Pediatric Decision-Making for Children in State Custody.

In summer 2022, six points of consensus emerged from a symposium addressing the question, "In the context of U.S. pediatric care, what moral precepts ought to guide parents and clinicians in medical decision making for children?" (Salter et al. 2023). The authors of this statement wrote, however, that the points of consensus may require modification or may not apply in their entirety to children in state custody. This article addresses the consensus recommendations in the context of the thousands of children removed annually from the custody of their parents. While the consensus statements developed at the symposium provide a good starting point for decision-making in the context of these children, some alterations and nuance must be applied to attend to the specific needs of this population. The article works through what special considerations and changes ought to be made to expand the reach of the original points of consensus without neglecting the particular conditions of children in state custody, as well as their parents and caregivers.

Family issues and custodial mothers' quest for justice: Evidence from Colombia.

Access to justice is limited for many worldwide. Although prior research generally recognizes the legal needs and barriers faced by women, less is known about mothers. This study examined the legal needs of mothers in different family configurations and the actions they took in response to these needs through the lens of help-seeking theories. We used unique data from the 2016 Colombian Quality of Life Survey (QLS) to produce descriptive statistics on the legal needs of mothers in two-parent families and custodial mothers. We then conducted multivariate analyses to examine the factors associated with having a family issue and seeking institutional help. Custodial mothers were more likely than mothers in two-parent families to have reported any legal need, and to report a family legal issue. The most frequent legal issues related to the family were issues with child support, custody, and/or visitation. The most frequent action taken to resolve issues was through an institutional actor. Among custodial mothers, single, younger mothers and mothers with more children were more likely to experience family legal issues, but they were not the ones seeking institutional help-those mothers were often more socioeconomically advantaged. That more socioeconomically disadvantaged mothers are more likely to experience a family legal issue but less likely to seek institutional help, the most frequent route to action, calls for research that examines the barriers faced by these mothers and policies to improve their access to justice.

Coparenting as a mediator between physical custody arrangements and children's mental health.

The detrimental effects of parental break-up on children's mental health are well-documented. However, research has also shown that children living in joint physical custody (JPC) arrangements often fare better than children living in sole physical custody (SPC) arrangements. Thus, the question arises: What are the differences between JPC and SPC that account for those results? Drawing on data from the Family Models in Germany (FAMOD) study conducted in 2019, structural equation models (SEM) were estimated to deduct the mediating role of coparenting support in children's mental health in 465 JPC and 652 SPC families with children aged 2-14. The findings suggest that the better mental health observed among children in JPC families than among children in SPC families was fully mediated by coparenting support. However, this held true only for internalizing and externalizing behavior, but not for prosocial behavior as no differences between JPC and SPC were found for this dimension. The findings affirm the importance of supportive coparenting for children's well-being after family dissolution in both SPC and JPC arrangements. After breaking up, parents should be supported in their parental engagement through coparenting counseling or psychoeducation classes.

A Research Note on Trends in the Stock and Flow of Child Support Agreements.

In this research note, we demonstrate that trends in the likelihood of child support agreements differ by marital history (i.e., never-married vs. ever-married) and by whether measures rely on the stock of families (i.e., all those in which children live apart from a parent) or the flow (i.e., those that include children who newly live apart from a parent) in a given year. While previous research has highlighted difference by marital history, the contrast between stock and flow is a new contribution. Trends are typically measured with reference to the stock of cases, even while the flow of cases, which more immediately reflects concurrent policy changes, is more relevant in many contexts. Interpretations of recent declines in child support agreements in the stock of cases-referenced as evidence for both mandating participation and the impracticality of requiring child support-may be better informed by considering the flow of cases. We find the flow of previously married mothers increasingly likely to have child support agreements while the likelihood is relatively consistent over time for never-married mothers. For both groups, using the flow measure, we find notable increases in agreements without payments due in the most recent period. These findings underscore the importance of differentiating stock and flow, and by marital history, in considering the proportion with agreements as an indicator of the effectiveness of current policy.

