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Ehrenthal DB, Wang Y, Pac J, Durrance CP, Kirby RS, Berger LM. Trends in prenatal prescription opioid use among Medicaid beneficiaries in Wisconsin, 2010-2019. J Perinatol 2024; 44:1111-1118. [PMID: 38561393 DOI: 10.1038/s41372-024-01954-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 03/20/2024] [Accepted: 03/25/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVE To examine changes in prenatal opioid prescription exposure following new guidelines and policies. STUDY DESIGN Cohort study of all (262,284) Wisconsin Medicaid-insured live births 2010-2019. Prenatal exposures were classified as analgesic, short term, and chronic (90+ days), and medications used to treat opioid use disorder (MOUD). We describe overall and stratified temporal trends and used linear probability models with interaction terms to test their significance. RESULT We found 42,437 (16.2%) infants with prenatal exposure; most (90.5%) reflected analgesic opioids. From 2010 to 2019, overall exposure declined 12.8 percentage points (95% CI = 12.1-13.1). Reductions were observed across maternal demographic groups and in both rural and urban settings, though the extent varied. There was a small reduction in chronic analgesic exposure and a concurrent increase in MOUD. CONCLUSION Broad and sustained declines in prenatal prescription opioid exposure occurred over the decade, with little change in the percentage of infants chronically exposed.
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Affiliation(s)
- Deborah B Ehrenthal
- Department of Biobehavioral Health, College of Health and Human Development, The Pennsylvania State University, University Park, PA, USA.
- Social Science Research Institute, The Pennsylvania State University, University Park, PA, USA.
| | - Yi Wang
- Social Science Research Institute, The Pennsylvania State University, University Park, PA, USA
- Silberman School of Social Work, Hunter College, City University of New York, New York, NY, USA
| | - Jessica Pac
- Sandra Rosenbaum School of Social Work, College of Letters and Sciences, University of Wisconsin-Madison, Madison, WI, USA
- Institute for Research on Poverty, College of Letters and Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | - Christine Piette Durrance
- Institute for Research on Poverty, College of Letters and Sciences, University of Wisconsin-Madison, Madison, WI, USA
- La Follette School of Public Affairs, University of Wisconsin-Madison, Madison, WI, USA
| | - Russell S Kirby
- Chiles Center, College of Public Health, University of South Florida, Tampa, FL, USA
| | - Lawrence M Berger
- Sandra Rosenbaum School of Social Work, College of Letters and Sciences, University of Wisconsin-Madison, Madison, WI, USA
- Institute for Research on Poverty, College of Letters and Sciences, University of Wisconsin-Madison, Madison, WI, USA
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2
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Sieger ML, Morin JC, Budris LM, Sienna M, Ostfeld-Johns S, Hart L, Morosky C. A Comparison of Two Statewide Datasets to Understand Population Prevalence of Substance Use in Pregnancy: Findings and Considerations for Policy & Research. Matern Child Health J 2024; 28:1121-1131. [PMID: 38539033 PMCID: PMC11060901 DOI: 10.1007/s10995-024-03914-6] [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] [Accepted: 02/12/2024] [Indexed: 04/04/2024]
Abstract
Mental health conditions including substance use disorder are the leading cause of pregnancy-related deaths in the U.S. Unfortunately, fears of child protective services' involvement interfere with maternal self-disclosure of substance use in pregnancy. Seeking to identify more mothers with substance use disorder in pregnancy or at delivery, and responsive to changes to the federal Child Abuse Prevention and Treatment Act (CAPTA), Connecticut requires hospital personnel to submit a deidentified notification to CPS for all newborns with prenatal substance exposure. However, it is unknown whether this approach aligns with maternal self-report on substance use. For the present study, we compared population parameters derived from CAPTA notifications submitted between March-December 2019 with parameters derived from self-report data on substance use in pregnancy from mothers who gave birth during the same timeframe. Results revealed that three times as many mothers self-reported any alcohol or drug use in pregnancy compared to the rate measured with CAPTA notifications. Compared to mothers who self-reported drug use in the third trimester, CAPTA notifications were made for statistically similar rates of Black mothers but half the self-reported rate of White and Hispanic mothers. This disparity reflects that CAPTA notifications were made for twice as many Black mothers as White or Hispanic. Although CAPTA notifications are not punitive in nature, this disparity reveals that the public health aims of this policy are not yet achieved.
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Affiliation(s)
- Margaret Lloyd Sieger
- School of Social Work, University of Connecticut, Hartford, CT, USA.
- School of Social Work, University of Connecticut, 38 Prospect Street, Room 310, Hartford, CT, 06105, USA.
| | | | - Lisa M Budris
- Connecticut Department of Public Health, Hartford, CT, USA
| | - Melissa Sienna
- CT Department of Children and Families, UCONN Health, Farmington, CT, USA
| | - Sharon Ostfeld-Johns
- Department of Pediatrics, Section of Hospital Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Lou Hart
- Department of Pediatrics, Section of Hospital Medicine, Yale School of Medicine, New Haven, CT, USA
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3
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Dubinin A, Bialostozky M, Richardson A, Laub N. Presentation, Management, and Child Protective Service Reporting of Children Who Test Positive for Cannabis in an Emergency Room Setting. Pediatr Emerg Care 2024; 40:443-448. [PMID: 38471748 DOI: 10.1097/pec.0000000000003145] [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] [Indexed: 03/14/2024]
Abstract
OBJECTIVES Rates of cannabis ingestion among young children are increasing. Small studies have evaluated symptomatology of these children. The literature lacks research regarding factors influencing medical management. Our goal was to 1) understand circumstances leading to exposure over time and 2) gain insight into factors that may influence emergency room management and Child Protective Services reporting over time. METHODS Retrospective cross-sectional study on children younger than 10 years with cannabis-positive urine drug screens in the emergency room setting. Single-factor analysis of variance and Fisher exact tests were used to assess for trends. Two-tailed t tests and Fisher exact tests were used to compare management of children presenting to the emergency room with chief complaint (CC) "ingestion" versus those without. RESULTS Of the 179 children, the mean age was 3.7 years and 48% were boys. We observed a significant increase over time in cannabis-positive children. The most common location of exposure was the primary residence (54%), with parents as the most frequent users (46%). In the emergency department, the most common CC was ingestion followed by altered mental status and fatigue. Children with an "ingestion" CC were managed with less testing than those with other CCs. They received fewer needle sticks (43% vs 91%), less imaging (5% vs 56% computed tomography heads), and fewer procedures (0% vs 8% lumbar punctures). Children with "ingestion" CC were less likely to be reported to Child Protective Services. CONCLUSIONS Pediatric cannabis exposures are increasing and have a wide array of clinical presentations that complicate emergency room management. Parental report of cannabis ingestion seems to impact and reduce potentially unnecessary testing.
