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，影响着10%的婴儿(#年超过360,000 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消极 对母亲和婴儿都有影响，例如母亲使用治疗的使用率较低 在怀孕期间，新生儿阿片类药物戒断综合征(NOWS)出生时的诊断率较高，以及 黑人和土著婴儿的儿童保护服务(CPS)转诊率高得不成比例。论 另一方面，没有实施暴露于物质的婴儿政策的国家缺乏系统性应对的基础设施 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 该法(CAPTA)--经修订，增加母婴健康和药物使用治疗的使用率 通过强制要求所有双胞胎都接受安全护理计划来确保婴儿安全。寻求保护二人组免受 密集的监测和寄养安置的威胁，2019年康涅狄格州成为唯一一个使用 需要由有围产期母亲的社区提供者制定计划的“蒙面”方法 向CP披露他们的可识别信息。 玛格丽特·劳埃德·西格博士是美国为数不多的研究人员之一，她致力于确定公众 卫生政策可以增加暴露于物质的婴儿-母亲二人组的健康和安全。她的初选 康涅狄格州的研究表明，供应商正在与母亲一起制定计划。有了这个K01奖和 来自三个州机构、两家大型分娩医院和一个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查计划的效果 关于以下方面的安全护理：(1)药物使用治疗利用，(2)儿童安全，以及(3)CPS中的种族差异 参与其中。拟议的项目将使用创新的、科学严谨的方法来实现其目标 连接三个州的行政数据库，并在制定安全护理计划时招募母亲 进行纵向调查。这一K01奖项将为Lloyd Sieger博士提供以下方面的培训和经验： 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的方法，以及(4)多站点、多状态的协作 研究。这项奖励还将导致R01提案，对外管局的计划进行多地点、多州的研究 护理，从而解决NIDA的优先事项，以了解防止儿童福利制度的有效政策 有物质使用障碍的母亲和有产前物质暴露的婴儿的参与。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 养育患有药物使用障碍的母亲和她们的婴儿。

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.