Implementation and Outcomes of Child Protection System Reporting Policies Regarding Infants Born with Prenatal Substance Exposure

项目摘要 意义：儿童保护系统（CPS）是产前物质的主要反应者 暴露（PSE），尽管指导CPS参与受物质影响的出生后的政策各不相同 在司法管辖范围内。虽然CPS在保护儿童免受伤害方面发挥着重要作用， 非通用的报告政策提供了更具战略性地部署CPS干预的可能性。得不好 了解授权报告人如何实施PSE报告政策，以及CPS的时间安排 接触药物婴儿的参与影响监护结果。此外，特派记者可以 提供关于最佳实践政策和标准化工具的关键见解，这些政策和工具可以提高 报告政策，以辨别何时需要CPS干预，以减轻虐待儿童的风险。 具体目标：本提案的目标是阐明CPS的实施和成果 报告政策，并列举改善政策绩效的可行做法， 目的：（1）描述在分娩时被诊断为物质使用的妇女和那些报告给CPS的妇女， 通过交叉公平透镜的描述性统计和多水平模型;（2）分析3年的监护 结果，比较出生与记录的PSE，并没有报告给CPS在早期 通过内容分析和半结构化访谈，评估政策的一致性 并确定最佳做法，可能会减少家庭风险和依赖CPS为某些家庭。 方法：对于前两个目标，一个非公开的出生队列数据集的链接行政记录， 将使用加州进行多水平和多项logistic回归。第三个目标，内容 对洛杉矶县14家高风险分娩医院的CPS报告政策的分析将通过以下方式得到加强： 对这些机构的劳动和分娩提供者进行半结构化访谈。拟建项目 创新地使用有足够样本量的关联行政数据， 个人和机构层面的人口特征导致的不同结果。该项目也是 创新性地纳入了政策内容分析，填补了当前政策成果中的一个关键空白 文学该项目在个人层面的纵向和深入的定性贡献方面具有重要意义 将信息提供给具有直接政策和方案相关性的重点领域。 奖学金申请人：本建议书中概述的培训计划将使申请人Julia Reddy具备以下能力： 先进的流行病学技能和关键的政策和系统知识。该计划将使申请人做好准备， 成功完成拟议的项目，并作为一个独立的公共卫生研究人员前进，重点 关于减轻家庭物质使用负担的政策和方案。申请人得到充分支持 由一个强大的导师和研究顾问团队谁拥有必要的经验和培训，以指导她 博士研究和专业发展援助，以及重要的机构支持，沿着。

PROJECT SUMMARY Significance: The child protection system (CPS) serves as a primary responder to prenatal substance exposure (PSE), although policies guiding CPS involvement following a substance affected birth vary across and within jurisdictional settings. While CPS plays an important role in protecting children from harm, nonuniversal reporting policies offer the potential to deploy CPS intervention more strategically. It is not well understood how PSE reporting policies are implemented by mandated reporters and how timing of CPS involvement for substance-exposed infants affects custodial outcomes. Moreover, mandated reporters can offer key insights into best practice policies and standardized tools that may improve the effectiveness of reporting policies at discerning when CPS intervention is needed to mitigate risk of child maltreatment. Specific Aims: The objective of this proposal is to elucidate the implementation and outcomes of CPS reporting policies and to enumerate promising practices for improving policy performance with three specific aims: (1) describe women diagnosed with substance use at delivery and those reported to CPS using descriptive statistics and multilevel modeling through an intersectional equity lens; (2) analyze 3-year custodial outcomes, comparing births with documented PSE that were and were not reported to CPS in the early neonatal period; and (3) through content analysis and semi-structured interviews, evaluate policy consistency and identify best practices that may attenuate family risk and reliance on CPS for certain families. Approach: For the first two aims, a nonpublic birth cohort dataset of linked administrative records from California will be used to conduct multilevel and multinomial logistic regressions. For the third aim, a content analysis of CPS reporting policies at 14 high-risk birth hospitals in Los Angeles County will be augmented by semi-structured interviews with labor and delivery providers at those institutions. The proposed project is innovative in its use of linked administrative data with a sufficient sample size for interrogative analyses of differential outcomes by demographic characteristics at individual and institutional levels. The project is also innovative in its inclusion of policy content analysis, which fills a key gap in the current policy outcomes literature. The project is significant in its contribution of individual-level longitudinal and in-depth qualitative information to a focus area with immediate policy and programmatic relevance. Fellowship Applicant: The training plan outlined in this proposal will equip the applicant, Julia Reddy, with advanced epidemiologic skills and critical policy and systems knowledge. This plan will prepare the applicant to successfully complete the proposed project and advance as an independent public health researcher, focusing on policies and programs to alleviate the burden of substance use on families. The applicant is well supported by a strong team of mentors and research advisors who have the requisite experience and training to guide her doctoral research and aid in her professional development, along with significant institutional support.