Maternal satisfaction with joint and sole child physical placement arrangements following separation in Wisconsin and Finland.

Families (and sometimes courts) make important decisions regarding child physical custody arrangements post-separation, and shared parenting arrangements are increasingly common in most developed countries. Shared arrangements may be differentially associated with parental satisfaction, and these associations may vary across countries. Using data from surveys of separated mothers in Wisconsin and Finland, the present study explores this possibility and is guided by three aims: (a) to identify child and family characteristics associated with sole and shared child placements 6 or more years after separation; (b) to estimate associations of children's post-separation placements with maternal satisfaction with placements and expense sharing; (c) to examine whether the relationship between post-separation placement and maternal satisfaction varies by mothers' earnings and the quality of parents' relationships. We find that Finnish mothers with shared placement are more satisfied with their placement than are their counterparts with sole placement, while we find the inverse is true for Wisconsin mothers. Moreover, parental satisfaction with shared placement, overall and relative to sole placement, varies greatly depending on the quality of a mother's relationship with the other parent; and differences in relationship quality in Wisconsin and Finland may help explain the difference in satisfaction with shared placement in the two locations. In both Finland and Wisconsin, we find mothers with shared placement are more satisfied with the way expenses are shared between parents than are mothers with sole placement. Associations between placement and satisfaction are robust to extensive controls for child and maternal characteristics.

How Expert Are the Experts? Child Custody Evaluations in Situations of Domestic Violence in Italy.

In recent decades, scholars and professionals have investigated the courts' treatment of mothers and children who claim that an ex-partner/father is abusive, especially in child custody proceedings. In Italy, Laws 54/2006 and 154/2013 established that joint-custody and coparenting are critical to ensure the best interest of the child. In the process of custody determination, judges can appoint an expert to assess parenting skills. The aim of this qualitative study was to investigate the knowledge, opinions, and practices of the Court-Appointed Experts (CAEs) in child custody disputes in cases involving allegations of domestic violence (DV). Semistructured face-to-face interviews were conducted with 15 CAEs; the interviews' transcripts were analyzed with qualitative content analysis. Results suggested that in the management of child custody cases, most CAEs showed: strong prejudices against women victims of DV, who were often blamed and/or secondarily victimized; adherence to controversial models (e.g., parental alienation syndrome) and characterization of mothers as "alienators"; poor knowledge of DV and relevant laws. CAEs' overlooking DV underlines the urgent need to develop and implement guidelines on child custody decision-making in the context of DV.

Noncustodial parents, instrumental networks, and child support compliance.

Research on child support compliance has focused on the characteristics of noncustodial parents (NCPs) that are associated with compliance, finding that compliance with child support orders is primarily related to the ability to pay support as demonstrated by earnings. Yet, there is evidence linking social support networks to both earnings and noncustodial parents' relationships with children. Using a social poverty framework, we show that relatively few NCPs are completely isolated: most have at least some people in their network who can loan money, provide a place to stay, or provide a ride. We explore whether the size of these instrumental support networks is positively linked to child support compliance both directly and indirectly through earnings. We find evidence of a direct association between instrumental support network size and child support compliance, but no evidence of an indirect association via increased earnings. These findings suggest the importance for researchers and child support practitioners to consider the contextual and relational factors of the social networks in which parents are embedded, and to more thoroughly examine the process by which support from one's network can lead to child support compliance.

Accessibility of child protection investigations during pandemic: A qualitative analysis of court proceedings.

