Infant risk and safety in the context of maternal substance use
Introduction
All infants, due to total dependence on a caregiver to meet their needs, are vulnerable. Substance-dependent infants are extremely vulnerable due to biological, environmental, economic and systemic risk factors often beginning in pregnancy and compounded by the postnatal care-giving environment (VCDRC, 2000). Substance-dependent mothers face unique challenges in caring for infants while managing drug use or pharmacotherapy. This complexity in the mother/infant dyad requires thorough assessment of risk and a prompt response from service providers. Consequently, many substance-exposed infants are brought to the attention of child protection services in the perinatal period, particularly prior to discharge from hospital when vulnerability is heightened. Once they enter the child protection system, infant cases are more likely to be substantiated and to result in placement in out-of-home care where they tend to remain longer than other children (Zhou & Chilvers, 2010).
While perception of risk is ubiquitous in child protection practice, few studies report how risk is experienced and enacted (Stanford, 2010 p. 1067–1068). Equally, limited attention has been given to the subjective experience of substance-dependent women involved with child protection services (Davies & Krane, 2006). This article draws upon a prospective case-study of twenty women accessing a specialist alcohol and other drug (AOD) obstetric service. Two perspectives are presented: those of service providers and mothers to demonstrate the need for a differential response to risk when problematic parental substance use has been identified in the perinatal period.
Section snippets
Literature review
Data from the U.S. (Havens, Simmons, Shannon, & Hansen, 2009), the U.K. (Crome & Kumar, 2007) and Australia (Bartu, Sharp, Ludlow, & Doherty, 2006) indicate that approximately 5% of women use substances during pregnancy; although underreporting by women, and limited screening by hospitals, suggests these estimates are likely to be lower than actual rates (Anthony, Austin, & Cormier, 2010). Substance-use frequently continues in the postnatal period, and together with mental health problems and
The policy and practice context
There is no legal mandate in Australian legislation to support intervention with unborn babies but duty of care is considered imperative. Some child protection systems are able to receive reports for the purpose of support to expectant women but concern must be for the infant's wellbeing in the postnatal period (Mathews, 2008). Despite potential to intervene early in the development of problems, the Australian practice response to substance use in pregnancy is inconsistent with some hospitals
Findings
The following section reports the reasons for and the number of notifications made by the Women's ADS to CP in the perinatal period and outlines individual women's involvement with CP at each study phase.
Discussion
This study documents a productive partnership between CP and the Women's ADS at a time of heightened infant vulnerability prior to discharge to home or to alternative care. The study demonstrates capacity by a specialist AOD obstetric provider to conduct accurate risk assessment operationalized as consensus with CP and by examination of the outcomes of a twelve-month follow-up which revealed that no woman unknown to CP was brought to the attention of the service within this time-frame. The
Conclusion
The present study demonstrates accurate assessment of at-risk substance-exposed infants by a specialist AOD obstetric provider and supports research identifying a sub-group of infants at increased risk of separation from mothers. The longitudinal method illustrates that practice is hamstrung by reliance on statutory services to monitor and intervene and that the current response does not lead to resolution of the issues that bring infants to the attention of child protection. If we are to
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