hind closed doors is unknown. Children exposed to harmful substances prenatally are twice as likely as those who are not exposed to be separated from their parents by age 3 years. 4 Many of them are not placed out-of-home perinatally, with opportunities to assist their families with in-home services.Our view is that, in some circumstances, CPS involvement is needed and can be valuable, while fully recognizing the need to improve this system and the quality of the response. We mentioned alternative strategies and the importance of taking them to scale. We also want to point readers to the innovative family care plans being evaluated in Connecticut. 5 As we strive to improve CPS, it is unclear how repeating vehement allegations of racism without specific evidence is helpful. We concur that CPS referral alone is seldom a sufficient approach. This work should always be undertaken in conjunction with social policies that support families and effective prevention and intervention programs that meet families' needs.