BACKGROUND: Qualitative research using published court records to examine contextual factors that contribute to child protection decisions in cases involving parents with intellectual disabilities is limited, particularly during the COVID-19 pandemic. METHOD: The present study conducted qualitative content analysis on 10 published Ontario court cases to study child protection decision-making between 2019 and 2021. RESULTS: The findings corroborated previous literature with nine out of 10 cases resulting in loss of child custody. Four major themes emerged from content analysis: (1) Impact of COVID-19 pandemic on cases; (2) Systemic barriers to accessibility; (3) Attitudes and bias toward parents with intellectual disabilities; and (4) Ultimate reliance on intellectual disability status for final custody decision. CONCLUSIONS: Conducting content analysis on published court cases is useful in learning about accessibility barriers for parents with intellectual disabilities and may help in understanding the impact of the COVID-19 pandemic on the child protection system.

Does the unconditional cash transfer program in South Africa provide support for women after child birth? Barriers to accessing the child support grant among women in informal work in Durban, South Africa.

BACKGROUND: The child support grant (CSG) is the largest unconditional cash transfer program in Africa and aims to alleviate poverty and improve child health and nutrition in low-income families in South Africa. Among informal working women, the CSG is an important source of income after childbirth when informal workers are unable to work, but reports suggest that women experience delays in accessing the CSG. We explore experiences and challenges of accessing the CSG among informal workers in Durban, South Africa. METHODS: We undertook a longitudinal mixed-methods cohort study. Women informal workers were recruited during pregnancy and followed-up for up to one year after the baby was born. Quantitative questionnaires and semi-structured in-depth interviews were used to collect data about women's plans for applying for the CSG, the application process, use of the CSG in the household, and household food insecurity. Interviews were conducted in IsiZulu by experienced researchers. Descriptive analysis of quantitative data used SPSS v26, and framework analysis using NVIVO v12.3 was used for qualitative analysis. RESULTS: Twenty-four informal working women were enrolled. The CSG received for older children was reported as an important and reliable source of income for mothers after childbirth. However, delays receiving the CSG for the new baby meant this support was unavailable to first-time mothers. The complex application process for the CSG required mothers to travel to various government departments to complete the required documentation, often taking the baby with them. This was costly and time-consuming for mothers who were already vulnerable, and led to delays in obtaining CSG funds. Many women experienced moderate or severe food insecurity before and after the baby was born. As a result, some mothers had to return to work earlier than planned, disrupting childcare and breastfeeding. CONCLUSIONS: Cash transfer programmes can effectively support low income households and improve outcomes for mothers and children. In South Africa there is a need for innovative approaches to streamline CSG applications, so women can access the funds immediately post-delivery to fill a resource gap and provide support at a vulnerable time for mothers and their children.

Attachment goes to court: child protection and custody issues.

Attachment theory and research are drawn upon in many applied settings, including family courts, but misunderstandings are widespread and sometimes result in misapplications. The aim of this consensus statement is, therefore, to enhance understanding, counter misinformation, and steer family-court utilisation of attachment theory in a supportive, evidence-based direction, especially with regard to child protection and child custody decision-making. The article is divided into two parts. In the first, we address problems related to the use of attachment theory and research in family courts, and discuss reasons for these problems. To this end, we examine family court applications of attachment theory in the current context of the best-interest-of-the-child standard, discuss misunderstandings regarding attachment theory, and identify factors that have hindered accurate implementation. In the second part, we provide recommendations for the application of attachment theory and research. To this end, we set out three attachment principles: the child's need for familiar, non-abusive caregivers; the value of continuity of good-enough care; and the benefits of networks of attachment relationships. We also discuss the suitability of assessments of attachment quality and caregiving behaviour to inform family court decision-making. We conclude that assessments of caregiver behaviour should take center stage. Although there is dissensus among us regarding the use of assessments of attachment quality to inform child custody and child-protection decisions, such assessments are currently most suitable for targeting and directing supportive interventions. Finally, we provide directions to guide future interdisciplinary research collaboration.

Employment and child support outcomes among noncustodial fathers: An evaluation of the Fathers Advancing Community Together program.

