Racial and Ethnic Disparities in Maternal and Infant Outcomes Among Opioid-Exposed Mother-Infant Dyads in Massachusetts (2017-2019).

Objectives. To examine the extent to which differences in medication for opioid use disorder (MOUD) in pregnancy and infant neonatal opioid withdrawal syndrome (NOWS) outcomes are associated with maternal race/ethnicity.Methods. We performed a secondary analysis of a statewide quality improvement database of opioid-exposed deliveries from January 2017 to April 2019 from 24 hospitals in Massachusetts. We used multivariable mixed-effects logistic regression to model the association between maternal race/ethnicity (non-Hispanic White, non-Hispanic Black, or Hispanic) and prenatal receipt of MOUD, NOWS severity, early intervention referral, and biological parental custody at discharge.Results. Among 1710 deliveries to women with opioid use disorder, 89.3% (n = 1527) were non-Hispanic White. In adjusted models, non-Hispanic Black women (AOR = 0.34; 95% confidence interval [CI] = 0.18, 0.66) and Hispanic women (AOR = 0.43; 95% CI = 0.27, 0.68) were less likely to receive MOUD during pregnancy compared with non-Hispanic White women. We found no statistically significant associations between maternal race/ethnicity and infant outcomes.Conclusions. We identified significant racial/ethnic differences in MOUD prenatal receipt that persisted in adjusted models. Research should focus on the perspectives and treatment experiences of non-Hispanic Black and Hispanic women to ensure equitable care for all mother-infant dyads.

Out-of-home placement to age 18 years in children exposed to a postpartum mental disorder.

OBJECTIVES: Little is known about risk of custody loss or out-of-home placement among children whose mothers experience postpartum mental disorders, and whether this risk differs from that of children whose mothers had earlier onset of their mental disorder. METHODS: National Danish registers comprising 1 868 467 births (1982-2012) were used to determine how the timing of maternal illness onset influences out-of-home placement risk up to age 18 years among children exposed to a maternal mental disorder. RESULTS: Compared to children unexposed to maternal mental illness, risk was higher for children exposed to a maternal mental disorder whose mothers had a first contact for a mental disorder in the 0-12 months of predelivery (8.17/1000 person-years; aIRR 4.56, 95% CI 4.08-5.09), the first 3 months postpartum (4.60/1000 person-years; 3.55, 2.95-4.26) and 4-12 months postpartum (6.49/1000 person-years; 3.93, 3.50-4.41). Risk was even higher for children exposed to a maternal mental disorder when illness onset was more than 1-year predelivery (9.11/1000 person-years; 5.48, 5.32-5.66). CONCLUSION: Risk of out-home placement in children exposed to mothers with a new-onset postpartum mental disorder is almost as high as in children whose mothers have long-standing illness. A better understanding of the trajectories of these mothers and children is warranted.

Maternal Mental Health after Custody Loss and Death of a Child: A Retrospective Cohort Study Using Linkable Administrative Data.

OBJECTIVE: The objective was to compare mental illness diagnoses and treatment use among mothers who lost custody of their child through involvement with child protection services and those seen in mothers dealing with the death of a child. METHODS: We studied mental health outcomes of a cohort of women whose first child was born in Manitoba, Canada between 1 April 1997 and 31 March 2015. Of these women, 5,792 had a child taken into care, and 1,143 mothers experienced the death of a child (<18 y old) before 31 March 2015. Adjusted relative rates (ARR) of 3 mental health diagnoses and 3 mental health treatment use outcomes between these 2 groups were examined. RESULTS: Mothers with a child taken into care had significantly greater ARR of depression (ARR = 1.90; 95% CI, 1.82 to 1.98), anxiety (ARR = 2.51; 95% CI, 2.40 to 2.63), substance use (ARR = 8.54; 95% CI, 7.49 to 9.74), physician visits for mental illness (ARR = 3.01; 95% CI, 2.91 to 3.12), and psychotropic medication use (ARR = 4.95; 95% CI, 4.85 to 5.06) in the years after custody loss compared with mothers who experienced the death of a child. CONCLUSION: Losing custody of a child to child protection services is associated with significantly worse maternal mental health than experiencing the death of a child. Greater acknowledgement and supportive services should be provided to mothers experiencing the loss of a child through the involvement of child protection services.

