Background

Our previous study showed that parents with mental health problems or substance abuse are at increased risk of having children removed from the home, primarily due to caregiving deficits, neglect, and prenatal exposure to substances, not physical abuse.

Objective

Using a larger sample and more rigorous analysis, the present study improves and expand upon the previous study, yielding more robust explanations for why these children are at increased risk of removal.

Participants and setting

The study uses a sample of 4070 Structured Decision Making® assessments conducted by San Francisco's Child Welfare provider involving parents reported for the first time from 2007 to 2015.

Methods

Using structural equation modeling, mediation models were constructed to test the indirect effects of thirteen child safety threats on safety decision.

Results

Four threats explained 95% of the effect of mental health problems on safety decision, two of which retained significance in the final model: Failure to Meet Immediate Needs (OR = 1.26, p ≤ 0.01) and Previous Maltreatment (OR = 1.24, p ≤ 0.05). Seven safety threats explained 91% of the effect of co-occurring mental health problems and substance abuse, two of which retained significance in the final model: Failure to Meet Immediate Needs (OR = 1.78, p ≤ 0.001) and Physical Harm (Drug-Exposed Infant; OR = 1.57, p ≤ 0.001).

Conclusions

As previously shown, parental mental health problems and substance abuse are not ipso facto safety threats. Rather, unmet child needs account for much of the increased risk of child removal in this population, underscoring the importance of timely resource referrals.

中文翻译：

---

儿童安全决策与父母心理健康问题：中介因素的新分析

背景

我们之前的研究表明，有心理健康问题或药物滥用的父母将孩子从家里带走的风险增加，这主要是由于看护不足、忽视和产前接触物质，而不是身体虐待。

客观的

本研究使用更大的样本和更严格的分析，对先前的研究进行了改进和扩展，从而为这些儿童为何面临更高的移除风险提供了更强有力的解释。

参与者和设置

该研究使用了旧金山儿童福利提供者进行的 4070 次结构化决策®评估的样本，这些评估涉及 2007 年至 2015 年首次报告的父母。

方法

使用结构方程模型，构建中介模型以测试 13 个儿童安全威胁对安全决策的间接影响。

结果

四种威胁解释了心理健康问题对安全决策的 95% 的影响，其中两种在最终模型中仍然具有重要意义：未能满足即时需求 ( OR  = 1.26, p  ≤ 0.01) 和先前的虐待 ( OR  = 1.24, p  ≤ 0.05)。七种安全威胁解释了同时发生的心理健康问题和药物滥用影响的 91%，其中两种在最终模型中仍然具有重要意义：未能满足即时需求（OR  = 1.78，p  ≤ 0.001）和身体伤害（药物-暴露婴儿；OR  = 1.57，p  ≤ 0.001）。

结论

如前所述，父母的心理健康问题和药物滥用并不是事实上的安全威胁。相反，未满足的儿童需求是该人群中儿童搬迁风险增加的主要原因，这凸显了及时资源转介的重要性。