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Child protection involvement of children of mothers with intellectual disability
- Authors:
- LIMA Fernando, et al
- Journal article citation:
- Child Abuse and Neglect, 126, 2022, p.105515.
- Publisher:
- Elsevier
Background: Children born to parents with intellectual disability (ID) have been shown as disproportionally represented in child protection services however with limited population-based research. Objectives: To investigate child protection involvement for children born to mothers with ID in Western Australia using linked administrative data. Participants and setting: A cohort of 1106 children born to a mother with ID and a comparison group of 9796 children of mothers without ID were identified in Western Australia. Methods: Cox regression analyses stratified by maternal Aboriginal status were conducted to investigate risk of child involvement with child protection services and care placement. Interaction with child age, intellectual disability status, and maternal mental health and substance use was investigated. Results: Children born to a mother with ID were both at higher risk of having contact with child protection services (HR: 4.35 (3.70-5.12)) and placement in out-of-home care (HR: 6.21 (4.73-8.17)). For non-Aboriginal children, the risks of child protection involvement and placement for those born to mothers with ID were 7 times and 12 times higher than those of mothers without ID. The risk was lower for Aboriginal children, at 1.8 and 1.9 times, respectively. Infants born to mothers with ID were at higher risk of child protection involvement compared to other age groups. Maternal mental health and substance use moderated the increased risk. Conclusions: Intellectual disability alone is not sufficient justification for removal of children from their parents. The challenge for family services is ensuring that resources are adequate to meet the family's needs. (Edited publisher abstract)
Factors contributing to level and type of child welfare involvement following prenatal substance exposure: a scoping review
- Authors:
- PEDDIREDDY Snigdha R., AUSTIN Anna E., GOTTFREDSON Nisha C.
- Journal article citation:
- Child Abuse and Neglect, 125, 2022, p.105484.
- Publisher:
- Elsevier
Background: An understanding of factors contributing to variation in child welfare outcomes in cases of prenatal substance exposure (PSE) can help identify gaps in research and practice and guide state and agency policy. Objective: To summarize the evidence base and identify critical gaps in the literature, the researchers conducted a scoping review regarding individual- and institutional-level factors associated with child welfare decision-marking across the service continuum and caregivers' perceptions of child welfare involvement in cases of PSE. Participants and setting: The sample included peer-reviewed studies based in the United States. Methods: conducted a comprehensive search of four databases for studies investigating 1) sociodemographic, behavioural, policy, or other factors contributing to variation in child welfare outcomes and 2) maternal, family, or provider perceptions of the child welfare process in cases of PSE. This study followed an established methodological framework for conducting scoping reviews. Results: Of the 23 articles included in the review, 20 explored variation in decision-making across the child welfare services continuum and three examined caregivers' perceptions of child welfare involvement. At the institutional level, provider characteristics, such as agency capacity, were linked to specific child welfare outcomes including reports and removals. At the individual level, factors such as socioeconomic status, race, and substance type were also associated with outcomes across the service continuum. Conclusions: Child welfare agencies use an unsystematic approach in addressing PSE, contributing to a variation in child welfare outcomes and potentially allowing for bias. This review highlights a need for increased resources and guidance for caseworkers. (Edited publisher abstract)
Differences in trauma exposure, PTSD and child well-being as a function of parental substance misuse in a child welfare sample
- Authors:
- JANKOWSKI Mary K., KNIGHT-ZHANG Erin, BUTCHER Rebecca
- Journal article citation:
- Children and Youth Services Review, 132, 2021, p.106326.
