Prenatal cocaine exposure and child welfare outcomes

This study examines the relationship between prenatal cocaine exposure and child welfare outcomes. Seventy-six infants positive for cocaine at birth were matched to 76 negative infants. With prenatal care and maternal use of alcohol and tobacco controlled, cocaine-exposed infants had significant decrements in birth weight, length, head circumference, and depressed 5-min Apgar scores. This confirmed the health risk of prenatal cocaine exposure for the sample. Three-year follow-up data were obtained from the State Central Register and foster care records. Adjusting for prior maternal involvement with child welfare services the study groups did not differ in incidents of child maltreatment or foster care placement. These findings suggest that prenatal cocaine exposure is not a marker for abusive parenting. However, from the perspective of a cumulative risk model, the identification of cocaine-exposed infants at birth can form the starting point for the development of appropriate diagnostic and follow-up services for mother and child.     

The impact of parental alcohol or drug removals on foster care placement experiences: a matched comparison group study

Research has established the coincidence of parental alcohol and other drug (AOD) use and child maltreatment, but few studies have examined the placement experiences and outcomes of children removed because of parental AOD use. The present study examines demographic characteristics and placement experiences of children removed from their homes because of parental AOD use (n = 1,333), first in comparison to the remaining sample of children in foster care (n = 4,554), then in comparison to a matched comparison group of children in foster care who were removed for other reasons (n = 1,333). Relative to the comparison sample, children removed for parental AOD use are less likely to experience co-occurring removal because of neglect and physical or sexual abuse and are more likely to be placed in relative foster care. In addition, these children remain in care longer, experience similar rates of reunification, and have significantly higher rates of adoption.     

Race/Ethnicity and rates of self-reported maltreatment among high-risk youth in public sectors of care

This study examined rates of youth-reported maltreatment history and the association between youth-reported maltreatment and foster care history across four racial/ethnic groups in a public system of care. Interviews were conducted with 1,045 youth (European Americans, African Americans, Hispanic Americans, and Asian Pacific Islanders) and their primary caregivers, sampled from one of five service sectors (alcohol/drug services, child welfare, juvenilejustice, mental health, and special education) in San Diego. Overall, racial/ethnic differences in youth-reported maltreatment were minimal. However, in the child welfare sector, African American youth self-reported maltreatment less frequently than other youth. There were significant racial/ethnic differences in foster care history, with African Americans far more likely to have been placed, even after controlling for youth-reported maltreatment, income, age, and gender. Furthermore, maltreatment history was associated with placement for all youth except African Americans. These results suggest that the overrepresentation of minority children in child welfare does not stem from greater rates of maltreatment.     

Alcohol and substance abuse identified during pregnancy: maternal morbidity, child morbidity and welfare interventions

Aim: To study the relations between postnatal maternal morbidity, child morbidity and welfare interventions in families with prenatal alcohol or substance abuse. Methods: A register‐based longitudinal retrospective cohort study. The exposed cohort included 638 children born to 524 women followed‐up during pregnancy for alcohol or substance abuse 1992–2001. Non‐exposed children (n = 1914) born to control women were matched for maternal age, parity, number of foetuses, month of birth and delivery hospital of the index child. Perinatal and follow‐up data of both cohorts were collected from national registers until 2007. Results: Postnatal maternal abuse‐related healthcare utilization and use of medication were associated with child out‐of‐home care. Significant differences were in particular observed in the categories of maternal mental and behavioural disorders caused by psychoactive substance use as well as injury and poisoning. Maternal inpatient care for mental and behavioural disorders peaked at the time of child out‐of‐home care. Maternal abuse‐related healthcare utilization was associated with early child healthcare utilization and use of medication for mental and behavioural disorders. These associations were largely explained by the association with child out‐of‐home care. Conclusions: Postnatal maternal abuse‐related morbidity is associated with significant early child morbidity, use of medication and timing of out‐of‐home care.     