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Kaufman JS, Yonkers KA, Maltz C, Friedhoff CM, Londoño Tobon A, Mele A, Tessier-Kay M, Grechukhina O, Lipkind H, Byatt N, Forray A. Reporting Perinatal Substance Use to Child Protective Services: Obstetric Provider Perspectives on the Impact on Care. J Womens Health (Larchmt) 2024. [PMID: 38770764 DOI: 10.1089/jwh.2023.0822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024] Open
Abstract
Objective: To understand obstetric provider perspectives on child protective services (CPS)-mandated reporting requirements and how they affect care for pregnant and postpartum patients with opioid use disorder (OUD). Methods: Key informant interviews were conducted virtually with obstetricians, nurse practitioners, and social workers caring for obstetric patients (n = 12). Providers were asked about their experience as mandated reporters working with patients with OUD. Transcripts were independently coded by two staff, and content analysis was used to identify themes. Results: Our analysis resulted in six thematic areas, including CPS-mandated strengths, concerns related to CPS reporting requirements, implementation of mandates, supporting patients after CPS report, communication between stakeholders, and the impact on care. Providers noted that the fear of CPS involvement causes some patients to delay or not engage in care. Other patients are hesitant to accept medications for OUD for fear of CPS involvement. The inconsistencies in how reporting mandates are applied and how CPS handles cases make communication about the policies challenging for providers and create anxiety for patients. Conclusions: The results of this study indicate that mandated reporting requirements and the potential for CPS involvement are perceived to have minimal positive effects on perinatal individuals with OUD and may negatively affect patients and their care. Clinicaltrials.gov number: NCT04240392.
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Affiliation(s)
- Joy S Kaufman
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Kimberly A Yonkers
- Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Caro Maltz
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Carolyn M Friedhoff
- Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Amalia Londoño Tobon
- Department of Psychiatry, Georgetown University School of Medicine, Washington, District of Columbia, USA
| | - Amanda Mele
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Olga Grechukhina
- Department of Obstetrics, Gynecology & Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut, USA
| | - Heather Lipkind
- Department of Obstetrics & Gynecology, Weill Cornell Medicine, New York, New York, USA
| | - Nancy Byatt
- Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Ariadna Forray
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
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5
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Rebbe R, Malicki D, Siddiqi N, Huang JS, Putnam-Hornstein E, Laub N. Child Protection System Interactions for Children With Positive Urine Screens for Illicit Drugs. JAMA Netw Open 2024; 7:e243133. [PMID: 38512254 PMCID: PMC10958236 DOI: 10.1001/jamanetworkopen.2024.3133] [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: 11/07/2023] [Accepted: 01/26/2024] [Indexed: 03/22/2024] Open
Abstract
Importance Young children are ingesting illicit drugs at increased rates, but it is unknown what the associated child protection system (CPS) responses are when a child tests positive. Objective To document the child protection system involvement and the characteristics of children who test positive for illicit substances. Design, Setting, and Participants This retrospective cross-sectional study linked medical discharge and child protection system administrative data. The setting was Rady Children's Hospital San Diego, a free-standing pediatric hospital in California. Participants included all emergency department and inpatient medical encounters involving children aged 12 years or younger with a positive urine drug test between 2016 and 2021. Statistical analysis was performed from February 2023 to January 2024. Exposure Drug type, including amphetamines, barbiturates, benzodiazepines, cannabis, cocaine, fentanyl, opiates, and phencyclidine. Main Measures and Outcomes CPS responses associated with the medical encounter including reports, substantiations, case openings, and out-of-home placements. Results A total of 511 emergency department and inpatient medical encounters involving children had a positive drug test (262 [51.3%] were female; 309 [60.5%] were age 6 years or younger; fewer than 10 [<3.0%] were American Indian or Alaska Native; 252 [49.3%] were Hispanic [any race], 20 [3.9%] were non-Hispanic Asian, 56 [11.0%] were non-Hispanic Black, 143 [28.0%] were non-Hispanic White, 36 [7.0%] had other or unknown race and ethnicity; 233 [43.6%] had a CPS report prior to the medical encounter). Following the positive screen, 244 (47.7%) were reported to child protection, and 61 (11.9%) were placed out-of-home within 30 days. Mean (SD) quarterly counts of encounters with positive drug tests doubled after the COVID-19 pandemic onset (32.9 [9.8]) compared with prior to the pandemic onset (16.5 [4.7]); for encounters positive for cannabis, mean (SD) quarterly counts were 3 times as high after the pandemic onset than prior (16.6 [4.7] vs 5.7 [2.9]). Encounters for children under age 1 were significantly more likely to have associated child protection reports (relative risk [RR], 2.91 [95% CI, 2.21-3.83]) and child protection case openings (RR, 1.71 [95% CI, 1.07-2.72]) than encounters involving older children. Conclusions and Relevance In this cross-sectional study of emergency department and inpatient medical encounters, less than half of children with positive urine drug screens were reported to CPS; out-of-home placements were uncommon. With increased encounters for positive drug tests, it is unclear what services these children and families are receiving.
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Affiliation(s)
- Rebecca Rebbe
- University of North Carolina at Chapel Hill School of Social Work, Chapel Hill
| | - Denise Malicki
- University of California, San Diego
- Rady Children’s Hospital, San Diego, California
- Chadwick Center for Children and Families, San Diego, California
| | - Nadia Siddiqi
- Nova Southeastern University, Fort Lauderdale, Florida
| | - Jeannie S. Huang
- University of California, San Diego
- Rady Children’s Hospital, San Diego, California
| | | | - Natalie Laub
- University of California, San Diego
- Rady Children’s Hospital, San Diego, California
- Chadwick Center for Children and Families, San Diego, California
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Chaiyachati BH, Deutsch SA. Improving health and well-being for infants with prenatal substance exposure. Curr Probl Pediatr Adolesc Health Care 2024; 54:101572. [PMID: 38431453 PMCID: PMC11025014 DOI: 10.1016/j.cppeds.2024.101572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
Substance use disorders (SUD) among caregiving adults has inexorable linkage to the health and well-being of millions of children in the U.S. This piece provides an overview of such linkages, examples of relevant policies and regulations, and the role of pediatric healthcare within the health trajectories of children and families at this intersection. A commonality throughout this work is need for non-stigmatizing engagement and support to facilitate connections to care and reduce barriers.
