The antecedents of out-of-home care among methadone-exposed children. (2018)
Type of ContentTheses / Dissertations
Degree NameMaster of Arts
PublisherUniversity of Canterbury
Opioid dependence during pregnancy is an increasing global health concern due to the effects of opioids on the health of both mother and child. Methadone maintenance treatment (MMT) is the gold-standard treatment for opioid-dependent pregnant women, although currently there is little evidence of the effects of prenatal methadone exposure beyond infancy. Children prenatally exposed to MMT are typically described as a dual-hazard population due to the risks of prenatal methadone exposure, and the postnatal psychosocial risks of having an opioid dependent parent. One such risk is an increased likelihood of placement of the prenatally exposed child in out-of-home care (OOHC). Whilst placement into OOHC is necessary for care and protection of the child, there is an increased likelihood of poor emotional and behavioural outcomes.
This thesis had three aims: 1) to describe the living arrangements of a cohort of New Zealand children exposed to methadone in-utero as toddlers and again in middle-childhood; 2) to determine the differences in neonatal, maternal and psychosocial characteristics between those who remained in the care of their mother and those who entered OOHC arrangements; and 3) to examine the way in which the effects of a) maternal characteristics, b) child characteristics, and c) familial psychosocial risk factors combine to influence child OOHC from birth to 18-months, and from 18-months to 9.5 years of age.
Data were drawn from an existing prospective longitudinal study of 105 pregnant women who were enrolled in the Canterbury Methadone Program and gave birth between 2002 and 2009. Children’s living arrangements were recorded at the 18 month and 9.5 year follow-up assessments. Neonatal, maternal and psychosocial characteristics of the mother-child dyads were drawn from comprehensive maternal interviews at the birth of the child, and primary caregiver interviews at the 18 month follow-up assessment. Results showed that children exposed to methadone experienced a high rate of OOHC and caregiver changes. At 18 months of age 19.4% of children were in OOHC, and this increased to 42.7% by 9.5 years of age. There were a considerable number of neonatal, maternal and psychosocial differences between the OOHC group and the maternal care (MC) group at both ages. The predictors of OOHC by 18-months of age were lower maternal scores on the personality dimension of Cooperativeness, maternal perinatal depression, a greater number of different drugs used during pregnancy, and being a single parent. Maternal depression predicted children entering OOHC between 18 months and 9.5 years, alongside low SES and the amount of methadone prescribed, measures which were derived from the 18 month caregiver interview.
Study findings suggest that the risk of entry into OOHC is predicted by a combination of maternal characteristics, drug use, social and economic support. Determining which families and their children are at risk of OOHC and is fundamental for designing and targeting interventions to assist mothers in retaining the care of their child in the home for optimal long-term behavioural, social and emotional well-being.
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The Mental Health Outcomes of Children Born to Methadone Dependent Mothers : The Role of Out-of-Home Care at Age 4.5-Years Lean, Rachel Emma (University of Canterbury. Psychology, 2012)Children born to methadone maintained mothers are at high risk of adverse socio-emotional and behavioural outcomes. However, existing studies inadequately report the extent of maternal methadone and other drug use, focus ...
Lee, Samantha Jean (University of Canterbury, 2018)The prevalence of opioid use among pregnant women is an increasing global health concern. Methadone maintenance therapy is associated with improved health outcomes for opioid-dependent pregnant women and their infants ...
Jordan, Emma Adrianne (University of Canterbury, 2018)Research suggests prenatal exposure to methadone is associated with increased risk of adverse neurological and developmental impairments. Presently, there is limited evidence on the effects of prenatal methadone exposure ...