Tribal communities face critical challenges in identifying and addressing substance use by pregnant women. These challenges are often exacerbated by limited resources for services and limited research on effective interventions. To address these challenges, tribal communities are developing innovative and culturally resonant approaches to address prenatal alcohol exposure (PAE) and prenatal substance exposure (PSE). This article describes an environmental scan that was completed to understand and support the important work of these communities. It concludes with a discussion of the implications for tribal practitioners, specifically those in child welfare as well as policymakers and funders in child welfare and allied service provision systems, and provides potential directions for future research.