Psychosocial and behavioral factors Psychosocial and behavioral factors related to the post-partum placements related to the post-partum placements of infants born to cocaine-using womenof infants born to cocaine-using women

Reviewed by:Reviewed by:Brittany WarringtonBrittany Warrington

Lisa KlineLisa KlineMatthew ChangMatthew Chang

October 14, 2008October 14, 2008PSYC308-UMBCPSYC308-UMBC

Sonia Minnes, Lynn T. Singer, Rashida Humphrey-Wall, Sudtida Satayathum

IntroductionIntroduction

Hypothesis: That Hypothesis: That cocaine-using women cocaine-using women who who lost custodylost custody of their infants at birth would of their infants at birth would report higher levels of report higher levels of psychological distress psychological distress symptomssymptoms, and have more , and have more violent partner violent partner relationshipsrelationships, negative coping skills, lower , negative coping skills, lower social support, and social support, and higher prevalence of higher prevalence of childhood traumachildhood trauma than similar women who than similar women who did not lose custody of their infants.did not lose custody of their infants.

Quote from researchersQuote from researchers

““We further hypothesized We further hypothesized that that higher levels of higher levels of cocaine use prenatallycocaine use prenatally and severity of and severity of psychological distress psychological distress symptoms would symptoms would increase the likelihood increase the likelihood of child placementof child placement.”.”

http://www.eurad.net/images/sick-baby.jpg

What was known beforehand?What was known beforehand? Previous studies have shown infant removal occurs Previous studies have shown infant removal occurs

more frequently if:more frequently if:– The mother used cocaine prenatallyThe mother used cocaine prenatally– Poor prenatal carePoor prenatal care– Positive toxicology screenPositive toxicology screen– African AmericanAfrican American

Specific areas of maternal history and psychological Specific areas of maternal history and psychological functioning are recognized as posing threats to functioning are recognized as posing threats to effective parentingeffective parenting Found to be more prevalent among cocaine-using womenFound to be more prevalent among cocaine-using women

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What was this research designed to What was this research designed to answer?answer?

If cocaine-using who did not maintain infant If cocaine-using who did not maintain infant custody would report more of the following custody would report more of the following than those who maintained custody:than those who maintained custody:

more psychological distressmore psychological distress domestic violencedomestic violence negative coping skillsnegative coping skills lower social supportlower social support more childhood traumamore childhood trauma

Why is this research important?Why is this research important?

Substantial postnatal risk factor for infant Substantial postnatal risk factor for infant neglect and abuseneglect and abuse

Use of illegal drugs often results in removal of Use of illegal drugs often results in removal of the childthe child

One of the leading causes of infant placementOne of the leading causes of infant placement Over 60% in some urban areasOver 60% in some urban areas

Correlations with child maltreatmentCorrelations with child maltreatment

Half of all parents who self-reported Half of all parents who self-reported abuse/neglect abuse/neglect Lifetime substance abuse disorderLifetime substance abuse disorder Threefold increaseThreefold increase

Protective service records indicate:Protective service records indicate: Maternal use of substances and child Maternal use of substances and child

maltreatmentmaltreatment 43-79% of affected children43-79% of affected children

At least 1 parentAt least 1 parent

MethodsMethods

MethodsMethods

ResultsResultsMaternal Characteristics

Mean(MC=142)

SD(MC=142)

Mean (NMC=63)

SD (NMC=63) P-value

Years of education

11.70 1.6 11.29 1.7 .09

Age (years) 29.18 4.9 30.40 5.2 .13

Number of prenatal visits

6.09 4.8 3.20 3.4 <.00001

WAIS-R Block Design

7.04 2.0 6.44 2.4 .07

PPVT-R Standard Score

74.38 14.3 71.40 13.5 .18

Table 1: Maternal characteristics at birth by custody status

WAIS-R Block Design-Wechsler Adult Intelligence Scale-Revised, Picture Completion and Block Design subscalesPPVT-R-Peabody Picture Vocabulary Test-Revised

ResultsResults

Maternal Characteristics

MC=142 NMC=63 p-value

Race (African American)

