Supporting Substance-Using Caregivers: Pregnancy, Birth, and Early Childhood

The American substance use crisis is significantly harming children and families.

From 2010 to 2017, the number of women with opioid-related diagnoses at delivery increased by 131%, and the number of babies born with Neonatal Abstinence Syndrome (NAS) increased by 82%. In 2022, more than a third of children entering foster care had at least one parent using substances. Today, one in eight children lives with a caregiver who has a substance use disorder.

Families with the youngest children are the most likely to experience adverse outcomes as a result of substance use disorders, such as child and maternal fatalities and near fatalities, and children’s removal from home. In addition to immediate harms to their health and wellbeing, substance-exposed infants and children face the potential for life-long mental and behavioral disorders and academic difficulties.

Social service leaders say they believe that supporting caregivers on their journey to recovery is essential for both parent and child health and well-being. Early intervention can strengthen family stability and improve the likelihood that children can remain in their parents’ care. Yet many jurisdictions punish or ignore parental substance use disorder, rather than see it as a disease requiring treatment.

The Government Performance Lab (GPL) has worked with jurisdictions across the United States that are reconsidering how they interact with substance-using caregivers, including Colorado, Connecticut, Florida, Michigan, New Hampshire, New Mexico, Rhode Island, and Washington.

This publication draws on those direct experiences, as well as observations in the field, and desk research to present three common challenges that jurisdictions must address and three promising practices that social service leaders can implement to better support substance-using caregivers and their families along the journey to recovery:

Challenge

• Engaging with supports can trigger stigma and fear of punitive responses
• Intervention often comes only after a crisis
• Recovery services are not usually designed for parents

Promising Practice

• Structure supports to build trust
• Offer support earlier
• Design recovery services to honor caregiving

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