National Study Highlights How State Policies and Child Welfare Reforms Shape Maternal Health and Substance Use Outcomes

Across the United States, overdose remains one of the leading causes of maternal death in the postpartum period. In response, many states have enacted a range of laws targeting prenatal drug use, such as mandatory reporting to child welfare and classification of drug use during pregnancy as child maltreatment. The impacts of these laws on access to care, treatment, and long-term outcomes for pregnant people with opioid use disorder remain understudied.    

A research team at the Johns Hopkins Bloomberg School of Public Health is working to answer this question. Led by Sachini Bandara, PhD '18, MS, Assistant Professor in the Department of Mental Health, and Alene Kennedy-Hendricks, PhD '15, Associate Professor in Health Policy and Management, this study seeks to understand how state-level laws and federal child welfare financing reforms are shaping maternal health care, overdose risk, and substance use treatment access.    

Bandara is the Director of Training and Kennedy-Hendricks is the Director of Research at the Center for Mental Health and Addiction Policy (CMAP). They are both interested in studying how mental health and drug policies play out in real-world systems. Bandara brings a background in health services and policy research, with a particular focus on criminal legal systems and child welfare responses, to substance use. Kennedy-Hendricks became interested in studying overdose mortality during her time as a PhD student;. as rates of overdose deaths rose nationally, it became a growing public health crisis that piqued her interest.    

The study on maternal care and substance use disorder is funded by the Centers for Disease Control and Prevention (CDC). They examine two key policy areas, including state laws targeting prenatal drug use and implementation of the Family First Prevention Services Act (FFPSA).    

Some states implemented laws that require health care providers to report suspected cases to child welfare and defining drug use as child maltreatment. Bandara and Kennedy-Hendricks aim to study how these laws impact access to prenatal and postpartum care, substance use disorder (SUD) treatment, and overdose outcomes. To access the real-world impacts of these laws, the team is using national Medicaid data from all 50 states. Applying a difference-in-differences statistical method, they will compare changes in care and outcomes in states before and after implementing new laws, with states that did not make such changes. Recent advancements in policy analysis methodology makes this study stand out as it can account for staggered adoption of policies over time. The study team includes a broad set of collaborators, including researchers at Johns Hopkins University, Cornell University, and Rutgers University. They also refer to an advisory board of practitioners and field experts to ensure real-world relevance.   

On the qualitative side, Bandara and Kennedy-Hendricks are also looking at the implementation of FFPSA. Passed in 2018, the act allows states to use federal Title IV-E funds—traditionally reserved for foster care—to support services that keep families together, including services related to parental substance use. The research team is conducting qualitative interviews with state-level experts to understand how Family First has been implemented, what substance use related services are being provided, and challenges in aligning substance use treatment evidence with child welfare priorities.    

Currently, the team is working on data collection and analysis, with hopes to release preliminary findings in the near future. Their goal for this study is to inform smarter, more compassionate policymaking that supports maternal health and reduces harm.    

Bandara and Kennedy-Hendricks emphasize that stigma and criminalization can drive people away from care. At the same time, the maternal mortality crisis continues to grow, especially among those with substance use disorders. This study is uniquely positioned to uncover how state decisions around enforcement, funding, and prevention can either support or hinder families during a critical period.  

Stay Connected  

For more information or to follow updates on this project, you can reach out directly to Sachini Bandara (sbandar2@jhu.edu) or Alene Kennedy-Hendricks (alene@jhu.edu).