State Implementation of CAPTA Federal Guidelines on Prenatal Substance Exposure: Impact on Entries in Foster Care

Background and Purpose

States in the U.S. do not have consistent policies and procedures. After 2010 Child Abuse Prevention and Treatment Act (CAPTA) reauthorization, states must have policies and procedures to address the needs of infants born identified as affected by illegal substance abuse or withdrawal symptoms resulting from prenatal drug exposure. This study examines the implementation of CAPTA in all 50 states and the District of Columbia with regards to prenatal drug exposure and seeks to answer the following questions: 1) Did all states implement CAPTA 2010 in their statutes?, 2) Are there differences in implementation between child welfare policy manuals and statutes in each state?, and 3) If there is a difference in implementation, does it impact the number of youth entering foster care?

Methods

This study used the data from the Adoption and Foster Care Analysis and Reporting System (AFCARS) 2011-2017 combined with prenatal drug exposure laws and policies for each state. Policies and laws in each state were obtained from child welfare agency and legislature  websites and between August 2018 to February 2019. The variables were coded 1 as “yes” and 0 as “no” depending on the existence of policy and statute for the prenatal substance exposure, to create a final variable identifying policy/statute match: ‘Neither policy and statute’ (n=2), ‘Statute only’ (n=3), ‘Policy only’ (n=12) and ‘Both having policy and statute’ (n=34). The number of youth entering foster care were identified due to prenatal drug exposure was derived infants who removed by “drug use of parent” and “drug use of child” under the age of one. Logistic regression examined whether entering foster care by the prenatal drug exposure issue was significantly associated with the matching type of policy and statute.

Results

The number of youth entering foster care by the prenatal drug exposure had increased from 2011-2017. The prenatal issue entrance numbers in groups of ‘policy only’ and ‘both having policy and statute’ had been increased in the period between 2011 and 2017 while Groups of ‘neither policy and statute’ and ‘statute only’ did not have specific patterns. The logistic regression, controlling for gender, fiscal year, and race/ethnicity showed that compared to ‘neither policy and statute’, ‘policy only’ group was more likely to enter foster care by the prenatal drug exposure (OR = 1.46; 95% CI 1.38,1.52), as were ‘statute only’ (OR = 1.4; 1.33, 1.47) and ‘both policy and statute’ (OR = 1.17; 1.12,1.23). We also found that White youths are more likely to enter the foster care (OR = 1.35; 1.33,1.38).

Conclusion and Implications

Despite federal guidance stemming from CAPTA’s 2010 reauthorization, some states have yet to implement policies or statutes addressing prenatal drug exposure. Seventeen states’ child welfare manuals and statutes do not match. States that have implemented statutes and policies, have experienced higher rates of increase in foster care entries for prenatal substance exposure in comparison to states without policies or statutes. This finding suggests that implementation of the CAPTA 2010 guidelines is associated with an increase in foster care entries.