Infants, children, and youth in foster care with prenatal substance exposure: a synthesis of two scoping reviews

Figures & data

Table 1 Search strategy

Query	Limiters/Expanders
S12	S4 AND S5 AND S9
S11	S4 AND S5 AND S9
S10	S4 AND S5 AND S9
S9	S6 OR S7 OR S8
S8	SU (infan* or newborn* or baby or babies or neonatal* or perinatal* or prenatal*)
S7	AB (infan* or newborn* or baby or babies or neonatal* or perinatal* or prenatal*)
S6	TI (infan* or newborn* or baby or babies or neonatal* or perinatal* or prenatal*)
S5	(SU "Prenatal Exposure" OR SU "Fetal Alcohol Syndrome" OR prenatal substance abuse or prenatal exposure or fetal alcohol or substance related disorder* or neonatal abstinence syndrome or NAS or addiction or "drug usage" or prenatal exposure or "drug use" or "substance use" or substance abuse or "drug abuse*" or impaired parent* or cocaine related disorder* or alcohol related disorder* or opioid related disorder* or amphetamine related disorder* or "drug exposed")
S4	S1 OR S2 OR S3
S3	SU "Foster Parents" OR SU "Foster Care" OR SU "Foster Children"
S2	AB (foster* or kinship or "out of home care")
S1	TI (foster* or kinship or "out of home care")

Figure 1. Flowchart of publication selection.

Table 2 Extracted data

Author (year) Country	Design	Primary focus	Aim	Sample
Adams and Bevan (2011) UK	Research (qualitative)	Supporting parents and foster care providers	Explore extent and nature of mother and baby fostering within social service agencies	N = 8 foster mothers
Adnams et al. (2007) South Africa	Research (quantitative)	Early screening, diagnosis and intervention	Assess effects of a classroom-based program for children with FASD	N = 105 children ages 9–10
Alberta Government Ministry of Human Services (2013) Canada	Educational resource	Supporting parents and foster care providers	Resource from training program for foster caregivers of infants affected by substance exposure	N/A
American Humane Association, Center for the Study of Social Policy, Child Welfare League of America, Children’s Defence Fund, and Zero to Three (2011) USA	Expert opinion – policy	Providing theoretically grounded care	Review evidence of the importance of addressing the needs of infants and toddlers	N/A
Assink et al. (2009) South Africa	Research (quantitative)	Early screening, diagnosis and intervention	Report use of occupational therapy techniques to help teachers working with children who have attention difficulties in classroom setting	N = 10 children ages 5–10
Bada et al. (2008) USA	Research (quantitative)	Early screening, diagnosis and intervention	Evaluate behavioral and adaptive outcomes for infants based on foster care living arrangement	Analytic sample N = 1,092 infants
Badry (2009) Canada	Research (mixed methods)	Early screening, diagnosis and intervention	Report development of enhanced practice standards in child welfare	N/A
Badry and Choate (2015) Canada	Peer-reviewed literature review	Intersectoral collaboration	Explore need for social work education to cover FASD related issues	N/A
Badry and Felske (2013) Canada	Research (qualitative)	Intersectoral collaboration	Present model developed from a photovoice project which considers women’s health issues in FASD prevention	N = 30 women in northern Canada.
Badry et al. (2014) Canada	Educational resource	Supporting parents and foster care providers	Describe curriculum providing online education for caregivers on FASD informed care and preferred practices	N/A
Badry and Pelech (2011) Canada	Non-peer reviewed research report	Early screening, diagnosis and intervention	Report on Alberta Children and Youth Services’ implementation of framework for addressing needs of children in care with FASD	N/A
Barth (2012) USA	Expert opinion	Supporting parents and foster care providers	Comment on current state of available evidence-informed parenting interventions for child welfare	N/A
Baskin et al. (2016) USA	Research (qualitative, grounded theory)	Supporting parents and foster care providers	Explore perspectives of clinicians on the needs of caregivers of children with FASD	N = 19 clinicians
Beckmann et al. (2010) USA	Expert opinion - policy	Supporting parents and foster care providers	Discuss areas of improvement and challenges of mandated training for parents of young children associated with child welfare system	N/A
Bernard and Dozier (2011) USA	Research (quantitative)	Supporting parents and foster care providers	Examine association between foster parent commitment to foster children and delight that they exhibit with young foster children	N = 70 foster parent-infant dyads.