Relevance of medical reports in criminal investigations of cases of suspected child abuse.

If a case of physical child abuse is suspected in Germany, the general feeling is often that "it does not matter whether you make a report or not" because, generally, no conviction is made anyway. This study investigates the juridical analysis of complaint cases of physical child abuse [criminal complaint parag. 225 StGB (German penal code) with filial victim]. It focuses on the doctor's role and the impact of their practice in relation to a later conviction. It is based on the analysis of 302 files of the enquiry from 2004-2009 from the department of public prosecution in Cologne, Germany. Besides general epidemiological data on the reporting person, the affected child and the presumed offender, the documents were reassessed for the relevance of medical reports for successful convictions. Only 7% (n = 21) of 302 complaints led to a conviction. In 38.1% (n = 8) of those cases, a medical report was mentioned as a piece of evidence, and just in two cases a (legal) medical report was quoted and mentioned as relevant for the conviction. 50% of the complaint cases with legal medical expertise led to a trial. In contrast, only 30.2% with a common medical report and 7.3% without a report led to a trial. The results show how a medical report existed in only a few cases. In those cases, the rate of performed trials was higher than for those without a medical report, but the report played a minor part when reasoning a verdict.

Self-esteem in children in joint physical custody and other living arrangements.

OBJECTIVES: Parental support has been shown to be important for children's self-esteem, which in turn is related to later important life outcomes. Today, an increasing number of children in the Western world spend time in both the parents' respective households after a separation. Children who live with both parents report more parental support than children who live only with one parent after a divorce. We took the opportunity of the commonness of children sharing their time between their parents' homes in Sweden to investigate children's self-esteem in relation to family type. STUDY DESIGN AND METHODS: With nationally representative survey data (ULF) collected from both parents and children, we analyze differences in children's self-esteem among 4823 10-18 year olds in nuclear families, joint physical custody and those living mostly or only with one parent after a separation using ordinary least squares regression, adjusting for demographic and socioeconomic characteristics. RESULTS: We found no significant difference in self-esteem between children who lived equally much with both parents, mostly with one parent and those in nuclear families, whereas children in single care showed lower self-esteem compared with children in the other living arrangements. The difference was not explained by socioeconomic factors. CONCLUSION: The self-esteem of children who share their time between their parent's respective homes after a separation does not deviate from that in their peers in nuclear families. Instead, those in single care reported lower self-esteem than those in the other living arrangements. These differences were not explained by socioeconomic factors. Longitudinal studies are needed to establish pre- and post-separation family characteristics that influence self-esteem and well-being in young people.

Child protection services and parents with intellectual and developmental disabilities.

BACKGROUND: Information about parents with intellectual and developmental disabilities (IDD) in the child protection system (CPS) continues to evolve. This study examined characteristics, experiences and representation of parents with IDD across three CPS decision points, as compared to parents with other disabilities and parents without disabilities in the United States. METHODS: The sample consisted of 303,039 individuals: 2,081 were individuals identified as parents in a CPS investigation; 1,101 had children in out-of-home care (OHC); and 308 experienced termination of parental rights (TPR). Descriptive statistics, chi-square analysis, disparity indices and logistic regression were employed. RESULTS: Parents with IDD were significantly more likely than parents without disabilities (but not significantly more likely than parents with other types of disabilities) to experience disproportionately representation. CONCLUSIONS: Parents with IDD are generally over-represented within CPS; however, this representation is dependent upon the comparison group utilized and other risk factors. CPS system-level changes are necessary.

'Framed': Terminating the Parenting Rights of Parents with Intellectual Disability in Iceland.

BACKGROUND: The aim was to investigate the role of measured intellectual function in framing parents as 'unfit' in child custody deprivation cases. METHOD: Grounded theory was used to analyse a national sample of custody deprivation cases in Iceland 2002-2014. RESULTS: The terminology used to evaluate and describe the intellectual and developmental status of parents in child deprivation custody cases served as a device to define and shape the 'unfit parent'. Intellect itself, whether as low, average or even above average at times acts as a master narrative which informs and explains all manner of perceived parental deficiencies. CONCLUSION: The intellectual and developmental status served as a yardstick of identifying, understanding and interpreting the unfit parent. As a tool to achieve an end, parents were framed in language and culture using underlying belief set to make sense of events and issues.

