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Lee E, Schofield D, Dronavalli M, Lawler K, Uebel H, Burns L, Bajuk B, Page A, Gu Y, Eastwood J, Dickson M, Green C, Dicair L, Oei JL. Health Care Needs and Costs for Children Exposed to Prenatal Substance Use to Adulthood. JAMA Pediatr 2024; 178:888-898. [PMID: 39037833 PMCID: PMC11264092 DOI: 10.1001/jamapediatrics.2024.2281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 05/15/2024] [Indexed: 07/24/2024]
Abstract
Importance Children exposed to substance use during pregnancy have increased health needs but whether these are influenced by engagement in out-of-home care is uncertain. Objective To evaluate the association between substance use during pregnancy, out-of-home care and hospitalization utilization, and costs from birth up to age 20 years. Design, Setting, and Participants This was a retrospective cohort study using individual-linked population birth, hospital, and out-of-home care information of all liveborn infants from New South Wales, Australia, between 2001 and 2020 using longitudinal population-based linkage records from administrative databases. Substance use during pregnancy included newborns with neonatal abstinence syndrome (n = 5946) and intrauterine exposure to drugs of addiction (n = 1260) and other substances (eg, tobacco, alcohol, and illicit drugs or misused prescription drugs; n = 202 098). Children not exposed to substance use during pregnancy were those without known exposure to substance use during pregnancy (n = 1 611 351). Data were analyzed from July 2001 to December 2021. Main Outcomes Main outcomes were hospital readmission, length of stay, and cost burden associated with substance use during pregnancy from birth up to age 20 years. Outcomes were investigated using 2-part and Poisson regression models adjusted for sociodemographic characteristics. Mediation analysis was used to evaluate whether the association of substance use during pregnancy with risk of readmission was mediated through engagement with out-of-home care. Results Of the 1 820 655 live births, 935 807 (51.4%) were male. The mean (SD) age of mothers was 30.8 (5.5) years. Compared with children who were not exposed to substance use during pregnancy, those who were exposed incurred significantly higher birth hospital costs (adjusted mean difference, A$1585 per child [US$1 = A$1.51]; 95% CI, 1585-1586). If discharged alive, more children with exposure to substance use during pregnancy had at least 1 readmission (90 433/209 304 [43.4%] vs 616 425/1 611 351[38.3%]; adjusted relative risk [RR], 1.06; 95% CI, 1.06-1.07), most commonly for respiratory conditions (RR, 1.11; 95% CI, 1.09-1.12) and mental health/behavioral disorders (RR, 1.36; 95% CI, 1.33-1.41). Excess hospital costs associated with substance use during pregnancy were A$129.0 million in 2019 to 2020. Mediation analyses showed that any out-of-home care contact mediated the association between substance use during pregnancy and risk of inpatient readmission and lower health care cost (decreased by A$25.4 million). For children with neonatal abstinence syndrome, any out-of-home care contact mediated readmission risk by approximately 30%, from adjusted RR, 1.28; 95% CI, 1.19-1.35, to RR, 1.01; 95% CI, 0.98-1.02. Conclusion and Relevance Children who were exposed to substance use during pregnancy incurred more hospital costs than children who were not exposed up to 20 years of age, but this was reduced in association with any contact with out-of-home care. This provides insights into possible strategies for reducing health and financial burdens associated with exposure to substance use during pregnancy for children.
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Affiliation(s)
- Evelyn Lee
- Centre for Social Research in Health, University of New South Wales, Kensington, New South Wales, Australia
- Centre for Economic Impacts of Genomic Medicine, Macquarie Business School, Macquarie University, North Ryde, New South Wales, Australia
| | - Deborah Schofield
- Centre for Economic Impacts of Genomic Medicine, Macquarie Business School, Macquarie University, North Ryde, New South Wales, Australia
| | - Mithilesh Dronavalli
- Translational Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
| | - Kate Lawler
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, University of New South Wales, Australia
| | - Hannah Uebel
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, University of New South Wales, Australia
- Department of Paediatrics, Sydney Children’s Hospital, Sydney, New South Wales, Australia
| | - Lucinda Burns
- National Drug and Alcohol Research Centre, University of New South Wales, Kensington, New South Wales, Australia
| | - Barbara Bajuk
- Critical Care Program, Sydney Children’s Hospitals Network, Sydney, New South Wales, Australia
| | - Andrew Page
- Translational Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
| | - Yuanyuan Gu
- Macquarie University Centre for the Health Economy, Macquarie Business School and Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - John Eastwood
- National Public Health Service, Te Whatu Ora – Health New Zealand, Dunedin, New Zealand
- School of Population Health, University of New South Wales, Kensington, New South Wales, Australia
- Department of Preventative and Social Medicine, University of Otago, Dunedin, New Zealand
- Sydney Institute for Women Children and their Families, Sydney Local Health District, Sydney, New South Wales, Australia
- Menzies Centre for Health Policy and Economics, School of Public Health, University of Sydney, Camperdown, New South Wales, Australia
- Early Years Research Group, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Michelle Dickson
- The Poche Centre for Indigenous Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | | | | | - Ju Lee Oei
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, University of New South Wales, Australia
- Department of Newborn Care, Royal Hospital for Women, Randwick, New South Wales, Australia
- Drug and Alcohol Services, Murrumbidgee Local Health District, Wagga Wagga, New South Wales, Australia
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Uebel H, Dronavalli M, Lawler K, Lee E, Bajuk B, Burns L, Page A, Dickson M, Green C, Dicair L, Eastwood J, Oei JL. School performance in children with prenatal drug exposure and out-of-home care in NSW, Australia: a retrospective population-based cohort study. THE LANCET. CHILD & ADOLESCENT HEALTH 2024; 8:500-509. [PMID: 38897715 DOI: 10.1016/s2352-4642(24)00076-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 03/05/2024] [Accepted: 03/18/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND Prenatal drug exposure (PDE) is a global public health problem that is strongly associated with the need for child protection services, including placement into out-of-home care (OOHC). We aimed to assess school outcomes for children with PDE (both with and without neonatal abstinence syndrome [NAS]) and the association of school performance with OOHC. METHODS Using linked population health, OOHC, and school test data, we compared results on the Australian standardised curriculum-based test, the National Assessment Program-Literacy and Numeracy (NAPLAN), for children with PDE who were born in New South Wales (NSW) between 2001 and 2020 and had completed at least one NAPLAN test between Jan 1, 2008, and June 30, 2021, administered in Year 3 (age 8-9 years), Year 5 (age 10-11 years), Year 7 (age 12-13 years), or Year 9 (age 14-15 years). Linked datasets included NSW Perinatal Data Collection (birth data), NSW Admitted Patient Data Collection (hospital diagnoses), NSW Education Standards Authority (NAPLAN scores), NSW Family and Community Services Dataset-KiDS Data Collection (OOHC information), NSW Mental Health Ambulatory Data Collection, and NSW Registry for Births, Deaths, and Marriages. The primary outcome was scoring above or below the National Minimum Standard (NMS) in any test domain (mathematics, language, writing, and spelling) at each year level, comparing the relative risk of scoring below NMS between children with and without PDE (and with or without NAS within the PDE group), and with and without OOHC contact. The association between OOHC on the likelihood of scoring above NMS was also investigated for PDE and non-PDE cohorts. FINDINGS The PDE cohort included 3836 children, and the non-PDE cohort included 897 487 children. Within the PDE cohort, 3192 children had a NAS diagnosis and 644 children had no NAS diagnosis. 1755 (45·8%) children with PDE required OOHC compared with 12 880 (1·4%) of 897 487 children without PDE. Children with PDE were more likely than children without PDE to score below NMS in any domain from Year 3 (risk ratio 2·72 [95% CI 2·58-2·76]) to Year 9 (2·36 [2·22-2·50]). Performance was similar regardless of a NAS diagnosis (Year 3: 0·96 [0·84-1·10]; Year 9: 0·98 [0·84-1·15]). The likelihood of scoring above NMS in Year 9 was reduced for children with PDE and without NAS (0·57 [0·45-0·73]) and NAS (0·58 [0·52-0·64]) compared with those without PDE, and also for children who received OOHC (0·60 [0·57-0·64]) compared with those without OOHC, when adjusted for confounders. Among children with PDE, those receiving OOHC had a similar likelihood of scoring above NMS compared with children who did not receive OOHC, from Year 3 (1·01 [0·92-1·11]) to Year 9 (0·90 [0·73-1·10]), when adjusted for confounding factors. By contrast, among children without PDE, those receiving OOHC were less likely to score above NMS than those who did not receive OOHC, from Year 3 (0·78 [0·76-0·80]) to Year 9 (0·58 [0·54-0·61]). INTERPRETATION Compared with children without PDE, school performance in children with PDE-regardless of whether they were diagnosed with NAS-is poor, and the gap widens with age. The risk of poor performance persists regardless of OOHC status. This finding underscores the need for all children with PDE to receive long-term, culturally sensitive, and proactive support to improve life success. FUNDING SPHERE Mindgardens Neuroscience Network, Australian Red Cross, Alpha Maxx Healthcare, Centre for Research Excellence for Integrated Health and Social Care, National Health and Medical Research Council, and University of Sydney.
