Loss Of Child Custody Research Articles

Association of Food and Housing Insecurity on Outcomes in Pregnant Patients With Substance Use Disorder.

Food insecurity (FI) may be associated with worsened neonatal abstinence syndrome severity in infants born to individuals with substance use disorder. This study evaluates FI and housing insecurity (HI) influence on maternal and neonatal outcomes. This was a cohort study of patients receiving obstetric care through a multispecialty program in Kentucky from 2015 to 2023. Inclusion criteria were: (1) program participants over age 18 consenting to observational research, (2) delivering at University of Kentucky, and (3) not withdrawing from research at any time. Initially, a subset of patients for whom FI and HI concerns were heightened were screened. In 2019, FI and HI screening became standard of care at the clinic. Housing was assessed on enrollment. A validated 2-question Hunger Vital Sign FI screen was utilized for a subset of patients. Maternal and neonatal outcomes, including adverse delivery outcomes, maternal comorbidities, and birth complications, were observed. Fisher's exact and 2 sample t tests were performed. Of 494 participants, 188 (38%) identified at risk for HI. At enrollment, 221 (45%) individuals reported owning their primary residence, 85 (17%) were in group residential treatment, 34 (6.9%) had no housing, and 134 (27%) lived at another's residence. Disposition of a child to a relative or not the patient's own care was greater with HI, 51% versus 47%. Of 155 respondents, 96 (62%) reported FI, associated with increased neonatal intensive care unit (NICU) admission, 86% versus 74%. Using the validated tool, Abuse Assessment Screen, abuse was significantly greater with FI, 76% versus 58%. Edinburgh Postpartum Depression Scales >12 indicating depression were more common with FI, 63% versus 32%, P < .05. Anxiety scores were also higher with FI, P < .05. Patients with FI were more likely to experience abuse. FI and HI were health-related needs associated with increased anxiety, depression, infant NICU admission, and loss of child custody.

Multiple marginalized identities: A qualitative exploration of intersectional perinatal experiences of birthing people of color with substance use disorder in Massachusetts

IntroductionRacial and ethnic inequities persist in receipt of prenatal care, mental health services, and addiction treatment for pregnant and postpartum individuals with substance use disorder (SUD). Further qualitative work is needed to understand the intersectionality of racial and ethnic discrimination, stigma related to substance use, and gender bias on perinatal SUD care from the perspectives of affected individuals. MethodsPeer interviewers conducted semi-structured qualitative interviews with recently pregnant people of color with SUD in Massachusetts to explore the impact of internalized, interpersonal, and structural racism on prenatal, birthing, and postpartum experiences. The study used a thematic analysis to generate the codebook and double coded transcripts, with an overall kappa coefficient of 0.89. Preliminary themes were triangulated with five participants to inform final theme development. ResultsThe study includes 23 participants of diverse racial/ethnic backgrounds: 39% mixed race/ethnicity (including 9% with Native American ancestry), 30% Hispanic or Latinx, 26% Black/African American, 4% Asian. While participants frequently names racial and ethnic discrimination, both interpersonal and structural, as barriers to care, some participants attributed poor experiences to other marginalized identities and experiences, such as having a SUD. Three unique themes emerged from the participants' experiences: 1) Participants of color faced increased scrutiny and mistrust from clinicians and treatment programs; 2) Greater self-advocacy was required from individuals of color to counteract stereotypes and stigma; 3) Experiences related to SUD history and pregnancy status intersected with racism and gender bias to create distinct forms of discrimination. ConclusionPregnant and postpartum people of color affected by perinatal SUD faced pervasive mistrust and unequal standards of care from mostly white healthcare staff and treatment spaces, which negatively impacted their treatment access, addiction medication receipt, postpartum pain management, and ability to retain custody of their children. Key clinical interventions and policy changes identified by participants for antiracist action include personalizing anesthetic plans for adequate peripartum pain control, minimizing reproductive injustices in contraceptive counseling, and addressing misuse of toxicology testing to mitigate inequitable Child Protective Services (CPS) involvement and custody loss.

Perinatal mental health and pregnancy-associated mortality: opportunities for change.

