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Powell M, Pilkington R, Varney B, Havard A, Lynch J, Dobbins T, Oei JL, Ahmed T, Falster K. The burden of prenatal and early life maternal substance use among children at risk of maltreatment: A systematic review. Drug Alcohol Rev 2024; 43:823-847. [PMID: 38548385 DOI: 10.1111/dar.13835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 02/21/2024] [Accepted: 02/22/2024] [Indexed: 05/04/2024]
Abstract
ISSUES Although maternal substance use is a known risk factor for child maltreatment, evidence on the scale of substance use is needed to inform prevention responses. This systematic review synthesised prevalence estimates of maternal substance use during pregnancy and early life among children at risk of maltreatment. Ovid, Pubmed, CINAHL, PsychInfo and ProQuest databases were searched. We included observational studies that sampled children at risk of maltreatment in high-income countries and reported information on maternal substance use during pregnancy and/or the child's first year of life. We extracted study characteristics and data to calculate prevalence, assessed risk of bias and conducted a narrative synthesis; there were insufficient comparable populations or outcomes to quantitatively synthesise results. KEY FINDINGS Thirty five of 14,084 titles were included. Fifteen studies had adequately sized and representative samples to estimate prevalence. Maternal substance use prevalence ranged from 2.4% to 40.6%. Maternal substance use was highest among infants referred to child protection at birth (40.6%) and children in out-of-home care (10.4% to 37.2%). Prevalence was higher when studies defined substance use more broadly and when maternal substance use was ascertained from both child and mother records. IMPLICATIONS Supportive, coordinated responses to maternal substance use are needed from health and child protection services, spanning alcohol and other drug treatment, antenatal and postnatal care. CONCLUSIONS Prenatal and early life maternal substance use is common among child maltreatment populations, particularly among younger children and those with more serious maltreatment.
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Affiliation(s)
- Madeleine Powell
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
- School of Population Health, UNSW Sydney, Sydney, Australia
| | | | - Bianca Varney
- School of Population Health, UNSW Sydney, Sydney, Australia
| | - Alys Havard
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
- School of Population Health, UNSW Sydney, Sydney, Australia
| | - John Lynch
- School of Public Health, University of Adelaide, Adelaide, Australia
- Population Health Sciences, University of Bristol, Bristol, UK
| | | | - Ju Lee Oei
- School of Women's and Children's Health, UNSW Sydney, Sydney, Australia
- Royal Hospital for Women, New South Wales Health, Sydney, Australia
| | - Tasnia Ahmed
- School of Population Health, UNSW Sydney, Sydney, Australia
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Mark TL, Dolan M, Allaire B, Parish W, Strack C, Poehler D, Madden E, Butler V. Untreated Psychiatric and Substance Use Disorders Among Caregivers With Children Reported to Child Protective Services. JAMA HEALTH FORUM 2024; 5:e240637. [PMID: 38639981 PMCID: PMC11065155 DOI: 10.1001/jamahealthforum.2024.0637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 02/27/2024] [Indexed: 04/20/2024] Open
Abstract
Importance Mental and substance use disorders can interfere with parents' ability to care for their children and are associated with a greater likelihood of child protective services involvement to address child maltreatment. Parent engagement in psychiatric and substance use disorder treatment can prevent child maltreatment and family separations. Objective To determine whether caregivers with psychiatric or substance use disorders whose children were referred to child protective services received Medicaid-funded psychiatric or substance use disorder treatment. Design, Setting, and Participants Caregivers listed on child welfare records were linked with their Medicaid records using 2017 to 2020 Medicaid and child welfare data from Florida and Kentucky. Medicaid claims were analyzed to determine if caregivers had a psychiatric or substance use disorder diagnosis and whether those caregivers received counseling or medications. The analysis was conducted in 2023. Exposure Diagnosis of a psychiatric or substance use disorder in 2020. Main Outcome and Measure Receipt of psychiatric or substance use disorder counseling or medications. Results Of the 58 551 caregivers, 65% were aged between 26 and 40 years; 69% were female and 31% were male. Overall, 78% identified as White, 20% identified as Black/African American, and less than 1% identified as American Indian/Alaska Native, Asian, or Native Hawaiian/Other Pacific Islander. In 2020, 59% of caregivers with Medicaid and children referred to child protective services had a mental health or substance use disorder diagnosis, compared with 33% of age- and sex-matched Medicaid beneficiaries without children referred to child protective services (P < .001). Among caregivers with a psychiatric disorder, 38% received counseling and 67% received psychiatric medication. Among those with a substance use disorder, 40% received counseling and 38% received a substance use disorder medication. Conclusions and Relevance In this case-control study, despite Medicaid coverage of an array of effective behavioral health treatments, large portions of caregivers with Medicaid coverage, who need treatment and whose children were referred to child protective services, were not receiving treatment. Medicaid and child welfare agencies should make a greater effort to connect caregivers to behavioral health services.
