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Mental health conditions including substance use disorder are the leading cause of pregnancy-related deaths in the U.S. Unfortunately, fears of child protective services' involvement interfere with maternal self-disclosure of substance use in pregnancy. Seeking to identify more mothers with substance use disorder in pregnancy or at delivery, and responsive to changes to the federal Child Abuse Prevention and Treatment Act (CAPTA), Connecticut requires hospital personnel to submit a deidentified notification to CPS for all newborns with prenatal substance exposure. However, it is unknown whether this approach aligns with maternal self-report on substance use. For the present study, we compared population parameters derived from CAPTA notifications submitted between March-December 2019 with parameters derived from self-report data on substance use in pregnancy from mothers who gave birth during the same timeframe. Results revealed that three times as many mothers self-reported any alcohol or drug use in pregnancy compared to the rate measured with CAPTA notifications. Compared to mothers who self-reported drug use in the third trimester, CAPTA notifications were made for statistically similar rates of Black mothers but half the self-reported rate of White and Hispanic mothers. This disparity reflects that CAPTA notifications were made for twice as many Black mothers as White or Hispanic. Although CAPTA notifications are not punitive in nature, this disparity reveals that the public health aims of this policy are not yet achieved. Significance: Accurate and equitable identification of infants with prenatal substance exposure and their mothers, coupled with non-stigmatized, non-punitive intervention is central to any public health response.The current study relies on 2019 data from Connecticut to understand accuracy and equity in identification of these infants by comparing hospital-based notifications to self-report substance use in pregnancy. We found that hospital approaches to detecting prenatal substance exposure identified twice as many Black mothers as White or Hispanic mothers. Compared to self-reported substance use in pregnancy, which detected equivalent rates of substance use across race groups, White and Hispanic mothers' substance use in pregnancy was under-identified in hospital settings. [ABSTRACT FROM AUTHOR]

Background: Previous literature suggests that children removed from home due to parental substance use disorder (SUD) and placed with older adult foster parents are more likely to achieve permanency than children placed with younger foster parents; however, little, if any, literature has examined this trend across racial identities. Objective: The aim of this study was to examine the intersectional effects of removal due to parental SUD, child's race/ethnicity, and foster parent age on likelihood of, and time to, child permanency. Methods: Twelve years of Adoption and Foster Care Analysis and Reporting System data were linked to capture all children in the U.S. foster care system between January 1, 2007 and September 30, 2018. Application of multiple sampling procedures resulted in a final analytic sample of 1,943,280. Results: All children with older adult foster parents were more likely to achieve permanency than those with younger foster parents. However, white children with substance-related removals were 17% more likely to achieve permanency when placed with an older adult foster parent than with a younger foster parent. In contrast, children of color with substance-related removals were only 9% more likely to achieve permanency when placed with an older adult foster parent than with a younger foster parent. Conclusions: These findings suggest that older adult foster parents are associated with beneficial effects that may mitigate the deleterious impact of parental SUD on permanency. However, the strength of this protective effect was diminished for children of color. These findings call for attention to the supports available to older adults who foster children of color. [ABSTRACT FROM AUTHOR]

In the U.S., the opioid epidemic has revitalized national attention to newborns with prenatal substance exposure (PSE). These newborns and their caregivers have specific health and treatment needs and frequently interact with multiple systems, including child protection systems (CPS). This study calculated rates of newborns (less than 15 days old) reported to CPS per 1,000 births due to PSE by state and year using data from the National Child Abuse and Neglect Data System (NCANDS). Given the lack of a clear definition of PSE reports in the data, we calculated rates using three different definitions. To examine the relationship between different state laws regarding the mandated reporting of PSE and PSE reports rates, we used panel data analysis. Rates of newborn reports more than doubled between 2011 and 2019. There was extensive state variability of rates including some states that were consistently more than 100 % greater than and others consistently more than 150 % less than the annual national mean. Reporting rates were not associated with state requirements to report PSE, but were positively associated with rates of diagnosed neonatal abstinence syndrome. State-level inconsistencies in identification, reporting, and CPS responses prevent a clear understanding of the scope of the affected population and service needs. [ABSTRACT FROM AUTHOR]