Newborns and Infants

Overview

In New York City and nationally, newborns and infants who come to the attention of the child welfare system follow a different trajectory than other children – they are more likely to enter foster care after an investigation, less likely to return home and more likely to be adopted, especially newborns.

Reducing family separation – especially permanent family separation – requires a focus on newborns and infants.

This brief shares national data on newborn and infant outcomes and uses zip code-level data from 2019 to offer new information about newborns and infants in NYC.

We find that:

  • Nearly half of all newborns in investigations were Black;
  • Almost one-quarter of newborns entered foster care after an investigation;
  • 72% of children whose parents’ rights were terminated 2018-2020 were 0-3 years old when they became court-involved.

This information can help advocates, policymakers, government officials and local groups consider the legislative and policy changes, investments and resources (including current legislation) that could directly support expecting parents and parents of babies.

Material supports can be targeted to these parents. The Bridge Project, for instance, offers $1,000 in guaranteed income to expecting parents in many low-income NYC neighborhoods, and a new bill would extend this approach statewide. Entitlements such as WIC, the Earned Income Tax Credit, welfare (TANF) and SNAP also could be adjusted for these families to reflect the higher cost of raising young children.

More than half of newborn investigations involved substance abuse allegations. Research has found that fear of being reported to child welfare is a significant barrier to 

prenatal care for some pregnant people, particularly those who use drugs and alcohol. In 2020, NYC’s public hospitals began requiring a mother’s consent to be drug tested and the city child welfare agency, ACS, clarified that a parent’s drug use or the positive toxicology of a parent or newborn does not, by itself, warrant a report to the SCR. However, legislation to require informed consent for drug testing of newborns and pregnant or postpartum parents has not been passed by the State Legislature.

Approaches that support families in finding material support, legal assistance, in-home substance use treatment, infant-parent mental health programs and other resources, like the Bronx Defenders’ Healthy Mothers, Healthy Babies program and Strong Starts Court Initiative, can be expanded and disconnected from the child welfare system.

These resources also can prevent re-entry for newborns and infants who enter foster care and then return home. A recent Chapin Hall study of NYC children who entered foster care 2003-2010 found that, of those who reunified before age 1, 37% re-entered foster care before age 18. Re-entry came soon after returning home or as they hit their teenage years, and the risk of being placed in congregate care was high.

Lastly, for families facing termination of parent rights, the Preserving Family Bonds Act would give children and parents the chance to stay in contact when it's in a child’s best interest. Passed for the third time in 2023, it has not yet been signed by the governor.

This brief offers information about where these resources and legislative action would make the biggest difference.

 

Data analysis by Cat Pisciotta and text by Nora McCarthy. NYC data is provided by the NYC Administration for Children’s Services (ACS) unless otherwise noted. Thank you to Fred Wulczyn and to Frank Edwards, C.M. Roberts, Kathleen S. Kenny, Mical Raz, Matty Lichtenstein and Mishka Terplan for permission to republish your work.

NATIONAL DATA

Nationally, infants are far likelier to enter foster care than older children

A national study by Chapin Hall examining data from 2006-2012 found that infants entered foster care at rates three times higher than teenagers after a substantiated investigation, with 11.5 infants per 1,000 entering foster care in 2014 compared to 3.5 children ages 1-5 or 1.9 children ages 13-17. Once infants entered foster care, they stayed for a significantly longer time.

A more recent analysis confirms these findings.

Download: Image

 

Chart reprinted from Infants in the Child Welfare System: Epidemiology and Development courtesy of the Center for State Child Welfare Data, Chapin Hall, University of Chicago.

NATIONAL DATA

Infants – especially newborns – are less likely to return home

Newborns and infants are less likely to reunify and more likely to be adopted than other children who enter foster care. A 2021 Children’s Bureau report found that half of children who were 0-3 months at foster care entry had their parents’ rights terminated, and 95% were adopted. In the Chapin Hall study, only 37% of newborns (under 1 month) were reunified while 56% of infants went home. Likewise, 52% of newborns were adopted while 29% of infants were adopted. Among children who entered foster care between age 1 and 17, 64% reunified and only 10% were adopted.