Bertrand (2009) USA	Research (quantitative)	Early screening, diagnosis and intervention	Report on five RCT studies for interventions for children and caregivers	N/A
Bick and Dozier (2013) USA	Research (quantitative)	Early screening, diagnosis and intervention	Examine effectiveness of Attachment Biobehavioral Catch-up (ABC) intervention amongst foster-mother infant dyads	N = 96 foster-mother-foster infant dyads 22 months or younger
Bick et al. (2013) USA	Research (quantitative)	Supporting parents and foster care providers	Investigate relevance of oxytocin production in formation and quality of mother-infant foster care bonds	N = 41 foster mother-infant dyads
Bishop et al. (2001) USA	Research (quantitative)	Early screening, diagnosis and intervention	Learn about what the outcomes of infants involved in the child welfare system are after legislative reforms	N = 46 infants aged 0–3
Bobbitt et al. (2016) Canada	Research (quantitative)	Supporting parents and foster care providers	Determine needs of foster caregivers	N = 125 foster caregivers
Boyd (2019) USA	Research (quantitative)	Early screening, diagnosis and intervention	Examine placement experiences and outcomes of infants in foster care who had substance abuse as a removal reason in case file	N = 32,117 who spent more than 8 days in out-of-home care
Boyd et al. (2016) Scotland	Program description	Early screening, diagnosis and intervention	Explore structure and cost of mental health care of infants in foster care and the New Orleans model	N/A
British Columbia Ministry of Children and Family Development and the Vancouver Island Foster Parent Support Services Society (2009) Canada	Educational resource	Supporting parents and foster care providers	Resource from training program for foster caregivers of infants affected by substance exposure	N/A
British Columbia Ministry of Children and Family Development and the Vancouver Island Foster Parent Support Services Society (2009) Canada	Educational resource	Supporting parents and foster care providers	Manual for education and support program for foster parents who care for infants with prenatal substance exposure	N/A
British Columbia Ministry of Children and Family Development (2009) Canada	Program description	Supporting parents and foster care providers	Outline of program standard of the Key Worker and Parent Support programs	N/A
Brown et al. (2007) Canada	Research(mixed methods)	Supporting parents and foster care providers	Concept mapping of the causes of placement breakdown for foster parents caring for a child with FASD	N = 63 foster parents
Brownell et al. (2011) Canada	Research (quantitative)	Early screening, diagnosis and intervention	Determine coverage and validity of a newborn screening test	N = 37,345 infants
Bruskas (2010) USA	Expert opinion	Providing theoretically grounded care	Apply theoretical frameworks to determine social setting of foster care, impactson developmental health and needs of infants in foster care	N/A
Burd et al. (2011) US	Peer-reviewed non-research (description of a court-team based model)	Intersectoral collaboration	Describe court team-based model	N/A
Burns et al. (2020) Canada	Research (quantitative)	Early screening, diagnosis and intervention	Explore the differences in adverse outcomes between youth with FASD living in child welfare care with those living with biological or adoptive families.	N = 665
Burnside and Fuchs (2013) Canada	Research (qualitative)	Early screening, diagnosis and intervention	Explore the lived experiences of youth with FASD in transition from child welfare care to adulthood and identified two intervention points for improvement	N = 20 transition age youth (age 16–21)
Burry and Noble (2001) USA	Program description	Supporting parents and foster care providers	Describe Support and Training for Adoptive Families project worker training	N/A
Burry and Wright (2006) US	Intervention – description	Early screening, diagnosis and intervention	Examine and explore use of visitation as a child welfare intervention for children with prenatal substance exposure	N/A
Casanueva et al. (2014) USA	Research (quantitative)	Supporting parents and foster care providers	Describe extent of caregiver instability and identify the risk factors of caregiver instability	N = 1,196 and followed for 5 to 7 years
Centre on the Developing Child at Harvard University (2016) USA	Expert opinion	Providing theoretically grounded care	Apply insights gained from new brain research to how infants in the child welfare system	N/A
Chamberlain et al. (2017) Australia	Research(qualitative)	Early screening, diagnosis and intervention	Provide understanding of how families experience the diagnostic process	N = 10 foster caregivers
Chasnoff et al. (2015) USA	Research (quantitative)	Early screening, diagnosis and intervention	Describe clinical characteristics and changes in pre- and post-assessment, co-occurring disorders	N = 547 children
Child and Youth Working Group (2007) Canada	Educational resource	Supporting parents and foster care providers	Resource for caregivers and professionals providing education onunderstanding and managing behavior associated with FASD	N/A
Child Trends and Zero to Three (2013) USA	Research (quantitative)	Intersectoral collaboration	Survey of state child welfare initiatives and policies that guide work in addressing the needs of maltreated infants and toddlers	N = 46 state directors of child welfare.