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Affiliation(s)
- Hannah Uebel
- School of Women's and Children's Health, University of New South Wales, Kensington, NSW, Australia; Department of Paediatrics, Sydney Children's Hospital, Sydney, NSW, Australia.
| | - Mithilesh Dronavalli
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Kate Lawler
- School of Women's and Children's Health, University of New South Wales, Kensington, NSW, Australia
| | - Evelyn Lee
- Centre for Social Research in Health, University of New South Wales, Kensington, NSW, Australia; Centre for Economic Impacts of Genomic Medicine, Macquarie University, North Ryde, NSW, Australia
| | - Barbara Bajuk
- Critical Care Program, Sydney Children's Hospitals Network, Sydney, NSW, Australia
| | - Lucinda Burns
- National Drug and Alcohol Research Centre, University of New South Wales, Kensington, NSW, Australia
| | - Andrew Page
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Michelle Dickson
- The Poche Centre for Indigenous Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | | | - Lauren Dicair
- The Poche Centre for Indigenous Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - John Eastwood
- National Public Health Service, Te Whatu Ora-Health New Zealand, Dunedin, New Zealand; School of Population Health, University of New South Wales, Kensington, NSW, Australia; Department of Preventative and Social Medicine, University of Otago, Dunedin, New Zealand; Sydney Institute for Women Children and their Families, Sydney Local Health District, Sydney, New South Wales, Australia; Menzies Centre for Health Policy and Economics, School of Public Health, University of Sydney, Camperdown, New South Wales, Australia; Early Years Research Group, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Ju Lee Oei
- School of Women's and Children's Health, University of New South Wales, Kensington, NSW, Australia; Department of Newborn Care, Royal Hospital for Women, Randwick, New South Wales, Australia; Drug and Alcohol Services, Murrumbidgee Local Health District, Wagga Wagga, New South Wales, Australia
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Lawler K, Dronavalli M, Page A, Lee E, Uebel H, Bajuk B, Burns L, Dickson M, Green C, Dicair L, Eastwood J, Oei JL. 'Joining the Dots: Linking Prenatal Drug Exposure to Childhood and Adolescence' - research protocol of a population cohort study. BMJ Paediatr Open 2024; 8:e002557. [PMID: 38604771 PMCID: PMC11015252 DOI: 10.1136/bmjpo-2024-002557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 03/28/2024] [Indexed: 04/13/2024] Open
Abstract
INTRODUCTION Prenatal drug exposure (PDE) is one of the most important causes of child harm, but comprehensive information about the long-term outcomes of the families is difficult to ascertain. The Joining the Dots cohort study uses linked population data to understand the relationship between services, therapeutic interventions and outcomes of children with PDE. METHODS AND ANALYSIS Information from routinely collected administrative databases was linked for all births registered in New South Wales (NSW), Australia between 1 July 2001 and 31 December 2020 (n=1 834 550). Outcomes for seven mutually exclusive groups of children with varying prenatal exposure to maternal substances of addiction, including smoking, alcohol, prescription/illicit drugs and neonatal abstinence syndrome will be assessed. Key exposure measures include maternal drug use type, maternal social demographics or social determinants of health, and maternal physical and mental health comorbidities. Key outcome measures will include child mortality, academic standardised testing results, rehospitalisation and maternal survival. Data analysis will be conducted using Stata V.18.0. ETHICS AND DISSEMINATION Approvals were obtained from the NSW Population and Health Services Research Ethics Committee (29 June 2020; 2019/ETH12716) and the Australian Capital Territory Health Human Research Ethics Committee (11 October 2021; 2021-1231, 2021-1232, 2021-1233); and the Aboriginal Health and Medical Research Council (5 July 2022; 1824/21), and all Australian educational sectors: Board of Studies (government schools), Australian Independent Schools and Catholic Education Commission (D2014/120797). Data were released to researchers in September 2022. Results will be presented in peer-reviewed academic journals and at international conferences. Collaborative efforts from similar datasets in other countries are welcome.
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Affiliation(s)
- Kate Lawler
- School of Women's and Children's Health, Faculty of Medicine and Health, University of New South Wales, Randwick, New South Wales, Australia
| | - Mithilesh Dronavalli
- School of Women's and Children's Health, Faculty of Medicine and Health, University of New South Wales, Randwick, New South Wales, Australia
- Translational Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
| | - Andrew Page
- Translational Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
| | - Evelyn Lee
- Centre for Social Research in Health, University of New South Wales, Randwick, New South Wales, Australia
- Centre for Economic Impacts of Genomic Medicine, Macquarie University, North Ryde, New South Wales, Australia
| | - Hannah Uebel
- School of Women's and Children's Health, Faculty of Medicine and Health, University of New South Wales, Randwick, New South Wales, Australia
- Sydney Children's Hospital Randwick, Randwick, New South Wales, Australia
| | - Barbara Bajuk
- Critical Care Program, Sydney Children's Hospitals Network Randwick and Westmead, Westmead, New South Wales, Australia
| | - Lucinda Burns
- National Drug and Alcohol Research Centre, University of New South Wales, Randwick, New South Wales, Australia
| | - Michelle Dickson
- The Poche Centre for Indigenous Health, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | | | | | - John Eastwood
- National Public Health Service, Te Whatu Ora-Health New Zealand, Dunedin, New Zealand
- School of Population Health, University of New South Wales, Randwick, New South Wales, Australia
| | - Ju Lee Oei
- School of Women's and Children's Health, Faculty of Medicine and Health, University of New South Wales, Randwick, New South Wales, Australia
- Department of Newborn Care, Royal Hospital for Women, Randwick, New South Wales, Australia
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Chan J, Ward B, Maher L, Crawford S, Stoové M, Dietze P. Parents who inject drugs: Demographics, care arrangements and correlates for child placement in out-of-home care. Drug Alcohol Rev 2024; 43:775-786. [PMID: 38147397 DOI: 10.1111/dar.13798] [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: 05/03/2023] [Revised: 11/22/2023] [Accepted: 11/27/2023] [Indexed: 12/27/2023]
Abstract
INTRODUCTION Children in families affected by substance use disorders are at high risk of being placed in out-of-home care (OOHC). We aimed to describe the characteristics of parents who inject drugs and identify correlates associated with child placement in OOHC. METHODS We used baseline data from a community-based cohort of parents who inject drugs (SuperMIX) from Melbourne, Australia. Participants were recruited via convenience, respondent-driven and snowball sampling from April 2008 to November 2020, with follow-up until March 2021. To explore correlates associated with child placement to OOHC, we used multivariable logistic regression and assessed for potential interactions between gender and a range of relevant covariates. RESULTS Of the 1067 participants, 611 (57%) reported being parents. Fifty-six percent of parents reported child protection involvement. Almost half (49%) had children in OOHC. Nearly half of the parents lived in unstable accommodation (44%) and many of them experienced moderate-severe levels of anxiety (48%) and depression (53%). Female or non-binary gender, identifying as Aboriginal or Torres Strait Islander, experiencing assault and having more children were associated with child removal to OOHC. Of the 563 participants who reported their own childhood care status, 135 (24%) reported they had been removed to OOHC. DISCUSSION AND CONCLUSIONS We identified high rates of child placement in OOHC among parents who inject drugs. There is a need for targeted health and social services, that are gender and culturally responsive, in addition to systems-level interventions addressing social inequities, such as housing, to support parents to care for their children.
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Affiliation(s)
| | - Bernadette Ward
- Burnet Institute, Melbourne, Australia
- School of Rural Health, Monash University, Melbourne, Australia
| | - Lisa Maher
- Burnet Institute, Melbourne, Australia
- Kirby Institute, UNSW Sydney, Sydney, Australia
| | - Sione Crawford
- Burnet Institute, Melbourne, Australia
- Harm Reduction Victoria, Melbourne, Australia
| | - Mark Stoové
- Burnet Institute, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Paul Dietze
- Burnet Institute, Melbourne, Australia
- National Drug Research Institute, Curtin University, Melbourne, Australia
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Fadaei-Kenarsary M, Esmaeilpour K, Shabani M, Sheibani V. Maternal Substance Use and Early-Life Adversity: Inducing Drug Dependence in Offspring, Interactions, Mechanisms, and Treatments. ADDICTION & HEALTH 2024; 16:51-66. [PMID: 38651025 PMCID: PMC11032613 DOI: 10.34172/ahj.2024.1478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 08/11/2023] [Indexed: 04/25/2024]
Abstract
The likelihood of substance dependency in offspring is increased in cases when there is a family history of drug or alcohol use. Mothering is limited by maternal addiction because of the separation. Maternal separation (MS) leads to the development of behavioural and neuropsychiatric issues in the future. Despite the importance of this issue, empirical investigations of the influences of maternal substance use and separation on substance use problems in offspring are limited, and studies that consider both effects are rare. This study aims to review a few studies on the mechanisms, treatments, genetics, epigenetics, molecular and psychological alterations, and neuroanatomical regions involved in the dependence of offspring who underwent maternal addiction and separation. The PubMed database was used. A total of 95 articles were found, including the most related ones in the review. The brain's lateral paragigantocellularis (LPGi), nucleus accumbens (NAc), caudate-putamen (CPu), prefrontal cortex (PFC), and hippocampus, can be affected by MS. Dopamine receptor subtype genes, alcohol biomarker minor allele, and preproenkephalin mRNA may be affected by alcohol or substance use disorders. After early-life adversity, histone acetylation in the hippocampus may be linked to brain-derived neurotrophic factor (BDNF) gene epigenetics and glucocorticoid receptors (GRs). The adverse early-life experiences differ in offspring›s genders and rewire the brain›s dopamine and endocannabinoid circuits, making offspring more susceptible to dependence. Related psychological factors rooted in early-life stress (ELS) and parental substance use disorder (SUD). Treatments include antidepressants, histone deacetylase inhibitors, lamotrigine, ketamine, choline, modafinil, methadone, dopamine, cannabinoid 1 receptor agonists/antagonists, vitamins, oxytocin, tetrahydrocannabinol, SR141716A, and dronabinol. Finally, the study emphasizes the need for multifaceted strategies to prevent these outcomes.
