Friday, March 31, 2017

SMALLEST VICTIMS Narcotic-dependent newborns growing along with drug epidemic

Posted: March 31, 2017
Sierra Weitzel and baby Mia

Sierra Weitzel shot heroin every day until she was homeless, broke and four months pregnant. Her body writhed from the early stages of withdrawal as she waited for emergency room doctors to tell her if her baby was dead.
“I didn’t know if I was still pregnant,” the 22-year-old Tinicum woman said. “I was so mixed up in my emotions. I was crying and throwing up. I didn't want to know how (the baby) was. I was too afraid."
When doctors assured her the baby was alive, Weitzel said she dropped to her knees, clasped her hands and thanked God. The first-time mom then got treatment, including methadone, a synthetic opioid prescribed to wean her off heroin.
She swore her baby wouldn't grow up like she did — with a mother who was addicted to painkillers and alcohol. While drugs didn't kill her mom, Weitzel believes they shortened her life. 
When Weitzel's daughter, Mia, arrived in January 2016, she was five days overdue, weighed a healthy 7 pounds 15 ounces and was dependent on the methadone used to treat her mother during pregnancy.

The first signs of neonatal abstinence syndrome appeared shortly after Mia was born. Withdrawal syndrome occurs when newborns are exposed to narcotics in the womb. Symptoms can include tremors, vomiting, diarrhea, irritability, sleep problems, fluctuating body temperature, seizures and gastrointestinal upset.
The number of newborns who've been exposed to drugs in the womb is growing, medical providers say, as the ripples of this narcotics epidemic reach the youngest, most vulnerable — and often overlooked — population.
How many babies are affected? No one knows, since there are no consistent, comprehensive measures to detect, track and protect them.
  • Different hospitals have different screening procedures and reporting methods.
  • Not all babies or mothers are tested for drug exposure.
  • Not all newborns who are exposed in the womb develop withdrawal symptoms. 
  • Not all babies with positive drug tests may be brought to the attention of child protective services.
  • A Pennsylvania law that requires checks on a child's welfare doesn't address what doctors say is the largest source of drug-exposed babies — legally prescribed opioids.
Child welfare advocates argue that government agencies and policymakers can't make informed decisions about laws and rules designed to address fetal drug exposure because they don't have a baseline to measure it.
"It isn't just knowing the overall number (of exposed newborns), but knowing the number in a timely way, as well as the type of exposure," said Cathleen Palm, founder and executive director of the Center for Children's Justice in Berks County. "Right now in Pennsylvania, there is no specific spotlight or coordinated strategy about the opioid epidemic and its impact on kids.”
Babies treated for withdrawal syndrome typically make a full recovery physically. Weitzel didn't know what exactly would happen when her baby was born, but she said she put her faith in the doctors at Grandview Hospital when Mia showed signs of withdrawal.

