Association Between State-Level Criminal Justice–Focused Prenatal Substance Use Policies in the US and Substance Use–Related Foster Care Admissions and Family Reunification

Abstract

IMPORTANCEStates have enacted criminal justice-related substance use policies to address prenatal substance use and protect infants from adverse health effects of parental substance use. However, little is known about the consequences of these policies for permanency outcomes among infants in the foster care system in the United States.OBJECTIVES To evaluate the consequences of criminal justice-related prenatal substance use policies for family reunification and to examine differences in parental reunification by racial/ethnic group. DESIGN, SETTING, AND PARTICIPANTSIn this cohort study using data from the 2005 to 2017 Adoption and Foster Care Analysis and Reporting System, 13 cohorts of infants who entered the foster care system were followed up. States with criminal justice-related prenatal substance use policies were compared with states without such policies before and after their enactment using a discrete-time hazard model adjusted for individual covariates, state, and cohort fixed effects. The sample consisted of 350 604 infants 1 year or younger who had been removed from their home because of parental drug or alcohol use. MAIN OUTCOMES AND MEASURESLength of time from entering the child welfare system to first reunification with a parent and hazard rates (HRs). RESULTSOf the 350 604 infants 1 year or younger, 182 314 (52%) were boys, 251 572 (72%) were non-Hispanic white children, and 160 927 (46%) lived in US states with a criminal justice-focused prenatal substance use policy. Among those who were reunified, 36% of the reunifications occurred during the first year and 45% in the second year. Foster care infants who were removed from their homes because of parental substance use who live in states that have adopted criminal justice-oriented policies had a lower chance of reunification with a parent compared with states that have not adopted those policies (HR, 0.95; 95% CI, 0.94-0.96). Specifically, non-Hispanic black children who live in a state that has adopted criminal justice-oriented policies had a lower chance of reunification with a parent than non-Hispanic black children who live in a state that has not adopted those policies (HR, 0.87; 95% CI, 0.81-0.94). CONCLUSIONS AND RELEVANCEGiven the child welfare system's legal mandate to make every effort toward parental reunification, a more comprehensive treatment and supportive policy approach toward parental substance use might be warranted.

Prenatal substance use policies and newborn health

“…Our findings for punitive PSUPs are in line with previous qualitative studies suggesting that by inducing fear of stigma or punishment, punitive policies may unintendedly deter pregnant women from seeking SUD treatment and prenatal care (Angelotta et al, 2016;Christian, 2004;Figdor & Kaeser, 1998;Jarlenski et al, 2018;Jessup et al, 2003;Miranda et al, 2015;Roberts et al, 2010Roberts et al, , 2011Stone, 2015;Thomas et al, 2018). Our findings are also in line with quantitative studies suggesting punitive PSUPs induce worse outcomes, including reductions in SUD treatment utilization among pregnant women (Atkins & Durrance, 2020;Kozhimannil et al, 2019) and increases in foster care entries among infants (Atkins & Durrance, 2021;Sanmartin et al, 2019Sanmartin et al, , 2020. A study using variation from eight states and five changing punitive PSUPs find a 24%-30% increase in NDWS in the first years of implementation (Faherty et al, 2019).…”

“…Two recent studies find that punitive PSUPs are negatively associated with the proportion of pregnant women entering SUD treatment (Atkins & Durrance, 2020;Kozhimannil et al, 2019). Another set of studies finds that punitive PSUPs are associated with increases in foster care placement for parental substance use (Atkins & Durrance, 2021;Sanmartin et al, 2019Sanmartin et al, , 2020. Three studies use a two-way fixed-effects (TWFE) design to estimate the impact of punitive PSUPs on NDWS with mixed findings (Atkins & Durrance, 2020;Faherty et al, 2019Faherty et al, , 2022.…”

Association of Individual and Community Factors With Hepatitis C Infections Among Pregnant People and Newborns

“…For example, Black pregnant people with OUD are less likely to be prescribed medications for opioid use disorder, 21 Black infants exposed to HCV are less likely to be tested for HCV, 7 and Black parents whose infants are placed in foster care for substance exposure are less likely to be reunified with their parents. 22 , 23 As systems are developed to address the rising numbers of maternal-infant dyads affected by HCV, it is critical that any intervention is applied equitably and addresses unequal treatment in these associated systems of care.…”

American Indian/Alaska Native Child Health and Poverty

“…If they are not placed within kinship care or another AI/AN family, they risk losing cultural knowledge and connections (which, in turn, is exponentially linked to poorer mental health outcomes). 32,33 The Indian Child Welfare Act (ICWA), ratified in 1978, was created to prevent disproportionate placement of AI/AN children out of their community. It gives rights to Tribes, allowing the children's community to decide who is best to raise them.…”