Perinatal Health Profiles Associated With Removal From the Home and Subsequent Child Protective Services Report in Maltreated Infants.

Infants face the highest risk of abuse and neglect nationally. There is a compelling need to understand the individual risk factors and needs of families of maltreated infants so that prevention efforts can be tailored for optimal effectiveness. Using linked birth certificate and CPS records data, we employed latent class analysis to identify distinct profiles of perinatal health factors associated with infant maltreatment. Classes were then regressed onto two key child welfare outcomes-removal from the home and re-report. Results indicated 10 latent classes primarily associated with supervisory neglect and presumed prenatal substance exposure. Rapid repeat pregnancy, smoking during pregnancy and inadequate prenatal care emerged as key risk factors. Presumed substance exposure was associated with high risk of removal from the home and low risk of re-report. The opposite was found for supervisory neglect. Substantial variation existed across classes and types of maltreatment, suggesting a need for tailored prevention strategies.

Opportunities and challenges for family-centered postpartum care during the COVID-19 pandemic: a qualitative study of nurse perspectives.

BACKGROUND: The global COVID-19 pandemic has forced the health care sector to make wide-ranging changes to protect patients as well as providers from the risk of infection. Many of these changes are likely to have greatest impact in contexts of care that employ family-centered care (FCC) models, including perinatal and maternity care. Research conducted in perinatal care settings during the pandemic has shown that some of these restrictions have negatively impacted patient and family experiences and outcomes, while others have been perceived as beneficial. The present qualitative study aimed to understand what changes have occurred in postpartum nursing practice during the pandemic, and how these changes have affected nurses, women and families during their stay in the hospital following a new birth. METHODS: Structured interviews were completed with 20 postpartum nurses from five hospitals across Texas. The interview protocol was designed to elicit information about changes to hospital policies in postpartum units during the pandemic, nurses' attitudes about these changes, perceived benefits and challenges for performance of their duties, and perceived effects on patients and their families. Nurses were recruited for the study using a purposive sampling approach. Interviews were conducted by video conference using Zoom and lasted approximately 30 to 45 min. Data were analyzed using a qualitative descriptive approach. RESULTS: Participants reported that their hospitals placed restrictions on the number and mobility of support persons allowed to stay with the mother in the unit and prohibited all other visitation. Some challenges of these policies included reduced opportunities for hands-on learning and an increased number of patients opting for early discharge. Perceived benefits for patient education and outcomes included improved frequency and effectiveness of nurse-family communication, increased father involvement, and greater opportunities for maternal rest, breastfeeding, skin-to-skin care and family bonding. CONCLUSIONS: Study findings suggest that some limitations on postpartum hospital visitation may achieve important, family-centered goals. Protected time for family-bonding, maternal rest, breastfeeding, father involvement and individualized education are critical to quality FCC. Research must examine which visitation policies maximize these benefits while preserving patient access to family and social support.

NICU and postpartum nurse perspectives on involving fathers in newborn care: a qualitative study.

BACKGROUND: Perinatal care nurses are well positioned to provide the education and support new fathers need to navigate the transition to fatherhood and to encourage positive father involvement from the earliest hours of a child's life. To effectively serve fathers in perinatal settings, it is important to understand the attitudes, beliefs, and behaviors of healthcare providers that may encourage and engage them, or alternatively alienate and discourage them. METHODS: This qualitative study involved structured interviews with ten NICU and postpartum nurses from hospitals in two large Texas cities. The interview protocol was designed to elicit descriptive information about nurses' attitudes and beliefs, sense of efficacy and intention for working with fathers, as well as their father-directed behaviors. Nurses were recruited for the study using a purposive sampling approach. Interviews were conducted by telephone and lasted approximately 25 to 35 min. Data were analyzed using a qualitative descriptive approach. RESULTS: Overall, study participants held very positive subjective attitudes toward fathers and father involvement. Nevertheless, many of the nurses signaled normative beliefs based on race/ethnicity, gender, and culture that may moderate their intention to engage with fathers. Participants also indicated that their education as well as the culture of perinatal healthcare are focused almost entirely on the mother-baby dyad. In line with this focus on mothers, participants comments reflected a normative belief that fathers are secondary caregivers to their newborns, there to help when the mother is unavailable. CONCLUSIONS: Nurse attitudes and practices that place mothers in the role of primary caregiver may be interpreted by fathers as excluding or disregarding them. Further research is needed to validate the results of this small-scale study, and to assess whether and how provider attitudes impact their practices in educating and engaging fathers in newborn care.

Paternity establishment at birth and early maltreatment: Risk and protective effects by maternal race and ethnicity.

BACKGROUND: Minority race/ethnicity, low socioeconomic status, and lack of established paternity have been identified in previous research as risk factors for child maltreatment. However, given vastly different patterns of income distribution, single parenting and co-parenting across racial and ethnic populations, it is difficult to know which of these factors contribute most to maltreatment risk. OBJECTIVE: The current study explores whether the odds of maltreatment differ across race/ethnicity when paternity is not established at birth after controlling for maternal socioeconomic status. METHODS: Using merged birth certificate and child protective services records for children born between 2009 and 2011 in Texas (N = 1,175,804), we conducted multiple logistic regression analyses testing the main effects of maternal race and lack of established paternity, as well as the interaction of the two, on substantiated maltreatment. RESULTS: Results show that children of black mothers were less likely to have established paternity and more likely to experience maltreatment compared with other groups. However, the odds of maltreatment were lower for children of black mothers without established paternity compared to children of white mothers without established paternity (OR = .71, 95% CI [0.67,0.75]). Alternatively, the odds of maltreatment were higher when paternity was not established at birth for Hispanic mothers (OR = 1.13, 95% CI [1.08,1.18]) and mothers of other race/ethnicities (OR = 1.35, 95% CI [1.11,1.65]) compared to white mothers. CONCLUSION: Research and prevention programming must consider that the processes and pathways linking paternity establishment and maltreatment may differ within and between racial/ethnic groups.