Training health professionals to reduce overreporting of birthing people who use drugs to child welfare.
Birth history
Child welfare
Opioid
Parenting
Substance use disorder
Journal
Addiction science & clinical practice
ISSN: 1940-0640
Titre abrégé: Addict Sci Clin Pract
Pays: England
ID NLM: 101316917
Informations de publication
Date de publication:
26 Apr 2024
26 Apr 2024
Historique:
received:
15
12
2023
accepted:
22
04
2024
medline:
27
4
2024
pubmed:
27
4
2024
entrez:
26
4
2024
Statut:
epublish
Résumé
Health care providers are a key source of reports of infants to child welfare related to birthing people's substance use. Many of these reports are overreports, or reports that exceed what is legally mandated, and reflect racial bias. We developed and evaluated a webinar for health professionals to address overreporting related to birthing people's substance use. This evaluation study collected data from health professionals registering to participate in a professional education webinar about pregnancy, substance use, and child welfare reporting. It collected baseline data upon webinar registration, immediate post-webinar data, and 6 month follow-up data. Differences in both pre-post-and 6 month follow-up data were used to examine changes from before to after the webinars in beliefs, attitudes, and practices related to pregnant and birthing people who use drugs and child welfare reporting. 592 nurses, social workers, physicians, public health professionals, and other health professionals completed the baseline survey. More than half of those completing the baseline survey (n = 307, 52%) completed one or both follow-up surveys. We observed statistically significant changes in five of the eleven opioid attitudes/beliefs and in four of the nine child welfare attitudes/beliefs from baseline to follow-ups, and few changes in "control statements," i.e. beliefs we did not expect to change based on webinar participation. All of the changes were in the direction of less support for child welfare reporting. In particular, the proportion agreeing with the main evaluation outcome of "I would rather err on the side of overreporting to child welfare than underreporting to child welfare" decreased from 41% at baseline to 28% and 31% post-webinar and at 6-month follow up (p = 0.001). In addition, fewer participants endorsed reporting everyone at the 6 month follow-up than at baseline (12% to 22%) and more participants endorsed reporting no one at the 6-month follow-up than at baseline (28% to 18%), p = 0.013. Webinars on the legal, scientific, and ethical aspects of reporting that are co-developed with people with lived experience may be a path to reducing health professional overreporting to child welfare related to birthing people's substance use.
Sections du résumé
BACKGROUND
BACKGROUND
Health care providers are a key source of reports of infants to child welfare related to birthing people's substance use. Many of these reports are overreports, or reports that exceed what is legally mandated, and reflect racial bias. We developed and evaluated a webinar for health professionals to address overreporting related to birthing people's substance use.
METHODS
METHODS
This evaluation study collected data from health professionals registering to participate in a professional education webinar about pregnancy, substance use, and child welfare reporting. It collected baseline data upon webinar registration, immediate post-webinar data, and 6 month follow-up data. Differences in both pre-post-and 6 month follow-up data were used to examine changes from before to after the webinars in beliefs, attitudes, and practices related to pregnant and birthing people who use drugs and child welfare reporting.
RESULTS
RESULTS
592 nurses, social workers, physicians, public health professionals, and other health professionals completed the baseline survey. More than half of those completing the baseline survey (n = 307, 52%) completed one or both follow-up surveys. We observed statistically significant changes in five of the eleven opioid attitudes/beliefs and in four of the nine child welfare attitudes/beliefs from baseline to follow-ups, and few changes in "control statements," i.e. beliefs we did not expect to change based on webinar participation. All of the changes were in the direction of less support for child welfare reporting. In particular, the proportion agreeing with the main evaluation outcome of "I would rather err on the side of overreporting to child welfare than underreporting to child welfare" decreased from 41% at baseline to 28% and 31% post-webinar and at 6-month follow up (p = 0.001). In addition, fewer participants endorsed reporting everyone at the 6 month follow-up than at baseline (12% to 22%) and more participants endorsed reporting no one at the 6-month follow-up than at baseline (28% to 18%), p = 0.013.
CONCLUSIONS
CONCLUSIONS
Webinars on the legal, scientific, and ethical aspects of reporting that are co-developed with people with lived experience may be a path to reducing health professional overreporting to child welfare related to birthing people's substance use.
Identifiants
pubmed: 38671544
doi: 10.1186/s13722-024-00466-6
pii: 10.1186/s13722-024-00466-6
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
32Informations de copyright
© 2024. The Author(s).
Références
Roberts SC, Zaugg C, Martinez N. Health care provider decision-making around prenatal substance use reporting. Drug Alcohol Depend. 2022;237: 109514.
doi: 10.1016/j.drugalcdep.2022.109514
pubmed: 35660333
Child Welfare Information Gateway. About CAPTA: A legislative history. https://www.childwelfare.gov/pubs/factsheets/about/ Accessed 12/6/2023. In: Department of Health and Human Services; Children’s Bureau, editor. Washington, DC: U.S.2019.
Centers for Disease Control and Prevention. Opioid data analysis and resources. Accessed 11 15 2023. https://www.cdc.gov/opioids/data/analysis-resources.html . 2023.
