84. Paying for Parenthood: Misinterpretation of ABIM Leave Policies May Lead to Unnecessary Extension of ID Fellowships

Background Many trainees plan pregnancy during fellowship training. A study of internal medicine program directors (PDs) demonstrated frequent misinterpretation of American Board of Internal Medicine (ABIM) leave policies when applied to parental leave. The ABIM has since attempted to clarify its leave and deficits in training policies. The primary aim of this study was to investigate how infectious disease (ID) program directors interpret the current ABIM leave policies in crafting parental leave for trainees. Methods We surveyed 155 ID program directors in an online, anonymous questionnaire regarding their knowledge of ABIM leave policies and application toward trainees’ leaves of absence. Results 75/155 (48%) of program directors responded to the survey. Most respondents incorrectly identified the leave limits permitted by ABIM policies, and a majority mistakenly chose to extend training when a clinically competent fellow was within their allowed duration of leave.(Figure 1) Most respondents correctly identified that equal time is permitted for both birth and non-birth parent parental leave, however, reported leave durations did not reflect this equity. PDs reported the majority (60.4%) of ID trainee maternity/birth parent leaves at their programs were ≤7weeks and 4.6% were≤3 weeks, while only 7% were≥12 weeks. In contrast, 50% of paternity/non birth parent leaves were ≤3weeks and none were ≥12 weeks. (Figure 2) PDs utilize various strategies to prevent extending training for fellows taking parental leaves that exceed the limits allowed by ABIM policies, including creating “home electives,” though 34% counsel trainees to take “a shorter maternity leave.” Conclusion Fellowship program directors often misinterpret ABIM leave policies, and misapply them when given example scenarios. These findings have clear implications for trainees’ family planning and may lead to shortened parental leaves and inappropriate fellowship training extensions. Disclosures All Authors: No reported disclosures

Impact of COVID-19 on resource families: Unique challenges and strengths

The emergence of COVID-19 forced significant adaptations for families worldwide. Children and youth in foster care and their caregivers or resource parents experience unique stressors. The current study aimed to understand the impact of the COVID-19 pandemic and “Safer-at-Home” orders on resource parents in Los Angeles County. Resource parents (n = 648) were surveyed about COVID-19 concerns, positive impact and strengths, access to and helpfulness of provided resources, visits with birth parents, children joining their families during the pandemic, and transition to telehealth. Between one-third and half of resource parents with foster or foster-adoptive children in their home reported significant anxiety about issues such as getting infected, uncertainty about the future, and financial hardship. In contrast, most resource parents reported some perceived benefits, such as increased family closeness. The most helpful resource reported was video visitation by social workers. A quarter of resource parents experienced in-person birth parent visits. Developmentally, parents with a foster or fosteradoptive child 0–5 years old reported significantly more worries related to COVID-19, while those with children of multiple ages reported feeling less valued as a resource parent and expressed more concerns about children falling behind with school, mental health and developmental services, birth parent visits, and delayed reunification. Lastly, younger parental age, fewer foster children in the home, and the less negative impact from COVID-19 a resource parent reported having were associated with an increased likelihood of resource parents welcoming a child into their home. Implications for policy and recommendations for practice are discussed.

539. Prevalence of Symptomatic and Asymptomatic COVID-19 Infection in Pregnant Women and Their Infants in an Urban Hospital

Background COVID-19 is an emerging pathogen that has caused a global pandemic, with New York City as one of its epicenters. Data are still forthcoming if pregnant women are more vulnerable to COVID-19, as they are with influenza. Additionally, it is not known if infants born to COVID-19 positive women are at risk of being infected at birth. Methods In March 2020, our hospital instituted a policy of testing all pregnant women presenting for active labor and scheduled C-section or induction of labor, with a nasopharyngeal swab that was sent for RT-PCR qualitative SARS-CoV-2 assay (Roche Cobas® 6800). Upon birth, infants were also tested, unless the parent did not give consent. We retrospectively reviewed the COVID-19 test results of all pregnant women and their infants, from March 23 through May 31, 2020 using our infection control surveillance system (VigiLanz®). We also reviewed the electronic medical record (EPIC®) for documentation of any symptoms consistent with COVID-19 infection either prior to hospitalization or during the hospital stay. Results A total of 415 women and 72 infants were tested for SARS-CoV-2. Of the 415 women tested, 41 (9.9%) were positive. Of the 72 infants tested, 2 (2.8%) were positive and concordant with their birth parent. Only 1 (2.4%) of the women who tested positive was symptomatic. The remaining 40 (97.6%) women did not report any symptoms of COVID-19 during labor. Neither of the two positive infants displayed any signs or symptoms of COVID-19. Of the 41 women who were positive, 5 did not consent to have their infant tested. The one symptomatic woman who tested positive for COVID-19 had an infant who tested negative by PCR. Conclusion During the first wave of the COVID-19 pandemic, we found 9.9% (41/415) of pregnant women presenting for labor tested positive for SARS-CoV-2. Among the 41 women who tested positive, only 1 (2.4%) had symptoms on presentation and only 2 newborn infants tested positive. Our data suggests that pregnant women may not be at increased risk for complications from COVID-19 disease and are not likely to transmit the disease to their infants during labor. Disclosures All Authors: No reported disclosures

