The intersection of prenatal substance exposure and child protection: Evidence from Pennsylvania

• 成果类型: Article; Early Access
• 署名作者: Font, Sarah; Connell, Christian M.; Goldstein, Ezra G.; Jones, Dylan
• 署名单位: Washington University (WUSTL); Pennsylvania Commonwealth System of Higher Education (PCSHE); Pennsylvania State University; Pennsylvania State University - University Park; University System of Georgia; Georgia Institute of Technology
• 刊物名称: JOURNAL OF POLICY ANALYSIS AND MANAGEMENT
• ISSN/ISSBN: 1520-7170
• DOI: 10.1002/pam.70049
• 发表日期: 2025
• 关键词: neonatal abstinence syndrome; diagnoses; ABUSE

摘要

Current U.S. law mandates notification of substance-affected infants to state child welfare systems (CWS) for the purpose of assessment and service connections. Yet, CWS appears to identify a small share of substance-affected infants at birth, potentially reflecting inconsistent diagnosis of prenatal substance exposure (PSE) and emerging efforts to limit toxicology testing. This study uses linked maternal and child administrative records (2015 to 2021) for Pennsylvania Medicaid-covered births with CWS cases by age 3 (N = 31,913) to investigate PSE prevalence. Using indicators from CWS records and both child and maternal Medicaid claims, we estimate that 45% of children involved with CWS by age 3 experienced PSE, as well as 59% of children entering foster care. Nearly half of these children were not involved with CWS at birth and a majority did not receive a medical diagnosis of PSE. Yet, extrapolated estimates suggest that 70% of Medicaid-covered children with a PSE indicator will experience a CWS case by age 3. Absent high uptake of robust supportive interventions from other systems or agencies, avoiding notification of PSE at birth may not reduce long-term involvement with CWS among children with PSE.