Determinants for Custody Under Child Protective Services for Newborns of Mothers with Inpatient Psychiatric Hospitalization

Abstract: Background/Significance

Mothers with serious mental illness are more likely to have their children under the custody of Child Protective Services (CPS) but there is limited research investigating which specific risk factors predispose mothers to this outcome.

Methods

We conducted a retrospective chart review over a 10-year period (2012-2021) for patients who were pregnant and psychiatrically hospitalized. The study endpoint was whether the newborn was placed under CPS custody. Variables of interest included psychiatric diagnoses (categorized by psychotic disorders vs. mood disorders), history of homelessness, history of incarceration, prenatal care, and substance use.

Results

CPS involvement at the time of birth was 64% for the study population. Most subjects were unemployed (89%), many had no prenatal care (42%), 47% had a history of incarceration, and 32% had a history of homelessness. The prevalence of psychotic disorders was 57% vs mood disorder prevalence at 43% in this hospitalized study population. Using logistic regression, after adjusting for potential confounders, women with psychotic disorders were at increased risk of having their newborns under CPS custody (odds ratio [OR]= 8.43; 95% confidence interval [95% CI] 2.16-32.85) compared with women with mood disorders. Furthermore, multivariate analyses revealed that mothers with history of homelessness had higher risk (OR = 6.59; 95% CI: 1.24-35.13) of their child being under CPS custody at birth than those without history of homelessness. Finally, mothers with psychotic disorders who had a history of homelessness were at 44-fold higher odds (95% CI: 4.55-426.63) of having their child under CPS custody than those with mood disorders and no history of homelessness.

Discussion

Placement of a child under CPS affects child’s health, behavior, and social outcomes while it also affects maternal health and social outcomes. Our study suggests that those suffering from psychotic illness and homelessness are more likely to have CPS involvement than their counterparts. Psychotic illness is generally debilitating and is known to be associated with socioeconomic disadvantage, which may further perpetuate difficulties in ability to raise children. While the sample size of this study was relatively low, we had reasonable statistical power to detect statistical significance for few risk factors in our analyses.

Conclusion/Implications:

Maternal social and mental health affects children’s health. Our findings call for the need for clinical and public health interventions aimed at reducing homelessness and for optimizing management of psychotic illness to improve health outcomes for mothers and children.

References:



Kaplan K, et al. Child protective service disparities and serious mental illnesses: results from a national survey. Psychiatr Serv 2019; 70:202–208

< Sweeney S, et al. Psychosis, Socioeconomic Disadvantage, and Health Service Use in South Australia: Findings from the Second Australian National Survey of Psychosis. Front Public Health. 2015;3:259.