Spending more than 30 days at home was associated with a much higher likelihood of reunification for babies.

Download: Image

 

Chart reprinted from Infants in the Child Welfare System: Epidemiology and Development courtesy of the Center for State Child Welfare Data, Chapin Hall, University of Chicago.

Type of exit for Children Placed

NATIONAL DATA

Medical professionals nationwide are increasingly reporting infants, particularly Black infants

In August, a multistate study found that rates of investigations of infants stemming from reports by medical professionals increased significantly from 2010-2019, particularly for Black infants. Nationwide in 2019, child welfare investigated 1 in 18 Black infants (5.4%), 1 in 31 Indigenous infants (3.2%), and 1 in 41 White infants (2.5%) following medical professionals’ reports.

Download: Image 1, Image 2

 

Charts reprinted from Medical Professional Reports and Child Welfare System Infant Investigations: An Analysis of National Child Abuse and Neglect Data System Data courtesy of the authors.

 

NEW YORK CITY

1 in 5 children who entered foster care was under 1 year old

Newborns under 31 days made up about 2% of investigations but 10% of foster care entries and infants (under 1) made up 6.7% of investigations but almost 20% of foster care entries. Children under 5 made up only 28% of children in an investigation but 43% of children entering foster care.

Download: Image, Data

 

Note: Child Census data comes from the American Community Survey’s 5-year (2015-2019) estimates. Estimates are not available for newborns and infants.

Almost 25% of newborns entered foster care after an investigation

Infants were also are 2-3 times more likely than older children to enter foster care after an investigation.

Download: Image, Data

 

Note: Percentages are based on aggregates. Note that these numbers are based on all investigations not indicated investigations.

Families with newborns and infants enrolled in ACS preventive services after an investigation at higher rates than families with older children

Download: Image, Data

 

Note: Percentages are based on aggregates. Note that these numbers are based on all investigations not indicated investigations.

Terminations of parental rights 2018-2020 primarily involved children who were under age 3 at removal

Family court data from 2018-2020 shows that children who were birth to age 3 at the time of initial court filing were overrepresented in every negative court outcome—removals, filings to terminate parental rights and terminations of parental rights. Children with an initial filing age 0-3 made up 44% of NYC children removed from their families but 72% of NYC children whose parents’ rights were terminated. Older children were more likely to reunify as well as to remain in foster care or age out.

In New York state, nearly 1 in 50 Black children will experience termination of both of their parents’ rights by age 18.

Download: Image, Image 2, Data 1, Data 2

 

Data source: NYS Unified Court System, Universal Case Management System – Family Court Data Metrics.

Almost 50% of newborns in investigations were Black

Download: Image, Data

More than half of newborn investigations included allegations of parental substance abuse

ACS has clarified in public guidance (and trainings for hospital staff) that a parent’s drug use or the positive toxicology of a parent or newborn does not, by itself, warrant a report to the SCR.

Download: Image, Data

Reporter types for newborns and infants vary significantly from older children

The “Social Services” reporter type very frequently includes social workers and others based in health care settings, such as hospitals. Reporter types received by ACS from the SCR are categorized by the reporter’s job role as shared with the SCR, rather than in relation to their affiliated organization or institution.

Download: Image, Data

 

 

Just 10 zip codes account for 25% of all investigations involving children under 1

These zip codes also accounted for 27% of investigations involving newborns (children under 30 days old.)

Download: Image, Data

 

Note: Newborns (under 31 days old) were in just under 2% of investigations in 2019, and infants (between 31 and 365 days old) were in about 7.5% of investigations in 2019.  It’s possible for one investigation to appear in both the newborn category and the infant category, if there were two babies in the family.

In addition to investigations, newborns can be involved in a pre-birth planning conference, which is held when a mother with a child in foster care has a baby and the pregnancy is known to the agency. This does not involve an SCR call. However, a report to the SCR may be made if no conference is held or ACS does not agree that the family has a plan for safely caring for the newborn.

