Child protection and out-of-home placement experiences of preschool children born to mothers enrolled in methadone maintenance treatment during pregnancy

• Methadone-maintained mothers are at high risk of child protection concern (59% v. 6%).
• Nearly half of all investigations of methadone maintained mothers result in child removal.
• These children are typically placed before age one and experience multiple placement changes.
• Predictors of removal were drug treatment, past concern, depression, and social risk.

Children born to opiate-dependent women engaged in methadone maintenance treatment are at high risk of child welfare concern. However, few studies have examined the early child protection service (CPS) contacts of this group or the risk factors that place some but not other mother–infant dyads at increased risk of serious concern resulting in the removal of the child from the family home. As part of a prospective longitudinal study based in New Zealand, 73 women enrolled in methadone maintenance treatment during pregnancy and 54 non-methadone maintained comparison mothers were recruited during pregnancy and interviewed close to delivery, 18-months and 4.5-years. At each follow-up evaluation, detailed life history methods were used to describe children's family circumstances and all CPS contacts. By 4.5-years postdelivery, methadone maintained mothers were ten-times more likely to have been investigated by child protection services than comparison mothers (59% v. 6%, p < .001). Of these contacts, almost half (44%) resulted in the removal of the child from the family home compared to no comparison children (p < .001). These children were most frequently placed before age 1, with an average of 1–2 caregiver changes (range: 0–7). In addition to maternal methadone maintenance treatment during pregnancy (p < .001), significant independent predictors of child out-of-home placement included maternal depression (p = .01), maternal history of child custody loss (p = .02), and to some extent, high levels of family socioeconomic adversity (p = .06). Findings highlight the complex psychosocial needs of this high-risk group, as well as the need for careful monitoring and parenting support following hospital discharge.