Does parental substance use always engender risk for children? Comparing incidence rate ratios of abusive and neglectful behaviors across substance use behavior patterns

Impact of Parental Substance Misuse on Children

The potential impact of parental substance misuse extends from the perinatal period through adolescence. Medical management of the affected child should address acute symptoms of toxicity or withdrawal and include a comprehensive assessment of the growth, development, and physical condition. When drug testing is utilized, the results should be part of an overall assessment of risk and protective factors in the child's home environment. The result of a child's drug test should not be the sole indicator of whether a child can safely remain in their home.

Review of Studies Regarding Assessment of Families Where Children Are at Risk of Harm Due to Parental Substance Misuse

Questions arise about links between the use of substances and violence, especially when parents misuse substances and there is potential to expose children to family violence.

BACKGROUND

The review has four aims: identify research into the harmful impacts of parental substance use on children; identify policies in Australia about the risks from parental substance misuse; identify interventions to manage unsafe parental substance use; and review practices involving confidentiality and collaboration when a parent has multiple complex needs.

METHOD

The paper provides a rapid review of the literature, linking parental substance misuse, family violence, and parenting capacity and covering both policies and empirical evidence.

RESULTS

The main finding is that parental substance misuse does affect parenting capacity and is associated with family violence. The concept of the cumulative risk of harm to vulnerable children is supported by research but is not yet implemented in policy. Reports indicate that some parents who misuse substances have multiple complex needs including comorbid mental health issues, domestic violence, and difficulty in managing their children's behavior. Early intervention therapies designed to address this cluster of issues are reviewed.

CONCLUSION

There is a need to establish objective assessment instruments that are relevant to the cohort of parents who misuse substances and engage in family violence and to improve policy to ensure vulnerable children and families in which parents misuse substances are referred to appropriate therapies.

Special Challenges Working with Foster Care Youth in the Inpatient Setting

The inpatient treatment of youth in care with severe emotional or behavioral disorders is complicated by systemic factors unique to foster care, for example, placement shortages and relinquishment of custody, and clinically by factors more prevalent in these highly vulnerable youth such as in utero exposure to alcohol, exposure to domestic violence, neglect, and physical, sexual, and emotional abuse. The authors discuss prolonged lengths of stay and boarding in emergency rooms, medical units, government offices, and detention centers. We also discuss working with foster families, biological families, and the child welfare system.

"My Goal is…to get Through the Day Without Pain": A Qualitative Study on Chronic Pain Experiences and Treatment Needs Among Child Caregiving Women

INTRODUCTION

We aimed to understand connections between pain, caregiving, physical and behavioral health treatment needs, and motivations for prescription opioid use among child caregiving women with chronic pain.

METHODS

We conducted in-depth, semi-structured interviews with 12 women (average age 48 years; 58% Black) in child caregiving roles, including women who were pregnant or trying to become pregnant and were caring for children or grandchildren < 18 years, and who received treatment at an outpatient pain management clinic. We used thematic text analysis to identify qualitative themes related to caregiving, pain, treatment, substance use, coping strategies, and sources of support.

RESULTS

A diverse sample of women reported high levels of stress and pain, substance use, interpersonal violence, depression, and financial strain. Most described difficulties at work, interacting with children or grandchildren, and engaging routine, daily activities due to their pain. Most indicated that they spent less time with family and friends due to their pain and had limited sources of support to help them navigate both caregiving and pain. Many described barriers to receiving appropriate healthcare, including prescription opioids, due to stigma or logistics, though most also reported positive healthcare experiences. Women also reported added daily-life, physical, mental health, and interpersonal stressors and difficulty navigating the healthcare system to receive needed care.

DISCUSSION

For women with chronic pain in child caregiver roles, results highlight the importance of care tailored to the physical needs of child caregiving and of trauma-informed approaches given the prevalence of comorbid conditions and trauma.

Parental Deprivation- and Threat-Based Factors Associated with Youth Emotion-Based Neurocircuitry and Externalizing Behavior: A Systematic Review

Parental factors, including negative parenting practices (e.g., family conflict, low monitoring), parental depression, and parental substance use, are associated with externalizing behaviors among youth. However, the ways in which these parental factors are associated with youth brain function and consequent externalizing behavior has been less studied. Both the dimensional and stress acceleration models provide frameworks for understanding how parental factors may be associated with frontolimbic and frontoparietal networks implicated in emotional attention and regulation processes. The current review builds upon this work by examining how deprivation- and threat-based parental factors are associated with youth neurocircuitry involved in emotional functioning and externalizing behaviors. A systematic review using PRISMA guidelines was completed and included five studies assessing parenting behaviors, six studies assessing parental depressive symptoms and/or diagnosis, and 12 studies assessing parental history of substance use. Synthesis of reviewed studies discusses support for the dimensional and stress acceleration models within the context of deprivation and threat. Further, a limited number of studies tested (i.e., six studies) and supported (i.e., three studies) youth neural structure and function as a mediator of the association between parental factors and youth externalizing behavior. Specific recommendations for future work include more deliberate planning related to sample composition, improved clarity related to parental constructs, consistency in methodology, and longitudinal study design in order to better understand associations between contextual parental influences and youth neural and behavioral functioning.

