Trajectories of Foster-Care Entry of Infants with Prenatal Substance Exposure in States

Background

In 2010, the Child Abuse Prevention and Treatment Act (CAPTA) mandated states have laws, policies, and/or procedures to report to child protective service when infants were exposed to substances prenatally. This study explores the varied implementation of this guidance in the 50 states and District of Columbia, as well as the associated impact on foster care entry for prenatal substance abuse and with seeks to answer the following questions: 1) did states implement policy and legislation regarding prenatal substance abuse and do they match, and 2) are there visible patterns of prenatally drug-exposed infants’ entry into foster care with relation to policy and statutes in each state?

Methods

This study used data from the Adoption and Foster Care Analysis and Reporting System (AFCARS) 2005-2017 combined with a policy scan of state legislation related to prenatal substance abuse. Statues related to prenatal substance abuse, differential response, prescription drug monitoring program (PDMP), and Good Samaritan laws in each state were included, as well as state child welfare policies. Policies and laws were obtained from child welfare agency and state websites between August 2018-February 2019. The number of infants entering foster for prenatal drug exposure was derived from AFCARS variables of removal reason “drug use of parent” and “drug use of child” for youth less than one year old. Graphs of the trajectories with prenatally substance-exposed infants’ entry and enactment years of statutes were created.

Results

Out of 580,867 infants entering foster care between 2005 and 2017, 233,094 infants entered foster care due to prenatal substance exposure. The proportion of infants’ entry into foster care for prenatal drug exposure increased 15.7% from 2005 to 2017. Additionally, 36 states enacted laws for prenatal substance abuse, 36 states had statutes for differential response, 41 states had Good Samaritan laws, and 51 states enacted legislation around PDMP. In the overall trend of infant entry, 16 states had increasing graphs, while 35 states had minimal change with less than 0.2% point change. Arizona and Oregon showed unusual patterns with wide fluctuations. In relation to statute enactment, for most states, legislation did not affect the trend. However, enactment of legislation was associated with trend variations in several states.

Conclusion and Implications

Despite federal guidance stemming from CAPTA’s 2010 reauthorization, there is wide variation in states’ policies and legislation. Seventeen states’ child welfare manuals and statutes do not match. States that have implemented statutes and policies have also experienced higher rates of increase in foster care entries for prenatal substance exposure in comparison to states without policies or statutes. This suggests that states responding to the opioid epidemic used multiple approaches including policy and legislation. The variation in trajectory across states, even with the overall increase of infants entering foster care with prenatal substance exposure, suggests that legislation plays a part but is not a sole causal factor. Other facets of the system response, including program development and access to treatment, should be explored to further understand the nature of the relationship between policy implementation and system response.