Infant Substance Exposure, Child Welfare System Referral, and Criminal Justice Notification: An Exploratory Project

Background: Nearly 304,000 infants have been referred to child protection systems (CPS) across the country for prenatal substance exposure since 2000. Though the number of infants coming into contact with the system is large, little systematic, national research has been conducted examining how these referrals compare to other referrals to the child welfare system, as well as whether outcomes associated with these referrals differ. This lack of national research is particularly concerning given changes to the Child Abuse Prevention and Treatment Act (CAPTA) in 2016, which required states to define and implement policies for addressing prenatal substance exposure in their child welfare systems. Despite the large numbers of infants referred for prenatal substance exposure and policy changes mandating codification of this form of maltreatment, limited research has examined national patterns and outcomes associated with prenatal substance exposure referrals.

Methods: This study has two specific aims: 1.) to identify and compare correlates of prenatal substance exposure referral and referral for substance exposure in infancy; and 2.) to examine the relationship between prenatal substance exposure referrals and police/prosecutor notification over time. To address these aims, we created a longitudinal dataset using data from the National Child Abuse and Neglect Data set, U.S. Census, U.S. Bureau of Justice Statistics, and National Governors Association between the years 2000 – 2023. Once assembled, we calculated descriptive statistics and estimated means difference tests, multilevel longitudinal mixed effects models, and marginal effects to examine out specific aims.

Results: According to results, both child and parent characteristics were associated with referrals for fetal exposure, and Black infants were significantly more likely to be referred for prenatal substance exposure as compared to other infants referred to CPS systems. As compared to cases involving infants referred to the child welfare system for substance exposure, cases involving infants referred specifically for prenatal substance exposure were more likely to result in police and prosecutor notification. Further, the difference in notification probability for cases involving Black children was significantly higher than cases not involving Black children.

Implications: Our findings have significant implications for broader policy effectiveness and child well-being. According to results, child and case characteristics affect referral for prenatal substance exposure, especially as compared to other infants referred to child welfare systems. Additionally, prenatal substance exposures are more likely to result in police/prosecutor notification, particularly when they involve Black infants. Our findings highlight potential disparate application of prenatal exposure referrals and disparate police/prosecutor notifications and demonstrate a need to better understand policies and decision-making processes underlying these cases and outcomes.