Choate (2013) Canada	Expert opinion	Supporting parents and foster care providers	Provide recommendations to adapt parenting assessments for FASD parents	N/A
Cohen (2009) USA	Expert opinion – policy	Providing theoretically grounded care	Review importance of the first three years of life for development and provide guidance for infants and toddlers in foster care	N/A
Cole and Hernandez (2011) USA	Research (quantitative)	Early screening, diagnosis and intervention	Describe relationship between crisis nursery services and placement outcomes for young children leaving the child welfare system	N = 198 infants and young children
Cole (2006) USA	Research (quantitative)	Providing theoretically grounded care	Describe quality of relational environment for infants in foster care	N = 46 caregiver-infant dyads
Coles et al. (2007) USA	Research (quantitative)	Early screening, diagnosis and intervention	Test intervention using computer games to teach fire and road safety	N = 32 children ages 4–10
Cook et al. (2013) Canada	Practice guidelines	Early screening, diagnosis and intervention	Treatment Improvement Protocol to improve outcomes for individuals at risk of having FASD, or ofhaving a child with FASD	N/A
Cook et al. (2016) Canada	Systematic review	Early screening, diagnosis and intervention	Provide best practices guidelines in diagnostic procedures from available literature	N/A
Crea et al. (2008) USA	Research (quantitative)	Early screening, diagnosis and intervention	Study behavioral outcomes for adopted children with prenatal substance exposure	N = 275 children in out of home care
D'Angiulli and Sullivan (2010) Canada	Research (quantitative)	Early screening, diagnosis and intervention	Examine whether the postnatal environment provided by specialized early foster care isassociated with signs of positive developmental outcomes in infants	N = 22 infants under the age of 24 months
Davidson-Arad and Mussel (2002) Israel	Research (quantitative)	Intersectoral collaboration	Track placement of babies born to motherswho are drug-addicted	N = 120 infants
Delfabbro et al. (2009) Australia	Research (quantitative)	Supporting parents and foster care providers	Provide profile of social and familial backgrounds of infants entering foster care; develop statistical models of family background factors that predict subsequent child abuse	N = 498 infants less than two years of age
Denys et al. (2011) Canada	Research (quantitative)	Early screening, diagnosis and intervention	Report on effectiveness of Step-by-Step Program, an intervention for parents with FASD	N = 24 parents with FASD
Doris et al. (2006) USA	Research (quantitative)	Early screening, diagnosis and intervention	Confirm relationships between prenatal cocaine exposure and neonatal health outcomes	N = 76 infants tested positive for cocaine matched with 76 tested negative
Dozier et al. (2013) USA	Expert opinion – with review of literature	Early screening, diagnosis and intervention	Two intervention programs highlighted - the Attachment and Biobehavioral Catch-Up (ABC) and the New Orleans Intervention	N/A
Dozier et al. (2008) USA	Research (quantitative)	Early screening, diagnosis and intervention	Assess the effects of the Attachment and Biobehavioral Catch-up (ABC) intervention	Intervention comparison group N = 47; non-intervention non-foster care comparison group N = 48
Dozier et al. (2006) USA	Research (quantitative)	Early screening, diagnosis and intervention	Present preliminary data on effectiveness of caregiver intervention to enhance regulatory capacities from the Attachment and Bio-behavioral Catch-up intervention	N = 60, with an additional 104 non-foster children to allow comparisons.
