The Impact of State-Level Prenatal Substance Use Policies on Foster Care Admissions: Evidence from a National Survey

Perinatal substance use is a significant risk factor for adverse pregnancy and birth outcomes. With an increasing prevalence of substance use disorder among parenting women, along with a lack of treatment utilization, it is evident that the impact of this crisis is spilling over to children and adolescents. Specifically, recent literature has documented a significant increase in foster care admission and child removal related to parental drug abuse and child neglect - an important but often overlooked aspect of this crisis impacting the ability of addicted parents to care for their children. To date, states have enacted policies of different types to address substance use among parenting/pregnant women and to protect infants from the harmful effects of such exposure. However, little is known about the impact of the various types of state-level prenatal substance use policies (i.e., treatment and supportive services; criminal justice initiatives; and health care provider reporting requirements) on foster care admissions and child removal. Using data from the 2000–2016 Adoption and Foster Care Analysis and Reporting System, we exploit state-level variation in the implementation of different types of policies to assess their impact on drug abuse and child neglect related foster care admissions under a difference-in-difference framework. The study found that state-level prenatal substance use policies focused only on the criminal justice sector were positively associated with the number of drug abuse and child neglect related foster care admissions. Additionally, the implementation of policies related to treatment and supportive services and provider reporting requirements were negatively associated with drug abuse and child neglect related foster care admissions. These results were consistent across age groups and for both non-Hispanic white children and children of other racial/ethnic groups. The findings imply that states with non-criminal justice policy engagement around prenatal substance use and policies that take a more supportive approach are more likely to see a decrease in admissions to foster care system by providing the mothers with appropriate resources to take care of their children and enabling them to recover from their substance use disorder condition.