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Affiliation(s)
- Maysam Fadaei-Kenarsary
- Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
| | - Khadijeh Esmaeilpour
- Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
- Department of Health Sciences, Faculty of Health, University of Waterloo, Waterloo, Ontario, Canada
| | - Mohammad Shabani
- Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
| | - Vahid Sheibani
- Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
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Palumbo R, Mechling BM, Ahern NR. Parental opioid use disorder: Examining their children's experiences, needs, and road to resilience. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2021; 35:24-37. [PMID: 34342918 DOI: 10.1111/jcap.12344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 07/13/2021] [Accepted: 07/25/2021] [Indexed: 11/29/2022]
Abstract
PROBLEM Over 8 million children in the United States live with a parent with substance use disorder (SUD), inclusive of opioid use disorder (OUD). This is an adverse childhood experience (ACE), that often leads to poor outcomes such as developing SUD or mental illness. Interventions and research have focused more on the parent and not their children. Without emphasis on child's experiences, their needs, and building interventions toward developing resilience, the intergenerational cycle of SUD/OUD will persist. METHODS Nine children (ages 12-17) in custody of Social Services, who experienced a parent with OUD, participated in this pilot study. The intervention was SAMHSA's Children's Program Kit: Supportive Education for Children of Addicted Parents. Thematic analysis of verbal responses/behaviors, observations, field notes, and any retained materials (i.e., handouts) was conducted over eight sessions. FINDINGS Findings included three themes regarding participant's experiences: Meaning of a Parent; Others Involved; and Witnessing the Cycle. Two sub-themes also emerged: Ways to Cope and Support from Various Sources. CONCLUSIONS Results support mental health nurses as forerunners in building, implementing, and evaluating child-focused interventions for children of parents with OUD. Interventions should focus on the needs of the children and use a strength-based approach to promote their resilience.
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Affiliation(s)
- Ruthanne Palumbo
- College of Health and Human Services, School of Nursing, University of North Carolina Wilmington, Wilmington, North Carolina, USA
| | - Brandy M Mechling
- College of Health and Human Services, School of Nursing, University of North Carolina Wilmington, Wilmington, North Carolina, USA
| | - Nancy R Ahern
- College of Health and Human Services, School of Nursing, University of North Carolina Wilmington, Wilmington, North Carolina, USA
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Continuation in Treatment and Maintenance of Custody of Newborns After Delivery in Women With Opioid Use Disorder. J Addict Med 2021; 14:119-125. [PMID: 30946092 DOI: 10.1097/adm.0000000000000534] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To identify variables associated with continuation in treatment and maintenance of custody after pregnancies in women with opioid use disorder (OUD). METHODS The medical records of pregnant women with documented OUD from 2011 to 2018 and with at least 6 months follow-up postpartum were retrospectively reviewed. RESULTS Via multivariate analysis, women on opioid maintenance therapy (OMT) were more likely to continue in treatment and maintain custody, whereas women enrolled in a residential treatment program during pregnancy were less likely to continue in treatment or maintain custody. Women who continued in treatment were significantly more likely to maintain custody of their children than those who did not. CONCLUSIONS Continuation in treatment and maintenance of custody were closely related. Care providers should attempt to improve both outcomes.
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Kepple NJ, Parker A. Examining Unique Substance-related Risk Profiles for Neglectful Behaviors among Parents with and without Clinical Depression. CHILDREN AND YOUTH SERVICES REVIEW 2021; 125:105987. [PMID: 33986556 PMCID: PMC8112573 DOI: 10.1016/j.childyouth.2021.105987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Parental substance use disorder (SUD) is one of the predominant parental risk factors observed for child neglect. Yet, individual risks do not exist in a vacuum. OBJECTIVE This study explored the relative importance of parental substance use behaviors based on the presence of key risk (clinical depression) and protective (social support type) factors. PARTICIPANTS AND SETTING The final analytic sample was composed of 3,545 parents of children aged 2 to 17 years from Wave 4 data collection of the National Survey of Child and Adolescent Well-Being (NSCAW I). METHODS Weighted negative binomial regression models examined the interactive relationship between parent self-report of past-year substance use patterns, clinical depression, and social support type for annual neglect frequencies. RESULTS Among parents meeting criteria for clinical depression, parental harmful/risky substance use was associated with lower annual neglect frequency compared to SUD only. In addition, the presence of tangible supports was associated with lower annual neglect frequency while the presence of social companionship was associated with higher annual neglect frequency. For parents not meeting criteria for clinical depression, the study observed an interactive effect where both harmful/risky use behaviors and meeting criteria for SUD significantly contribute to higher average neglect frequencies compared to non-use, depending on social companionship level. CONCLUSIONS In order to mitigate neglect risk among substance-using parents, practitioners should look beyond abstinence to address parents' underlying cognitive/affecting functioning and social settings.
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Affiliation(s)
- Nancy J. Kepple
- University of Kansas
- Cofrin Logan Center for Addiction Research and Treatment
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Associations between Parental Mental Health and Child Maltreatment: The Importance of Family Characteristics. SOCIAL SCIENCES-BASEL 2021. [DOI: 10.3390/socsci10060190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The study expands the literature on parents’ mental health and risk of poor parenting by exploring the association between parental mental health diagnoses and types of child maltreatment among 522 parents who were adjudicated for child maltreatment by Israeli courts. The study was cross-sectional and used a manual for the content analysis of court cases. The results showed that 62% of the parents suffered from mental health problems, including emotional problems, personality disorders, mental illness or intellectual disability. Child neglect was associated with all types of mental health diagnoses for both the mothers and fathers. However, child abuse and specifically physical abuse were associated only with the mother’s mental health diagnoses. The mother’s mental illness and personality disorder predicted child neglect and the mother’s personality disorder predicted child abuse, after controlling for poverty, child’s intellectual disability and age. No mental health diagnosis of the father predicted child maltreatment. The study concluded that the effect of mental health condition is greater for mothers. A mother’s personality disorder and mental illness should raise a special concern. Screening for maternal mental health in every case involved in the child welfare system and implications of the findings for prevention of child maltreatment are discussed.
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Developing a model of care for substance use in pregnancy and parenting services, Sydney, Australia: Service provider perspectives. J Subst Abuse Treat 2021; 131:108420. [PMID: 34098295 DOI: 10.1016/j.jsat.2021.108420] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 04/14/2021] [Accepted: 04/15/2021] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The absence of a clear model of care for services supporting pregnant women and mothers with substance use disorders has impeded opportunities to build an evidence base for the effectiveness of these services. Previous research has typically focused on the needs of pregnant women or mothers, as two distinct groups. This paper explores service providers' perceptions of key components of a model of care, extending from perinatal care to community-based support for up to 17 years post-delivery. A model of care is outlined and feasibility factors affecting implementation are highlighted. METHODS Qualitative methods were adopted as a first step to informing development of the model of care. Semi-structured in-depth interviews were conducted with thirty-eight staff providing a range of substance use in pregnancy and parenting services (SUPPS) in hospital and community-based agencies, in a metropolitan health district in Sydney, Australia. Interview data was entered into NVivo and analysed using constant comparative methods. RESULTS Guiding principles for the model of care included integrated care, harm reduction and person-centredness. Practice approaches integral to the model of care were promoting engagement with women, flexible service provision, trauma-informed care, and continuity of care. Feasibility factors influencing implementation of the model of care included fragmentation or siloing of the service network and workforce sustainability. CONCLUSIONS A harm reduction approach was crucial for promoting engagement of women with SUPPS, particularly child protection services. A greater focus on providing ongoing community-based support for mothers also has the potential to achieve sustainable positive outcomes for women and children. Implementation of the SUPPS model of care could be undermined by threats to integration of service delivery and continuity of care. Further research is needed to explore consumer perspectives and inform the model of care as a framework for evaluation.
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Mechling BM, Ahern NR, Palumbo R. Promoting resilience for children of parents with opioid use disorder: A pilot study of a directed intervention. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2021; 34:191-198. [PMID: 33870601 DOI: 10.1111/jcap.12319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 11/17/2020] [Accepted: 03/13/2021] [Indexed: 11/27/2022]
Abstract
PROBLEM Having a parent with Opioid Use Disorder (OUD) is a childhood adverse experience (ACE), magnified by other accompanying ACEs. Outcomes for these children tend to include developing mental illness and/or Substance Use Disorders themselves. Few studies address these children's experiences and needs. Without child-focused interventions to foster their resilience, generational ramifications of the OUD crisis will persist. METHODS Nine children (ages 12-17), in Department of Social Services' custody, participated in this pilot study. The intervention delivered was Substance Abuse and Mental Health Administration's Children's Program Kit (CPK): Supportive Education for Children of Addicted Parents. Measures included OUD knowledge pre/posttests and the Behavioral and Emotional Rating Scale (BERS-2). FINDINGS Findings from paired-samples t tests showed a significant increase in youth OUD knowledge from pre to posttest. Affective strength on the parent version (foster parent or social worker's perception of participant) and overall strength index on the youth's version BERS-2 increased significantly from pre to posttest. Career strength, a separate strength index, showed significant increased scores on both youth and parent BERS-2 versions pre to posttest. CONCLUSIONS Results support Psychiatric Mental Health nurses to lead development and implementation of interventions, such as the CPK, with a strength-based approach to promote the knowledge and resilience of these children.
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Affiliation(s)
- Brandy M Mechling
- School of Nursing, College of Health and Human Services, University of North Carolina Wilmington, Wilmington, North Carolina, USA
| | - Nancy R Ahern
- School of Nursing, College of Health and Human Services, University of North Carolina Wilmington, Wilmington, North Carolina, USA
| | - Ruthanne Palumbo
- School of Nursing, College of Health and Human Services, University of North Carolina Wilmington, Wilmington, North Carolina, USA
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Canfield M, Norton S, Downs J, Gilchrist G. Parental status and characteristics of women in substance use treatment services: Analysis of electronic patient records. J Subst Abuse Treat 2021; 127:108365. [PMID: 34134870 DOI: 10.1016/j.jsat.2021.108365] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 12/03/2020] [Accepted: 03/04/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Many women receiving substance use treatment services are mothers. Despite this, research has not proved whether substance use treatment services are addressing the specific needs of mothers. This study explored differences in sociodemographic, psychological, patterns of substance use, and treatment characteristics between mothers and women without children, and between mothers whose children were in alternative care. METHOD The study extracted data from electronic patient records (EPRs) of women who attended South London and Maudsley (SLaM) National Health Services (NHS) Foundation Trust addiction services between 2013 and 2020 (N = 4370). RESULTS The study identified 1730 participants (39.6%) as mothers, of whom 1340 (77.4%) had dependent children. The average number of births was 1.83 (SD = 1.0). Of the participants, 54.3% of mothers did not disclose whether their dependent child(ren) was under their care and 37.5% of mothers indicated that at least one of their child(ren) was in alternative care. Alcohol was the most reported type of substance used in the past 28 days. Mothers also highly reported suicide attempts and hospitalization due to mental health problems. Compared to women without children, mothers were more likely to be young, experience housing problems, use opioids and/or crack-cocaine in the past 28 days and experience lifetime domestic violence victimizations. Mothers were also less likely to have alcohol-related problems, experience overdose, and social isolation than women without children. CONCLUSION The study highlights the need for substance use services to invest in approaches to improve mothers' disclosure of parenting and childcare issues. It also demonstrates that EPRs can identify key characteristics of mothers.
