Public Policy & Health for Substance Exposed Infant-Mother Dyads

产前物质暴露是一个重大的公共卫生问题，影响到10%的婴儿（超过360，000人）。 2020年）。为保护这些新生儿而制定的以刑事司法为导向的政策与消极的 对母亲和婴儿的后果，如产妇使用药物治疗率较低 在怀孕期间，出生时诊断为新生儿阿片类药物戒断综合征（NOWS）的比率较高， 黑人和土著婴儿的儿童保护服务转介率高得不成比例。上 另一方面，没有婴儿接触药物政策的国家缺乏系统应对的基础设施， 支持这些家庭。2016年，美国主要的儿童福利政策--《儿童虐待预防和治疗》（Child Abuse Prevention and Treatment） 修订了《母婴保健和药物使用治疗法》， 通过强制规定所有二人组接受安全护理计划，确保婴儿安全。试图保护二分体不受 由于对寄养安置的严密监视和威胁，康涅狄格州在2019年成为唯一一个使用 “掩蔽”方法，要求社区提供者为围产期母亲制定计划， 向CPS披露其可识别信息。 玛格丽特·劳埃德·西格博士是美国少数几个致力于确定公众如何 卫生政策可以提高接触药物的母婴二人组的健康和安全。她的初步 康涅狄格州的研究表明，供应商正在与母亲一起制定计划。凭借这一K 01奖项， 来自三个国家机构，两个大型分娩医院和一个多学科指导团队的支持， 国家专家劳埃德·西格尔博士将应用卫生服务利用理论来检查计划的效果 安全护理：（1）物质使用治疗利用，（2）儿童安全，（3）CPS中的种族差异 参与。拟议项目将采用创新的、科学严谨的方法实现其目标， 将三个州的行政数据库连接起来，并在制定安全护理计划时招募母亲 进行纵向调查该K 01奖项将为劳埃德·西格博士提供以下方面的培训和经验：（1） 相关的，多系统的临床问题，（2）对围产期母亲的纵向调查研究，（3）统计 多系统数据链接和多层次分析的方法，以及（4）多站点，多状态的协作 research.该奖项还将导致R 01建议进行多地点，多个国家的安全计划研究 照顾，从而解决NIDA的优先事项，以了解有效的政策，防止儿童福利制度 有物质使用障碍的母亲和产前接触物质的婴儿的参与。最后， 该奖项将为劳埃德·西格尔博士富有成效的独立研究计划奠定基础， 整合物质使用流行病学，政策和临床干预措施，以改善孕妇和 养育患有物质使用障碍的母亲及其婴儿。

Prenatal substance exposure is a significant public health problem affecting 10% of infants (over 360,000 in 2020). Criminal justice-oriented policies enacted to protect these newborns are associated with negative consequences for both the mother and infant, suchas lower rates of maternal substanceuse treatment utilization in pregnancy, higher rates of neonatal opioid withdrawal syndrome (NOWS) diagnoses at birth, and disproportionately higher child protective services (CPS) referral rates for Black and Indigenous infants. On the other hand, states without substance-exposed infant policy lack infrastructure for systematic responses to support these families. In 2016, the primary U.S. child welfare policy—the Child Abuse Prevention and Treatment Act (CAPTA)—was amended to increase mother-infant health and substance use treatment utilization while ensuring infant safety by mandating that all dyads receive a plan of safe care. Seeking to protect dyads from intensive surveillance and threat of foster care placement, in 2019 Connecticut became the only state to use a “masked” approach that requires plans be developed by community providers with perinatal mothers without disclosing their identifiable information to CPS. Dr. Margaret Lloyd Sieger is one of a small handful of researchers in the U.S. working to identify how public health policy can increase health and safety for substance exposed infant-mother dyads. Her preliminary research in Connecticut indicates that providers are developing plans with mothers. With this K01 award and support from three state agencies, two large birthing hospitals, and a multidisciplinary mentorship team of national experts, Dr. Lloyd Sieger will apply a theory of health services utilization to examine the effect of plans of safe care on: (1) substance use treatment utilization, (2) child safety, and (3) racial disparities in CPS involvement. The proposed project will achieve its aims using innovative, scientifically rigorous approaches to linking three state administrative databases and recruiting mothers at the time they develop a plan of safe care for a longitudinal survey. This K01 award will provide Dr. Lloyd Sieger with training and experience in: (1) pertinent, multisystem clinical issues, (2) longitudinal survey research with perinatal mothers, (3) statistical methods for multi-system data linkage and multilevel analysis, and (4) collaborations for multi-site, multi-state research. This award will also lead to an R01 proposal to conduct a multi-site, multi-state study on plans of safe care, thereby addressing NIDA’s priorities to understand effective policies that prevent child welfare system involvement for mothers with substance use disorders and infants with prenatal substance exposure. Finally, this award will set the foundation for Dr. Lloyd Sieger’s productive, independent program of research that integrates substance use epidemiology, policy, and clinical interventions to improve outcomes for pregnant and parenting mothers with substance use disorder and their infants.