The Policy to Practice Gap: Factors Associated with Practitioner Knowledge of CAPTA 2010 Mandates for Identifying and Intervening in Cases of Prenatal Alcohol and Drug Exposure

Background/Purpose:

The Child Abuse Prevention and Treatment Act Reauthorization of 2010 (the CAPTA Reauthorization) included mandates for intervening in cases of prenatal substance exposure (PSE).  This legislation requires that health and human services professionals refer families with PSE to child protective services and develop a “plan of safe care” for mother and baby.  However, the policy does not describe how professionals identify PSE nor who is responsible for identification or reporting, both critical factors for policy implementation.  Social workers, child welfare professionals, and early intervention specialists presumably play key roles in successfully implementing this policy, but the extent to which these professionals are knowledgeable about PSE identification methods and reporting requirements is unknown. This study examined the relationship between awareness of the CAPTA reauthorization and PSE practice knowledge among these professionals.

Method:

These data come from a substudy of a federally-funded project aimed at reducing the effects of parental substance use among families with children in foster care.  A survey for social service professionals was developed to gauge familiarity with the CAPTA Reauthorization and its implications for practice, including knowledge pertinent to PSE.  The survey was administered to a convenience sample of 259 social work, child welfare, or early intervention professionals.  CAPTA Drug and Alcohol Exposure Knowledge Scales were created based on eight PSE knowledge items (Drug Exposure Knowledge Scale α = 0.724; Alcohol Exposure Knowledge Scale α = 0.745).  Multiple regression analyses measured association between demographic factors, annual PSE referrals, CAPTA awareness, and scores on the Knowledge Scales.  All analyses were conducted using Stata 13.

Results:  While only a small minority of respondents were aware of the CAPTA Reauthorization (8% of the sample), professionals’ knowledge of correct markers of, and CPS responses to, PSE was moderate and varied according to substance type (mean Drug Scale score = 4.1; mean Alcohol Scale score = 3.4).  Ordinary least squares regression models revealed that fewer years in practice and fewer annual drug referrals significantly predicted score on the Drug Scale and that fewer years in practice and awareness of the CAPTA Reauthorization significantly predicted score on the Alcohol Scale.  Awareness of the CAPTA Reauthorization was marginally significantly associated with the Drug Scale as well.

Implications:  The results of this study filled a significant gap in the literature regarding implementation of the 2010 CAPTA Reauthorization.  This legislation was significant because it paid equal attention to prenatal alcohol exposure as it did drug exposure.  However, this study suggests that the majority of social work and early intervention professionals are unaware of this legislation and, perhaps reflecting this, are less knowledgeable about prenatal alcohol exposure identification and intervention compared to drug exposure. Moreover, this study suggests that more experienced professionals are less knowledgeable regarding correct information on drug and alcohol exposure compared to less experienced professionals, possibly reflecting problems with buy-in from front-line staff.  Policy implementation strategies are needed to increase the likelihood that CAPTA achieves its desired intent.