Prenatal substance exposure (1) is a significant public health problem that can lead to multiple negative consequences for infants (2) and their families. Although multifaceted care is critical for the health and well-being of both parents and their children, there are barriers to pregnant individuals receiving care (3) for substance use. These barriers include factors such as stigma, limited access to healthcare services, lack of knowledge, fear of legal consequences (such as involvement with the child welfare system), and co-occurring mental health issues. There has been progress in addressing the needs of families affected by substance use disorder, including through legislative efforts, but additional considerations are needed to ensure all families have access to the care they want and need.

Features of Programs and Services

• Family-centered, collaborative care. Wraparound services (4) help address many barriers to access in care for pregnant individuals with substance use disorder. By providing access to a comprehensive array of services best suited for the family, wraparound services could increase their access to a wide range of needed primary, prenatal, postnatal and mental health care, onsite substance use and trauma/violence counseling and support.
• Developmentally appropriate. The Five Points of Family Intervention Framework (5) was developed (6) to guide state agencies’ efforts (7)  to prevent, intervene, identify, and treat parents and children affected by prenatal substance use. The five points, which refer to “key periods in time” where coordinated care is especially meaningful, are 1) pre-pregnancy, 2) prenatal, 3) birth, 4) neonatal, infancy, and postpartum, and 5) childhood and adolescence.
• Non-punitive. One example is through Plans of Safe Care (5) within the Child Abuse Prevention and Treatment Act (CAPTA). Plans of Safe Care in many states connect families with non-punitive, multi-disciplinary resources like substance use treatment, parenting or job skills classes, home visiting services, pediatric care, and collaborative engagement with family members, healthcare, and child welfare agencies.
• Evidence informed. The Title IV-E Prevention Services Clearinghouse, created through the Family First Prevention Services Act, provides a list of substance abuse, mental health, and in-home skill-based services with research evidence. Efforts are also being made to improve the Clearinghouse’s procedures, including its systematic review process.

Recommendations for Policymakers’ Consideration

• Strengthen our understanding of how to best support substance-affected infants and their families. Examples could include:
  • Investigating impactful, effective outreach strategies to families.
  • Nurturing collaborations with local healthcare, social services, and community groups to ensure families impacted by prenatal substance exposure can easily access comprehensive support.
  • Conducting empirical evaluations to assess the short and long-term effectiveness of Plans of Safe Care approaches in supporting families affected by prenatal substance exposure. This is especially important given the variability in implementation (8) of Plans of Safe Care across states and jurisdictions.
• Incentivize the provision of integrated care programs, which address the multifaceted needs of pregnant individuals with substance use disorders and their infants, including maternal mental health, socioeconomic factors, access to healthcare, and community resources. Integrated care and continuity of services can help to address the multifaceted needs of families.
• Encourage the implementation of programs aligned with the Five Points of Family Intervention Framework that serve families affected by or at risk for substance use disorder.

Select Resources

• NIDA (2024). Substance use in women research report: Substance use while pregnant and breastfeeding.
• Deutsch et al. (2022). Impact of Plans of Safe Care on prenatally substance exposed infants.
• Deutsch et al. (2021). Supporting mother-infant dyads impacted by prenatal substance exposure.
• Choi et al. (2022). Differential gateways, facilitators, and barriers to substance use disorder treatment for pregnant women and mothers: A scoping systematic review.

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1 NIDA (2020). Substance use in women research report: Substance use while pregnant and breastfeeding.
2 Anbalagan & Mendez (2023). Neonatal abstinence syndrome.
3 Choi et al. (2022). Differential gateways, facilitators, and barriers to substance use disorder treatment for pregnant women and mothers: A scoping systematic review.
4 Rutman et al. (2020). Multi-service prevention programs for pregnant and parenting women with substance use and multiple vulnerabilities: Program structure and clients’ perspectives on wraparound programming.
5 Deutsch et al. (2021). Supporting mother-infant dyads impacted by prenatal substance exposure.
6 SAMHSA (2009). Substance-exposed infants: State responses to the problem.
7 NCSACW (2023). Infants and families affected by prenatal substance exposure: Five points of family intervention.
8 Lloyd Sieger & Rebbe (2020). Variation in states’ implementation of CAPTA’s substance-exposed infants mandates: A policy diffusion analysis.