Prior research underscores the importance of fathers' involvement in their children's lives. However, there is mixed evidence about the degree to which fatherhood programs improve economic stability and child support outcomes among noncustodial fathers. We attempted to address some of these gaps in the literature by evaluating the Fathers Advancing Community Together (FACT) program. FACT was implemented by Rubicon Programs, a community-based nonprofit organization in the Bay Area, California known for providing services to help move people out of poverty. The program provided parents economic stability, responsible parenting, and healthy relationship workshops, as well as support services and intensive case management. We relied on data from the Department of Child Support Services to assess whether FACT increased the likelihood of employment, child support modifications, and child support payments among noncustodial fathers during a 6-month post-enrollment period. Using 3:1 coarsened exact matching procedures, the total sample resulted in 744 fathers (186 in the intervention group and 558 in the comparison group). Results from logistic regression models indicate that FACT participants were more likely to be employed and more likely to receive a child support modification during the post-enrollment period than their comparison counterparts, though we found no significant relationship between FACT participation and whether fathers made a child support payment.

Investigaciones previas subrayan la importancia de la participación de los padres en las vidas de sus hijos. Sin embargo, hay datos contradictorios acerca del grado en el cual los programas sobre la paternidad mejoran los resultados en la estabilidad económica y la manutención infantil entre los padres que no tienen la custodia de sus hijos. Intentamos abordar algunos de estos vacíos en las publicaciones evaluando el programa "Padres que fomentan la comunidad juntos" (Fathers Advancing Community Together, FACT). El programa FACT fue implementado por Rubicon Programs, una organización comunitaria sin fines de lucro en el Área de la Bahía de California, conocida por prestar servicios para ayudar a las personas a salir de la pobreza. El programa ofreció talleres de estabilidad económica para los padres, crianza responsable y relaciones sanas, así como servicios de apoyo y gestión intensiva de casos. Utilizamos datos del Departamento de Servicios de Manutención Infantil (Department of Child Support Services) para evaluar si el FACT aumentó la probabilidad de empleo, las modificaciones en la manutención infantil y los pagos de la manutención infantil entre padres sin la custodia de sus hijos durante un periodo de seis meses posterior a la inscripción. Utilizando métodos de emparejamiento exacto 3:1, la muestra total dio como resultado 744 padres (186 en el grupo de intervención y 558 en el grupo de comparación). Los resultados de los modelos de regresión logística indican que los participantes del FACT tuvieron más probabilidades de ser empleados y de recibir una modificación en la manutención infantil durante el periodo posterior a la inscripción que sus homólogos del grupo de de comparación, aunque no encontramos una relación significativa entre la participación en el FACT y si los padres hicieron un pago de manutención infantil.

Living arrangements after parental separation have minimal impact on mental health at age 7 years.

AIM: This study compared mental health after parental separation in 7-year-old children living in joint physical custody with sole physical custody family arrangements. METHODS: The study population included 39 661 children from the Danish National Birth Cohort, living in a nuclear family at age 6 months. Child mental health was measured at age 7 years with maternal reports of the Strength and Difficulties Questionnaire (SDQ) operationalised as a high total score. Associations between living arrangements and mental health were analysed using logistic regression models, taking into account early childhood indicators of family relations, parental mental health and socioeconomic conditions. RESULTS: There were no statistically significant differences between the living arrangements after parental separation with joint physical custody having an odds ratio (OR) of 1.37 (95% CI 1.10-1.70), sole physical custody without a new partner OR 1.33 (95% CI 1.19-1.47) and OR 1.55 (95% CI 1.30-1.84) for sole physical custody with new partner, with children in a nuclear family as reference. CONCLUSION: This study indicates that living arrangements after parental separation have a minimal influence on child mental health at age 7 years.

Early childhood social determinants and family relationships predict parental separation and living arrangements thereafter.