Perinatal mental health conditions have been associated with adverse pregnancy outcomes, including maternal death. This quality improvement project analyzed pregnancy-associated death among veterans with mental health conditions in order to identify opportunities to improve healthcare and reduce maternal deaths. Pregnancy-associated deaths among veterans using Veterans Health Administration (VHA) maternity care benefits between fiscal year 2011 and 2020 were identified from national VHA databases. Deaths among individuals with active mental health conditions underwent individual chart review using a standardized abstraction template adapted from the Centers for Disease Control and Prevention (CDC). Thirty-two pregnancy-associated deaths were identified among 39,720 paid deliveries with 81% (n = 26) occurring among individuals with an active perinatal mental health condition. In the perinatal mental health cohort, most deaths (n = 16, 62%) occurred in the late postpartum period and 42% (n = 11) were due to suicide, homicide, or overdose. Opportunities to improve care included addressing (1) racial disparities, (2) mental health effects of perinatal loss, (3) late postpartum vulnerability, (4) lack of psychotropic medication continuity, (5) mental health conditions in intimate partners, (6) child custody loss, (7) lack of patient education or stigmatizing patient education, and (8) missed opportunities for addressing reproductive health concerns in mental health contexts. Pregnancy-associated deaths related to active perinatal mental health conditions can be reduced. Mental healthcare clinicians, clinical teams, and healthcare systems have opportunities to improve care for individuals with perinatal mental health conditions.

Who Gets the Kid? Female Empowerment and Child Custody in Taiwan

Women’s status in Taiwan has improved substantially due to rapid social and legal changes, yet how female empowerment affects child custody outcomes has been studied little. This study analyzes the entirety of divorce registration records in 2002–2004 and 2018–2020 to reveal the evolution of custodial arrangements in Taiwan. It pays particular attention to how mother’s changing traits and spousal pairings in age and education affect the probability of different child custody outcomes. The findings show that maternal age and education matter in both absolute and relative terms. Higher maternal age and education are associated with more mother-sole and joint custody decisions. Women in age and educational hypogamy secure mother-sole custody more often than their nonhypogamous peers. Furthermore, with improved women’s status at the society level, all women and particularly those in nontraditional unions now have become less likely to face a complete loss of child custody upon divorce than before.

Adolescent child custody loss and substance use treatment as predictors of young adult substance use trajectories among females with foster care and juvenile justice involvement

This study aimed to identify trajectories of substance use from adolescence to young adulthood among 166 females with dual child welfare and juvenile justice system involvement, and to explore the influence of adolescent child custody status and substance use treatment on substance use trajectories. Results identified four substance use trajectory groups (stable moderate substance use, decreasing substance use, increasing substance use, stable high substance use). Custody loss during adolescence predicted membership in the stable high substance use trajectory group (log odds estimate = 2.99, p = < 0.01). No significant associations were found with adolescent substance use treatment. The findings can inform policymakers, foster care professionals, and law enforcement officers to promote the delivery of timely and appropriate substance use services that respond to the unique needs of females across the child welfare and juvenile justice system populations.

Justice For Survivors of Intimate Partner Violence Conference Report

Domestic violence survivors seeking justice and safety in New York State’s family and supreme courts often encounter a deeply flawed, poorly functioning system that exposes them and their children to further harm. On October 13 and 14, 2022, a coalition of leading nonprofit agencies that serve and advocate for survivors convened a conference in New York City to address these systemic inequities and identify meaningful solutions. During the conference, Justice for Survivors of Intimate Partner Violence: Transforming an Inequitable Family Law System, attorneys, scholars, survivor leaders, members of the judiciary, social service professionals, psychologists and advocates identified key obstacles facing survivors and recommended needed reforms to New York State’s family law system.&#x0D; Specifically, the conference focused on widespread inequities in custody, visitation, and family offense cases, which proceed in both the family and supreme courts, and the devastating impact they have on survivors. Throughout the two days, panelists confronted the ways in which these courts fail to provide an effective and equitable system for domestic violence survivors seeking safety and protection for themselves and their families, and identified the most significant challenges they face. In family law proceedings, the stakes could not be higher for survivors and their children, as this inadequate and inequitable system of justice has led to tragic consequences, including death or injury at the hands of abusers, loss of child custody and/or visitation rights, and further trauma inflicted by the litigation itself. Panelists also addressed the egregious under-funding and poor functioning of the Family Courts and the endemic bias woven into these institutions. &#x0D; The Conference included ten keynote and panel presentations addressing significant systemic challenges and potential solutions for survivors of intimate partner violence in the family law system. The Conference featured first-hand accounts by survivors and practitioners, original research presented by renowned experts, and insights provided by prominent sitting and retired judges. Conference panelists drew from materials regarding the intersection of racism, misogyny, and other forms of oppression and its impact on systems, including groundbreaking reports on gender and racial bias in the court system. In addition, each panel provided relevant materials, including scholarly research, reports, studies, articles, statutes and proposed legislation, all of which remain available on the Conference website at https://www.familylaw2022.com/.

