Unique Profiles of Postpartum Family Needs and Evidence of Racial and Ethnic Disparities: Insights from Community Implementation of Family Connects.

OBJECTIVES: To delineate specific family needs during the postpartum period using data from Family Connects (FC), a universal home-visiting initiative, and to scrutinize potential racial and ethnic disparities in these needs. METHOD: FC implementation data spanned from July 1, 2009, to August 31, 2021, in seven counties across the USA. Data encompassed nurse-led in-home assessments for 34,119 families. Nurses evaluated needs across four domains (healthcare, parenting/childcare, safe home, and parent support) comprising 12 risk factors. FINDINGS: Overall, families reported high levels of need, and community connections were facilitated for 57% of visited families. Significant differences in need profiles between whites and minority groups were revealed, reflecting both disparity and uniqueness. Employing the Oaxaca decomposition approach, we found that racial/ethnic disparities in socioeconomic attributes were associated with racial/ethnic gaps in the need profiles. CONCLUSIONS: The event of giving birth is both high risk and high opportunity for preventive intervention. Home-visiting programs, as an evidence-based approach, must address the diverse spectrum of familial needs comprehensively.

Impact of the COVID-19 pandemic on substance use among adults without children, parents, and adolescents.

Impact of the COVID-19 pandemic on alcohol and illicit substance use among adults without children, parents, and adolescents was investigated through two studies with five samples from independent ongoing U.S. longitudinal studies. In Study 1, 931 adults without children, parents, and adolescents were surveyed about the pandemic's impact on personal behavior. 19-25% of adults without children, parents, and adolescents reported an increase in alcohol or illicit substance use. In Study 2, 274 adults without children, parents, and adolescents who had been interviewed prior to the pandemic onset about alcohol and illicit substance use problems were re-interviewed after the pandemic's onset to test within-person change. The rate of alcohol or illicit substance use problems increased from pre-pandemic to post-pandemic onset from 13% to 36% among the three groups. Increase in alcohol and illicit substance use problems was positively correlated with increased depression/anxiety and household disruption, suggesting possible mechanisms for increases in substance problems. Findings in both studies held across low- and middle-income families. Findings suggest the need for communitywide policies to increase resources for alcohol and illicit substance use screening and intervention, especially for adolescents.

Maximizing the return on investment in Early Childhood Home Visiting through enhanced eligibility screening.

BACKGROUND: The MIECHV (Maternal, Infant, and Early Childhood Home Visiting) program invests substantial federal resources to prevent child maltreatment and emergency medical costs. Eligibility is based on screening of demographic or clinical risk factors, but because screening accuracy in predicting poor outcomes is unknown, assignment to home-visiting might miss high-risk families or waste resources on low-risk families. OBJECTIVES: To guide eligibility decisions, this study tested accuracy of demographic and clinical screening in predicting child maltreatment and emergency medical care. PARTICIPANTS AND SETTING: A population-representative sample of 201 birthing mothers (39.8% Black, 33.8% Latina) in Durham, NC, was enrolled between July 2009, and December 2010, and followed through December 2015. METHODS: Participants were screened demographically (i.e., Medicaid, first-born, teenage, no high school diploma) and clinically (i.e., health/health care, parenting readiness, home safety, and parent mental health) at birth and followed through age 60 months, when Child Protective Services and hospital records were reviewed. Cox hazard models tested accuracy of prediction from screening variables. RESULTS: Demographic factors did not significantly predict outcomes, except having Medicaid/uninsured predicted more emergency medical care and being first-born was a (surprising) protective factor against a child maltreatment investigation. In contrast, clinical factors strongly predicted both maltreatment investigations (Hazard Ratio = 4.01 [95% CI = 1.97, 8.15], sensitivity = 0.70, specificity = 0.64, accuracy = 0.65) and emergency medical care (Hazard Ratio = 2.14 [95% CI = 1.03, 2.14], sensitivity = 0.50, specificity = 0.69, accuracy = 0.58). CONCLUSIONS: Even with added costs for clinical screening, selecting families for home visiting based on assessed clinical risk will improve accuracy and may yield a higher return on investment. The authors recommend a universal system of screening and care to support birthing families.