title: "I felt for a long time like everything beautiful in me had been taken out": Women's suffering, remembering, and survival following the loss of child custody.
abstract: BACKGROUND
  Child Protective Services' (CPS) placements of children in out-of-home care disproportionately impact families marginalized by poverty, racism and criminalization. CPS' mandate to protect children from neglect and abuse is frequently criticized as failing to address the multiple social and structural domains shaping parents' lives, especially mothers.
  
  
  METHODS
  We conducted a thematic narrative analysis of in-depth interviews to explore the impact of child custody loss on 19 women who use drugs residing in Toronto, Canada. We also assessed the potential roles of intersectional forms of violence and inequities in power that can both give rise to child custody loss and mediate its consequences.
  
  
  RESULTS
  Trauma was identified as a key impact of separation, further exacerbated by women's cumulative trauma histories and ongoing mother-child apartness. Women described this trauma as unbearable and reported persistent symptoms of post-traumatic stress disorder and other mental health conditions. Practices of dissociation through increased use of drugs and alcohol were central in tending to the pain of separation, and were often synergistically reinforced by heightened structural vulnerability observed in increased exposure to housing instability, intimate partner violence, and initiation of injection drug use and sex work. Women's survival hinged largely on hopefulness of reuniting with children, a goal pivotal to their sense of future and day-to-day intentions toward ameliorated life circumstances.
  
  
  CONCLUSIONS
  Findings highlight needs for strategies addressing women's health and structural vulnerability following custody loss and also direct attention to altering institutional processes to support community-based alternatives to parent-child separation.
authors.affiliation: Department of Maternal and Child Health, The Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 401 Rosenau Hall, CB #7445, Chapel Hill, NC 27599-7445, USA. Electronic address: kskenny@live.unc.edu.
authors.forename: Kathleen S
authors.initials: KS
authors.lastname: Kenny
authors.affiliation: Department of Health Behavior, The Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 170 Rosenau Hall, CB #7400, Chapel Hill, NC 27599-7400, USA.
authors.forename: Clare
authors.initials: C
authors.lastname: Barrington
authors.affiliation: Department of Maternal and Child Health, The Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 401 Rosenau Hall, CB #7445, Chapel Hill, NC 27599-7445, USA.
authors.forename: Sherri L
authors.initials: SL
authors.lastname: Green
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002655:Child Custody / Q000331:legislation & jurisprudence*; D017579:Domestic Violence; D006798:Housing; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D009035:Mothers / Q000523:psychology*; D009864:Ontario; D011203:Poverty; D060386:Sex Workers; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology; D013315:Stress, Psychological / Q000523:psychology*; D019966:Substance-Related Disorders / Q000523:psychology; D013534:Survival; D014930:Women / Q000523:psychology*; D014947:Wounds and Injuries / Q000523:psychology; D055815:Young Adult
keywords: Child custody loss; Drug use; Mothers; Qualitative; Trauma; Women drug users