Father-Mother Co-Involvement in Child Maltreatment: Associations of Prior Perpetration, Parental Substance Use, Parental Medical Conditions, Inadequate Housing, and Intimate Partner Violence with Different Maltreatment Types

The current study applied a family systems approach to examine dyadic parental risk factors linked with mother-father co-involved physical abuse, neglect, sexual abuse, and emotional abuse. Parental substance use, mental health problems, disability and medical conditions, inadequate housing, economic insecurity, intimate partner violence, and prior maltreatment history were investigated as key risk factors at the dyadic parental level. Logistic regression analysis was conducted using national child welfare administrative data from the National Child Abuse and Neglect Data System. The results showed differential associations between risk factors and four child maltreatment types: physical abuse, neglect, emotional abuse, and sexual abuse. Intimate partner violence was associated with higher odds of mother-father co-involved neglect and emotional abuse. Parental substance use, inadequate housing, and prior maltreatment history were all associated with higher odds of mother-father co-involved neglect, but lower odds of physical abuse. Parental disability and medical conditions were associated with higher odds of mother-father co-involved sexual abuse, whereas parental substance use was associated with lower odds of sexual abuse. Implications include more nuanced ways of addressing multiple risk factors within the family to prevent future occurrences of child maltreatment involving both mothers and fathers.

Documenting maternal and childcare information of mothers presented to substance use treatment services: A qualitative study of reports in a clinical case register

BACKGROUND

Mothers compose a significant proportion of women in substance use treatment services. These women have needs that, if not addressed, can negatively impact their capacity to parent. This study explores the feasibility of using free-text notes from electronic health records (EHRs) to identify factors that impair mothers' ability to care for their children.

METHOD

This study is a qualitative analysis of EHRs of 50 women attending substance use services in Southeast London who were parents of dependent children (defined as mothers of children aged <18 years independent of living together). We developed a sampling stratification process to ensure an adequate volume of data were available and analyzed per case. The study identified and tested search terms. We extracted data from clinical notes and letters of communication with other services/agencies (free-text notes) using the identified search terms and conducted deductive thematic analysis.

RESULTS

The mean number of documents per case was 92.17 (SD = 18.51). The study identified five themes with subthemes: childcare arrangements, family context, safeguarding issues, factors that might impact the treatment plan and care of the child, and communication between the health care and child welfare systems.

CONCLUSION

The study demonstrates a novel approach for exploring parenting-related characteristics of mothers in substance use treatment. Despite a range of maternal and childcare-related information available on EHRs, the type of treatment and support being offered to patients in response to the reported information is less well documented. Findings highlight the need for further investments in implementing effective family centered strategies within substance use services.

Reframing caring for parents who struggle with substance-use disorders

Nancy Suchman and the colleagues she influenced have produced ground-breaking and attitude-challenging work in understanding how parenting and substance use come together. Dr Suchman and her colleagues make the claim that there is nothing about a substance-use disorder that precludes effective and sensitive caring for children especially with interventions that focus on the parent-child relationship. Suchman's legacy is to highlight how substance use as an illness pulls individuals away from important, caring relationships and limits their giving themselves to those relationships. Restoring the salience of caring relationships and of the individual's ability to care may be as impactful on their substance use as a strict focus on the reduction of drug use and achieving abstinence.

Assessing the effects of the Sacramento Neighborhood Alcohol Prevention Project (SNAPP) on child abuse and neglect

BACKGROUND

The role of alcohol use in the etiology of abusive and neglectful parenting is significant. We examined how the Sacramento Neighborhood Alcohol Prevention Project (SNAPP) may have reduced rates of substantiated child maltreatment, entries into foster care, and entries into foster care where alcohol use was a factor.

PARTICIPANTS AND SETTING

The study sample is 326 Census block groups: 21 and 16 in the South and North intervention areas, respectively, and 289 in the At-Large comparison area in Sacramento, California.

METHODS

SNAPP used a quasi-experimental design to reduce alcohol supply and alcohol-related problems among 15-29 year olds in two economically, racially, and ethnically diverse neighborhoods. The dependent variables are substantiated child abuse and neglect; total foster care entries; and alcohol-related foster care entries.

RESULTS

Substantiated child abuse and neglect was inconclusive for both intervention areas. In the North, total (RR = 0.822, 95 % CI [0.721, 0.933]) and alcohol-related (RR = 0.760, 95 % CI [0.634, 0.914]) foster care entries decreased by 17.8 % and 24.0 %, respectively. Intervention effects in the South were not well-supported for foster care entries (RR = 1.118, 95 % CI [0.988, 1.258]), but increased alcohol-related foster care entries (RR = 1.264, 95 % CI [1.075, 1.484]).

CONCLUSIONS

Environmental intervention strategies may be effective at reducing child abuse and neglect. However, given the mixed findings from our work, we need to identify under what conditions these interventions work best and whether some components of these strategies (e.g. awareness vs. enforcement of underage sales) differentially affect child abuse and neglect.

