Development and Implementation of State and Federal Child Welfare Laws Related to Drug Use in Pregnancy.

Policy Points Over the past several decades, states have adopted policies intended to address prenatal drug use. Many of these policies have utilized existing child welfare mechanisms despite potential adverse effects. Recent federal policy changes were intended to facilitate care for substance-exposed infants and their families, but state uptake has been incomplete. Using legal mapping and qualitative interviews, we examine the development of state child welfare laws related to substance use in pregnancy from 1974 to 2019, with a particular focus on laws adopted between 2009 and 2019. Our findings reveal policies that may disincentivize treatment-seeking and widespread implementation challenges, suggesting a need for new treatment-oriented policies and refined state and federal guidance. CONTEXT: Amid increasing drug use among pregnant individuals, legislators have pursued policies intended to reduce substance use during pregnancy. Many states have utilized child welfare mechanisms despite evidence that these policies might disincentivize treatment-seeking. Recent federal changes were intended to facilitate care for substance-exposed infants and their families, but implementation of these changes at the state level has been slowed and complicated by existing state policies. We seek to provide a timeline of state child welfare laws related to prenatal drug use and describe stakeholder perceptions of implementation. METHODS: We catalogued child welfare laws related to prenatal drug use, including laws that defined child abuse and neglect and established child welfare reporting standards, for all 50 states and the District of Columbia (DC), from 1974 to 2019. In the 19 states that changed relevant laws between 2009 and 2019, qualitative interviews were conducted with stakeholders to capture state-level perspectives on policy implementation. FINDINGS: Twenty-four states and DC have passed laws classifying prenatal drug use as child abuse or neglect. Thirty-seven states and DC mandate reporting of suspected prenatal drug use to the state. Qualitative findings suggested variation in implementation within and across states between 2009 and 2019 and revealed that implementation of changes to federal law during that decade, intended to encourage states to provide comprehensive social services and linkages to evidence-based care to drug-exposed infants and their families, has been complicated by existing policies and a lack of guidance for practitioners. CONCLUSIONS: Many states have enacted laws that may disincentivize treatment-seeking among pregnant people who use drugs and lead to family separation. To craft effective state laws and support their implementation, state policymakers and practitioners could benefit from a treatment-oriented approach to prenatal substance use and additional state and federal guidance.

When Does A Minor's Legal Competence To Make Health Care Decisions Matter?

In this article, I examine the role of minors' competence for medical decision-making in modern American law. The doctrine of parental consent remains the default legal and bioethical framework for health care decisions on behalf of children, complemented by a complex array of exceptions. Some of those exceptions vest decisional authority in the minors themselves. Yet, in American law, judgments of minors' competence do not typically trigger shifts in decision-making authority from adults to minors. Rather, minors' decisional capacity becomes relevant only after legislatures or courts determine that the default of parental discretion does not achieve important policy goals or protect implicated constitutional rights in a particular health care context and that those goals can best be achieved or rights best protected by authorizing capable minors to choose for themselves. It is at that point that psychological and neuroscientific evidence plays an important role in informing the legal inquiry as to whether minors whose health is at issue are legally competent to decide.

Variation in States' Implementation of CAPTA's Substance-Exposed Infants Mandates: A Policy Diffusion Analysis.

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.

Association Between State-Level Criminal Justice-Focused Prenatal Substance Use Policies in the US and Substance Use-Related Foster Care Admissions and Family Reunification.

Importance: States have enacted criminal justice-related substance use policies to address prenatal substance use and protect infants from adverse health effects of parental substance use. However, little is known about the consequences of these policies for permanency outcomes among infants in the foster care system in the United States. Objectives: To evaluate the consequences of criminal justice-related prenatal substance use policies for family reunification and to examine differences in parental reunification by racial/ethnic group. Design, Setting, and Participants: In this cohort study using data from the 2005 to 2017 Adoption and Foster Care Analysis and Reporting System, 13 cohorts of infants who entered the foster care system were followed up. States with criminal justice-related prenatal substance use policies were compared with states without such policies before and after their enactment using a discrete-time hazard model adjusted for individual covariates, state, and cohort fixed effects. The sample consisted of 350 604 infants 1 year or younger who had been removed from their home because of parental drug or alcohol use. Main Outcomes and Measures: Length of time from entering the child welfare system to first reunification with a parent and hazard rates (HRs). Results: Of the 350 604 infants 1 year or younger, 182 314 (52%) were boys, 251 572 (72%) were non-Hispanic white children, and 160 927 (46%) lived in US states with a criminal justice-focused prenatal substance use policy. Among those who were reunified, 36% of the reunifications occurred during the first year and 45% in the second year. Foster care infants who were removed from their homes because of parental substance use who live in states that have adopted criminal justice-oriented policies had a lower chance of reunification with a parent compared with states that have not adopted those policies (HR, 0.95; 95% CI, 0.94-0.96). Specifically, non-Hispanic black children who live in a state that has adopted criminal justice-oriented policies had a lower chance of reunification with a parent than non-Hispanic black children who live in a state that has not adopted those policies (HR, 0.87; 95% CI, 0.81-0.94). Conclusions and Relevance: Given the child welfare system's legal mandate to make every effort toward parental reunification, a more comprehensive treatment and supportive policy approach toward parental substance use might be warranted.

