Providing a Safe Haven: Staff Response to a Simulated Infant Relinquishment in the Emergency Department.

Every state in the United States has established laws that allow an unharmed newborn to be relinquished to personnel in a safe haven, such as hospital emergency departments, without legal penalty to the parents. These Safe Haven, Baby Moses, or Safe Surrender laws are in place so that mothers in crisis can safely and legally relinquish their babies at a designated location where they can be protected and given medical care until a permanent home can be found. It is important for health care professionals to know about and understand their state's law and how to respond should an infant be surrendered at their facility. No articles were found in the peer-reviewed literature that describe a method to evaluate nurse competency during infant relinquishment at a Safe Haven location. This article will describe commonalities and differences among these Safe Haven Laws, responsibilities of the hospital and staff receiving a relinquished infant, and 1 hospital's experience when running an infant relinquishment drill in their emergency department.

Infant Homicides Within the Context of Safe Haven Laws - United States, 2008-2017.

Homicide is the 13th leading cause of death among infants (i.e., children aged <1 year) in the United States (1). Infant homicides occurring within the first 24 hours of life (i.e., neonaticide) are primarily perpetrated by the mother, who might be of young age, unmarried, have lower educational attainment, and is most likely associated with concealment of an unintended pregnancy and nonhospital birthing (2). After the first day of life, infant homicides might be associated with other factors (e.g., child abuse and neglect or caregiver frustration) (2). A 2002 study of the age variation in homicide risk in U.S. infants during 1989-1998 found that the overall infant homicide rate was 8.3 per 100,000 person-years, and on the first day of life was 222.2 per 100,000 person-years, a homicide rate at least 10 times greater than that for any other time of life (3). Because of this period of heightened risk, by 2008 all 50 states* and Puerto Rico had enacted Safe Haven Laws. These laws allow a parent† to legally surrender an infant who might otherwise be abandoned or endangered (4). CDC analyzed infant homicides in the United States during 2008-2017 to determine whether rates changed after nationwide implementation of Safe Haven Laws, and to examine the association between infant homicide rates and state-specific Safe Haven age limits. During 2008-2017, the overall infant homicide rate was 7.2 per 100,000 person-years, and on the first day of life was 74.0 per 100,000 person-years, representing a 66.7% decrease from 1989-1998. However, the homicide rate on first day of life was still 5.4 times higher than that for any other time in life. No obvious association was found between infant homicide rates and Safe Haven age limits. States are encouraged to evaluate the effectiveness of their Safe Haven Laws and other prevention strategies to ensure they are achieving the intended benefits of preventing infant homicides. Programs and policies that strengthen economic supports, provide affordable childcare, and enhance and improve skills for young parents might contribute to the prevention of infant homicides.

Safely surrendered infants in Los Angeles County: A medically vulnerable population.

BACKGROUND: As a means to provide safety for a population at great risk of harm through abandonment, every state in the United States now has laws and practices for the safe relinquishment of newborns and infants. However, there is no national database tracking the population of infants surrendered through such programmes, and few states monitor these numbers. The primary aim of this study was therefore to examine the descriptive characteristics of infants who have been safely surrendered in a large, socio-economically diverse urban area. The secondary aim was to compare them with local population norms to determine whether differences exist and to begin exploring what implications such differences may have for the treatment provided to these infants. METHODS: A retrospective cross-sectional study was conducted among safely surrendered infants. RESULTS: Over half of the infants had medical issues, and the majority of the infants were surrendered in communities characterized by low median income. CONCLUSIONS: Preliminary information highlights potential economic, social, and medical risk factors, suggesting that these infants may require increased monitoring and/or specialized care.

El horizonte de la atención médica en pediatría: ¿qué hacer en el caso de niños que se encuentran en situación de abandono, conflicto, daño o peligro, aunado a una enfermedad grave? / The horizon of medical attention in pediatrics: what to do in the case of children who are in abandonment, conflict, harm or danger situations in combination with a severe disease?