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Affiliation(s)
- Martha Canfield
- Department of Psychology, Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Sam Norton
- Department of Psychology, Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Department of Inflammation Biology, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Johnny Downs
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Gail Gilchrist
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
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Best E, Lokuge B, Dunlop A, Dunford A. Unmet need for postpartum long-acting reversible contraception in women with substance use disorders and/or socioeconomic disadvantage. Aust N Z J Obstet Gynaecol 2021; 61:304-309. [PMID: 33619725 DOI: 10.1111/ajo.13306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 12/13/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND In Australia, it is estimated that 30% of pregnancies are unintended and 25% of pregnancies end in abortion. Unintended pregnancy can be particularly problematic for women with substance use disorders (SUD) and/or socioeconomic disadvantage. Long-acting reversible contraception (LARC) including progestogen implants and intrauterine devices (IUD) are safe, affordable and extremely effective in decreasing rates of unintended pregnancy, yet are currently underutilised in Australia. AIMS To determine the current rate of unintended pregnancy, contraception counselling and postpartum LARC use in women who attend an antenatal clinic for SUD and/or socioeconomic disadvantage in pregnancy. We hypothesise that there is an unmet need for contraception in this population. MATERIALS AND METHODS We conducted a retrospective audit of women who birthed in a tertiary hospital in 2018 with SUD and/or additional social support needs. We recorded the rate of unintended pregnancy, the occurrence of antenatal and postpartum contraception counselling and the rate of immediate postpartum LARC uptake through review of our electronic medical database. RESULTS Of the 210 women in our study population, we identified a high proportion of unintended pregnancies (64%), a low rate of antenatal (11%) and postpartum (35%) contraception counselling, and a low uptake of immediate postpartum LARC use (3.3%), confirming an unmet need for contraception. CONCLUSIONS Further intervention is required to enhance the access to immediate postpartum LARC and reduce the risk and health burden of unintended pregnancy.
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Affiliation(s)
- Emanuelle Best
- Department of Maternity and Gynaecology, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Buddhima Lokuge
- Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, New South Wales, Australia
| | - Adrian Dunlop
- Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, New South Wales, Australia.,School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Angela Dunford
- Department of Maternity and Gynaecology, John Hunter Hospital, Newcastle, New South Wales, Australia
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Care Coordination for Vulnerable Families in the Sydney Local Health District: What Works for Whom, under What Circumstances, and Why? Int J Integr Care 2020; 20:22. [PMID: 33335463 PMCID: PMC7716786 DOI: 10.5334/ijic.5437] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introduction: Healthy Homes and Neighbourhoods (HHAN), an integrated care programme in the Sydney Local Health District (SLHD), seeks to address the needs of disadvantaged families through care coordination, as one of its components. This research aims to determine for whom, when and why the care coordination component of HHAN works, and establish the reported outcomes for clients, service-providers and partner organisations. Methods: Critical realist methodology was utilised to undertake a qualitative evaluation of the impact of care coordination. Purposive sampling was used to select a total of 37 participants for interview, including consumers, service-providers and key stakeholders. Thematic analysis was undertaken to derive the major modes of intervention of HHAN, and data representing these elements was coded and summarised under contexts, mechanisms and outcomes. Results: Analysis indicates that care coordination has a positive impact on clients’ sense of independence, self-awareness and outlook on life. Trust and favourable interpersonal relations were identified as major underlying mechanisms for a successful client-provider working relationship. The identified modes of intervention facilitating positive consumer outcomes included accessibility, flexibility and service navigation. Persistent siloes in health and systemic resistance to collaboration was seen to hinder effective care delivery. Conclusions: This study suggests that a care coordination model may be effective in engaging disadvantaged families in healthcare, assist them in navigating the health system and can lead to beneficial health and social outcomes. Successful implementation of care coordination requires flexible programme design and experienced and skilful clinicians to fulfil the care coordinator role. There is a need to appreciate the negative impact that the complex and siloed health system can have on disadvantaged families.
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Uebel H, Wright IM, Burns L, Hilder L, Bajuk B, Breen C, Abdel-Latif ME, Falconer J, Clews S, Ward M, Eastwood J, Oei JL. Characteristics and causes of death in children with neonatal abstinence syndrome. J Paediatr Child Health 2020; 56:1933-1940. [PMID: 32815631 DOI: 10.1111/jpc.15091] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/21/2020] [Accepted: 07/06/2020] [Indexed: 11/29/2022]
Abstract
AIM To determine characteristics of death in children with neonatal abstinence syndrome (NAS). METHODS A population-based linkage study of children from birth to 13 years of age in New South Wales (NSW), Australia, born 1 July 2000 to 31 December 2011. Infants with an International Statistical Classification of Diseases and Related Problems, Australian modification coding of NAS (P96.1, n = 3842) were compared to infants (n = 1 018 421) without NAS by birth, hospitalisation and death records linkage. RESULTS Forty-five (1.2%) children with NAS died, compared to 3665 (0.4%) other children. Most deaths (n = 30, 66%) in NAS children occurred between 1 month and 1 year. Risk of death was independently increased in full-term children (hazard ratio 2.34, 95% confidence interval 1.63-3.35; P < 0.001) from lower socio-economic groups (1.23, 1.12-1.35; P < 0.001), most commonly from ill-defined or external causes, including assault and accidents (P < 0.001). CONCLUSIONS Children with NAS, especially those of term gestation and from lower socio-economic groups, are more likely to die, especially from external causes.
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Affiliation(s)
- Hannah Uebel
- School of Women's and Children's Heath, University of New South Wales, Sydney, New South Wales, Australia.,Department of Paediatrics, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Ian M Wright
- College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Camperdown, NSW, Australia
| | - Lucinda Burns
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia
| | - Lisa Hilder
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia
| | - Barbara Bajuk
- Perinatal Services Network, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Courtney Breen
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia
| | - Mohamed E Abdel-Latif
- Department of Neonatology, The Canberra Hospital, Canberra, Australian Capital Territory, Australia.,Faculty of Medicine, The Australian National University, Canberra, Australian Capital Territory, Australia
| | | | - Sarah Clews
- The Langton Centre, Sydney, New South Wales, Australia
| | - Meredith Ward
- School of Women's and Children's Heath, University of New South Wales, Sydney, New South Wales, Australia.,Department of Newborn Care, Royal Hospital for Women, Sydney, New South Wales, Australia
| | - John Eastwood
- School of Women's and Children's Heath, University of New South Wales, Sydney, New South Wales, Australia.,Department of Community Pediatrics, Sydney Local Health District, Sydney, New South Wales, Australia.,Sydney Medical School, University of Sydney, Camperdown, NSW, Australia.,Sydney Institute for Women Children and their Families, Camperdown, NSW, Australia.,Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
| | - Ju Lee Oei
- School of Women's and Children's Heath, University of New South Wales, Sydney, New South Wales, Australia.,Department of Newborn Care, Royal Hospital for Women, Sydney, New South Wales, Australia.,Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
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Suomi A, Lucas N, McArthur M, Humphreys C, Dobbins T, Taplin S. Cluster randomized controlled trial (RCT) to support parental contact for children in out-of-home care. CHILD ABUSE & NEGLECT 2020; 109:104708. [PMID: 32942192 DOI: 10.1016/j.chiabu.2020.104708] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 08/18/2020] [Accepted: 08/24/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND There is an identified need to improve the evidence-base in relation to contact visits for children in the out-of-home-care (OOHC) system, to ensure optimal outcomes. OBJECTIVE The aim of this cluster randomized controlled trial (RCT) was to test the effectiveness of a contact intervention for parents having supervised contact with children in long-term OOHC. PARTICIPANTS 183 study children in 15 clusters (OOHC services) and their parent(s) were randomized to the intervention (8 clusters, 100 children) and control groups (7 clusters, 83 children) in three Australian jurisdictions. SETTING The manualized intervention consisted of increasing the preparation and support provided by caseworkers to parents before and after their contact visits. METHOD Interviews were conducted with carers, parents and caseworkers of the study children at baseline and nine months post-randomization. Interviews included standardized assessment tools measuring child and adult wellbeing and relationships, carer and caseworker ability to support contact, and contact visit cancellations by the parent. RESULTS Compared with controls, the intention-to-treat (ITT) analyses showed that fewer visits were cancelled by parents in the intervention group at follow-up (-10.27; 95 % CI: -17.04 to -3.50, p = .006). In addition, per-protocol (PP) analyses showed higher caseworker receptivity to contact (6.03; 95 % CI: 0.04-12.03, p = .04), and higher parent satisfaction with contact (7.41; 95 % CI: 0.70-14.11, p = .03) in the intervention group at follow-up. CONCLUSIONS While the intervention did not have an effect on child wellbeing, as measured by the SDQ, the trial reports significant positive findings and demonstrates the benefits of the kC kContact intervention in providing support to parents to attend contact visits. The findings of the current study provide an important contribution to knowledge in an area where few RCTs have been completed, notwithstanding the null findings.
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Affiliation(s)
- Aino Suomi
- Institute of Child Protection Studies, The Australian Catholic University, Australia; Research School of Population Health, The Australian National University, Australia
| | - Nina Lucas
- Institute of Child Protection Studies, The Australian Catholic University, Australia
| | - Morag McArthur
- Institute of Child Protection Studies, The Australian Catholic University, Australia
| | - Cathy Humphreys
- Department of Social Work, The University of Melbourne, Australia
| | - Timothy Dobbins
- School of Public Health and Community Medicine, The University of New South Wales, Australia
| | - Stephanie Taplin
- Institute of Child Protection Studies, The Australian Catholic University, Australia.