AIM: Parental separation has been associated with poor mental health in children with better outcomes in children living in joint physical custody compared with those living with one parent after the separation. In this study, we investigated socioeconomic and relational predictors in early childhood of later parental separation and family arrangements thereafter. METHODS: This study included 34 768 children from the Danish National Birth Cohort, who were living with both parents at the 6 months' data collection and followed up in 2010-2014 at age 11 years. Questionnaire data from the two data collections were linked with population registers in Statistics Denmark about parental income, education and psychiatric care and analysed in logistic regression models. RESULTS: Socioeconomic indicators of the family and parental psychiatric disorders before birth of the child and family relationships in infancy predicted parental separation at age 11 year. For children with separated parents, a high family income and a high parental educational level were the main predictors of living in joint physical custody at the 11-year follow-up. CONCLUSION: Socioeconomic living conditions predict parental separation as well as living arrangements thereafter. Studies of consequences of living arrangements after parental separation should account for family factors preceding the separation.

Joint Physical Custody and Adolescents' Life Satisfaction in 37 North American and European Countries.

Joint physical custody, a parental care arrangement in which a child lives with each parent about equally after separation or divorce, is an increasingly common phenomenon in many Western countries. Although attention from family scholars, practitioners, and law professionals is growing, there are hardly any numbers on the prevalence of joint physical custody (JPC). Moreover, studies using large-scale representative data on the effects of JPC for children's well-being are still rare. The data for this study come from Health Behaviour in School-Aged Children (HBSC), a representative cross-national survey of adolescents in 37 European and North American countries that was conducted in 2002, 2006, and 2010 and included information on students at the ages of 11, 13, and 15 years (N = 92,886). First, results revealed that symmetrical JPC after family dissolution is still very rare in the majority of countries (5% or less), but reaches 10-20% in some countries. Second, adolescents' life satisfaction in nonintact families is higher in symmetric JPC arrangements than in asymmetric care arrangements. However, after controlling for children and family characteristics, the differences disappear. Thus, it is not the symmetric JPC arrangement that induces adolescents' higher life satisfaction, but rather the children and family characteristics that are associated with the choice of such a custody arrangement by separated or divorced parents.

La custodia física conjunta, un acuerdo de cuidado parental por medio del cual un niño vive con cada padre más o menos por igual después de la separación o el divorcio, es un fenómeno cada vez más común en muchos países occidentales. Aunque la atención por parte de los investigadores familiares, los profesionales de la salud y los abogados está aumentando, hay muy pocas cifras sobre el predominio de la custodia física conjunta. Además, los estudios que utilizan datos representativos a gran escala sobre los efectos de la custodia física conjunta para el bienestar de los niños todavía son escasos. Los datos para este estudio provienen del Estudio sobre las conductas saludables de los jóvenes escolarizados (Health Behaviour in School-Aged Children, HBSC), una encuesta transnacional representativa de adolescentes en 37 países europeos y norteamericanos que se realizó en 2002, 2006 y 2010 e incluyó información sobre alumnos a las edades de 11, 13, y 15 años (N=92,886). En primer lugar, los resultados revelaron que la custodia física conjunta simétrica después de la división familiar aun es muy rara en la mayoría de los países (5 % o menos), pero llega a entre el 10 y el 20 % en algunos países. En segundo lugar, la satisfacción con la vida de los adolescentes en familias no intactas es mayor en los acuerdos de custodia física conjunta simétrica que en los acuerdos de cuidado asimétrico. Sin embargo, después de tener en cuenta las características de los niños y las familias, las diferencias desaparecen. Por lo tanto, no es el acuerdo de custodia física conjunta simétrica lo que causa una mayor satisfacción con la vida en los adolescentes, sino las características de los niños y las familias que están asociadas con la elección de dicho acuerdo de custodia por parte de los padres separados o divorciados.

Divorced and separated parents during the COVID-19 pandemic.

