Examining Reporting of Infants with Prenatal Substance Exposure in Ncands Data

Background and Purpose: According to the Office of the Surgeon General, alcohol and drug misuse and related disorders are major public health challenges that are taking an enormous toll on our society. To track some of the most vulnerable populations affected by these issues, the Comprehensive Addiction and Recovery Act amended the Child Abuse Prevention and Treatment Act to have states collect and report data about infants with prenatal substance exposure (IPSE). Since federal fiscal year (FFY) 2018, states have been providing data about IPSE referrals in their annual data submissions to the National Child Abuse and Neglect Data System (NCANDS). The number of IPSE identified using the NCANDS definition has increased during the past few years, although some of the increase is due to new and improved reporting by states.

This study explored selected characteristics of IPSE and their experiences with child protective services (CPS) compared with infants without substance exposure who were referred to CPS (non-IPSE). Understanding the characteristics of this subgroup of children by analyzing demographics, experiences with CPS, risk factors, and postinvestigation service receipt, may inform policy makers and services providers to enable them to target specific prevention efforts and interventions.

Methods: All data used in this study were collected and analyzed through NCANDS. We compared race and ethnicity, selected caregiver risk factors, and selected postinvestigation service provision for IPSE and non-IPSE in the FFY 2023 dataset. For analyses of subsequent rereporting to CPS, we compared IPSE and non-IPSE from FFY 2019 data (on their patterns of rereporting, substantiations as a victim, and determinations as a child fatality in FFY 2020–FFY 2023.

Results: When looking at the same states we see a larger percentage of White infants and a smaller percentage of Hispanic infants in the IPSE group compared to the non-IPSE group. The caregiver risk factor of domestic violence is present in a lower percentage of IPSE infants than for non-IPSE infants. The caregiver risk factor of drug abuse is present in a higher percentage of IPSE than for non-IPSE. While the percentage of removals (foster care services provided as a result of the investigation) is only slightly higher than for non-IPSE infants, the percentage of IPSE infants with health-related and home health services is higher, as is substance abuse services. Overall, postinvestigation services are provided at a higher percentage for IPSE referrals than for all non-IPSE. Among children identified as IPSE in FFY 2019, 36% experienced a rereport to CPS within the subsequent 4 years, lower than the 41% of non-IPSE. Approximately 14% were found to be victims within the subsequent 4 years, compared with 15% of non-IPSE. Among IPSE children, 27 (.08%) died during the following 4 years due to maltreatment, while 113 non-IPSE infants later died (.06%).

Conclusions and Implications: The results of the study provide important future directions for research on the longitudinal impact of being exposed to substances during infancy on well-being.