Worker Perceptions of the Multi-Agency Investigation & Support Team (MIST): A Process Evaluation of a Cross-Agency Response to Severe Child Abuse.

The Multi-agency Investigation & Support Team (MIST) was a new approach to abuse investigations that aimed to minimize the distress and uncertainty experienced by children and non-abusive caregivers in dealing with the many agencies typically involved in a case post-disclosure, while also attempting to improve the accessibility of supportive and therapeutic services. As part of a broader evaluation, this study examined worker perceptions early in the implementation of this new approach. Thirty-three (33) interviews were conducted with workers affected by this new pilot. The interviews identified almost exclusively positive perceptions of the changes relative to practice as usual, particularly in terms of improvements to collaboration and communication across agencies, and the benefits of providing support alongside the investigation process. Some areas of difficulty and areas for improvement were identified, particularly the need for stronger governance of the cross-agency protocol and improved connection to some of the groups involved in the response that were not co-located. The study suggests professionals working in the MIST model consider the model beneficial to the quality of the response to severe child abuse while highlighting that the process of change into this new way of working was challenging at times.

State Lawmaker's Views on Childhood Obesity and Related School Wellness Legislation.

BACKGROUND: School wellness legislation has potential to impact the health of children and alter the obesity crisis in the United Sates. Little is known about how state lawmakers perceive child wellness legislation effectiveness relative to obesity prevention. Our purpose was to understand state lawmakers' perceptions of childhood obesity and school wellness policies relative to the Social Ecological Model (SEM). METHODS: Twenty-one state representatives and nine state senators from one US state completed in-depth interviews. Member checks and peer debriefing occurred throughout data collection and analysis. Transcripts were coded and triangulated. A conventional content analysis generated consistent themes. RESULTS: Five main themes developed: (1) child overweight and obesity is problematic; (2) current legislation is ineffective; (3) funding and enforcing child wellness legislation is difficult; (4) it is difficult to legislate personal behavior; and (5) efforts from other levels of the SEM are more effective at promoting wellness. CONCLUSIONS: Lawmakers understand negative impacts of child obesity, but perceive immediate legislative issues like budgetary concerns inhibit robust policy-oriented action. Participants believe parents, guardians, and individuals should ultimately be responsible for child wellness. Community, school, and family efforts to address childhood obesity and support wellness may be more effective in achieving positive outcomes than state and federal policy.

Challenges of developing a district child welfare plan in South Africa: lessons from a community-engaged HIV/AIDS research project.

The Amajuba Child Health and Wellbeing Research Project measured the impact of orphaning due to HIV/AIDS on South African households between 2004 and 2007. Community engagement was a central component of the project and extended through 2010. We describe researcher engagement with the community to recruit participants, build local buy-in, stimulate interest in study findings, and promote integration of government social welfare services for families and children affected by HIV/AIDS. This narrative documents the experience of researchers, drawing also on project reports, public documents, and published articles, with the objective of documenting lessons learned in this collaboration between researchers from two universities and a community in South Africa during a period that spanned seven years. This experience is then analyzed within the context of an applied research, community-engagement framework.

Reforming a System That Cannot Reform Itself: Child Welfare Reform by Class Action Lawsuits.

Class action lawsuits have become an increasingly common way to facilitate institutional reform. The purpose of this article is to provide an introduction to social workers of child welfare reform by class action lawsuits and subsequent consent decrees. The authors provide an overview of class action lawsuits, with a focus on their role in implementing systematic change in the United States. They highlight consent decrees as a means of settling class action lawsuits. They illustrate the current state of the child welfare system and how child advocacy groups have used class action lawsuits to initiate reform. Authors provide two case examples of child welfare reform by consent decree and engage in comparative analysis to investigate similarities and differences in the two cases. Finally, they note implications for social work practice and education and provide recommendations to equip and train social workers involved in child welfare services.

Sexualised violence against children: a review of laws and policies in Kenya.

Child sexual abuse (CSA) is a major global health challenge. Extant literature shows that CSA is prevalent in Kenya. As a signatory of the United Nations Convention on the Rights of the Child and the African Charter on the Rights and Welfare of the Child, the Kenyan government is mandated to ensure that children are protected from sexual abuse through sound laws and policies. This paper reviews existing laws and policies on CSA and highlights their strengths and weaknesses. Our findings indicate that laws on child protection exist and are protective to a large extent, as harsh penalties are outlined for sexual offences. Survivors of CSA are entitled to free legal and medical services. However, there are no reparations offered to survivors in criminal proceedings. Moreover, there is no legislation on age-appropriate comprehensive sexuality education which plays an important role in cultivating positive gender norms and describing what constitutes CSA and reporting procedures. The national standard operating procedures for the management of sexual violence against children lack CSA screening procedures. There is urgent need for review of these laws and policies and development of multisectoral protocols at the national and county level, that outline roles and responsibilities for various service providers, supervisory and accountability measures and referral networks.