The COVID-19 pandemic has caused significant stress for individuals, couples, and families. Divorced and separated couples with children face unique stresses amid the pandemic. This mixed-methods study explored these challenges among 296 divorced and separated parents: namely 204 women formerly partnered with men, 34 men formerly partnered with women, and 58 women formerly partnered with women, who were surveyed during Summer/Fall of 2020. Participants described legal, financial, and coparenting challenges. Those who were not yet divorced described difficulties filing for or finalizing their divorce because of court closures and lack of responsiveness from legal professionals. Those who were already divorced also faced legal challenges, such as being unable to obtain a court date to modify custody arrangements. Financial challenges included renegotiating financial support obligations in the context of job loss. Salient coparenting conflicts, explored through closed- and open-ended questions, included communication issues, different views on virus risk mitigation behaviors, financial issues (especially for those not yet divorced), and transitioning between households and handling remote schooling (especially for those with shared physical custody). Participants elaborated on COVID-19-specific challenges, revealing that (a) lack of communication or agreement regarding shared strategies for risk mitigation reflected and exacerbated challenging dynamics between coparents, (b) remote schooling was often the site of disagreement when one parent felt that they were doing more than their fair share of coordination and oversight, and (c) different perspectives on science were expected to lead to future contention when making a joint decision about whether to vaccinate children. Findings have implications for family and legal professionals working with divorced, divorcing, and separated parents.

La pandemia de la COVID-19 ha generado mucho estrés en las personas, las parejas y las familias. Las parejas separadas y divorciadas que tienen niños enfrentan tensiones únicas en medio de la pandemia. En este estudio de métodos combinados se analizaron estas dificultades entre 296 padres divorciados y separados, por ejemplo, 204 mujeres que antes estaban en pareja con hombres, 34 hombres que antes estaban en pareja con mujeres y 58 mujeres que antes estaban en pareja con mujeres, a quienes se los encuestó durante el verano/otoño de 2020. Los participantes describieron las dificultades legales, económicas y de cocrianza. Aquellos que aún no estaban divorciados describieron dificultades para presentar la demanda de divorcio o para finalizar su divorcio debido a los cierres de los juzgados y a la falta de respuesta de los abogados. Los que ya estaban divorciados también enfrentaron dificultades legales, como no poder obtener una cita en el juzgado para modificar los acuerdos de tenencia. Entre las dificultades económicas se encontraron la renegociación de las obligaciones de ayuda económica en el contexto de la pérdida del empleo. Los conflictos de cocrianza más destacados, analizados mediante preguntas cerradas y abiertas, fueron los problemas de comunicación, los diferentes puntos de vista sobre las conductas de disminución del riesgo de contagio del virus, los problemas económicos (especialmente para aquellos que aún no estaban divorciados) y la transición entre hogares y el manejo de las clases virtuales (especialmente para aquellos con tenencia compartida). Los participantes explicaron en profundidad las dificultades específicas de la COVID-19, y revelaron que (a) la falta de comunicación o de acuerdo con respecto a las estrategias compartidas para la reducción de riesgos reflejaron y exacerbaron la dinámica compleja entre los copadres, (b) las clases virtuales fueron generalmente el punto de desacuerdo cuando uno de los padres sentía que estaba haciendo más de lo que le correspondía con respecto a la coordinación y la supervisión, y (c) se esperó que los diferentes puntos de vista sobre la ciencia condujeran a futuras disputas a la hora de tomar una decisión conjunta acerca de si vacunar o no a los niños. Los resultados tienen consecuencias para los especialistas en familia y en leyes que trabajan con padres divorciados, que se están divorciando y separados.

The female payer: Gender differences in characteristics among child support payers.

Nonresident mothers who formally pay child support are becoming increasingly prevalent. If the profile of female payers differs from that of men or if their payment is motivated differently, existing gender-based child support policies and enforcement strategies face significant challenges. This study uses the payment framework of male compliance to map the differences between male and female payers of child support. The analysis applies discriminant analysis to a combination of register and fiscal data of separated parents. Whereas the separate aspects of the payment framework did not reach the threshold for acceptable discrimination, the full model revealed considerable differences between male and female payers. The aspect of willingness to pay showed the greatest discriminating power, suggesting that paying mothers have a higher willingness to do so than fathers. We conclude that while the discrepancies between nonresident mothers and fathers who pay child support can be partly attributed to demographic differences and residency patterns of children, differing motivations are also of importance.

