Foster Care Outcomes and Experiences of Infants Removed Due to Substance Abuse

Background: National data consistently indicate that infants have the highest rate of substantiated maltreatment compared to children of other ages. Prenatal exposure to substances is generally considered to play a substantial role in the increased risk of child welfare contact among infants. While some studies have examined case characteristics of infants prenatally exposed to substances, less is known about the foster care experiences of infants removed specifically due to substance abuse. Previous studies also suggest that racial disparities in maltreatment are most pronounced among the youngest children, yet it is unknown whether there are racial differences in rates of infant substance abuse removals. Using national data, this study assessed the extent of racial differences in substance abuse removals and explored whether case outcomes and placement experiences of infants removed solely for substance abuse differed from infants who were removed for other reasons.

Methods: This analysis used data from the Adoption and Foster Care Analysis and Reporting System FY2015 Foster Care Data file. The study sample included (n = 32,117) infants who were born between October 2014 and September 2015 and spent more than 8 days in foster care. Information about infants, including child characteristics, placement setting, case plan goal, length of stay, and reason for discharge were analyzed. Binary logistic regression was used to compare infants who were removed solely due to alcohol or drug abuse to infants who did not have substance abuse as the sole removal reason. T-tests were used to evaluate differences between groups in average length of days in current placement and total days in foster care.

Results: Nearly 17% of infants in this sample had substance abuse recorded as their sole removal reason. Black infants were underrepresented among infants with substance abuse as the sole removal reason compared to their numbers among infants in foster care in 2015 (15.6% vs. 20.8%). Infants removed solely due to substance abuse differed significantly from infants removed for other reasons with respect to placement settings, case plan goal, total days in foster care, and manner of discharge. Infants with substance abuse as their sole removal reason had greater odds of being White (OR=1.59; 95% CI: 1.49, 1.69; p=<.001), American Indian/Alaska Native (OR=1.61; 95% CI: 0.45, 1.78; p<.001), or of Hispanic origin (OR=1.29, 95% CI: 1.25, 1.33; p<.001). Infants with substance abuse as their sole removal reason had lower odds (OR=0.61; 95% CI: 0.57, 0.65; p=<.001) of remaining in care and they had greater odds (OR=1.30; 95% CI: 1.06,1.58; p<.05) of being discharged to live with a relative.

Implications: Substance abuse removals do not appear to be a current driving factor behind Black/White foster care placement disparity among infants at the national level. This study sheds light on the relationship between substance abuse related removals and the distinct case dynamics of the youngest, most vulnerable children. Results point to a need for researchers, policy makers, and practitioners to devote further attention to opportunities for prevention and the intersection of substance abuse and child welfare services for families with young children.