Mary Harrington

A Review of Recent Findings on Substance Abuse Treatment for Pregnant Women

Recent years have brought an increased interest in the treatment needs of pregnant substance abusers. This article reviews the literature on this subject, providing an overview of what is known about the prevalence of substance abuse during pregnancy; the factors in womens lives, especially pregnant women, that lead to substance abuse and that facilitate and impede treatment success; and the components of successful treatment programs. The prevalence of prenatal illicit drug use is known to be about 5% of all pregnant women nationwide, with higher rates for selected subgroups. Local studies have shown much higher rates. Substance abuse is associated with poverty, with the substance abuse of significant others, and with family violence. Perinatal substance abusers experience poorer birth outcomes. The negative consequences for babies do not stop at birth; home environments may be chaotic and often children are removed from their mothers care if substance abuse continues after birth. While the literature on prevalence, correlates, and outcomes of perinatal substance abuse is plentiful, there continues to be sparse information on successful treatment approaches. Sample sizes are small and there are few studies with adequate comparison groups. The small number of outcome studies we review suggest that, as with the broader treatment literature for other populations, success (as measured by abstinence) is associated with retention. Retention is facilitated by the provision of support services, such as child care, parenting classes, and vocational training. There is no clear empirical basis for concluding that one type of treatment (for example, residential treatment) is more effective than another.

The Children's Health Insurance Program Reauthorization Act Evaluation: Findings on Children's Health Insurance Coverage in an Evolving Health Care Landscape

The Childrens Health Insurance Program (CHIP) Reauthorization Act (CHIPRA) reauthorized CHIP through federal fiscal year 2019 and, together with provisions in the Affordable Care Act, federal funding for the program was extended through federal fiscal year 2015. Congressional action is required or federal funding for the program will end in September 2015. This supplement to Academic Pediatrics is intended to inform discussions about CHIPs future. Most of the new research presented comes from a large evaluation of CHIP mandated by Congress in the CHIPRA. Since CHIP started in 1997, millions of lower-income children have secured health insurance coverage and needed care, reducing the financial burdens and stress on their families. States made substantial progress in simplifying enrollment and retention. When implemented optimally, Express Lane Eligibility has the potential to help cover more of the millions of eligible children who remain uninsured. Children move frequently between Medicaid and CHIP, and many experienced a gap in coverage with this transition. CHIP enrollees had good access to care. For nearly every health care access, use, care, and cost measure examined, CHIP enrollees fared better than uninsured children. Access in CHIP was similar to private coverage for most measures, but financial burdens were substantially lower and access to weekend and nighttime care was not as good. The Affordable Care Act coverage options have the potential to reduce uninsured rates among children, but complex transition issues must first be resolved to ensure families have access to affordable coverage, leading many stakeholders to recommend funding for CHIP be continued.

Enrollment and Disenrollment Experiences of Families Covered by CHIP

OBJECTIVE To understand why families enroll in and disenroll from Childrens Health Insurance Program (CHIP), their experience with the CHIP application and renewal process, and the insurance coverage of their children after disenrolling. METHODS We conducted a large household telephone survey in 2012 of CHIP enrollees and disenrollees in 10 states. We used survey responses to assess the perceptions and experiences of families with the CHIP application and renewal process. In addition, we combined the survey data with CHIP/Medicaid administrative data to analyze coverage outcomes of children after disenrolling. RESULTS A large majority of recent CHIP enrollees had positive impressions of the application process; 89% found the process very or somewhat easy, and 90% of those receiving assistance found it very helpful. Families had similarly favorable impressions of the renewal process, including those recently disenrolling from CHIP. After disenrolling, children were far more likely to gain Medicaid coverage (49%) than private insurance (18%), while a sizable percentage were uninsured (32%). The likelihood of becoming uninsured was especially high among 18- and 19-year-olds (62%), who lost CHIP coverage due to their age. CONCLUSIONS Satisfaction with the CHIP application and renewal process is high among those with recent coverage, consistent with efforts by many states to simplify these processes for families. Medicaid is a critical source of coverage for those leaving CHIP, a role that may only increase as states expanding Medicaid through the Affordable Care Act create a new coverage option for older teens losing CHIP eligibility.