Sequencing drinking events and use of punitive, nonpunitive, and positive parenting behaviors with ecological momentary assessment

BACKGROUND

The relationship between alcohol use and parenting is primarily predicated on use of both past year drinking and parenting behaviors, making it difficult to develop prevention and intervention efforts that target alcohol-related maltreatment. Here, we assess the sequencing of parenting behaviors in relation to alcohol use (e.g., whether punitive parenting and alcohol use occur simultaneously).

METHODS

Using Ecological Momentary Assessment, a convenience sample of parents was asked to take three brief surveys daily (at 10 a.m., 3 p.m., and 9 p.m.) for 14 days. If the parent was with the focal child, they were asked to identify whether they had used one of six randomly assigned parenting behaviors (punitive, nonpunitive, or positive). Alcohol use was queried at the 9 p.m. survey on days 7 and 14. Logistic multilevel models were used to analyze the data.

FINDINGS

Parents reported less nonpunitive parenting during the time in which they reported drinking, and less positive parenting behaviors on the morning after the drinking occurred.

CONCLUSIONS

Parents may be less attentive to children's behavior while drinking, or they may be less inclined to find that behavior needing correction. Drinking may reduce the likelihood of positive parenting the next day if parents are feeling hungover or have negative aftereffects from drinking. These parents may want to explicitly have another adult provide caregiving duties during the drinking event or plan drinking when it is less likely to cause the least amount of harm (e.g., when children are in bed).

Neighborhood market potentials for alcohol use and rates of child abuse and neglect

BACKGROUND

Alcohol use can lead to child abuse and neglect even if the person using alcohol does not use heavily. Yet relatively few measures that reflect alcohol use are available at smaller geographic units. We assess whether the estimated level of total alcohol use per capita is related to measures of child abuse and neglect that include substantiated reports of maltreatment, total entries into foster care, and alcohol-related entries into foster care.

METHODS

Our sample consists of 326 Census block groups in Sacramento, California over three time points (978 space-time units). Administrative data for substantiations of child abuse and neglect and foster care entries are our outcomes. We create market potentials for alcohol use among 18- to 29-year-olds as our primary independent variable. Data are analyzed using Bayesian conditionally autoregressive spatio-temporal models.

RESULTS

Higher alcohol use potentials (as measured by total volume per capita of 18- to 29-year olds) are related to more children entering foster care due to drinking-related concerns by a parent or caregiver (RR = 1.032, 95% CI = [1.013, 1.051]), but not total substantiations for foster care entries. Neighborhoods with higher total volume of alcohol per 18- to 29-year-olds had more foster care entries when we used number of substantiations as the denominator (RR = 1.012, 95% CI = [1.0001, 1.023]) but were not related to foster care entries with alcohol misuse as a concern as a subset of all foster care entries.

CONCLUSIONS

Higher estimated volume of alcohol use per capita among young adults (aged 18 to 29) was related to more children entering foster care due to alcohol-related concerns. Reducing alcohol supply in alcohol outlets, specifically through off-premise establishments, might reduce rates for all entries into foster care or other out-of-home placement and substantiated child abuse and neglect.

The co-occurrence of substance misuse, domestic abuse, and child maltreatment: Can Family Drug and Alcohol Courts play a part?

This review article focuses on the inter-relationship between substance misuse, domestic abuse, and child maltreatment, especially in the context of care (child protection) proceedings. It reviews what is known about the prevalence and impact of co-occurring domestic abuse and substance misuse on adult and child victims, and the response of criminal and family law and intervention programmes in supporting families to address these problems holistically. Special attention is paid to the role of Family Drug and Alcohol Courts (FDACs), a radical problem-solving approach to care proceedings, which provide integrated interventions to the range of co-occurring problems that trigger the proceedings. Despite clear evidence of the greater harm to children when exposed to these two parental difficulties, the review has found a lack of systematic information on the prevalence of co-occurrence and a lack of effective integrated interventions, including within care proceedings. It argues that the FDAC approach is well suited to respond to co-occurring substance misuse and domestic abuse in care proceedings and it has the potential to break down silos across sectors. However, in the absence of empirical evidence, this premise would need testing. A particular focus of the review has been on efforts to overcome silos in practice, law and policy. Promising initiatives are described in criminal and family law to improve the response to domestic abuse that build on the Domestic Abuse Act 2021, the first dedicated domestic abuse legislation in England and Wales. All of them are based on problem-solving approaches used in other jurisdictions. Despite these initiatives, the review concludes that there remain significant barriers to effectively align law, policy and practice to ensure that domestic abuse strategy recognizes and responds to the overlaps with substance misuse.

Reflective functioning in mothers with addictions: Differential relationships involving family history of mental illness and substance use

Parental reflective functioning (RF) is often cited as an important domain in which mothers with addictions struggle in their roles as parents, though the links between addiction and RF remain unclear. Exposure to attachment trauma associated with parental mental illness and substance use is commonly associated with both addiction and lower RF. We thus examined how family history of parental mental illness and substance use may relate to the RF of mothers with addictions. One hundred ninety-four mothers in outpatient substance use treatment completed the Parent Development Interview and provided information about whether their mothers and fathers experienced mental illness or problems with substance use. Univariate ANOVAs revealed an interaction between family history of maternal mental illness and maternal substance use. Among mothers with a history of maternal substance use, those with a history of maternal mental illness had higher RF than those who had no history of maternal mental illness. Among mothers who did not report a family history of maternal mental illness, mothers who had a family history of maternal substance use exhibited significantly lower RF than mothers with no family history of maternal substance use. Exposure to paternal mental illness or substance use was not associated with mothers' RF. These findings highlight the importance of disentangling the contributions of attachment trauma to mothers' RF and utilizing interventions that support mothers' capacity to reflect about how their early experiences of being cared for by a mother with a mental illness or addiction may impact their current caregiving behaviors.