 

Just 9 zip codes accounted for 25% of all children under 1 entering foster care

Download: Image, Data

 

Note: Total children under 1 entering foster care: 335 (30 days or younger) + 338 (31 days to 364 days) = 673

In these 25 zip codes, the percent of newborns entering foster care after an investigation was above the citywide rate

In the first six months of 2023, removals for children of all ages were down by more than 30% compared to 2019.

Download: Image, Data

 

Note: Zip codes with less than 10 investigations for newborns in 2019 were excluded. In 2019, 23% of newborns involved in investigations entered foster care (aggregate number).

The percent of infants entering foster care after an investigation was above the citywide rate in these zip codes

Download: Image, Data

 

Note: Zip codes with less than 10 investigations for infants in 2019 were excluded. In 2019, 9% of infants involved in investigations entered foster care (aggregate number).

 

More than half of all newborns and infants in investigations or who enter foster care live in majority Black and Latino neighborhoods

Download: Image 1, Image 2, Data 1, Data 2

 

Note: Majority Black/Latino neighborhoods are defined as those with 75% or more Black/Latino residents (all ages). Majority White/Asian neighborhoods are those with 75% or more White/Asian residents (all ages). Total births data comes from NYC Department of Health data at the zip code level and is based on total births between 2017 and 2019 (which were averaged to get a yearly average).

 

 

Related References

This list is drawn from Medical Professional Reports and Child Welfare System Infant Investigations: An Analysis of National Child Abuse and Neglect Data System Data by Frank Edwards, Sarah C.M. Roberts, Kathleen S. Kenny, Mical Raz, Matty Lichtenstein, and Mishka Terplan.

Committee Opinion No. 473: Substance Abuse Reporting and Pregnancy: The Role of the Obstetrician–Gynecologist. Obstet Gynecol 2011;117(1):200–201; doi: 10.1097/AOG.0b013e31820a6216

Edwards F. Family surveillance: Police and the reporting of child abuse and neglect. RSF Russell Sage Found J Soc Sci 2019;5(1):50–70; doi: 10 .7758/RSF.2019.5.1.03.

Ellsworth MA, Stevens TP, D’Angio CT. Infant race affects application of clinical guidelines when screening for drugs of abuse in newborns. Pediatrics 2010;125(6):e1379–e1385; doi: 10.1542/peds.2008-3525

Fong K. Concealment and constraint: Child protective services fears and poor Mothers’ Institutional Engagement. Soc Forces 2019;97(4):1785– 1810; doi: 10.1093/sf/soy093.

Fong K. Getting eyes in the home: Child protective services investigations and state surveillance of family life. Am Sociol Rev 2020;85(4):610–638; doi: 10.1177/0003122420938460

Jarlenski M, Shroff J, Terplan M, et al. Association of race with urine toxicology testing among pregnant patients during labor and delivery. JAMA Health Forum 2023;4(4):e230441; doi: 10.1001/jamahealthforum .2023.0441

Kenny KS, Kru ̈si A, Barrington C, et al. Health consequences of child removal among Indigenous and non-Indigenous sex workers: Examining trajectories, mechanisms and resiliencies. Sociol Health Illn 2021;43(8): 1903–1920; doi: 10.1111/1467-9566.13364

Kenny KS, Ranville F, Green SL, et al. Family separation and maternal self- rated health: Evidence from a Prospective Cohort of Marginalized Mothers in a Canadian Setting. Matern Child Health J 2019;23(9):1232– 1239; doi: 10.1007/s10995-019-02762-z

Maclean JC, Witman A, Durrance CP, et al. Prenatal Substance Use Policies And Infant Maltreatment Reports: Study examines prenatal substance use policies and infant maltreatment reports. Health Aff (Millwood) 2022; 41(5):703–712; doi: 10.1377/hlthaff.2021.01755

National Institute on Alcohol Abuse and Alcoholism. Alcohol Policy Information System: Pregnancy and Alcohol Reporting Requirements. National Institute on Alcohol Abuse and Alcoholism: Washington, DC; n.d.