Commentary on Rosen et al.: Attending to the unique needs of pregnant and parenting women at risk for overdose.

Women experience unique determinants of overdose risk, including fears concerning child protective services involvement and child custody loss. When addressing the risk for opioid overdose, harm reduction services must account for the needs of pregnant and parenting people. Decades of research has examined the unique social, structural and policy drivers of drug-related harms among women who use drugs (WWUD). Much of this research has been concerned with the social dynamics of drug use and how women's intimate relationships influence harm through patterns of drug use initiation, control over drug use and sexual and injection-related risk for HIV and HCV acquisition [1-6]. Rosen et al. [7] bring this scholarship into the current era by addressing the nature of and reasons for solitary drug use (a risk factor for overdose death [8]) among WWUD. They identify three motivations for solitary drug use among women in their sample: (i) the need to alleviate opioid withdrawal symptoms, (ii) a desire to avoid anticipated and experienced substance use stigma and (iii) an attempt to reduce vulnerability to violence while intoxicated. An important additional consideration emerging in our research is the fear of child protective services (CPS) involvement among pregnant and parenting WWUD 1 and how that fear influences solitary drug use and other overdose risk factors. Some have argued that families are ground zero for the US drug war [9], and WWUD and their children (especially in communities of color) have been subjected to increased harms. In the United States, 53% of Black children will have CPS involvement by their 18th birthday [10], and parental substance use was a condition of removal for nearly 40% of all children placed in foster care in 2019 [11]. We have found that fear of CPS involvement weighs heavily upon women's decisions about when, where and with whom to use drugs. In our unpublished but forthcoming study on the acceptability of overdose prevention sites (a harm reduction strategy recommended by Rosen et al. to address the concerns in their study), women who had children living at home (or were care-givers to family members) found themselves in need of a safe space to use drugs that was both (i) outside the home and (ii) supervised in case of overdose. In the absence of such a site, some respondents describe using opioids alone, out of sight of children and other family members. Providing a supervised environment for parents while also reducing children's exposure to parental substance use and the trauma of a parent's overdose is a potential benefit of overdose prevention sites. We have also found that fear of CPS influences decisions to seek emergency medical assistance for an overdose by calling 911 [12]. It is well established that people who use drugs fear calling 911 because of the risk of law enforcement involvement [13] In our state, Nevada, where a 911 Good Samaritan Law protects 911 callers from some charges, involvement with CPS is not specifically protected under the law, leading to more risk to parenting women and heightened fear related to summoning help for overdose response. To our knowledge, this protection is not included in any state's 911 Good Samaritan Law. Similar to our findings in the later years of the HIV epidemic [6], in which we identified a host of competing priorities that challenged women's ability to negotiate HIV prevention behavior, Rosen et al.'s research [7] highlights issues that challenge women's ability to reduce their risk for fatal overdose. Harris et al. [14], too, recently found that women worry much more about their personal safety and care-giving responsibilities than the ‘inevitability’ of overdose. They conclude that gender-responsive harm reduction programming is needed to explicitly address women's concerns, including provision of child-care, women-only programs and women-focused mental health programming. We argue that other important additions to these gender-responsive approaches include explicit protections for pregnant and parenting people that keep parents safe from harm and guard against state surveillance that can result in family separation. None. L.L. is a staff member of the Washoe County Human Services Agency, in the CQI unit of Children's Services. Karla D. Wagner: Conceptualization; writing—original draft; writing—review and editing. Lisa Lee: Conceptualization; writing—original draft; writing—review and editing. None.

