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Child Welfare Involvement and Health Outcomes in Infants With Prenatal Substance Exposure.
Wan-Ting Chen1, Christian M Connell1,2, Sarah A Font3
1Human Development & Family Studies, College of Health and Human Development, The Pennsylvania State University, State College.
JAMA Health Forum
|June 5, 2026
Summary
Child welfare system (CWS) involvement at birth was linked to fewer emergency department (ED) visits for infants with prenatal substance exposure. However, CWS involvement also correlated with fewer well-child visits.
Area of Science:
- Pediatric Health
- Public Health Policy
- Child Welfare Research
Background:
- The child welfare system (CWS) frequently engages with infants born with prenatal substance exposure.
- Evidence regarding the positive and negative impacts of CWS involvement is limited.
Purpose of the Study:
- To investigate the association between CWS involvement at birth and injuries or emergency department (ED) use in the first year of life for infants with prenatal substance exposure.
Main Methods:
- A retrospective cohort study utilized linked administrative data from Pennsylvania's CWS and Medicaid claims.
- A sibling fixed-effects design compared infants born to the same mother with differing CWS involvement status.
- The study included Medicaid-enrolled infants with prenatal substance exposure, confirmed CWS cases at birth, and continuous Medicaid enrollment.
Main Results:
- Infants involved with CWS at birth showed a 20% relative reduction in moderate- to high-complexity ED visits and a 24% reduction in repeat ED visits.
- Conversely, CWS-involved siblings had 15% fewer on-time well-child visits.
- Overall, 14.5% of infants had injury claims, 33.8% had moderate- to high-complexity ED visits, and 14.3% had repeat ED visits by age one.
Conclusions:
- Child welfare system involvement appears associated with decreased healthcare utilization, particularly for moderate- to high-complexity ED visits, among infants exposed to substances prenatally.
- This association warrants further investigation into the nuanced effects of CWS involvement on infant health outcomes.
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