Child Abuse Prevention and Treatment Act, family care plans and infants with prenatal substance exposure: Theoretical framework and directions for future research

Synopsis

The anticipated revisions to CAPTA intend to shift child welfare intervention for infants affected by prenatal substance exposure (PSE) from a punitive, child-centred, safety-focused approach to a supportive, family-centred, public health-focused approach. Given the importance of early attachment and bonding, the emerging research regarding non-pharmacological approaches to treating infants with Neonatal Opioid Withdrawal Syndrome, and the fact that PSE is not necessarily indicative of either maternal substance use disorder or infant safety risk, this updated federal policy has the potential to improve health and safety outcomes for mothers and babies. The policy aims to achieve these goals through a standardized process of notification and family care plan development, thus decreasing the time before at-risk dyads are identified and receive needed services. Unfortunately, research has not yet established whether, and how, this policy achieves its aims.

Moreover, CAPTA policy is implemented with considerable discretion at the state level. Existing research is clear that punitive, criminal justice-oriented approaches to substance use in pregnancy that, for all intents and purposes, seek to scare women into substance abstinence achieve the opposite outcome. The CAPTA reauthorization has the potential to foster a public health-oriented approach to obstetric and neonatal care for these mothers and their babies. However, much will depend on implementation, sustained appropriations, and expert technical assistance to avoid further stigmatizing this population or unintentionally “widening the net”. The most critical element of effective implementation will be research evidence. The Gelberg-Andersen Model for Vulnerable Populations provides a framework for asking theory-driven research questions of relevance to assessing CAPTA's effectiveness and for ensuring maternal–infant health and safety for all families affected by SUD.

Reference:

Lloyd Sieger, M. H., Nichols, C., & Chasnoff, I. J. (2022). Child Abuse Prevention and Treatment Act, family care plans and infants with prenatal substance exposure: Theoretical framework and directions for future research. Infant and Child Development, e2309. https://doi.org/10.1002/icd.2309