Child protective services' response to prenatal drug exposure: results from a nationwide survey

Objective: This survey was conducted to: (1) document child protective serv ices (CPS) agencies' actual practices regarding prenatal drug exposure; (2) examine urban and rural differences in CPS responses; (3) explore whether CPS practices varied as a function of county median income, birth rate, pop ulation size, or percent minority births; and (4) assess respondent satisfa ction with their county's current responses. Method: Data were collected via a nationwide telephone survey of child welf are supervisors from two urban and two rural counties in every state (N = 2 00). Results: Ninety percent of counties (100% of urban and 80% of rural) report ed receiving referrals of infants with prenatal drug exposure. Among those receiving referrals, extreme variations in practice were found; all possibl e response options (from very inactive to very aggressive) were equally rep resented on key questions (e.g., filing court petitions, taking custody). R ural counties tended to have stronger responses than urban counties (t[175] = -2.26, p = .024). County response did not vary with county-level median family income, percent minority births, or birth rate. Despite wide variati ons in practice, the majority of respondents (69%) felt their county's resp onse was appropriate. Of respondents who did indicate that their county's r esponse was inappropriate, most (85%) felt that the county needed to do mor e to protect children. Conclusions: There is currently tremendous variation across US counties in CPS responses to, and beliefs regarding, the issue of prenatal drug exposur e. Some of this variation is due to differences between urban and rural cou nties, with little variation explained by differences in median income or p ercent minority births at the county level. There is a need for research-ba sed guidance and consensus building in CPS practice in this area. (C) 2001 Elsevier Science Ltd. All rights reserved.