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Affiliation(s)
| | | | | | | | | | | | - Emily Madden
- Office of the Assistant Secretary for Planning and Evaluation, Department of Health and Human Services, Washington, DC
| | - Valeria Butler
- Office of Planning, Research and Evaluation, Administration for Children and Families, Department of Health and Human Services, Washington, DC
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Ruisniemi A, Itäpuisto M, Kuusisto K. Relational parenthood in addiction recovery. NORDIC STUDIES ON ALCOHOL AND DRUGS 2024; 41:175-185. [PMID: 38645969 PMCID: PMC11027853 DOI: 10.1177/14550725231202071] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 09/04/2023] [Indexed: 04/23/2024] Open
Abstract
Aims: The purpose of this research was to elicit how parents attending family-focused substance abuse treatment construct their parenthood in relation to other people. Design: Relational parenthood of addiction treatment attendees is scrutinised from seven thematic interviews carried out in a community-based inpatient substance abuse treatment unit in Finland. The core analytical concept of the research is relationality. The data were first content coded via Atlas.ti22 and the relations and codes classified into the five following parenthood types emerging from the data: (1) worn-out; (2) coping; (3) ambivalent; (4) changing; and (5) supported. Content codes and parenthood types were cross-tabulated to ascertain how these types are emphasised in different relationships. Results: Worn-out and coping parenthood types emerged in the closest relationships, mostly with their own children and the other parent. Ambivalent parenthood was present in all relations as expressions of inner conflict, which can lead to changing parenthood. Changing parenthood emerged in relation to interviewees' own children as an empowering experience. It also emerged in relation to other people as readiness to accept help. Supported parenthood was most often found in relation to significant others and professionals, presumably due to the context of the interviews. Conclusion: The parenthood types illustrate how parenting changes over time, which is also an important part of social identity change in recovering from addiction. In treatment, it is extremely important to understand the different sides of parenthood and to use the information to strengthen clients' parenthood.
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Affiliation(s)
- Arja Ruisniemi
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | | | - Katja Kuusisto
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
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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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Mark TL, Dolan M, Allaire B, Parish W, Poehler D, Strack C, Madden E, Butler V. Linked Child Welfare and Medicaid Data in Kentucky and Florida Highlights Racial Disparities in Access to Care. CHILD MALTREATMENT 2024:10775595241234569. [PMID: 38378439 DOI: 10.1177/10775595241234569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
Parents with serious mental health (MH) and substance use disorders (SUD) can face profound challenges caring for their children. MH/SUD treatment can improve outcomes for both parents and their children. This study evaluated whether parents with Medicaid with MH/SUD conditions whose children had child protective services (CPS) involvement were receiving MH/SUD treatment and whether receipt differed by race. We analyzed the 2020 Child and Caregiver Outcomes Using Linked Data (CCOULD) which contains Medicaid and child welfare records from Kentucky and Florida on 58,551 CPS-involved caregivers. Among caregivers with an MH diagnosis, White individuals were more likely than Black individuals to have received counseling (42% vs. 20%) or an MH medication (69% vs. 52%). Among caregivers with an SUD, White individuals were more likely than Black individuals to have received counseling (43% vs. 20%) or an SUD medication (43% vs. 11%). More effort is needed to connect parents with CPS involvement to MH/SUD treatment, particularly Black parents.
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Affiliation(s)
- Tami L Mark
- RTI International, Research Triangle Park, NC, USA
| | | | | | | | | | | | - Emily Madden
- US Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation, Washington, DC, USA
| | - Valeria Butler
- US Department of Health and Human Services, Administration for Children and Families, Office of Planning, Research and Evaluation, Washington, DC, USA
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Bosak J, Messersmith L, Bryer C, Drainoni M, Goodman D, Adams M, Barry T, Flanagan C, Flanagan V, Wolff K, Declercq E. "They just looked at me like I was human": The experiences of parenting women and providers with substance use disorder treatment. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 157:209240. [PMID: 38061633 DOI: 10.1016/j.josat.2023.209240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 09/11/2023] [Accepted: 11/30/2023] [Indexed: 02/20/2024]
Abstract
BACKGROUND The current US addiction treatment system does not effectively meet the needs of pregnant and parenting women with substance use disorder (SUD). The aim of this research was to identify barriers and facilitators to engagement and retention in SUD residential treatment for pregnant and parenting women. This research was part of a co-design process to collaboratively create a more patient-centered long-term residential program. DESIGN AND METHODS The study conducted semi-structured individual interviews with both parenting women with lived experience (WWLE) in residential SUD treatment and SUD treatment providers. Interviews aimed to elicit participants' experiences either receiving or providing care. The study team analyzed data in NVivo-12 using a deductive codebook based on the six principles of trauma informed care (TIC). RESULTS We conducted a total of 32 interviews (WWLE =13, SUD providers =19). The study identified four major themes: 1) peer relationships provide inspiration and diminish shame; 2) providing individuals safe space to stumble in recovery creates opportunities for growth and builds self-efficacy; 3) reasonable, clear boundaries create a structured, protective environment for early recovery; 4) nonjudgmental connections facilitate engagement and build trust. We identified small pivotal moments along the continuum of care that showed how the elements in the four themes enhanced engagement and retention in treatment. These interactions, along the care continuum, are either structural (workflow process) or relational (interpersonal). CONCLUSION This research increases understanding of the interplay of the structural and relational barriers and facilitators to engagement and retention in treatment. These seemingly minor positive or negative interactions along the care continuum are pivotal to fully operationalizing TIC and optimizing women's engagement in treatment. Improvement strategies that integrate the voices of WWLE and collaboratively co-design a more patient-centered system are critical steps to improving engagement in SUD treatment and more equitable SUD treatment services.