Trends from 2005 to 2018 in child maltreatment outcomes with caregivers' substance use

BACKGROUND

Caregivers' substance use is associated with child maltreatment.

OBJECTIVE

Examine trends from 2005 to 2018 in percentages of three outcomes with caregivers' drug or alcohol use: child protective services (CPS) referrals, substantiated maltreatment reports, and foster care placements.

PARTICIPANTS AND SETTING

22 U.S. states that contributed child-level maltreatment outcomes and caregivers' substance use data to the National Child Abuse and Neglect Data System from 2005 to 2018.

METHODS

Joinpoint regression was used to examine the average annual percent change (AAPC) in outcomes with caregivers' drug or alcohol use and to identify temporal changes.

RESULTS

From 2005 to 2018, CPS referrals with caregivers' drug use increased (AAPC 2.33, p < .001), while referrals with alcohol use remained unchanged (AAPC -0.11, p = .92) (trend difference p = .04). Substantiated reports with caregivers' drug and alcohol use increased (AAPC drug use 3.63, p < .001, AAPC alcohol use 1.28, p = .03), with a greater increase observed with drug use (difference p = .03). Foster care placements with caregivers' drug use increased (AAPC 2.54, p < .001), while placements with alcohol use did not change (AAPC -1.22, p = .29), (difference p = .005). Within the study period, changes in trends with caregivers' drug use included increased substantiated reports from 2010 to 2018 (p < .001) and increased foster care placements from 2009 to 2018 (p < .001). With caregivers' alcohol use, CPS referrals and foster care placements decreased from 2007 to 2018 (all p < .001).

CONCLUSIONS

Trends differed for outcomes with caregivers' drug versus alcohol use. Findings can inform policies to improve care for families affected by substance use.

Long-term trends in adolescent alcohol, tobacco and cannabis use and emerging substance use issues in Aotearoa New Zealand

This narrative review summarises the latest evidence on the causes and consequences of substance use in adolescence and describes long-term trends in adolescent alcohol, tobacco and cannabis use in Aotearoa. Adolescence is a time of rapid brain development when young people are uniquely vulnerable to the risks of substance use. It is a major cause of health and social harm in this age group and can affect adult outcomes and the health of the next generation. Therefore, substance use trends are central to understanding the current and future state of child and youth wellbeing in Aotearoa. Adolescent use of alcohol, tobacco and cannabis peaked in the late 1990s/early 2000s, then declined rapidly, and prevalence is now much lower than 20 years ago. However, levels of adolescent binge drinking remain high by international standards and disparities in tobacco and cannabis use by ethnicity and socioeconomic status are wide. Evidence suggests we may again be at a turning point, with-long term declines stalling or reversing in the past 2-5 years, and vaping emerging as a new risk. Greater investment in primary prevention is indicated, including restrictions on alcohol marketing and availability, and alleviation of poverty, racism and marginalisation.

The Relative Influence of Family and Neighborhood Factors on Child Maltreatment at Critical Stages of Child Development

This study examines the impact of family and neighborhood factors on physical and psychological abuse across three developmental stages of children: early childhood (age 3), young school age (age 5), and middle childhood (age 9). Data from the Fragile Families and Child Wellbeing Study, a longitudinal national cohort study of children from 20 urban U.S. cities, are used. Path analysis is employed to investigate the longitudinal relationships between family and neighborhood context variables and abuse risk, as well as the importance of different factors at key developmental stages. Economic hardship, maternal substance use, intimate partner violence, and exposure to community violence are found to be related to child abuse risk regardless of developmental stage, while maternal depression and neighborhood informal social control are found to have impacts only within certain child development stages. Findings suggest the need for early intervention and prevention strategies that specifically target economic hardship, poverty, intimate partner violence, and exposure to community violence.

Caregiver drug use in Ontario child welfare investigations: The need for coordinated intervention

BACKGROUND

Caregiver substance abuse is associated with harmful parenting behaviors, increased child welfare involvement, and negative child outcomes, and the opioid epidemic has brought increased attention to the safety and wellbeing of children living with caregivers who abuse substances.

OBJECTIVE

This paper investigates the impact of primary caregiver drug abuse concerns on child welfare investigations in Ontario, Canada and examines how different drug abuse categories impact out-of-home placements in a Canadian setting, with a focus on opioids, opiates, and morphine derivatives.

PARTICIPANTS AND SETTING

Secondary analyses of data from the Ontario Incidence Study of Reported Child Abuse and Neglect 2018 (OIS-2018) were conducted. The OIS-2018 collected information on child welfare investigations from workers who conducted the investigations. The final unweighted sample of the OIS-2018 included 7590 investigations involving children under 18 years old.