Accessibility of child protection investigations during pandemic: A qualitative analysis of court proceedings.

Qualitative research using published court records to examine contextual factors that contribute to child protection decisions in cases involving parents with intellectual disabilities is limited, particularly during the COVID-19 pandemic. The present study conducted qualitative content analysis on 10 published Ontario court cases to study child protection decision-making between 2019 and 2021. The findings corroborated previous literature with nine out of 10 cases resulting in loss of child custody. Four major themes emerged from content analysis: (1) Impact of COVID-19 pandemic on cases; (2) Systemic barriers to accessibility; (3) Attitudes and bias toward parents with intellectual disabilities; and (4) Ultimate reliance on intellectual disability status for final custody decision. Conducting content analysis on published court cases is useful in learning about accessibility barriers for parents with intellectual disabilities and may help in understanding the impact of the COVID-19 pandemic on the child protection system.

Post-separation abuse: A concept analysis.

To report an analysis of the concept of post-separation abuse and its impact on the health of children and adult survivors. Concept analysis. A literature search was conducted via PubMed, Cochrane and Embase and identified articles published from 1987 to 2021. Walker and Avant's (2019) eight stage methodology was used for this concept analysis, including identifying the concept, determining the purpose of analysis, identifying uses of the concept, defining attributes, identifying a model case and contrary case, antecedents and consequences and defining empirical referents. Post-separation abuse can be defined as the ongoing, willful pattern of intimidation of a former intimate partner including legal abuse, economic abuse, threats and endangerment to children, isolation and discrediting and harassment and stalking. An analysis of literature identified essential attributes including fear and intimidation; domination, power and control; intrusion and entrapment; omnipresence; and manipulation of systems. Antecedents to post-separation abuse include patriarchal norms, physical separation, children, spatiality and availability, pre-separation IPV and coercive control and perpetrator characteristics. Consequences include lethality, adverse health consequences, institutional violence and betrayal, such as loss of child custody and economic deprivation. This concept analysis provides a significant contribution to the literature because it advances the science for understanding the phenomenon of post-separation abuse. It will aid in developing risk assessment tools and interventions to improve standards of care for adult and children survivors following separation from an abusive partner. This concept analysis of post-separation abuse provides a comprehensive insight into the phenomenon and a theoretical foundation to inform instrument development, future research and intervention. Post-separation abuse is a complex, multi-faceted phenomenon that requires differential social, legal and healthcare systems responses to support the health and well-being of survivors and their children.

Mothers Who Use Drugs: Closing the Gaps in Harm Reduction Response Amidst the Dual Epidemics of Overdose and Violence in a Canadian Urban Setting.

Objectives. To identify key gaps in overdose prevention interventions for mothers who use drugs and the paradoxical impact of institutional practices that can increase overdose risk in the context of punitive drug policies and a toxic drug supply. Methods. Semistructured interviews were conducted with 40 women accessing 2 women-only, low-barrier supervised consumption sites in Greater Vancouver, British Columbia, Canada, between 2017 and 2019. Our analysis drew on intersectional understandings of structural, everyday, and symbolic violence. Results. Participants' substance use and overdose risk (e.g., injecting alone) was shaped by fear of institutional and partner scrutiny and loss (or feared loss) of child custody or reunification. Findings indicate that punitive policies and institutional practices that frame women who use drugs as unfit parents continue to negatively shape the lives of women, most significantly among Indigenous participants. Conclusions. Nonpunitive policies, including access to safe, nontoxic drug supplies, are critical first steps to decreasing women's overdose risk alongside gender-specific and culturally informed harm-reduction responses, including community-based, peer-led initiatives to maintain parent-child relationships. (Am J Public Health. 2022;112(S2):S191-S198. https://doi.org/10.2105/AJPH.2022.306776).