Resumen: Introducción: Las leyes refieren que los menores no tienen la capacidad para dar su consentimiento informado para su propia atención médica; sin embargo, hay condiciones especiales en las que se les permite determinar lo referente a su salud. Cuanto mayores sean las limitaciones de juicio y experiencia en los menores, menos peso se otorga a los valores y objetivos que expresan; cuanto más adversas sean las consecuencias, se deberá exigir un nivel más alto de autoridad para decidir en nombre del menor, dejando al Estado la capacidad de garantizar el bienestar del menor. Caso clínico: Niña de 12 años con diagnóstico de leucemia linfoblástica aguda LI, con antecedentes familiares y sociales precarios; evolución entorpecida por el desapego al tratamiento y sus condiciones insalubres y pobreza extrema. Ambos padres fallecieron al poco tiempo de iniciar su tratamiento, quedando ella al cuidado de su medio hermana mayor de edad. Se exponen la labor y el dilema ético del oncólogo tratante y del personal del Hospital Infantil de México Federico Gómez en la creación de redes de apoyo con el objetivo de priorizar el bienestar de la menor, sin dar lugar al quebrantamiento y la desintegración familiar, consiguiendo exitosamente su recuperación. Conclusiones: El caso fue sometido al Comité de Bioética Hospitalaria. Se formaron redes de apoyo interinstitucionales para intervenir en la dinámica familiar, resolviendo los requerimientos de la menor, y se consiguió con éxito superar la enfermedad.

Abstract: Background: Laws refer that minors do not have the capability to give informed consent for their own medical attention. However, there are special conditions in which they are allowed to decide about their health. The greater the judgement and experience limitations in minors, the less weight is given to the values and objectives they express. Also, the more adverse consequences might be, the higher the level of authority that is demanded to decide on behalf of the minor, thus granting the State the capability to guarantee the well-being of the minor. Case report: 12-year-old female patient with a diagnosis of acute lymphoblastic leukemia, with precarious social and family background; evolution of the disease obstructed by the disregard of the treatment due to her unsanitary and extreme poverty conditions. Both of her parents died soon after the start of the treatment and she was kept under the care of her half-sister of legal age. The work and the ethical dilemma of the pediatrician and the staff of Hospital Infantil de México Federico Gómez are exposed within the building of support networks with the objective of prioritizing the minor's well-being, without allowing family break-up or disintegration, thus succeeding in her recovery. Conclusions: The case was submitted to the Hospital Bioethics Committee. Inter-institutional support networks were built in order to improve dynamics of the family, thus solving the needs of the minor. Despite the misfortune of the situation, the disease was successfully overcome.

[The horizon of medical attention in pediatrics: what to do in the case of children who are in abandonment, conflict, harm or danger situations in combination with a severe disease?] / El horizonte de la atención médica en pediatría: ¿qué hacer en el caso de niños que se encuentran en situación de abandono, conflicto, daño o peligro, aunado a una enfermedad grave?

Background: Laws refer that minors do not have the capability to give informed consent for their own medical attention. However, there are special conditions in which they are allowed to decide about their health. The greater the judgement and experience limitations in minors, the less weight is given to the values and objectives they express. Also, the more adverse consequences might be, the higher the level of authority that is demanded to decide on behalf of the minor, thus granting the State the capability to guarantee the well-being of the minor. Case report: 12-year-old female patient with a diagnosis of acute lymphoblastic leukemia, with precarious social and family background; evolution of the disease obstructed by the disregard of the treatment due to her unsanitary and extreme poverty conditions. Both of her parents died soon after the start of the treatment and she was kept under the care of her half-sister of legal age. The work and the ethical dilemma of the pediatrician and the staff of Hospital Infantil de México Federico Gómez are exposed within the building of support -networks with the objective of prioritizing the minor's well-being, without allowing family break-up or disintegration, thus succeeding in her recovery. Conclusions: The case was submitted to the Hospital Bioethics Committee. Inter-institutional support networks were built in order to improve dynamics of the family, thus solving the needs of the minor. Despite the misfortune of the situation, the disease was successfully overcome.