Foster families who care for infants with prenatal drug exposure: support during the transition from NICU to home

Infants exposed prenatally to drugs and alcohol tend to enter the child welfare system at a younger age than many other foster children and often directly from the hospital following birth. This article examines three concepts from the postpartum family adaptation literature: transition to parenthood, maternal and paternal role identities, and attachment. It applies these concepts to the experiences of foster parents who care for infants with prenatal drug and alcohol exposure. Also reviewed are recommended strategies to promote development of the foster parent-infant relationship and to increase parental knowledge within the NICU setting and during the period of transition from hospital to home. Nurses within the NICU have a unique knowledge and experience of caring for infants in withdrawal. This knowledge needs to be shared beyond the hospital with community professionals, who may have limited training in infant health, mental health, or development.     

Abuse of alcohol, drugs and tobacco during pregnancy--consequences for the child.

There is an increasing awareness that alcohol and drug abuse and smoking are not only harmful for the consumer but will also, when taken by a pregnant woman, adversely affect her unborn child. The consequence of the abuse will result from a combination of specific toxic effects of abusing substances and a nonspecific effect from the often very unstable environment of an alcohol- or drug-dependent mother. Poor prenatal care is a common finding in alcohol and drug abuse leading to a high incidence of complications during pregnancy and delivery including premature labor and small-for-gestational-age babies. An increased perinatal mortality has been reported following all types of abuse including tobacco use, probably as a consequence of poor prenatal care as well as of a toxic effect on the fetus. Withdrawal symptoms after birth are most prominent in opiate addiction. The already intrauterinely damaged child will if it stays with its parents often continue to be exposed to several abverse environmental factors. However, symptoms such as mental retardation following alcohol abuse and hyperactivity and emotional disturbances following drug exposure during intrauterine life have also been found in children who have been taken from the parents and placed in foster homes immediately after birth. This means that children of abusing parents both in their custody and in foster home will have to be regarded as risk children that should be subjected to careful medical and psychological follow-up.     

The geography of drug market activities and child maltreatment

This study examines how drug market activities place children at risk of maltreatment over space and time. Data were collected for 95 Census tracts in Sacramento, California, over 7 years and were analyzed using Bayesian space-time models. Referrals for child maltreatment investigations were less likely to occur in places where current drug market activity was present. However, past-year local and spatially lagged drugs sales were positively related to referrals. After the investigative phase, Census tracts with more drug sales had higher numbers of substantiations, and those with more possessions also had more entries into foster care. The temporal delay between drug sales and child maltreatment referrals may indicate that the surveillance systems designed to protect children may not be responsive to changing neighborhood conditions or be indicative of the time it takes for the detrimental effects of the drug use to appear.     

Foster care for child maltreatment: impact on delinquent behavior

Previous reports of child maltreatment sequelae have not systematically examined the effects of societal intervention. A historical cohort study has been undertaken to examine the impact of one intervention, foster care, on the subsequent development of juvenile delinquency among child victims. One hundred fourteen foster children, aged 11 to 18 years, in foster care for three or more years, and who were in foster care as a result of maltreatment were studied. A comparison cohort was composed of 106 victims of maltreatment who were left in their family home; these children were similar to the children in foster care with regard to age, race, sex, and year of diagnosis. Cohort differences in maternal education, type of abuse, history of prior maltreatment, sex, and race were controlled in the analysis. Foster children committed 0.050 crimes per person-year after age 11 years; home care children committed 0.059 crimes per person-year after age 11 years (P greater than .2). Foster children were more likely to have committed criminal assault. Among foster children, increased number of foster home placements correlated with increased number of delinquency convictions. Overall, there appears to be no support for the idea that foster care is responsible for a significant portion of later problems encountered by victims of maltreatment.     