She recalled the heartbreaking time, just days after Mia's birth, when the muscles in her tiny body would stiffen when she was held. She couldn’t latch onto her mother’s breast to feed. She was tightly swaddled to regulate her body temperature and control tremors.
For nine days, doctors watched Mia's symptoms. So did Weitzel, who slept in the hospital. At night, Weitzel cradled Mia, refusing to let her go until the nurses nudged her to put the baby down and try to get some sleep.
"I would get depressed; I knew she didn't deserve this," said Weitzel, who has been sober for nearly 20 months. "It was hard watching her go through pain like that and not being able to do a thing.”
In Weitzel's case, the doctors knew about her addiction and were prepared to treat Mia. That doesn't always happen,  doctors say. Too often, doctors say mothers hide their addiction, so hospitals and caseworkers can't prepare in advance to treat babies born into addiction or even track those whose symptoms are mild or who have no symptoms.
From what doctors and hospitals do know, the number of babies diagnosed with withdrawal syndrome has steadily risen during the past 15 years, along with the nation’s growing abuse of opiates such as heroin and opiods such as oxycodone. The number of affected babies in the country who were admitted to neonatal intensive care units jumped from seven per 1,000 admissions to 27 per 1,000 between 2004 and 2013, according to a study in the New England Journal of Medicine in 2015.
Hospital costs of treating drug-dependent newborns and their mothers have gone from $732 million in 2009 to $1.5 billion in 2012. State Medicaid has paid 81 percent, according to a study in the Journal of Perinatology, which focuses on maternal, fetal and newborn care.
“Individuals who don’t pay attention to this are burying their heads in the sand. It’s a major health issue,” said Dr. Joel Sorosky, chairman of the OB-GYN Department at Abington Hospital-Jefferson Health. “Our neonatal unit used to be a spot for premature babies, but now it’s booming for reasons that could be preventable with education.”
Since 2003, federal law has required states to advise child welfare authorities of affected newborns, but Pennsylvania has a blanket exception for babies exposed to narcotics through doctor-ordered prescription drugs, including methadone. Child welfare advocates say the exception places medically fragile babies at risk for abuse, neglect and even death in homes with unstable caregivers who are unprepared for the demands of a newborn.
Among Medicaid births in Pennsylvania, at least 61 of the more than 7,500 babies born addicted to drugs between 2010 and 2014 died before their first birthdays, according to state data obtained by Palm, of the Berks County-based children's justice center. Some deaths were linked to parental substance abuse, Palm said. There's no reliable data available for births to women with private insurance, Palm said. 
Heroin and synthetic opioids are among the most addictive drugs because they disrupt and overtake the brain and central nervous system functions. With chronic use, the brain's endorphin-secreting cells rely on the narcotics to function and the body requires higher doses to prevent withdrawal symptoms and allow users to feel normal, according to drug treatment specialists.
A 2016 University of Pennsylvania study found evidence that such dependence interferes with the natural care-giving instincts of humans, essentially reducing their ability to care for others. But when researchers treated chronic users with naltrexone, a drug that blocks the effects of narcotics, their brains produced the type of caregiver response found in healthy brains.
“Families that suffer from addiction don’t love their children any less, but they can have a diminished capacity to care for them,” said Laurie O’Connor, director of the Montgomery County Office of Children and Youth. "You don’t see that kind of thing with other kinds of drugs."
Sierra and baby Mia
The impact of parental substance abuse on children is something the Pennsylvania Legislature is addressing. A bill to create a task force charged with developing strategies for improving the safety and well-being of these children was unanimously voted out of the House Children and Youth Committee on March 22 and is expected to be up for a  full House vote perhaps as soon as April. 
“These children are the innocent victims,” said Rep. Katharine Watson, R-144, of Warrington, who proposed House Bill 235 and chairs the House Children and Youth Committee. “We, as a commonwealth, have a responsibility to protect them as children and what we know is, if (they're) not taken care of and protected, if you look at a balanced ledger line in the budget, it will cost more later.”
Protection was the priority when the Bucks County Children and Youth social services agency became involved with Mia and Weitzel, the mom acknowledged.
But rather than separate mother and infant, the caseworker who showed up when Mia was 2 days old provided support for her, Weitzel said. When Mia was discharged after nine days of treatment for methadone withdrawal, the caseworker developed a care plan that included weekly home visits from the caseworker to teach parenting skills.
Still, Weitzel said, "there was always this fear in the back of my mind that I could lose her — even though I was doing everything right (by getting treatment)."
The agency was ready to close its case with Weitzel after three months, satisfied that Mia, who's now nearly 15 months old, was in a safe home. But when her caseworker asked if she wanted three more months of help and support, Weitzel quickly agreed.  
Today Weitzel is grateful — for the doctors who didn’t judge her, for the caseworkers who taught her to care for Mia, and for her family who took her in and never gave up. Weitzel hopes to one day become a certified recovery specialist so she can help pregnant women facing addiction realize they have a chance to save themselves and their babies.
"Just because you're pregnant doesn't mean the addiction switch turns off; I know that, and what they need is for the community to understand that, like any other disease, they (people with addiction) need treatment," Weitzel said. “They also need to know they are not alone, that people care. My baby is doing awesome today, but I couldn’t have done it alone.”

