PROJECT SUMMARY
Significance: The child protection system (CPS) serves as a primary responder to prenatal substance
exposure (PSE), although policies guiding CPS involvement following a substance affected birth vary across
and within jurisdictional settings. While CPS plays an important role in protecting children from harm,
nonuniversal reporting policies offer the potential to deploy CPS intervention more strategically. It is not well
understood how PSE reporting policies are implemented by mandated reporters and how timing of CPS
involvement for substance-exposed infants affects custodial outcomes. Moreover, mandated reporters can
offer key insights into best practice policies and standardized tools that may improve the effectiveness of
reporting policies at discerning when CPS intervention is needed to mitigate risk of child maltreatment.
Specific Aims: The objective of this proposal is to elucidate the implementation and outcomes of CPS
reporting policies and to enumerate promising practices for improving policy performance with three specific
aims: (1) describe women diagnosed with substance use at delivery and those reported to CPS using
descriptive statistics and multilevel modeling through an intersectional equity lens; (2) analyze 3-year custodial
outcomes, comparing births with documented PSE that were and were not reported to CPS in the early
neonatal period; and (3) through content analysis and semi-structured interviews, evaluate policy consistency
and identify best practices that may attenuate family risk and reliance on CPS for certain families.
Approach: For the first two aims, a nonpublic birth cohort dataset of linked administrative records from
California will be used to conduct multilevel and multinomial logistic regressions. For the third aim, a content
analysis of CPS reporting policies at 14 high-risk birth hospitals in Los Angeles County will be augmented by
semi-structured interviews with labor and delivery providers at those institutions. The proposed project is
innovative in its use of linked administrative data with a sufficient sample size for interrogative analyses of
differential outcomes by demographic characteristics at individual and institutional levels. The project is also
innovative in its inclusion of policy content analysis, which fills a key gap in the current policy outcomes
literature. The project is significant in its contribution of individual-level longitudinal and in-depth qualitative
information to a focus area with immediate policy and programmatic relevance.
Fellowship Applicant: The training plan outlined in this proposal will equip the applicant, Julia Reddy, with
advanced epidemiologic skills and critical policy and systems knowledge. This plan will prepare the applicant to
successfully complete the proposed project and advance as an independent public health researcher, focusing
on policies and programs to alleviate the burden of substance use on families. The applicant is well supported
by a strong team of mentors and research advisors who have the requisite experience and training to guide her
doctoral research and aid in her professional development, along with significant institutional support.