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The impact of the prescription opioid epidemic on young children: Trends and mortality. Drug Alcohol Depend 2020; 211:107924. [PMID: 32178937 DOI: 10.1016/j.drugalcdep.2020.107924] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 02/11/2020] [Accepted: 02/12/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Our objective was to describe trends and deaths in young children associated with opioid analgesics. METHODS Analysis of pediatric exposures using the RADARS System Poison Center Program from July 1, 2010 through December 31, 2018. Cases involving a child < 6 years, with an exposure to one or more opioids: buprenorphine, fentanyl, hydrocodone, hydromorphone, methadone, morphine, oxycodone, oxymorphone, and tramadol. Poisson regression was used to model the shape of the time response curve. RESULTS 48,560 cases were identified, median age 2 years (IQR 1.4, 2.0), 52.4 % male. The most commonly involved opioid was hydrocodone (32.5 %); buprenorphine and methadone had the highest exposure rates when adjusted for dispensed prescriptions (0.84 and 0.73 per 10,000 prescriptions). There were 28 deaths, methadone being the most commonly involved opioid (16). Exposures decreased significantly accounting for population (from 8.39 to 4.19 exposures per 100,000 children) and per prescription (from 0.33 to 0.25 exposures per 10,000 prescriptions). After adjustment for prescriptions, the exposure rate for hydromorphone and fentanyl increased over the study period, while buprenorphine had the greatest decrease in exposure rate. Among 28 deaths, 11 (39 %) were known or suspected to have been exposed, but medical care was not sought or was delayed. CONCLUSION Pediatric opioid exposure rates by prescription and population decreased from July 2010 through December 2018. However, with over 48,000 exposures and 28 deaths, the opioid epidemic continues to impact young children. Many exposures including deaths were preventable. Continued improvements in prevention require a multifaceted approach.
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Living a normal life? Follow-up study of women who had been in opioid maintenance treatment during pregnancy. J Subst Abuse Treat 2020; 113:108004. [PMID: 32359675 DOI: 10.1016/j.jsat.2020.108004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 03/04/2020] [Accepted: 03/28/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND There are few longitudinal follow-up studies of patients in opioid maintenance treatment (OMT). For this reason we performed a follow-up study of a cohort of 67 women who had used OMT-medications during pregnancy an average of ten years earlier. The aim of our study was to explore how the women were doing over time regarding OMT medication adherence and use of other legal and illegal substances, as well as to evaluate the mortality for the women and custody situation for the children in the cohort. METHODS Participants were recruited from two cohorts in our previous pregnancy study covering women who gave birth from 2004 to 2009. Sixty-seven women agreed to be interviewed, which is 73% of the eligible women from our original study. We developed a questionnaire, which we used in the interview, that focused primarily on these women's current life situation (custody of child they had delivered, the use of medications in OMT and other legal and illegal substances, and several other health and social aspects of the participants' lives). RESULTS Two women had died prior to the follow-up. Eighty-one percent of the women had custody of the child they had delivered in our pregnancy study and half the women were single parents. Fifty-four percent of the women were employed. At follow-up, 42% of the women were in methadone maintenance treatment (MMT), 39% were in buprenorphine maintenance treatment (BMT), and 19% had left OMT. One-third of the women had changed their OMT medication during the follow-up period. The majority (77%) were satisfied with their current OMT medication. The women in MMT seemed to be more severe substance dependent than the rest of the participants. There was little use of legal and illegal substances at follow-up, especially among women with custody of their child. The frequency of substance use was low. Fourteen percent of the women were in the process of leaving OMT and another half of the women wanted to leave OMT, but had no plan for how and when. CONCLUSION This follow-up study describes a predominantly well rehabilitated cohort of women who had given birth while in OMT ten years earlier. The majority of the women had custody of their children and used very few legal and illegal drugs. Our findings may be explained partly from a life course perspective, with the women having experienced turning points when starting OMT or becoming mothers.
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Yeoh SL, Eastwood J, Wright IM, Morton R, Melhuish E, Ward M, Oei JL. Cognitive and Motor Outcomes of Children With Prenatal Opioid Exposure: A Systematic Review and Meta-analysis. JAMA Netw Open 2019; 2:e197025. [PMID: 31298718 PMCID: PMC6628595 DOI: 10.1001/jamanetworkopen.2019.7025] [Citation(s) in RCA: 110] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
IMPORTANCE Prenatal opioid exposure (POE) is one of the fastest-growing global health problems, but its association with long-term neurologic and physical development remains unknown. OBJECTIVE To assess the association between POE and cognitive and motor development in children from age 6 months to 18 years. DATA SOURCES Key search terms included prenatal opioid exposure, neonatal abstinence syndrome, and neurocognitive development. Studies were searched using PubMed and Embase, with no publication date restriction, through August 20, 2018. STUDY SELECTION Only published cohort studies comparing the results of age-appropriate standardized cognitive and/or motor tests between children with any POE (aged 0-18 years) with drug-free controls were included. Data that were not convertible to means and SDs were excluded. DATA EXTRACTION AND SYNTHESIS This study was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines. Data were pooled using a random-effects model. MAIN OUTCOMES AND MEASURES Standardized mean difference of cognitive and motor tests between POE and nonexposed children. RESULTS Twenty-six peer-reviewed cohort studies were included. Cognitive outcomes were compared for a total of 1455 children with POE and 2982 nonexposed children across 3 age groups (mean [SE] age at cognitive testing was 13 [1.58] months for the toddler group; 4.5 [0.38] years for the preschool group; and 13 [2.36] years for the school-aged group). Motor outcomes were compared for 688 children with POE and 1500 nonexposed children up to age 6 years (mean [SD] age at motor testing, 2 [0.45] years). Standardized mean difference was lower in cognitive tests for children with POE at 0 to 2 years (d = -0.52; 95% CI, -0.74 to -0.31; P < .001) and 3 to 6 years (d = -0.38; 95% CI, -0.69 to -0.07; P < .001); the difference was not significant for those aged 7 to 18 years (d = -0.44; 95% CI, -1.16 to 0.28; P = .23). Motor scores were lower in children with POE (d = 0.49; 95% CI, 0.23-0.74; P < .001). CONCLUSIONS AND RELEVANCE Prenatal opioid exposure appeared to be negatively associated with neurocognitive and physical development from age 6 months, and this association persisted until adolescence. The cause and association of this with POE or other factors (eg, withdrawal treatment) are uncertain but suggest that POE necessitates long-term support and intervention.
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Affiliation(s)
- Su Lynn Yeoh
- Medical student, University of New South Wales, Sydney, New South Wales, Australia
| | - John Eastwood
- Medical student, University of New South Wales, Sydney, New South Wales, Australia
- Sydney Local Health District, Croydon, New South Wales, Australia
- Ingham Institute of Applied Medical Research, Liverpool, New South Wales, Australia
- Sydney Medical School, Faculty of Medicine and Health, Sydney University, Sydney, New South Wales, Australia
- Sydney Institute for Women, Children and Their Families, Camperdown, Sydney, New South Wales, Australia
| | - Ian M. Wright
- Early Start Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
- University of Queensland Centre for Clinical Research, Herston, Queensland, Australia
| | - Rachael Morton
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Edward Melhuish
- University of Queensland Centre for Clinical Research, Herston, Queensland, Australia
- Department of Education, University of Oxford, Oxford, United Kingdom
- Birkbeck, University of London, London, United Kingdom
| | - Meredith Ward
- Medical student, University of New South Wales, Sydney, New South Wales, Australia
- Birkbeck, University of London, London, United Kingdom
| | - Ju Lee Oei
- Medical student, University of New South Wales, Sydney, New South Wales, Australia
- Department of Newborn Care, Royal Hospital for Women, Sydney, Australia
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Tensions and contradictions in family court innovation with high risk parents: The place of family drug treatment courts in contemporary family justice. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 68:101-108. [PMID: 31130174 DOI: 10.1016/j.drugpo.2018.04.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 04/24/2018] [Accepted: 04/25/2018] [Indexed: 11/21/2022]
Abstract
Parental substance misuse is a leading factor in child abuse and neglect and frequently results in court-mandated permanent child removal. Family drug treatment courts, which originated in the USA and are only found in adversarial family justice systems, are a radical innovation to tackle this problem. Unlike ordinary court, they treat parents within the court arena as well as adjudicating, and in this way they seek to draw a new balance between parental needs and the child's right to timely permanency. Family drug treatment courts have spread to England, Australia and Northern Ireland and international research has found they have higher rates of parental substance misuse cessation and family reunification and lower foster care costs than ordinary courts. Yet their growth has been far from straightforward. In the USA they have not kept pace with the rise of criminal drug treatment courts and in England and Australia their numbers remain small. The central purpose of this article is to explore why the family drug treatment movement has not achieved wider impact and to consider opportunities and challenges for its future development. To address these questions we draw on evidence and experience from the USA, England and Australia. We discuss the operational challenges, tensions between children's needs for stability and parental timescales for recovery, the impact of wider economic and political change, and issues in data evaluation. We conclude that despite the promise of family drug treatment courts as a new paradigm to address risky parenting, effecting systemic change in the courts is extremely difficult.
