The proposed research will examine the formulation and implementation of California's 1990 law (SB 2669) mandating protocols for identifying and intervening in cases of prenatal substance use or exposure. Results from a recent toxicological prevalence study of 30,000 delivering women in California provide regional prevalence rates of perinatal drug and alcohol use. Based on these results, the proposed research will, first, survey a scientific sample of 1,200 mother/newborn pairs in the two regions with the highest prevalence rates to examine if and how those with problem prenatal use or exposure are identified and referred for services by hospitals. The samples will be equally divided between two regions and between two hospitals in each region to compare the impact of different regional and hospital practices. Within each hospital, 300 selected mother/infant pairs will be determined to be either hospital identified problem prenatal use or exposure cases (n=100), cases of use or exposure identified through maternal self-report but not identified by the hospital (n=100), or controls with no identified or reported use or exposure (n= 10()). Self-reported use or exposure will be defined as meeting a threshold of self-reported drug and alcohol use during pregnancy. All mothers will be recruited and screened in the hospital postpartum and re-interviewed 6 months after delivery to learn about their and their infants' health status, maternal substance use, infant development, referral to services, and service utilization. The proposed research will, next, examine the way in which the state, county, and hospital protocols were developed and implemented in the six regions with the highest prevalence rates. Semi-structured surveys of key informants, as well as a thorough analysis of all pertinent documents, will complement results obtained from the hospital samples by providing an in-depth analysis of how health care providers, government officials, and advocacy groups view the law and its implementation at the state level and, in the six regions, at the local level. Lastly, the effect of the law on the child welfare systems in the six regions will be determined through a time series analysis of secondary data spanning the period 1985-1995. This comprehensive analysis of the experience of implementing standards of care within a large state, drawing on complementary data sources and methodologies, will be valuable for institutions and practitioners in that it will identify and explicate areas of effectiveness and deficiency.