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Affiliation(s)
- J Bosak
- Community Health Services, Boston University School of Public Health, 801 Massachusetts Ave, Boston, MA 02118, United States; Dartmouth Hitchcock Medical Center, 1 Medical Drive, Lebanon, NH 03766, United States; Dartmouth Geisel School of Medicine, 1 Medical Drive, Lebanon, NH 03766, United States.
| | - L Messersmith
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Ave, Boston, MA 02118, United States
| | - C Bryer
- Dartmouth Hitchcock Medical Center, 1 Medical Drive, Lebanon, NH 03766, United States
| | - M Drainoni
- Section of Infectious Diseases, Department of Medicine, Boston University Aram V. Chobanian & Edward Avedisian School of Medicine, 801 Massachusetts Ave, Boston, MA 02118, United States; Department of Health Law Policy & Management, Boston University School of Public Health, 801 Massachusetts Ave, Boston, MA, United States
| | - D Goodman
- Dartmouth Hitchcock Medical Center, 1 Medical Drive, Lebanon, NH 03766, United States; Dartmouth Geisel School of Medicine, 1 Medical Drive, Lebanon, NH 03766, United States
| | - M Adams
- Families Flourish Northeast, P.O Box 20, Enfield Center, NH 03749, United States
| | - T Barry
- Dartmouth Hitchcock Medical Center, 1 Medical Drive, Lebanon, NH 03766, United States
| | - C Flanagan
- Families Flourish Northeast, P.O Box 20, Enfield Center, NH 03749, United States
| | - V Flanagan
- Dartmouth Hitchcock Medical Center, 1 Medical Drive, Lebanon, NH 03766, United States
| | - K Wolff
- Independent Researcher, 566 Hanover Center Rd, Hanover, NH 03755, United States
| | - E Declercq
- Community Health Services, Boston University School of Public Health, 801 Massachusetts Ave, Boston, MA 02118, United States
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Mersky JP, Lee CP, Liu X, Janczewski CE. Impact of a family treatment court on child permanency and safety. CHILD ABUSE & NEGLECT 2023; 146:106512. [PMID: 37866252 DOI: 10.1016/j.chiabu.2023.106512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 09/01/2023] [Accepted: 10/11/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND Family Treatment Courts have been linked to promising effects on key child welfare outcomes, though few rigorous program evaluations have been conducted. OBJECTIVE This study employs a robust quasi-experimental design to evaluate effects associated with Family Treatment Court participation on child permanency and safety. PARTICIPANTS AND SETTING The sample included 648 eligible adults who were referred to a Family Treatment Court in a Midwest metropolitan area, including 266 program participants and 382 non-participants. METHODS Propensity score weighting was applied to match program and comparison groups on demographic and case characteristics. Child welfare records yielded safety and permanency outcomes. Participants and non-participants were compared following an intent-to-treat principle, with logistic regressions used to test the odds of reunification and maltreatment recurrence, and Kaplan-Meier analyses used to explore time to reunification and permanency. Moderation tests were performed to analyze differences in program impact across racial/ethnic groups and substance use types. RESULTS Compared to non-participants, program participants were 81 % more likely to reunify. Group differences in time to reunification and permanency were mixed, and there was no evidence of program impact on maltreatment recurrence. Substance use type and race/ethnicity did not moderate associations between program participation and study outcomes. CONCLUSIONS Mounting evidence suggests that Family Treatment Courts are more effective than usual services in promoting family reunification, though it is unclear if these interventions hasten reunification or increase safety post-reunification. Rigorous evaluations are needed to explore moderating and mediating processes and identify implementation drivers and local conditions that contribute to heterogeneous results.
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Affiliation(s)
- Joshua P Mersky
- Institute for Child and Family Well-being, Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee, WI, United States of America.
