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Prenatal Substance Exposure and Multilevel Predictors of Child Protection System Reporting.

Julia Reddy1, Carolyn T Halpern1, Davida M Schiff2

  • 1Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC.

The Journal of Pediatrics
|March 21, 2025
PubMed
Summary

Child protection system (CPS) reports for infants with prenatal substance exposure vary by hospital. Publicly insured births in predominantly privately insured hospitals faced higher reporting rates, suggesting potential bias in CPS reporting.

Keywords:
drug/alcoholhierarchical modelinghospitalpolicyracestatistical interaction

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Area of Science:

  • Perinatal health
  • Public health policy
  • Child welfare systems

Background:

  • Prenatal substance exposure is a significant concern impacting infant well-being and necessitating child protection system (CPS) involvement.
  • Existing research highlights disparities in healthcare access and outcomes, but the influence of hospital-level factors on CPS reporting for exposed infants is less understood.

Purpose of the Study:

  • To describe child protection system (CPS) reporting patterns following births with documented prenatal substance exposure.
  • To examine how individual- and hospital-level factors are associated with CPS reporting in this vulnerable infant population.

Main Methods:

  • Retrospective cohort study utilizing state-level administrative data from California births in 2018.
  • Analysis of births to Black, White, and US-born Hispanic mothers with documented prenatal substance exposure.
  • Application of random intercept mixed-models to assess hospital and individual predictors of CPS reporting, including interaction effects.

Main Results:

  • Out of 260,525 births, 2.6% had documented prenatal substance exposure, with racial disparities observed in substance use patterns.
  • Delivery hospitals accounted for 24% of the variance in CPS reporting.
  • Publicly insured births in hospitals with a majority of privately insured births had nearly double the likelihood of CPS reporting compared to privately insured births.

Conclusions:

  • Significant variation exists in CPS reporting for births with prenatal substance exposure, influenced by hospital-level factors.
  • Interactions between hospital and individual characteristics suggest potential biases and inconsistencies in CPS policy implementation.
  • Improved decision-making tools and provider training are recommended to mitigate disparities and enhance equitable CPS involvement.