Social Worker Attitudes Toward Alcohol and/or Drug Use In Pregnancy and Reporting to Government Authorities

Background and Purpose: Health professionals frequently defer to social workers as experts in deciding whether or not to report alcohol and/or drug (AOD) use in pregnancy to government authorities, such as Child Protective Services (CPS) and police. Evidence suggests that policies and practices around reporting AOD use in pregnancy can have negative consequences, including deterring patients from accessing prenatal care and substance use treatment in pregnancy. Further, research indicates that judgement from providers discourages pregnant people who use AOD from receiving prenatal care. However, scant research has explored social workers’ attitudes toward or reporting practices around AOD use in pregnancy. This study aims to describe social workers’ attitudes toward and reporting practices related to AOD use in pregnancy, and assess the extent to which these attitudes are related to reporting to CPS and the police.

Methods: We conducted a national survey with licensed social workers who 1) provide services to pregnant, birthing and/or postpartum people, 2) have worked in an emergency department, in labor and delivery, postpartum or neonatal intensive care units, outpatient perinatal care or integrated behavioral health for at least one year. We recruited a convenience sample (N=528) by distributing the survey through professional organizations, state social work licensing boards, and within our own networks. Surveys assessed attitudes toward AOD use in pregnancy using the Modified Attitudes about Drug Use in Pregnancy Scale, a validated 13-item scale. Additionally, respondents were presented a text-based vignette describing a birthing person with a positive toxicology result in the postpartum unit and asked how likely they were to recommend reporting to CPS and the police. We conducted bivariate analyses to assess differences in mean scores of attitudes toward AOD use in pregnancy by reporting recommendation.

Results: Most respondents (82.58%) indicated they would recommend reporting to CPS in response to the vignette, while few (7.01%) indicated they would recommend reporting to the police. Over a third (39.20%) of respondents reported believing that prenatal drug use should be considered a form of child abuse, with 6.82% indicating that people who use drugs in pregnancy should be punished. There was a significant difference in mean attitude scores between those who were likely (M=3.57, SD=0.68) and unlikely to recommend reporting to CPS (M=4.15, SD=0.65; p<.001), with lower scores suggesting higher stigma toward AOD use in pregnancy. There was also a significant difference in mean attitude scores between those who were likely (M=2.97, SD=0.81) and unlikely to recommend reporting to the police (M=3.72, SD=0.67; p<.001).

Conclusions and Implications: These findings have important implications for striving toward reproductive justice in social work practice. The difference in mean attitude scores among those who did and did not recommend reporting suggests that there may be a relationship between attitudes toward AOD use in pregnancy and reporting to CPS and the police among social workers. Social workers should receive training around providing non-stigmatizing, supportive services to pregnant and postpartum people who use AOD, including best practices for interventions and community resource referrals as alternatives to reporting to government authorities.