METHODS

Descriptive and bivariate analyses were conducted as well as a logistic regression predicting out-of-home placement.

RESULTS

Investigations involving noted primary caregiver drug abuse concerns involved increased household and family risks as well as more intrusive forms of child welfare involvement. Results of the logistic regression controlling for family, child, and case characteristics revealed that investigations involving noted primary caregiver drug abuse were more likely to involve out-of-home placements, and investigations that involved caregivers who abused opioids specifically were approximately 3.5 times more likely to result in a placement.

CONCLUSIONS

A coordinated response involving the child welfare, addictions treatment, and other allied systems is warranted to support families with substance abuse concerns and provide appropriate services.

Moderators and mediators of outcomes of parents with substance use problems: further evaluation of the Parents under Pressure programme

BACKGROUND AND AIMS

Family-focused interventions can improve family functioning when parents have substance use problems. However, there has been little focus upon potential predictors of change and analysis of mechanisms of change. This study aims to identify mediators and moderators of change in a pragmatic, multi-site, randomized controlled trial of the Parents under Pressure (PuP) programme, a family-focused intervention for parents with substance use and other problems, and treatment-as-usual (TAU).

DESIGN

Secondary analysis of data: multi-level modelling was used to investigate moderators of treatment outcome; mediation was tested with cross-lagged models.

SETTING

Community-based family support services in the United Kingdom.

PARTICIPANTS

Parents (n = 100) attending community-based addiction services with children aged 2.5 years or younger.

MEASUREMENTS

Predictors of the primary outcome, child abuse potential, were: baseline child age and gender, composite family risk score, parental substance use and parental emotional dysregulation. Mediation was tested across three time-points with the observed variables parental emotion dysregulation and child abuse potential.

FINDINGS

Increased child age [Z = 2.14, 95% confidence interval (CI) = 0.01, 0.33] at baseline was associated with greater reductions in child abuse potential for PuP programme participants compared with TAU. Poorer parental emotional regulation (Z = 2.48, 95% CI = -2.76, -0.32) was associated with greater reductions in child abuse potential for all participants. Parental substance use (either recent use or primary substance of concern) did not alter any treatment effects on child abuse potential. The mediation analysis showed that PuP produced greater improvements in emotional regulation at post-treatment (P < 0.001) compared with TAU, which predicted lower child abuse potential at 6-month follow up (P < 0.05).

CONCLUSIONS

For UK parents enrolled in a family-focused intervention, baseline measurements of higher child age appear to be associated with greater reductions in child abuse potential at 6-month follow-up in PuP participants compared with treatment as usual (TAU). Poorer parental emotional regulation and, potentially, higher family risk, appears to be associated with greater reductions in child abuse potential at 6-month follow-up in PuP and TAU. Emotional regulation appeared to act as a mediator as improvements in parental emotional regulation post-treatment appeared to be associated with greater reductions in child abuse potential at 6-month follow up. Notably, participation in the PuP programme led to better parental emotional regulation compared with TAU.

All in the family: parental substance misuse, harsh parenting, and youth substance misuse among juvenile justice-involved youth

PURPOSE

Research consistently connects parental and youth substance misuse, yet less is known about the mechanisms driving this association among justice-involved youth. We examine whether harsh parenting is an explanatory mechanism for the association between parental substance use and parental mental health and youth substance use disorder in a sample of justice-involved youth.

METHODS

Data were drawn from the Northwestern Juvenile Project, a large-scale longitudinal survey of mental health and substance misuse in a representative sample of youth in juvenile detention. Harsh parenting, child maltreatment, youth alcohol and cannabis use disorder, and parental substance misuse and mental health were assessed among 1,825 detained youth (35.95% female) at baseline, three-year follow-up, and four-year follow-up.

RESULTS

At baseline, over 80% of youth used alcohol and/or cannabis; at the four-year follow-up, 16.35% and 19.69% of the youth were diagnosed with alcohol and cannabis use disorder, respectively. More than 20% of youth reported their parent misused substances and 6.11% reported a parent had a severe mental health need. Black youth experienced significantly fewer types of harsh parenting compared to White youth. Multivariate path analyses revealed harsh parenting mediated the association between parental substance misuse and mental health on youth alcohol and cannabis use disorder. Harsh parenting that does not rise to the level of child maltreatment mediated the association between parental substance misuse and mental health on youth alcohol use disorder; in contrast, child maltreatment did not mediate these associations. Multigroup analyses revealed the effect of harsh parenting on youth alcohol and cannabis use disorder did not vary across sex or race-ethnic subgroups.

CONCLUSIONS

Harsh parenting represents one mechanism for the intergenerational continuity of alcohol and cannabis misuse and should be regularly assessed for and addressed in juvenile justice settings.

Associations Between Adverse Childhood Experiences and Substance Use in Nursing Students

Adverse childhood experiences (ACEs) are a public health problem, and exposure to ACEs can lead to negative health consequences, including substance use. Little is known about ACEs and substance use in the nursing student population. The purpose of the current study was to describe the types of ACEs encountered by nursing students and the rate at which they occur; and examine associations between individual ACEs and alcohol and drug use. This study uses a cross-sectional, descriptive design. Measurements were used to assess and quantify ACEs and alcohol and drug use. There were small to medium associations between alcohol use and ACE items, and more modest associations found between drug use and ACE items (p < 0.001). Findings highlight the need for a trauma-informed approach to nursing education. [Journal of Psychosocial Nursing and Mental Health Services, 59(7), 43-47.].

