Advancing Equity in Treatment Outcomes for Black Pregnant and Postpartum People Who Use Drugs and have Child Welfare and Criminal Legal Systems Involvement

项目摘要/摘要 在妊娠期提供药物使用障碍治疗是改善孕产妇和 新生儿健康，但歧视性政策、做法和获得必要资源有助于 成瘾护理和育儿结果方面的不平等。许多使用毒品的孕妇都经历过 监禁和儿童福利系统的参与也是如此。刑事法律政策和刑事法律政策 儿童福利系统倾向于将怀孕期间使用药物定为刑事犯罪，而不是投资于 治疗。值得注意的是，由于监禁背后的结构性种族主义和历史力量 这些政策系统性地贬低了黑人妇女的生育价值，产生了不同的负面影响 在黑人孕妇和育儿人群中，导致不成比例的儿童移居以及不同的 药物治疗结果。虽然政策、历史和社会学分析已经记录了 种族主义和将吸毒的黑人孕妇定为刑事犯罪，一个未被研究的方面是这些 结构性和人际歧视的力量影响生活体验、治疗和康复 双重参与这些系统的孕妇和产后黑人的结局。 了解这些相互交错的系统对于针对种族根源和消除种族至关重要 物质使用、治疗和产妇保健方面的差异和歧视。这样做的总体目标是 NIDA关于卫生公平的行政补编是审查种族主义的经验和对 在一组孕妇和产后样本中使用 毒品问题，以及刑事、法律和儿童福利制度的双重介入。这项研究还将 评估儿童福利系统工作者就案件作出决定的做法和观点 涉及怀孕期间吸毒和目前或最近被监禁的人。这项建议 将通过评估经过验证的种族主义措施的一系列定性访谈来实现这些目标 在孕产妇健康方面，并在社区成员的方法协作下，与直接、生活 经验。本项目将提升家长职业发展奖的培训目标，以提高 通过在以下方面提供培训机会，为怀孕、被监禁的阿片类药物使用障碍患者提供护理 如何研究和影响产妇保健中的种族主义。来自采访的数据将产生可操作的见解 未来对在监狱和儿童福利系统工作的人的政策和培训干预。这 研究是创新的，因为它将增加对监禁种族主义维度的现有理解 和儿童福利制度，通过检查这些制度的交叉点对个人 治疗途径和育儿结果。为本补编提出的工作，它直接与 随着NIDA种族公平倡议的目标，将有助于促进种族公平的长期目标 在孕产妇健康和药物使用治疗和结果方面。

PROEJCT SUMMARY/ABSTRACT Providing substance use disorder treatment in pregnancy is an essential strategy to improve maternal and newborn wellbeing, but discriminatory policies, practice, and access to necessary resources contribute to inequities in addiction care and parenting outcomes. Many pregnant people who use drugs experience incarceration and also have involvement from the child welfare system. Policies in both the criminal legal and child welfare systems have trended toward criminalizing drug use in pregnancy rather than investing in robust treatment. Significantly, due to the structural racism that underlies incarceration and historical forces that have systematically devalued Black women’s reproduction, these policies have had a differentially negative impact on Black pregnant and parenting people, contributing to disproportionate child removals as well as disparate drug treatment outcomes. While policy, historical, and sociologic analyses have documented the links between racism and criminalizing Black pregnant individuals who use drugs, one understudied aspect is how these forces of structural and interpersonal discrimination affect the lived experiences, treatment, and recovery outcomes among pregnant and postpartum Black people with dual involvement in these systems. Understanding these intersecting systems is essential for targeting root causes of and eliminating racial disparities and discrimination in substance use treatment and maternal health. The overall objective of this NIDA Administrative Supplement on Health Equity is to examine experiences of racism and the impact on treatment, pregnancy, and parenting outcomes among a sample of pregnant and postpartum people who use drugs and who have dual involvement from criminal legal and child welfare systems. This study will also evaluate the practices and perspectives of child welfare system workers who make decisions on cases involving people who used drugs in pregnancy and who were currently or recently incarcerated. The proposal will accomplish these aims through a series of qualitative interviews that assess validated measures of racism in maternal health, and with methodological collaboration from community members with direct, lived experience. This project will enhance the training goals of the parent career development award to improve access to care for pregnant, incarcerated people with opioid use disorder by providing training opportunities in how to study and impact racism in maternal health. Data from interviews will produce actionable insights for future policy and training interventions for people who work in incarceration and child welfare systems. This research is innovative because it will add to existing understandings of racialized dimensions of incarceration and child welfare systems by examining the impact at the intersection of these systems on individuals’ treatment pathways and parenting outcomes. The work proposed for this supplement, which directly aligns with the goals of NIDA’s Racial Equity Initiative, will contribute to the long-term goal of advancing racial equity in maternal health and substance use treatment and outcomes.