Doctoral Dissertation Research Improvement: Medical System-State Collaborations

这项研究探讨了政府的命令如何影响对使用药物的孕妇的医疗反应。 联邦和州的授权越来越多地鼓励医疗提供者在怀疑孕妇在围产期使用药物时启动惩罚性的州反应。 这对医务人员作为病人护理提供者的专业角色提出了挑战。 本研究使用多种定性方法来调查这一过程中不同行为者（国家行为者、医疗专业人员和孕妇）的行为。 这项研究的结果有可能影响政府关于使用药物的孕妇的政策制定以及医学专家和孕产妇健康倡导者的反应。本研究采用多层次分析，以评估宏观，微观和中间层次的因素，相互塑造对孕妇的干预。 为了评估宏观层面的过程，通过与利益相关者（如医学专家和儿童福利倡导者）的访谈进行系统层面的分析，研究政策领域（包括药物政策，儿童福利政策和母婴健康政策）如何塑造医疗议程并鼓励医学法律合作。 在中级水平上，对一个分娩单位进行了为期一年的人种学研究，揭示了日常医疗实践是如何进行的，以及国家在多大程度上被邀请参与或干预这些过程。在微观层面上，对医疗专业人员和直接受医疗发起的国家制裁影响的妇女进行的半结构化访谈显示了医疗-国家合作如何影响护理结果和患者福祉。 贯穿始终的一个关键考虑因素是社会阶层和种族在塑造机构反应方面所发挥的作用。该奖项反映了NSF的法定使命，并被认为值得通过使用基金会的智力价值和更广泛的影响审查标准进行评估来支持。

The study examines how government mandates affect medical responses to substance-using pregnant women. Federal and state mandates increasingly encourage medical providers to initiate punitive state responses when they suspect perinatal substance use by pregnant women. This challenges the professional role of medical personnel as providers of care to their patients. This study uses a variety of qualitative methods to investigate the actions of the different actors in this process, state actors, medical professionals, and pregnant women. Findings of this research have the potential to influence government policy-making concerning substance-using pregnant women as well as the responses of medical experts and maternal health advocates. This study employs a multi-level analysis to assess macro, micro, and intermediate level factors that mutually shape interventions on pregnant women. To assess macro-level processes, a systems-level analysis informed by interviews with stakeholders such as medical experts and child welfare advocates looks at how policy domains (including drug policy, child welfare policy, and maternal-fetal health policy) shape medical agendas and encourage medico-legal collaborations. At an intermediate level, a year-long ethnographic study of a Labor and Delivery unit uncovers how day-to-day medical practices are carried out and to what extent the state is invited into or intervenes upon these processes. At the micro level, semi-structured interviews with medical professionals and women directly affected by medically-initiated state sanctions show how medical-state collaborations affect care outcomes and patient well-being. A key consideration throughout is the role that social class and race play in shaping institutional responses.This award reflects NSF's statutory mission and has been deemed worthy of support through evaluation using the Foundation's intellectual merit and broader impacts review criteria.