Examining Unique Substance-related Risk Profiles for Neglectful Behaviors among Parents with and without Clinical Depression

BACKGROUND

Parental substance use disorder (SUD) is one of the predominant parental risk factors observed for child neglect. Yet, individual risks do not exist in a vacuum.

OBJECTIVE

This study explored the relative importance of parental substance use behaviors based on the presence of key risk (clinical depression) and protective (social support type) factors.

PARTICIPANTS AND SETTING

The final analytic sample was composed of 3,545 parents of children aged 2 to 17 years from Wave 4 data collection of the National Survey of Child and Adolescent Well-Being (NSCAW I).

METHODS

Weighted negative binomial regression models examined the interactive relationship between parent self-report of past-year substance use patterns, clinical depression, and social support type for annual neglect frequencies.

RESULTS

Among parents meeting criteria for clinical depression, parental harmful/risky substance use was associated with lower annual neglect frequency compared to SUD only. In addition, the presence of tangible supports was associated with lower annual neglect frequency while the presence of social companionship was associated with higher annual neglect frequency. For parents not meeting criteria for clinical depression, the study observed an interactive effect where both harmful/risky use behaviors and meeting criteria for SUD significantly contribute to higher average neglect frequencies compared to non-use, depending on social companionship level.

CONCLUSIONS

In order to mitigate neglect risk among substance-using parents, practitioners should look beyond abstinence to address parents' underlying cognitive/affecting functioning and social settings.

Parenting in poor health: Examining associations between parental health, prescription drug use, and child maltreatment

RATIONALE

Child maltreatment and problematic parenting are related to negative outcomes for children. Poor parental health could be a risk factor for problematic parenting through several mechanisms: 1) inadequate emotional regulation and coping; 2) impairment of parental capacity; and, 3) impairment of the parent-child relationship.

OBJECTIVE

This study examines relationships between self-rated parental health, prescription drug use, and a broad array of negative parenting outcomes.

METHODS

A sample of general population parents of children aged ten and younger was recruited from 30 mid-sized cities in California (n = 681). Weighted mixed-effects negative binomial and logistic regression models were used to examine associations between poor parental health, prescription drug use and child maltreatment (physical abuse, supervisory neglect, and physical neglect), and problematic parenting (psychological aggression and corporal punishment).

RESULTS

Parents in poor health used physical abuse, corporal punishment, and psychological aggression more frequently and had higher odds of supervisory neglect. Parents who were taking more prescription medications had higher odds of physical neglect. Exploratory analyses suggested that prescriptions for certain medical conditions both increased and decreased the risk of problematic parenting.

CONCLUSIONS

Poor health and prescription drug use are not uncommon and present largely under-recognized risk factors for a spectrum of adverse parenting outcomes. Our study provides additional evidence that parents in poor health are at heightened risk of negative parenting, and need targeted intervention supports to support family well-being.

Pathways From Parental Substance Use to Child Internalizing and Externalizing Behaviors in a Child Protective Services Sample

This study examines the role of mediation in the pathway from parental substance use to children developing child internalizing and externalizing behaviors. Using the National Survey of Child and Adolescent Well-Being II, a random half sample (i.e., split-half approach) of children aged 18 months to 17 years who remained in the home following a child welfare investigation (N = 1,633) was used to examine direct and mediated pathways from parental self-reported alcohol and drug use to, separately, parent report of child internalizing and externalizing behaviors. Four parallel mediators were examined: child-reported exposure to violence, child-reported parental monitoring, parent-reported harsh physical discipline, and parent-reported emotional maltreatment. The strongest models for both parental alcohol and drug use to internalizing and externalizing behaviors were single-mediator models through emotional maltreatment. Results suggest emotional maltreatment is a crucial intervention target for families with substance use disorders. Parenting interventions must also strengthen parent-child relationships in order to be effective at improving child outcomes.

Documentation of drug abuse in the family or household of children admitted to the hospital for non-accidental trauma

BACKGROUND

Drug abuse in the family is known to increase the risk of child abuse, but its impact on outcomes of hospitalizations for non-accidental trauma (NAT) has not been characterized.

OBJECTIVE

We aimed to identify how frequently drug abuse in the household was documented among children with known or suspected NAT, and to correlate drug abuse in the family with hospitalization outcomes.

PARTICIPANTS AND SETTING

At our tertiary care hospital, we retrospectively queried hospital admissions of children ages 0-17 who had a Child Abuse and Neglect consultation ordered during an inpatient stay.

METHODS

Case manager documentation and consult notes from the inpatient response team were used to determine suspected or confirmed presence of household substance abuse.