- Publisher:
- Elsevier
Parental substance misuse can have multiplicative effects on children, from increased risk of trauma exposure (Sprang et al., 2008), greater likelihood of referral to child protective services (Stanton-Tindall et al., 2013), and negative long-term outcomes in psychological adjustment and well-being (e.g., Seay & Kohl, 2015). With the rise of the opiate crisis in the United States, many states have seen a dramatic increase in the number of children affected by parental substance misuse and referrals to child protective services. In a sample of children involved with child protective services (n = 436), this study compared children with allegations and risk factors for parental substance misuse versus those without in terms of their trauma exposure, PTSD symptoms and child well-being. This study also conducted a focus group with child welfare intake and assessment workers (n = 20) to provide context and increase understanding of the findings. Three-hundred and twenty-three of the 436 children (74%) had positive indicators for parental substance misuse, as identified by child welfare staff. Youth with parental substance misuse displayed poorer outcomes than those without, but only for those ages 11 to 20, not children under 11. The nuances of these data, as well as the implications, are discussed. (Edited publisher abstract)
Evaluation of interprofessional training to strengthen communication and coordination among providers working with expectant mothers and infants affected by substance use
- Authors:
- WEST Allison, et al
- Journal article citation:
- Children and Youth Services Review, 132, 2021, p.106331.
- Publisher:
- Elsevier
Providers across disciplines need knowledge, attitudes, confidence and resources to communicate and collaborate effectively when working with families with infants affected by substance use. This pre-post study assessed the acceptability, perceived utility, and preliminary outcomes of a hybrid online and in-person interprofessional training program for 104 providers working in child welfare, early intervention, and maternal and early childhood home visiting programs. Participants completed a baseline self-report pretest survey, a hybrid online and in-person training program, and a posttest survey. Quantitative data were analyzed using paired t tests; qualitative data from open-ended questions were analyzed using thematic coding. Quantitative data indicated improvements in knowledge and confidence across all provider types, and improvements in home visitor and early intervention providers’ perceptions of having the resources to collaborate with child welfare. Overall, the training was described as acceptable and useful. Findings provide initial support for interprofessional training to improve provider competence and collaborative capacity for working with families and infants affected by substance use. (Edited publisher abstract)
Sobriety treatment and recovery teams for families with co-occurring substance use and child maltreatment: a propensity score-matched evaluation
- Authors:
- HALL Martin T., et al
- Journal article citation:
- Children and Youth Services Review, 131, 2021, p.106256.
- Publisher:
- Elsevier
Background and Objectives: The U.S. has seen increased prevalence of substance use, child maltreatment, and child entry into out-of-home care (OOHC). This study tested whether Sobriety Treatment and Recovery Teams (START) were superior to usual child welfare services with regard to: (1) OOHC placements within 12 months of the index maltreatment event; (2) reunification for children who were placed in out-of-home care; and (3) subsequent maltreatment within 12 months of the index maltreatment event. Methods: Administrative data from families involved with Child Protective Services in Kentucky between 2010 and 2016 were analyzed. Propensity score matching was used to match the youngest child in families receiving START to children in families receiving usual services (N = 1042). Between-subjects statistical tests were used to estimate treatment effects in the 12 months following initial maltreatment. Results: Children in families receiving START were less likely to be placed in OOHC than children in families receiving usual services (20.7% vs. 34.2%; 95% confidence interval (CI) = −17.6%, −9.2%); p < 0.001). Of children who were placed in OOHC, a higher percentage of those receiving START were reunified with their caregivers, though differences were not statistically significant (50.0% vs. 41.6%; 95% CI = −7.1%, 24.0%; p = 0.32). Rates of subsequent maltreatment were higher among children in families receiving START than those in families receiving usual services (12.3% vs. 6.1%; 95% CI = 3.0%, 9.3%; p < 0.001). Conclusions: With regard to preventing OOHC placements, START outperformed usual services. Of children placed in OOHC, half of those served by START were successfully reunified in spite of notable risk factors. Finally, recurrent maltreatment was higher among children in families receiving START, perhaps due to increased surveillance relative to usual services. (Edited publisher abstract)
Multisystemic Therapy - Building Stronger Families (MST-BSF): substance misuse, child neglect, and parenting outcomes from an 18-month randomized effectiveness trial
- Authors:
- SCHAEFFER Cindy M., et al
- Journal article citation:
- Child Abuse and Neglect, 122, 2021, p.105379.