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Affiliation(s)
- Barbara H Chaiyachati
- Department of Pediatrics, Perelman School of Medicine, and Leonard Davis Institute, University of Pennsylvania, Philadelphia, PA, USA; Division of General Pediatrics, Clinical Futures & Policy Lab, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Stephanie A Deutsch
- Department of Pediatrics, Nemours Children's Hospital, Delaware, Wilmington, DE, USA; Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
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Reddy J, Palmer L, Putnam-Hornstein E. Three-Year Custody Outcomes Among Infants Investigated by Child Protection Systems for Prenatal Substance Exposure in California. Matern Child Health J 2023; 27:94-103. [PMID: 37256517 PMCID: PMC10692263 DOI: 10.1007/s10995-023-03690-9] [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] [Accepted: 05/16/2023] [Indexed: 06/01/2023]
Abstract
OBJECTIVE Infants affected by prenatal alcohol and drug use are more likely to be removed from parental custody than those in the general population, although it is unclear whether their custody outcomes differ from infants investigated by child protection systems (CPS) for other reasons. This analysis seeks to compare trajectories of involvement and custody outcomes among infants investigated by CPS with and without documentation of prenatal substance exposure (PSE). METHOD We used vital birth records linked to administrative CPS records to examine the timing of system involvement and 3-year custodial outcomes among investigated infants with and without identified PSE. We defined PSE according to documentation on the state's standardized hotline screening form, which CPS completes upon referral for alleged maltreatment. We estimated the likelihood a child was in nonparental custody at age 3 by specifying multivariable generalized linear models, adjusted for covariates available in the birth record. RESULTS In our sample of 22,855 infants investigated by CPS in 2017 in California, more than 26% had documentation of PSE. These infants experienced an accelerated timeline of system penetration and were 2.2 times as likely to be in nonparental placement at age 3. DISCUSSION PSE confers an independent risk of custody interruption among infants investigated by CPS. The younger age of these infants, complexity of parental substance use, and potential misalignment of administrative permanency timelines with parental recovery all suggest the need for increased research, policy, and programmatic interventions to serve this vulnerable population.
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Affiliation(s)
- Julia Reddy
- Gillings School of Global Public Health, University of North Carolina, 412 Rosenau Hall, Chapel Hill, NC, 27599, USA.
| | - Lindsey Palmer
- The Pennsylvania State University, 133 Health and Human Development Building, University Park, PA, 16802, USA
| | - Emily Putnam-Hornstein
- School of Social Work, University of North Carolina at Chapel Hill, Tate-Turner-Kuralt Building, 325 Pittsboro St, Chapel Hill, NC, 27599-3550, USA
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8
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Stritzel H. Substance Use-Associated Infant Maltreatment Report Rates in the Context of Complex Prenatal Substance Use Policy Environments. CHILD MALTREATMENT 2023:10775595231213404. [PMID: 37955183 DOI: 10.1177/10775595231213404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
State responses to substance use during pregnancy have included policies designed to increase access to substance use treatment as well as punish such substance use. Prior research has found that punitive policies are associated with increased rates of child maltreatment reporting, but it is unclear if the presence of punitive-promoting policies also moderate the association between access-promoting polices and maltreatment reports. Using data from the National Child Abuse and Neglect Data System and state-level fixed effects models, this study investigates how interactions between access-promoting and punitive prenatal substance use policies are associated with rates of substance use-associated maltreatment reports among infants. In states with punitive policies, access-promoting policies were associated with smaller decreases in these reports than in states without punitive policies. In some cases, access-promoting policies were associated with greater increases in these reports when punitive policies were also present than when only one type of policy was adopted. Interactions between prenatal substance use policies may result in unintended and counterproductive consequences for maternal and child health and the child welfare system.
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Affiliation(s)
- Haley Stritzel
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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9
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Morehouse E, Ingoldsby E, Newburg-Rinn S, Bertrand J, Usher K. Knowledge, Training, and Support Needs for Identification and Appropriate Care of Children with Prenatal Alcohol and Other Drug Exposures in the Child Welfare System. CHILD WELFARE 2023; 101:51-76. [PMID: 38415275 PMCID: PMC10896263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
Increased awareness of the conditions associated with prenatal substance exposure may enhance care delivery among professionals working in child welfare. The ways in which prenatal substance exposure intersects with child welfare are critically important, yet prenatal substance exposure knowledge is uneven among these professionals. Also, caregivers may lack information that prepares them to care for children with prenatal substance exposure, particularly children with prenatal alcohol exposure. This study explores what professionals working in child welfare and caregivers know about prenatal substance exposure and prenatal alcohol exposure and their training and support needs.
