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As he made the case to convict Michael McCarthy of murder, prosecutors in the Bella Bond murder trial acknowledged another culprit:  heroin addiction.

“If there weren’t heroin in this case,” Suffolk County assistant district attorney David Deakin told the jury, “there would be no case.”

“If there weren’t heroin in this case, there would be no case.”

McCarthy is the ex-boyfriend of Bella Bond’s mother. Prosecutors say the pair lived in a haze of heroin addiction. As the opioid epidemic continues to ravage lives, so does the debate over how the state can best protect the children of addicts.

In the two years since Bella Bond’s body was discovered washed up on a Boston Harbor beach, there’s been a sharp uptick in the number of Massachusetts kids in foster care. And while there’s broad agreement that safety must be the priority, some child welfare advocates say foster care is not always the best solution.

“It’s not just a choice between keeping kids at home where they’re at risk or removing them where they’re safe,” said Matt Stone, the executive director of Youth Villages.

Stone’s organization contracts with the Massachusetts Department of Children and Families to provide intense family support services so children can live at home instead of foster care.

“It does a lot of trauma and damage to children to be removed from families,” said Stone. “Most families can be taught to live together safely and successfully.”

“Most families can be taught to live together safely and successfully.”

Nicole Smith and her three children are living together with help from Youth Villages. Smith is a heroin addict and says she was sober for six years. When her youngest child, a four-year-old boy, went to school, she says she relapsed.

“I was used to being a full-time Mom, and all my kids were suddenly in school and I was left with too much time on my own,” said Smith.  “I was so used to go go, go, go and that’s what kept me sober.”

Last January, Smith’s four-year-old was found alone outside the family’s Webster apartment. DCF was called in and placed all three kids in foster care.

“If I hadn’t done some of the things I’d done, they wouldn’t have had the right to come in here and take my kids,” said Smith.

Smith’s children returned home in February and Nicole Shea, a social worker from Youth Villages, became constant fixture in the family’s life. She’s at their apartment three times a week to help Smith develop strategies for managing both her children and her addiction. She also has unlimited access to the home and regularly looks through drawers and cabinets for evidence of drug use.

“We’ve never found anything during our safety sweeps,” said Shea.  “She [Smith] does what she has to do. She goes to the methadone clinic. She keeps all of her scheduled appointments.”

Only a fraction of DCF’s overall budget funds intensive programs like the one that has helped keep Smith and her kids together. Advocates say moving funds from foster care to intensive family support programs would enable kids to live with their parents and reduce the burden on an overwhelmed foster care system. 

Yet, even for the most motivated person, addiction is tough to beat.

“I think the opioid epidemic represents a unique risk factor,” saidMaria Mossaides, the state’s child advocate. She supports efforts to keep families together, but defends the uptick in foster care placements. She points to research that suggests addiction changes the way a parent relates to a child.

“It takes a full year to 18 months after you’ve given up drugs and are in recovery for your brain to return to what they consider to be a normal state,” said Mossaides.      

“I think the opioid epidemic represents a unique risk factor.”

Nicole Smith says she’s a changed person, and she has new methods of coping with the issues she now believes drive her addiction.  

“I’m an addict, I’m in recovery,” said Smith, “but it doesn’t mean that’s all I am.”

Shea says Smith has progressed to the point her family no longer needs intensive support. Making the call to let the kids stay and step away from a family where addiction is an issue means accepting some level of risk and relying on professional judgement.

“You just get to know the family,” said Shea. “I think, honestly, in this situation, the best place for the children is home with the family.”

Smith and her kids won’t be completely on their own. DCF will continue monthly check-ins for an undetermined length of time.