Results suggest that narrative and expository processing differ with respect to integration of text content with prior knowledge.

Background: A frequent response for prenatal substance exposure (PSE) is intervention by child protective services (CPS). Previous research has examined differences in reports to CPS regarding PSE by substance exposure and by maternal race. However, little is known regarding the frequency of immediate removals by CPS relating to PSE and maternal race. Methods:We investigated hospital reports to CPS and CPS removals of PSE infants by using linked birth, hospital discharge, and CPS records for all children born in Washington State between 2006 and 2013 (N = 760,863). We identified PSE using diagnostic codes, calculated prevalence by substance type and maternal race, and tested for differences by interactions of race and substance using multinomial logistic regression.Results: Prevalence of PSE births varied by race with 8.1% of Native American, 2.8% of black, 1.9% of white, and 0.8% of Hispanic births diagnosed with PSE. Opioids was the most common type of PSE diagnosis at 48.2%. The majority of PSE infants (86.7%) were not removed by CPS but variations by substance type were observed. Of the interactions in the multinomial logistic regression model, only black infants exposed to alcohol were more likely to result in reports to CPS without removal than the referent group of white infants exposed to opioids. Conclusions:Findings indicate that most infants diagnosed with PSE were not removed by CPS and minority PSE infants were not reported to CPS or removed by CPS more than white infants. Racial differences identified in the prevalence of PSE present opportunities for targeted prevention efforts.

Objective: To examine whether hospital-level factors contribute to discrepancies in reporting to child protective services (CPS) of infants diagnosed with prenatal substance exposure. Study design: We used a linked dataset of birth, hospital, and CPS records using diagnostic codes (ICD-9) to identify infants diagnosed with prenatal substance exposure. Employing multilevel models, we examined hospital-level and individual birth-level factors in relation to a report to CPS among those infants prenatally exposed to substances. Results: Of the 760,863 infants born in Washington State between 2006 and 2013, 12,308 (1.6%) were diagnosed with prenatal substance exposure. Infants born at hospitals that served larger populations of patients with Medicaid (OR: 1.25, 95% CI: 1.07, 1.45) and hospitals with higher occupancy rates (OR: 1.43, CI: 1.15, 1.77) were more likely to be reported to CPS. Infants exposed to amphetamines (OR: 2.58, CI: 2.31, 2.90) and cocaine (OR: 2.33, CI: 1.92, 2.83) were more likely to be reported and infants exposed to cannabis (OR: 0.62, CI: 0.55, 0.70) were less likely to be reported to CPS than infants exposed to opioids. Infants with Native American mothers were more likely to be reported to CPS than infants with white mothers (OR: 1.47, CI: 1.27, 1.70). Conclusions: Hospital-level and individual birth-level factors impact the likelihood of infants prenatally exposed to substances being reported to CPS, providing additional knowledge about which infants are reported to CPS. Targeted education and improved policies are necessary to ensure more standardized approaches to CPS reporting of prenatal substance exposure.

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