This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator.
Specific aims : To prevent the abandonment of infants and young children by providing coordinated, culturally sensitive, and comprehensive services to families of children at risk of being abandoned, primarily those prenatally exposed to controlled substances or testing positive for HIV. To provide empirical data to support the formation of policy, in Oklahoma and nationwide, regarding how to allocate limited resources for such families, and how to make better informed treatment decisions. The number of women abusing illegal drugs during pregnancy in the US is currently estimated at between 100,000 - 375, 000. The infants exposed in utero to drugs are by definition born into high-risk families. Significant risk factors associated with a substance abusing caregiver includes poverty, domestic violence, poor prenatal/perinatal care, crime, poor nutrition, and limited education. Most obviously, the prenatal drug exposure itself predisposes children to a wide range of neurodevelopmental and behavioral deficits that, while not as devastating as previously thought, have been shown to both interfere with parent-child attachment and to be capable of persisting through at least the early school years. Child maltreatment also has been shown to be far more prevalent in families in which one or more caregiver is a substance abuser. Given the risk factors, the needs of these infants and their families are difficult to overestimate. Experts currently suggest that these children require a range of coordinated services, including medical, education, supportive, and therapeutic services if they are to provide adequately for their high risk children. Unfortunately, the organization, resources, and infrastructure needed for an effective response to children at risk due to prenatal substance exposure are lacking in most areas of the US. Early societal reactions to prenatal substance exposure tended to focus on the direct physiological effects of the drug, and inappropriately assumed that these effects were disastrous in and of themselves. More current research has made it clear that this most often is not the case, and that complex postnatal and environmental factors are equally if not more damaging to the child. However, disagreement continues as to how best to respond to the growing numbers of children at risk due to substance exposure; current societal responses range from simply ignoring the issue to the extreme of almost immediate termination of parental rights. One necessary step towards resolving this issue is to determine what factors, if any, can predict eventual success in treatment. The next step will involve determining what approach is most effective with these families. Deciding between an empowerment approach versus an expectation-based approach is an ongoing debate among child welcare workers as well as mental health professionals. The empowerment/client-centered approach views the relationship between staff and client as the essential focus of treatment. This is similar to the David Olds' home visitation model utilizing nurses and the belief that through the development of trust and by allowing the client to chose areas to work on, change is more likely to occur. The expectation-based model utilizes behavioral principles. The clients are given clear sets of requirements and are provided with both positive and negative consequences for complying or not complying with those requirem
Showing the most recent 10 out of 209 publications
