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).

项目摘要 怀孕的药物（包括非法物质和酒精）是一个关键的公共卫生问题， 影响十分之一的怀孕。由于阿片类药物危机，最近有指数增长 诊断母体阿片类药物使用障碍和新生儿阿片类药物戒断综合征。同时， 从2011年到2017年，进入全国寄养的婴儿在全国范围内增长了25％；婴儿现在占五分之一 年度寄养安置。目前，婴儿是发展寄养最快的小组，大多数是由于 父母使用物质。美国寄养系统的婴儿的兴起引起了公众的关注 联邦政策的变更旨在通过将护理人员连接到 通过提供包裹物的治疗物质使用障碍和减轻产后不良后果的治疗 通过安全护理计划（POSC）服务。但是，国家对联邦政策变化的反应已有 被脱节了，迄今为止的研究尚不清楚这些政策是否实现了他们既定的目标 或产生意想不到的后果，例如加剧系统中的种族不成比例。这 研究旨在评估儿童福利政策干预措施和当地因素，以改善怀孕的福祉 患有药物使用障碍及其婴儿的人：1）对国家法规进行严格分析， 法规以及与POSC和POSC组件相关的指导可能会影响 实施服务（例如，治疗，产后支持）； 2）确定状态POSC策略是否为 与婴儿寄养安置的减少和急诊科有关滥用伤害的访问相关 POSC的实施是否与种族和种族不成比例的变化有关 婴儿寄养； 3）定性调查背景障碍和促进者的影响 实施POSC和探索与改进或相关的POSC实施元素 通过与主要利益相关者的访谈（例如，前线案件工作者， 法官，临床医生，决策者）。