# Improving outcomes for substance-affected families in the child welfare system

> **NIH NIH R01** · EMORY UNIVERSITY · 2024 · $614,433

## Abstract

PROJECT SUMMARY
Substance use in pregnancy, including illicit substances and alcohol, is a critical public health problem,
affecting 1 in 10 pregnancies. Because of the opioid crisis, there were recent exponential increases in
diagnoses of maternal opioid use disorder and neonatal opioid withdrawal syndrome. In parallel, the rate of
infants entering foster care nationwide grew 25% from 2011 to 2017; infants now account for one fifth of
annual foster placements. At present, infants are the fastest growing group entering foster care, most due to
parental substance use. The rise of infants in the US foster system garnered public attention leading to recent
federal policy changes that aimed to prevent foster placement where possible by connecting caregivers to
treatment for substance use disorder and mitigating postnatal adverse outcomes by providing wrap-around
services through Plans of Safe Care (POSC). However, state responses to changes in federal policy have
been disjointed, and research to date remains unclear as to whether these policies achieved their stated goal
or had unintended consequences such as exacerbating underlying racial disproportionality in the system. This
study aims to evaluate child welfare policy interventions and local factors to improve the wellbeing of pregnant
people with substance use disorder and their infants by: 1) conducting a rigorous analysis of state statutes,
regulations, and guidance related to POSC and categorizing POSC components likely to influence the
implementation of services (e.g., treatment, postnatal supports); 2) determining if state POSC policies were
associated with reductions in infant foster placements and emergency department visits for injury from abuse
and whether implementation of POSC was associated with changes to racial and ethnic disproportionality in
infant foster placement; and 3) qualitatively investigating the contextual barriers and facilitators influencing the
implementation of POSC and exploring elements of POSC implementation associated with improving or
worsening racial and ethnic equity through interviews with key stakeholders (e.g., frontline case workers,
judges, clinicians, policymakers).

## Key facts

- **NIH application ID:** 11140581
- **Project number:** 7R01DA056436-02
- **Recipient organization:** EMORY UNIVERSITY
- **Principal Investigator:** Stephen W Patrick
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $614,433
- **Award type:** 7
- **Project period:** 2023-08-01 → 2028-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/11140581

## Citation

> US National Institutes of Health, RePORTER application 11140581, Improving outcomes for substance-affected families in the child welfare system (7R01DA056436-02). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/11140581. Licensed CC0.

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