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Affiliation(s)
| | | | - Sharon Newburg-Rinn
- Children's Bureau, Administration for Children and Families U.S. Department of Health and Human Services
| | - Jacquelyn Bertrand
- National Center on Birth Defects and Developmental Disabilities Centers for Disease Control and Prevention
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10
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Zaugg C, Terplan M, Roberts SCM. Clinician views on reporting pregnant and birthing patients who use alcohol and/or drugs to child welfare. Am J Obstet Gynecol MFM 2023; 5:101109. [PMID: 37524258 DOI: 10.1016/j.ajogmf.2023.101109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/17/2023] [Accepted: 07/21/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND Multiple health professional associations have expressed concern with policies that require clinician reporting of pregnant people's substance use to child welfare, including that reporting negatively affects patient outcomes and the patient-provider relationship. However, research has shown that clinicians continue to report pregnant and birthing patients at high rates. OBJECTIVE This study aimed to explore clinician views on reporting pregnant and birthing patients who use alcohol or drugs during pregnancy to child welfare and whether there are patterns in the types of decisions that clinicians agree with, disagree with, or feel conflicted about. STUDY DESIGN In-depth interviews were conducted with 37 hospital-based clinicians (13 obstetrics and gynecology physicians, 12 emergency medicine physicians, 10 family medicine physicians, and 2 advance practice registered nurses) in the United States. The participants discussed one or more patient cases where they or someone else on the care team had to decide whether to report that patient to child welfare related to their use of alcohol or drugs during pregnancy. Cases were categorized on the basis of whether the participant agreed, disagreed, or was conflicted by the reporting decision in that case. Patterns were explored by patient-level factors, provider specialty, and whether the participant perceived that the decision was influenced by a state or hospital policy. RESULTS A total of 53 patient cases (average 2 per interview) were identified. The participants typically described cases where they agreed with the decision to report or believed there was no other option than reporting. These cases typically involved patients who used nonprescribed opioids during pregnancy, were experiencing factors (eg, unstable housing and untreated mental health disorders) in addition to substance use, and/or left the hospital against medical advice without their infant. Moreover, some participants, mostly obstetricians and gynecologists, described cases where they felt conflicted about or disagreed with the decision to report. These cases typically involved pregnant patients using cannabis and patients reported because of hospital and/or state policy. Only 1 participant described a case where they disagreed with the decision to not report. CONCLUSION The participants agreed with most, but not all, child welfare reporting decisions. When participants disagreed or felt conflicted with reporting decisions, these feelings were almost entirely related to decisions to report, which, in some cases, were prompted by hospital or state policies. Policies may prompt reporting that exceeds what clinicians believe is appropriate.
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Affiliation(s)
- Claudia Zaugg
- Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, Oakland, CA (Ms Zaugg and Dr Roberts).
| | | | - Sarah C M Roberts
- Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, Oakland, CA (Ms Zaugg and Dr Roberts)
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Wang K, Richards T, Kopiec K, Newburg-Rinn S, Bertrand J. Exploring Child Welfare Practices to Care for Children with Prenatal Substance Exposure. CHILD WELFARE 2023; 101:141-168. [PMID: 38021378 PMCID: PMC10683787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
This article presents findings from a mixed-methods study exploring child welfare agency practices addressing children with prenatal substance exposure and their families. Data sources include: (a) interviews with 159 professionals in child welfare; (b) surveys with 271 professionals in child welfare; and (c) a systematic review of state and local child welfare documents guiding processes in the five states in the study sample. Findings from descriptive statistics of survey data, grounded theory analysis of interviews, and content analysis of documents suggest practices center on infants identified by hospitals as affected by prenatal substance exposure. Without practice guidance and access to treatment services, the needs of older children whose prenatal exposure to substances, including alcohol and other types of legal and illegal substances, is not recognized at birth may be overlooked.
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Affiliation(s)
| | | | | | - Sharon Newburg-Rinn
- Children's Bureau, Administration, for Children and Families, U.S. Department of Health and Human Services
| | - Jacquelyn Bertrand
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention
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12
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Siegel MR, Cohen SJ, Koenigs K, Woods GT, Schwartz LN, Sarathy L, Chou JH, Terplan M, Wilens T, Ecker JL, Bernstein SN, Schiff DM. Assessing the clinical utility of toxicology testing in the peripartum period. Am J Obstet Gynecol MFM 2023; 5:100963. [PMID: 37030508 DOI: 10.1016/j.ajogmf.2023.100963] [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: 01/23/2023] [Revised: 03/30/2023] [Accepted: 03/31/2023] [Indexed: 04/10/2023]
Abstract
BACKGROUND Toxicology testing is frequently used as a means of gathering objective data about substance use in pregnancy, but little is known about the clinical utility of testing in the peripartum setting. OBJECTIVE This study aimed to characterize the utility of obtaining maternal-neonatal dyad toxicology testing at the time of delivery. STUDY DESIGN We performed a retrospective chart review of all deliveries in a single healthcare system in Massachusetts between 2016 and 2020, and identified deliveries with either maternal or neonatal toxicology testing at delivery. An unexpected result was defined as a positive test for a nonprescribed substance that was not known on the basis of clinical history, self-report, or previous toxicology testing within a week of delivery, excluding results for cannabis. We evaluated the characteristics of maternal-infant dyads with unexpected positive results, unexpected positive results by rationale for testing, changes in clinical management after an unexpected positive test, and maternal outcomes in the year after delivery using descriptive statistics. RESULTS Of the 2036 maternal-infant dyads with toxicology tests performed during the study period, there were 80 (3.9%) with an unexpected positive result. Diagnosis of substance use disorder with active use in the last 2 years was the clinical rationale for testing that yielded the greatest number of unexpected positive results (10.7% of total tests ordered for this rationale). Inadequate prenatal care (5.8%), maternal use of medication for opioid use disorder (3.8%), maternal medical indications such as hypertension or placental abruption (2.3%), history of substance use disorder in remission (1.7%), or maternal cannabis use (1.6%) yielded lower rates of unexpected results compared with a recent substance use disorder (within the last 2 years). Solely on the basis of findings from unexpected test results, 42% of dyads were referred to child protective services, 30% of dyads had no documentation of maternal counseling during delivery hospitalization, and 31% did not receive breastfeeding counseling after an unexpected test; 22.8% had monitoring for neonatal opioid withdrawal syndrome. Postpartum, 26 (32.5%) were referred to substance use disorder treatment, 31 (38.8%) attended a postpartum mental health visit, and only 26 (32.5%) attended a postpartum visit. Fifteen individuals (18.8%) were readmitted in the year after delivery, all for substance-related medical complications. CONCLUSION Unexpected positive toxicology results at delivery were uncommon, particularly when tests were sent for frequently used clinical rationales for testing, suggesting a need to revisit guidelines surrounding appropriateness of indications for toxicology testing. The poor maternal outcomes in this cohort highlight a missed opportunity for maternal connection to counseling and treatment in the peripartum period.
