Across the country, people are becoming unexpected caregivers of children whose parents have become addicted to opioids. In most states, they're doing it with little to no help at all.

For more than a decade, Mercedes Bristol and Delia Martinez have been raising children they never expected to care for. The two women got an out-of-the-blue call from the state of Texas, telling them to come pick the kids up or they'd go into the state's care. Bristol and Martinez aren't foster parents; they're part of the growing number of grandparents across the country who have to take conservatorship over their grandchildren.

After her son became addicted to drugs, Bristol, who is single, was tasked with raising his five children by herself. Martinez and her husband had to put retirement on hold in order to provide for their three grandchildren after her son went to jail. As they began navigating the complex and bureaucratic network of family services in Texas, they discovered two things: the growing number of grandparents or other relatives that had taken over for parents who developed addictions to opiates, and the lack of a centralized support system for these unexpected caregivers.

Bristol and Martinez live in San Antonio, a prominent center in the opioid crisis. Bexar County sees the most births of babies with opioid withdrawal symptoms and the third-highest overdose rate in Texas. With the jump in opioid usage and abuse, there has been a 6 percent increase in children being raised by relatives nationwide.

Though the city and county formed a joint task force to study and combat the issue of opioid abuse, little has been done to meaningfully address the estimated issue of the some 30,000 displaced children in the area. That task force, formed in August and bolstered by an additional $3 million federal grant in November, is made up of local public-health officials and recovery experts. Their focus has been on increasing the availability of overdose reversal drugs to first responders, working with doctors to adjust their prescription habits, and educating the community on the dangers of opioid use. So far, nothing has been said about the family members left behind.

Bristol and Martinez started to hear the same story from grandparents they would meet at a local support group started by people in similar situations. A grandparent or older relative would get a call from Texas' Department of Family and Protective Services informing them that a parent had tested positive for opiates. They could either pick up the child or let the child be placed in foster care. After that, DFPS stopped helping the displaced children.

"So she took off, of course, to go pick up the baby," Martinez says. "After she took them home, she's calling them asking if there's any way they could help, and they said no because she took the baby home already and they closed the case."

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In 2017, the state's child welfare network hit a breaking point. Case workers with Texas' DFPS left their jobs in droves, citing unmanageable caseloads and overwork. Children that couldn't be placed in foster care or with families quickly were made to sleep in state offices. Some children disappeared from the state's view entirely. State leaders are in an ongoing fight with a federal judge over whether they need federal help to reform the DFPS.

In this year's legislative session, several reforms were passed but the heart of the problem went unsolved. Most were fixes to problems with coordination between state agencies, courts, and non-profit organizations. One bill introduced monthly payments of about $350 to relatives taking care of children, but they must wade through the state's bureaucracy to qualify for official kinship care status. As of now, only 10,000 children qualify for the program. A quarter of a million others aren't officially recognized as being in a relative's care and won't receive state support.

Much like the national response to the opioid crisis, the work being done for the millions of families left behind is a patchwork of state-by-state responses with little federal aid. A 2017 report from Generations United, a youth advocacy group, states that 2.6 million children are being raised by a relative that is not a parent. In places that have been hit the hardest by the opioid crisis, the percentage of children in this situation has increased by double digits.

Jaia Peterson Lent, the group's deputy executive director, says the number of children placed with families or foster care has risen with the onset of the crisis. "At the same time that we're seeing an increase in the number of children coming to the attention of the child welfare system, we're seeing recognition by the child welfare community that children do best with relatives," Peterson says.

As welfare systems are recognizing the need to reduce dependence on group care settings, states are putting more emphasis on placing children with relatives. But the level of support can not only vary state by state, but can shift widely from county to county.

"Some counties are pretty advanced in terms of providing a full range of support for relatives and prioritizing relatives," she says. "Others, pretty standardly, just place the child with a relative, say 'good luck,' and don't provide them with the services they need."

Some states have kinship care and kinship navigator programs, where a state or regional welfare agency will offer relatives training on how to care for their child and financial support, though such programs can be limited in reach. States like Washington and Ohio have been implementing these programs, but they aren't available in every county.

Inroads are being made in Richland County, Ohio, Peterson says, where child welfare officials are some of the most active with their kinship navigator program. "They have some innovative approaches where they're engaging grandparents, and in some cases birth parents that are in recovery."

Yet these success stories remain few and far between. Legislation to study and take action on the issue has stalled in Congress, with two bills sitting in committees that would create a task force to study the issue of grandparents raising grandchildren.

A recent Supreme Court decision to not hear a case brought against the state of Kentucky, a prominent battleground in the opioid fight, is being hailed as a victory for these family members. In January, the Sixth Circuit Court of Appeals ruled that the Kentucky Cabinet for Health and Family Services has to pay relatives who take in children the same amount as registered foster care parents. They are now eligible for a base pay rate of $750 a month.

Richard Dawahare, a Lexington attorney who was court-appointed to represent two children whose mother was declared unfit in Kentucky's Dependency, Neglect, and Abuse court, argued the case for the payments. Dawahare argued that, under the Child Welfare Act of 1980, relatives who have children placed with them, temporarily or permanently, are obligated to financial assistance from the state. After the state scrapped their kinship care program in 2013, less has been available to relatives who take in children.

Fourteen states filed briefs in support of the state of Kentucky, which gave Dawahare an idea of the resistance that states have to making these payments. But he thinks that the ruling will apply to other states in the Sixth Circuit district and set a precedent for future cases.

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On a recent Monday morning at an elementary school on San Antonio's far west side, Bristol and Martinez are conducting one of their support groups. In conjunction with local school districts, they have organized these meetings to find kindred spirits and trade knowledge about caring for their children. They've expanded to five in the past year with a membership of approximately 200 grandparents in similar situations, though they are sure there are hundreds more out there. Just recently, representatives from the DFPS and other state welfare agencies began to attend these meetings to open better lines of communication about referrals to vita services.

A dozen grandparents share their stories with a handful of local, regional, and state welfare workers. Most of them will tell the story of one of their children who became addicted to pills, heroin, and other opioids. The state calls them in the middle of the night and tells them to get their grandchild or grandchildren. There's no financial assistance offered to them. The state closes the case and moves on.

Bristol and Martinez are also advocating for legislation at the state and national levels to combat these problems, working with Generations United to connect with policymakers. In their communications with other advocates throughout the country, they've learned that Texas has a bad reputation when it comes to family assistance.

This past spring, Bristol and Martinez went to Austin to testify for HB-4, which would make some grandparents eligible for foster care maintenance payments, but only if the they meet a laundry list of qualifications through the DFPS.

"So we'll be back in the next session to advocate for the next step," Bristol says. "We want to make sure all grandparents are eligible."

Martinez believes that the governor needs to make this issue a priority. In one meeting with a state representative that she did not name, she says that he asserted that the issue didn't exist in his district. Martinez didn't believe him.

"Just let me know where your district is and I'll find them," she told him. "It's not just one side of town or one ethnic group, it's all of these people from all walks of life that are going through this."

Martinez says that all she has heard from state officials when it comes to child welfare reform is that the communities need to step up and help while the state tries to find solutions.

"Well, here we are," she says. "Two grandmothers stepping up to do it. We're trying to do as much as we can but it's just the two of us."

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