that many child protection workers have never heard of it. Today it serves only about 1,000 women–a fraction of the estimated 44,000 parents who use illegal drugs and have children under ACS supervision. As a result, many families continue to be split up in order for addicted women to get treatment. That raises a question: Now that crack has taught ACS about addiction, will the child welfare system invest in addict mothers?

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After Robin Wiley’s kids were taken from her and she ended up in the shelter, she went into treatment. But she didn’t complete it. In retrospect, she thinks that being alone was one reason she dropped out. Believing the children were better off without her and berating herself for losing them, Wiley fell further into addiction. Separated from her sons and daughter, she felt a depressing relief: “Now I can get high without worrying about those kids,” she thought. “I really said that,” remembers Wiley, who has been clean for nearly 11 years now. “That’s how bad it was with the drugs.”

Back in the 1980s, crack’s toll on Wiley and other women was so extreme that it seemed naive to think they could be helped by preventive services. By the end of that decade, though, it was clear that child welfare simply could not afford to wait for drug treatment providers–who were geared toward the needs of heroin-addicted men–to catch up with crack. In part, financial prudence motivated the city to launch the Family Rehabilitation Program. “It looked as though everyone in New York was either going to have a child in care or become a foster parent,” says Shirley Whitney, a former deputy commissioner of the Child Welfare Administration, an ACS predecessor. “Even though intensive prevention was expensive, it was vastly more cost effective than foster care.”

Whitney visited model programs and read up on the newest treatment research. About 70 percent of women who are addicted to drugs have been sexually or physically abused as children; research showed that these mothers needed programs for women only, where they could focus on the issues that led them to abuse drugs. Research also indicated that motherhood motivates women to enter treatment. (It’s also why many women drop out–because being away from their kids demoralizes them.)

Whitney’s Family Rehabilitation Program let mothers keep their children while they attended drug treatment during the day and got intensive support, including nearly daily visits from a social worker. This policy reflected a renewed faith that even seriously addicted parents could be rehabilitated. It was a tough sell. Child welfare workers had seen mothers addicted to crack do terrible things to their children. “Some [preventive] agencies decided to wait and see what happened with the program. They were not convinced that we weren’t going to have a lot of deaths.” Whitney says.

The Family Rehabilitation Program began in 1991. Within three years, it had 31 providers treating more than 700 women and 2,000 children. Some of the private nonprofit agencies that provide FRP services connected women to existing drug treatment programs. Others were “dual” models, offering treatment and support services in one place. The traditional treatment model, which was designed for male addicts, was often punishing and humiliating. But FRPs were different. They could not drop clients simply because they relapsed, and they were charged with getting to the core issues that had led these women to crack. “We used to say that the women had to be free to surface all the pain, anything that made them feel ashamed, otherwise it would remain a pain inside and they would start self-medicating again,” Whitney says. While “crackheads” were being maligned in the press and popular culture, the FRPs insisted on a cutting-edge notion–that addicted women were using drugs to stifle pain.

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Nothing in Madeline Brame’s case files suggests that she could go from homeless, addicted and mentally ill to stable, drug-free and loving toward her newborn son, Ayumi. Brame, 41, has spent much of the last two decades bouncing between prison and the streets. She abandoned her first four children to family. Remarkably, she got clean for five years. Then she went on a bender–smoking crack, forging checks, prostituting herself–and ended up seven months pregnant at Rikers Island.

Brame had tried many times to kick her addiction. She joined support groups in upstate prisons, and did a stint in a therapeutic community that, she recalls, used demoralizing techniques like “toothbrushes to clean floors and ‘dummy’ signs around your neck.” She didn’t need these lessons in debasement because she’d already had so many before: “I’ve had sex for the change in a car ashtray to get high.”

At Rikers, Brame got a lucky break. Instead of enduring more jail time while her son went into foster care, she entered Palladia’s Albert and Mildred Dreitzer Center for Women and Children, a five-story apartment building in East Harlem where mentally ill and addicted women can get drug treatment, therapy, vocational training and parenting skills while their children attend day care on site. Dreitzer is not part of the city FRP program–it is funded through dollars from the state Temporary Assistance to Needy Families surplus–but its methods and concerns are similar.

Dreitzer works with some of the city’s toughest female addicts. Some have 20-year histories of drug addiction, abusive relationships, prostitution and incarceration. They’ve abandoned children to foster care. Offering these clients treatment with their children at their side requires something of a leap of faith.