National Institute on Alcohol Abuse and Alcoholism. Alcohol Policy Information System: Pregnancy and Drugs Reporting Requirements. National Institute on Alcohol Abuse and Alcoholism: Washington, DC; n.d.

Paik L. Trapped in a Maze: How Social Control Institutions Drive Family Poverty and Inequality. University of California Press: Oakland, CA; 2021.

Pearson RJ, Grant C, Wijlaars L, et al. Mental health service use among mothers involved in public family law proceedings: Linked data cohort study in South London 2007–2019. Soc Psychiatry Psychiatr Epidemiol 2022;57(10):2097–2108; doi: 10.1007/s00127-022-02221-1

Putnam-Hornstein E, Prindle JJ, Leventhal JM. Prenatal substance expo- sure and reporting of child maltreatment by race and ethnicity. Pediatrics 2016;138(3):e20161273; doi: 10.1542/peds.2016-1273

Raz M. Unintended consequences of expanded mandatory reporting laws. Pediatrics 2017;139(4);e20163511; doi: 10.1542/peds.2016-3511

Rebbe R, Mienko JA, Brown E, et al. Child protection reports and removals of infants diagnosed with prenatal substance exposure. Child Abuse Negl 2019;88:28–36; doi: 10.1016/j.chiabu.2018.11.001

Reich JA. Fixing Families: Parents, Power, and the Child Welfare System. Routledge: New York, NY; 2005.

Roberts D. The racial geography of child welfare: Toward a new research paradigm. Child Welfare 2008;87(2):125–150.

Roberts DE. Punishing drug addicts who have babies: Women of color, equality, and the right of privacy. Harv Law Rev 1991;104(7):1419–1482; doi: 10.2307/1341597.

Roberts SCM, Nuru-Jeter A. Universal screening for alcohol and drug use and racial disparities in child protective services reporting. J Behav Health Serv Res 2012;39(1):3–16; doi: 10.1007/s11414-011-9247-x

Roberts SCM, Nuru-Jeter A. Women’s perspectives on screening for alcohol and drug use in prenatal care. Womens Health Issues 2010;20(3): 193–200; doi: 10.1016/j.whi.2010.02.003

Roberts SCM, Pies C. Complex calculations: How drug use during preg- nancy becomes a barrier to prenatal care. Matern Child Health J 2011; 15(3):333–341; doi: 10.1007/s10995-010-0594-7

Roberts SCM, Zahnd E, Sufrin C, et al. Does adopting a prenatal substance use protocol reduce racial disparities in CPS reporting related to maternal drug use? A California case study. J Perinatol 2015;35(2):146–150; doi: 10 .1038/jp.2014.168

The American College of Obstetricians and Gynecologists. Opposition to Criminalization of Individuals During Pregnancy and the Postpartum Period. The American College of Obstetricians and Gynecologists: Washington, DC; 2020.

Thomas S, Treffers R, Berglas NF, et al. Drug use during pregnancy policies in the United States From 1970 to 2016. Contemp Drug Probl 2018;45(4): 441–459; doi: 10.1177/0091450918790790

Wall-Wieler E, Roos LL, Bolton J, et al. Maternal health and social out- comes after having a child taken into care: population-based longitudinal cohort study using linkable administrative data. J Epidemiol Community Health 2017;17(12):1145–1151; doi: 10.1136/jech-2017-209542

Wall-Wieler E, Roos LL, Brownell M, et al. Postpartum depression and anxiety among mothers whose child was placed in care of child protec- tion services at birth: A retrospective cohort study using linkable administrative data. Matern Child Health J 2018;22(10):1393–1399; doi: 10 .1007/s10995-018-2607-x

Wall-Wieler E, Roos LL, Brownell M, et al. Suicide attempts and completions among mothers whose children were taken into care by child protection services: A cohort study using linkable administra- tive data. Can J Psychiatry 2018;63(3):170–177; doi: 10.1177/ 0706743717741058