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Affiliation(s)
- Molly R Siegel
- Department of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital, Boston, MA (Dr Siegel, Dr Koenigs, Dr Woods, Dr Ecker, and Dr Bernstein).
| | - Samuel J Cohen
- Department of Pediatrics, Boston Medical Center, Boston, MA (Dr Cohen)
| | - Kathleen Koenigs
- Department of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital, Boston, MA (Dr Siegel, Dr Koenigs, Dr Woods, Dr Ecker, and Dr Bernstein)
| | - Gregory T Woods
- Department of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital, Boston, MA (Dr Siegel, Dr Koenigs, Dr Woods, Dr Ecker, and Dr Bernstein)
| | | | - Leela Sarathy
- Division of Newborn Medicine, Massachusetts General Hospital for Children, Boston, MA (Dr Sarathy and Dr Chou)
| | - Joseph H Chou
- Division of Newborn Medicine, Massachusetts General Hospital for Children, Boston, MA (Dr Sarathy and Dr Chou)
| | | | - Timothy Wilens
- Division of Child and Adolescent Psychiatry, Massachusetts General Hospital, Boston, MA (Dr Wilens)
| | - Jeffrey L Ecker
- Department of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital, Boston, MA (Dr Siegel, Dr Koenigs, Dr Woods, Dr Ecker, and Dr Bernstein)
| | - Sarah N Bernstein
- Department of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital, Boston, MA (Dr Siegel, Dr Koenigs, Dr Woods, Dr Ecker, and Dr Bernstein)
| | - Davida M Schiff
- Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, MA (Dr Schiff)
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Siegel MR, Mahowald GK, Uljon SN, James K, Leffert L, Sullivan MW, Hernandez SJ, Gray JR, Schiff DM, Bernstein SN. Fentanyl in the labor epidural impacts the results of intrapartum and postpartum maternal and neonatal toxicology tests. Am J Obstet Gynecol 2022:S0002-9378(22)02185-8. [PMID: 36427599 DOI: 10.1016/j.ajog.2022.11.1293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 10/30/2022] [Accepted: 11/18/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND A positive urine fentanyl toxicology test may have considerable consequences for peripartum individuals, yet the extent to which fentanyl administration in a labor epidural may lead to such a positive test is poorly characterized. OBJECTIVE This study aimed to quantify the extent to which neuraxial fentanyl in labor neuraxial analgesia can lead to a positive peripartum maternal or neonatal urine toxicology test. STUDY DESIGN We performed a prospective cohort study of pregnant participants planning a vaginal delivery with neuraxial analgesia. Participants with a history of substance use disorder, hypertension, or renal or liver disease were excluded. A urine sample was collected before initiation of neuraxial analgesia, each time the bladder was emptied during labor, and up to 4 times postpartum. Neonatal urine was collected once. Urine fentanyl testing was performed using 2 common toxicology testing methods, namely immunoassay and liquid chromatography with tandem mass spectrometric detection. RESULTS A total of 33 maternal-infant dyads yielded a total of 178 urine specimens. All maternal specimens were negative for fentanyl using liquid chromatography with tandem mass spectrometric analysis and immunoassay before initiation of neuraxial analgesia. Intrapartum, 26 of 30 (76.7%) participants had positive liquid chromatography with tandem mass spectrometry results for fentanyl or its metabolites, and 12 of 30 (40%) participants had positive immunoassay results. Postpartum, 19 of 21 (90.5%) participants had positive liquid chromatograph with tandem mass spectrometric results, and 13 of 21 (61.9%) had a positive immunoassay result. Of the 13 neonatal specimens collected, 10 (76.9%) were positive on liquid chromatography with tandem mass spectrometry analysis, the last of which remained positive 29 hours and 50 minutes after delivery. CONCLUSION Neuraxial fentanyl for labor analgesia may lead to positive maternal and neonatal toxicology tests at various times after epidural initiation and cessation and at different rates depending on the testing method used. Caution should be used in interpreting toxicology test results of individuals who received neuraxial analgesia to avoid false assumptions about nonprescribed use.
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Affiliation(s)
- Molly R Siegel
- Departments of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital, Boston, MA.
| | | | - Sacha N Uljon
- Pathology, Massachusetts General Hospital, Boston, MA
| | - Kaitlyn James
- Departments of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital, Boston, MA
| | - Lisa Leffert
- Department of Anesthesiology, Yale School of Medicine, New Haven, CT
| | - Mackenzie W Sullivan
- Departments of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital, Boston, MA
| | - Susan J Hernandez
- Departments of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital, Boston, MA
| | - Jessica R Gray
- Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Davida M Schiff
- Division of General Academic Pediatrics, Massachusetts General Hospital, Boston, MA
| | - Sarah N Bernstein
- Departments of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital, Boston, MA
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14
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He Y, Leventhal JM, Gaither JR, Jones EA, Kistin CJ. Trends from 2005 to 2018 in child maltreatment outcomes with caregivers' substance use. CHILD ABUSE & NEGLECT 2022; 131:105781. [PMID: 35820322 DOI: 10.1016/j.chiabu.2022.105781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 05/22/2022] [Accepted: 07/01/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Caregivers' substance use is associated with child maltreatment. OBJECTIVE Examine trends from 2005 to 2018 in percentages of three outcomes with caregivers' drug or alcohol use: child protective services (CPS) referrals, substantiated maltreatment reports, and foster care placements. PARTICIPANTS AND SETTING 22 U.S. states that contributed child-level maltreatment outcomes and caregivers' substance use data to the National Child Abuse and Neglect Data System from 2005 to 2018. METHODS Joinpoint regression was used to examine the average annual percent change (AAPC) in outcomes with caregivers' drug or alcohol use and to identify temporal changes. RESULTS From 2005 to 2018, CPS referrals with caregivers' drug use increased (AAPC 2.33, p < .001), while referrals with alcohol use remained unchanged (AAPC -0.11, p = .92) (trend difference p = .04). Substantiated reports with caregivers' drug and alcohol use increased (AAPC drug use 3.63, p < .001, AAPC alcohol use 1.28, p = .03), with a greater increase observed with drug use (difference p = .03). Foster care placements with caregivers' drug use increased (AAPC 2.54, p < .001), while placements with alcohol use did not change (AAPC -1.22, p = .29), (difference p = .005). Within the study period, changes in trends with caregivers' drug use included increased substantiated reports from 2010 to 2018 (p < .001) and increased foster care placements from 2009 to 2018 (p < .001). With caregivers' alcohol use, CPS referrals and foster care placements decreased from 2007 to 2018 (all p < .001). CONCLUSIONS Trends differed for outcomes with caregivers' drug versus alcohol use. Findings can inform policies to improve care for families affected by substance use.