Introducción: Las leyes refieren que los menores no tienen la capacidad para dar su consentimiento informado para su propia atención médica; sin embargo, hay condiciones especiales en las que se les permite determinar lo referente a su salud. Cuanto mayores sean las limitaciones de juicio y experiencia en los menores, menos peso se otorga a los valores y objetivos que expresan; cuanto más adversas sean las consecuencias, se deberá exigir un nivel más alto de autoridad para decidir en nombre del menor, dejando al Estado la capacidad de garantizar el bienestar del menor. Caso clínico: Niña de 12 años con diagnóstico de leucemia linfoblástica aguda LI, con antecedentes familiares y sociales precarios; evolución entorpecida por el desapego al tratamiento y sus condiciones insalubres y pobreza extrema. Ambos padres fallecieron al poco tiempo de iniciar su tratamiento, quedando ella al cuidado de su medio hermana mayor de edad. Se exponen la labor y el dilema ético del oncólogo tratante y del personal del Hospital Infantil de México Federico Gómez en la creación de redes de apoyo con el objetivo de priorizar el bienestar de la menor, sin dar lugar al quebrantamiento y la desintegración familiar, consiguiendo exitosamente su recuperación. Conclusiones: El caso fue sometido al Comité de Bioética Hospitalaria. Se formaron redes de apoyo interinstitucionales para intervenir en la dinámica familiar, resolviendo los requerimientos de la menor, y se consiguió con éxito superar la enfermedad.

Contornos da judicialização: reflexões sobre famílias recasadas e abandono afetivo / Outlines of judicialization: reflectionson remarried families and emotional abandonment / Contornos de la judicialización: reflexiones sobre familias reconstituidas y abandono afectivo

Este artigo buscou articular duas pesquisas que se situam na perspectiva da psicologia jurídica e que tomam como objetos de estudo questões referentes à família na esfera da justiça. O objetivo principal desta escrita é analisar os contornos que caracterizam o movimento de judicialização nas demandas de famílias recasadas e de abandono afetivo. De maneira geral, a judicialização pode ser compreendida como o movimento de expansão dos poderes judiciários em questões que antes eram resolvidas em outros espaços. Quanto às famílias recasadas, identificou-se o caminho das jurisprudências para a resolução de solicitações que não estão contempladas na legislação. Contudo, nos relatos dos entrevistados, verificou-se a busca por soluções sem recorrer ao Judiciário, o que difere da proposta encontrada no referencial teórico de criação de legislação específica para atender a essa configuração familiar. Quanto ao abandono afetivo, a análise dos aspectos vinculados à produção e comprovação dessa demanda no sistema jurídico aponta para a dificuldade da medição dos danos e da relação com a ausência de afeto, além do importante recorte de gênero, que posiciona diferentemente as figuras parentais e define funções específicas para cada um. Dessa forma, conclui-se que o movimento de judicialização reflete e ao mesmo tempo forja as demandas, denotando uma mudança social na maneira como a sociedade lida com seus impasses familiares.

This paper aims to articulate two studies in the overview of Legal Psychology and taking as objects of study issues relating to the family in the sphere of justice. The main purpose of this paper is to analyze the outlines that characterize the movement of judicialization on the demands of remarried families and emotional abandonment. In general, judicialization can be understood as the movement of expansion of judicial powers to matters that used to be resolved in other spaces. With respect to remarried families, this study identified how jurisprudence can provide a way to resolve demands that are not covered by the legislation. However, respondents' reports indicated that they look for solutions without resorting to court, which differs from the proposal found on the theoretical reference to formulate specific legislation to address this family configuration. In regards to emotional abandonment, the analysis of aspects related to the production and validation of this demand by the legal system highlights the difficulty to measure damage and its relationship with absence of affection, in addition to the important gender approach, that assigns different positions and specific roles for each parental figure. Therefore, we conclude that the judicialization trend reflects and at the same time forges demands, denoting a social change in the way society deals with family impasses.

