Social Determinants of Health and Parenting Self-Efficacy Among Mothers of Preterm Infants.

Objective: To explore the relationships between social and environmental factors and parenting self-efficacy (PSE) among mothers of preterm infants hospitalized in neonatal intensive care units (NICUs) using a social determinants of health (SDoH) framework. Method: We analyzed data from a prospective cohort study that included 187 mother-infant dyads admitted to four NICUs in the Mountain West region between June 2017 and December 2019. We used multivariable linear regression models to assess the independent associations between maternal and infant characteristics and PSE. Results: Our final multiple linear regression model predicting the efficacy score including maternal race/ethnicity, age, insurance, employment status before giving birth, gestational age, depression, and having other children was significant (F(12,160) = 3.17, p = .0004, adjusted R¬2 = .131). Significant predictors of PSE were race/ethnicity (ß= 3.3, p = .022), having another child/children (ß= 4.2, p = .005), and depression (ß= -4.2, p = .004). Conclusions: Findings suggest that social workers and medical practitioners should consider SDoH, such as insurance type, household income, and employment, along with traditional clinical indicators when assessing families' infant care needs. Social workers, medical practitioners, and researchers should be mindful of how implicit bias may influence the allocation of care and parental supports.

Family outcomes in alternative response: A multilevel analysis of recurrence.

Alternative response (AR) is preventative, family-centered, strengths-based approach within child protective services (CPS). When AR is offered it typically creates a two-track system where low- to moderate-risk families are not subjected to a traditional, fact-finding response that concludes with a determination of child abuse/neglect. One area that continues to concern child welfare administrators and researchers is recurrence, or when a family returns to CPS. Yet, it is unclear whether AR families have the same or different predictors of recurrence than TR families. Using a multilevel analytic approach, the present study followed 17,741 families in one mid-Atlantic state for 18-months post-response to determine what child, family, and county-level predicted a reported re-investigation and a substantiated re-investigation. We found few differences in predictors at the child and family level but found distinct differences at the county level for AR families. Recommendations are provided for policy, practice, and research, including a suggestion for further inquiry on what makes an optimal AR track.