Variation in States’ Implementation of CAPTA’s Substance-Exposed Infants Mandates: A Policy Diffusion Analysis

Sieger, Margaret H. Lloyd; Rebbe, Rebecca

doi:10.1177/1077559520922313

Cited by 10 publications

(2 citation statements)

References 18 publications

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“… 1. Scholars have also studied how federal law changed state child welfare mandates. The research shows that states do not uniformly implement changes in federal law with states being “innovators/early adopters,” “early majority,” “late majority,” or “laggards” (Sieger & Rebbe 2020). …”

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confidence: 99%

Structural Racism and Criminal Violence: An Analysis of State-Level Variation in Homicide

2021

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We advance a structural racism approach to understanding the variation in homicide across the U.S. states. We conceptualize structural racism by juxtaposing the conditions for Blacks with those for Whites across multiple domains. We also include two ideological beliefs, racial resentments and Whites perceptions that their racialized social status is threatened by minority gains. The results show that higher Black homicide rates are associated with greater exposure to structural racism and that states with more Whites who harbor racial resentments have higher rates of Black homicides. We also found that states with more Whites who feel that their status is threatened exhibit higher rates of White homicides. However, the results reveal that structural racism exhibits a non-significant association with White homicide rates. We conclude that the challenge going forward is to develop strategies that can undo the oppression of Blacks without enhancing attitudes of Whites that promote criminality.

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confidence: 99%

Structural Racism and Criminal Violence: An Analysis of State-Level Variation in Homicide

2021

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“…Although the family‐focused, public health‐based family care plans under this reauthorization certainly seem to represent a sea‐change in child welfare policy that has long focused on the child's safety to, at times, the exclusion of the caregiver‐child dyad, no scholarship has explored the theoretical implications of this policy, including how the CAPTA reauthorization could achieve the goals of dyadic health, development, and safety. The CAPTA reauthorization's goals are lofty both due to the conceptual divergence from extant child welfare practice and given the historically slow implementation of CAPTA's provisions related to substance‐exposed infants (SEIs) (Chasnoff, Barber, Brook, & Akin, 2018; Lloyd Sieger & Rebbe, 2020). Moreover, no research has tested whether CAPTA “works” for this population.…”

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confidence: 99%

Child Abuse Prevention and Treatment Act, family care plans and infants with prenatal substance exposure: Theoretical framework and directions for future research

Sieger

Nichols

Chasnoff

2022

Infant and Child Development

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In May 2021, a reauthorization of the Child Abuse Prevention and Treatment Act (CAPTA) was introduced in the U.S. Senate. This reauthorization substantially amends provisions concerning infants affected by prenatal substance exposure (PSE) and decidedly shifts the policy from a child safety‐ to a public health‐focused approach to achieve the larger goals of healthy and safe child development and caregiver recovery from substance use disorder. Despite its honourable aspirations, no research has tested whether CAPTA “works.” To advance scholarship on this policy, we summarize the service needs for this population and clarify how the CAPTA reauthorization aims to address these needs. We then apply a health utilization theory to understanding the mechanisms of effect on maternal‐child outcomes. Based on this theoretical analysis, we discuss directions for future research.

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Hospital Readmissions Among Infants With Neonatal Opioid Withdrawal Syndrome

Gaither,

Drago,

Grossman

et al. 2024

JAMA Netw Open

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ImportanceAlthough cases of neonatal opioid withdrawal syndrome (NOWS) increased 5-fold in recent years, no study has examined national hospital readmission rates for these infants.ObjectiveTo examine hospital readmissions for infants with and without NOWS.Design, Setting, and ParticipantsThis retrospective cohort study analyzed serial cross-sectional samples of US hospital discharge records from the Nationwide Readmissions Database for calendar years 2016 to 2020. Infants with NOWS were identified using International Classification of Diseases, Tenth Revision, Clinical Modification codes. The data analysis was performed between January 5, 2023, and May 6, 2024.ExposureNeonatal opioid withdrawal syndrome.Main Outcome and MeasuresSurvey-weighted logistic regression was used to examine 90-day all-cause and cause-specific hospital readmissions. Multivariable models adjusted for sex, low birth weight, gestational age, multiple gestation, type of insurance, and year of birth.ResultsOf the 13 855 246 newborns identified in this weighted analysis, 89 018 (0.6%) were diagnosed with NOWS, of whom 53.8% were male and 81.1% born full-term (&gt;36 weeks gestation). The 90-day all-cause readmission rate was 4.2% for infants with NOWS compared with 3.0% for those without NOWS (P &lt; .001). After risk adjustment, the odds of all-cause readmission were higher among infants with NOWS (adjusted odds ratio [AOR], 1.18; 95% CI, 1.08-1.29). Infants with NOWS had significantly higher odds of readmissions for seizures (AOR, 1.58; 95% CI, 1.01-2.46), failure to thrive (AOR, 1.99; 95% CI, 1.36-2.93), traumatic brain injury (AOR, 2.95; 95% CI, 1.76-4.93), and skull fractures (AOR 3.72; 95% CI, 2.33-5.93). Infants with NOWS had higher odds of receiving a diagnosis of confirmed maltreatment (AOR, 4.26; 95% CI, 2.19-8.27), including for neglect (AOR, 14.18; 95% CI, 5.55-36.22) and physical abuse (AOR, 2.42; 95% CI, 0.93-6.29); however, the latter finding was not statistically significant.Conclusions and RelevanceIn this nationally representative cohort study, infants with NOWS were at increased risk of readmission for any cause as well as for trauma and confirmed maltreatment. These findings may in part reflect the dual stressors that mothers with opioid use disorder face in caring for a newborn with NOWS in the context of a substance use disorder and underscore the need for family-based, in-home services that focus concurrently on substance use treatment and parenting support.

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Variation in States’ Implementation of CAPTA’s Substance-Exposed Infants Mandates: A Policy Diffusion Analysis

Cited by 10 publications

References 18 publications

Structural Racism and Criminal Violence: An Analysis of State-Level Variation in Homicide

Structural Racism and Criminal Violence: An Analysis of State-Level Variation in Homicide

Child Abuse Prevention and Treatment Act, family care plans and infants with prenatal substance exposure: Theoretical framework and directions for future research

Hospital Readmissions Among Infants With Neonatal Opioid Withdrawal Syndrome

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