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It was around midnight when the 14-year-old boy climbed into the back seat of a state social worker’s car last fall, clutching a grocery bag stuffed with what clothes he could grab on the way out of his house.

The worker, who had just whisked the boy away from his drug-addicted parents near Worcester, dreaded the youth’s inevitable question.

“What’s going to happen to me?” the teen asked.

The social worker wished he had an answer. Because of a severe shortage of foster families in Massachusetts, he had nowhere to take the teenager. So he began driving laps up and down Route 9, trying to reassure the boy, waiting for a call that an emergency foster home was open. He watched helplessly as an unmistakable look fell over the boy’s face: Maybe no one wants me.

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Children are landing in foster care and mired there for increasingly longer stretches of time as the opioid epidemic continues to splinter families and overwhelm the state’s child protection system. Facing this deluge of need, the Department of Children and Families has been unable to recruit and retain enough foster parents to shelter all the abused and neglected children without a safe home.

It is a crisis in care largely unaddressed, and the children are paying the price, a Globe review found.

The number of children in foster care has spiked by almost 20 percent in the last five years, and now stands at roughly 9,200. Yet the state relies on a chaotic, often paper-based system for tracking all of these children on a daily basis. And virtually every night, DCF response workers, with kids in their back seats, are crisscrossing Massachusetts, or camping out at a 24-hour McDonald’s as they await word of a foster family with space for another child.

Many DCF offices have become de facto day-care centers, with toddlers crawling amid computers and paper clips. Portable cribs, packages of diapers, boxes of crayons, coloring books, and videos have become routine office supplies for social workers as they scour the state for available foster homes.

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When they do find an opening, it’s often in a home that can take a child only on an emergency basis, for a night or two. Almost one-third of children in foster care in Massachusetts get bumped from one temporary foster home to another in their first few months away from their parents, a rate greater than just about anywhere else in the country.

The shuffling from home to home has a profound and lasting effect on children, social workers say.

“We are seeing in real time a healthy child come into care for a valid reason, and they come out the other end with behavioral problems, attachment issues, and become labeled hard to place,” said Adriana Zwick, a social worker and chapter president of the Service Employees International Union Local 509, the union that represents DCF workers.

Marylou Sudders, the state’s health and human services secretary, said Massachusetts is doing its best to tackle a cascade of complex problems in foster care.

“I wish there was one answer to this,” Sudders said. “It is multifaceted.”

A driving force behind the mounting demand for foster care is opioids; even though state statistics suggest overdose deaths are starting to decline, the epidemic is far from over. Many parents are overdosing, or so strung out on drugs that their children are routinely left to fend for themselves until they are scooped up by DCF, social workers say.

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“With the opioid crisis, between a day and night, you can have three, four, or five overdoses,” said Marianne Walles, a DCF supervisor in the Malden office and a union officer. “Some will survive and some won’t.”

Another factor: DCF became hypervigilant in removing kids following the tragic 2014 and 2015 deaths of youngsters killed in abusive families the agency was supposed to be monitoring. The rate of removals has since declined, but DCF remains reluctant to return children to unstable homes, workers say.

Facing a persistent and severe shortage of safe places for these children, DCF says it launched an aggressive advertising campaign that netted a gain of about 300 foster homes since 2017, for a statewide total of 2,423. Still, supply hasn’t kept up with demand.

Quantifying the size of the shortfall is difficult because the state doesn’t track how many licensed foster homes are actually accepting children, or how many beds are available, at any given time. But Sudders, the state health secretary, offered some sense of the problem’s scale, saying that even 600 new foster homes would not be enough.

The state also doesn’t track why families decide to stop accepting children. But foster parents interviewed by the Globe spoke to the question, and forcefully: They said they were exasperated with a bureaucracy that fails to communicate vital information and doesn’t supply sufficient therapy and other support for highly traumatized kids in their care. They also point to a maze of sometimes conflicting and outdated rules they’re required to follow.

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Additionally, they say their daily stipend, which ranges from about $23 to $27.50 per child, does not reflect what many foster parents say they actually need to spend.

Although the lack of state data makes it hard to measure the gap between foster care supply and demand, several key indicators point to a crisis.

The state generally limits the number of foster children per home to four. But it grants exceptions when there aren’t enough homes with room to meet the demand any given day, and the latest numbers show that’s happening regularly. The number of emergency waivers to exceed the four-child limit has more than doubled since 2014.

And kids are increasingly shuffled among different emergency foster homes as they await a more stable situation, exacerbating an already traumatic time for them.

Despite its wealth, Massachusetts ranks near the bottom — behind only Oklahoma, Arkansas, and Illinois — in finding stable placements for kids during their first year in foster care, according to data from the federal Department of Health and Human Services. About one quarter of children placed in Massachusetts foster care in 2015 had to be moved more than twice, according to state data obtained through a public records request. That’s jumped to more than 30 percent last year.

DCF tries to place children removed from their homes with relatives. When relatives can’t be found, are unable to care for a child, or have histories that may disqualify them, such as a criminal conviction, foster care is a last resort.

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Ideally, children removed during daytime hours would go straight to a permanent foster home, said Walles, the DCF supervisor.

“If we had enough foster homes, the first placement would be their only placement,” she said.

