انگیختگی ادراکی ایجاد حافظه های جدید اپیزودیک را بهبود می بخشد

Objective: This study seeks to: (1) assess the relationship between identified prenatal substance use and the risk of subsequent maltreatment allegations among families involved with child protective services; and (2) compare the types of safety threats encountered by children whose parents had substance-exposed infant (SEI) allegations to the types of safety threats faced by children whose parents had other types of allegations. Method: Survey data from a probability sample of parents were linked to state administrative data over a 33-month time frame. Cox regression models were conducted to assess the relative risk of subsequent allegations associated with parents whose child welfare case opened following an SEI allegation (the SEI group) compared to parents whose case opened following other types of allegations. Results: The likelihood of subsequent allegations is greater among parents in the SEI group. However, the increased risk stems almost entirely from subsequent SEI-related allegations. Parents in the SEI group are not more likely to incur other types of allegations such as physical abuse or lack of supervision. Conclusions: An increased risk of subsequent maltreatment has been used to justify opening child protective cases on the basis of an SEI allegation alone. By looking closely at the types of subsequent allegations as well as the incidence of subsequent allegations, this research helps to clarify the maltreatment risks associated with SEI cases.

One of the legacies of the cocaine epidemic of the late 1980s and early 1990s is the large number of families who became involved with child protective services as a result of drug enforcement and surveillance policies. Child protective services have been concerned about parental substance use for decades, but with the cocaine epidemic came a new concern: prenatal drug exposure. In response to alarms sounded by medical researchers suggesting that a generation of “cocaine-damaged” infants faced an uncertain future of developmental and behavioral problems, some states moved to mandate the reporting of infant substance exposure to child protective authorities. In addition, fearful of the risks prenatal drug use posed to subsequent child safety and well-being, caseworkers and judges escalated the removal of children from drug-using parents on allegations of “inadequate supervision,” “environmental neglect,” or “risk of harm.” After a decade, opinions on how best to fashion a child protective response to the problem of prenatal substance use have diverged (see Barth 2001 and Ondersma et al 2000). On the one hand, in light of follow-up research that shows the developmental consequences of prenatal drug exposure to be less dire than originally feared Lester et al 1995, LaGasse et al 1999, Mayes et al 1992 and Slutsker 1992, hospitals are reconsidering the advisability of testing newborns for substance exposure. Some court jurisdictions are treating prenatal substance exposure as a public health matter and invoking child protective authority only if there is a finding of direct harm to a child. On the other hand, public intolerance for maternal substance use continues. In South Carolina, women who use substances during pregnancy can be prosecuted in criminal court; Wisconsin passed a “Cocaine Mom Bill” enabling the state to mandate substance abuse treatment for pregnant women; and Illinois has a law stipulating that a second substance-exposed infant (SEI) finding shall constitute sufficient evidence to initiate termination of parental rights. As child welfare administrators and practitioners struggle to form appropriate policy and practice responses to families with substance-exposed infants, researchers have attempted to answer a fundamental question: To what extent does prenatal substance use place children at risk of subsequent abuse or neglect? Generally, evidence points to an association between parental substance use and intervention by child protective services Children’s Bureau, US Department of Health and Human Services 1997, Curtis and McCullough 1993 and Magura and Laudet 1996. And researchers have identified an association between parental substance use and subsequent maltreatment as measured by child protective services reports Jaudes et al 1995 and Wolock and Magura 1996 and incidents of maltreatment found in medical records (Wasserman & Leventhal, 1993). Still, such studies fall short of demonstrating that substance use, per se, increases threats to child safety. Case-control studies that compare samples of identified substance users in the child welfare system to matched samples from the general population cannot control adequately for the myriad of social, environmental, and other factors that confound the association between parental substance use, threats to child safety, and involvement with child protective services. Differences attributed to substance use might be because of other factors that affect detection or identification of substance use or affect the likelihood of child welfare involvement (see Franck, 1996). For several reasons there is a distinction between substance-exposed infants identified by the child welfare system and all infants exposed to substances. First, research has identified race and class bias in hospital policy and practice regarding tests for infant substance exposure (Chasnoff, Landress, & Barrett, 1990). Some hospitals have a policy to test every newborn; others test only “high-risk” cases. Second, despite evidence of the deleterious effects of fetal exposure to alcohol, infants are tested for exposure to illicit substances, not for exposure to alcohol. Finally, tests identify substance use in the past several days only; an infant might be exposed to substances at various points during a pregnancy and still test negative at birth. The distinction between prenatal substance exposure and identified prenatal substance exposure has two implications for studies seeking to assess the subsequent maltreatment risks associated with prenatal substance exposure. First, to avoid the spurious attribution of safety risks to substance exposure when such risks stem from factors associated with child welfare involvement, studies should make comparisons among families already involved with the child welfare system. For example, safety risks among families with substance-exposed infant allegations should be compared to safety risks among families with other types of maltreatment allegations. Second, if researchers cannot isolate the effects of prenatal substance exposure from the effects of identified prenatal substance exposure, studies should clearly specify that their findings apply to identified prenatal substance exposure. Some researchers have conducted bivariate analyses to assess risks associated with identified prenatal substance use among families involved with child protective services. One study found that infants with verified substance exposure had more caregiving needs than infants with suspected substance exposure (McNichol, 1999). Another study found that families with SEI allegations have higher subsequent maltreatment rates than families with other types of allegations (Goerge & Harden, 1993). Such findings suggest that, even among families involved with child protective services, children in families with identified prenatal substance use face greater subsequent maltreatment risks than children with other types of allegations. Such findings provide justification for opening child protective cases on the basis of prenatal substance use alone. The important implications of such findings warrant investigation using multivariate survival analysis methods. The purposes of this study are to: (1) assess the relationship between identified prenatal substance use and the risk of subsequent maltreatment allegations among families involved with child protective services; and (2) compare the types of safety threats encountered by children whose parents had SEI allegations to the types of safety threats faced by children whose parents had other types of allegations. A clearer understanding of these relationships can help child welfare agencies develop family-centered protective interventions that better balance the severity of risks posed by prenatal substance use against the harms of parent-infant separation and out-of-home placement. The study addresses the following questions: 1. Are child welfare cases that open because of an SEI allegation at greater risk of subsequent abuse or neglect allegations than cases that open for other reasons? 2. Is giving birth to a substance-exposed infant after a child welfare case opens a predictor of subsequent abuse or neglect allegations? 3. What types of subsequent abuse and neglect allegations are parents with prior SEI allegations likely to incur? Illinois provides a rich source of data for addressing these research questions. In Illinois, unlike many states, evidence of fetal substance exposure constitutes prima facie evidence of child neglect, and infant substance exposure is identified as a particular type of child protective services allegation: a substance-exposed infant, or SEI, allegation. The parents of all infants testing positive for illicit drugs are charged with neglect and have a child welfare case opened. Thus, all infants identified as being exposed to illicit drugs can be followed longitudinally with state administrative data.

