Putting Families First: How the Opioid Epidemic is Affecting Children and Families, and the Child Welfare Policy Options to Address It

Abstract: Opioids and Child Welfare Across the country, placements in foster care are rising. In 2016, the U.S. Department of Health and Human Services reported that 273,539 children in the U.S. entered foster care. In 34 percent of those cases, parental drug abuse was one of the factors leading to the child’s removal from their family. Additionally, the U.S. Substance Abuse and Mental Health Services Administration estimates that 400,000 births nationally are affected by prenatal exposure to alcohol and illicit drugs, which represents 10 percent of all live births. As the opioid epidemic continues, increasing numbers of children are at high risk for developmental and behavioral disorders because of their prenatal substance and alcohol exposure. In addition, children who remain at home may endure the challenges and trauma resulting from impaired caregiving due to parental substance use disorders (SUDs). This article explores the intersection of the opioid epidemic and child welfare, examining current research and publicly available data to discuss policy opportunities for better serving families affected by parental SUDs, including: ensuring health and safety for infants prenatally exposed to substances; appropriate identification, diagnosis, and treatment of developmental and behavioral needs; ensuring parents have access to outpatient treatment and services that can allow families to stay together when safe and appropriate; and ensuring sufficient access to inpatient treatment options that can serve parents and children together

Validity and Reliability of the Perceived Readiness for Discharge After Birth Scale

Objective: To assess the psychometric properties of a scale measuring mothers’ perceptions of readiness for discharge after birth. Design: Psychometric analyses including construct validity using factor analysis and known groups comparisons, predictive validity, and reliability. Data were collected at discharge and 6 weeks postdischarge. Setting: Tertiary-level perinatal center in the Midwestern United States. Participants: 1,462 postpartum mothers. Intervention: None. Main Outcome Measures: Perceived Readiness for Discharge After Birth Scale scores; subscale scores for personal status and knowledge factors.\u27 Results: Exploratory and confirmatory factor analyses indicated that the scale contained two factors. Perceived Readiness for Discharge After Birth Scale scores were lower for mothers who were breast-feeding, married, primiparous, and had a short hospital stay (less than 30 hours) than for their comparison groups. The Perceived Readiness for Discharge After Birth Scale personal status factor was predictive of self-reported physical and psychosocial problems and unscheduled utilization of health services in the first 6 weeks postpartum. The knowledge factor was predictive of postdischarge telephone calls to the pediatric provider. Reliability estimates ranged from 0.83 to 0.89 for the total scale and subscales. Conclusions: The Perceived Readiness for Discharge After Birth Scale performed well in psychometric testing. Assessing mothers’perceptions of readiness for discharge is important for measuring outcomes of hospitalization and for identifying mothers at risk for postdischarge problems

Altered perception of facially expressed tiredness in insomnia

The present study compared normal sleepers and individuals displaying insomnia symptoms in their ratings for the expression intensity of tiredness and alertness whilst observing tired and neutral faces. Fifty-six normal sleepers and 58 individuals with insomnia symptoms observed 98 facial photographs (49 neutral, 49 tired). Using a visual analogue scale, participants were required to rate the extent to which each face appeared as tired and alert. Tired faces were created by manipulating neutral photographs to include previously identified facial tiredness cues. All participants rated sleep-related faces as more tired and less alert relative to neutral photographs. A significant Group × Face × Rating interaction demonstrated that, compared with normal sleepers, the insomnia symptoms group showed lower ratings for the expression of tiredness, but not alertness, whilst observing the tired faces. The findings suggest that the presence of insomnia symptoms is associated with reduced ratings of expression intensity for sleep-related facial photographs displaying tiredness. These outcomes add to the body of literature on how facial cues of tiredness are perceived by those with insomnia symptoms. Further work is required to elucidate the mechanisms underlying the relationship between insomnia symptoms and reduced perceptions of facially expressed tiredness

Length of Stay after Vaginal Birth: Sociodemographic and Readiness-for-Discharge Factors

