This study examines racial disparities in Child Protective Services (CPS) reporting at delivery in a county with universal screening for alcohol/drug use in prenatal care. It also explores two mechanisms through which universal screening could reduce reporting disparities: Equitable Surveillance and Effective Treatment. Equitable Surveillance is premised on the assumptions that identification of drug use through screening in prenatal care leads to CPS reporting at delivery and that Black women are screened more than White women, which leads to disproportionate reporting of Black newborns. Universal screening would correct this by ensuring that prenatal providers screen and therefore also report White women to CPS, thereby reducing disparities. Effective Treatment is premised on the idea that identification of drug use through screening in prenatal care leads women to receive treatment during pregnancy, which thereby reduces CPS reporting at delivery. Universal screening would lead to prenatal providers screening more Black women and thereby to more Black women receiving treatment prenatally. The increase in treatment receipt during pregnancy would then decrease the number of Black newborns reported to CPS at delivery, thereby reducing disparities. County data were used to compare the racial/ethnic distribution of women and newborns in three points in the system (identification in prenatal care, treatment entry during pregnancy, and reporting to CPS at delivery related to maternal alcohol/drug use) and explore pathways to treatment. Despite Black women having alcohol/drug use identified by prenatal care providers at similar rates to White women and entering treatment more than expected, Black newborns were four times more likely than White newborns to be reported to CPS at delivery. This contradicts the premise of Effective Treatment. By default, findings were more consistent with Equitable Surveillance than Effective Treatment. Providers and policy makers should not assume that universal screening in prenatal care reduces CPS reporting disparities.
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USPSTF. Screening for Illicit Drug Use: U.S. Preventive Services Task Force Recommendation Statement. 2008. http://www.ahrq.gov/clinic/uspstf08/druguse/drugrs.pdf.
USPSTF. Screening and Behavioral Counseling Interventions in Primary Care to Reduce Alcohol Misuse Recommendation Statement. 2004. http://www.ahrq.gov/clinic/3rduspstf/alcohol/alcomisrs.pdf.
Goler NC, Armstrong MA, Taillac CJ, et al. Substance abuse treatment linked with prenatal visits improves perinatal outcomes: a new standard. Journal of Perinatology. 2008;28(9):597–603.
ACOG. ACOG Committee Opinion No. 422: at-risk drinking and illicit drug use: ethical issues in obstetric and gynecologic practice. Obstetrics and Gynecology. 2008;112(6):1449–1460.
Washington State Department of Health. Substance Abuse During Pregnancy: Guidelines for Screening. Revised Edition 2008. 2008.
Perinatal substance use: A guide for hospitals and health care providers: Virginia Departments of Health, Social Services, and Mental Health, Mental Retardation, and Substance Abuse Services. 2007.
Littaua R, Ramstrom K, Jocson M. Local MCAH Jurisdiction Survey on Prenatal Substance Use Screening Data.: Maternal, Child and Adolescent Health/Office of Family Planning Branch, California Department of Health Services.;2006.
Whitlock EP, Green CA, Polen MR. Behavioral Counseling Interventions in Primary Care to Reduce Risky/Harmful Alcohol Use. Portland: AHRQ; 2004.
Polen M, Whitlock E, Wisdom J, et al. Screening in primary care settings for illicit drug use: Staged systematic review for the United States Preventive Services Task Force: Agency for Healthcare Research and Quality. AHRQ Publication No. 08-05108-EF-s. Rockville, MD. 2008.
Chang G, McNamara TK, Orav EJ, et al. Brief intervention for prenatal alcohol use: a randomized trial. Obstetrics and Gynecology. 2005;105(5 Pt 1):991–998.
Chang G, Wilkins-Haug L, Berman S, et al. Brief intervention for alcohol use in pregnancy: a randomized trial. Addiction. 1999;94(10):1499–1508.
O’Connor MJ, Whaley SE. Brief intervention for alcohol use by pregnant women. American Journal of Public Health. 2007;97(2):252–258.
Armstrong MA, Gonzales Osejo V, Lieberman L, et al. Perinatal substance abuse intervention in obstetric clinics decreases adverse neonatal outcomes. Journal of Perinatology. 2003;23(1):3–9
Roberts DE. Killing the black body: race, reproduction, and the meaning of liberty. New York: Vintage; 1999.