What is known about the LGBTQ perspective in child welfare services? A scoping review protocol.

INTRODUCTION: In previous studies, it is estimated that sexual minorities (eg, lesbian, gay, bisexual, transgender and questioning (LGBTQ) individuals) are overrepresented in the child welfare system. However, the numbers are unclear, and there are limited studies in this field. No systematic review of LGBTQ issues across a broader context (ie, youth, foster parents and service providers) of child welfare services exists. The overall objective of this scoping review is to systematically scope the existing research on LGBTQ issues in the context of child welfare services, including policy, practice, service providers and users' perspectives. METHODS AND ANALYSIS: The scoping review framework outlined by the Joanna Briggs Institute (JBI) based on previous work by Arksey and O'Malley and Levac and colleagues will guide this review. In addition, the PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation will be used throughout the process. We will search electronic databases (PubMed, EMBASE, PsycINFO, Web of Science and Idunn) and grey literature sources to identify studies that are appropriate for inclusion in this review. Using inclusion and exclusion criteria based on the 'Population-Concept-Context' framework, two researchers will independently screen titles, abstracts and full-text articles considered for inclusion. Any qualitative, quantitative and mixed-method study of LGBTQ issues in the child welfare context will be described and synthesised using a thematic synthesis approach. ETHICS AND DISSEMINATION: A scoping review is a secondary analysis of published literature and does not require ethics approval. This scoping review is meant to provide an overview of the existing literature, aiming to expand policy-makers' and practitioners' knowledge of LGBTQ issues in a child welfare context and identify research gaps that can be used as a basis for further research. The results will be disseminated through a peer-reviewed publication, a conference presentation and a presentation to the key stakeholders.

Child Marriages, Child Protection and Sustainable Development in Kenya: Is Legislation Sufficient?

Globally, 15 million girls are married before the age of 18, with Kenya having one of the highest child marriages prevalence in the world, estimated at 25-30%. Child marriages in Kenya are rampant in rural areas. Child marriages are part of customary practices in communities where they are prevalent. Child marriages have also been used as a survival strategy by families. Child marriages compromise a child's development and threaten the achievement of Sustainable Development Goals. This paper highlights international conventions and analyses Kenyan legislative framework that have been put in place to protect children from child marriages. A review of literature was undertaken and the analysis showed that Kenya has a strong legal framework to fight child marriages and to prosecute perpetrators. However, the practice still remains rampant and is on the increase in certain areas. Indeed, child marriage policies and reproductive health measures targeting children should reflect a child-rights approach and also focus on socioeconomic vulnerabilities to address the root causes. In addition, it should be acknowledged that child protection and reproductive well-being are collective processes requiring collective responsibility and not only legislative and policy reforms.

Advancing Public Health Policy in Louisiana Through Evidence-Based Strategies: Successes and Opportunities.

In 2013, a team of public health professionals at Tulane University launched a project to explore strategies for shaping a healthier Louisiana. The team investigated methods for improving diet and physical activity behaviors in early childhood, school, and community settings that could be translated into specific policies. Through key informant interviews and scans of academic journals and reports issued by public health agencies, the team generated a set of actionable steps that could increase healthful behaviors. Previous efforts to address similar topics in Louisiana and other states, and their reception from policy makers, were also considered during analysis. Subsequently, a state legislator used the team's work to introduce public health legislation in 2014. The legislation led to a number of incremental changes in state policy and resolutions for additional policy-relevant studies. This case study summarizes the promising physical activity and nutrition strategies that were considered by the Tulane team, how the team's work product was integrated into state legislation, the outcomes of the legislation, and a set of recommendations for how Louisiana can expand on this work. This article demonstrates how the work of public health professionals can have a positive influence on the policy-making process through research and education.

Hot Topic: Title IV-E MSW Education and "Intent to Stay" in Public Child Welfare.

The 2018 proposed Family First Prevention Services Act suggests a change in the funding formula of Title IV-E of the Social Security Act-from entitlement to block grants. This study aimed to support the continuation of entitlement support based on the evidence that Title IV-E educational programs are effective in improving retention after the workers have obtained an MSW degree. Using a multigroup, multiple regression approach, this study analyzed secondary data collected from an e-survey sent to public child welfare (PCW) workers in a southern state. Data from 1,025 workers compare "intent to stay" (ITS) factors between PCW workers who received and those who did not receive the Title IV-E MSW educational stipend. The main analysis was conducted using Mplus version 7.4, with R version 3.3.2 used for data screening. Findings indicate that Title IV-E-supported education moderates the strength of the following ITS factors: respect from coworkers, team cohesion, self-assessed skills in working with special needs clients, and holding an MSW degree. MSW holders expressed lower ITS levels unless they had received Title IV-E stipends. These results provide evidence that Title IV-E education could help retain MSW graduates in PCW.