Background: The impact of reductions in postpartum length of stay have been widely reported, but factors influencing length of hospital stay after vaginal birth have received less attention. The study purpose was to compare the sociodemographic characteristics and readiness for discharge of new mothers and their newborns at 3 discharge time intervals, and to determine which variables were associated with postpartum length of stay. Methods: The study sample comprised 1,192 mothers who were discharged within 2 postpartum days after uncomplicated vaginal birth at a tertiary perinatal center in the midwestern United States. The sample was divided into 3 postpartum length-of-stay groups: group 1 (18–30 hr), group 2 (31–42 hr), and group 3 (43–54 hr). Sociodemographic and readiness-for-discharge data were collected by self-report and from a computerized hospital information system. Measures of readiness for discharge included perceived readiness (single item and Readiness for Discharge After Birth Scale), documented maternal and neonatal clinical problems, and feeding method. Results: Compared with other groups, the longest length-of-stay group was older; of higher socioeconomic status and education; and with more primiparous, breastfeeding, white, married mothers who were living with the baby’s father, had adequate home help, and had a private payor source. This group also reported greater readiness for discharge, but their newborns had more documented clinical problems during the postbirth hospitalization. In logistic regression modeling, earlier discharge was associated with young age, multiparity, public payor source, low socioeconomic status, lack of readiness for discharge, bottle-feeding, and absence of a neonatal clinical problem. Conclusions: Sociodemographic chracteristics and readiness for discharge (clinical and perceived) were associated with length of postpartum hospital stay. Length of stay is an outcome of a complex interface between patient, provider, and payor influences on discharge timing that requires additional study. Including perceived readiness for discharge in clinical discharge criteria will add an important dimension to assessment of readiness for discharge after birth

Oral health status of rural-urban migrant children in South China

International Journal of Paediatric Dentistry 2011; 21: 58-67 Background. In China, there is a massive rural-urban migration and the children of migrants are often unregistered residents (a 'floating population').Aim. This pilot study aimed to profile the oral health of migrant children in South China's principal city of migration and identify its socio-demographic/behavioural determinants.Design. An epidemiological survey was conducted in an area of Guangzhou among 5-year-old migrant children (n = 138) who received oral examinations according to the World Health Organization criteria. Parents' oral health knowledge/attitude, child practices, and impact of children's oral health on their quality-of-life (QoL) were assessed.Results. The caries rate and mean (SD) dmft were 86% and 5.17 (4.16), respectively, higher than those national statistics for both rural and urban areas (P < 0.05). Oral hygiene was satisfactory (DI-S < 1.0) in 3% of children. Oral health impacts on QoL were considerable; 60% reported one or more impacts. 58% variance in 'dmft' was explained by 'non-local-born', 'low-educated parents', 'bedtime feeding', 'parental unawareness of fluoride's effect and importance of teeth', and 'poor oral hygiene' (all P < 0.05). 'Non-local-born' and 'dmft' indicated poor oral health-related QoL (both P < 0.05), accounting for 32% of variance.Conclusion. Oral health is poor among rural-urban migrant children and requires effective interventions in targeted sub-groups. © 2010 The Authors. International Journal of Paediatric Dentistry © 2010 BSPD, IAPD and Blackwell Publishing Ltd.postprin

A Critical Appraisal of Guidelines for Antenatal Care: Components of Care and Priorities in Prenatal Education

There are a variety of published prenatal care (PNC) guidelines that claim a scientific basis for the information included. Four sets of PNC guidelines published between 2005 and 2009 were examined and critiqued. The recommendations for assessment procedures, laboratory testing, and education/counseling topics were analyzed within and between these guidelines. The PNC components were synthesized to provide an organized, comprehensive appendix that can guide providers of antepartum care. The appendix may be used to locate which guidelines addressed which topics to assist practitioners to identify evidence sources. The suggested timing for introducing and reinforcing specific topics is also presented in the appendix. Although education is often assumed to be a vital component of PNC, it was inconsistently included in the guidelines that were reviewed. Even when education was included, important detail was lacking. Addressing each woman\u27s needs as the first priority was suggested historically and remains relevant in current practice to systematically provide care while maintaining the woman as the central player. More attention to gaps in current research is important for the development of comprehensive prenatal guidelines that contribute effectively to the long‐term health and well‐being of women, families, and their communities

Conference Proceedings: The Purpose Challenge: Bridging the Gap Between Industry and Academia to Achieve Social Impact Goals

Key themes emerged focusing on the different issues addressed under the PURPOSE umbrella, how advertising agencies differ from corporate in purpose-driven marketing initiatives, and how academia can be a resource for professionals on this topic. The UT Purpose Project was discussed as a potential outlet for purpose research. From the conversations about academic purpose-oriented studies, industry professionals saw value in the potential insights derived from academic work. Cultural differences between industry and academic were discussed such as the industry’s need for speedy decisions and academician slower pace in producing quality research. Professionals felt they needed the potential insights from academic work to help justify decisions in a more objective way to their teams, executives and clients. However, it was acknowledged by both profession and industry professionals that the way academic articles are written hinders communication between academics and industry. As a solution, professional panelists noted their desire for current, relevant, white-paper type research being available for public consumption. The academic researchers desired conversations with industry professionals about purpose questions that would be relevant to industry as a way to make research more useful.https://trace.tennessee.edu/utpurposeproject/1002/thumbnail.jp