Improving outcomes for substance-affected families in the child welfare system

改善儿童福利系统中受药物影响的家庭的成果

• 批准号: 10734742
• 负责人: Stephen W Patrick
• 金额: $ 64.89万
• 依托单位: VANDERBILT UNIVERSITY MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-01 至 2028-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10734742
• 关键词: 1 year old; Accounting; Address; Affect; Alcohol consumption; Alcohols; Anthropology; Attention; Biometry; Birth; Caregivers; Caring; Categories; Characteristics; Child; Child Psychiatry; Child Welfare; Child abuse prevention; Communities; Complex; Congresses; County; Diagnosis; Disparity; Drug usage; Effectiveness; Elements; Emergency department visit; Equity; Ethnic Origin; Ethnic equity; Evaluation; Family; Fostering; Goals; Government; Harm Reduction; Health; Individual; Inequality; Infant; Injury; Intervention; Interview; Knowledge; Laws; Legal; Methodology; Mothers; Neonatal Abstinence Syndrome; Nonprofit Organizations; Outcome; Parents; Pediatrics; Personal Satisfaction; Persons; Pharmaceutical Preparations; Policies; Policy Analysis; Policy Maker; Pregnancy; Pregnant Women; Prevalence; Public Health; Publications; Race; Racial Equity; Regulation; Research; Services; Sexual abuse; Social Work; Substance Use Disorder; Surveys; Syndrome; System; United States; Woman; Work; addiction; adverse outcome; age group; battered child; black women; care systems; child neglect; design; experience; federal policy; foster care; health equity; illicit drug use; improved; improved outcome; infant outcome; maternal opioid use; multidisciplinary; opioid epidemic; opioid use disorder; physical abuse; postnatal; pregnant; prevent; racial disparity; response; substance use; substance use treatment

PROJECT SUMMARY Substance use in pregnancy, including illicit substances and alcohol, is a critical public health problem, affecting 1 in 10 pregnancies. Because of the opioid crisis, there were recent exponential increases in diagnoses of maternal opioid use disorder and neonatal opioid withdrawal syndrome. In parallel, the rate of infants entering foster care nationwide grew 25% from 2011 to 2017; infants now account for one fifth of annual foster placements. At present, infants are the fastest growing group entering foster care, most due to parental substance use. The rise of infants in the US foster system garnered public attention leading to recent federal policy changes that aimed to prevent foster placement where possible by connecting caregivers to treatment for substance use disorder and mitigating postnatal adverse outcomes by providing wrap-around services through Plans of Safe Care (POSC). However, state responses to changes in federal policy have been disjointed, and research to date remains unclear as to whether these policies achieved their stated goal or had unintended consequences such as exacerbating underlying racial disproportionality in the system. This study aims to evaluate child welfare policy interventions and local factors to improve the wellbeing of pregnant people with substance use disorder and their infants by: 1) conducting a rigorous analysis of state statutes, regulations, and guidance related to POSC and categorizing POSC components likely to influence the implementation of services (e.g., treatment, postnatal supports); 2) determining if state POSC policies were associated with reductions in infant foster placements and emergency department visits for injury from abuse and whether implementation of POSC was associated with changes to racial and ethnic disproportionality in infant foster placement; and 3) qualitatively investigating the contextual barriers and facilitators influencing the implementation of POSC and exploring elements of POSC implementation associated with improving or worsening racial and ethnic equity through interviews with key stakeholders (e.g., frontline case workers, judges, clinicians, policymakers).

项目概要 怀孕期间使用药物，包括非法药物和酒精，是一个严重的公共卫生问题， 影响十分之一的怀孕。由于阿片类药物危机，最近的药物数量呈指数级增长 母亲阿片类药物使用障碍和新生儿阿片类药物戒断综合征的诊断。同时，速率 2011年至2017年，全国范围内接受寄养的婴儿数量增长了25%；婴儿现在占五分之一 年度寄养安置。目前，婴儿是进入寄养家庭增长最快的群体，主要原因是 父母物质的使用。美国寄养系统中婴儿的崛起引起了公众的关注，导致最近 联邦政策变化旨在通过将看护者与看护者联系起来来尽可能防止寄养安置 通过提供全面治疗来治疗物质使用障碍并减轻产后不良后果 通过安全护理计划 (POSC) 提供服务。然而，各州对联邦政策变化的反应 支离破碎，迄今为止的研究仍不清楚这些政策是否实现了其既定目标 或者产生意想不到的后果，例如加剧系统中潜在的种族不平等。这 研究旨在评估儿童福利政策干预措施和当地因素，以改善孕妇的福祉 患有物质使用障碍的人及其婴儿：1) 对州法规进行严格分析， 与 POSC 相关的法规和指南以及可能影响 POSC 组成部分的分类 实施服务（例如治疗、产后支持）； 2) 确定州 POSC 政策是否 与婴儿寄养安置和因虐待受伤而急诊就诊的减少有关 POSC 的实施是否与种族和族裔比例失调的变化有关 婴儿寄养安置； 3）定性调查影响环境的障碍和促进因素 POSC 的实施并探索与改进或相关的 POSC 实施要素 通过采访主要利益相关者（例如一线案件工作者、 法官、临床医生、政策制定者）​​。