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Affiliation(s)
- Yuan He
- Department of Pediatrics, Boston Medical Center and Boston University School of Medicine, 801 Albany Street, Boston, MA 02119, United States of America.
| | - John M Leventhal
- Department of Pediatrics, Yale School of Medicine, 20 York Street, New Haven, CT 06510, United States of America
| | - Julie R Gaither
- Department of Pediatrics, Yale School of Medicine, 20 York Street, New Haven, CT 06510, United States of America
| | - Eric A Jones
- Biostatistics and Epidemiology Data Analytics Center (BEDAC), 85 East Newton Street, Boston, MA 02118, United States of America
| | - Caroline J Kistin
- Department of Pediatrics, Boston Medical Center and Boston University School of Medicine, 801 Albany Street, Boston, MA 02119, United States of America
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15
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Austin AE, Gest C, Atkeson A, Berkoff MC, Puls HT, Shanahan ME. Prenatal Substance Exposure and Child Maltreatment: A Systematic Review. CHILD MALTREATMENT 2022; 27:290-315. [PMID: 33550839 DOI: 10.1177/1077559521990116] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
State and federal policies regarding substance use in pregnancy, specifically whether a notification to child protective services is required, continue to evolve. To inform practice, policy, and future research, we sought to synthesize and critically evaluate the existing literature regarding the association of prenatal substance exposure with child maltreatment. We conducted a comprehensive electronic search of PubMed, Web of Science, PsycInfo, CHINAL, Social Work Abstracts, Sociological Abstracts, and Social Services Abstracts. We identified 30 studies that examined the association of exposure to any/multiple substances, cocaine, alcohol, opioids, marijuana, and amphetamine/methamphetamine with child maltreatment. Overall, results indicated that substance exposed infants have an increased likelihood of child protective services involvement, maternal self-reported risk of maltreatment behaviors, hospitalizations and clinic visits for suspected maltreatment, and adolescent retrospective self-report of maltreatment compared to unexposed infants. While study results suggest an association of prenatal substance exposure with child maltreatment, there are several methodological considerations that have implications for results and interpretation, including definitions of prenatal substance exposure and maltreatment, study populations used, and potential unmeasured confounding. As each may bias study results, careful interpretation and further research are warranted to appropriately inform programs and policy.
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Affiliation(s)
- Anna E Austin
- 359831Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, USA
- Injury Prevention Research Center, University of North Carolina at Chapel Hill, NC, USA
| | - Caitlin Gest
- 359831Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, USA
| | - Alexandra Atkeson
- 359831Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, USA
| | - Molly C Berkoff
- Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, NC, USA
| | - Henry T Puls
- Department of Pediatrics, Children's Mercy Kansas City and School of Medicine, University of Missouri-Kansas City, NC, USA
| | - Meghan E Shanahan
- 359831Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, USA
- Injury Prevention Research Center, University of North Carolina at Chapel Hill, NC, USA
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16
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Rebbe R, Mienko JA, Martinson ML. Reports and Removals of Child Maltreatment-Related Hospitalizations: A Population-Based Study. CHILD MALTREATMENT 2022; 27:235-245. [PMID: 33375836 PMCID: PMC11326083 DOI: 10.1177/1077559520984549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Despite U.S. child protective services (CPS) agencies relying on mandated reporters to refer concerns of child maltreatment to them, there is little data regarding which children mandated reporters decide to report and not to report. This study addresses this gap by utilizing a population-based linked administrative dataset to identify which children who are hospitalized for maltreatment-related reasons are reported to CPS and which are removed by CPS. The dataset was comprised of all children born in Washington State between 1999 and 2013 (N = 1,271,416), all hospitalizations for children under the age of three, and all CPS records. We identified maltreatment-related hospitalizations using standardized diagnostic codes. We examined the records for children with maltreatment-related hospitalizations to identify hospitalization-related CPS reports and if the child was removed from their parents. We tested for differences in these system responses using multinomial regression. About two-thirds of children identified as experiencing a child maltreatment-related hospitalization were not reported to CPS. We found differences in responses by maltreatment subtype and the type of diagnostic code. Children whose hospitalizations were related to abuse and associated with a specific maltreatment code had increased odds of being both reported to CPS and subsequently removed by CPS.
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Affiliation(s)
- Rebecca Rebbe
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Joseph A Mienko
- Center for Social Sector Analytics & Technology, School of Social Work, University of Washington, Seattle, WA, USA
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17
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Peddireddy SR, Austin AE, Gottfredson NC. Factors contributing to level and type of child welfare involvement following prenatal substance exposure: A scoping review. CHILD ABUSE & NEGLECT 2022; 125:105484. [PMID: 35032823 DOI: 10.1016/j.chiabu.2022.105484] [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: 08/16/2021] [Revised: 12/14/2021] [Accepted: 01/03/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND An understanding of factors contributing to variation in child welfare outcomes in cases of prenatal substance exposure (PSE) can help identify gaps in research and practice and guide state and agency policy. OBJECTIVE To summarize the evidence base and identify critical gaps in the literature, we conducted a scoping review regarding individual- and institutional-level factors associated with child welfare decision-marking across the service continuum and caregivers' perceptions of child welfare involvement in cases of PSE. PARTICIPANTS AND SETTING The sample included peer-reviewed studies based in the United States. METHODS We conducted a comprehensive search of four databases for studies investigating 1) sociodemographic, behavioral, policy, or other factors contributing to variation in child welfare outcomes and 2) maternal, family, or provider perceptions of the child welfare process in cases of PSE. We followed an established methodological framework for conducting scoping reviews. RESULTS Of the 23 articles included in the review, 20 explored variation in decision-making across the child welfare services continuum and three examined caregivers' perceptions of child welfare involvement. At the institutional level, provider characteristics, such as agency capacity, were linked to specific child welfare outcomes including reports and removals. At the individual level, factors such as socioeconomic status, race, and substance type were also associated with outcomes across the service continuum. CONCLUSIONS Child welfare agencies use an unsystematic approach in addressing PSE, contributing to a variation in child welfare outcomes and potentially allowing for bias. This review highlights a need for increased resources and guidance for caseworkers.
