THC Exposure at Birth and Subsequent Risk of Maltreatment

Chronic substance abuse compromises appropriate parenting practices and helps to create an environment that is often not responsive to the material and emotional needs of children. Chronic substance abuse can increase harsh and coercive caregiving practices and thus increase the risk of child maltreatment. Estimates from the Adoption and Foster Care Analysis and Reporting System (AFCARS) indicate that substance abuse is a consistent and increasing factor related to the placement of children in foster care. The cascade of negative effects associated with child maltreatment is well documented.

Drug testing newborns is one strategy used by health care systems to help identify potential parental substance abuse and help connect parents with necessary services. Yet there are long-standing concerns about testing practices, especially in relation to racial bias. Given that a physician’s discretion is a primary vehicle for which mothers/children to test, one could reasonably hypothesize that testing these practice may unintentionally result in racial disparities. Moreover, potential disparities may be observed further downstream and significantly contribute to the racial disproportionality observed in child welfare systems. Similarly, there are serious concerns about how child protective services (CPS) should best respond to a positive drug test. These concerns are elevated with regard to mothers and infants that test positive for Delta-9-tetrahydrocannabino (THC) only. As many states now permit the use of marijuana for recreational purposes (similar to alcohol and tobacco), should states initiate child maltreatment investigations for THC only births? Are THC exposed newborns at an increased risk of subsequent maltreatment?

The current project is a collaboration between the Children and Adolescent Data Lab (School of Social Work) and Michigan Medicine. The collaboration builds on prior work , and seeks to answer two critical questions. First, is there a racial disparity at the decision to test newborns for drug exposure? Second, are THC exposed newborns at an increased risk of child maltreatment? The answers to these questions have important implications for racial equity, child well-being and the use of limited MDHHS and CPS resources.