Eiden et al. (2007) USA	Research (quantitative)	Supporting parents and foster care providers	Describe demographic and perinatal risk characteristics of infants and caregivers	N = 220 infant-mother dyads. 115 cocaine-exposed and 105 non-exposed
Enns and Taylor (2016) Canada	Research (quantitative)	Early screening, diagnosis and intervention	Identify predictors of FASD from neuro-psychological assessments	N = 180 children and adolescents
Evaluation Directorate, Government of Canada and the Public Health Agency of Canada (2014) Canada	Non-peer reviewed evaluation report	Intersectoral collaboration	Assess performance and relevance of Canada's Federal FASD initiative	N/A
First Nations Child and Family Caring Society & Paukuutit Inuit Women of Canada (2006) Canada	Gray literature (report on research project)	Intersectoral collaboration	Examine availability of FASD services and training opportunities among First Nations and Inuit communities across Canada	N/A
First Nations of Quebec and Labrador Health and Social Services (2007) Canada	Non-peer reviewed research report	Early screening, diagnosis and intervention	Provide overview of models for respite care services for individuals with FASD among Quebec First Nations communities	N/A
Frame (2002) USA	Research (quantitative)	Early screening, diagnosis and intervention	Examine outcomes of infants and toddlers placed in Foster Care prior to the Adoption and Safe Families Act of 1997	N = 1,357 infants and toddlers
Frame et al. (2000) US	Research (quantitative)	Early screening, diagnosis and intervention	Examine factors associated with infant re-entry into the foster care system	N = 88 infants aged newborn to 1 year
França et al. (2016) USA	Research (quantitative)	Intersectoral collaboration	Estimate labour costs of caring for NAS infants within the local department of children and families.	N = 6,170 infants
Fuchs et al. (2010) Canada	Research (quantitative)	Early screening, diagnosis and intervention	Describe characteristics of children in care in Manitoba, Canada	N = 1,403 children in child welfare system
Green (2007) USA	Peer-reviewed literature review	Early screening, diagnosis and intervention	Review of literature on FASD in school settings	N/A
Gregory et al. (2015) UK	Research (quantitative)	Early screening, diagnosis and intervention	Review charts of children seen in clinic to provide guidance to pediatricians	N = 72 children
Hubberstey et al. (2014) Canada	Research (mixed methods, program evaluation)	Early screening, diagnosis and intervention	Report findings from FASD Youth Outreach Program (YOP)	N = 87 youth
Humphreys and Kiraly (2011) Australia	Research (quantitative)	Supporting parents and foster care providers	Understand current practices related to family contact for infants in protective care	N = 119 infants less than one year of age in foster care
Johnson (2014) UK	Expert opinion (program description)	Intersectoral collaboration	Describe process developed to facilitate the discharge of infants with NAS to a home environment, including foster care	N = 126 infants
Kable et al. (2012) USA	Research (quantitative)	Supporting parents and foster care providers	Report effectiveness of delivering a parental education program via workshop, leaflet, or online module.	N/A
Kable et al. (2007) USA	Research (quantitative)	Early screening, diagnosis and intervention	Report the effectiveness of the Math Interactive Learning Experience	N = 561 children ages 3 to 10
Kahlberg and Buckley (2007) US	Peer-reviewed literature review	Early screening, diagnosis and intervention	Review effective interventions for FASD	N/A
Kalland et al.(2006) Finland	Research (quantitative)	Supporting parents and foster care providers	Investigate neonatal health and maternal background of children in foster care	N = 1,668 children
Kenrick (2009) USA	Research (mixed methods)	Supporting parents and foster care providers	Describe Concurrent Planning Project	N = 26 families (27 infants in total)
Koponen et al. (2020) Finland	Research (quantitative)	Early screening, diagnosis and intervention	Investigate the effect of dual exposure to substances and adverse childhood experiences on the health and development of youth with PSE	N = 615 exposed and 1787 unexposed youths
Koponen et al. (2009) Finland	Research (mixed methods)	Supporting parents and foster care providers	Examine effect of caregiving environment for children in care with FASD	N = 38 children under age 16 in care
Lange et al. (2013) Canada	Peer reviewed literature review	Early screening, diagnosis and intervention	Obtain estimates of pooled prevalence rates of FASD diagnosis in multiple countries	N/A
Larrieu et al. (2008) USA	Research (quantitative)	Supporting parents and foster care providers	Analyze and determine risk factors that are predictors of child welfare placement outcomes and permanent loss of custody	N = 141, analytic sample = 93 mothers that had a child or children placed in foster care