| | - ChienTi Plummer Lee
- Institute for Child and Family Well-being, Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee, WI, United States of America
| | - Xiyao Liu
- Institute for Child and Family Well-being, Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee, WI, United States of America
| | - Colleen E Janczewski
- Institute for Child and Family Well-being, Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee, WI, United States of America
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Darlington CK, Clark R, Jacoby SF, Terplan M, Alexander K, Compton P. Outcomes and experiences after child custody loss among mothers who use drugs: A mixed studies systematic review. Drug Alcohol Depend 2023; 251:110944. [PMID: 37713979 DOI: 10.1016/j.drugalcdep.2023.110944] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 08/07/2023] [Accepted: 08/10/2023] [Indexed: 09/17/2023]
Abstract
BACKGROUND Mothers who use drugs are more likely to experience child custody loss than mothers who do not use drugs. The negative impact of removal on children has been well characterized in current literature while less is known about the impact of custody loss on mothers. The purpose of this mixed studies systematic review is to describe the state of science on the maternal outcomes and experiences after child custody loss among mothers who use drugs. METHODS PubMed, PsycINFO, CINAHL, and Social Work Abstract databases were systematically searched between June 2022 to January 2023. Article eligibility criteria centered on the outcomes and experiences of mothers who use drugs after losing child custody. Studies were analyzed using results-based convergent synthesis methodology for mixed studies reviews. Study quality was assessed using the Mixed Methods Appraisal Tool (MMAT). A visual synthesis model was derived from combined results across all studies. RESULTS Of 2434 articles screened, 22 relevant scientific articles were selected for inclusion. Longitudinal, cohort studies (n=4) and a cross-sectional study (n=1) identified positive associations between custody loss and poorer mental health, increased drug use and overdose risk, less treatment engagement, and worsened social factors. Qualitative studies (n=17) identified themes that described re-traumatization after child custody loss and the development of coping mechanisms through identity negotiation. CONCLUSION Our findings indicate that child custody loss associated with drug use may exacerbate trauma and worsen maternal health. Immediate implications are provided for maternal health policy and practice in healthcare, child welfare, and legal professions.
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Affiliation(s)
- Caroline K Darlington
- University of Pennsylvania School of Nursing, Philadelphia, PA, United States; Leonard Davis Institute of Health Economics, Philadelphia, PA, United States.
| | - Rebecca Clark
- University of Pennsylvania School of Nursing, Philadelphia, PA, United States; Leonard Davis Institute of Health Economics, Philadelphia, PA, United States; Pennsylvania Hospital, Philadelphia, PA, United States
| | - Sara F Jacoby
- University of Pennsylvania School of Nursing, Philadelphia, PA, United States; Leonard Davis Institute of Health Economics, Philadelphia, PA, United States
| | - Mishka Terplan
- Friends Research Institute, Baltimore, MD, United States
| | | | - Peggy Compton
- University of Pennsylvania School of Nursing, Philadelphia, PA, United States; Leonard Davis Institute of Health Economics, Philadelphia, PA, United States
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Bailey A, Harrington C, Evans EA. A scoping review of community-based post-opioid overdose intervention programs: implications of program structure and outcomes. HEALTH & JUSTICE 2023; 11:3. [PMID: 36707446 PMCID: PMC9883127 DOI: 10.1186/s40352-022-00201-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 12/14/2022] [Indexed: 06/18/2023]
Abstract
BACKGROUND An emergent intervention to address the opioid epidemic is the use of multidisciplinary outreach teams which connect an individual in the community to healthcare resources after the experience of an opioid overdose. While these interventions are receiving federal funding, less is known empirically to inform future interventions. Understanding the process and outcomes of these interventions is advisable due to the novel partnerships of public health and law enforcement agencies who sometimes hold divergent goals. The objective of the present review was to describe program structure and evaluated outcomes of community-based post-overdose interventions. RESULTS A search of PubMed, PsycInfo, and Web of Science yielded 5 peer-reviewed articles that detail the implementation and outcomes of interventions delivered in the United States published from 2001 to July 2021. Most interventions used a multidisciplinary outreach team and referenced first responder data to contact individuals who recently experienced an overdose at their residence. Services offered often included referral to substance use treatment, recovery coaches, and social services. Method of outreach, evaluation measures, and outcomes varied. From the available literature, facilitators of program engagement included communication, information sharing, and leadership buy-in among multidisciplinary partners. CONCLUSIONS Future studies could benefit from exploration of service provision in rural areas, for family affected by overdose, and for minoritized populations. Community-based post-overdose interventions utilizing a law enforcement partnership are emergent with promising yet limited examples in empirical literature.
