Novel Implementation of State Reporting Policy for Substance-Exposed Infants

Overview

Journal Hosp Pediatr

Specialty Pediatrics

Date 2022 Sep 12

PMID 36093638

Authors

Margaret Lloyd Sieger

Cynthia Nichols

Shiyi Chen

Melissa Sienna

Marilyn Sanders

Affiliations

Soon will be listed here.

Abstract

Background: The Child Abuse Prevention and Treatment Act's provisions concerning hospitalist and child protective services response to infants with prenatal substance exposure (IPSE) were revised in 2016 to address the impact of the opioid epidemic. In 2019, Connecticut unveiled a statewide hospital reporting infrastructure to divert IPSE without safety concerns from CPS using a deidentified notification to CPS and a plan of safe care (POSC). Connecticut is the first state to implement a separate, deidentified notification system.

Methods: We used notification and birth data to determine rates per 1000 births. We employed multinomial logistic regression to understand factors associated with 3 mutually exclusive outcomes: (1) diversion with POSC, (2) report with POSC, or (3) report without POSC.

Results: During the first 28 months of policy implementation, hospitalists submitted over 4700 notifications (8% of total Connecticut births). Over three-quarters (79%) of notifications included marijuana exposure, and 21% included opioid exposure. Fewer than 3% included alcohol exposure. Black mothers were disproportionally overrepresented among notifications compared with the state population, and all other race groups underrepresented. Over half of identified IPSE were diverted. Type of substance exposure was the strongest predictor of outcome, controlling for maternal age and race group.

Conclusions: Connecticut Child Abuse Prevention and Treatment Act diverted IPSE without provider safety concerns away from child protective services. Substance exposure type was associated with the dyad's outcome at hospital discharge. Nonuniversal screening practices may contribute to racial disproportionality in implementation.

Citing Articles

The Hypocritical Oath? Unintended Consequences of Prenatal Substance Use Policies and Considerations for Health Care Providers.

Philippopoulos A, Brown Z, Lewkowitz A, Howard E, Micalizzi L J Perinat Neonatal Nurs. 2024; 38(4):414-419.

PMID: 39527551 PMC: 11566900. DOI: 10.1097/JPN.0000000000000836.

Family Care Plans for Infants with Prenatal Substance Exposure.

Sieger M, Nichols C, Chasnoff I, Putnam-Hornstein E, Patrick S, Copenhaver M Child Welfare. 2024; 101(2):169-192.

PMID: 38784917 PMC: 11115427.

References

Lloyd Sieger M, Nichols C, Chasnoff I . Child Abuse Prevention and Treatment Act, family care plans and infants with prenatal substance exposure: Theoretical framework and directions for future research. Infant Child Dev. 2024; 31(3). PMC: 10823434. DOI: 10.1002/icd.2309. View

Lloyd Sieger M, Rebbe R, Patrick S . The 2021 Reauthorization of CAPTA - Letting Public Health Lead. N Engl J Med. 2021; 385(18):1636-1639. PMC: 9549935. DOI: 10.1056/NEJMp2111378. View

Putnam-Hornstein E, Prindle J, Leventhal J . Prenatal Substance Exposure and Reporting of Child Maltreatment by Race and Ethnicity. Pediatrics. 2016; 138(3). DOI: 10.1542/peds.2016-1273. View

Rebbe R, Mienko J, Brown E, Rowhani-Rahbar A . Child protection reports and removals of infants diagnosed with prenatal substance exposure. Child Abuse Negl. 2018; 88:28-36. PMC: 6333477. DOI: 10.1016/j.chiabu.2018.11.001. View

Chasnoff I, Landress H, Barrett M . The prevalence of illicit-drug or alcohol use during pregnancy and discrepancies in mandatory reporting in Pinellas County, Florida. N Engl J Med. 1990; 322(17):1202-6. DOI: 10.1056/NEJM199004263221706. View

Fried P, Smith A . A literature review of the consequences of prenatal marihuana exposure. An emerging theme of a deficiency in aspects of executive function. Neurotoxicol Teratol. 2001; 23(1):1-11. DOI: 10.1016/s0892-0362(00)00119-7. View