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Testing the cycle of maltreatment hypothesis: Meta-analytic evidence of the intergenerational transmission of child maltreatment. Dev Psychopathol 2019; 31:23-51. [PMID: 30757994 DOI: 10.1017/s0954579418001700] [Citation(s) in RCA: 145] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
It has long been claimed that "maltreatment begets maltreatment," that is, a parent's history of maltreatment increases the risk that his or her child will also suffer maltreatment. However, significant methodological concerns have been raised regarding evidence supporting this assertion, with some arguing that the association weakens in samples with higher methodological rigor. In the current study, the intergenerational transmission of maltreatment hypothesis is examined in 142 studies (149 samples; 227,918 dyads) that underwent a methodological quality review, as well as data extraction on a number of potential moderator variables. Results reveal a modest association of intergenerational maltreatment (k = 80; d = 0.45, 95% confidence interval; CI [0.37, 0.54]). Support for the intergenerational transmission of specific maltreatment types was also observed (neglect: k = 13, d = 0.24, 95% CI [0.11, 0.37]; physical abuse: k = 61, d = 0.41, 95% CI [0.33, 0.49]; emotional abuse: k = 18, d = 0.57, 95% CI [0.43, 0.71]; sexual abuse: k = 18, d = 0.39, 95% CI [0.24, 0.55]). Methodological quality only emerged as a significant moderator of the intergenerational transmission of physical abuse, with a weakening of effect sizes as methodological rigor increased. Evidence from this meta-analysis confirms the cycle of maltreatment hypothesis, although effect sizes were modest. Future research should focus on deepening understanding of mechanisms of transmission, as well as identifying protective factors that can effectively break the cycle of maltreatment.
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Luo C, Sanger N, Zielinski L, Bhatt M, Shahid H, Shams I, Mouravska N, Luetam S, Hudson J, Thabane L, Samaan Z. Sociodemographic characteristics of patients with children in a methadone maintenance program: a cross-sectional study. Harm Reduct J 2019; 16:13. [PMID: 30744638 PMCID: PMC6371427 DOI: 10.1186/s12954-019-0283-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 01/30/2019] [Indexed: 01/12/2023] Open
Abstract
Background Ever-increasing numbers of opioid use disorder (OUD) in Canada has created the recent opioid crisis. One common treatment for OUD is methadone maintenance treatment (MMT). Various factors, including being a parent which entails specific stressors, may increase susceptibility to negative treatment outcomes. This study aims to investigate differences between OUD patients with and without children in socio-demographic and clinical outcomes. Methods Data for this study are part of a larger program. All participants are 18+ years old with OUD, provided consent, and receiving MMT. We performed a multivariable logistic regression to examine the differences between participants’ parental status, sociodemographic variables, and clinical parameters including MMT outcomes. We performed subgroup analyses on individuals with children younger than 18. Results A total of 1099 participants were included, with 64% having children. Participants with children were older (OR 1.06, 95% CI 1.04, 1.08), more likely to be female (OR 2.39, 95% CI 1.75, 3.27), living with a partner (OR 1.75, 95% CI 1.27, 2.41), first exposed to opioids through a prescription (OR 1.517, 95% CI 1.13, 2.04) and had lower levels of education (OR 1.86, 95% CI 1.20, 2.87). There was no significant difference in illicit opioid use patterns between groups. Same results held true in the subgroup analyses based on the age of the children except for participant age. Conclusion Our results demonstrate social and demographic differences between parents and non-parents receiving MMT. These differences highlight the need to understand necessary additional support for parents such as child support and other necessary therapies.
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Affiliation(s)
- Candice Luo
- Bachelor of Health Sciences Program, McMaster University, 1280 Main St. W., Hamilton, Ontario, L8S 4L8, Canada
| | - Nitika Sanger
- Medical Sciences Graduate Program, McMaster University, 1280 Main St. W., Hamilton, Ontario, L8S 4L8, Canada
| | - Laura Zielinski
- MiNDS Graduate Program, McMaster University, 1280 Main St. W., Hamilton, Ontario, L8S 4L8, Canada
| | - Meha Bhatt
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St. W., Hamilton, Ontario, L8S 4L8, Canada
| | - Hamnah Shahid
- Arts and Science Program, McMaster University, 1280 Main St. W., Hamilton, Ontario, L8S 4L8, Canada
| | - Ieta Shams
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main St. W., Hamilton, Ontario, L8S 4L8, Canada
| | - Natalia Mouravska
- Hamilton Health Sciences, 237 Barton St. E., Hamilton, Ontario, L8L 2X2, Canada
| | - Sabrina Luetam
- Michael G. DeGroote School of Medicine, McMaster University, 1280 Main St. W., Hamilton, Ontario, L8S 4L8, Canada
| | - Jackie Hudson
- Peter Boris Centre for Addictions Research, St Joseph's Healthcare Hamilton, 100th West 5th St., Hamilton, Ontario, L8N 3K7, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St. W., Hamilton, Ontario, L8S 4L8, Canada
| | - Zainab Samaan
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St. W., Hamilton, Ontario, L8S 4L8, Canada. .,Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main St. W., Hamilton, Ontario, L8S 4L8, Canada. .,Peter Boris Centre for Addictions Research, St Joseph's Healthcare Hamilton, 100th West 5th St., Hamilton, Ontario, L8N 3K7, Canada. .,Populaton Genomics Program, Chanchlani Research Centre, McMaster University, 1280 Main St. W., Hamilton, Ontario, L8S 4L8, Canada. .,Mood Disorders Program, St. Joseph's Healthcare, 100 West 5th St., Hamilton, Ontario, L8N 3K7, Canada.
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23
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Mechling BM, Ahern NR, Palumbo R. Applying ambiguous loss theory to children of parents with an opioid use disorder. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2018; 31:53-60. [DOI: 10.1111/jcap.12209] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 09/05/2018] [Accepted: 09/07/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Brandy M. Mechling
- School of Nursing, University of North Carolina Wilmington; Wilmington North Carolina
| | - Nancy R. Ahern
- School of Nursing, University of North Carolina Wilmington; Wilmington North Carolina
| | - Ruthanne Palumbo
- School of Nursing, University of North Carolina Wilmington; Wilmington North Carolina
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24
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Oei JL. Adult consequences of prenatal drug exposure. Intern Med J 2018; 48:25-31. [PMID: 29314518 DOI: 10.1111/imj.13658] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 06/07/2017] [Accepted: 06/30/2017] [Indexed: 01/07/2023]
Abstract
Maternal drug use is not new but over the last few decades, the number of mothers using drugs of addiction has escalated to epidemic levels. These drugs are both legal (e.g. prescription medication) and illegal (e.g. heroin) and all will cross the placental barrier into the developing infant. The most immediate and obvious consequence of intra-uterine drug exposure is newborn withdrawal or the Neonatal Abstinence Syndrome (NAS) which is now, with prompt recognition and treatment, an uncommon cause of neonatal death. Thousands (if not millions) of adults most likely would have had a history of passive drug exposure during gestation and the outcomes of these people are unknown. Most are physically healthy and do not need extra medical attention but the effects of prenatal drug exposure may be subtle and extensive. Drug-use disorders are accompanied by a myriad of other adverse problems, including poverty, mental and physical health problems and inadequate parenting ability that may compound the negative effects of drugs. Emerging data suggest that vulnerability to health and neurocognitive issues are pervasive and long-lasting as are lifestyle issues. This review will address current evidence in this area and highlight the knowledge gaps that must be addressed in order to optimise the outcomes for this vulnerable and marginalised but rapidly expanding population of adults.
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Affiliation(s)
- Ju Lee Oei
- Department of Newborn Care, The Royal Hospital for Women, and School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
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25
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Canfield M, Radcliffe P, Marlow S, Boreham M, Gilchrist G. Maternal substance use and child protection: a rapid evidence assessment of factors associated with loss of child care. CHILD ABUSE & NEGLECT 2017; 70:11-27. [PMID: 28551458 DOI: 10.1016/j.chiabu.2017.05.005] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 05/04/2017] [Accepted: 05/08/2017] [Indexed: 05/23/2023]
Abstract
This article reviews the literature on the factors associated with mothers who use substances losing care of their children. A rapid evidence assessment was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta Analyses. Medline and PsycINFO databases were searched to identify primary research studies published in English during January 2000-September 2016. Studies were included if they presented individual, formal support (e.g., receiving substance use treatment) or informal support (e.g., receiving social and family support) factors associated with mothers who use substances retaining or losing care of their child/ren (losing care refers to child protection services placing child/ren under the custody of a family relative, foster care, child care institution, or adoption). Evaluation studies or trials of interventions were excluded as were studies that focused on reunification or re-entering care as the outcome. Thirteen studies were included. Factors associated with mothers who use substances losing care of their children included: maternal characteristics (low socioeconomic status, younger age of first child, criminal justice involvement); psychological factors (mental health co-morbidity, adverse childhood experiences); patterns of substance use (use of cocaine prenatally, injection drug use); formal and informal support (not receiving treatment for substance use, fewer prenatal care visits, lack of social support). There is not enough evidence to determine the influence of substance use treatment in preventing mothers losing care of their children. Factors identified in this review provide the evidence to inform a prevention agenda and afford services the opportunity to design interventions that meet the needs of those mothers who are more likely to lose care of their children.
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Affiliation(s)
- Martha Canfield
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8BB, UK.
| | - Polly Radcliffe
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8BB, UK.
| | - Sally Marlow
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8BB, UK.
| | - Marggie Boreham
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8BB, UK.
| | - Gail Gilchrist
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8BB, UK.
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26
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Taplin S. Prenatal reporting to child protection: Characteristics and service responses in one Australian jurisdiction. CHILD ABUSE & NEGLECT 2017; 65:68-76. [PMID: 28113086 DOI: 10.1016/j.chiabu.2017.01.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 10/27/2016] [Accepted: 01/11/2017] [Indexed: 06/06/2023]
Abstract
Prenatal reporting to child protection services has been enacted into most jurisdictions across Australia and in other countries, its aims being to intervene early and provide supports which will either identify or prevent the need for a baby to be taken into care and protection once born. Despite indications that there are increasing numbers of prenatal reports, little is known about the characteristics of those reported, the timing and reasons for reports, service responses, and the impacts of being reported. This study is one of the first to use administrative data to examine the characteristics of two samples from one Australian jurisdiction: (i) data from casefiles of 38 cases reported in 2012-13, and (ii) administrative data from 117 cases reported prenatally in 2013. These data showed that women who were reported to child protection services in relation to their pregnancy were predominantly disadvantaged, and were likely to be reported relatively late in their pregnancy due to 'future risk concerns'. Approximately two-thirds of those reported were provided with some prenatal support, as recorded by the child protection system, generally of limited duration. Twelve percent of the babies born to the larger cohort of women were removed within 100days of their birth. It is likely that longer term supportive interventions are needed, to reduce the risk factors evident in women reported during pregnancy, and to improve their ability to safely care for their children. Information on the short and long-term impacts from rigorous evaluations and longer-term intervention trials are also vital to ensure that prenatal reporting and interventions are, in fact, improving outcomes for infants and families.