- Publisher:
- Elsevier
Background: Parental substance misuse impacts millions of children globally and is a major determinant of repeat maltreatment and out-of-home placement. There is little published research on family-based, comprehensive treatment models that simultaneously address parental substance misuse and child maltreatment. Objective: This study reports outcomes from a randomized clinical trial examining the effectiveness of the Multisystemic Therapy – Building Stronger Families (MST-BSF) treatment model with families involved with Child Protective Services due to physical abuse and/or neglect plus parental substance misuse. Participants and setting: Ninety-eight families who had an open case with Child Protective Services in two areas of the state of Connecticut participated. Method: Families referred by the Connecticut Department of Children and Families were randomly assigned to MST-BSF or Comprehensive Community Treatment (CCT). Both interventions were delivered by community-based therapists. Outcomes were measured across 5 assessments extending 18 months post-baseline. Results: Intent-to-treat analyses showed that MST-BSF was significantly more effective than CCT in reducing parent self-reported alcohol and opiate use and in improving child-reported neglectful parenting. Although means were in predicted directions, new incidents of abuse across 18 months did not differ between groups. The study features high recruitment and engagement rates for a population experiencing multiple involvements with child protection. Conclusion: The outcomes of this study support the effectiveness of MST-BSF, an intensive family- and ecologically- based treatment, for significantly reducing parental alcohol and opiate misuse and child neglect. These findings help in our understanding of how best to address the understudied issue of interventions for child neglect. (Edited publisher abstract)
Supporting mother-infant dyads impacted by prenatal substance exposure
- Authors:
- DEUTSCH Stephanie Anne, et al
- Journal article citation:
- Children and Youth Services Review, 129, 2021, p.106191.
- Publisher:
- Elsevier
Improving health and well-being of mothers, infants, and children represents a national public health priority, with emphasis placed on understanding how environmental and social determinants (access to quality health care, education, employment, economic opportunities, social support, and resource availability) influence maternal health behaviors and infant-child well-being. Substance use during pregnancy is a predominant maternal-infant health risk; many affected mother-infant dyads also face co-occurring psychosocial adversities, often necessitating social services-based interventions. Best practices to support infants exposed to substances across the medical, mental health, substance use, and social service sectors have historically been affected by heterogeneity of dyad needs, varied stakeholder perspectives, and limited cross-sector resource availability. Recent legislative changes designating a universal, family-centered, non-punitive, and supportive social services-based approach toward affected mother-infant dyads, known as Plans of Safe Care, offer a potential solution to comprehensively address diverse needs. This narrative review discusses current public health-based efforts and novel implementation of federally-funded family support programs, including Plans of Safe Care and Family First legislation, to address the multiple health and psychosocial adversities facing prenatally substance exposed mother-infant dyads. Opportunities for future research, including analysis of the impact of Plans of Safe Care and other policy interventions on dyad health and safety outcomes is explored. (Edited publisher abstract)
Associations of housing stress with later substance use outcomes: a systematic review
- Authors:
- AUSTIN Anna E., et al
- Journal article citation:
- Addictive Behaviors, 123, December 2021, p.107076.
