Differential Child Welfare Case Trajectories of Substance Exposed Infants

Background and Purpose:

Substance exposure during pregnancy is dangerous; often affecting infants’ short-term and long-term health. However, the field lacks a basic understanding of the incidence of prenatal substance exposure and how safety-net systems such as the child protective system (CPS) intervene in response. While all substances can be toxic to an infant in utero, they affect infants dissimilarly.  What is not clear is if CPS treats different types of substance exposure equally.  The research questions for this study are 1) when are substance-exposed infants referred to child protective services and 2) how do differences in substance exposure affect infants’ interactions with the child welfare system?

Methods:

All birth records for children born in Washington State from 1999-2013 whose birth records indicated substance exposure in utero through ICD-9 codes were included in the study (n=6533).  Birth records were linked with CPS records using a combination of deterministic and probabilistic techniques.  The various stages of a CPS case (investigation, maltreatment substantiation, out of home placement, re-referral, and adoption) were examined using chi-square tests as a descriptive comparison followed by multinomial logit models using birth weight and birth payment as controls.  Event history analysis, with both survival curves and Cox proportional models, was then used to determine the timing of CPS case milestones.

 

Results:

Results indicate that the type of substance an infant is exposed to prenatally affects their reporting to CPS and trajectories through the CPS system.  Specifically, a statistically significant (p<.001) higher proportion of infants exposed to cocaine were reported to CPS within the first year of life (73.32%) than other substances (range of 48.82% to 63.94%).  The logistic regression results find that cocaine exposure consistently increases a child’s likelihood to progress through all of the tested stages of a CPS case compared to children exposed to other substances.  

 

Conclusions and Implications:

This study represents the first population-based study of prenatal substance exposure in Washington State and one of only a handful of such studies that have ever been conducted in the world. This research expands the current knowledge base of the incidence of prenatal substance abuse and specifically improves our understanding of how and when this high-risk population interacts with CPS. While substance abuse is frequently discussed as a variable of interest in studies of the child welfare system, there is a paucity of research available to help the field understand how different types of substances impacts child welfare system trajectories and how these impacts vary throughout early childhood. These results support the importance of considering details of the types of substance-abuse history in studies of the child welfare system. The high-rate of CPS reports among this population also suggests the opportunity for early intervention when mothers test positive for substances such as cocaine during pregnancy. Results will be discussed in the context of practice and policy tools to address the needs of substance-exposed infants and their families, both within the child welfare system and beyond.