Using an adoption design to test genetically based differences in risk for child behavior problems in response to home environmental influences

Differential susceptibility theory (DST) posits that individuals differ in their developmental plasticity: some children are highly responsive to both environmental adversity and support, while others are less affected. According to this theory, “plasticity” genes that confer risk for psychopathology in adverse environments may promote superior functioning in supportive environments. We tested DST using a broad measure of child genetic liability (based on birth parent psychopathology), adoptive home environmental variables (e.g., marital warmth, parenting stress, and internalizing symptoms), and measures of child externalizing problems (n = 337) and social competence (n = 330) in 54-month-old adopted children from the Early Growth and Development Study. This adoption design is useful for examining DST because children are placed at birth or shortly thereafter with nongenetically related adoptive parents, naturally disentangling heritable and postnatal environmental effects. We conducted a series of multivariable regression analyses that included Gene × Environment interaction terms and found little evidence of DST; rather, interactions varied depending on the environmental factor of interest, in both significance and shape. Our mixed findings suggest further investigation of DST is warranted before tailoring screening and intervention recommendations to children based on their genetic liability or “sensitivity.”

Developing a new cohort of children born to women who used opioids in pregnancy using administrative data: insights into cohort creation and early results

Background with rationaleChildren born to opioid-dependent mothers are at a developmental disadvantage from pre-birth. They are additionally affected by the mother’s compromised ability to recognise and respond to the infant’s cues. Development is often compounded by environmental factors. Research to date has primarily focused on early infancy and small, clinical samples. This group is difficult to follow-up using traditional methods due to chaotic home environments, housing instability and parent-child separation. The use of administrative data circumnavigates such difficulties, allowing follow-up of children over longer periods, even when removed from the birth parent. Main AimThis paper will describe the complex creation of a cohort of children born to opioid-dependent women, using administrative data. It will also describe early results about pregnancy and neonatal outcomes. Methods/ApproachData were pooled from women who gave birth between 2007 and 2017 using five datasets (c.5,000 women): women who were recorded as using heroin, street methadone or opioid substitution therapy (OST) on the Drugs Misuse Database, or on OST prescription records; women admitted to hospital, or psychiatric care, for an opioid related reason; and/or women whose children were recorded as having Neonatal Abstinence Syndrome (NAS). Data on children’s neonatal outcomes will be described, including birth weight and gestation, congenital abnormalities, neonatal death and NAS treatment. Models will be fitted to investigate the associations between possible teratogenicity of prenatal opioids and developmental outcomes. ResultsThe development of this cohort using administrative data sources has been complex, requiring five different datasets to ensure all women of interest are captured. Descriptive results on outcomes will be available in the Autumn. ConclusionThis administrative data study demonstrates the value of using linked data sources to enhance our knowledge of the trajectories of this vulnerable group of children, and the additional support that they, and their carers, may require.

“Who you are in these pieces of paper”: Imagining Future Kinship through Auto/Biographical Adoption Documents in the United States

At First Steps, a small private adoption agency outside Chicago, social workers spent more time processing paperwork than interacting with clients. In addition to mediating the relationship between individuals and the bureaucratic adoption apparatus, these documents created anticipatory (p)re-kinned subjectivities. Based on ethnographic fieldwork carried out between 2009 and 2016, this article examines the completion and circulation of two different forms of auto/biographical documentation during the adoption process: the birth parent file and the adoptive family profile. These documents played a vital role in the adoption process by simultaneously enabling the creation and dissolution of kinship, through the folding of past, present, and future narratives and possibilities into adoption knowledge and decision making. Aided by the documentary termination of birth parental rights and the imagination of visual and narrative adoptive futures, domestic adoption legally split biological kinship from social kinship, rendering the former past and the latter present/future.

Navigating Openness and Contact in Child Welfare Adoptions

Some children who are adopted via foster care have contact with their birth families (e.g., birth siblings), yet little research has addressed this. This chapter addresses the experiences of families who adopted their children through foster care, with attention to adoptive parents’ feelings and patterns regarding birth family contact. As this chapter details, many families involved in child welfare adoptions had complex feelings about openness. Some families had significant concerns that mitigated their willingness to pursue contact. Others were opposed to birth parent contact but, to varying degrees, were willing to pursue birth sibling contact. In some cases, contact was initiated but then halted temporarily or permanently because of the perceived risks and drawbacks associated with such contact. Yet amid a lack of contact, families often remained communicatively open with their children, and some did not rule out contact in the future.