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Affiliation(s)
- Snigdha R Peddireddy
- Department of Health Behavior, University of North Carolina at Chapel Hill Gillings School of Global Public Health, 135 Dauer Dr., Chapel Hill, NC 27599, USA; Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, 1518 Clifton Rd., Atlanta, GA 30322, USA
| | - Anna E Austin
- Department of Maternal and Child Health, University of North Carolina at Chapel Hill Gillings School of Global Public Health, 135 Dauer Dr., Chapel Hill, NC 27599, USA
| | - Nisha C Gottfredson
- Department of Health Behavior, University of North Carolina at Chapel Hill Gillings School of Global Public Health, 135 Dauer Dr., Chapel Hill, NC 27599, USA.
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18
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Impact of Plans of Safe Care on Prenatally Substance Exposed Infants. J Pediatr 2022; 241:54-61.e7. [PMID: 34699908 PMCID: PMC8792271 DOI: 10.1016/j.jpeds.2021.10.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 10/14/2021] [Accepted: 10/15/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To assess the impact of recent federal statute changes mandating child welfare-based Plan of Safe Care (POSC) supportive programming and community-based linkages to treatment providers, resources, and services for families of infants affected by prenatal substance exposure (IPSE). STUDY DESIGN Retrospective review of Delaware's statewide child welfare case registry data for IPSE birth notifications and subsequent hotline reports for serious physical injury/fatality concerns from November 1, 2018-October 31, 2020. Abstracted variables included IPSE sex, substance exposure type, family characteristics (maternal personal child welfare history or mental health diagnosis, treatment engagement), and POSC referrals. RESULTS Of 1436 IPSE, 1347 (93.8%) had POSC support. Most IPSE (67.2%) had exposure to single substance types prenatally. Nearly 90% avoided out-of-home placement. Nearly one-fourth of mothers delivered a prior IPSE; 40% of mothers had personal histories of childhood protective services involvement. Also, 43.5% of mothers and 9.1% of fathers were referred to community-based resources, including substance use, mental health treatment, parenting classes, and home visiting nursing. Nearly 58% of IPSE were referred for pediatric/developmental assessment. Notably, 0.82% (11 out of 1347) of IPSE with POSC sustained serious physical or fatal injury. CONCLUSIONS POSC promote supportive, potentially protective linkages to community-based programming for IPSE and their families.
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19
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Apfeld JC, Crichton KG, Minneci PC, Puls HT, Cooper JN. Identification of physical abuse-related hospitalizations in young children: Impact of the transition to ICD-10-CM coding. CHILD ABUSE & NEGLECT 2021; 118:105159. [PMID: 34147940 PMCID: PMC8292224 DOI: 10.1016/j.chiabu.2021.105159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 05/28/2021] [Accepted: 06/03/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Administrative healthcare databases are frequently used for child physical abuse (CPA)-related research and surveillance. In October 2015, the United States transitioned to the International Classification of Diseases, Clinical Modification-10th Revision (ICD-10-CM) coding regimen. ICD-10-CM expands coding related to CPA, including codes to differentiate suspected from confirmed CPA. OBJECTIVE This study examined the impact of the transition to ICD-10-CM coding on population-level trends in rates of hospitalizations coded for CPA. PARTICIPANTS AND SETTINGS Hospitalizations coded as related to CPA in children <5 years-of-age from 2010 to 2017 were identified across 19 Statewide Inpatient Databases. METHODS Interrupted time series analyses were used to assess the impact of the coding transition on hospitalizations coded for CPA, overall and by child race/ethnicity. RESULTS Of 9715 hospitalizations coded for CPA, 2797 (29%) occurred after the coding transition, including 51% coded for suspected CPA and 49% coded for confirmed CPA. There was a marginally-significant increase in the trend in CPA-related hospitalization after the coding transition among all children (0.09 per 100,000 children-per-quarter, p = 0.06), a significant increase in the trend among white children (0.15 per 100,000 children-per-quarter, p = 0.01), and no change among Black or Hispanic children. After the coding transition, hospitalizations coded for suspected CPA increased significantly overall (0.10 per 100,000 children-per-quarter, p < 0.001), and in particular among white children (0.12 per 100,000 children-per-quarter, p = 0.01) but not among Black or Hispanic children. CONCLUSIONS The transition to ICD-10-CM differentially impacted trends in hospitalizations coded for CPA by child race/ethnicity. Further research is necessary to discern the reasons for these discrepancies.
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Affiliation(s)
- Jordan C Apfeld
- Center for Surgical Outcomes Research and Center for Innovation in Pediatric Practice, Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Dr., Columbus 43205, OH, USA.
| | - Kristin G Crichton
- Division of Child and Family Advocacy, Nationwide Children's Hospital, 655 E Livingston Ave, Columbus 43205, OH, USA.
| | - Peter C Minneci
- Center for Surgical Outcomes Research and Center for Innovation in Pediatric Practice, Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Dr., Columbus 43205, OH, USA; Department of Surgery, Nationwide Children's Hospital, 700 Children's Dr., Columbus 43205, OH, USA.
| | - Henry T Puls
- Division of Hospital Medicine, Department of Pediatrics, Children's Mercy Kansas City, University of Missouri-Kansas City School of Medicine, 2401 Gillham Road, Kansas City 64108, MO, USA.
| | - Jennifer N Cooper
- Center for Surgical Outcomes Research and Center for Innovation in Pediatric Practice, Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Dr., Columbus 43205, OH, USA.