Sunday, March 26, 2017

Rep. Katharine Watson's bill would create task force to address opioid impact on young children

Posted March 22, 2017

They are the youngest, most vulnerable — and often overlooked — victims of the nation’s opioid epidemic: the children of parents with substance abuse disorders.
State Rep. Katharine Watson, R-144, of Warrington wants her fellow state lawmakers to start paying closer attention to them.
Rep. Katharine Watson
“Infants and children are often the forgotten victims of this devastating epidemic and are driving the large majority,” Watson said. “Whether they are born addicted to opiates and require intense care in their first few weeks of life or are living in a home where parents are struggling with addiction, these children need our attention.”

Saturday, March 11, 2017

Bonsai master devotes life to ancient art of tiny ornamental potted trees

Posted March 5, 2017

A bonsai master lives atop a Solebury hillside blanketed with trees stretching into the clouds.
Chase Rosade works on his living art
Visitors climb a long, twisted, upaved path that resembles the branches of living art in his collection.
The trip isn't designed for anyone in a hurry. Concentration, patience and observation are required.
The same qualities found in bonsai artists like Chase Rosade, who specialize in bonsai, (pronounced bone-sigh). It is the art of growing trees and shrubs in containers, where they are shaped to control their growth. 
Rosade opened his namesake bonsai studio in 1970, turning a childhood love of trees into a career. That was the same year the Bucks County native first created an exhibit of bonsai for the Philadelphia Flower Show. Since then, his creations and live demonstrations have been a yearly staple at the show, which opens to the public March 11 in the Philadelphia Convention Center and runs through March 19.
At his Solebury home, which also serves as his studio, greenhouse and display garden, Rosade's bonsai collection fills the plate-glass windows. Outside, posted signs warn visitors that parking spaces are reserved for bonsai lovers. In the greenhouse abutting his studio, hundreds of bonsai are sheltered for the winter. Visitors feel like giants amid this forest of tiny trees, some no taller than 30-ounce water bottles.
There's a 40-year-old elm tree that stands less than 2 feet tall. A pint-size trident maple is 75 years old. One of the largest is a 4-foot-tall Ponderosa spruce that's about 250 years old. In the Colorado forest where it started its life, these trees can grow 100 feet tall with a canopy broaden enough to bridge the distance from home plate to first base, he said.
A prized tree is the Japanese maple that Rosade grew from seed. He potted the 2-inch shoot in 1958 when he was 24. In nature, these trees typically grow 1 foot a year for the first 50 years and can live for more than 100 years. His bonsai version is roughly the height of one that's less than three years old. 
For a tree to become a bonsai requires heavily pruning its leaves, branches and roots to control its growth, Rosade said. The size of the bonsai depends on how it’s maintained. Wire is used to train branches to grow in the direction the artist chooses; Rosade describes it like braces used to straighten teeth.
It's not an art for the impatient, he said. 
“There is nothing to make you hurry,” Rosade said. “And I’m not in any hurry.”

