Universal Screening for Alcohol and Drug Use and Racial Disparities in Child Protective Services Reporting

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.