But with too few long-term beds available, many children are placed in temporary, or so-called hot line homes, with families who agree to open their doors in the middle of the night to a child who needs an emergency place to stay.

And in some parts of Massachusetts, open hot line homes are scarce because they are already full with children who have nowhere else to go.

For the 15 communities surrounding Lowell, for example, there are no hot line homes and haven’t been for years, according to SEIU, the workers’ union.

One Lowell social worker recently drove nearly 100 miles, to Fall River, to find a child a bed for the night.

“It’s gotten extremely more likely we’ll be driving around all night, or that siblings are split up, with one kid going to a foster home in Amesbury, the other in Medford,” said the social worker, who asked to remain anonymous because she fears retribution from the agency.

The deluge of children with nowhere to go has grown so acute, response workers say they routinely beg hot line homes to accept youngsters for longer than the usual single night while workers search for relatives able to take them, or for a more long-term foster home.

Ethel Everett, an SEIU union officer and foster family resource worker in the Springfield area, said dozens of families have stopped taking new children in her region in the last year or so, and there
haven’t been enough new ones to fill the void.

“We have close to 25 to 30 kids daily we have to place, going night to night in foster homes, or in short-term placements,” she said.

Sometimes, social workers say, no hot line home materializes, and children wait till morning with social workers in cars, in hospital waiting rooms, in police station lobbies.

The state’s failure to track which homes are open and available on any given night means that workers have to rely on an archaic, hit-or-miss system, calling foster parents around the state to find open homes. Sudders, the health and human services secretary, said the state is examining ways to improve its computer system, which she acknowledged hadn’t been updated in more than a decade.

Walles, the Malden office supervisor, said it’s not uncommon for her office to get calls after 5 p.m. from Worcester, asking for help finding an immediate placement for as many as three children.

“They are traveling that distance just for the night, and they have to be back in Worcester the next morning to bring the child to school or day care,” Walles said. “Even if the emergency is at 3 a.m., social workers will contact each other in different regions looking for beds because you are so desperate for a kid to lay their head down, even if it’s for just a couple hours.”

Waiting for a place to go during the day, they languish in a netherworld — cramped DCF offices, napping on piled-up blankets and playing under workers’ desks because temporary, licensed day care and preschool slots are not available.

“I’m amazed at the fact that a child has not choked on a paper clip and suffered horrible circumstances,” said Zwick, the SEIU chapter president.

Linda Spears, the Department of Children and Families commissioner, acknowledged the agency’s challenges and said the complexity of problems workers see now are tougher than they’ve ever been.

“In many instances, families are dealing with domestic violence problems and safety for the parent, and they are dealing with addictions and mental health issues,” she said.

Spears said DCF hopes to launch a program May 1 to provide day care for the hardest-hit 10 agency offices so children aren’t warehoused in workers’ cubicles. The agency aims to expand the program to the remaining 19 offices later this year.

Creating more stability for children removed from their families is a top priority for the agency, she said. It has hired workers to help find more relatives who will step forward for children DCF takes into state custody, to ease the strain on foster homes and because that tends to be better for youngsters. This initiative has boosted such placements, known as kinship care, about 11 percent since 2014, according to the agency’s data.

“There is not one simple solution to all of this,” Spears said.

But she said the agency is making progress. She said the agency has posted billboards on major state highways and launched a robust social media campaign over the past two years urgently seeking more foster families.

DCF has also hired more than 300 social workers since 2015 to reduce caseloads on each worker and more carefully monitor children. The state says average caseloads are now close to industry standards, but the SEIU says that in some offices, they never went down, or are beginning to creep back up.

Some child advocates, however, say Massachusetts leaders should consider a wholesale change in the state’s approach to child protection.

Instead of spending and focusing so much on foster care, they argue the state should shift more funding to the critical services troubled families need to stay intact — substance abuse and mental health treatment, and domestic violence prevention — which have not kept pace with the soaring need.

“That doesn’t mean that children should be left home in risky situations, but many more of them could be maintained safely in their own homes if parents are provided better support,” said Michael Dsida, deputy chief counsel at the state public defender agency, the Committee for Public Counsel Services. Dsida has been representing children and families for 30 years.

Roughly 80 percent of the children in DCF’s caseload — more than 36,000 youngsters — remained at home in fractured families desperate for help, and potentially at risk of entering the foster system. Yet less than 10 percent of the agency’s services budget goes to family support and stabilization services, according to a recent budget analysis by Massachusetts Law Reform Institute.

“Foster care is warranted in some cases because of the risks children face in their homes,” Dsida said. “But there has to be more thought given to the harm that they suffer as a result of being removed from their homes and placed in an overtaxed foster care system.”

In the meantime, DCF social workers continue their nightly odysseys, waiting for word that a safe harbor has turned up.

The worker who drove laps up and down Route 9 for hours last fall, waiting for a foster home for the 14-year-old in his back seat, finally got his call. Around 4 a.m. he walked the teen into a home in Lynn, 60 miles from where they started, to meet the strangers who had agreed to take him for what was left of the night.

Just a few hours later, another social worker was back on that doorstep to drive the boy back to Worcester. It was a weekday, and he had to go to school.


Kay Lazar can be reached at kay.lazar@globe.com. Follow her on Twitter @GlobeKayLazar.