Infants, Neglect and Parental Substance Use: A Population Based Examination of Maltreatment Recurrence

Purpose: Child protective services (CPS) responds to many children affected by parental substance use following allegations of maltreatment, typically child neglect. Data quality on parental substance use remains low-quality and highly variable, and states vary whether prenatal substance exposure must be reported to CPS or constitutes child maltreatment. The states that do provide information on parental substance use indicate that 1 in 3 investigations include concerns related to parental substance use. Caseworkers may not systematically assess for substance use if it is not alleged in the initial report; thus, longitudinal studies are needed to accurately estimate the proportion of children whose neglect or abuse experiences involve substance abuse.

Data and Methods: Using a statewide sample of Pennsylvania child welfare case records this study aims to 1) estimate the proportion of infants whose first CPS case involved prenatal substance exposure or parental substance use; (2) examine rates of recurrent involvement for allegations related to parental substance use, and; (3) assess alternative measures of future risk dependent on whether substance use was identified in the initial case versus later cases. Population is all children who had a confirmed neglect allegation as an infant (birth to 1 year) between January 1, 2014 and December 31, 2015. These children will be followed in CPS records until age 4.

Results: Of the 8,952 infants with a confirmed neglect case, 63% had an initial case which included concerns related to parental substance use. By age 4 years, 50% would have a subsequent confirmed case, two-thirds of which would include parental substance use. Subsequent involvement did not differ dependent on whether the initial case included parental substance use. Overall, 70% of children who had a first case for neglect during infancy would experience a case related to parental substance use (either initial or subsequent). The younger the child was at initial case the more likely that case had to do with substance use. For example, 80% of infants whose initial case occurred within the first month of life would have a confirmed case due to parental substance use by age 4 years. Using Medicaid records, it was found that children whose initial case did not include substance use but were later reported due to concerns of substance use, had twice the risk of maltreatment related hospitalizations.

Conclusion: Given the overwhelming proportion of cases that include concerns related to parental substance use, and the differences in rates of later hospitalizations due to maltreatment injuries between those whose initial case included an awareness of parental substance use (and therefore likely received services for it) being substantially lower compared to those who only had substance use discovered at a later point, parental substance use should consistently be assessed following an initial case opening.