Webinar urges states to use existing data and plans of safe care to identify and support infants affected by fetal alcohol spectrum disorders

Sean Couch, a senior program associate with the National Center on Substance Abuse and Child Welfare, outlined how jurisdictions can use existing data and cross‑system collaboration to identify and support infants and families affected by prenatal alcohol exposure and fetal alcohol spectrum disorder (FASD). "The topic for today is fetal alcohol spectrum disorder data systems and strategies for change," Couch said at the start of the session.

Couch defined prenatal alcohol exposure as any alcohol consumption during pregnancy and summarized FASD as a spectrum of conditions that can range from mild to severe, affecting growth, cognition, behavior and sensory systems. He cited federal public‑health estimates and recent studies to illustrate scale: "nearly 14% or one in seven of pregnant women in the United States reported drinking alcohol in the past 30 days," and diagnosed FASD prevalence in U.S. studies ranges from about 11 to 50 per 1,000 children, he said. Couch also referenced 2024 CDC figures that have been reported as as many as 1 in 20 school‑aged children (about 3.75 million) possibly having FASDs.

On clinical impact, Couch noted that among infants and toddlers with confirmed prenatal alcohol exposure, "74 to 87% are exhibiting significant delays in cognitive, language, motor and social‑emotional domains," using the statistic to emphasize the importance of early identification and intervention. He also said roughly 40% of pregnant women who report alcohol use report at least one additional substance (tobacco, cannabis or opioids), and cautioned that self‑report data may undercount use because of stigma.

Couch reviewed federal policy that shapes local practice. He summarized the Child Abuse Prevention and Treatment Act (CAPTA) and the 2016 Comprehensive Addiction and Recovery Act amendment, which clarified that infants born and identified as affected by substance use (including FASD) are eligible for a plan of safe care and that states should report counts of affected infants, plans created and whether those plans resulted in referrals for services. "Plan of safe care is designed to improve the safety and well‑being of infants that are affected by prenatal substance exposure," he said, describing the plan as a family‑centered tool that covers infant medical needs, caregiver substance‑use and mental‑health supports, and child‑focused services such as early intervention.

Couch listed actionable surveillance and administrative data sources jurisdictions can use now: the Behavioral Risk Factor Surveillance System (BRFSS) and PRAMS for maternal alcohol use trends; the National Survey on Drug Use and Health (NSDUH) for state and national substance‑use estimates; the National Child Abuse and Neglect Data System (NCANDS) for counts of infants reported as affected who received a plan of safe care; state child‑welfare and health systems; hospital discharge and birth certificate records for clinical validation; and Alcohol‑Related Disease Impact tools for mortality and economic burden estimates. He cautioned that some plans of safe care created during prenatal care without child‑protective involvement may not be captured in NCANDS submissions.

On practice, Couch emphasized universal verbal prenatal screening (not routine toxicology) using validated tools recommended by professional bodies, closed‑loop referral and enrollment tracking so clinicians can confirm whether families connected with services, and cross‑system training so health, child welfare, education and treatment partners recognize and respond to FASD. "Screening, brief intervention during pregnancy, can reduce the incidence of prenatal alcohol exposure," he said, and framed plans of safe care as a coordination tool jurisdictions can standardize and adopt upstream during prenatal care.

Couch highlighted state examples to illustrate implementation. Minnesota used PRAMS and BRFSS, stood up a pregnancy health and substance‑use task force, conducted statewide screening assessments and developed implementation guidance. Alaska created regional FASD diagnostic teams for multidisciplinary assessment and coordination. Pennsylvania impaneled a cross‑system task force and local committees and integrated family navigators. Florida operates statewide diagnostic services and a training institute through the Florida Center for Early Childhood offering ongoing professional and caregiver training.

Couch closed with three primary takeaways: leverage data to create scoreboards that measure progress; prioritize screening and early intervention to connect families with services as early as possible; and develop cross‑system collaborations that use plans of safe care as a family‑owned coordination tool. He invited attendees to contact the National Center for training and technical assistance to support local implementation efforts.

Notes on sources and precision: the article reports numerical estimates as they were presented. The presenter did not always name the original source for every figure; for example, he cited a figure that "70% of children in foster care are affected by prenatal alcohol exposure" without specifying the underlying study or dataset. The National Center and federal systems named in the presentation include the Administration for Children and Families (ACF) and SAMHSA.