Bonsai symbolism 

The word bonsai takes its name from two Chinese characters that mean tree planted in a shallow container or penjing. While the art is most closely associated with Japan, it’s China that has a longer documented history background with potted plants and horticultural practice, according to the Pennsylvania Bonsai Society. 
The Japanese are credited with creating bonsai in the art form that is most familiar today, which is the recreation of the forms and characteristics of trees, bushes and other plants in miniature. Symmetry, balance and proportion are critical to good bonsai presentation. Branch placement, styling and the container are designed to convey symbolism and to promote the spiritual connection between man and nature.
In the small, tight-knit world of bonsai enthusiasts, Rosade is a legend with an international reputation for excellence. He is the expert that other national – and international – horticulture experts call when they need advice on all things bonsai. He's also a founding member of the Pennsylvania Bonsai Society, one of the oldest in the U.S., as well as the National Bonsai Foundation.
Rosade, who's 82, is credited with bringing bonsai into the mainstream in the United States, specifically on the East Coast, according to Mike Wigginton, president of the 60-member Pennsylvania Bonsai Society, and a former Rosade student. 
“He has been tireless, almost, in his pursuit of bonsai,” Wigginton added, praising Rosade's mastery of the art. “You can tell it’s his passion.”
Rosade, whose father was an avid gardener, has been fascinated with trees and plants since childhood. He discovered bonsai at Philadelphia Flower Show when he was just 11.
“I just found these little plants in pots that looked like bigger trees fascinating,” he said. " 'Wow, someone can do that? How do they do it?' "
He earned his bachelor's degree in ornamental horticulture at Delaware Valley College, now University, in Doylestown Township. After graduation, Rosade traveled across Europe for nearly a year before landing in Nara, Japan. There, he met Kyozo Yoshida, a bonsai tree developer and grower. Rosade spent a year studying bonsai with Yoshida before returning to Bucks County.
A speech to a local Rotary Club led to a suggestion Rosade teach a class in bonsai growing. One class became a dozen classes, he said, and he's still teaching more than 50 years later, plus lecturing and judging bonsai contests around the world. He said he has bonsai students on five continents.

Longtime students

Chase Rosade
Royersford residents Jim and Linda Brant, who became interested in bonsai after seeing Rosade demonstrate the art at the Philadelphia Flower Show, have been students of Rosade for 40 years. They have more than 70 bonsai; their oldest tree is 30 years old.

Linda Brant said the bonsai master treats beginners and experts equally. “Also, he considers himself as still learning,” Jim Brant added.
Bob Mahler, 47, is another longtime student.
The Montgomery County man first met Rosade when he was 15 and his mother took him to the Philadelphia Flower Show. (“I was dragged there, most likely,” he joked). Like Rosade, Mahler was immediately intrigued that a plant could be grown in a pot for such a long time.
After his mother took a class at Rosade's studio, she volunteered her son to help him care for the plants. He spent time with Rosade a couple days a week after school, helping with repotting, watering, weeding, and pruning the dwarf trees.
Over time, Rosade filled a void, said Mahler, who lost his father at age 11. When he was 19, Mahler moved to Japan for a bonsai apprenticeship. He spent 11 years as the bonsai curator at the famed Brooklyn Botanic Gardens. Today, he owns and operates his own bonsai studio in Lehigh County.
“Bonsai would not be where it is today without this guy,” Mahler said of Rosade. “If it wasn’t for him I wouldn’t be where I am today, and it started at the Philadelphia Flower show.”

The big show 

Rosade still travels the world in pursuit of bonsai. He visited China in November and he'll attend the world bonsai meeting in April. For the moment, though, his energy is devoted to his upcoming exhibit at the Philadelphia Flower Show.
Among the 16 trees on display at the flower show will be a roughly 40-year-old spruce that Rosade tends. The tree stands less than 3 feet tall, a tiny mirror image of wild evergreen spruces.

This specimen is the only contribution from Rosade. Rather than show the usual eight to 20 trees he usually brings from his personal collection, he invited 15 other bonsai growers to show with him. They include former students and other East Coast bonsai masters.
“It’s nice to show what other people can do,” he said, noting the flower show is a good way to educate people about bonsai.    
For example, no matter how small the bonsai tree, it produces normal size leaves, needles, blooms, and yes, fruit. The trick is regular pruning to encourage new growth, he said. Any tree or bush can be a bonsai. Some flowers, too, like chrysanthemums.
“You can grow it the way you want to grow it,” Rosade said. “It’s the challenge. It’s constantly changing and getting better.”
Lately, the bonsai master doesn’t spend as much time as he once did in the greenhouse. Still, he has no plans to retire. Every day, he said, something bonsai-related keeps him occupied. 
“A finished tree is a dead bonsai,” he concluded.
Jo Ciavaglia: 215-949-4181; email:; Twitter: @JoCiavaglia

Did You Know?