Este artículo tiene por objeto articular dos estudios que se encuentran en la perspectiva de la Psicología Forense, teniendo como objeto de estudio las cuestiones relacionadas con la familia en el ámbito de la justicia. El objetivo principal es analizar los contornos que caracterizan el movimiento de la judicialización de las demandas de las familias reconstituidas y abandono afectivo. En términos generales, puede entenderse la judicialización como el movimiento de expansión de los poderes judiciales en los asuntos que se resolvieron en otros espacios. En cuanto a las familias reconstituidas se identificó el camino de la jurisprudencia para solucionar las solicitudes que no están cubiertas por la legislación. Sin embargo, en los reportes de los encuestados se encontró la búsqueda de soluciones sin recurrir a los tribunales, lo que difiere de la propuesta que se encuentra en el marco teórico de creación de una legislación específica para satisfacer esta configuración familiar. En cuanto al abandono afectivo, el análisis de los aspectos relacionados con la producción y prueba de esta demanda en el sistema legal denota la dificultad de medir el daño y la relación con la ausencia de afecto, más allá del importante enfoque de género, que diferencia la colocación de las figuras parentales y define las funciones específicas de cada uno. Por lo tanto, se concluye que el movimiento de judicialización refleja y, al mismo tiempo forja las demandas, lo que denota un cambio social en la forma en que la sociedad aborda los estancamientos de la familia.

Unmet Needs, Unwanted Persons: A Call for Expansion of Safe Haven Laws.

Legislative strategies for reducing infant abandonment and neonaticide developed in response to a series of sensational cases that occurred in Texas in 1999. The media coverage of these cases implied that the incidence of the crime was increasing, and Texas legislators responded with a law permitting parents to anonymously surrender their newborn at designated locations such as hospitals. This was the first "safe haven" law. Interest peaked nationwide, and by 2008 all states had a similar version of the law. These laws can trigger rapid cessation of parental rights and a fast-tracked adoption to a preapproved family, reflecting the legislators' assumption that it is better to permit struggling mothers to leave their children with well-intentioned strangers than to abandon the children or end their lives. These laws, however, suffer from several inadequacies.

Análisis de la mortalidad expósita de la inclusa de Toledo y sus condicionantes (1900-1930) / Analysis of the mortality experience among the abandoned children in the foundling hospital of Toledo and its determinants (1900-1930)

El objetivo de este trabajo es analizar la mortalidad expósita y sus causas en una cohorte de niños abandonados en la inclusa toledana, aquellos que nacieron en la Maternidad aneja, como grupo homogéneo que partía de unas condiciones de alumbramiento similares y fueron institucionalizados al nacer. Ello permite comparar esta mortalidad expósita con la de otras inclusas españolas y con la mortalidad poblacional, a la vez que explica los distintos factores que pudieron condicionarla (AU)

The aim of this work is to analyze the mortality and its causes in the abandoned children of the Children’s home of Toledo, who were born in the Maternity House, because it was a homogeneous group which had the same conditions in their delivery and they were abandoned at the moment of their birth. It allows us to compare the mortality of this group of foundlings with the mortality of the general population and with the mortality of those abandoned in other Charity Institutions. This paper explains the different factors which could determine the mortality (AU)

Anonymous birth law saves babies--optimization, sustainability and public awareness.

The aims of this study are to assess the impact of Austria's anonymous birth law from the time relevant statistical records are available and to evaluate the use of hatches versus anonymous hospital delivery. This study is a complete census of police-reported neonaticides (1975-2012) as well as anonymous births including baby hatches in Austria during 2002-2012. The time trends of neonaticide rates, anonymous births and baby hatches were analysed by means of Poisson and logistic regression model. Predicted and observed rates were derived and compared using a Bayesian Poisson regression model. Predicted numbers of neonaticides for the period of the active awareness campaign, 2002-2004, were more than three times larger than the observed number (p = 0.0067). Of the 365 women who benefitted from this legislation, only 11.5% chose to put their babies in a baby hatch. Since the law was introduced, a significant decreasing tendency of numbers of anonymous births (p = 047) was observed, while there was significant increase of neonaticide rates (p = 0.0001). The implementation of the anonymous delivery law is associated with a decrease in the number of police-reported neonaticides. The subsequent significantly decreasing numbers of anonymous births with an accompanying increase of neonaticides represents additional evidence for the effectiveness of the measure.

Infanticide and illegal infant abandonment in Malaysia.

