Public Policy & Health for Substance Exposed Infant-Mother Dyads

公共政策

• 批准号: 10643277
• 负责人: Margaret Lloyd Sieger
• 金额: $ 15.44万
• 依托单位: UNIVERSITY OF CONNECTICUT STORRS
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-06-15 至 2028-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10643277
• 关键词: Address; Affect; Amendment; Award; Birth; Black race; Caring; Cause of Death; Child; Child Abuse and Neglect; Child Rearing; Child Welfare; Child abuse prevention; Clinical; Collaborations; Communities; Complex; Connecticut; Criminal Justice; Data; Data Analyses; Data Collection; Data Set; Data Sources; Development Plans; Diagnosis; Early identification; Ensure; Epidemiology; Family; Foundations; Health; Health Personnel; Health Policy; Home; Hospitals; Indigenous; Infant; Infant Health; Infrastructure; Intervention; Intervention Studies; Justice; Lead; Link; Longitudinal Surveys; Masks; Maternal Health Services; Mentored Research Scientist Development Award; Mentorship; Modeling; Mothers; National Institute of Drug Abuse; Neonatal Abstinence Syndrome; Newborn Infant; Outcome; Perinatal; Policies; Policy Research; Population; Population Heterogeneity; Positioning Attribute; Pregnancy; Prevention Research; Productivity; Provider; Public Health; Public Policy; Records; Research; Research Personnel; Research Priority; Risk; Role; Safety; Services; Site; Statistical Methods; Substance Use Disorder; System; Testing; Time; Training; Vulnerable Populations; Woman; Work; administrative database; adverse outcome; career development; child protection; child protective service; ethnic disparity; experience; family support; fetal substance exposure; foster care; genetic linkage analysis; health care service utilization; health service use; high risk; improved; improved outcome; innovation; maternal outcome; minority children; multidisciplinary; multilevel analysis; opioid overdose; perinatal women; pregnant; prevent; programs; racial disparity; recruit; referral services; response; safety outcomes; secondary analysis; service intervention; substance use; substance use treatment; theories

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.

产前物质暴露是一个重大的公共卫生问题，影响 10% 的婴儿（美国超过 360,000 名婴儿） 2020）。为保护这些新生儿而制定的以刑事司法为导向的政策与负面影响有关 对母亲和婴儿的影响，例如母亲药物滥用治疗利用率较低 怀孕期间，出生时诊断出新生儿阿片类药物戒断综合征 (NOWS) 的比例较高，以及 黑人和土著婴儿的儿童保护服务 (CPS) 转介率不成比例地较高。上 另一方面，没有针对婴儿接触物质政策的国家缺乏系统性应对措施的基础设施 支持这些家庭。 2016年，美国首要儿童福利政策——虐待儿童预防和治疗 法案 (CAPTA)——经过修订，以提高母婴健康和药物滥用治疗的利用率，同时 通过强制所有二人接受安全护理计划来确保婴儿安全。寻求保护二人免受 由于密集的监视和寄养安置的威胁，康涅狄格州于 2019 年成为唯一一个使用寄养安置的州 “隐蔽”方法，要求社区提供者在没有围产期母亲的情况下制定计划 向 CPS 披露其身份信息。 玛格丽特·劳埃德·西格 (Margaret Lloyd Sieger) 博士是美国少数研究人员之一，致力于确定公众如何 卫生政策可以提高接触物质的母婴二人的健康和安全。她的初步 康涅狄格州的研究表明，提供者正在与母亲一起制定计划。凭借这个K01奖以及 来自三个国家机构、两家大型分娩医院以及多学科指导团队的支持 国家专家 Lloyd Sieger 博士将应用卫生服务利用理论来检验计划的效果 安全护理的以下方面：(1) 物质使用治疗的利用，(2) 儿童安全，以及 (3) CPS 中的种族差异 参与。拟议的项目将采用创新的、科学严谨的方法来实现其目标 连接三个国家行政数据库并在制定安全护理计划时招募母亲 进行纵向调查。该 K01 奖项将为 Lloyd Sieger 博士提供以下方面的培训和经验：(1) 相关的多系统临床问题，(2) 围产期母亲的纵向调查研究，(3) 统计 多系统数据联动和多层次分析方法，以及（4）多地点、多状态的协作 研究。该奖项还将引发一项 R01 提案，对安全计划进行多地点、多州研究。 照，从而解决 NIDA 的优先事项，以了解阻碍儿童福利制度的有效政策 患有药物滥用障碍的母亲和产前接触过药物的婴儿的参与。最后， 该奖项将为 Lloyd Sieger 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，以改善孕妇和儿童的结局 养育患有药物滥用障碍的母亲及其婴儿。