Brame didn’t understand her addiction when she arrived at Dreitzer. “I didn’t know the connection between the way I feel about myself and the way I was raised–that not wanting to feel is the root of my problem,” she says. Brame joined a group at Dreitzer called “Seeking Safety,” a nationally recognized program that teaches women about post-traumatic stress disorder. It was eye opening. “I thought everyone had flashbacks, but no,” says Brame. “I’m suffering from trauma.”

Like Brame, many women don’t understand the connection between emotional pain and the drugs they used to blot it out. Nor do they think treatment can help. It’s not easy to engage angry, fearful clients, even at Dreitzer, where participants all live under one roof, in full view of dozens of professional staff. Engagement is even harder for most FRPs, where clients go through drug treatment during the day, then return with their children at night to dangerous neighborhoods rife with the temptation to use drugs.

FRP caseworkers are expected to bend over backwards to keep mothers involved–even if it means waiting in the morning at the door of a recalcitrant client’s apartment and coaxing her out. And unlike typical drug treatment, which focuses only on staying clean, FRPs emphasize motherhood and the maternal role. If the mothers don’t understand parenting, they’ll soon get frustrated and go right back to drugs, says Sharon Dorr, director of residential programs at Palladia. “They say, ‘Why is he doing that? He’s 2 years old, he should know not to do that.’ We say, ‘He’s doing that because he’s 2 years old.'”

Most of the mothers grew up in chaos themselves, so during home visits, social workers teach parents every aspect of caring: “This is how you hold a child, feed a child, give warmth and nurturing,” says Elaine Caraccioli, a supervisor at Family Consultation Services, an FRP in Queens Village. “When women are starting treatment is the time to be nurturing, to play the mommy’s role and help them get on their feet,” she adds. “Over time we wean the women from being dependent on a social worker’s mothering. Then they have to do the mothering themselves.”

At Dreitzer, child care experts have helped Brame learn how to hold Ayumi and feed him and soothe him when he’s crying. “I had no idea of this feeling before,” she says. “I thought I had no motherly instinct.” Ayumi is nearly 18 months old now. He’s saying “No” and “What” and falling on the floor when he doesn’t want to go somewhere. Ordinarily, Brame says she’d have felt frustrated by his behavior, but in a class she learned about children’s “ages and stages,” so now she feels relieved to see that he’s growing up normally. “He’s such a joy,” Brame says, “because I know that if he didn’t do these things, there would be something wrong.”

This combination of treatment and nurturing makes FRPs surprisingly successful at keeping moms off drugs and kids out of care. A 1999 study by the National Institute on Drug Abuse found FRPs more successful than traditional treatment, a conclusion echoed by current FRPs in New York City. The Seaman’s Society for Children and Families, for example, deals with 30 families and sends children from only about two of them into foster care each year. Likewise, the Family Consultation Center sends 10 children out of 200–just 5 percent.

FRP has “never gotten the fanfare I feel it should have,” says Willard Hill, executive director of Family Consultation Services. Hill blames the money: A year’s worth of preventive care for one parent costs about $6,300, he says, while FRP’s intensive oversight costs more like $12,000. Of course, compared to foster care for one child, which can run to $20,000, that’s still a bargain.

Then there’s politics. Just a few years after they were established, state budget cuts to preventive services led Mayor Rudolph Giuliani to slash the FRP budget by more than $6 million, closing 15 centers and dropping 300 families from treatment in 1995. Despite protests by providers and women in treatment, in 1996 he halved the program, closing the drug-treatment portion of the dual programs entirely. This wasn’t just a money-saving move: The mayor pressed for a change in state law that would have made a positive tox drug test conclusive evidence of child neglect.

Mike Arsham, director of the Child Welfare Organizing Project, believes FRPs were starved of funding because it’s unsettling to think that children are best off living with drug-abusing mothers. “We have evidence of what works, and there’s still enormous ambivalence about providing it,” Arsham says. “We don’t like these women. We don’t want to spend the money to help them.”

Following the Giuliani cuts, most FRPs began referring clients to separate drug treatment programs. That has made it harder for caseworkers to supervise families, because it’s difficult to get separate programs to work together to keep kids safe. FRPs make drug-treatment providers call every time a client fails to show up–that way, child protection caseworkers can get to the house right away to find out if the kids are OK. But some off-site programs wait weeks to call ACS and say, “Your client hasn’t been coming.”

