Cross Agency Training to Promote Integrated Care for Substance Exposed Newborns

Training of these professionals was successfully piloted and implemented with six regional cohorts from three state agencies. Independent evaluation data indicated high satisfaction ratings, significant pre- to post increases in knowledge and self-efficacy to provide care, and intentions to increase inter-professional collaborations.

Valuation of peers’ safe choices is associated with substance-naïveté in adolescents

Social influences on decision-making are particularly pronounced during adolescence and have both protective and detrimental effects. To evaluate how responsiveness to social signals may be linked to substance use in adolescents, we used functional neuroimaging and a gambling task in which adolescents who have and have not used substances (substance-exposed and substance-naïve, respectively) made choices alone and after observing peers’ decisions. Using quantitative model-based analyses, we identify behavioral and neural evidence that observing others’ safe choices increases the subjective value and selection of safe options for substance-naïve relative to substance-exposed adolescents. Moreover, the effects of observing others’ risky choices do not vary by substance exposure. These results provide neurobehavioral evidence for a role of positive peers (here, those who make safer choices) in guiding adolescent real-world risky decision-making.

Incidence of Injury, Maltreatment, and Developmental Disorders Among Substance Exposed Infants

Recent changes to federal legislation created a requirement for states to address the needs of infants with prenatal substance exposure. Understanding clinical outcomes among substance exposed infants prior to these changes is important for establishing a baseline of risk and informing systems-level responses. Using North Carolina, Georgia, and Texas Medicaid data, we examined the incidence of inpatient and outpatient diagnoses for injury, maltreatment, and developmental disorders prior to age 12 months and compared types of diagnoses among substance exposed and unexposed infants. The cumulative incidence of maltreatment (1.2% vs. 0.2%) and developmental disorder (10.7% vs. 1.5%) diagnoses prior to age 12 months was significantly higher among substance exposed compared to unexposed infants. The incidence of injury diagnoses was similar (3.7% vs. 3.4%). We observed differences in types of maltreatment and injury diagnoses. For example, diagnoses for neglect were more common among substance exposed infants while diagnoses for physical abuse were more common among unexposed infants. Results provide insight for informing monitoring and intervention by medical and public health professionals.

Variation in States’ Implementation of CAPTA’s Substance-Exposed Infants Mandates: A Policy Diffusion Analysis

In 2016, federal law changed state child welfare mandates related to prenatally substance-exposed infants. Little is known regarding the status or implications of policy implementation. The current study examined thematic clusters among states’ policies responsive to this 2016 mandate. Cluster analysis identified four distinct categories of states’ implementation: (1) “innovators/early adopters,” (2) “early majority,” (3) “late majority,” and (4) “laggards.” Innovator/early adopter states ( n = 14) were most likely to have implemented plan of safe care policies consistent with Child Abuse Prevention and Treatment Act (CAPTA). Early majority states ( n = 15) have started developing some aspects of CAPTA 2016 but have some aspects that are still in development. Late majority states ( n = 17) have adopted few aspects of CAPTA 2016 but had implemented more CAPTA 2003 and 2010 aspects than states in the laggard cluster. Laggard states ( n = 6) have implemented the fewest CAPTA prenatal substance exposure domains. In bivariate analyses, the only variable associated with clusters was Census region (e.g., New England), suggesting that states’ implementation decisions may be influenced by their regional neighbors.