Prevalence, Trends and Custody Among Children of Parents with Intellectual Disabilities in Norway.

BACKGROUND: This study addresses children of parents with intellectual disability in Norway. The aim was to examine: (i) the impact of definitions of intellectual disability on prevalence, (ii) whether numbers were increasing, (iii) the prevalence of motherhood and fatherhood and (iv) rates of lost custody. METHODS: Analyses of national registers (n = 30 834) and mapping in four municipalities (n = 85). RESULTS: 0.19% of all children had parents with recorded intellectual disability, increasing to 0.87% with wider inclusion criteria. The number of children born to parents with intellectual disability has been declining since the mid-1980s. The proportion of mothers with intellectual disability was twice that of fathers. Parental custody was revoked for 30-50% of children, with single mothers being at particular risk. Parents with intellectual disability accounted for 20-25% of all custody cases. CONCLUSIONS: The results show that prevalence depends on the definition of intellectual disability. The decreasing number of children and the need for development of specially adapted family supports are discussed.

Psychological complaints among children in joint physical custody and other family types: Considering parental factors.

AIMS: Increasing proportions of Scandinavian children and children in other Western countries live in joint physical custody, moving between parents' homes when parents live apart. Children and parents in non-intact families are at risk of worse mental health. The potential influence of parental ill-health on child well-being in the context of differing living arrangements has not been studied thoroughly. This study investigates the psychological complaints of children in joint physical custody in comparison to children in sole parental care and nuclear families, while controlling for socioeconomic differences and parental ill-health. METHODS: Data were obtained from Statistics Sweden's yearly Survey of Living Conditions 2007-2011 and child supplements with children 10-18 years, living in households of adult participants. Children in joint physical custody (n=391) were compared with children in sole parental care (n=654) and children in nuclear families (n=3,639), using a scale of psychological complaints as the outcome measure. RESULTS: Multiple regression modelling showed that children in joint physical custody did not report higher levels of psychological complaints than those in nuclear families, while children in sole parental care reported elevated levels of complaints compared with those in joint physical custody. Adding socioeconomic variables and parental ill-health only marginally attenuated the coefficients for the living arrangement groups. Low parental education and parental worry/anxiety were however associated with higher levels of psychological complaints. CONCLUSIONS: Psychological complaints were lower among adolescents in joint physical custody than in adolescents in sole parental care. The difference was not explained by parental ill-health or socioeconomic variables.

Joint physical custody, turning to parents for emotional support, and subjective health: A study of adolescents in Stockholm, Sweden.

AIMS: Among children with separated parents, the arrangement of joint physical custody, i.e. children living equally much in both parents' homes, has increased substantially during the last decades in Sweden. To date, empirical research on the living conditions of this group is limited. This study analyses family type differences in turning to parents for emotional support and in subjective health among adolescents. The focus of the study is adolescents in joint physical custody, who are compared with those living with two original parents in the same household; those living (only) in a single-parent household; and those living (only) in a reconstituted family. METHODS: The data come from the Stockholm School Survey of 2004, a total population survey of students in grade 9 (15-16 years) in Stockholm (n=8,840). Ordinary least squares (OLS) regressions were conducted. RESULTS: Turning to both parents about problems is most commonly reported by adolescents in intact families, followed by those in joint physical custody. Adolescents in non-traditional family types report worse subjective health than adolescents in intact families, but the difference is smaller for those in joint physical custody than for those living with a single parent. The slightly poorer health of adolescents in joint physical custody than those in intact families is not explained by their lower use of parents as a source of emotional support. CONCLUSIONS: The study suggests that joint physical custody is associated with a higher inclination to use parents as a source of emotional support and better subjective health than other post-divorce family types.

Child custody disputes within the context of child protection investigations: secondary analysis of the Canadian Incident Study of Reported Child Abuse and Neglect.