FRPs also have trouble finding drug-treatment programs that do not automatically drop clients when they relapse. “Usually those programs kick out anyone with a positive tox. That’s like suspending a kid for being truant,” says Hill. If clients do get dropped, it’s up to the FRP to convince reluctant programs to take relapsed women. Sometimes caseworkers must call program after program. “Drug treatment is still very hard to get,” says Joyce Russell Anderson, director of the FRP at Seaman’s Society for Children and Families, on Staten Island.

Even less-specialized treatment programs can be hard to find, say social workers. “Referring clients out is the worst,” agrees Laly Woodards, a caseworker at Episcopal Family Services, a preventive agency in the South Bronx. “We have 15 agencies in the neighborhood that are supposed to be doing counseling and substance abuse treatment. But they don’t have space, the clients don’t qualify, or they don’t have Medicaid. It’s a big, big runaround.”

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The crack crisis upended the fledgling belief of the early 1980s that troubled families deserved compassion and support. Now, 20 years after the drug devastated poor neighborhoods, ACS is just beginning to invest again in programs that could turn the agency from a system parents fear to one they welcome as a help. The process is complicated by the fact that prevention is out of step with current federal child welfare policy. In 1997, Congress passed the Adoption and Safe Families Act (ASFA), which demands that agencies start terminating parental rights much earlier than they used to–after children have been in foster care only 15 months–and move them into adoption. The new policy is a sharp departure from Washington’s earlier commitment to family preservation. For ACS, the change means that federal funding for preventive services is now minuscule compared to money automatically available to put kids in foster care and encourage adoption.

In New York City, judges so far have been lenient about enforcing the Adoption and Safe Families Act. And AFSA’s timetable has pushed ACS towards at least a nod to improving drug treatment: The agency started working with the state Office of Alcoholism and Substance Abuse Services (OASAS) to improve how the two systems treat the families they mutually serve. “We needed to facilitate a more timely and thoughtful approach to child welfare cases involving substance abuse,” says ACS spokesperson Maclean Guthrie. “Because of this, we have a network in place today that enables us to support families in our system who are affected by substance abuse.”

ACS and OASAS have begun a significant effort to bring child protection workers up to speed on what types of drug treatment are available. In 2002, ACS started hiring OASAS drug treatment specialists to work in its field offices. When workers get cases involving drug abuse, they can turn to an OASAS expert for help evaluating the situation and finding the best treatment. So far, though, the specialists have been consulted on only about 3 percent of all ACS cases.

Meanwhile, the state drug agency’s resources for family rehabilitation work are unpredictable. Using $33 million a year in TANF dollars, OASAS launched a Child Welfare and Substance Abuse Initiative four years ago. In last year’s budget, however, funding was cut in half.

Still, ACS has unquestionably recognized the need for the Family Rehabilitation Program. Slots for clients have increased by 40 percent in five years, from 700 families in 1999, to more than 1,000 in 2003.

Of course, that’s only a fraction of those who need help. And families pay the price.

Robin Wiley didn’t lose her older children to foster care for very long. She stayed in treatment only six months, and they came home the next year. Things were not easy for quite awhile after that. Both Robin and the children were tremendously angry at the system. Her daughter had been sexually abused in a foster home. Her older son had been bullied and moved from home to home. Each foster mother criticized how he did his chores, ate, dressed and acted. He stopped listening to adults.

But foster care may have been hardest on her youngest child, who was taken from Wiley the day he was born and was five when he came home. In all those years, Wiley’s only chance to bond with her son was during brief, supervised visits. When she got him back, he had to adjust to a new mom, and she had to start parenting a child she barely knew. Their relationship started off rocky and has remained so. “I was so happy for him to be home,” Wiley says, “but as time went on I felt there was something missing.”

Wiley is filled with memories that sting, like the times, after her son came home, when she would take him to pediatrician appointments. The doctor would ask, “When did he start crawling and taking his first steps?” She didn’t know the answer. “He feels like he’s not really part of this family, because I don’t have memories of his childhood moments,” Wiley says. “For me and my son, there’s pieces missing.”

Nora McCarthy is an editor at Represent, a magazine by and for young people in foster care.