Search

Mental health conditions including substance use disorder are the leading cause of pregnancy-related deaths in the U.S. Unfortunately, fears of child protective services' involvement interfere with maternal self-disclosure of substance use in pregnancy. Seeking to identify more mothers with substance use disorder in pregnancy or at delivery, and responsive to changes to the federal Child Abuse Prevention and Treatment Act (CAPTA), Connecticut requires hospital personnel to submit a deidentified notification to CPS for all newborns with prenatal substance exposure. However, it is unknown whether this approach aligns with maternal self-report on substance use. For the present study, we compared population parameters derived from CAPTA notifications submitted between March-December 2019 with parameters derived from self-report data on substance use in pregnancy from mothers who gave birth during the same timeframe. Results revealed that three times as many mothers self-reported any alcohol or drug use in pregnancy compared to the rate measured with CAPTA notifications. Compared to mothers who self-reported drug use in the third trimester, CAPTA notifications were made for statistically similar rates of Black mothers but half the self-reported rate of White and Hispanic mothers. This disparity reflects that CAPTA notifications were made for twice as many Black mothers as White or Hispanic. Although CAPTA notifications are not punitive in nature, this disparity reveals that the public health aims of this policy are not yet achieved. Significance: Accurate and equitable identification of infants with prenatal substance exposure and their mothers, coupled with non-stigmatized, non-punitive intervention is central to any public health response.The current study relies on 2019 data from Connecticut to understand accuracy and equity in identification of these infants by comparing hospital-based notifications to self-report substance use in pregnancy. We found that hospital approaches to detecting prenatal substance exposure identified twice as many Black mothers as White or Hispanic mothers. Compared to self-reported substance use in pregnancy, which detected equivalent rates of substance use across race groups, White and Hispanic mothers' substance use in pregnancy was under-identified in hospital settings. [ABSTRACT FROM AUTHOR]

Background: Previous literature suggests that children removed from home due to parental substance use disorder (SUD) and placed with older adult foster parents are more likely to achieve permanency than children placed with younger foster parents; however, little, if any, literature has examined this trend across racial identities. Objective: The aim of this study was to examine the intersectional effects of removal due to parental SUD, child's race/ethnicity, and foster parent age on likelihood of, and time to, child permanency. Methods: Twelve years of Adoption and Foster Care Analysis and Reporting System data were linked to capture all children in the U.S. foster care system between January 1, 2007 and September 30, 2018. Application of multiple sampling procedures resulted in a final analytic sample of 1,943,280. Results: All children with older adult foster parents were more likely to achieve permanency than those with younger foster parents. However, white children with substance-related removals were 17% more likely to achieve permanency when placed with an older adult foster parent than with a younger foster parent. In contrast, children of color with substance-related removals were only 9% more likely to achieve permanency when placed with an older adult foster parent than with a younger foster parent. Conclusions: These findings suggest that older adult foster parents are associated with beneficial effects that may mitigate the deleterious impact of parental SUD on permanency. However, the strength of this protective effect was diminished for children of color. These findings call for attention to the supports available to older adults who foster children of color. [ABSTRACT FROM AUTHOR]

The article discusses a study on the Child Abuse Prevention and Treatment Act in Connecticut which examined the associations between mothers' and infants' characteristics and the possible outcomes after a notification. Topics covered include the information solicited by the notification system on family care plans, how safety concern was captured in the study and the factors associated with receiving FCP in Connecticut.

In the U.S., the opioid epidemic has revitalized national attention to newborns with prenatal substance exposure (PSE). These newborns and their caregivers have specific health and treatment needs and frequently interact with multiple systems, including child protection systems (CPS). This study calculated rates of newborns (less than 15 days old) reported to CPS per 1,000 births due to PSE by state and year using data from the National Child Abuse and Neglect Data System (NCANDS). Given the lack of a clear definition of PSE reports in the data, we calculated rates using three different definitions. To examine the relationship between different state laws regarding the mandated reporting of PSE and PSE reports rates, we used panel data analysis. Rates of newborn reports more than doubled between 2011 and 2019. There was extensive state variability of rates including some states that were consistently more than 100 % greater than and others consistently more than 150 % less than the annual national mean. Reporting rates were not associated with state requirements to report PSE, but were positively associated with rates of diagnosed neonatal abstinence syndrome. State-level inconsistencies in identification, reporting, and CPS responses prevent a clear understanding of the scope of the affected population and service needs. [ABSTRACT FROM AUTHOR]

The purpose of this study is to investigate the use of buprenorphine within non-hospital residential programs. We hypothesize that programs offering long-term treatment will be less likely to accept or prescribe buprenorphine, but those that accept public insurance will demonstrate relative increased likelihood of buprenorphine availability. This study analyzed data from the 2021 National Substance Use and Mental Health Services Survey. The analytic sample (n=3654) included a subset of facilities that reported providing only substance use treatment, including three non-mutually exclusive service types: detox, short-term, and long-term. A logistic regression examined the association between buprenorphine availability and residential service type, holding constant characteristics associated with the outcome of interest. We then tested an interaction between public insurance and long-term service type on the outcome of interest. While long-term service type was associated with reduced odds of buprenorphine availability (OR=.288, p <.05), programs that both offered long-term residential programs and accepted public health insurance had 3.5 higher odds of accepting or prescribing buprenorphine (OR=4.586, p<.01) compared to long-term programs without public insurance. Patients who require treatment of longer duration may face barriers to buprenorphine availability; however, public insurance acceptance may increase odds of availability of buprenorphine among long-term programs. • Public insurance acceptance among long-term residential programs increases buprenorphine availability. • More residential programs with buprenorphine availability offer detox and short-term services. • Residential programs offering naloxone and overdose education have increased odds of buprenorphine availability. • Efforts to expand public insurance and naloxone/overdose education in long-term residential programs may improve buprenorphine availability. [ABSTRACT FROM AUTHOR]

The article explores how local factors contributed to variable implementation of federal child welfare policies intended to improve outcomes for families affected by substance use disorder. Topics covered include the sampling and recruitment of participants, the points of entry for Plan of Safe Care Practice (POSC) policy and the responsibility for completing POSC. It points out that clear policy language should align with meaningful practice.

Recent federal policy has solidified the importance of preserving families, yet over 400,000 children enter foster care each year. Although a few studies have found that certain types of services, like intensive family preservation services, may reduce child removals, more research is needed. This study examined the relationship between family preservation, family support, and basic need service utilization and child removal among families with substantiated cases of maltreatment. We conducted a survival analysis using data from the National Child Abuse and Neglect Data System (NCANDS). We took a cohort of families with an investigation and substantiation of maltreatment in FY 2018 and followed them through FY 2019 to identify any that experienced a child removal during the study period. This included a total of n = 558,915 children. Approximately 15.33% of children experienced a removal during the study period. Case management was the most frequently reported service, followed by transportation services and family preservation services. In the multivariable analysis, family preservation services (HR = 0.95, p <.01), home-based services (HR = 0.98, p <.001), and housing services (HR = 0.87, p <.001) decreased the hazards of child removal. Family support services (HR = 1.36, p <.001), transportation services (HR = 2.30, p <.001), education (HR = 1.13, p <.01), case management (HR = 1.83, p <.001), or daycare (HR = 1.26, p <.001) increased the hazards of child removal. Findings from this study suggest that utilization of various services is associated with future child removals. While preservation and home-based services decreased the likelihood of removal, several basic needs services increased the hazards of child removal. This may reflect too little too late with services that may be better applied as primary or secondary preventive efforts. Implications for policy and future rollout of the Families First Prevention Services Act are explored. [ABSTRACT FROM AUTHOR]