The easiest way to kill most bonsai is bringing it indoors. Many of the popular bonsai varieties – like evergreens and juniper -  live outdoors like their older – taller – siblings. During the growing season virtually all bonsai should live outside.
Indoor plants that cannot be allowed to freeze:
fig, natal plum, citrus, serissa, jade, myrtle, gardenia, bougenvalia
Outdoor plants that require a cold dormancy period:
juniper, maple, azalea, apple, pine, elm, spruce, larch

Just The Facts

Bonsai styles
Formal: A single upright trunk that tapers toward the top
Informal: A single upright trunk with well balanced curves. The top usually bends toward the front.
Semi or full cascade: single arching or cascading trunk either severely slanted or extending below the container.
Group or forest: Usually trees of related species representing a miniature landscape.
Free form: A sparse single upright trunk – straight, slanted, or curved characterized by a tasteful, simple elegance.
Other bonsai styles: slanting, broom, windswept, multiple trunk (twin, triple, or clump), and rock planting (on, in, or over a rock). Deserving special classification based on size is the miniature (Shohin) bonsai (less than 10 inches).
Source: Pennsylvania Bonsai Society

State DHS taking 'broader' look at child welfare agency linked to Grace Packer case

Posted: Mar 10, 2017 

State child welfare officials are taking a deeper look at the past and current practices of a private for-profit Lehigh County child welfare agency with ties to an Abington woman who was a former employee and foster parent and is accused along with her boyfriend in the rape and killing of her adopted daughter last year.
Grace Packer
The Department of Human Services' review of The IMPACT Project in Emmaus was described as taking a “broader scope,” beyond the mandatory review it's also conducting into the death of Grace Packer, 14, allegedly at the hands of Sara Packer, 42, and Packer’s boyfriend, Jacob Sullivan, 44, said DHS spokeswoman Rachel Kostelac. The examination includes the agency’s current cases, administrative policies and internal oversight, Kostelac said.
So far, three counties — Montgomery, Lehigh and Northampton — have announced they will no longer use IMPACT for child welfare services for the foreseeable future following recent allegations by former foster children that its workers failed to address abuse claims involving Sara Packer more than a decade ago. The agency has provided services, such as specialized foster care and juvenile court evaluations, in more than 30 counties in Pennsylvania and Delaware since 1991.
The IMPACT Project’s executive director, Courtney Wagaman, wrote in a March 8 statement that since its inception, IMPACT has operated in “the best interest, safety and welfare” of children in its care and “stringently adheres, without exception” to requirements that any instance of suspected child abuse is promptly reported to the appropriate authorities.
State records show that IMPACT has routinely passed annual license renewal inspections, the most recent one on April 19 and 20. At the time, the agency had 78 children in its care, 41 approved foster care families, and employed 20 staffers. The 2016 review mentioned the agency’s personnel records were “in good condition with excellent training and supervision.”
The only reports citing noncompliance came from a March 2011 inspection, and involved the agency's failure to get physical and dental exams for some foster children within 60 days of placement as required by law, according to the report. IMPACT took corrective action, including implementing policies to withhold foster parent paychecks until appointments are made.
Sara Packer at her January 2017 arraignment
IMPACT has significant ties to Sara Packer, who worked there as a case manager for two years. Packer and her former husband, David W. Packer, also became licensed as foster parents in 2000, while she was an IMPACT employee. Over the next decade, the couple took in 30 foster children, though it’s unknown how many were placed with the family through IMPACT. It is also unclear if Sara Packer provided foster care services for IMPACT while she was an employee.
IMPACT placed Grace Packer — then known as Susan Hunsicker — her younger brother and older sister with the Packers for foster care in 2004; at the time Sara Packer was working for Northampton County’s Office of Children, Youth and Families as a case manager and later adoption supervisor. Sara and David Packer adopted Grace and her younger brother in March 2007.