Infant abandonment and infanticide are poorly understood in Malaysia. The information available in the public arena comes predominantly from anecdotal sources. The aim of this study was to describe the prevalence and characteristics of infanticide and illegal infant abandonment in Malaysia and to estimate annual rates for the most recent decade. Summaries of data about infanticide and illegal infant abandonment were gathered from police records; the annual number of live births was ascertained from the national registry. The estimated inferred infanticide rates for Malaysia were compared with the infanticide rates among countries of very high, high, medium, and low rankings on the Human Development, Gender Inequality, and Gini indices. From 1999 to 2011, 1,069 cases of illegal infant abandonment were recorded and 1,147 people were arrested as suspected perpetrators. The estimated inferred infanticide rate fluctuated between 4.82 and 9.11 per 100,000 live births, a moderate rate relative to the infanticide rates of other countries. There are substantial missing data, with details undocumented for about 78-87% of cases and suspected perpetrators. Of the documented cases, it appeared that more boys than girls were victims and that suspected perpetrators were predominantly Malays who were women, usually mothers of the victim; the possibility of arrest bias must be acknowledged. Economic and social inequality, particularly gender inequality, might contribute to the phenomena of infanticide and abandonment. Strategies to reduce rates of infanticide and illegal infant abandonment in Malaysia will require strengthening of the surveillance system and attention to the gender-based inequalities that underpin human development.

Releasing mother's burdens: child abandonment and retrieval in Madrid, 1890-1935.

In nineteenth-century Europe, the foundling hospital grew beyond its traditional purpose of mitigating the shame of unwed mothers by also permitting widows, widowers, and poor married couples to abandon their children there temporarily. In the Foundling Hospital of Madrid (FHM), this new short-term abandonment could be completely anonymous due to the implementation of a wheel­a device on the outside wall of the institution that could be turned to place a child inside­which remained open until 1929. The use of survival-analysis techniques to disentangle the determinants of retrieval in a discrete framework reveals important differences in the situations of the women who abandoned their children at the FHM, partly depending on whether they accessed it through the Maternity Hospital after giving birth or they accessed it directly. The evidence suggests that those who abandoned their children through the Maternity Hospital retrieved them only when they had attained a certain degree of economic stability, whereas those who abandoned otherwise did so just as soon as the immediate condition prompting the abandonment had improved.

Children abandoned and taken back: children, women, and families in dire straits in Lyon in the nineteenth century.

Abandoning a child was no rare deed in European towns in the nineteenth century, mostly among single women in underprivileged environments. On the other hand, taking this same child back was more unusual. By analyzing the registers of the Lyon hospitals, it is possible to determine the percentage of children taken back by their mothers, how this was actually achieved, and to examine the family status of the mothers at the time of both events. Both of these acts -- abandoning a child and then taking it back -- can be put back in their context in these women's lives, for instance, by looking into the length of time separating the two procedures. To finish with, it appears that the 'Hospices civils de Lyon' encouraged mothers to take the children back and generally had a conciliatory attitude toward them, supposedly in the children's interest.

A inconstância dos laços afetivos na vida das crianças e adolescentes abrigados / The fickleness of emotional ties in the lives of sheltered children and adolescents / La inconstancia de los vínculos emocionales en la vida de niños y adolescentes residentes en albergues públicos

O artigo propõe uma reflexão sobre as práticas institucionais de abrigos, no que concerne às múltiplas transferências pelas quais passam as crianças e adolescentes, considerando nossa experiência de atendimento clínico psicanalítico com essa clientela. Propõe-se essa reflexão a partir da noção de desamparo considerada por Freud como estrutural ao aparelho psíquico. O desamparo é inerente à situação de dependência em que o bebê humano nasce, conduzindo à necessidade de comunicação e à construção de um aparelho psíquico, o que se faz na relação da criança com outras pessoas. Selecionamos alguns casos para exemplificar a especificidade desta clientela e os desafios jurídicos e operacionais suscitados pela mesma. Investigamos em que sentido a situação de vulnerabilidade social em que se encontram, com relações afetivas instáveis e referências familiares frágeis, relaciona-se com o desamparo fundamental.(AU)