Leenaars et al. (2012) Canada	Research (quantitative)	Supporting parents and foster care providers	Evaluate the Coaching Families Program	N = 186 caregivers of children with FASD
Loomes et al. (2008) Canada	Research (quantitative)	Early screening, diagnosis and intervention	Evaluate intervention to improve working memory skills in children with FASD	N = 33 children age 4-11
Lloyd et al. (2019) USA	Research (qualitative)	Intersectoral collaboration	Analyze state plans for consistency with federal legislation	N = 51 plans
McCombs-Thornton (2012) USA	Research (mixed methods)	Early screening, diagnosis and intervention	Evaluate Zero to Three’s Safe Babies Court Team Project	N = 298 children compared to 511 young child welfare participants
McGee (2011) USA	Expert opinion, with review of literature, thesis	Providing theoretically grounded care	Discuss adverse effects of trauma, abuse and neglect on infant mental health and provide recommendations to promote mental health	N/A
McGlade et al. (2009) Australia	Research (quantitative)	Supporting parents and foster care providers	Compare child protection outcomes of infants of substance-using mothers with infants of non-substance using mothers	N = 119 infants of substance using mothers matchedwith N = 238 infants of non-substance using mothers
McLaughlin et al. (2011) USA	Research (quantitative)	Early screening, diagnosis and intervention	Assess effect of prenatal substance exposure on 9-year-old children	N = 332 children aged 9
McSwiney (2017) Canada	Non-peer-reviewed program description	Intersectoral collaboration	Report on Canada’s Aboriginal HeadstartProgram.	N/A
Manitoba Family Services and Consumer Affairs (2011) Canada	Practice guidelines	Intersectoral collaboration	Manual providingoverview of agency protocols	N/A
Marcellus and Nelson (2011) Canada	Program description	Intersectoral collaboration	Comment on sustainability of the Safe Babies program	N/A
Marcellus (2010) Canada	Research (qualitative)	Providing theoretically grounded care	Describe resilience based intervention model for infants in foster care	N = 11 families in 5 different communities
Marcellus (2008) Canada	Research (qualitative)	Supporting parents and foster care providers	Describe process of becoming and providing foster caregiving for infants with prenatal drug and alcohol exposure	N = 11 families
Marcellus (2004) Canada	Program description	Intersectoral collaboration	Evaluate Safe Babies project	N/A
Marcellus (2000) Canada	Program development	Supporting parents and foster care providers	Describe development of a specialized program for foster parents who care for infants with prenatal substance exposure	N/A
Markowitz (2015) USA	Research (quantitative)	Providing theoretically grounded care	Investigate duration, frequency and type of foster care and its effect on early attachment development	N = 45 infants
Mauren (2007) USA	Research (quantitative, doctoral dissertation)	Early screening, diagnosis and intervention	Explore effects of placement stability on functioning in later childhood children with FASD	N = 88 children and youth ages 6–18
Melmed (2011) USA	Expert opinion - policy	IMH (policy)	Argues for policy changes to help meet the needs of infants in foster care who have experienced maltreatment	N/A
Michaud and Temple (2013) Canada	Research (qualitative)	Supporting parents and foster care providers	Explore experiences of caregivers of children with FASD and what they believe they need to ensure positive outcomes	N = 5 mothers (foster, adoptive and biological) of children with FASD
Minnes et al.(2008) USA	Research (quantitative)	Supporting parents and foster care providers	Determine if cocaine using women who did not maintain infant custody reported more negative outcomes than those who maintained custody	N = 144 women who did not maintain custody and N = 66 women who did not
Miron et al. (2013) USA	Intervention	Providing theoretically grounded care	Highlight issues for child welfare workers to consider related to moving infants who are part of a sibling group	N/A
Miron et al. (2013) Australia	Research (qualitative)	Providing theoretically grounded care	Compare approaches to infant/biological parent visitation within the context of out-of-home care, from a human rights perspective	N/A
Moe and Slinning (2001) Norway	Research (quantitative)	Early screening, diagnosis and intervention	Follow developmental outcomes of a polysubstance-exposed infant cohort	N = 78 polysubstance exposed children and comparison group N = 58
Morrison and Mishna (2006) Canada	Research (qualitative)	Early screening, diagnosis and intervention	Reports on use of an ecological, specially tailored treatment intervention for children with FASD	N = 1 case study of 8-year old boy
