Sanmartin Maria X, Ali Mir M, Lynch Sean, Aktas Arda
Department of Health Professions, Hofstra University, Hempstead, New York.
Office of the Assistant Secretary for Planning and Evaluation, US Department of Health and Human Services, Washington, DC.
JAMA Pediatr. 2020 Aug 1;174(8):782-788. doi: 10.1001/jamapediatrics.2020.1027.
States have enacted criminal justice-related substance use policies to address prenatal substance use and protect infants from adverse health effects of parental substance use. However, little is known about the consequences of these policies for permanency outcomes among infants in the foster care system in the United States.
To evaluate the consequences of criminal justice-related prenatal substance use policies for family reunification and to examine differences in parental reunification by racial/ethnic group.
DESIGN, SETTING, AND PARTICIPANTS: In this cohort study using data from the 2005 to 2017 Adoption and Foster Care Analysis and Reporting System, 13 cohorts of infants who entered the foster care system were followed up. States with criminal justice-related prenatal substance use policies were compared with states without such policies before and after their enactment using a discrete-time hazard model adjusted for individual covariates, state, and cohort fixed effects. The sample consisted of 350 604 infants 1 year or younger who had been removed from their home because of parental drug or alcohol use.
Length of time from entering the child welfare system to first reunification with a parent and hazard rates (HRs).
Of the 350 604 infants 1 year or younger, 182 314 (52%) were boys, 251 572 (72%) were non-Hispanic white children, and 160 927 (46%) lived in US states with a criminal justice-focused prenatal substance use policy. Among those who were reunified, 36% of the reunifications occurred during the first year and 45% in the second year. Foster care infants who were removed from their homes because of parental substance use who live in states that have adopted criminal justice-oriented policies had a lower chance of reunification with a parent compared with states that have not adopted those policies (HR, 0.95; 95% CI, 0.94-0.96). Specifically, non-Hispanic black children who live in a state that has adopted criminal justice-oriented policies had a lower chance of reunification with a parent than non-Hispanic black children who live in a state that has not adopted those policies (HR, 0.87; 95% CI, 0.81-0.94).
Given the child welfare system's legal mandate to make every effort toward parental reunification, a more comprehensive treatment and supportive policy approach toward parental substance use might be warranted.
各州已制定与刑事司法相关的物质使用政策，以应对产前物质使用问题，并保护婴儿免受父母物质使用带来的不良健康影响。然而，对于这些政策对美国寄养系统中婴儿永久性结果的影响知之甚少。
评估与刑事司法相关的产前物质使用政策对家庭团聚的影响，并研究不同种族/族裔群体在父母团聚方面的差异。
设计、设置和参与者：在这项队列研究中，使用了2005年至2017年收养和寄养分析与报告系统的数据，对13组进入寄养系统的婴儿进行了随访。采用离散时间风险模型，对有与刑事司法相关的产前物质使用政策的州和没有此类政策的州在政策颁布前后进行比较，并对个体协变量、州和队列固定效应进行了调整。样本包括350604名1岁及以下因父母吸毒或酗酒而被带离家庭的婴儿。
从进入儿童福利系统到首次与父母团聚的时间长度和风险率（HRs）。
在350604名1岁及以下的婴儿中，182314名（52%）为男孩，251572名（72%）为非西班牙裔白人儿童，160927名（46%）居住在美国有以刑事司法为重点的产前物质使用政策的州。在那些实现团聚的人中，36%的团聚发生在第一年，45%发生在第二年。与未采取此类政策的州相比，因父母物质使用而被带离家庭、居住在采取了以刑事司法为导向政策的州的寄养婴儿与父母团聚的机会较低（HR，0.95；95%CI，0.94 - 0.96）。具体而言，居住在采取了以刑事司法为导向政策的州的非西班牙裔黑人儿童与父母团聚的机会低于居住在未采取此类政策的州的非西班牙裔黑人儿童（HR，0.87；95%CI，0.81 - 0.94）。
鉴于儿童福利系统有尽一切努力实现父母团聚的法律要求，可能需要对父母物质使用问题采取更全面的治疗和支持性政策方法。
