Introduction
This report presents the results of a federally funded study that examined federal and State policies guiding child welfare prenatal substance exposure (PSE) identification and care, child welfare staff awareness and knowledge of PSE and practices to identify affected children and families, how PSE information is shared and documented, and how child welfare agencies interact with caregivers and allied service providers in supporting children and families. The study included interviews with child welfare directors and reviews of State policy documents pertaining to PSE in five States; interviews with child welfare staff and directors (n=171) at 22 agency sites, as well as a survey of allied PSE-relevant service providers (n=271), and a review of local agency-level policy documents; and in-depth interviews with 13 local agency data staff at two States, as well as a survey of 21 allied PSE-relevant service providers, focus groups or interviews with 48 caregivers, and a review of 212 local agency case files. Results from the study are reported and indicate: States reported policy revisions and enhanced collaborative partnerships in response to CAPTA/CARA legislation; defining prenatal exposure as child maltreatment may be a barrier to providing supportive services to families; most staff reported participating in training related to PSE and stated a high level of awareness about the effects of PSE, yet many displayed inaccurate knowledge about the effects of prenatal alcohol syndrome; staff reported inconsistent assessment for PSE; when PSE is a concern, most CW staff reported that they would refer to developmental and early intervention services along with medical providers; PSE information was not consistently located in a single report or location; and among the caregivers who had cared for a child with PSE, few reported that they were fully prepared to do so. Additional findings are reported and recommendations are made.