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He Y, Chaiyachati BH, Matone M, Bastos S, Kallem S, Mehta A, Wood JN. "Instead of just taking my baby, they could've actually given me a chance": Experiences with plans of safe care among birth parents impacted by perinatal substance use. CHILD ABUSE & NEGLECT 2024; 152:106798. [PMID: 38615413 PMCID: PMC11206134 DOI: 10.1016/j.chiabu.2024.106798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 02/05/2024] [Accepted: 04/07/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND Federal legislation mandates healthcare providers to notify child protective service (CPS) agencies and offer a voluntary care plan called a "plan of safe care" (POSC) for all infants born affected by prenatal substance use. While POSCs aim to provide supportive services for families impacted by substance use, little is known about birth parents' perceptions and experiences. OBJECTIVE To examine birth parents' perceptions and experiences regarding POSC. PARTICIPANTS AND SETTING Parents offered a POSC in Philadelphia in the prior year were included. METHODS This is a qualitative interview study. Participants were recruited from birth hospitals and community-based programs with telephone consent and interview procedures. Transcripts were analyzed using an inductive, grounded theory approach to identify content themes. RESULTS Twelve birth parents were interviewed (30.7 % of eligible, contacted individuals). Fear of CPS involvement and stigma were common. Some birth parents reported that the increased scrutiny related to POSCs negatively impacted their attitudes toward healthcare providers and medications for opioid use disorder (MOUD). While parents found the consolidated resource information helpful, many did not know how to access services. Finally, parents desired more individualized plans tailored to their unique family needs. CONCLUSIONS Stigma, confusion, and fear of CPS involvement undermine the goal of POSCs to support substance-exposed infants and birth parents. Providers serving this population should be transparent regarding CPS notifications, provide compassionate, non-stigmatizing care, and offer coordination services to support engagement after discharge. Policymakers should consider separating POSCs from CPS to avoid exacerbating fear and mistrust.
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Affiliation(s)
- Yuan He
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, United States of America; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States of America; Leonard Davis Institute, University of Pennsylvania, Philadelphia, PA, United States of America.
| | - Barbara H Chaiyachati
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, United States of America; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States of America; Leonard Davis Institute, University of Pennsylvania, Philadelphia, PA, United States of America; Safe Place: Center for Child Protection and Health, Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, United States of America; Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, PA, United States of America
| | - Meredith Matone
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, United States of America; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States of America; Leonard Davis Institute, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Shelley Bastos
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, United States of America
| | - Stacey Kallem
- Philadelphia Department of Public Health, Philadelphia, PA, United States of America
| | - Aasta Mehta
- Philadelphia Department of Public Health, Philadelphia, PA, United States of America
| | - Joanne N Wood
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, United States of America; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States of America; Leonard Davis Institute, University of Pennsylvania, Philadelphia, PA, United States of America; Safe Place: Center for Child Protection and Health, Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, United States of America; Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, PA, United States of America
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Powell M, Pilkington R, Varney B, Havard A, Lynch J, Dobbins T, Oei JL, Ahmed T, Falster K. The burden of prenatal and early life maternal substance use among children at risk of maltreatment: A systematic review. Drug Alcohol Rev 2024; 43:823-847. [PMID: 38548385 DOI: 10.1111/dar.13835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 02/21/2024] [Accepted: 02/22/2024] [Indexed: 05/04/2024]
Abstract
ISSUES Although maternal substance use is a known risk factor for child maltreatment, evidence on the scale of substance use is needed to inform prevention responses. This systematic review synthesised prevalence estimates of maternal substance use during pregnancy and early life among children at risk of maltreatment. Ovid, Pubmed, CINAHL, PsychInfo and ProQuest databases were searched. We included observational studies that sampled children at risk of maltreatment in high-income countries and reported information on maternal substance use during pregnancy and/or the child's first year of life. We extracted study characteristics and data to calculate prevalence, assessed risk of bias and conducted a narrative synthesis; there were insufficient comparable populations or outcomes to quantitatively synthesise results. KEY FINDINGS Thirty five of 14,084 titles were included. Fifteen studies had adequately sized and representative samples to estimate prevalence. Maternal substance use prevalence ranged from 2.4% to 40.6%. Maternal substance use was highest among infants referred to child protection at birth (40.6%) and children in out-of-home care (10.4% to 37.2%). Prevalence was higher when studies defined substance use more broadly and when maternal substance use was ascertained from both child and mother records. IMPLICATIONS Supportive, coordinated responses to maternal substance use are needed from health and child protection services, spanning alcohol and other drug treatment, antenatal and postnatal care. CONCLUSIONS Prenatal and early life maternal substance use is common among child maltreatment populations, particularly among younger children and those with more serious maltreatment.