Ferguson v. City of Charleston, S.C., 308 380(Unites States Court of Appeals, Fourth Circuit 2002).
42 U.S.C.A. Section 5106a, (2007).
ACOG. ACOG Committee Opinion. Number 294, May 2004. At-risk drinking and illicit drug use: ethical issues in obstetric and gynecologic practice. Obstetrics and Gynecology. 2004;103(5 Pt 1):1021–1031.
Chasnoff IJ, Landress HJ, Barrett ME. The prevalence of illicit-drug or alcohol use during pregnancy and discrepancies in mandatory reporting in Pinellas County, Florida. New England Journal of Medicine. 1990;322(17):1202–1206.
Chasnoff IJ. Fetal Alcohol Spectrum Disorders Seminar for County MCAH Teams and Partners; 2007; Sacramento, CA.
Hill R. An analysis of racial/ethnic disproportionality and disparity at the national, state, and county levels: Casey-CSSP Alliance for Racial Equity in Child Welfare;2007.
Neuspiel DR, Zingman TM, Templeton VH, et al. Custody of cocaine-exposed newborns: determinants of discharge decisions. American Journal of Public Health. 1993;83(12):1726–1729.
Chambers CD, Hughes S, Meltzer SB, et al. Alcohol consumption among low-income pregnant Latinas. Alcoholism, Clinical and Experimental Research. 2005;29(11):2022–8.
Vega WA, Kolody B, Hwang J, et al. Perinatal drug use among immigrant and native-born Latinas. Substance Use and Misuse. 1997;32(1):43–62.
MacMahon JR. Perinatal substance abuse: The impact of reporting infants to Child Protective Services. Pediatrics. 1997;100(5).
Weisner C, Matzger H. A prospective study of the factors influencing entry to alcohol and drug treatment. Journal of Behavioral Health Services Research. 2002;29(2):126–137.
Roberts SC, Nuru-Jeter A. Women’s perspectives on screening for alcohol and drug use in prenatal care. Womens Health Issues. May-Jun 2010;20(3):193–200.
Nguyen D, Smith LM, Lagasse LL, et al. Intrauterine growth of infants exposed to prenatal methamphetamine: results from the infant development, environment, and lifestyle study. The Journal of Pediatrics. 2010;157(2):337–339.
American Community Survey. 2006.
CDPH. Comprehensive Perinatal Services Program. http://www.cdph.ca.gov/PROGRAMS/CPSP/Pages/default.aspx. 2008.
PSAP. Findings from a small pilot study of health care providers in Contra Costa County. 2006.
Hamilton BE, Martin JA, Ventura SJ. Births: Preliminary Data for 2007. National Vital Statistics Reports. 2009;57(23).
Demioz L. Contra Costa County Births 2000–2006. California Department of Health Services, Birth Statistical Master File, 2006: Contra Costa Health Services; 2006.
Creswell JPC, VL. Designing and conducting mixed methods research. Thousand Oaks: Sage Publications; 2007
Roberts SC, Pies C. Complex calculations: How drug use during pregnancy becomes a barrier to prenatal care. Matern Child Health Journal. 2011;15(3):333–41.
Miles MB, Huberman AM. Qualitative Data Analysis: An Expanded Sourcebook. Thousand Oaks: Sage Publications; 1994.
Patton MQ. Qualitative research and evaluation methods. Thousand Oaks: Sage Publications; 2002.
Keppel K, Bilheimer L, Gurley L. Improving population health and reducing health care disparities. Health Affairs (Millwood). 2007;26(5):1281–1292.
Lester BM, Andreozzi L, Appiah L. Substance use during pregnancy: time for policy to catch up with research. Harm Reduction Journal. Apr 20 2004; 1(1):5.
This project was supported by a March of Dimes Community Award and NIAAA Graduate Training on Alcohol Problems, T32 AA07240. This manuscript was a chapter in Sarah Roberts’ dissertation. Cheri Pies provided helpful comments on this paper.
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Roberts, S.C.M., Nuru-Jeter, A. Universal Screening for Alcohol and Drug Use and Racial Disparities in Child Protective Services Reporting. J Behav Health Serv Res 39, 3–16 (2012). https://doi.org/10.1007/s11414-011-9247-x
- Black Woman
- Prenatal Care
- Racial Disparity
- Child Protective Service
- Universal Screening