Substance-Exposed Infants and the Risk of Subsequent Maltreatment

Parental substance use disorders increase the risk of child maltreatment and placement in foster care in part by compromising appropriate parenting practices and creating an environment that is not responsive to the needs of children. Substance use was second only to mental health as the most frequently identified risk factor for child maltreatment. Estimates from the Adoption and Foster Care Analysis and Reporting System (AFCARS) indicate that the prevalence of parental substance use disorders as an identified condition of removal more than doubled between 2000 and 2019, and that 50% of children under the age of one placed in foster care were removed for reasons related to parental substance use.

The amended Child Abuse Prevention and Treatment Act (CAPTA) requires states to have policies to identify substance-exposed infants (SEI). Specifically, CAPTA requires that health providers notify Children’s Protective Services (CPS) of all infants identified as affected by substance abuse, withdrawal symptoms resulting from prenatal drug exposure, or a fetal alcohol spectrum disorder. While CAPTA does not require states to investigate every report of substance exposure at birth, thirty-seven states and the District of Columbia require clinicians to report prenatal drug use, and forty-three jurisdictions include prenatal substance exposure as part of their definition of maltreatment.(Mathematica, 2023) While newborn drug testing is a commonly used approach to identify prenatal substance exposure, there are no guidelines that support the use of prenatal or newborn drug testing as an evidence-based practice to identify newborns at risk of maltreatment due to parental substance use disorder. This webinar will cover the complicated nature of drug testing newborns, CPS requirements around investigations, and the long term risk of maltreatment associated with substance-exposed newborns.