Academic journal article Social Work

Infant Mortality in Michigan's Child Welfare System

Academic journal article Social Work

Infant Mortality in Michigan's Child Welfare System

Article excerpt

Infant mortality in the United States has been a topic of increasing concern over the past decade. The United States currently ranks 24th overall in infant mortality internationally (National Center for Health Statistics, 1993; Wegman, 1990); moreover, the international standing of the United States in postneonatal mortality has deteriorated from third in 1950 to 19th in 1989 (National Center for Health Statistics, 1993; Kleinman & Kiely, 1990). Infant mortality during the neonatal period (the first 27 days of life) has traditionally been differentiated from deaths occurring in the postneonatal period (the remaining 11 months of the first year).

Neonatal deaths (the majority of infant deaths) are considered to reflect endogenous causes, or the influence of intrauterine events, whereas post-neonatal deaths are considered to reflect exogenous influences, or causes related to parenting and infant care, and are thus considered more preventable (Kessel, 1990). Advances in medical technology have lessened the distinction between neonatal and postneonatal mortality in that infants receiving perinatal intensive care are more likely to survive beyond the first four weeks of life but not beyond the first year. Nevertheless, post-neonatal mortality is considered an important indicator, particularly of the need for preventive and acute child health care (Kessel, 1990).

While U.S. public health officials have become increasingly concerned with postneonatal mortality rates, child welfare professionals have documented an alarming rise in the number of infants placed in foster care (Gittler & McPherson, 1990; McCullough, 1991). Many of these infants have special health care needs; drug-exposed and medically fragile infants are contributing substantially to increases in infant placements (Ford & Kroll, 1990). It is estimated that between 350,000 and 739,200 infants are exposed to illegal substances during pregnancy each year (Gomby & Shiono, 1991). It is also estimated that as many as 80 percent of drug-exposed infants of untreated mothers will be placed in foster care before their first birthday (McCullough, 1991).

Although such infants are known to be vulnerable to developmental problems, researchers concur that the postnatal environment is probably more important in determining child outcomes; intensive treatment programs combined with broad-based family support services can ameliorate the negative effects of in utero drug exposure (Kronstadt, 1991). Moreover, as Neuspiel and Hamel (1991) observed, "the 'crack baby' has become a media star, with multiple misconceptions arising from journalistic sensationalism". They suggested that it is more constructive to view these infants and their families from a "risk" perspective rather than simply assuming an ominous prognosis, which may pose a barrier to the development of appropriate and timely interventions.

Although developmental outcomes for drug-exposed infants are significantly influenced by the environment, anecdotal reports have indicated that many of these infants die in out-of-home placement (Cook County State's Attorney's Office, 1990). A review of the literature failed to identify studies on infant death while in foster care. Because such infants are in a high-risk group, the authors explored the mortality of infants in foster care placement in Michigan as part of a series of ongoing studies on child welfare conducted by the Center for the Study of Youth Policy at the University of Michigan, Ann Arbor.

Methods

Postneonatal mortality rates for infants in out-of-home placement were calculated at three-year intervals from 1980 to 1989 using data provided by the State of Michigan Department of Social Service's Children's Services Management Information System (CSMIS) in Lansing. CSMIS is an administrative data set used to report descriptive information about all children's services cases. Data are entered into the system by workers who complete a form indicating any change in the child's status, such as a change in living arrangement, legal status, or a case closing. …

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