Do paternal arrest and imprisonment lead to child behaviour problems and substance use? A longitudinal analysis

BACKGROUND: Children of prisoners are at increased risk of impaired health, behavioural problems and substance misuse; however, the causal pathways to these problems are unclear. Under some circumstances, parental imprisonment may result in improved outcomes for the child. This study investigates the impact of paternal arrest and imprisonment on child behaviour and substance use, as a function of child gender, and in the context of known social and familial risk factors. METHODS: Longitudinal analysis of an Australian birth cohort (N = 2,399) recruited 1981-83, with child outcomes measured at age 14. Participants were recruited prenatally from a large, public hospital in Brisbane, Australia and followed up in the community. History of paternal arrest and imprisonment were based on maternal self-report, at age 14. Outcome measures included mother- and child-reported internalising and externalising behaviour (CBCL and YSR), and child self-reported alcohol and tobacco use. RESULTS: In univariate analyses, paternal imprisonment was associated with maternal reports of increased child internalising (OR = 1.82, 95%CI 1.08-3.06) and externalising (OR = 2.24, 95%CI 1.41-3.57), and alcohol use (OR = 1.68, 95%CI 1.11-2.53) at age 14. However, controlling for socio-economic status, maternal mental health and substance use, parenting style and family adjustment, these associations became non-significant. For boys only, in the multivariate model paternal arrest but not imprisonment predicted alcohol (OR = 1.79, 95%CI 1.09-2.95) and tobacco (OR = 1.83, 95%CI 1.03-3.25) use at age 14. CONCLUSIONS: The association between paternal arrest and imprisonment and adverse outcomes in adolescence is accounted for by well-established social and familial risk factors. Paternal imprisonment may not, in itself, increase the risk for child behaviour and substance use problems.     

Longitudinal analysis of repeated child abuse reporting and victimization: multistate analysis of associated factors

Most child subjects of maltreatment reports to child protective services (CPS) are involved just once, whereas other children experience repeated investigations and victimizations. This study examines individual, maltreatment, and service-related factors associated with maltreatment rereporting and substantiated rereporting in a multistate context. Case-level National Child Abuse and Neglect Data System data (505,621 children) were analyzed. Within 24 months, 22% of children were rereported, and 7% were rereported with substantiation. Younger and White and mixed race children, those with disabilities, and those whose caregivers abused alcohol were more likely to be rereported and rereported and substantiated. Service provision, including foster care placement, was associated with increased likelihood of subsequent events. When CPS agency performance is assessed using measures of reentry, separate measures may be necessary for children who receive services, so that improvements in safety can be appropriately recognized. Reentry into CPS is a complex interaction of risks to children and systemic factors tied to the intervention they receive.     

Suicidal ideation among 8-year-olds who are maltreated and at risk: findings from the LONGSCAN studies

Suicidal ideation was examined among 1,051 8-year-old children identified as maltreated or at risk for maltreatment. Of these children, 9.9% reported suicidal ideation. Many variables, including maltreatment, had bivariate associations with suicidal ideation. Severity of physical abuse, chronicity of maltreatment, and the presence of multiple types of maltreatment strongly predicted suicidal ideation. In multivariate analyses of the domains of proximity, only ethnic background remained significant among demographic variables, only witnessed violence and maltreatment remained significant among family or contextual variables, and only child psychological distress, substance use, and poor social problem solving remained significant among child variables. The effects of ethnicity, maltreatment, and witnessed violence on suicidal ideation were mediated by child functioning. There were few interactions between maltreatment and other factors to predict suicidal ideation. Children who are maltreated and those exposed to community and domestic violence are at increased risk of suicidal ideation, even by age 8.     

Safety and stability for foster children: a developmental perspective

Children in foster care face a challenging journey through childhood. In addition to the troubling family circumstances that bring them into state care, they face additional difficulties within the child welfare system that may further compromise their healthy development. This article discusses the importance of safety and stability to healthy child development and reviews the research on the risks associated with maltreatment and the foster care experience. It finds: Family stability is best viewed as a process of caregiving practices that, when present, can greatly facilitate healthy child development. Children in foster care, as a result of exposure to risk factors such as poverty, maltreatment, and the foster care experience, face multiple threats to their healthy development, including poor physical health, attachment disorders, compromised brain functioning, inadequate social skills, and mental health difficulties. Providing stable and nurturing families can bolster the resilience of children in care and ameliorate negative impacts on their developmental outcomes. The author concludes that developmentally-sensitive child welfare policies and practices designed to promote the well-being of the whole child, such as ongoing screening and assessment and coordinated systems of care, are needed to facilitate the healthy development of children in foster care.     