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Affiliation(s)
- Amelia Bailey
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA 01003 USA
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI 02912 USA
| | - Calla Harrington
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA 01003 USA
| | - Elizabeth A. Evans
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA 01003 USA
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Shockley McCarthy K, Price Wolf J, Dellor E. Promoting permanency in families with parental substance misuse: lessons from a process evaluation of a multi-system program. BMC Public Health 2022; 22:2261. [PMID: 36463173 PMCID: PMC9719642 DOI: 10.1186/s12889-022-14528-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 11/02/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Families affected by substance misuse are at increased risk for child maltreatment and child welfare system involvement. The Enhancing Permanency in Children and Families (EPIC) program uses four evidence-based and informed multi-system practices to promote safety and permanency outcomes for children involved with the child welfare system due to parental substance misuse: 1) Peer Recovery Support (PRS), 2) Family Treatment Drug Court (FTDC), 3) Medications for Opioid Use Disorder (MOUD) and 4) Nurturing Parent Program (NPP) relational skill-building. The purpose of the current study was to identify barriers, facilitators, and lessons learned in the implementation of and client engagement with the main components of EPIC. METHODS Seventeen key EPIC personnel participated in the study. Individual semi-structured interviews were conducted. Qualitative analysis involved the thematic coding of the interviews, and program facilitators and barriers were revealed. RESULTS PRS were identified as a primary strength of the EPIC program, providing experiential connection to participating families and a valuable source of information. High turnover and matching PRS to families were barriers to PRS implementation. FTDC contributed to client success as judges developed interpersonal relationships with the clients that balanced support with accountability. Client attitudes toward court presented barriers to FTDC engagement. MOUD provided stabilization and was perceived by caseworkers as an engagement facilitator and a layer of client accountability; however, the lack of availability of MOUD service providers presented a barrier for some clients. Parental relational skill-building was not valued by clients and was perceived as conflicting with sobriety-focused activities. CONCLUSIONS The EPIC program provides comprehensive, coordinated multi-system support and care to families affected by parental substance misuse. Continued efforts to improve recruitment and retention of PRS, reframing client perceptions of FTDC, and increasing access to MOUD may contribute to increased engagement in the program. Findings highlight the utility of tracking process outcomes in community-based interventions to promote participant engagement in programs set in complex systems. TRIAL REGISTRATION NCT04700696 . Registered January 7, 2021-retrospectively registered.
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Affiliation(s)
- Karla Shockley McCarthy
- grid.261331.40000 0001 2285 7943College of Social Work, The Ohio State University, 1947 College Rd N, Columbus, OH 43210 USA
| | - Jennifer Price Wolf
- grid.186587.50000 0001 0722 3678School of Social Work, San Jose State University, One Washington Square, San Jose, CA 95112 USA
| | - Elinam Dellor
- grid.261331.40000 0001 2285 7943College of Social Work, The Ohio State University, 1947 College Rd N, Columbus, OH 43210 USA
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McTavish JR, McKee C, Tanaka M, MacMillan HL. Child Welfare Reform: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192114071. [PMID: 36360960 PMCID: PMC9655914 DOI: 10.3390/ijerph192114071] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/20/2022] [Accepted: 10/24/2022] [Indexed: 06/01/2023]
Abstract
While there have been ongoing calls to reform child welfare so that it better meets children's and families' needs, to date there have been no comprehensive summaries of child welfare reform strategies. For this systematic scoping review, we summarized authors' recommendations for improving child welfare. We conducted a systematic search (2010 to 2021) and included published reviews that addressed authors' recommendations for improving child welfare for children, youth, and families coming into contact with child welfare in high-income countries. A total of 4758 records was identified by the systematic search, 685 full-text articles were screened for eligibility, and 433 reviews were found to be eligible for this scoping review. Reviews were theoretically divided, with some review authors recommending reform efforts at the macro level (e.g., addressing poverty) and others recommending reform efforts at the practice level (e.g., implementing evidence-based parenting programs). Reform efforts across socioecological levels were summarized in this scoping review. An important next step is to formulate what policy solutions are likely to lead to the greatest improvement in safety and well-being for children and families involved in child welfare.
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Affiliation(s)
- Jill R. McTavish
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, 293 Wellington Street North, Hamilton, ON L8L 8E7, Canada
| | - Christine McKee
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, 293 Wellington Street North, Hamilton, ON L8L 8E7, Canada
| | - Masako Tanaka
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, 293 Wellington Street North, Hamilton, ON L8L 8E7, Canada
| | - Harriet L. MacMillan
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, 293 Wellington Street North, Hamilton, ON L8L 8E7, Canada
- Department of Pediatrics, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada
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Tractenberg SG, Schneider JA, de Mattos BP, Bicca CHM, Kluwe-Schiavon B, de Castro TG, Habigzang LF, Grassi-Oliveira R. The Perceptions of Women About Their High Experience of Using Crack Cocaine. Front Psychiatry 2022; 13:898570. [PMID: 35573329 PMCID: PMC9098819 DOI: 10.3389/fpsyt.2022.898570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 04/06/2022] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION The aim of this study was to explore the perceptions of women about their experience in using crack cocaine, discussing their motivations for using it and the repercussions in their lives. OBJECTIVE To investigate these experiences, a qualitative exploratory study was conducted, using the inductive thematic analyses of the content. METHODS Eight female crack cocaine users took part in this study. They were assessed by a semi-structured interview, addressing the crack cocaine use experience. Four main themes emerged in the interviews: (1) crack cocaine "high" experience; (2) symptoms related to crack cocaine use; (3) circumstances of crack cocaine use; and (4) crack cocaine use consequences. RESULTS The main perceptions reported by the users were related to a feeling of being disconnected to the world preceded by a pleasant experience, especially during the first moments of use. They revealed that the drug fulfills a key role of coping strategy to handle with negative thoughts, emotions or life experiences. An important influence of social issues was reported in relation to the onset of crack cocaine use. Negative consequences and significant impact on their lives appeared in their reports, regarding the loss of family ties, involvement with prostitution, traumatic experiences and violence. CONCLUSION Taking together all women's perceptions suggests that beyond the positive immediate rewarding effect, the maintenance of use might be related to the dissociative experience and self-medication role, acting as negative reward by relieving of negative life experiences that, in turn, are both cause and consequence of the drug use.