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20
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Kemper EW, Davis E, Bui AL, DeChalus A, Martos M, McDade JE, Seimears TL, Olszewski AE. The "War on Drugs" Affects Children Too: Racial Inequities in Pediatric Populations. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2021; 21:49-51. [PMID: 33825642 DOI: 10.1080/15265161.2021.1891336] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Emily W Kemper
- University of Washington and Seattle Children's Hospital
| | - Emily Davis
- University of Washington and Seattle Children's Hospital
| | - Anthony L Bui
- University of Washington and Seattle Children's Hospital
| | | | - Melissa Martos
- University of Washington and Seattle Children's Hospital
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21
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Rebbe R, Bishop AS, Ahn J, Mienko JA. Opioid overdose events and child maltreatment indicators: Differential county-level associations. CHILDREN AND YOUTH SERVICES REVIEW 2020; 119:105671. [PMID: 33384462 PMCID: PMC7771646 DOI: 10.1016/j.childyouth.2020.105671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Rebecca Rebbe
- Suzanne Dworak-Peck School of Social Work, University of Southern California, 1150 South Olive Street, Suite 1400, Los Angeles CA USA 90015
| | - Asia S. Bishop
- School of Social Work, University of Washington, 4101 15 Ave NE Seattle WA USA, 98105
| | - Jooree Ahn
- Center for Social Sector Analytics & Technology, School of Social Work, University of Washington, 4101 15 Ave NE Seattle WA USA, 98105
| | - Joseph A. Mienko
- Center for Social Sector Analytics & Technology, School of Social Work, University of Washington, 4101 15 Ave NE Seattle WA USA, 98105
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22
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Lloyd Sieger MH, Rebbe R. Variation in States' Implementation of CAPTA's Substance-Exposed Infants Mandates: A Policy Diffusion Analysis. CHILD MALTREATMENT 2020; 25:457-467. [PMID: 32367745 DOI: 10.1177/1077559520922313] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
In 2016, federal law changed state child welfare mandates related to prenatally substance-exposed infants. Little is known regarding the status or implications of policy implementation. The current study examined thematic clusters among states' policies responsive to this 2016 mandate. Cluster analysis identified four distinct categories of states' implementation: (1) "innovators/early adopters," (2) "early majority," (3) "late majority," and (4) "laggards." Innovator/early adopter states (n = 14) were most likely to have implemented plan of safe care policies consistent with Child Abuse Prevention and Treatment Act (CAPTA). Early majority states (n = 15) have started developing some aspects of CAPTA 2016 but have some aspects that are still in development. Late majority states (n = 17) have adopted few aspects of CAPTA 2016 but had implemented more CAPTA 2003 and 2010 aspects than states in the laggard cluster. Laggard states (n = 6) have implemented the fewest CAPTA prenatal substance exposure domains. In bivariate analyses, the only variable associated with clusters was Census region (e.g., New England), suggesting that states' implementation decisions may be influenced by their regional neighbors.
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Affiliation(s)
| | - Rebecca Rebbe
- School of Social Work, 5116University of Southern California, Los Angeles, CA, USA
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23
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Deutsch SA, Donahue J, Parker T, Hossain J, De Jong A. Factors Associated with Child-Welfare Involvement among Prenatally Substance-Exposed Infants. J Pediatr 2020; 222:35-44.e1. [PMID: 32418814 PMCID: PMC8064022 DOI: 10.1016/j.jpeds.2020.03.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 02/25/2020] [Accepted: 03/17/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To assess factors impacting child-welfare involvement and child abuse and neglect outcomes among prenatally substance-exposed infants. STUDY DESIGN This was a retrospective review of case registry data regarding substance-exposed infants tracked statewide in Delaware from 2014 to 2018. Differences in maternal, infant, and substance exposure factors by level of child-welfare involvement (screened-in vs screened-out case status) and child abuse and neglect outcomes were examined. Screened-in status was defined as case acceptance for investigation, family assessment, or treatment referral. Using logistic regression, associations between factors and screened-in status and between factors and child abuse and neglect outcomes were assessed. Cases involving child abuse and neglect were analyzed qualitatively. RESULTS Among 1222 substance-exposed infants, 70% were screened-in by child welfare for ongoing involvement; 28 (2.3%) of substance-exposed infants were identified as child abuse and neglect victims sustaining serious physical or fatal injury before 1 year of age. Most substance-exposed infants remained with caregivers; few entered foster care. Polysubstance exposure and maternal mental health condition were factors associated with screened-in status. Neither substance exposure type nor maternal mental health condition reliably predicted future child abuse and neglect. CONCLUSIONS Substance-exposed infants had a significant risk for child abuse and neglect. Although maternal and substance exposure factors were associated with screened-in case status, they unreliably predicted future risk of child abuse and neglect.
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Affiliation(s)
- Stephanie Anne Deutsch
- Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE; Department of Pediatrics, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA.
| | | | - Trenee Parker
- Department of Services for Children, Youth and their Families, Wilmington, DE
| | - Jobayer Hossain
- Biostatistics Core, Nemours Biomedical Research, Nemours Children’s Health System, Wilmington, DE
| | - Allan De Jong
- Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE and Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA
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24
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Singh S, Filion KB, Abenhaim HA, Eisenberg MJ. Prevalence and outcomes of prenatal recreational cannabis use in high-income countries: a scoping review. BJOG 2019; 127:8-16. [PMID: 31529594 DOI: 10.1111/1471-0528.15946] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND With expanding recreational cannabis legalisation, pregnant women and their offspring are at risk of potentially harmful consequences. OBJECTIVES To assess the prevalence of recreational cannabis use among pregnant women, health outcomes associated with prenatal recreational cannabis use, and the potential impact of recreational cannabis legalisation on this population. SEARCH STRATEGY Five databases and the grey literature were systematically searched (2000-2019). SELECTION CRITERIA Human studies published in English or French reporting on the prevalence of prenatal recreational cannabis use in high-income countries. DATA COLLECTION AND ANALYSIS Data on study characteristics, prenatal substance use, and health outcomes were extracted and qualitatively synthesised. MAIN RESULTS Forty-one publications met our inclusion criteria. The overall prevalence of prenatal cannabis use varied substantially (min-max: 0.24-22.6%), with the greatest use in the first trimester. In the three studies with temporal data available, rates of prenatal cannabis use increased across years. Only 7/41 and 5/41 studies provided information on gestational age of exposure and frequency of use, respectively. The concomitant use of alcohol, illicit drugs, and tobacco was higher among cannabis users than nonusers. Prenatal cannabis use was associated with select neonatal, but not maternal, health outcomes. There were insufficient data to compare prenatal cannabis use between the pre- and post-legalisation periods. CONCLUSION Cannabis use among pregnant women is prevalent and may be associated with adverse neonatal outcomes. Future studies should assess the gestational age and frequency of cannabis exposure, and usage patterns prior to and following legalisation. TWEETABLE ABSTRACT Women who consume cannabis during pregnancy could risk predisposing their newborns to poor birth outcomes.
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Affiliation(s)
- S Singh
- Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada
| | - K B Filion
- Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada.,Department of Medicine, McGill University, Montreal, Quebec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - H A Abenhaim
- Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada.,Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - M J Eisenberg
- Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.,Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
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