Addressing the needs of infants with prenatal substance exposure: implementation of CAPTA and CARA legislation in an urban hospital setting.

Introduction: In recent years, federal legislation, including the Child Abuse Prevention and Treatment Act (CAPTA) and the Comprehensive Addiction and Recovery Act (CARA), have focused on the needs of infants with prenatal substance exposure (IPSE). This manuscript provides data from the implementation of this legislation in a large urban hospital setting. Method: This paper provides data on 403 mothers and infants at risk of IPSE, who were recruited from a large NYC hospital system through case record review and verbal screening. Participants provided self-report data maternal substance use, mental health, and trauma; administrative data were also obtained from the electronic medical record and the state child welfare database. Results: In this sample, 10.7% of at-risk mothers met DSM5 criteria for active substance use disorder (SUD), while an additional 36.8% met criteria for SUD in remission. Moreover, 7.5% of mothers met state eligibility for a Plan of Safe Care (POSC). Mothers were more likely to report mental health symptoms than active substance use, with 34.1% reporting moderate-to-severe depressive symptoms and 27.8% reporting moderate-to-severe anxiety. Mothers with active SUDs were more likely to experience the most severe mental health symptomatology. As for infants, 1.6% met the threshold required for notification under CAPTA at birth. During the 6-months after birth, 4.2% infants were involved in an indicated report of child maltreatment, and 1.0% were placed in out-of-home care. Discussion: These findings suggest that, although CARA and CAPTA legislation were intended to address a high prevalence of IPSE, some of the concerns driving this legislation may be overstated as, based on our data, the actual number of affected infants is relatively small, even in an at-risk population.