Impact of maternal substance use during pregnancy on childhood outcome

The impact of maternal substance abuse is reflected in the 2002-2003 National Survey on Drug Use and Health. Among pregnant women in the 15-44 age group, 4.3%, 18% and 9.8% used illicit drugs, tobacco and alcohol, respectively. Maternal pregnancy complications following substance use include increases in sexually transmitted disorders, placental abruption and HIV-positive status. Effects on the neonate include a decrease in growth parameters and increases in central nervous system and autonomic nervous system signs and in referrals to child protective agencies. In childhood, behavioral and cognitive effects are seen after prenatal cocaine exposure; tobacco and alcohol have separate and specific effects. The ongoing use of alcohol and tobacco by the caretaker affects childhood behavior. Therefore, efforts should be made to prevent and treat behavioral problems as well as to limit the onset of drug use by adolescent children born to women who use drugs during pregnancy.     

Parenting skills and family support programs for drug-abusing mothers

Children born to drug-using mothers can suffer from fetal alcohol or drug syndrome (FAS/FDS) or fetal alcohol or drug effect (FAE/FDE). Such children have a greater likelihood of developing acute or chronic physical, cognitive and behavioral problems. In-utero exposure to tobacco, alcohol or drugs impact on the developing fetus and, after birth, the family environment and family system exert effects on the infants and children of substance-abusing parents. Evidence-based prevention and maternal drug treatment programs focus on enhancing parental childcaring abilities, supporting parent-child attachment and encouraging family support systems to improve children's health and cognitive outcomes. FAS/FDS prevention programs, as well as selective and indicated prenatal and postnatal interventions, can improve the support given both to mother and to child, and evidence-based, in-home parenting and family-skills-training approaches are particularly useful.     

Effects of placement type on the language developmental trajectories of maltreated children from infancy to early childhood

This study describes the developmental trajectories of language skills in infants with substantiated maltreatment histories over a 5-year period and evaluates the effect of three different custodial placements on their language trajectories over time: in-home (remaining in the care of the biological parent/parents), nonkin foster care, and nonparental kinship care. Participants included 963 infants reported to child protective services prior to their first birthday and whose maltreatment was substantiated. Results from covariate-controlled growth modeling revealed no significant placement effects. Across all groups, children's auditory and expressive communication scores decreased significantly from Wave 1 (intake) in the infants' first year to Wave 4, when children were about 3.5 years of age, then improved to baseline levels by Wave 5, when children were about 6 years old. Despite these fluctuations, children's average language scores in each placement group remained below the population mean at each wave of the study.     

The physical, developmental, and mental health needs of young children in child welfare by initial placement type

The American Academy of Pediatrics recommends comprehensive assessments for children entering foster care. These children may be placed with biological parents, kin, or in nonrelative foster care. It is not known whether health-related needs differ by placement. Chart abstractions were conducted of child welfare and medical records of 1542 children, ages 3 months to 5 years 11 months, admitted to San Diego's sole emergency shelter/receiving facility from April 1, 1998, through June 30, 1999, for investigation of alleged maltreatment. Children were discharged to three placement types: biological parents (28.5%), kinship caregivers (28.4%), or nonrelative foster parents (43.1%). Overall, 86.7% of children studied demonstrated physical, developmental, or mental health needs, with more than half displaying two or more problems. More than half of the children had a "Suspect" score on the Denver-II; 70.3% of children with "Suspect" scores were found to have delay on a developmental evaluation. Almost one tenth of the sample were diagnosed with one or more mental health conditions. Few differences were found for physical, developmental, or mental health concerns by placement. Results suggest that young children placed with biological parents or in kinship care have similar needs to those of children placed with foster parents. This study confirms the importance of comprehensive assessments for young children removed from their homes, regardless of placement. It also illustrates a need for standardized assessment criteria, particularly for developmental and mental health status, and for collaborative care models for all young children entering the child welfare system, regardless of their placement following investigation.     

