The US is failing infants exposed to drugs and alcohol

Joseph Adonis of New York, age 14 months, died from acute heroin, cocaine and fentanyl poisoning.

A medically fragile toddler in Arizona died after being left unattended his crib by parents with a long history of substance abuse.

A Missouri four-year old died from malnutrition and chronic abuse by a caregiver prone to “unpredictable behavior” due to drug abuse.

These cases are not isolated tragedies. More than a decade into the opioid epidemic, trends in pediatric poisonings, Narcan administrations to infants and child fatalities continue to signal a crisis for children.

The high human and economic costs of mass incarceration during the crack-cocaine epidemic of the 1980s and 1990s have led states to pursue less punitive, more rehabilitative approaches to addiction. And although this approach has broad public support, a recent poll found that more than 80 percent of the public also want the child protection system to respond to the needs of young children whose parents abuse drugs or alcohol.

Federal law instructs states to meet the needs of substance-exposed infants and their caregivers with a “plan of safe care,” also known as a family recovery plan. Although these can be CPS-monitored plans that require substance abuse treatment, in many states they are merely a form that documents services that mothers or infants already do or could receive. The voluntary nature of these plans may mean that the vast majority of eligible parents receive no substance use treatment, as studies in New Mexico and Delaware have found.

Moreover, several states, including New York and Colorado, are considering laws to prevent doctors from conducting a toxicology test on newborn children without parental consent, even when there is reasonable suspicion that the child was prenatally exposed.

Individual hospitals, such as Mass General, are also implementing these policies on their own. Without reliable procedures to detect prenatal substance exposure, infants and their caregivers will not even receive a voluntary plan of safe care.

These policies fail to appreciate that untreated parental substance abuse places young children at elevated risk of death, poisonings, injuries, physical and sexual abuse, and severe neglect, in addition to poor physical, cognitive and emotional development. Parents with substance use disorders may take many years to be “ready” for treatment, but there is no pause button on infants’ development.

There is a better way to approach this problem. First, children must be at the center of policymaking. They are entitled to receive minimally adequate care and to be protected from foreseeable harms. Parental addiction is a foreseeable risk to infant health and safety that the state has an obligation to mitigate.

Second, a compassionate response to parents experiencing addiction or engaged in substance abuse can include CPS and court-ordered treatment. CPS involvement and the desire to maintain or regain custody can be a powerful motivator for parents to engage in treatment and is a critical safeguard for children when parents are unable to provide minimally adequate care. Policies or practices that generically discourage the involvement of CPS, rather than incentivizing the right tool for the situation, are misguided. 

Third, timely and comprehensive treatment access is essential. At the first sign of substance abuse, pregnant women and parents should be provided with immediate and comprehensive treatment and aftercare to maximize the odds that they can safely and permanently care for their children. The treatment array should include co-residential treatment slots for parents and children as well as robust outpatient treatment and recovery supports. 

Finally, data collection and evaluation are necessary to inform and revise existing policy. Massive policy and practice changes have been made, without any systematic data collection or evaluation to understand the relative harms and benefits to children and families.

Current evidence is insufficient to determine whether, and under what circumstances, “Plans of Safe Care” are effective or safe alternatives to CPS.

The drug epidemic continues to harm millions of families. As the U.S. rightly moves to prioritize compassionate care over incarceration for those experiencing addiction, we cannot afford to ignore the known threat that parental addiction poses to the safety and development of young children. 

Naomi Schaefer Riley is a senior fellow at the American Enterprise Institute, where she focuses on child welfare and foster care issues. Sarah Font is an associate professor of sociology at Penn State University.