State regulations do not prohibit employees of private or public child welfare agencies it licenses and oversees from providing foster care services. But financial conflicts of interest can occur when an agency contracts for foster care services with one of its employees, Kostelac said. When this happens, the agency has to get a waiver of the regulations and state permission, a requirement to bypass any state mandate.
Last year, DHS granted 225 waivers and all but 23 were requests to place more than six kids — the maximum under state regulations — with the same foster family. Kostelac confirmed that the department has no record of a waiver submitted for Sara Packer while she worked at IMPACT.
Jacob Sullivan
Neither Bucks nor Montgomery counties' children and youth departments allow staff to act as foster parents for children in the agency’s custody. Wagaman, the executive director at IMPACT, did not immediately respond to an email Friday asking if the agency currently or in the past has allowed employees to serve as foster parents for children in its care.
Montgomery County spokeswoman Lorie Slass said private child welfare providers with whom it contracts are responsible for addressing the daily needs of children placed through the agency, and must visit children in their foster homes at least once a month. County child welfare employees are responsible for case management and service coordination, and visit the provider foster homes at least on a quarterly basis.
Child welfare employees frequently also are licensed foster parents, said Christine James-Brown, CEO of the Child Welfare League of America, the nation’s oldest child welfare organization. Allowing agency employees to provide foster care services to children placed within the agency can also be a positive, she said. For instance, an employee might know more about a child’s history than an outsider.
Those professionals working in the child welfare field need to be subjected to the same level of scrutiny, accountability, training and supervision as someone from outside the organization seeking to be a foster or adoptive parent, she said.
“Just because they work for an organization doesn’t give them a pass on anything,” James-Brown said. “Most organizations are especially careful because they don’t want to be under the kind of scrutiny that they have fouled up.”
It has been the best practice for many years that child welfare employees who apply to be foster parents are assessed by an agency other than the one they work for, added Donna Petras, vice president of models of practice and training for the Child Welfare League.
“This is to prevent bias in the assessment and overlooking possible red flags due to bias in favor of a colleague,” Petras said.
Questions about IMPACT have surfaced recently after two former foster children of the Packers' alleged in interviews that they told IMPACT caseworkers about the couple’s abusive behavior toward foster children in their care, including Grace, back in 2006. The women each came forward with the allegations after Sara Packer was arrested.
The state Department of Human Services revoked Sara and David Packer's foster parent licenses in 2010, the same year that David Packer was arrested and charged with sexually assaulting Grace Packer, then 9, over four years, and another foster child with mental challenges starting when she was 15. David Packer later was convicted of both crimes and served five years in prison before being released in 2015. He is required to register as a sexually violent predator.
A subsequent child welfare investigation found substantial evidence that Sara Packer committed child abuse “by omission” under the state’s civil Child Protective Services Law, meaning she failed to stop the abuse, but the offense did not rise to the level of a crime. She retained custody of Grace and her brother. The Packers divorced last year, records show.
Bucks County authorities have charged Sara Packer, formerly of Abington but recently of Horsham and Richland, and Sullivan, of Horsham, with the killing of Grace Packer. The teen was raped, drugged, beaten and strangled in July, authorities say, and her dismembered remains were found Oct. 31 in a remote section of Luzerne County.
In the months that followed the killing, Sara Packer reported her daughter missing to police and also continued to collect government checks for Grace’s care, according to police. The couple remains incarcerated without bail in Bucks County's prison and are awaiting trial on homicide and related charges. 
Jo Ciavaglia: 215-949-4181; email:; Twitter: @JoCiavaglia