NIAAA. Alcohol policy information system. http://www.alcoholpolicy.niaaa.nih.gov/
Edwards F, Roberts SCM, Kenny KS, Raz M, Lichtenstein M, Terplan M. Medical professional reports and child welfare system infant investigations: an analysis of national child abuse and neglect data system data. Health Equity. 2023;7(1):653–62.
doi: 10.1089/heq.2023.0136
pubmed: 37786528
pmcid: 10541941
Stone R. Pregnant women and substance use: fear, stigma, and barriers to care. Health Justice. 2015;3:2.
doi: 10.1186/s40352-015-0015-5
pmcid: 5151516
Roberts SCM, Pies C. Complex calculations: how drug use during pregnancy becomes a barrier to prenatal care. Matern Child Health J. 2011;15(3):333–41.
doi: 10.1007/s10995-010-0594-7
pubmed: 20232126
Wolfson L, Schmidt RA, Stinson J, Poole N. Examining barriers to harm reduction and child welfare services for pregnant women and mothers who use substances using a stigma action framework. Health Soc Care Commun. 2021;29(3):589–601.
doi: 10.1111/hsc.13335
Proulx D, Fantasia HC. The lived experience of postpartum women attending outpatient substance treatment for opioid or heroin use. J Midwifery Womens Health. 2021;66(2):211–7.
doi: 10.1111/jmwh.13165
pubmed: 33314604
Leiner C, Cody T, Mullins N, Ramage M, Ostrach BMM. The elephant in the room; a qualitative study of perinatal fears in opioid use disorder treatment in Southern Appalachia. BMC Pregnancy Childbirth. 2021;21(1):143.
doi: 10.1186/s12884-021-03596-w
pubmed: 33596843
pmcid: 7890815
Ostrach B, Leiner C. I didn’t want to be on suboxone at first ambivalence in perinatal substance use treatment. J Addict Med. 2019;13(4):264–71.
doi: 10.1097/ADM.0000000000000491
pubmed: 30585875
Faherty LJ, Heins S, Kranz AM, Patrick SW, Stein BD. Association between punitive policies and neonatal abstinence syndrome among medicaid-insured infants in complex policy environments. Addiction. 2022;117(1):162–71.
doi: 10.1111/add.15602
pubmed: 34096671
Kozhimannil KB, Dowd WN, Ali MM, Novak P, Chen J. Substance use disorder treatment admissions and state-level prenatal substance use policies: evidence from a national treatment database. Addict Behav. 2019;90:272–7.
doi: 10.1016/j.addbeh.2018.11.019
pubmed: 30472535
Subbaraman MS, Thomas S, Treffers R, Delucchi K, Kerr WC, Martinez P, et al. Associations between state-level policies regarding alcohol use among pregnant women, adverse birth outcomes, and prenatal care utilization: results from 1972 to 2013 Vital Statistics. Alcohol Clin Exp Res. 2018;42(8):1511–7.
doi: 10.1111/acer.13804
Roberts SCM, Schulte A, Zaugg C, Leslie D, Corr TE, Liu G. Association of pregnancy-specific alcohol policies with infant morbidities and maltreatment. JAMA Netw Open. 2023. https://doi.org/10.1001/jamanetworkopen.2023.27138 .
doi: 10.1001/jamanetworkopen.2023.27138
pubmed: 37921775
pmcid: 10401306
Pregnancy Justice. The rise of pregnancy criminalization: a pregnancy justice report. https://www.pregnancyjusticeus.org/rise-of-pregnancy-criminalization-report/ Accessed 9 20 2023. 2023.
Zaugg C, Terplan M, Roberts SCM. Clinician views on reporting pregnant and birthing patients who use alcohol and/or drugs to child welfare. Am J Obstet Gynecol MFM. 2023;5(10): 101109.
doi: 10.1016/j.ajogmf.2023.101109
pubmed: 37524258
Work EC, Muftu S, MacMillan KDL, Gray JR, Bell N, Terplan M, et al. Prescribed and penalized: the detrimental impact of mandated reporting for prenatal utilization of medication for opioid use disorder. Matern Child Health J. 2023;27:1–9.
doi: 10.1007/s10995-023-03672-x
Movement for Family Power. “Whatever they do, I’m her comfort, I’m her protector.” How the foster system has become ground zero for the U.S. drug war. https://static1.squarespace.com/static/5be5ed0fd274cb7c8a5d0cba/t/5eead939ca509d4e36a89277/1592449422870/MFP+Drug+War+Foster+System+Report.pdf . 2020.
Stone EM, Kennedy-Hendricks A, Barry CL, Bachhuber MA, McGinty EE. The role of stigma in US primary care physicians treatment of opioid use disorder. Drug Alcohol Depend. 2021;221:108627.
doi: 10.1016/j.drugalcdep.2021.108627
pubmed: 33621805
pmcid: 8026666
Countey H, Steinbronn C, Grady SE. Changing student attitudes and perceptions toward opioid use disorder. Ment Health Clin. 2018;8(5):222–6.
doi: 10.9740/mhc.2018.09.222
pubmed: 30206505
pmcid: 6125113
Atkins L, Francis J, Islam R, O’Connor D, Patey A, Ivers N, et al. A guide to using the theoretical domains framework of behaviour change to investigate implementation problems. Implement Sci. 2017;12(1):77.
doi: 10.1186/s13012-017-0605-9
pubmed: 28637486
pmcid: 5480145