Lee E, Pluym I, Wong D, Kwan L, Varma V, Rao R . The impact of state legalization on rates of marijuana use in pregnancy in a universal drug screening population. J Matern Fetal Neonatal Med. 2020; 35(9):1660-1667. DOI: 10.1080/14767058.2020.1765157. View

Chasnoff I . Medical marijuana laws and pregnancy: implications for public health policy. Am J Obstet Gynecol. 2016; 216(1):27-30. DOI: 10.1016/j.ajog.2016.07.010. View

Patrick S, Davis M, Lehmann C, Lehman C, Cooper W . Increasing incidence and geographic distribution of neonatal abstinence syndrome: United States 2009 to 2012. J Perinatol. 2015; 35(8):650-5. PMC: 4520760. DOI: 10.1038/jp.2015.36. View

10.

Patel E, Bandara S, Saloner B, Stuart E, Goodman D, Terplan M . Heterogeneity in prenatal substance use screening despite universal screening recommendations: findings from the Pregnancy Risk Assessment Monitoring System, 2016-2018. Am J Obstet Gynecol MFM. 2021; 3(5):100419. DOI: 10.1016/j.ajogmf.2021.100419. View

11.

Sharapova S, Phillips E, Sirocco K, Kaminski J, Leeb R, Rolle I . Effects of prenatal marijuana exposure on neuropsychological outcomes in children aged 1-11 years: A systematic review. Paediatr Perinat Epidemiol. 2018; 32(6):512-532. PMC: 6261687. DOI: 10.1111/ppe.12505. View

12.

Perreira K, Cortes K . Race/ethnicity and nativity differences in alcohol and tobacco use during pregnancy. Am J Public Health. 2006; 96(9):1629-36. PMC: 1551957. DOI: 10.2105/AJPH.2004.056598. View

13.

Patrick S, Schiff D . A Public Health Response to Opioid Use in Pregnancy. Pediatrics. 2017; 139(3). DOI: 10.1542/peds.2016-4070. View

14.

Chang G . Maternal Substance Use: Consequences, Identification, and Interventions. Alcohol Res. 2020; 40(2):06. PMC: 7304408. DOI: 10.35946/arcr.v40.2.06. View

15.

Roberts S, Zahnd E, Sufrin C, Armstrong M . Does adopting a prenatal substance use protocol reduce racial disparities in CPS reporting related to maternal drug use? A California case study. J Perinatol. 2014; 35(2):146-50. DOI: 10.1038/jp.2014.168. View

16.

Austin A, Gest C, Atkeson A, Berkoff M, Puls H, Shanahan M . Prenatal Substance Exposure and Child Maltreatment: A Systematic Review. Child Maltreat. 2021; 27(2):290-315. DOI: 10.1177/1077559521990116. View

17.

Shi Y, Zhu B, Liang D . The associations between prenatal cannabis use disorder and neonatal outcomes. Addiction. 2021; 116(11):3069-3079. PMC: 8492477. DOI: 10.1111/add.15467. View

18.

Benningfield M, Arria A, Kaltenbach K, Heil S, Stine S, Coyle M . Co-occurring psychiatric symptoms are associated with increased psychological, social, and medical impairment in opioid dependent pregnant women. Am J Addict. 2010; 19(5):416-21. PMC: 2924760. DOI: 10.1111/j.1521-0391.2010.00064.x. View

19.

Marcellus L, Badry D . Infants, children, and youth in foster care with prenatal substance exposure: a synthesis of two scoping reviews. Int J Dev Disabil. 2023; 69(2):265-290. PMC: 10071944. DOI: 10.1080/20473869.2021.1945890. View

20.

Faherty L, Kranz A, Russell-Fritch J, Patrick S, Cantor J, Stein B . Association of Punitive and Reporting State Policies Related to Substance Use in Pregnancy With Rates of Neonatal Abstinence Syndrome. JAMA Netw Open. 2019; 2(11):e1914078. PMC: 6902764. DOI: 10.1001/jamanetworkopen.2019.14078. View