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Affiliation(s)
- Stephanie Taplin
- Institute of Child Protection Studies, Australian Catholic University, Australia.
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27
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Oei JL, Melhuish E, Uebel H, Azzam N, Breen C, Burns L, Hilder L, Bajuk B, Abdel-Latif ME, Ward M, Feller JM, Falconer J, Clews S, Eastwood J, Li A, Wright IM. Neonatal Abstinence Syndrome and High School Performance. Pediatrics 2017; 139:peds.2016-2651. [PMID: 28093465 DOI: 10.1542/peds.2016-2651] [Citation(s) in RCA: 108] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/14/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Little is known of the long-term, including school, outcomes of children diagnosed with Neonatal abstinence syndrome (NAS) (International Statistical Classification of Disease and Related Problems [10th Edition], Australian Modification, P96.1). METHODS Linked analysis of health and curriculum-based test data for all children born in the state of New South Wales (NSW), Australia, between 2000 and 2006. Children with NAS (n = 2234) were compared with a control group matched for gestation, socioeconomic status, and gender (n = 4330, control) and with other NSW children (n = 598 265, population) for results on the National Assessment Program: Literacy and Numeracy, in grades 3, 5, and 7. RESULTS Mean test scores (range 0-1000) for children with NAS were significantly lower in grade 3 (359 vs control: 410 vs population: 421). The deficit was progressive. By grade 7, children with NAS scored lower than other children in grade 5. The risk of not meeting minimum standards was independently associated with NAS (adjusted odds ratio [aOR], 2.5; 95% confidence interval [CI], 2.2-2.7), indigenous status (aOR, 2.2; 95% CI, 2.2-2.3), male gender (aOR, 1.3; 95% CI, 1.3-1.4), and low parental education (aOR, 1.5; 95% CI, 1.1-1.6), with all Ps < .001. CONCLUSIONS A neonatal diagnostic code of NAS is strongly associated with poor and deteriorating school performance. Parental education may decrease the risk of failure. Children with NAS and their families must be identified early and provided with support to minimize the consequences of poor educational outcomes.
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Affiliation(s)
- Ju Lee Oei
- School of Women's and Children's Health, .,Department of Newborn Care, Royal Hospital for Women, Randwick, New South Wales, Australia.,Ingham Research Centre, Liverpool, New South Wales, Australia
| | - Edward Melhuish
- Early Start Research Institute and.,Department of Education, University of Oxford, Oxford, United Kingdom.,Department of Psychological Sciences, Birkbeck, University of London, London, United Kingdom
| | | | | | | | | | - Lisa Hilder
- National Perinatal Epidemiology and Statistics Unit, University of New South Wales, Sydney, New South Wales, Australia
| | | | - Mohamed E Abdel-Latif
- Department of Neonatology, The Canberra Hospital, Garran, Australian Capital Territory, Australia.,Faculty of Medicine, the Australian National University, Deakin, Australian Capital Territory, Australia
| | - Meredith Ward
- School of Women's and Children's Health.,Department of Newborn Care, Royal Hospital for Women, Randwick, New South Wales, Australia
| | - John M Feller
- School of Women's and Children's Health.,Sydney Children's Hospital, Sydney Children's Hospital Network, Randwick, New South Wales, Australia
| | - Janet Falconer
- The Langton Centre, Surry Hills, New South Wales, Australia
| | - Sara Clews
- The Langton Centre, Surry Hills, New South Wales, Australia
| | - John Eastwood
- School of Women's and Children's Health.,Ingham Research Centre, Liverpool, New South Wales, Australia.,Community Health Services, Sydney Local Health District, Sydney, New South Wales, Australia.,School of Public Health, Menzies Centre for Health Policy, and Charles Perkins Centre, University of Sydney, Camperdown, New South Wales, Australia; and.,School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | - Annie Li
- School of Women's and Children's Health
| | - Ian M Wright
- Early Start Research Institute and.,Illawarra Health and Medical Research Institute and School of Medicine, The University of Wollongong, Wollongong, New South Wales, Australia.,Department of Paediatrics, The Wollongong Hospital, Wollongong, New South Wales, Australia
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28
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Burns L, Coleman-Cowger VH, Breen C. Managing Maternal Substance Use in the Perinatal Period: Current Concerns and Treatment Approaches in the United States and Australia. Subst Abuse 2016; 10:55-61. [PMID: 27980414 PMCID: PMC5147518 DOI: 10.4137/sart.s34558] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 09/07/2016] [Accepted: 10/04/2016] [Indexed: 01/18/2023]
Abstract
Substance use in pregnancy can have adverse effects on mother and fetus alike. Australia and the US are countries with high levels of substance use and policies advising abstinence, although the Australian approach occurs within a broader framework of harm minimization. Less attention has been paid to treatment of the mothers' substance use and what is considered gold standard. This is despite evidence that prior substance use in pregnancy is the most important factor in predicting future substance use in pregnancy. This paper draws together information from both the peer-reviewed and gray literature to provide a contemporary overview of patterns and outcomes of the three main drugs, alcohol, tobacco, and cannabis, used in Australia and the US during pregnancy and discusses what are considered gold standard screening and treatment approaches for these substances. This paper does not set out to be a comprehensive review of the area but rather aims to provide a concise summary of current guidelines for policy makers and practitioners who provide treatment for women who use substances in pregnancy.
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Affiliation(s)
- Lucinda Burns
- National Drug and Alcohol Research Centre, University of New South Wales, New South Wales, Australia
| | | | - Courtney Breen
- University of New South Wales, New South Wales, Australia
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29
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Black KI, Day CA. Improving Access to Long-Acting Contraceptive Methods and Reducing Unplanned Pregnancy Among Women with Substance Use Disorders. Subst Abuse 2016; 10:27-33. [PMID: 27199563 PMCID: PMC4869602 DOI: 10.4137/sart.s34555] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 03/06/2016] [Accepted: 03/09/2016] [Indexed: 01/10/2023]
Abstract
Much has been written about the consequences of substance use in pregnancy, but there has been far less focus on the prevention of unintended pregnancies in women with substance use disorders (SUDs). We examine the literature on pregnancy incidence for women with SUDs, the clinical and economic benefits of increasing access to long-acting reversible contraceptive (LARC) methods in this population, and the current hurdles to increased access and uptake. High rates of unintended pregnancies and poor physical and psychosocial outcomes among women with SUDs underscore the need for increased access to, and uptake of, LARC methods among these women. A small number of studies that focused on improving access to contraception, especially LARC, via integrated contraception services predominantly provided in drug treatment programs were identified. However, a number of barriers remain, highlighting that much more research is needed in this area.
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Affiliation(s)
- Kirsten I. Black
- Central Clinical School, Sydney Medical School, The University of Sydney, NSW, Australia
| | - Carolyn A. Day
- Discipline of Addiction Medicine, Central Clinical School, Sydney Medical School, The University of Sydney, NSW, Australia
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30
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Uebel H, Wright IM, Burns L, Hilder L, Bajuk B, Breen C, Abdel-Latif ME, Ward M, Eastwood J, Feller JM, Falconer J, Clews S, Oei JL. Epidemiological Evidence for a Decreasing Incidence of Neonatal Abstinence Syndrome, 2000-11. Paediatr Perinat Epidemiol 2016; 30:267-73. [PMID: 26849178 DOI: 10.1111/ppe.12282] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND This study analyses the incidence of Neonatal Abstinence Syndrome (NAS) in a large geographically defined population in Australia. METHOD Database linkage analysis of all births between 2000 and 2011 in New South Wales (NSW), Australia. The diagnosis of NAS was derived from hospital coding P96.1, 'Neonatal withdrawal symptoms from maternal use of drugs of addiction'. Temporal trends were studied by comparing epoch 1 (2000-05) with epoch 2 (2006-11). The relationship with changes in maternal factors was further analysed. RESULTS The NAS was coded in 3842 of 1 022 263 live born infants (0.38%). NAS incidence peaked at 5.07 per 1000 live births in 2002, decreasing to 3.18 in 2011 and was negatively correlated with maternal age (r = -0.7). The rate of NAS in epoch 2 (3.4 per 1000 births, 95% CI 3.28, 3.58) was significantly lower than in epoch 1 (4.1 per 1000 births, 95% CI 3.96, 4.33). Epoch 2 mothers were significantly older (mean 29.8 years vs. 28.3 years), less likely to be multiparous (OR 0.7, 95% CI 0.6, 0.9) or smoke (OR 0.4, 95% CI 0.4, 0.5). They were more likely to engage in antenatal care earlier (mean first visit: 14.1 vs. 18.9 weeks). Most infants (~80%) were born at term (>37 weeks gestation). CONCLUSION The incidence of NAS as a discharge diagnosis has decreased in our population since 2002. Mothers are also older and engaging earlier in prenatal care. Whether these changes alter NAS presentation and diagnosis or whether pregnant women are using drugs that do not cause typical NAS (e.g. amphetamines) is uncertain and requires further study.