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Affiliation(s)
- Saulo G Tractenberg
- Graduate Program in Psychology, School of Health and Life Science, Pontifical Catholic University of Rio Grande Do Sul (PUCRS), Porto Alegre, Brazil
| | - Jaluza A Schneider
- Graduate Program in Psychology, School of Health and Life Science, Pontifical Catholic University of Rio Grande Do Sul (PUCRS), Porto Alegre, Brazil
| | - Bernardo P de Mattos
- Graduate Program in Psychology, School of Health and Life Science, Pontifical Catholic University of Rio Grande Do Sul (PUCRS), Porto Alegre, Brazil
| | - Carla H M Bicca
- Graduate Program in Psychology, School of Health and Life Science, Pontifical Catholic University of Rio Grande Do Sul (PUCRS), Porto Alegre, Brazil
| | - Bruno Kluwe-Schiavon
- Decision in Context, Research Center for Psychological Science, University of Lisbon (ULisbon), Lisbon, Portugal
| | - Thiago G de Castro
- Department of Psychology, Federal University of Rio Grande Do Sul (UFRGS), Porto Alegre, Brazil
| | - Luísa F Habigzang
- Graduate Program in Psychology, School of Health and Life Science, Pontifical Catholic University of Rio Grande Do Sul (PUCRS), Porto Alegre, Brazil
| | - Rodrigo Grassi-Oliveira
- Graduate Program in Psychology, School of Health and Life Science, Pontifical Catholic University of Rio Grande Do Sul (PUCRS), Porto Alegre, Brazil.,Translational Neuropsychiatry Unit, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Lyall V, Wolfson L, Reid N, Poole N, Moritz KM, Egert S, Browne AJ, Askew DA. "The Problem Is that We Hear a Bit of Everything…": A Qualitative Systematic Review of Factors Associated with Alcohol Use, Reduction, and Abstinence in Pregnancy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:3445. [PMID: 33810338 PMCID: PMC8037183 DOI: 10.3390/ijerph18073445] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/22/2021] [Accepted: 03/24/2021] [Indexed: 01/09/2023]
Abstract
Understanding the factors that contribute to women's alcohol use in pregnancy is critical to supporting women's health and wellness and preventing Fetal Alcohol Spectrum Disorder. A systematic review of qualitative studies involving pregnant and recently postpartum women was undertaken to understand the barriers and facilitators that influence alcohol use in pregnancy (PROSPERO: CRD42018098831). Twenty-seven (n = 27) articles were identified through EMBASE, CINAHL, PsycINFO, PubMed and Web of Science. The included articles were thematically analyzed using NVivo12. The analysis was informed by Canada's Action Framework for Building an Inclusive Health System to articulate the ways in which stigma and related barriers are enacted at the individual, interpersonal, institutional and population levels. Five themes impacting women's alcohol use, abstention and reduction were identified: (1) social relationships and norms; (2) stigma; (3) trauma and other stressors; (4) alcohol information and messaging; and (5) access to trusted equitable care and essential resources. The impact of structural and systemic factors on prenatal alcohol use was largely absent in the included studies, instead focusing on individual choice. This silence risks perpetuating stigma and highlights the criticality of addressing intersecting structural and systemic factors in supporting maternal and fetal health.
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Affiliation(s)
- Vivian Lyall
- Primary Care Clinical Unit, University of Queensland, Brisbane, QLD 4006, Australia; (V.L.); (D.A.A.)
| | - Lindsay Wolfson
- Centre of Excellence for Women’s Health, Vancouver, BC V6H 3N1, Canada;
- Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, BC V5R OA4, Canada
| | - Natasha Reid
- Child Health Research Centre, University of Queensland, Brisbane, QLD 4101, Australia; (N.R.); (K.M.M.)
| | - Nancy Poole
- Centre of Excellence for Women’s Health, Vancouver, BC V6H 3N1, Canada;
- Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, BC V5R OA4, Canada
| | - Karen M. Moritz
- Child Health Research Centre, University of Queensland, Brisbane, QLD 4101, Australia; (N.R.); (K.M.M.)
- School of Biomedical Sciences, The University of Queensland, St. Lucia, QLD 4072, Australia
| | - Sonya Egert
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Inala, QLD 4077, Australia;
| | - Annette J. Browne
- School of Nursing, University of British Columbia, Vancouver, BC V6T 1Z4, Canada;
| | - Deborah A. Askew
- Primary Care Clinical Unit, University of Queensland, Brisbane, QLD 4006, Australia; (V.L.); (D.A.A.)