The article analyzes the institutional practices of public shelters as far as the numerous relocations experienced by children and adolescents, considering a clinical psychoanalytic practice with this clientele. Such a refection is based upon the notion of helplessness considered by Freud as the structural psychic apparatus. Helplessness is inherent to the situation of dependence into which the human baby is born, thus leading it to the need for communication and the construction of a psychic apparatus built on the child's relationship with others. Some cases were selected to illustrate the specificity of this clientele and the legal and operational challenges arising from it. The author investigates how the situation of social vulnerability, unstable personal relationships and weak family bonds are related to the concept of helplessness.(AU)

El artículo propone hacer una reflexión sobre las prácticas institucionales de los albergues públicos, en lo concerniente a las múltiples transferencias por las que pasan los niños y adolescentes, considerando nuestra experiencia de atención clínica sicoanalítica para ese público. Se propone esa reflexión a partir de la noción de desamparo considerada por Freud, como estructural del aparato psíquico. El desamparo es inherente a la situación de dependencia en la que el ser humano nace, conduciendo a la necesidad de comunicación y a la construcción de un aparato psíquico, lo que se logra a través del relacionamiento del niño con otras personas. Seleccionamos algunos casos para ejemplificar las especificidades de esta clientela y los desafíos jurídicos y operacionales suscitados por la misma. Investigamos en que sentido se relacionan la situación de vulnerabilidad social en la que se encuentran con las relaciones afectivas inestables, referentes familiares frágiles y desamparo fundamental.(AU)

A inconstância dos laços afetivos na vida das crianças e adolescentes abrigados / The fickleness of emotional ties in the lives of sheltered children and adolescents / La inconstancia de los vínculos emocionales en la vida de niños y adolescentes residentes en albergues públicos

O artigo propõe uma reflexão sobre as práticas institucionais de abrigos, no que concerne às múltiplas transferências pelas quais passam as crianças e adolescentes, considerando nossa experiência de atendimento clínico psicanalítico com essa clientela. Propõe-se essa reflexão a partir da noção de desamparo considerada por Freud como estrutural ao aparelho psíquico. O desamparo é inerente à situação de dependência em que o bebê humano nasce, conduzindo à necessidade de comunicação e à construção de um aparelho psíquico, o que se faz na relação da criança com outras pessoas. Selecionamos alguns casos para exemplificar a especificidade desta clientela e os desafios jurídicos e operacionais suscitados pela mesma. Investigamos em que sentido a situação de vulnerabilidade social em que se encontram, com relações afetivas instáveis e referências familiares frágeis, relaciona-se com o desamparo fundamental.

The article analyzes the institutional practices of public shelters as far as the numerous relocations experienced by children and adolescents, considering a clinical psychoanalytic practice with this clientele. Such a refection is based upon the notion of helplessness considered by Freud as the structural psychic apparatus. Helplessness is inherent to the situation of dependence into which the human baby is born, thus leading it to the need for communication and the construction of a psychic apparatus built on the child's relationship with others. Some cases were selected to illustrate the specificity of this clientele and the legal and operational challenges arising from it. The author investigates how the situation of social vulnerability, unstable personal relationships and weak family bonds are related to the concept of helplessness.

El artículo propone hacer una reflexión sobre las prácticas institucionales de los albergues públicos, en lo concerniente a las múltiples transferencias por las que pasan los niños y adolescentes, considerando nuestra experiencia de atención clínica sicoanalítica para ese público. Se propone esa reflexión a partir de la noción de desamparo considerada por Freud, como estructural del aparato psíquico. El desamparo es inherente a la situación de dependencia en la que el ser humano nace, conduciendo a la necesidad de comunicación y a la construcción de un aparato psíquico, lo que se logra a través del relacionamiento del niño con otras personas. Seleccionamos algunos casos para ejemplificar las especificidades de esta clientela y los desafíos jurídicos y operacionales suscitados por la misma. Investigamos en que sentido se relacionan la situación de vulnerabilidad social en la que se encuentran con las relaciones afectivas inestables, referentes familiares frágiles y desamparo fundamental.