“I was already in the system from the start”: how substance-using women in the street sex trade make decisions about pregnancy

The present study examines how substance-using women in the street sex trade formulate understandings of pregnancy at the intersections of healthcare, social services, and family systems in ways that reflect internalized dominant cultural assumptions about substance use, motherhood, and the street sex trade. Three primary frameworks emerged with respect to pregnancy-related decision-making as prompted by heightened scrutiny, intensified stigma, and prioritization of fetal over maternal wellbeing. Healthcare, social services, and family systems can improve care for pregnant substance-using women in the street sex trade by acknowledging the dynamic interplay between women’s substance use, relationships, and pregnancy-related decision-making as well as the intersectional harms compounded by child custody loss and persistent lack of support to low-income women.

High intensity parental dispute in the Jewish ultra-Orthodox community in Israel: Perspectives of social workers and disaffiliated parents

• Most studies on HIPD have been conducted in Western societies, with a focus on the nuclear family. • The ultra-Orthodox is extremely instructive for understanding HIPD in closed communities. • Community leaders and institutions play a key role of in the dispute and escalation process. • The findings highlight the need to promote knowledge, awareness, and skills among social workers. The present study discusses the role of the Jewish ultra-Orthodox community in high intensity parental disputes (HIPD) in cases of divorce following one parent’s disaffiliation from the community. In the ultra-Orthodox community, a parent who disaffiliates might encounter harsh sanctions, including excommunication, often resulting in divorce and loss of child custody. Based on a qualitative, context-informed perspective, we explored the role of the ultra-Orthodox community and its leaders in HIPD cases from the perspectives of social workers and disaffiliated divorced parents. We conducted nine semi-structured in-depth interviews with social workers specialized in HIPD, reviewed 25 reports by twelve social workers likewise specialized in HIPD, and conducted 14 semi-structured in-depth interviews with disaffiliated divorced parents. The interviews and reports were thematically analyzed and triangulated, yielding three main themes: (1) the active role of the community; (2) the children as instrumental in the community’s active role; and (3) challenges for social work. The discussion sheds light on the community’s role in the dispute escalation process. It also highlights the importance of promoting awareness, knowledge, and skills among social workers for intervening in such complex situations, given the clash between the need to collaborate with community leaders and their often-counterproductive role in HIPD.

Overdose among mothers: The association between child removal and unintentional drug overdose in a longitudinal cohort of marginalised women in Canada

BackgroundAccidental overdose is a major public health concern in North America with research primarily focused on cisgender men. Little is known about the burden of overdose among marginalised women, particularly in the context of child custody loss. This study aims to examine the prevalence of overdose and the association with child removal in a cohort of marginalised women. MethodsThis study draws on a merged dataset (2010–2018) of two community-based longitudinal cohorts of over 1000 marginalised women in Canada recruited using time-location sampling. After restricting to women who had ever had a live birth, bivariate and multivariable logistic regression using generalised estimating equations (GEE) were used to examine the association between child removal and overdose. Joint effects of child removal and Indigeneity were also investigated. ResultsOf the 696 women who reported ever having a live birth, 39.7% (n = 276) reported child removal at baseline. Unintended, non-fatal overdose rates were high, with 35.1% (n = 244) of women reporting ever having an overdose. Using bivariate GEE analyses, having a child apprehended and being Indigenous were positively correlated with overdose. Using multivariable GEE, child removal increased the odds of overdose by 55% (AOR: 1.55; 95% CI 1.01–2.39) after adjusting for education and Indigenous ancestry. Using multivariable joint-effects analysis, Indigenous women who had experienced child removal had over twice the odds of an unintended overdose than non-Indigenous women who had not lost custody after adjusting for education, food insecurity, and sex work (AOR: 2.09; 95% CI 1.15–3.79). ConclusionThis analysis suggests that, after controlling for known confounders, women who have a child removed experience higher odds of overdose, and these odds are highest among Indigenous women. The high prevalence of overdose in this cohort suggests the need for further strategies to prevent overdose among pregnant and parenting women.

Guideline No. 405: Screening and Counselling for Alcohol Consumption During Pregnancy.

