A New Haven 10-month-old who died in June was the 11th young child to die from ingesting opioids in Connecticut since 2020, highlighting the growing effect of the opioid crisis on children, according to a new report from the state’s Office of the Child Advocate.
The report also alleges that the Connecticut Department of Children and Families and state’s probation system failed to keep Marcello Meadows safe and ensure the family had the services they needed to effectively cope with substance abuse. Marcello died from fentanyl, xylazine and cocaine intoxication.
“We’re still in the throes of this public health crisis, and public health solutions need to be multi-generational,” Child Advocate Sarah Eagan said in an interview.
Since 2020, more than 40 children under 5 have died or nearly died from opioid intoxication in Connecticut. Many of those survived because first responders were able to administer naloxone, according to the OCA report.
Fentanyl overdose deaths had not previously been recorded in this age group, according to a previous OCA report.
Marcello’s death was ruled a homicide. His mother, Alexandra Polino, was charged with manslaughter and two counts of risk of injury to a child.
“There’s no evidence that anyone intentionally harmed him, but he was harmed nonetheless,” Eagan said.
The family had an open case with DCF until June 7, 2023, three weeks before Marcello’s death. The case was closed after a provider inaccurately reported that Polino had successfully completed treatment, according to the OCA report. Shortly after Marcello’s birth, the court issued warrants for Polino for violating probation. The warrants were served after Marcello died.
The report also questions whether services to the family were administered effectively. The agencies involved provided some treatment but didn’t follow all the policies and procedures to manage risk and safety, according to the report.
“Although OCA supports treatment-focused family preservation efforts whenever safe and feasible, OCA finds that agencies’ policies and processes for assessing and managing risk and safety in the context of caregiver substance misuse require further improvement with concurrent quality improvement activities,” the report states.
Marcello’s older sibling was born in 2019 and tested positive for illicit opioids, but the hospital didn’t report complete information to DCF. Marcello was born in 2022, already exposed to opioids, and DCF created a safety plan for his well-being that included getting Polino treatment, according to the report.
There were ongoing concerns regarding Polino’s substance abuse, and both probation and DCF referred her for services, according to the report. In 2022, probation staff assessed Polino as in need of high supervision but did not conduct a home visit or assess the need for a DCF report.
Probation staff also did not adhere to policies regarding supervision, case documentation and home visits, nor did it serve Polino with the outstanding warrants quickly, the OCA report says.
DCF visitation and case supervision met agency standards, and the agency connected the family with community services, but it did not meet expectations for safety planning, according to the report.
Case records also don’t show a plan for reliable drug testing, according to the report.
“DCF closed its case with Marcello’s family in June 2023 despite Ms. Polino having tested positive for fentanyl on multiple occasions, and without conducting a meaningful assessment of Marcello’s father,” Eagan’s report states.
The in-home treatment provider also didn’t meet requirements for drug testing or communication with other agencies. The provider had staff turnover that affected the quality of the services, the report says.
Further review
Gary A. Roberge, executive director of the Judicial Branch’s Court Support Services Division, said in an emailed statement that the judicial branch worked closely with OCA regarding its involvement in the case.
“The Branch has addressed the policy violations identified in this report to ensure similar violations will not occur in future cases,” Roberge’s statement said. “Although the Branch’s policies and procedures were found to be sound in the areas reviewed, we will continue to review and discuss whether additional modifications should be implemented.”
Republican Sens. Lisa Seminara, ranking member of the Committee on Children, and minority leader Sen. Stephen Harding issued a statement on the report Tuesday. They said they should hear as soon as possible from child protection officials on how they are improving the system.
“This report shines a bright light — yet again — on several instances where state government has failed a child under its supervision,” they said. “This is the third report from the Child Advocate in a year which has pointed to systemic shortcomings. That is simply unacceptable. Equally galling is that new protective guidelines weren’t followed in Marcello’s case.”
On Tuesday afternoon, the Committee on Children voted to discuss recommendations for systems improvements from OCA.
The OCA report says there is an urgent need to give further attention to “in-home cases” like Marcello’s. The office has published three fatality reviews in the last year regarding death by homicide of children under active or recent supervision.
“DCF is making numerous efforts to strengthen practice,” the report states. “However case reviews and DCF systems data continue to show persistent deficiencies in safety planning and case management. Available data shows a marked decline in DCF’s risk and safety assessment and case supervision over the last two years.”
In a statement, DCF commissioner delegate Jodi Hill-Lilly emphasized the crisis-level problem of opioid use in Connecticut.
“Fentanyl related overdoses of adults and children is a public health crisis — an epidemic that knows no boundaries — impacting children, adults and families across Connecticut and the country,” Hill-Lilly’s statement said.
She also said that DCF has undertaken several measures, including safety assessments in substance abuse cases, expanding access to fentanyl testing, working with service providers to ensure that information-sharing is efficient, working to address provider staff turnover and engaging more fathers in the care of children.
Connecticut has one of the 10 highest rates for adult opioid overdoses in the country, according to the report. Recommendations urged the state to put more consideration to the effects of the opioid crisis on children.
Opioid use has been a growing topic of concern for child welfare agencies across the country. In addition to the risk of children accidentally ingesting the drugs, many children have faced neglect while their caretakers struggle with addiction, and others have lost parents who overdose.
The report on Marcello marks the second OCA review in recent months about the death of a baby from opioids. The other regarded a Salem toddler who ingested opioids and animal tranquilizers in 2022.
“What are the safety measures that we really need to be taking for children?” Eagan said. “Fentanyl is a game-changer. Trace amounts of fentanyl can be lethal to a young child.”
DCF has undertaken “intensive efforts to address child safety as the fentanyl crisis began impacting our state,” Hill-Lilly said.
They’ve developed safety guidance for cases involving substance abuse and conducted hundreds of team meetings on cases that involved fentanyl, according to her statement.
“Focusing our efforts on the high-risk nature of the 0-5 population is a priority in my administration as are continued community partnerships,” Hill-Lilly’s statement said. “We are continuously introspective about how we enhance and improve our case practice. DCF is in frequent communication with OCA regarding our overlapping work, and we remain committed to collaborating with the OCA on our shared mission of supporting and improving the safety and well-being of the children and families we collectively serve.”
Eagan’s report makes several recommendations for DCF, including ways to improve safety planning for young children, especially those whose caretakers have substance abuse issues.
The report also says DCF should review the impact of telework on DCF case practice and make progress toward implementing a new information management system. Hill-Lilly said last week that there will likely be a new case management system in 2025.
Eagan’s office also recommended more wrap-around treatment and support for caregivers who have substance abuse problems and more progress monitoring for the state’s child welfare work. She’s been an advocate for more transparency, better systems of quality improvement and more public reporting of outcomes from DCF.
“When we are thinking about prevention, intervention, safety, we have to be thinking in that family context,” Eagan said in an interview.
She said there should be systems set up to improve communication and information sharing regarding families dealing with addiction among state agencies.
The report also recommended several measures for the judicial branch, including more training for probation officers to assess and engage with caregivers who have issues with substance abuse or untreated serious mental illness.
It also recommends that staff get more training on how to assess household safety and when a possible DCF report is needed as well as improve information sharing with DCF.
The agency has created a centralized policy unit and a first audit of the adult probation policy. An audit of the warrant service and arrest process is scheduled to begin soon, according to the report.
Community-based support can be located by calling 211 or the Substance Use Access line at 1-800-563-4086. The Child Abuse and Neglect Careline is available to report suspicions of child maltreatment at 1-800-842-2288.
This story was originally published by The Connecticut Mirror Feb. 20, 2024.