RESULTS

We identified 185 children meeting inclusion criteria (59 % <1 year; 34 % 1-5 years; 7% 6-14 years of age). Drug abuse in the family was documented in 44 cases (24 %). Among 178 children surviving to discharge, drug abuse was associated with lower likelihood of discharge home (50 % vs. 70 % among children with no documented drug abuse, p = 0.018). After discharge, we found no statistically significant differences in rehospitalizations or emergency department visits according to documentation of drug abuse in the family.

CONCLUSION

Our study addresses the role of family drug abuse in outcomes of hospitalizations for NAT. Significantly, half of cases with suspected or known drug abuse had no prior CPS involvement, and drug abuse was associated with discharge outcomes after controlling for prior CPS involvement.

Intrauterine Substance Exposure and the Risk for Subsequent Physical Abuse Hospitalizations

OBJECTIVE

To describe the relative risk for a physical abuse hospitalization among substance exposed infants (SEI) with and without neonatal abstinence syndrome (NAS).

METHODS

We created a nationally representative US birth cohort using the 2013 and 2014 Nationwide Readmissions Databases. International Classification of Diseases, Ninth Revision, Clinical Modification codes were used to identify newborns, predictor variables, and subsequent hospitalizations for physical abuse within 6 months of discharge from newborns' birth hospitalization. Predictor variables included newborn demographics, prematurity or low birth weight, and intrauterine substance exposure: non-SEI, SEI without NAS, and SEI with NAS. Multiple logistic regression calculated adjusted relative risks and 95% confidence intervals. A subanalysis of newborns with narcotic exposure was performed.

RESULTS

There were 3,740,582 newborns in the cohort; of which 13,024 (0.4%) were SEI without NAS and 20,196 (0.5%) SEI with NAS. Overall, 1247 (0.03%) newborns were subsequently hospitalized for physical abuse within 6 months. Compared to non-SEI, SEI with NAS (adjusted relative risks: 3.84 [95% confidence intervals: 2.79-5.28]) were at increased risk for having a subsequent hospitalization for physical abuse, but SEI without NAS were not. A similar pattern was observed among narcotic-exposed infants; infants with NAS due to narcotics were at increased risk, but narcotic-exposed infants without NAS were not.

CONCLUSIONS

Our results suggest that newborns diagnosed with NAS are at increased risk of physical abuse during early infancy, above that of substance-exposed infants without NAS. These results should improve the identification of higher-risk infants who may benefit from more rigorous safety planning and follow-up care.

Drug Court as an Intervention Point to Affect the Well-Being of Families of Parents with Substance Use Disorders

Background: A high proportion of justice-involved individuals have a substance use disorder and many of those individuals serve in a caregiving role to a child under 18. Given the negative impact of substance use and justice-involvement on the wellbeing of children, the criminal justice system may offer a unique intervention point with high public health impact. This study describes characteristics of adult drug court participants (DCP) that affect the wellbeing of their children and families and compares the DCP parenting and mental health characteristics to their child's other caregiver in order to understand how parenting differs within drug court families. Method: Data were collected from a sample of 100 DCP; 58 had a matched other caregiver. Drug court data regarding substance use and criminogenic risk/need were collected. Analyses differentiated the parenting behaviors and mental health needs of DCP from other caregivers. Results: The DCP were at moderate to high risk for recidivism and presented with multiple and significant criminogenic and psychosocial functioning needs. Risk for potential maltreatment and poor parenting behaviors were elevated, and significantly higher compared to other caregivers. DCP demonstrated clinically elevated mental health needs, and were significantly different across all indicators of mental health compared to other caregivers. Conclusions: Adult drug courts address the occurrence of substance use disorders but there are additional needs to be intervened upon. Adult drug courts may be a viable intervention point to address issues of parenting and mental health to improve the wellbeing of criminal justice-involved individuals, their children, and families.

Differential responses to infant faces in relation to maternal substance use: An exploratory study

BACKGROUND

Maternal substance use and addiction has been associated with negative consequences for parenting and may increase addiction vulnerability in the developing child. Neuroimaging research suggests that substance use may decrease the reward of caring for infants and heighten stress reactivity to affective infant cues.

METHODS

Thirty-two substance-using mothers and twenty-two non-substance-using mothers were presented with emotional face and cry stimuli generated from their own and a demographically matched unknown infant during fMRI scanning. Between-group differences in neural activity during task performance were assessed using whole-brain, mixed-effects models corrected for multiple comparisons (voxel-level p < 0.001, pFWE<0.05).

RESULTS

Relative to non-substance-using mothers, substance-using mothers exhibited greater activation when viewing their own infant's face as compared to an unknown infant's face across multiple brain regions, including superior medial frontal, inferior parietal, and middle temporal regions. Substance-using mothers also had a decreased response to sad infant faces in the ventral striatum relative to the non-substance-using mothers. Neural responses to own vs. unknown infant cries did not significantly differ between substance-using and non-substance-using mothers.

CONCLUSIONS

Findings suggest overlapping cortical and subcortical brain regions implicated in responding to infant faces, with activation differences related to infant familiarity, emotional expression, and maternal substance use. While prior work has focused on attenuated neural responses to infant cues, greater attention is needed toward understanding the increased reactivity to affective infant cues observed in substance-using mothers.