This national study of child custody disputes within the context of child protection investigations confirms and reinforces the perception in the field that child custody disputes are more likely to reopen for investigations, include higher rates of malicious referrals and involve a higher proportion of children with emotional and functioning issues compared to non-custody-related investigations. Future research might consider the reasons for these higher rates so to improve the identification of these cases and to make more informed decisions about how best to respond to these families. The greatest contribution of this study is that it provides important new evidence to reinforce the need to prioritize child custody disputes within the context of child protection services given the unique challenges and opportunities for making well-informed case plan decisions.

Custodial Grandparent's Job Loss During the COVID-19 Pandemic and Its Relationship With Parenting Stress and Mental Health.

Involuntary job loss during the COVID-19 pandemic adds challenges, especially for custodial grandparents that are taking care of grandchildren. Grandparents are relatively vulnerable, and they need more attention and support when facing the negative impacts of COVID-19. This study analyzed cross-sectional survey data collected from 234 custodial grandparents via Qualtrics Panels in June 2020 in the United States. After using the propensity score weighting adjustment, results from logistic and ordinary least squares regression showed that compared with grandparents that did not lose their job during the pandemic, grandparents that did had more parenting stress and worse mental health. Moderation analysis also showed that social support was a significant moderator of the relationship between job loss and mental health, but not the relationship between job loss and parenting stress. The findings and implications are discussed.

The Effect of CASA on Child Welfare Permanency Outcomes.

The present study is the largest and most rigorous study to date on the effects of being appointed a Court Appointed Special Advocate (CASA) on permanency outcomes of children in foster care. The intent-to-treat study accounts for selection bias by applying inverse probability weighting to logistic and sequential logistic regressions in a large sample of children in foster care in the state of Texas (N = 31,754). Overall, children appointed a CASA have significantly lower odds than children without a CASA of achieving permanency. They have lower odds of being reunified, greater odds of being adopted (if not reunified), and lower odds of being placed in permanent kin guardianship (if not reunified or adopted) than children who are not appointed CASA. This study makes an additional contribution by looking beyond the aggregate effect of CASA on permanency by examining the effect of CASA for different age groups and different types of first placement after removal.

Mothers with self-reported axis I diagnoses and child protection.

PURPOSE: To describe mothers with serious mental illness (SMI) and their children, who are involved with child protective services. METHODS: A retrospective review was conducted of 122 files from a large metropolitan Department of Child and Family Services. FINDINGS: The most frequently occurring diagnoses in these mothers were polysubstance dependence (39.3%) and dual diagnoses (mental illness with substance abuse; 19.7%). There was an overrepresentation of African American mothers (60%) compared with the county population and a greater prevalence of child neglect (59.0%) compared with national prevalence. Most mothers and children had been exposed to domestic violence (62.6%). Mental health services were seldom utilized, and foster care was the most common placement (36.5%). Also, there was close spacing of the age of the children, with an average of 1.25 years between siblings. CONCLUSIONS: Identifying common descriptive factors of mothers with mental illness can assist in responding to mothers with SMI and their children. There is a need to coordinate services of the Department of Child and Family Service and mental health providers that address parenting and the support of children.

Moral competence and conduct disorder among Filipino children in conflict with the law.

AIMS: The numbers of children in conflict with the law continue to rise in Asia, yet few studies have been conducted regarding factors associated with it. It has been theorized that children with conduct disorder represent majority of children in conflict with the law, and that poor moral competence mediates the association between conduct disorder and antisocial behavior. This study aimed to present a profile of Filipino children in conflict with the law, determine the prevalence of conduct disorder in the sample, and investigate variables associated with conduct disorder. METHODS: This was a cross-sectional study conducted at a conflict with the law Custodial Care Center in the Philippines. The procedure entailed a diagnostic interview and questionnaire administration conducted by psychiatrists. Questionnaires administered included the Moral Competence Test and Parental Warmth and Acceptance Scale. Statistical analyses of data included descriptive statistics, chi-square tests, and independent t tests. SPSS v.23.0 was used for data encoding and analysis. RESULTS: Twenty-three participants were included in the study, with 10 participants with conduct disorder and 13 controls. Majority were male adolescents between the ages of 16 and 18 years. Conduct disorder was associated with commission of multiple violations, particularly theft and homicide, the presence of a substance use disorder, and a history of abuse. Participants with conduct disorder had lower moral competence levels compared to participants without conduct disorder. CONCLUSION: Conduct disorder was associated with high-risk antisocial behavior and lower levels of moral competence.