80.3 81.0 .91

No prenatal care 13.4 30.2 .004

Maternal employment

6.3 3.2 .37

Married 8.5 4.8 .35

Low socioeconomic status

98.0 98.4 .81

Table 1: Maternal characteristics at birth by custody status

ResultsResultsMaternal drug use

Mean (MC=142)

SD(MC=142)

Mean(NMC=63)

SD(NMC=63)

p-value

Avg. cigarettes per day

10.7 9.1 13.8 13.8 .49

Avg. drinks per week

9.0 16.4 10.9 21.3 .82

Avg. joints per week

1.4 3.4 1.2 3.9 .13

Avg. cocaine units per week

16.2 25.8 41.2 68.6 .001

Table 2: Maternal drug use characteristics by custody status

Maternal drug use MC=142 NMC=63 p-value

Tobacco use 88.7 88.9 .98

Alcohol use 88.7 79.4 .08

Marijuana use 50.7 47.6 .68

Heavy cocaine use 44.4 69.8 .001

DiscussionDiscussion

3 maternal characteristics:3 maternal characteristics:– Few prenatal care visitsFew prenatal care visits– Heavier cocaine useHeavier cocaine use– Clinically elevated psychological distressClinically elevated psychological distress

DiscussionDiscussion Other similarities between NMCOther similarities between NMC

Greater use of maladaptive coping skillsGreater use of maladaptive coping skills Less use of positive coping skills Less use of positive coping skills Relationship violenceRelationship violence Childhood abuseChildhood abuse

http://www.wmin.ac.uk/sabe/images/Girl%20-%20Domestic%20Violence.jpg

DiscussionDiscussion Three weaknesses of the study:Three weaknesses of the study:11. Reflect a specific, urban, human service agency from . Reflect a specific, urban, human service agency from

1994-19961994-1996 CPS practices vary from city to city, year to yearCPS practices vary from city to city, year to year

22. A potential bias exists. A potential bias exists Not all women at the hospital were screenedNot all women at the hospital were screened

Only those posing specific identifiable risksOnly those posing specific identifiable risks

3. 3. A reduced number of women received the CTQ, A reduced number of women received the CTQ, reliance on past memory, and differential timing of reliance on past memory, and differential timing of initial data collectioninitial data collection

Retrospective data are subject to errorsRetrospective data are subject to errors

DiscussionDiscussion Ways to Ways to

improve/expand the improve/expand the experiment:experiment: Longitudinal studyLongitudinal study

Multiple citiesMultiple cities

Screen all women, not Screen all women, not just those displaying just those displaying risksrisks

<http://www.destination360.com/north-america/us/new-york/images/s/new-york-city.jpg>.

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ReferencesReferences "Domestic Violence and Housing." (Photograph) University of Westminster: School of

Architecture and the Built Environment. University of Westminster. <http://www.wmin.ac.uk/sabe/images/girl%20-%20domestic%20violence.jpg>.

Minnes, Sonia, Lynn T. Singer, Rashida Humphrey-Wall, and Sudtida Satayathum. "Psychosocial and behavioral factors related to the post-partum placements of infants born to cocaine-using women." Child Abuse and Neglect 32 (2008): 353-66.

"New York City (Photograph)." Destination 360. 12 Oct. 2008 <http://www.destination360.com/north-america/us/new-york/images/s/new-york-city.jpg>.

"San Francisco: 36th Annual San Francisco Blues Festival." (Photograph) Downtown Hotels and Events. 12 Oct. 2008 <http://bergoiata.org/fe/californie-paysages/moon%20over%20san%20francisco.jpg>.

"Sick Baby.“(Photograph) EURAD: Europe Against Drugs. Europe Against Drugs. 24 Sept. 2008 <http://www.eurad.net/images/sick-baby.jpg>.

"Toxicology Screening.“(Photograph) Mayo Clinic Proceedings. Mayo Clinic. 24 Sept. 2008 <http://www.mayoclinicproceedings.com/images/8005/8005a2-fig2.jpg>.