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Affiliation(s)
- Hannah Uebel
- School of Women's and Children's Heath, University of New South Wales, Kensington, NSW, Australia
| | - Ian M Wright
- Illawarra Health and Medical Research Institute and Graduate School of Medicine, The University of Wollongong, Wollongong, NSW, Australia.,Department of Paediatrics, The Wollongong Hospital, Wollongong, NSW, Australia
| | - Lucy Burns
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Lisa Hilder
- School of Women's and Children's Heath, University of New South Wales, Kensington, NSW, Australia.,Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW, Australia
| | - Barbara Bajuk
- Perinatal Services Network, Westmead, NSW, Australia
| | - Courtney Breen
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Mohamed E Abdel-Latif
- Department of Neonatology, The Canberra Hospital, Garran, ACT, Australia.,Faculty of Medicine, the Australian National University, Deakin, ACT, Australia
| | - Meredith Ward
- School of Women's and Children's Heath, University of New South Wales, Kensington, NSW, Australia.,Department of Newborn Care, Royal Hospital for Women, Randwick, NSW, Australia
| | - John Eastwood
- School of Women's and Children's Heath, University of New South Wales, Kensington, NSW, Australia.,Sydney Local Health District, Sydney, NSW, Australia.,Ingham Institute of Applied Medicine, University of New South Wales, Liverpool, NSW, Australia
| | - John M Feller
- School of Women's and Children's Heath, University of New South Wales, Kensington, NSW, Australia.,Sydney Children's Hospital, Randwick, NSW, Australia
| | | | - Sara Clews
- The Langton Centre, Surry Hills, NSW, Australia
| | - Ju Lee Oei
- School of Women's and Children's Heath, University of New South Wales, Kensington, NSW, Australia.,Department of Newborn Care, Royal Hospital for Women, Randwick, NSW, Australia.,Ingham Institute of Applied Medicine, University of New South Wales, Liverpool, NSW, Australia
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31
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Doab A, Fowler C, Dawson A. Factors that influence mother-child reunification for mothers with a history of substance use: A systematic review of the evidence to inform policy and practice in Australia. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2015; 26:820-31. [PMID: 26152330 DOI: 10.1016/j.drugpo.2015.05.025] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 03/10/2015] [Accepted: 05/28/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND An estimated 60-70% of Australian children in out of home care have a parent with a substance use disorder (SUD). The assessment of a parent's history and needs and the design of supportive interventions, particularly for mothers who are often the primary carers of children, are important considerations in deciding whether or not family reunification is desirable and possible. It is not clear from the research how the needs of families can be best met. There are no systematic reviews that provide evidence to inform the development of preventative and remedial interventions and related policy options. We undertook a systematic review to examine maternal characteristics and program features that facilitate or pose a barrier to mother-child reunification in contexts where mothers have a SUD. METHODS A structured search of nine databases was undertaken to identify peer reviewed literature in English between 2004 and 2014 and examine factors that influenced mother-child reunification in mothers with SUD. We employed a narrative synthesis design to analyse the findings sections of all papers as the methods of the various studies did not permit the pooling of data. RESULTS A total of 11 studies were included in this review. Findings show that factors such as timeliness of treatment entry, treatment completion and the receipt of matched services, and programs that provided a greater level of integrated care are positively related to reunification. The presence of a mental health disorder, use of opiates and having a greater number of children were barriers to reunification. CONCLUSION Women with SUD who have a child in out of home care appear to have multiple unmet needs. Accessible, stigma free and comprehensive integrated care services, as well as greater access to primary health care that address social and medical issues must be considered to improve the physical and psycho-social outcomes of these women and their children.
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Affiliation(s)
- Anna Doab
- Faculty of Health, University of Technology Sydney, NSW, Australia.
| | - Cathrine Fowler
- Faculty of Health, University of Technology Sydney, NSW, Australia; Tresillian Family Care Centres, NSW, Australia
| | - Angela Dawson
- Faculty of Health, University of Technology Sydney, NSW, Australia
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32
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Fowler C, Rossiter C, Sherwood J, Day C. New Understandings of Mothering: Mothers in an Abstinence-Based Drug Treatment Program. Int J Ment Health Addict 2014. [DOI: 10.1007/s11469-014-9518-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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33
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Taplin S, Mattick RP. The nature and extent of child protection involvement among heroin-using mothers in treatment: high rates of reports, removals at birth and children in care. Drug Alcohol Rev 2014; 34:31-7. [PMID: 24890662 DOI: 10.1111/dar.12165] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Accepted: 05/05/2014] [Indexed: 01/15/2023]
Abstract
INTRODUCTION AND AIMS A substantial proportion of women in treatment for substance use problems are mothers of dependent children, but only a small number of studies have explored the nature and extent of their child protection involvement with substance-using mothers themselves. DESIGN AND METHODS A large sample of mothers on the opioid treatment program (OTP) in Sydney, Australia, were interviewed. This paper describes their characteristics, the extent and nature of their involvement with the child protection system, the parenting-related interventions provided and their views of their own parenting. RESULTS The 171 mothers were disadvantaged and marginalised and had 302 children under the age of 16 years, 99 of whom were in out-of-home care. Nearly half the children in care (n = 42) had been removed at the time of their birth, and half (n = 49) had been removed from a mother who was on an OTP at the time. Among the younger children (age 1-2 years), higher proportions had been removed at birth than among the older children. None of the 32 mothers who had a child removed at birth and then gave birth subsequently retained care of their new baby. Women often chose to enter treatment (63.6%) for child-related reasons (35%) and attempted to shield their children from their substance use. Few health services were provided to them outside the availability of OTP. DISCUSSION AND CONCLUSIONS Entering treatment presents an opportunity for improving outcomes for these women and their children and to reduce future involvement with the child protection system.
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Affiliation(s)
- Stephanie Taplin
- Institute of Child Protection Studies, Australian Catholic University, Canberra, Australia
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34
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Gisev N, Degenhardt L, Larney S, Larance B, Gibson A, Kimber J, Burns L. A comparative study of opioid substitution therapy utilisation among opioid-dependent men and women. Drug Alcohol Rev 2014; 33:499-505. [PMID: 24840554 DOI: 10.1111/dar.12151] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 04/13/2014] [Indexed: 01/18/2023]
Abstract
INTRODUCTION AND AIMS Few population-based studies have examined differences in opioid substitution therapy (OST) treatment utilisation between men and women. Using a population of opioid-dependent people in New South Wales, Australia, first-episode and long-term OST treatment utilisation profiles were compared between men and women, differentiating between treatment initiation in the community and in custody. DESIGN AND METHODS Retrospective data linkage study using records of new OST entrants (2001-2010) and custody episodes (2000-2012). First OST treatment episode and overall treatment utilisation characteristics were compared between men and women initiating treatment in the community or in custody. Treatment retention was evaluated at 3, 6, 9 and 12 months after first commencing OST and overall, as the median proportion of follow-up time spent in treatment. RESULTS There were 15,600 new OST entrants in the cohort--10,930 were men (70.1%) and 4670 women (29.9%); 12,584 (80.7%) initiated treatment in the community and 3016 (19.3%) in custody. More men initiated OST in custody (24.0% vs. 8.3%, P < 0.001) and only received OST in custody (57.5% vs. 41.8%, P < 0.001). Women were retained longer in their first OST treatment episode at all four time points in both treatment settings and in treatment overall (community: 46.6% vs. 39.1%, P < 0.001; custody: 41.3% vs. 30.8%, P < 0.001). DISCUSSION AND CONCLUSIONS There are a number of key differences in OST treatment utilisation profiles between men and women. Whereas men commonly initiate and only receive OST in custody, treatment retention is higher among women, independent of the setting treatment is initiated.
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Affiliation(s)
- Natasa Gisev
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
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Lund IO, Brendryen H, Ravndal E. A longitudinal study on substance use and related problems in women in opioid maintenance treatment from pregnancy to four years after giving birth. Subst Abuse 2014; 8:35-40. [PMID: 24855370 PMCID: PMC4024055 DOI: 10.4137/sart.s15055] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 03/26/2014] [Accepted: 03/27/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Women in opioid maintenance treatment (OMT) have a past characterized by drug abuse, which is a challenging start for parenthood. Studies of mothers in OMT are typically limited to pregnancy and early infancy. Knowledge about how they cope with substance use and related problems in the years following birth is therefore important. The aims of the study were to examine changes in mothers' substance use, psychological problems, and other challenges; from one to four years after their children were born, and describe kindergarten attendance and prevalence and type of child protective services involvement when the children were four years old. METHOD A four-year prospective cohort study of mothers in OMT. The European severity index was used to map substance use and related problems during the third trimester of pregnancy, one and four years after birth. RESULTS At the four-year follow-up, use of illegal substances remained low (4%) and use of legal substances (39%) was similar to the one-year follow-up. The proportion of women with psychological problems was significantly higher than at one-year follow-up (69 vs. 39%, P = 0.009). At age four, most children (89%) attended kindergarten, and the child protective services were following 73% of the families, mostly with voluntary measures. CONCLUSION Mothers in OMT cope well with substance use over time, given access to sufficient support. The findings imply that a preventive governmental strategy with close support of mother and child, have a positive impact contributing to making OMT and motherhood more compatible.
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Affiliation(s)
- Ingunn O Lund
- Norwegian Institute of Alcohol and Drug Research (SIRUS), Oslo, Norway
- Norwegian Center for Addiction Research (SERAF), University of Oslo, Oslo, Norway
| | - Håvar Brendryen
- Norwegian Center for Addiction Research (SERAF), University of Oslo, Oslo, Norway
| | - Edle Ravndal
- Norwegian Center for Addiction Research (SERAF), University of Oslo, Oslo, Norway
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Raitasalo K, Holmila M, Autti-Rämö I, Notkola IL, Tapanainen H. Hospitalisations and out-of-home placements of children of substance-abusing mothers: A register-based cohort study. Drug Alcohol Rev 2014; 34:38-45. [DOI: 10.1111/dar.12121] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Accepted: 01/23/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Kirsimarja Raitasalo
- Alcohol and Drugs; National Institute for Health and Welfare (THL); Helsinki Finland
| | - Marja Holmila
- Alcohol and Drugs; National Institute for Health and Welfare (THL); Helsinki Finland
| | - Ilona Autti-Rämö
- Research Department; The Social Insurance Institution of Finland (Kela); Helsinki Finland
| | - Irma-L. Notkola
- Finnish Information Centre for Register Research; Helsinki Finland
| | - Heli Tapanainen
- Alcohol and Drugs; National Institute for Health and Welfare (THL); Helsinki Finland
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