Improving the Child Welfare System to Respond to the Needs of Substance-Exposed Infants.

Abstract

Every day in the United States, 130 people die of an opioid overdose,1 and nearly 90 infants are admitted to hospitals with opioid withdrawal, also known as neonatal abstinence syndrome (NAS).2 The health care system has been largely unprepared for the magnitude of this crisis. As the numbers of opioid-exposed infants grew, pediatricians focused primarily on improving clinical care. The breadth of the crisis requires alignments of the public health system, hospitals, and our nation’s child welfare system. Recent improvements in the child welfare system through federal legislative action have enabled the system to be more responsive to the unique needs of families affected by the opioid crisis; however, more progress and funding are needed. The US child welfare system evolved over the last 200 years, beginning with reliance on small nonprofit organizations in the 19th and early-20th centuries. The publication of Kempe et al.’s “The Battered-Child Syndrome” in the 1960s3 and the passage of the Child Abuse Prevention and Treatment Act of 1974 (CAPTA)4 coincided with the emergence of a more organized system of care, one designed primarily to protect children from neglect and physical and sexual abuse. It was not set up to be responsive to the complex needs of families affected by substance use disorder.5 The already overburdened child welfare system is facing new demands made on it by the opioid crisis.6–8 Our analysis of data from the nation’s foster care system reveals that from 2011 to 2017, the number of infants entering that system each year …