Mukherjee et al. (2015) UK	Research (mixed methods)	Intersectoral collaboration	Assess the knowledge and understanding of health professionals regarding FASD	N = 505professionals
Muhajarine et al. (2014) Canada	Non-peer reviewed evaluation report	Intersectoral collaboration	Examine five FASD-related programs and make suggestions for enhancing program effectiveness	N/A
Mukherjee et al. (2013) UK	Research (mixed methods)	Supporting parents and foster care providers	Assess family impact of caring for a child with FASD	N = 66 caregivers
Nash et al. (2015) Canada	Research (quantitative)	Early screening, diagnosis and interpretation	Assess effectiveness of ALERT Program to improve executive functioning in children with FASD	N = 25 children ages 8 to 12
O’Connor et al. (2012) US	Research (quantitative)	Early screening, diagnosis and intervention	Assess effectiveness of Children’s Friendship Training (CFT) to improve social skills in children with FASD	N = 85 children ages 6 to 12
Olson et al.(2007) US	Peer-reviewed literature review	Early screening, diagnosis and intervention	Review literature focused on importance of early diagnosis and intervention	N/A
Paley and O'Connor (2011) USA	Peer-reviewed literature review	Providing theoretically grounded care	Review current literature on empirically tested interventions for children and adolescents with FASD	N/A
Paley and Auerbach(2010) US	Peer-reviewed literature review	Early screening, diagnosis and intervention	Review literature on children and youth with FASD in the child welfare and courts systems, with recommendations for practice	N/A
Pei et al. (2016) Canada	Peer-reviewed literature review	Early screening, diagnosis and intervention	Review of interventions across the lifespan	N/A
Pelech et al. (2013) Canada	Research (quantitative)	Intersectoral collaboration	Reports oneffectiveness of Promising Practices, an enhanced community of practice approach for child welfare staff and foster carers	N = 182 children in care
Pomeroy and Parrish (2013) US	Research (quantitative)	Intersectoral collaboration	Reports oneffectiveness of online FASD training for volunteers in the courts system	N = 338 court system volunteers
Popova et al. (2011) Canada	Peer reviewed literature review	Early screening, assessment and intervention	Systematic review of studies reporting on the prevalence of FASD diagnoses in the criminal justice system	N/A
Popova et al. (2014) Canada	Research (quantitative)	Early screening, assessment and intervention	Calculate prevalence of children with FASD in care in each province, and provide an estimated cost of providing care for these children	N/A
Prindle et al. (2018) USA	Research (quantitative)	Early screening, assessment and intervention	Estimate population prevalence of medically diagnosed substance exposure and neonatal withdrawal disorders and explore rates of CPS involvement during first year	N = 551,232 infants
Reid et al. (2015) Australia	Peer reviewed literature review	Early screening, assessment and intervention	Provide systematic review of evidenced based interventions for individuals with FASD across the life span	N/A
Roberts (2015) UK	Peer-reviewed non-research (editorial)	Early screening, assessment and intervention	Provide recommendations for teachers and school staff to support the learning of children with FASD	N/A
Roberts and Associates (2008) Canada	Non-peer reviewed literature review	Intersectoral collaboration	Document information available on nature, scope, economic impact, and other factors related to FASD	N/A
Rojmahamongkol et al. (2015) USA	Research (quantitative)	Early screening, assessment and intervention	Assess knowledge, attitudes and practices of pediatricians on FASD	N = 149 pediatricians
Ryan et al. (2006) USA	Research (quantitative)	Supporting parents and foster care providers	Report effectiveness of a trial combining child welfare and addictions services using a recovery coach	N = 738 caregivers
Rowbottom et al. (2010) Canada	Peer-reviewed literature review	Supporting parents and foster care providers	Review of interventions for non-biological caregivers of children with FASD	N/A
Sarkola et al. (2007) Finland	Research (quantitative)	Early screening, assessment and intervention	Determine risk profiles of children born to problematic substance using mothers	N = 526 pregnant women, 626 infants and children
Schofield and Simmonds (2011) UK	Intervention	Supporting parents and foster care providers	Explore issue of parent contact with infants subject to care proceedings	N/A
Silver and Dicker (2007) USA	Practice guidelines	Early screening, assessment and intervention	Inform professional practice of workers involved in the mental health assessment of infants in foster care	N/A