- Publisher:
- Elsevier
A synthesis of existing evidence regarding the association of housing stress with later substance use outcomes can help support and inform housing interventions as a potential strategy to address problematic substance use. We conducted a comprehensive search of PubMed, Web of Science, PsycInfo, CINAHL, Social Work Abstracts, and Sociological Abstracts and systematically screened for articles examining housing stress and later substance use outcomes among U.S. adults. Across 38 relevant articles published from 1991 to 2020, results demonstrated an association of homelessness with an increased likelihood of substance use, substance use disorders (SUD), and overdose death. Results regarding the association of homelessness with receipt and completion of SUD treatment were mixed, and one study indicated no association of homelessness with motivation to change substance use behaviors. Several studies did not find an association of unstable housing with substance use or receipt of SUD treatment, while others found an association of unstable housing with intensified SUD symptoms and a decreased likelihood of completing SUD treatment. Overall, while there is evidence of an association of homelessness with later substance use, SUD, and overdose death, results for other forms of housing stress and some substance use outcomes are less consistent. There are several methodological considerations specific to selected measures of housing stress and substance use, study populations, and analytic approaches that have implications for results and directions for future research. Despite these considerations, results collectively suggest that innovative interventions to address housing stress, namely homelessness, may help mitigate some substance use outcomes. (Edited publisher abstract)
Understanding the relations among adverse childhood experiences (ACE), substance use, and reoffending among detained youth
- Authors:
- WEBER Shelby, LYNCH Shannon
- Journal article citation:
- Child Abuse and Neglect, 120, 2021, p.105211.
- Publisher:
- Elsevier
Background: System-involved youth experience elevated rates of exposure to adverse childhood experiences (ACE), which is related to reentry in the criminal legal system and increased risk of using substances, but there is little research on the indirect role of substance use in the relation between adversity and offending in youth offenders. Notably, the majority of youth report exposure to multiple adverse events and these experiences vary by gender. Objective: The present study aimed to expand upon current literature by evaluating gender differences in the relations among cumulative ACEs, substance use severity, and reoffending in a sample of rural detained youth (N = 417). Methods and Results: Using Poisson (count) regression analyses, cumulative adversity significantly predicted reoffending among girls and boys. Additionally, there was a significant indirect effect of ACEs on reoffending via substance use. Girls reported higher exposure to adversity and substance use, and gender significantly interacted with ACEs to predict substance use and reoffending. Conclusions: These findings demonstrate the importance of cumulative experiences of adversity in childhood and substance use as predictors of youth reentry into the criminal legal system. Understanding the role of substance use in the relation between ACEs and reoffending has the potential to contribute to our knowledge of detained youth's treatment needs and reoffending risk. (Edited publisher abstract)
The Sobriety Treatment and Recovery Teams program for families with parental substance use: comparison of child welfare outcomes through 12 months post-intervention
- Authors:
- HUEBNER Ruth A., et al
- Journal article citation:
- Child Abuse and Neglect, 120, 2021, p.105260.
- Publisher:
- Elsevier
Background: The 2018 Family First Prevention Services Act (FFPSA) shifted child welfare funding to interventions proven effective in preserving families with parental substance use and child welfare involvement. The Sobriety Treatment and Recovery Teams (START) program serves this population with FFPSA aligned goals. Objective: This study was the first to test the sustained effects of START from the initial CPS report through 12-months post-intervention. Participants and setting: Children (n = 784) receiving START services in four sites were compared to 784 children receiving child welfare treatment as usual (TAU). Methods: Using child welfare administrative data, children in START were matched to children in TAU using propensity score matching. Outcomes were tested during the intervention period, and at six- and 12-months post-intervention using comparative statistics and multilevel logistic regression. Results: The odds of START children being placed in out-of-home care (OOHC) during the intervention period were half those of children in TAU (20.3% vs. 35.2%, p < .001, OR = 0.47, 95% CI [0.37, 0.59]). When placed in OOHC, START children were more likely to be reunified with their parents (p = .042, OR = 1.44, 95% CI [0.99, 1.62]). At 12-months post-intervention, 68.5% of START and 56.0% of TAU-served children remained free from both OOHC placement and child abuse and neglect (after multilevel clustering adjustment: p < .001, OR = 1.85, 95% CI [1.41, 2.43]). Conclusion: The primary impact of START was significantly reduced rates of OOHC placement, with results sustained through 12-months post-intervention and after accounting for family clusters and site differences. (Edited publisher abstract)