Substance Use in Pregnant Women

From Treatment Programs HARPS Program (Helping At-Risk Pregnant Women Succeed) - Chris Cooper, MSN, NNP-CB, APRN and Dawn Forbes, MD
From Treatment Programs HARPS Program (Helping At-Risk Pregnant Women Succeed) – Chris Cooper, MSN, NNP-CB, APRN and Dawn Forbes, MD

Re-blogged from

To best understand the regulations around substance use and pregnant women, social workers must first understand that there are no regulations regarding testing for substance use. “In none of the laws is there mandatory testing,” says Lynn Paltrow, JD, executive director of National Advocates for Pregnant Women, an organization seeking to protect the rights of pregnant women through legal advocacy, organization, and public education. “Who gets tested is discretionary. [However,] there are a number of studies and investigative journalism that show that the people targeted for testing are of low income and color.”

With no consistency in testing rules, it’s no surprise that subsequent actions are equally as varied. The most extreme responses occur in South Carolina and Alabama, where the women can be arrested, Paltrow explains, citing the state’s child endangerment laws. “The Alabama Supreme Court decided that the word ‘child’ extends to fertilized egg,” she says.

In other states and counties, the interventions are less severe. Take Philadelphia, for example. “When a woman tests positive for substance use during pregnancy in Philadelphia, the Department of Human Services [DHS] is notified. After she gives birth, the hospital is required to contact DHS to report the substance use, even if both mother and newborn test negative for substances at that time,” says Christine Edinger, LSW, director of DHS contracts for the Health Federation of Philadelphia.

“If this is the first instance of substance use during pregnancy for the mother, then her case is sent to the DHS Child Abuse Prevention and Treatment Act [CAPTA]. She is then assigned a CAPTA worker and an assessment is completed,” Edinger continues. For those who tested positive in a previous pregnancy, an intake worker is assigned, and an investigation is completed, she adds. Depending on the outcome of the assessment or investigation, the woman may then be referred to community services provided by the Health Federation of Philadelphia.

The process is similar in Nebraska. “If a baby is born with a positive drug screen, it’s an automatic call to Child Protective Services,” says Heather Bird, LICSW, LADC, MPA, program director for the Nebraska Family Works Program and Better Together, both in Omaha.

All policies focusing on pregnant and postpartum women refer to all substances. How the legalization of marijuana and the use of medical marijuana in several states affects said policies continues to unfold.

Here in Boone County, from what CASA has observed, our procedure seems to be very similar to Nebraska’s. A mother who is found to have a substance exposed baby gets an immediate visit from DCFS. She will, most likely, have her baby taken from her care and put into foster care. The first option for foster care will be the baby’s extended biological family. This includes grandparents, aunts and uncles, or even great aunts and uncles. Secondly, well-suited godparents will be looked into. Finally, if there are no family members or godparents available or who have appropriately clean backgrounds the baby will be placed into traditional foster care. Within 24 business hours after the baby is removed from the mother’s care a Shelter Care Hearing will take place before a judge and, if the judge finds sufficient cause to believe the child was more likely than not abused/neglected, the State’s Attorney’s office will open a new case for the mother, father, child, and any existing siblings that were in the mother’s care. It is at that point, the Shelter Care Hearing, when Boone County CASA gets appointed to serve as the baby’s Guardian ad Litem. In all cases the mother will be given a chance to reclaim custody of the baby by completing services. She may have to have a substance abuse assessment, complete in-patient or intensive outpatient addiction treatment, and may have to attend counseling if there is believed to be underlying issues causing or contributing to her substance use. Should she complete her services, which is the goal of the court, the family will be reunited and the case closed.


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