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Affiliation(s)
- Madeleine Powell
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
- School of Population Health, UNSW Sydney, Sydney, Australia
| | | | - Bianca Varney
- School of Population Health, UNSW Sydney, Sydney, Australia
| | - Alys Havard
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
- School of Population Health, UNSW Sydney, Sydney, Australia
| | - John Lynch
- School of Public Health, University of Adelaide, Adelaide, Australia
- Population Health Sciences, University of Bristol, Bristol, UK
| | | | - Ju Lee Oei
- School of Women's and Children's Health, UNSW Sydney, Sydney, Australia
- Royal Hospital for Women, New South Wales Health, Sydney, Australia
| | - Tasnia Ahmed
- School of Population Health, UNSW Sydney, Sydney, Australia
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Salt E, Wiggins A, Pick A, Bada H, Howard C, Currie M, Rayens MK. A case-control study comparing rates and diagnoses of hospital readmission in infants affected by neonatal abstinence syndrome. J Matern Fetal Neonatal Med 2023; 36:2162820. [PMID: 36597833 DOI: 10.1080/14767058.2022.2162820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Rates of neonatal abstinence syndrome/neonatal opioid withdrawal syndrome (NAS/NOWS), a withdrawal syndrome from opioids and other substances resulting from intrauterine exposure, have been increasing exponentially in the U.S. To improve health outcomes, it is important to understand population health risks, including rehospitalization and related diagnoses, using current data. This study will compare and describe the rates of rehospitalization, the demographic characteristics and the rehospitalization diagnoses and age at diagnosis between the infants affected by NAS/NOWS to those sampled who were unaffected. This study will also describe the frequency of NAS/NOWS births per year along with a yearly comparison of readmissions in those affected by NAS/NOWS to those who were not (2016-2020). METHODS Health claims data were used to conduct a case/control study. Diagnosis codes for neonatal withdrawal syndrome/NAS/NOWS (P04.49 or P96.1 and P96.1 alone) from 1 October 2015 to 1 June 2021 were extracted, and controls were case-matched based on month/year of birth. Rehospitalizations following birth and the related diagnoses were described and grouped using the Agency of Healthcare Research Quality Clinical Classifications Software Refined Frequency distribution. The chi-square test of association and generalized estimating equation modeling were used for data analysis. RESULTS Infants affected by NAS/NOWS are 2.7 times more likely to have a rehospitalization. White, non-Hispanic neonates (OR = 1.5; p = .007) and those infants residing in rural areas (OR = 1.9; p < .001) were disproportionately affected. We identified a host of admission diagnoses with increased prevalence in infants affected by NAS/NOWS when compared to those who were not affected (e.g. infectious diseases, feeding disorders). CONCLUSIONS Infants with NAS/NOWS are at increased risk of rehospitalization with a host of diagnoses, and specific demographic groups (White, rural) are more highly affected.
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Affiliation(s)
- Elizabeth Salt
- University of Kentucky, College of Nursing, Lexington, KY, USA
| | - Amanda Wiggins
- University of Kentucky, College of Nursing, Lexington, KY, USA
| | - Abigail Pick
- University of Kentucky, College of Nursing, Lexington, KY, USA
| | - Henrietta Bada
- Division of Maternal and Child Health, Kentucky Department of Public Health, Frankfort, KY, USA
| | - Christina Howard
- Department of Pediatrics, Pediatric Forensic Medicine, University of Kentucky, Lexington, KY, USA
| | - Melissa Currie
- Pediatric Forensic Medicine, University of Louisville School of Medicine, Norton Children's Pediatric Protection Specialists, Louisville, KY, USA
| | - Mary Kay Rayens
- University of Kentucky, College of Nursing, Lexington, KY, USA
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Perlman NC, Cantonwine DE, Smith NA. Toxicology Testing in a Newborn ICU: Does Social Profiling Play a Role? Hosp Pediatr 2021; 11:e179-e183. [PMID: 34373267 DOI: 10.1542/hpeds.2020-005765] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE A rising incidence in maternal drug use during pregnancy has led to a concomitant rise in neonatal opioid withdrawal syndrome. Despite evidence that drug use during pregnancy affects all demographic groups equally, authors of recent studies have suggested that minority women are tested for drug use more than their counterparts. In this study, we aimed to assess whether toxicology testing of neonates was associated with maternal characteristics. METHODS Retrospective cohort study reviewing charts of neonates born at an urban academic center between January 1, 2018, and December 31, 2018, who underwent toxicology testing. Demographics from tested neonates were taken from mothers' self-reported data and compared with sociodemographics of all mothers with deliveries in 2018, including age, race, marital status, and zip code. Indication for toxicology testing as recorded by ordering clinician was also collected. There were no standardized guidelines for toxicology testing during this study period. RESULTS Of 6438 births in 2018, toxicology testing was sent on 86 neonates (1.3%). Mothers of neonates with testing were younger (P < .0001), less likely to be white (P < .0001), self-reported "single" (P < .0001), and lived in lowest income zip codes (P < .0001). Indications for testing were varied, with the most common indications including maternal substance use disorder (37%) and marijuana use (26%). CONCLUSION Maternal age, race, marital, and socioeconomic status were associated with toxicology testing on neonates, although data suggest that drug use affects all demographic groups. Current practice at our institution may overtest some groups. Evidence-based, standardized guidelines are urgently needed to reduce bias and repercussions of toxicology testing of neonates.
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Affiliation(s)
- Nicola C Perlman
- Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Boston, Massachusetts
| | - David E Cantonwine
- Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital and Harvard Medical School, Harvard University, Cambridge, Massachusetts
| | - Nicole A Smith
- Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital and Harvard Medical School, Harvard University, Cambridge, Massachusetts
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