Parenting stress: A novel mechanism of addiction vulnerability

Addiction remains a significant public health concern. Despite numerous public health initiatives, many parents continue to use substances during the prenatal and postpartum period. While stress has been implicated in the maintenance of substance use disorders more generally, we propose that parenting stress specifically increases vulnerability to substance use in adults caring for young children. To explore this notion, we first consider the neurobiology of the adult transition to parenthood and the value of adopting a parenting-specific approach to understanding addictive processes. Next, we consider the neurobiology of addiction and parenting before directly addressing parenting stress in the context of addiction. Finally, we describe current interventions with parents that incorporate the management of negative affect to enhance caregiving quality and decrease substance use. Taken together, this article proposes that the unique demands of caring for a developing child may be more stressful above and beyond other forms of stress. As a consequence, intervention approaches that target stress in the parenting role hold promise for decreasing parental substance abuse.

Examining the relationships between parent experiences and youth self-reports of slapping/spanking: a population-based cross-sectional study

BACKGROUND

Slapping/spanking is related to a number of poor health outcomes. Understanding what factors are related to the increased or decreased use of spanking/slapping is necessary to inform prevention. This study used a population-based sample to determine the prevalence of slapping/spanking reported by youth; the relationship between sociodemographic factors and slapping/spanking; and the extent to which parental exposures to victimization and maltreatment in childhood and current parental mental health, substance use and family circumstances, are associated with youth reports of slapping/spanking.

METHODS

Data were from the 2014 Ontario Child Health Study, a provincially representative sample of households with children and youth aged 4-17 years. Self-reported lifetime slapping/spanking prevalence was determined using a sub-sample of youth aged 14-17 years (n = 1883). Parents/primary caregivers (i.e., person most knowledgeable (PMK) of the youth) self-reported their own childhood experiences including bullying victimization, slapping/spanking and child maltreatment, and current mental health, substance use and family circumstances including mental health functioning and emotional well-being, alcohol use, smoking, marital conflict and family functioning. Analyses were conducted in 2018.

RESULTS

Living in urban compared to rural residence and family poverty were associated with decreased odds of slapping/spanking. PMK childhood experiences of physical and verbal bullying victimization, spanking, sexual abuse, emotional abuse, and exposure to physical intimate partner violence were associated with increased odds of youth reported slapping/spanking (adjusted odds ratio [AOR] ranged from 1.33-1.77). PMK experiences of physical abuse and exposure to emotional/verbal intimate partner violence in childhood was associated with decreased odds of youth reported slapping/spanking (AOR = 0.72 and 0.88, respectively). PMK's higher levels of marital conflict, languishing to moderate mental health functioning and emotional well-being, and moderate or greater alcohol use were associated with increased odds of youth reported slapping/spanking (AOR ranged from 1.36-1.61).

CONCLUSIONS

It may be important to consider parent/primary caregiver's childhood experiences with victimization and maltreatment along with their current parental mental health, substance use and family circumstances when developing and testing strategies to prevent slapping/spanking.

Mothering, Substance Use Disorders and Intergenerational Trauma Transmission: An Attachment-Based Perspective

Background: A growing body of research underlines that interpersonal trauma in childhood leads to heightened susceptibility for substance use disorders (SUDs) in later life. Little research has been conducted on parenting experiences of mothers in recovery from substance use, taking into account their own upbringing as a child and the potential aftermath of interpersonal childhood trauma. Methods: Through in-depth qualitative interviews, 23 mothers with SUDs reflected on parenting experiences and parent-child bonding, related to both their children and parents. Interviews were transcribed verbatim and data were analyzed adopting thematic analysis. Results: Throughout the narratives, consequences of trauma on mothers' sense of self and its subsequent impact on parenting arose as salient themes. Five latent mechanisms of intergenerational trauma transmission were identified: 1) early interpersonal childhood trauma experiences in mothers; 2) trauma as a precursor of substance use; 3) substance use as a (self-fooling) enabler of parental functioning; 4) continued substance use impacting parental functioning; and 5) dysfunctional parental functioning and its relational impact upon offspring. Discussion: Findings suggest disruptive attachment can increase the vulnerability for SUDs on the one hand, but can be an expression of underlying trauma on the other, hence serving as a covert mechanism by which trauma can be transmitted across generations. Results indicate the need for preventive, attachment-based and trauma-sensitive interventions targeted at disruptive intergenerational patterns.

Types of Substance Use and Punitive Parenting: A Preliminary Exploration

Very little is known about how type of substance use is comparatively related to a range of parenting behaviors. We conduct a preliminary examination to ascertain effects of substance type on physical abuse compared with other child discipline tactics with data from a telephone survey in 2009 of 3,023 parents in 50 cities in California. Kruskal-Wallis tests and hierarchical generalized linear models are conducted to determine the relationship between substance type and frequency of nonviolent discipline, corporal punishment, and child physical abuse. Type of drug used is differentially related to use of discipline strategies in multivariate models. Nonviolent discipline and corporal punishment show a dose-response relationship when a parent who reported using more substances also reported using both types of discipline more frequently. We suggest that addiction professionals should consider partnering with a specialist in child development or child welfare to conduct in-depth assessments of parenting strategies among the highest-risk groups, such as those with past-year alcohol use or a history of polysubstance use or methamphetamine use.