Who should respond to substance-exposed infants? Reflections on U.S. policies limiting the role of child protective services

The number of U.S. adults with substance use disorders has increased rapidly over the past decade, raising concerns about the safety and wellbeing of young children with affected caregivers. There are ongoing debates about which government entities --child welfare agencies, health departments, law enforcement - should be responsible for responding to this problem and how they should respond. Regardless of the responsible entity suggested, myriad challenges inhibit effective responses to this crisis. This article discusses how federal and state agencies are currently responding to children in families affected by substance use, with a particular emphasis on substance-exposed infants. We reflect on three core issues that present a challenge to effective and compassionate care for both infants and their caregivers, including gaps in infrastructure, lack of effective treatment engagement and facilitation strategies, and decentralized and siloed data to evaluate the effects of policy and programmatic changes. We provide recommendations for improving upon the status quo.