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

项目摘要 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， 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。与此同时， 从2011年到2017年，全国范围内进入寄养家庭的婴儿增长了25%;现在， 年度寄养安置目前，婴儿是进入寄养家庭增长最快的群体，大多数是由于 父母使用药物。美国寄养系统中婴儿数量的增加引起了公众的关注， 联邦政策的变化，旨在防止寄养安置在可能的情况下，连接照顾者， 治疗药物使用障碍并通过提供环绕式护理减轻产后不良后果 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 迄今为止的研究仍然不清楚这些政策是否实现了既定目标 或者产生了意想不到的后果，比如加剧了系统中潜在的种族歧视。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和他们的婴儿通过：1）对州法规进行严格分析， 与POSC相关的法规和指南，并对可能影响 服务的实现（例如，治疗，产后支持）; 2）确定州POSC政策是否 与减少婴儿寄养安置和因虐待受伤而到急诊室就诊有关 以及POSC的实施是否与种族和民族歧视的变化有关， 婴儿寄养安置;和3）定性调查的背景障碍和促进因素影响， 实施POSC，并探讨POSC实施的要素， 通过与关键利益攸关方的访谈，前线个案工作者， 法官、临床医生、决策者）。

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).