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Inala, QLD 4077, Australia;
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14
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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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15
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Dolbin-MacNab ML, Smith GC, Hayslip B. Reunification in Custodial Grandfamilies: An Examination of Resilient Family Processes. FAMILY RELATIONS 2021; 70:225-245. [PMID: 33424073 PMCID: PMC7787395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVE This study examined how custodial grandmothers navigated the process of their grandchildren being reunified with a biological parent. BACKGROUND Prior research has focused on factors associated with unsuccessful reunification instead of resilient family processes that may support successful reunification. How custodial grandfamilies navigate reunification has not been examined, despite their unique relational configuration and grandparents' frequent involvement in raising their grandchildren. METHOD Guided by Walsh's model of family resilience, semistructured, in-depth qualitative interviews were conducted with a convenience sample of 17 grandmothers whose custodial grandchildren had been reunified with a biological parent. Data analysis was guided by grounded theory methodology. RESULTS Grandmothers believed in parents fulfilling their obligations, prioritizing grandchildren's needs, and coping via their faith. Grandmothers supported reunified parents and children by providing emotional support and instrumental assistance, while maintaining clear role boundaries. Accessing resources and engaging in open family communication were helpful to the reunification, although there were still challenges in navigating family relationships. CONCLUSION Within custodial grandfamilies, not all reunifications were a positive outcome for the grandchildren. Grandmothers remained heavily involved in supporting and monitoring the reunifications, with the quality of the grandmother-parent relationship being paramount. IMPLICATIONS Practitioners should address family dynamics when working with custodial grandfamilies before, during, and after a reunification.
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16
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Lloyd Sieger MH. Reunification for young children of color with substance removals: An intersectional analysis of longitudinal national data. CHILD ABUSE & NEGLECT 2020; 108:104664. [PMID: 32799013 DOI: 10.1016/j.chiabu.2020.104664] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 07/15/2020] [Accepted: 07/31/2020] [Indexed: 05/05/2023]
Abstract
BACKGROUND The opioid epidemic has resulted in increasing attention to the effect of parental substance use disorders on child welfare system involvement, including foster care utilization. Opioid use disorders are more common among whites than people of color, however. OBJECTIVE This study sought to determine number and proportion of children of color with substance removals and whether disparities exist in likelihood of reunification compared to white children. PARTICIPANTS & SETTING This study used U.S. Adoption and Foster Care Analysis and Reporting System (AFCARS) data to determine rates of foster care entries and outcomes between 2007-2017 across intersections of child race/ethnicity, age, and substance removal status. METHODS Survival analyses were employed to test the primary research questions. RESULTS During the 10 year period observed, the number and proportion of white children with substance removals (ages 0-4 and 5+) in foster care increased two- to three-fold compared to children of color with substance removals depending on child age. However, children of color, particularly ages 0-4, faced disadvantages respecting foster care outcomes. Results of the multivariate proportional hazards models revealed that reunification was significantly and substantially more likely for every group compared to young (0-4) children of color with substance removals. Further probing revealed that racial disparities were driven primarily by Black/African American children. CONCLUSIONS Children of color with substance removals, particularly Black/African American children, are at higher risk of poor child welfare outcomes compared to their white peers.
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Affiliation(s)
- Margaret H Lloyd Sieger
- University of Connecticut, School of Social Work, 38 Prospect Street, Room 310, Hartford, CT, 06105, United States.
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17
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Ward B, Kippen R, Reupert A, Maybery D, Agius PA, Quinn B, Jenkinson R, Hickman M, Sutton K, Goldsmith R, Dietze PM. Parent and child co-resident status among an Australian community-based sample of methamphetamine smokers. Drug Alcohol Rev 2020; 40:1275-1280. [PMID: 32896037 DOI: 10.1111/dar.13155] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 07/09/2020] [Accepted: 07/20/2020] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Children in families where there is substance misuse are at high risk of being removed from their parents' care. This study describes the characteristics of a community sample of parents who primarily smoke methamphetamine and their child or children's residential status. DESIGN AND METHODS Baseline data from a prospective study of methamphetamine smokers ('VMAX'). Participants were recruited via convenience, respondent-driven and snowball sampling. Univariable and multivariable logistic regression analyses were used to estimate associations between parental status; fathers' or mothers' socio-demographic, psychosocial, mental health, alcohol, methamphetamine use dependence, alcohol use and child or children's co-residential status. RESULTS Of the 744 participants, 394 (53%) reported being parents; 76% (88% of fathers, 57% of mothers) reported no co-resident children. Compared to parents without co-resident children, parents with co-resident children were more likely to have a higher income. Fathers with co-resident children were more likely to be partnered and not to have experienced violence in the previous 6 months. Mothers with co-resident children were less likely to have been homeless recently or to have accessed treatment for methamphetamine use. DISCUSSION AND CONCLUSIONS The prevalence of non-co-resident children was much higher than previously reported in studies of parents who use methamphetamine; irrespective of whether in or out of treatment. There is a need for accessible support and services for parents who use methamphetamine; irrespective of their child or children's co-residency status. Research is needed to determine the longitudinal impact of methamphetamine use on parents' and children's wellbeing and to identify how parents with co-resident children (particularly mothers) can be supported.
