The intersection of prenatal substance exposure and child protection: Evidence from Pennsylvania
Journal of Policy Analysis and Management · 2026 · Sarah A. Font、Christian M. Connell、Ezra G. Goldstein、Dylan Jones
中文摘要
现行美国法律要求将受物质影响的婴儿上报至州儿童福利系统（CWS），以便进行评估和衔接服务。然而，儿童福利系统似乎在出生时仅识别出很小比例的受物质影响的婴儿，这可能反映了产前物质暴露（PSE）诊断的不一致，以及新出现的限制毒理学检测的举措。本研究使用宾夕法尼亚州2015至2021年医疗补助（Medicaid）覆盖的、3岁前有儿童福利系统案例的出生人群中母亲与儿童相链接的行政记录（N = 31,913）来考察产前物质暴露的发生率。利用儿童福利系统记录以及儿童和母亲的医疗补助索赔中的指标，我们估计，3岁前卷入儿童福利系统的儿童中有45%经历过产前物质暴露，进入寄养照护的儿童中这一比例为59%。这些儿童中近一半在出生时并未卷入儿童福利系统，且大多数未获得产前物质暴露的医学诊断。然而，外推估计表明，具有产前物质暴露指标的医疗补助覆盖儿童中，将有70%在3岁前经历儿童福利系统案例。如果其他系统或机构未能高度采用强有力的支持性干预措施，避免在出生时上报产前物质暴露，可能无法减少有产前物质暴露的儿童与儿童福利系统的长期牵连。
Abstract
Abstract Current U.S. law mandates notification of substance‐affected infants to state child welfare systems (CWS) for the purpose of assessment and service connections. Yet, CWS appears to identify a small share of substance‐affected infants at birth, potentially reflecting inconsistent diagnosis of prenatal substance exposure (PSE) and emerging efforts to limit toxicology testing. This study uses linked maternal and child administrative records (2015 to 2021) for Pennsylvania Medicaid‐covered births with CWS cases by age 3 ( N = 31,913) to investigate PSE prevalence. Using indicators from CWS records and both child and maternal Medicaid claims, we estimate that 45% of children involved with CWS by age 3 experienced PSE, as well as 59% of children entering foster care. Nearly half of these children were not involved with CWS at birth and a majority did not receive a medical diagnosis of PSE. Yet, extrapolated estimates suggest that 70% of Medicaid‐covered children with a PSE indicator will experience a CWS case by age 3. Absent high uptake of robust supportive interventions from other systems or agencies, avoiding notification of PSE at birth may not reduce long‐term involvement with CWS among children with PSE.