To establish national standards of care for screening and counselling pregnant women and women of child-bearing age about alcohol consumption and possible alcohol use disorder based on current best evidence. Health care providers who care for pregnant women and women of child-bearing age. Pregnant women and women of child-bearing age and their families. Medline, EMBASE, and CENTRAL databases were searched for "alcohol use and pregnancy." The results were filtered for a publication date between 2010 and September 2018. The search terms were developed using Medical Subject Headings terms and keywords, including pre-pregnancy, pregnant, breastfeeding, lactation, female, women, preconception care, prenatal care, fetal alcohol spectrum disorder, prenatal alcohol exposure, drinking behavior, alcohol abstinence, alcohol drinking, binge drinking, alcohol-related disorders, alcoholism, alcohol consumption, alcohol abuse, benzodiazepines, disulfiram, naltrexane, acamprosate, ondansetron, topiramate, cyanamide, calcium carbimide, alcohol deterrents, disease management, detoxification, Alcoholics Anonymous, alcohol counselling, harm reduction, pre-pregnancy care, prenatal care, incidence, prevalence, epidemiological monitoring, and brief intervention. Evidence was included from clinical trials, observational studies, reviews, systematic reviews and meta-analyses, guidelines, and conference consensus. The content and recommendations in this guideline were drafted and agreed upon by the authors. The Board of Directors of the Society of Obstetricians and Gynaecologists of Canada approved the final draft for publication. The quality of evidence was rated using the criteria described in the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology framework. Implementation of the recommendations in these guidelines using validated screening tools and brief intervention approaches may increase obstetrical care provider recognition of alcohol consumption and problematic alcohol use among women of child-bearing age and those who are pregnant. It is anticipated that health care providers will become confident and competent in managing and supporting these women so they can achieve optimal health and pregnancy outcomes. RECOMMENDATIONS (GRADE RATINGS IN PARENTHESES).

Perceived community-based needs of low-income parents with psychiatric disabilities who experienced legal challenges to their parenting rights

Substantial numbers of US parents with psychiatric disabilities are highly vulnerable to loss of child custody or visitation, through child welfare system involvement or divorce proceedings. This study describes the community-based needs of parents with psychiatric disabilities who experienced legal challenges to their parenting rights. This exploratory study involved semi-structured telephone interviews with twelve former clients of a legal services program that provides representation to low-income parents with psychiatric disabilities facing challenges to child custody or visitation. Interviews were audio-recorded, professionally-transcribed, and analyzed using a qualitative, content analysis approach. Three broad themes emerged regarding the types of supports parents reported as useful for their well-being: (1) informal support networks; (2) responsive mental health care for the whole family; and (3) meaningful legal representation. Within these three areas, unmet needs were frequent and problematic. A fourth theme emerged: chronic economic hardships and material deprivation, which point to unmet financial needs. The needs and supports described in this study should be addressed through the development of comprehensive services and supports that meet the psychosocial, legal, and socioeconomic needs of parents with psychiatric disabilities and their children. Future research is also warranted.

The experiences of pregnant women attending a specialist service and using methamphetamine

BackgroundPregnant women attending the Specialist Drug and Alcohol Service in Perth use methamphetamine as their primary drug of choice. This is the only tertiary service for pregnant and postnatal women with complex Alcohol and Other Drug Use in Western Australia. It is a midwifery-led multidisciplinary team. Many of the women struggle with addiction, polysubstance use, co-occurring mental health, family and domestic violence, complex trauma and fear of Child Protection and infant removal. Therefore, the aim of this study was to understand the impact of methamphetamine use of pregnant women attending the service and explore and highlight the potential barriers to engagement and follow-up. MethodsA qualitative study informed by phenomenological methods was undertaken using semi-structured interviews with 20 women with methamphetamine use attending the service in order to explore and understand the experience of using methamphetamine in pregnancy and the postpartum period. A thematic analysis was undertaken with data from the women in the study (n=20) to identify key themes. ResultsKey themes that emerged from the women’s experiences detail their resilience and experience with methamphetamine and the impact that methamphetamine has on their life. A key concern for women regarding methamphetamine use and engagement with specialist services was the welfare of their child(ren). Agencies charged with child protection was a barrier to treatment because women feared disclosure of methamphetamine use would result in loss of child custody. Themes highlighted the multiple layers of adversities, and trauma from childhood to adulthood including, co-occurring drug use, mental health and life histories of trauma (abuse, violence, and neglect; intergenerational trauma; intergenerational drug and alcohol use, and child removal), the omnipresence of methamphetamine, and the impact on pregnancy and mothering. ConclusionWe conclude that understanding the experiences of women and the impact methamphetamine use has on their life is paramount to providing effective and appropriate care to support pregnant women in a trauma-informed and woman-centred approach. Poor engagement in pregnancy care for women with methamphetamine use has significant impacts on mother and infant.