Three primary lessons emerge from this study. First, efforts to understand the child safety risks associated with SEI allegations should specify whether the “maltreatment” identified in subsequent allegations is SEI-related or not. If infant substance exposure is defined as maltreatment then justified as such because recipients of SEI allegations show an increased likelihood of subsequent incidents of maltreatment, we risk perpetuating a tautology if subsequent incidents tend to be incidents of infant substance exposure. Efforts to assess the risks associated with open child welfare cases should look beyond the status of having subsequent allegations to the types of subsequent allegations and the circumstances surrounding them. Second, we need to look more closely at other risk factors associated with SEI allegations and parental substance use. We often focus on SEI status or substance use, per se, when associated factors may be a more appropriate point of intervention. For example, in this study, living with another adult emerges as a potential protective factor against subsequent allegations. Finally, we need to look at the phenomenon of subsequent births among women involved with child protective services. This study suggests that, among parents with child welfare cases, a substantial portion of subsequent allegations are related to subsequent births. We are left to wonder whether the association between subsequent allegations and new births indicates harm to newborn children or represents the risk aversion of CPS investigators when parents already involved with child protective services have a new child. All three-study lessons point to the need for better measures of the child safety threats associated with parental substance use. The study findings not only have implications for understanding the relationship between parental substance use and child maltreatment, but they highlight the need to more precisely describe subsequent allegations if they are to be used as indicators of child maltreatment.