Admissibility of attachment theory, research and assessments in child custody decision-making? Yes and No!

Attachment theory, research, and assessments have become increasingly applied to settle child custody cases. We discuss such applications in relation to admissibility criteria for scientific evidence and testimony proposed by Faigman et al. (2014). We argue that attachment theory and research can provide valid "framework evidence"; group-based attachment research has yielded general principles suitable as a frame of reference for pertinent court decisions. In particular, child custody decision-making should generally be guided by research indicating that children benefit from attachment networks. In contrast, assessments of attachment quality fall short of providing valid "diagnostic evidence"; information that a specific individual/dyad is a "true" instance of a general group-level principle. In particular, such assessments do not yield valid information about whether a particular caregiver has better caregiving skills than another caregiver and will better support child development. We conclude that attachment theory and research should be admissible for framework but not for diagnostic testimony.

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.

Sociodemographic Characteristics and Clinical Outcomes of People Receiving Inadequate Prenatal Care: A Retrospective Cohort Study.

OBJECTIVE: This study sought to describe the incidence inadequate prenatal care (IPNC) at an urban level II hospital in Hamilton, Ontario, and to compare the characteristics and outcomes of mothers who received IPNC and their newborns with those who received adequate prenatal care (APNC). This study is the first part of a mixed-methods research program aimed at informing the development of an interdisciplinary, patient-centred, prenatal care program for people who struggle to access conventional modes of care. METHODS: This retrospective cohort study compared mothers and neonates born at St. Joseph's Health Care Hamilton in 2016 with IPNC (fewer than or equal to four antenatal visits, or first visit in third trimester) with those born with APNC (five or more prenatal visits and initial visit before the third trimester). Cases and controls matched 3:1 for age and parity were identified through a retrospective chart review. RESULTS: In total 3235 charts were reviewed, and 69 cases of IPNC were identified (2.1%). The IPNC group had lower education and higher unemployment levels, as well as higher rates of smoking and drug use. Our primary and secondary outcomes of newborn custody loss, neonatal intensive care unit admission, and neonatal length of stay were significantly higher in the IPNC group. CONCLUSION: Patients delivering with IPNC represent a high-risk group with increased rates of adverse neonatal outcomes and newborn custody loss. This quantitative study will inform future research and innovative interdisciplinary program development aimed at increasing access to prenatal care in an effort to improve maternal and neonatal outcomes.

Children with two homes: Psychological problems in relation to living arrangements in Nordic 2- to 9-year-olds.

AIM: Joint physical custody, children spending equal time in each parents' respective home after a parental divorce, is particularly common in Nordic compared with other Western countries. Older children have been shown to fare well in this practice but for young children there are few existing studies. The aim of this paper is to study psychological problems in 2- to 9-year-old Nordic children in different family forms. METHODS: Total symptom score according to the Strengths and Difficulties Questionnaire as well as scores showing externalizing problems were compared among 152 children in joint physical custody, 303 in single care and 3207 in nuclear families through multiple linear regression analyses. RESULTS: Children in single care had more psychological symptoms than those in joint physical custody (B = 1.08; 95% CI 0.48 to 1.67) and those in nuclear families had the least reported symptoms (B = -0.53; 95% CI -0.89 to -0.17). Externalizing problems were also lower in nuclear families (B = -0.28, 95% CI -0.52 to -0.04) compared with joint physical custody after adjusting for covariates. CONCLUSIONS: Young children with non-cohabiting parents suffered from more psychological problems than those in intact families. Children in joint physical custody had a lower total problem score than those in single care after adjusting for covariates. Longitudinal studies with information on family factors before the separation are needed to inform policy of young children's post-separation living arrangements.