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

项目总结 怀孕期间使用包括非法物质和酒精在内的物质是一个严重的公共卫生问题， 每10个孕妇中就有一个受到影响。由于阿片类药物危机，最近出现了指数级增长 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。与此平行的是， 从2011年到2017年，全国范围内进入寄养中心的婴儿增长了25%；婴儿现在占到 一年一度的寄养家庭。目前，婴儿是进入寄养家庭的增长最快的群体，主要原因是 使用亲本物质。美国寄养系统中婴儿的兴起引起了公众的关注，导致最近 联邦政策变化，旨在尽可能通过将照顾者与 药物使用障碍的治疗和通过提供包裹式治疗减轻出生后不良后果 通过安全护理计划(POSC)提供的服务。然而，州政府对联邦政策变化的反应是 到目前为止，研究仍然不清楚这些政策是否达到了他们所宣称的目标 或者产生了意想不到的后果，例如加剧了制度中潜在的种族不均衡。这 这项研究旨在评估儿童福利政策干预和当地因素，以改善孕妇的福祉 物质使用障碍者及其婴儿：1)对州法规进行严格分析， 与POSC相关的法规和指南，以及对可能影响POSC的组件进行分类 实施服务(例如，治疗、产后支持)；2)确定国家POSC政策是否 与婴儿寄养安置和因虐待受伤而到急诊科就诊的减少有关 以及POSC的实施是否与#年种族和民族不成比例的变化有关 婴儿寄养安置；3)定性调查影响婴儿寄养的背景障碍和促进者 实施POSC并探索与改进或改进相关的POSC实施要素 通过与关键利益攸关方(例如，前线案件工作人员、 法官、临床医生、政策制定者)。

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).