Assessing the effects of an education program on mental health problems in separated parents.

BACKGROUND: Parental separation is a stressful experience that can lead to parents suffering mental health problems (MHPs). Parental separation education programs for coping with post-separation adjustment have proven to be effective in reducing conflict and improving co-parenting. However, the effects of these programs on MHPs have not been assessed. A field study was carried out to assess the impact of a parental separation education program on parental MHPs. METHOD: A total of 116 separated parents who completed the program "Parental separation, not family breakdown" completed the Brief Symptom Inventory (BSI) pre- and post-intervention. RESULTS: Separated parents had significantly higher pre-intervention scores on the nine symptom dimensions and the global indexes of distress in comparison to the normative population. The intervention yielded a significant improvement (i.e., reduction of clinical symptoms) in all MHPs, ranging from 19% in phobic anxiety to 36% in depression and general anxiety; and in the global indexes of distress (36% in the global severity index; 28% in the positive symptom distress index; and 33% in the positive symptom total). Approximately 45% of parents significantly improved through the intervention. CONCLUSIONS: The implications of the outcomes of the separation and intervention in parents' MHPs and children wellbeing are discussed.

Children ever in care: an examination of cumulative disproportionality.

Most studies of ethnic disproportionality in child welfare examine data in one of two ways: a point in time approach or an entry cohort approach. While each provides insight into disproportionality, neither gives a full picture of the differences among ethnic groups in the experience of the child welfare system over time. This study uses longitudinal administrative child welfare data to examine ethnic disproportionality in involvement with the child welfare system during the first seven years of life at three levels of contact: (1) initial referrals, (2) substantiated referrals, and (3) first entries. Findings suggest the experience of African American families, and probably Native American families, with the child welfare system is much different from other families.

Addressing the disproportionate representation of children of color: a collaborative community approach.

The state of Indiana recommended a committee be formed to address the disproportional representation of black youth in out-of-home placements. In response, the Indiana Disproportionality Committee (IDC) was established. This article presents the development, objectives and future of the IDC. One of the objectives, research, will be offered as an example of the committee's collaborative strategies. The IDC, in partnership with another organization, has begun exploring relationships between ethnicity, risk factors and treatment outcomes. The results of this research effort have examined disproportion and disparity, leading the IDC to identify needs for change within the state. Barriers and successes of the IDC will be shared, so that others can use these efforts to guide their own strategies to reduce disproportionality.

Child support and justice-involved military veterans.

The study examines and evaluates the effectiveness of a federal and county collaboration in Pennsylvania designed to help military veterans with child support arrearages in the criminal justice system. The study focused on the veteran participants (n=232) identified psychosocial problems, their range of justice involvement, strategies to mitigate, address barriers and legal dilemmas through the collaborative. The average age 40, majority male, Caucasian, divorced, enrolled in Veterans Administration (VA) healthcare, serving on supervised parole or probation, homeless episodes, and income <$500.00 per month. In general, the findings enhance the limited body of knowledge about military-veteran child support and provide strategies and specific insight into the problems veterans face on individual, familial, and societal levels.

Predictors of having a first child taken into care at birth: A population-based retrospective cohort study.

The objective of this study is to determine which maternal events and diagnoses in the two years before childbirth are associated with higher risk for having a first child taken into care at birth by child protection services. A population-based retrospective cohort of women whose first child was born in Manitoba, Canada between 2002 and 2012 and lived in the province at least two years before the birth of their first child (n=53,565) was created using linkable administrative data. A logistic regression model determined the adjusted odds ratios (AOR) of having a child taken into care at birth. Characteristics having the strongest association with a woman's first child being taken into care at birth were mother being in care at the birth of her child (AOR=11.10; 95% CI=8.38-14.71), substance abuse (AOR=8.94; 95% CI=5.08-15.71), schizophrenia (AOR=6.69; 95% CI=3.89-11.52) developmental disability (AOR=6.45; 95% CI=2.69-14.29), and no prenatal care (AOR=5.47; 95% CI=3.56-8.41). Most characteristics of women deemed to be at high risk for having their child taken into care at birth are modifiable or could be mitigated with appropriate services.