PC1062: Racial Disparities in Foster Care Placement of Opioid Exposed Infants

Background: Neonatal Abstinence Syndrome (NAS) or Neonatal Opioid Withdrawal Syndrome (NOWS) has become an important and prevalent diagnosis. However, there remains a paucity of data on racial disparities in infant outcomes. One outcome is foster care placement. Evaluating for racial inequities in placement could have important implications for child protection systems. This study sought to ascertain whether or not there are disparities in foster care placement based on Maternal Race/Ethnicity, with specific attention being paid to Black versus White maternal race for opioid-exposed infants.

Methods: Opioid-exposed infants born between April 2017 and May 2021 and admitted to the Neonatal Intensive Care Unit (NICU) formed the study population. Primary exposure was Maternal Race/Ethnicity, with “White or Caucasian” serving as the reference group. Social Work notes in mothers’ and infants’ medical charts were reviewed for details, including mother’s history, other children, involvement with child protective services or prior foster care, current custody status, and final placement decisions. The primary outcome was placement into foster care. Secondary outcomes included discharge with parents and discharging home with safety plan.

Results: A total of 379 pregnancies occurred, with exclusion criteria (unknown maternal race or only one mother in a racial group and unknown final placement) resulting in a total of 350 pregnancies. Within this group, 23.1% (81) identified as Black or African American, 70% (245) White or Caucasian, 6.9% (24) Hispanic or Latinx. A total of 88 (25%) pregnancies resulted in foster care placement. Of these, 22% (18/81) of Black mothers had children placed into foster care, which was similar to that of White mothers – 24% (59/245, p=0.8). However, 46% (11/24) of Hispanic or Latinx mothers had pregnancies which resulted in foster care placement (p=0.03 compared to White, p=0.04 compared to Black). The prevalence ratio (PR) of foster care placement was 0.92 (95%CI 0.58,1.47) for Black relative to White, 1.90 (95%CI 1.41,2.39) Hispanic or Latinx relative to White, 2.06 (95%CI 1.47,3.74) Hispanic or Latinx relative to Black. With respect to discharge with safety plans, infants of Black mothers were 2.1 times (95%CI 1.88,2.35) more likely to go home with a safety plan than infants of White mothers. Infants of Hispanic or Latinx mothers were 1.76 (95%CI 0.88,2.64) times more likely to go home with a safety plan than infants of White mothers.

Conclusion: This study identified disparities within foster care placement between infants of Hispanic or Latinx mothers and both Black and White mothers. Additionally, safety plans were more likely to be implemented for infants of both Black and Hispanic or Latinx mothers. Identifying racial disparities in foster care placement is critical to addressing structural racism within child protective systems and essential in building systems that better support birth parents and their children.