Commentary on Hancock et al. (2020): Low dead space syringes are just one component of an integrated package of care needed to tackle HCV and social exclusion among people who inject drugs.

Commentary on Hancock et al. (2020): Low dead space syringes are just one component of an integrated package of care needed to tackle HCV and social exclusion among people who inject drugs.

CHILD VISITATION RIGHTS IN PRACTICE

Child visitation can facilitate the continued involvement of both parents in their children’s lives after a divorce. This study aims to examine the issue of visitation rights and report the results of an analysis of relevant court cases involving Malaysian Muslim families. It describes the structure or type of visitation awarded to non-custodial parents as a result of their loss of child custody. Content analysis technique was applied to elaborate on the reported court cases. A cross tabulation method was also performed to describe the frequency of cases for the respective types of visitation. This study has revealed several details about visitation rights hidden in the masses of case law. These include granted visitation rights which comprise scheduled, reasonable and dual-form visitation, counting omission of access rights which occurred most frequently including cases where parties received legal representation. The study has contributed towards a greater understanding of how visitation orders are made in practice through a quantitative analysis of past court decisions.

Need for women-centered treatment for substance use disorders: results from focus group discussions

BackgroundThere are few women-centered treatment programs for substance use disorder. We therefore undertook an exploratory study to better understand the treatment experience, barriers, and facilitators of mothers with substance use disorder.MethodsWe conducted two focus groups with a total of ten women with a history of substance use disorder in Kingston (Canada). Women were recruited from a community program for mothers with substance use disorder. The focus groups were recorded, and the resulting data were transcribed, coded, and thematically analyzed. Barriers, facilitators and treatment needs were identified.ResultsThe mean age of the participants was 31.1 years, 30% were currently using substances, and 60% had a child in their care. A key concern for women regarding substance use treatment was the welfare of their child(ren). Agencies charged with child protection were a barrier to treatment because women feared disclosing substance use would result in loss of child custody. In contrast, when agencies stipulated that women must attend treatment to retain custody, they facilitated treatment engagement. Other barriers to treatment included identifying treatment programs and completing admission requirements, wait times, counselor ability to address woman-centered issues, fear, safety, and stigma. Women’s personal motivation for treatment was a facilitator. Suggestions to improve treatment programs included to allow children to accompany their mothers, involvement of peer support, and women-only programs.ConclusionsThis small but novel study provides important data to inform treatment programming for mothers with substance use disorders.

Exploring opioid use disorder, its impact, and treatment among individuals experiencing homelessness as part of a family

BackgroundOpioid Use Disorder (OUD) causes significant morbidity and mortality among people experiencing homelessness. We aimed to explore the unique way in which OUD impacts individuals experiencing homelessness as part of a family. MethodsWe conducted semi-structured interviews with adults experiencing OUD staying in Boston-area family shelters along with dependent children. We used Borkan’s Immersion-Crystallization method to uncover themes from interview transcripts. ResultsWe conducted 14 interviews. Eleven participants identified as female and three as male. Mean age was 35 (range 24–51) and median number of children was 2.5 (range 1-5). Emergent themes fell in three categories:1) Initiation of OUD: Many patients were introduced to opioids through physician prescriptions, with recreational use coming first for some. Parents and partners also contributed to opioid use.2) Impact of OUD: Overdose, homelessness, and unemployment were common impacts of OUD. Many patients described co-morbid chronic pain and mental illness. Psychosocial trauma, prominently due to loss of child custody, was common.3) Treatment for OUD: Childcare, transportation to treatment at distant sites, and requirements that interfered with life responsibilities were barriers to treatment that shelter-based opioid treatment (SBOT) allowed patients to overcome. Family unity was universally seen as motivation for treatment. ConclusionsAccording to a sample of adults experiencing OUD in the context of family homelessness, an ideal OUD treatment program would overcome logistical barriers, provide comprehensive treatment for comorbidities, support employment and housing needs, and focus care on the family. Future work should explore the generalizability and financial feasibility of this model.