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Affiliation(s)
- Bernadette Ward
- School of Rural Health, Monash University, Bendigo, Australia.,Burnet Institute, Melbourne, Australia
| | - Rebecca Kippen
- School of Rural Health, Monash University, Bendigo, Australia
| | - Andrea Reupert
- Faculty of Education, Monash University, Melbourne, Australia
| | - Darryl Maybery
- School of Rural Health, Monash University, Warragul, Australia
| | - Paul A Agius
- Burnet Institute, Melbourne, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Brendan Quinn
- Burnet Institute, Melbourne, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,Australian Institute of Family Studies, Melbourne, Australia
| | - Rebecca Jenkinson
- Burnet Institute, Melbourne, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,Australian Institute of Family Studies, Melbourne, Australia
| | - Matthew Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Keith Sutton
- Burnet Institute, Melbourne, Australia.,School of Rural Health, Monash University, Warragul, Australia
| | | | - Paul M Dietze
- Burnet Institute, Melbourne, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,National Drug Research Institute, Curtin University, Perth, Australia
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18
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Boreham M, Marlow S, Gilchrist G. "..that warm feeling that [alcohol] gave me was what I interpreted love would feel like.." Lived experience of excessive alcohol use and care proceedings by mothers in the family justice system in the UK. Addict Behav 2019; 92:186-193. [PMID: 30654324 DOI: 10.1016/j.addbeh.2018.12.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Revised: 11/13/2018] [Accepted: 12/22/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND When mothers who have been identified as using alcohol excessively appear in child care proceedings seeking to retain care of, or be reunited with, their children, family courts primarily focus on whether those mothers can make lasting changes to their use of alcohol, very often requiring them to achieve abstinence. The aim of this study was to advance the evidence base around how such mothers make sense of their alcohol use, and their position as mothers, in the systems and processes around care proceedings. METHODS Qualitative, face-to-face interviews were carried out at various children and families' services locations across the UK. These yielded in-depth accounts, to which Interpretative Phenomenological Analysis (IPA) was applied. RESULTS Six mothers were recruited from collaborations with 31 local authorities. Themes relating to alcohol use included relationships in childhood, repeated traumatic events, and the use of alcohol to self-manage these. In response to extreme fear arising from violence in their relationships with older men, alcohol provided the means to function. Escalation of alcohol use in participants' lives was accompanied by greater isolation, alongside shameful feelings about being a "drunk", which were barriers to help-seeking. Themes relating to motherhood in the context of care proceedings included wanting to change behaviour for themselves and their children, being excluded from their children's lives, and experiencing a continual requirement to prove their parenting and their abstinence from alcohol. Language used by social services, the courts and alcohol treatment services, placed mothers in conflicting positions of being in recovery, but having to present as recovered. CONCLUSION Despite excessive alcohol misuse in mothers being closely enmeshed with other issues, awareness and understanding of factors such as complex trauma, and how to support mothers with these factors, is limited, and should be considered in terms of improving research and best practice.
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Affiliation(s)
- Maggie Boreham
- National Addiction Centre, King's College London, 4 Windsor Walk, London SE5 8BB, UK.; Pause Hackney, Hackney Service Centre, 1 Hillman Street, London E8 1DY, UK
| | - Sally Marlow
- National Addiction Centre, King's College London, 4 Windsor Walk, London SE5 8BB, UK.; Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience at King's College London, De Crespigny Park, London SE5 8AF, UK.
| | - Gail Gilchrist
- National Addiction Centre, King's College London, 4 Windsor Walk, London SE5 8BB, UK
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Raynor PA, Pope C, York J, Smith G, Mueller M. Exploring Self-Care and Preferred Supports for Adult Parents in Recovery from Substance Use Disorders: Qualitative Findings from a Feasibility Study. Issues Ment Health Nurs 2017; 38:956-963. [PMID: 29028365 DOI: 10.1080/01612840.2017.1370520] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Very little is known about the self-care behaviors (SCB) that adult parents employ and the preferred supports they utilize to maintain their recovery from substance use disorders (SUD) while also parenting their children. This study used a qualitative descriptive approach to explore perceptions of self-care and parenting to inform future self-care interventions for parents in early recovery. Nineteen mothers and fathers of at least one child between the ages of 6-18 were interviewed by telephone about parental self-care practices while in recovery from SUD, recovery management, and preferred supports in the community. Participants described the experience of parenting as challenging, with variations in the level of support and resources. Self-care included meaningful connection with recovery support and children, taking care of physical health, maintaining spirituality, healthy eating, exercise, journaling, continuing education, staying busy, sponsorship, establishing boundaries, self-monitoring, abstinence, and dealing with destructive emotions. Participants reported SCB as being a critical component of their ongoing recovery and their parenting practices, though differences in SCB by gender and for minorities require further exploration. Parental gains were perceived as benefits of SCB that minimized the negative impact of prior parental drug use on their children.
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Affiliation(s)
- Phyllis A Raynor
- a University of South Carolina, College of Nursing , Columbia , South Carolina , USA
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20
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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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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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