Risk factors for out-of-home custody child care among families with alcohol and substance abuse problems

AIM: To study the risk of children to mothers with alcohol and/or substance abuse related problems for early childhood out-of-home care in Finland. METHODS: A population-based cross-sectional retrospective analysis of 526 pregnant women attending special outpatient clinics during 1992-2001 and their 626 offspring, with out-of-home care data until 2003 provided by the National Child Welfare Register. RESULTS: Fifty percent (95% confidence interval 46-54%) were at some point and 38% (34-42%) by the age of two years, in out-of-home care. Out-of-home care was associated with maternal care for substance abuse after delivery, nonemployment, housing, daily smoking during pregnancy, increasing number of previous births, mother in custody in her childhood, maternal education, previous child in custody, drug in urine during pregnancy, unplanned pregnancy, partner with significant abuse, regular health-care contact for abuse, daily alcohol consumption before and/or during pregnancy, newborn not discharged with mother, neonatal abstinence symptoms (NAS), intensified perinatal surveillance or NICU, and delayed discharge from hospital. CONCLUSIONS: There is a substantial risk of children born to mothers with significant alcohol and/or substance abuse related problems for out-of-home care during early childhood. Factors identified during the pre- and perinatal period are associated with this risk.     

Exploring the spatial dynamics of alcohol outlets and Child Protective Services referrals, substantiations, and foster care entries

Controlling for neighborhood demographic characteristics, this study examined the relationship of alcohol outlets with rates of Child Protective Services (CPS) referrals, substantiations, and foster care entries from 1998-2003 in 579 zip codes in California. Data for this panel study were analyzed using spatial random effects panel models. Zip codes with higher concentrations of off-premise alcohol outlets (e.g., convenience or liquor stores) and proportions of Black residents had higher rates of maltreatment. Higher average household size and median household income were generally related to lower child maltreatment rates. More specifically, the model derived estimates that an average decrease of one off-premise outlet per zip code would reduce total referrals to CPS in the 579 zip codes by 1,040 cases, substantiations by 180 cases, and foster care entries by 93 cases. Characteristics of adjacent zip codes also were related to maltreatment rates in local neighborhoods, indicating a spatial dynamic to this relationship. Reductions in number of alcohol outlets per zip code, particularly off-premise outlets, may result in lower rates of child maltreatment.     

Exploration of Criteria for Residential and Foster Care

Foster family placements of children "at risk" often break down prematurely. In this paper the psychosocial characteristics of children in foster and residential care in Holland are analysed to identify some provisional criteria that can increase the success of foster family placements. Successful placement was found to be associated with young age of the child, and with the absence of serious emotional and behavioural difficulties at the time of the placement. Further factors influencing success were: a low involvement of the birth parents, a careful selection of foster parent families, a "good" match between the problems of the foster child and the capacities of the foster family to care and rear, a good preparation of all parties involved during the process of placement, and professional guidance during the whole process of foster care.     

The early intervention foster care program: permanent placement outcomes from a randomized trial

Preschool-aged foster children face multiple risks for poor long-term outcomes. These risks appear to increase with the number of placement changes experienced. The Early Intervention Foster Care Program (EIFC) targets the spectrum of challenges that preschool-aged foster children face via a team approach delivered in home and community settings. In this article, we report on permanent placement outcomes from the EIFC randomized clinical trial. Children in EIFC had significantly fewer failed permanent placements than children in the regular foster care comparison condition. The number of prior placements was positively associated with the risk of failed permanent placements for children in the comparison condition but not for children in EIFC. Type of prior maltreatment did not predict permanent placement outcomes. These results provide the foundation of an evidence base for the EIFC program as a preventive intervention to improve permanent placement outcomes for preschool-aged foster children.