Child Guardianship in a Canadian Home Visitation Program for Women who use Substances in the Perinatal Period
Can J Clin Pharmacol Vol 16 (1) Winter 2009:e126-e139; January 30, 2009
Original Research
Rosanne M T Mills, Jodi E Siever, Matt Hicks, Dorothy Badry, Suzanne C Tough, Karen Benzies

Background
Retaining guardianship of one's infant is often a priority for pregnant women who use substances, and may be beneficial to infants when they are safe in their mothers' care. Previous studies from the United States have identified several maternal psychosocial characteristics associated with the ability to keep an infant free from abuse or neglect; however, little is known about the impact of multiple risk factors on guardianship, particularly in Canadian intervention programs.

Objective
To describe maternal characteristics associated with child guardianship among pregnant women at risk of an alcohol and/or substance exposed pregnancy who attended a Canadian home visitation program.

Methods
Guardianship status at 6 months post-enrolment was extracted from a provincial program's records for all women enrolled between November 1999 and May 2005 (n=64). Bivariate analyses were performed to determine client characteristics most likely to have retained guardianship.

Results
At follow-up, 70% of participants were guardians of the index infant. Higher income, more prenatal care, no history of sexual abuse, better alcohol and psychiatric scores, and fewer risk factors on a cumulative risk index were significantly associated with retaining guardianship at 6 month follow-up (p<0.05).

Conclusions
Retaining child guardianship may be the greatest challenge and opportunity for women experiencing problems in multiple domains of their lives, including those associated with substance dependence. Programs targeted at women who use substances while pregnant may best assist mothers to retain guardianship of their infants by supporting clients to address the complex social and health problems often found in conjunction with addictions.

Key words: Pregnancy, child welfare, substance-related disorders, prenatal exposure delayed effects

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