Abstract
There is documented correlation between parental substance abuse, child maltreatment, and poor outcomes. In two health districts in Sydney, Australia (Site A and B), specialised clinics were established to provide comprehensive assessments for infants of substance abusing mothers (ISAM). We aimed to determine whether there was a difference in outcomes between infants who attended clinic versus those who did not; and to identify differences in the pathways to care between sites. We analysed child protection reports and available health markers of all ISAM referrals in 2011. We held stakeholder meetings with services involved with ISAM in both sites; to describe service components; strengths and weaknesses of pathways. Fifty-five per cent (11/20) attended clinic in Site A; 80% (25/31) in Site B. Three-quarters of ISAM had at least one referral to child welfare; child protection service involvement was more common in those who attended. Immunisation status was lower than the national Australian average; approximately half were seen by community nursing services. Gaps in services, lack of database, and differences in pathways between sites were identified. Attending clinics correlates with child protection service involvement and may afford health protection. Transparent communication, service integration, and shared learning can improve outcomes for this vulnerable group.
Highlights
There is an extensive body of literature worldwide confirming the strong correlation between substance abuse and child maltreatment [1,2,3]
There were concerns voiced by clinicians that Infants of substance abusing mothers (ISAM) were falling through gaps within the system, and that various components of the hospital and community services working with this client group were not communicating effectively
Quantitative Component—Audit In Site A in 2011, a total number of 56 women were seen through the drugs in pregnancy coordinated care program (DAPCC); the women were being seen through three separate centres in the local health district
Summary
There is an extensive body of literature worldwide confirming the strong correlation between substance abuse and child maltreatment [1,2,3]. Australian study reported that maternal disclosure of substance use is greatly associated with increased rates of involvement with statutory child protection services [4]. Infants of substance abusing mothers (ISAM) have poorer developmental, behavioural, and social outcomes [3]. A multi-disciplinary service with Drug Health, Community Health, Maternity services and Social Work involvement was set up and operated in these health districts from 2005 onwards. In 2007, a specialised multi-disciplinary paediatric clinic, was set up to provide comprehensive paediatric, developmental and psychosocial assessment and support for ISAM. Referral to the clinic was primarily through perinatal identification of at risk families, by antenatal health care workers (social workers, drug health workers, neonatologists) and through identification of children with child protection concerns, usually referred by Community Services (CS), the statutory child protection service. There were concerns voiced by clinicians that ISAM were falling through gaps within the system, and that various components of the hospital and community services working with this client group were not communicating effectively
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