Parental opioid use is affecting the physical, developmental, and mental health of the pediatric population nationwide and raises questions of safety when these children remain in the care of opioid-addicted parents. Pediatric providers face many barriers to identifying and caring for children beyond the neonatal period who have been affected by parental opioid abuse both in utero and in the home. These barriers include communication between providers and services, identification of intrauterine exposure, parental opioid abuse screening, and knowledge of child protective services involvement. In addition, understanding current state and national health policy regarding parental opioid abuse helps providers navigate these barriers. The purpose of this article is to identify barriers to care of children affected by parental opioid abuse both in utero and in the home, to discuss current health policy surrounding the issue, and to identify implications for the care of these children in the primary care pediatric setting.

Adverse childhood experiences in young children result in negative outcomes as trauma affects brain development. In child welfare services, early recognition of delayed social−emotional skills and treatment referral is essential in reducing the effects of trauma. This quality improvement pilot project implemented an evidence-based social−emotional screening protocol using the Ages and Stages Questionnaire: Social Emotional-2 screening tool for very young children placed in out-of-home care through the county's child welfare system. Findings showed significant improvement in identification of children younger than 3 years with social−emotional concerns (p < .0001) and significant improvement in referral of those children positively identified (p = .0130). Ongoing use of the protocol was recommended, because it showed improved identification and referral for young children in the child welfare system with social−emotional concerns that were potentially trauma related. Further collaboration between child protective services, pediatric medical systems, and pediatric mental health systems is needed to facilitate traumainformed care for children in the child welfare system. J Pediatr Health Care. (2019) 33, 675−683 KEY WORDSTrauma, social−emotional, child welfare Childhood trauma is a prominent issue in the United States. The U.S. Department of Health and Human Services, Administration for Children and Families (2018) data shows that in 2016, an estimated 676,000 children were victims of childhood trauma and maltreatment. The Substance Abuse and Mental Health Services Administration (2014) defines trauma as an event or series of experiences that are physically or emotionally harmful and have lasting effects on an individual's functioning and well-being. Adverse childhood experiences (ACEs) are stressful events occurring before 18 years old that can cause childhood trauma and include physical abuse, sexual abuse, neglect, exposure to violence,