December 2020Vol. 21, No. 9Using Research to Help Child Welfare Support Children and Families Impacted by Prenatal Exposure to

Parental substance use is estimated to play a role in at least half of child welfare cases, yet child welfare agencies need more research and guidance to identify and serve impacted children—particularly those exposed to alcohol or other drugs in the prenatal period.

A recent literature review in the Journal of Public Child Welfare identified 32 peer-reviewed articles addressing child welfare policies and practices related to prenatal exposure published between 2006 and 2018. Articles were split evenly between research (i.e., research studies and program evaluations) and nonresearch (i.e., structured reviews of policies, instruments, and evidence-based practices).

The following are among the literature review's key findings:

• Roughly half of the articles (56 percent) addressed both alcohol and drugs.
• Half of the articles focused on newborns and children under 1 year of age, and most concentrated on hospital reports of newborns with prenatal substance exposure. The findings raise concerns of a serious underidentification of prenatal alcohol exposure, which does not show up on newborn toxicology tests.
• The findings also imply an underestimation of the potentially extreme and permanent impacts of prenatal alcohol exposure among older children. These include cognitive and behavioral factors that likely lead to difficult interactions with parents, other adults, and friends; experiences of maltreatment; child welfare involvement and placement instability; and inadequate or inappropriate services that may over rely on pharmaceutical prescriptions due to a lack of knowledge of what would be helpful to children prenatally exposed to alcohol.
• There is little research on child welfare policy and/or practice for identifying and caring for children with prenatal substance exposure, particularly alcohol exposure, including how service providers document and share the critical information needed to serve and protect these children.
• Gaps in the literature around the use of child welfare records and data systems most likely reflect gaps in policy and practice. For example, child welfare court reports merit more consideration as a way to identify prenatal substance exposure, particularly among older children.

The review was conducted as part of an ongoing project funded by the Children's Bureau and Centers for Disease Control and Prevention. Project Officer Sharon Newburg-Rinn, a social science research analyst at the Children's Bureau, is among the article's coauthors. The project team is currently conducting a multisite study of policies, practices, and procedures used by state and local child welfare agencies. Findings will inform the development of resources for the field in the project's second phase.