Smariga (2007) USA	Intervention	Providing theoretically grounded care	Explain why visitation is important for infants and toddlers in foster care	N/A
Smith (2012) USA	Educational resource (dissertation)	Supporting parents and foster care providers	Create training manual for prospective foster parents who plan to care for infants who have been physically abused and/or neglected	N = 15 (5 foster parents, 5 social workers, 5 foster parent coordinators)
Soh et al. (2015) USA	Research (quantitative)	Early screening, assessment and intervention	Reports oneffectiveness of the ALERT Program to improve executive functioning and increase gray matter in children with FASD	N = 65 children ages 8 to 12
Spieker et al. (2012) USA	Research (quantitative)	Early screening, assessment and intervention	Study impact of participation of parent-toddler dyads in a 10-week intervention (Promoting First Relationships)	N = 210 infants between the ages of 10 and 24 months
Silver and Dicker (2007) USA	Practice guidelines	Early screening, assessment and intervention	Inform professional practice of workers involved in the mental health assessment of infants in foster care	N/A
Stacks et al. (2011) US	Research (quantitative)	Early screening, assessment and intervention	Evaluate the language trajectories of maltreated infants over a 5-year period within placement context	N = 963 infants under the age of one with substantiated maltreatment
Stacks and Partridge (2011) US	Research (quantitative)	Early screening, assessment and intervention	Examine differences between kinship and foster placements for infants placed in out-of-home care prior to their first birthday	N = 457 infants removed from parental care between birth and first birthday
Tonmyr et al. (2011) Canada	Research (quantitative)	Providing theoretically grounded care	Examine factors associated with decisions in favour of out-of-home placement following investigations involving infants at risk of maltreatment	N = 763 infants less than one year of age
Toutain and Lejeune (2008) France	Research (quantitative)	Providing theoretically grounded care	Determine associations of FAS/FASD in infants with medial social and judiciary context	N = 28 FASD infants with FASD
Twomey et al. (2011) USA	Research (mixed methods, program evaluation)	Early screening, assessment and intervention	Describe care coordination program, the Vulnerable Infants Program of Rhode Island, to promote permanency for substance-exposed infants and provide evaluation data for thefinal four years of operation	N = 203 infants and 195 mothers
Twomey et al. (2010) USA	Research (mixed methods, program evaluation)	Early screening, assessment and intervention	Describe Vulnerable Infants Program of Rhode Island, including context, goals of the program and evaluation of outcomes of the first four years of the program	N = 203 infants, 195 mothers enrolled
Ungar et al. (2014) Canada	Research (mixed methods)	Early screening, assessment and intervention	Report findings from Pathways to Resilience Program, designed to support youth with special needs who access multiple services	N = 116 youth
Van Andel et al. (2016) Netherlands	Research (quantitative)	Early screening, assessment and intervention	Explore efficacy of Foster Family Intervention on improving quality of newly formed relationships between foster carers and infants/toddlers	N = 123 infants and toddlers
Van Andel et al. (2012) Netherlands	Program description	Early screening, assessment and intervention	Explain aims and principles underlying the Foster carer-Foster child Intervention (FFI) and describe implementation	N/A
Victor et al. (2008) USA	Research (quantitative)	Early screening, assessment and intervention	Explore association between foster care placement history and behavioral and executive functioning in children with FASD	N = 136 children
Wakelyn (2011) UK	Research (qualitative)	Providing theoretically grounded care	Follow experience of an infant or young child in care, learn about the possible reasons for under-detection of mental health and emotional difficulties	N = 1 3-month old at first visit, 13 months at last visit
Warren (2013) USA	Program description	Intersectoral collaboration	Describe benefits and tasks of being a Court Appointed Special Advocate for a baby (CASA)	N = 1 CASA worker.
Watkins et al. (2013) Australia	Peer reviewed literature review	Early screening, assessment and intervention	Systematic review on diagnosis prepared and evaluated by a panel of pediatricians.
Watts (2015) UK	Educational resource	Intersectoral collaboration	Chart progress of Scottish Government in developing training materials to address FASD knowledge gaps
Wells et al. (2013) US	Research (quantitative)	Early screening, assessment and intervention	Report on effectiveness of ALERT Program in improving executive functioning in children with FASD	N = 78 children ages 6 to 12
Werk et al. (2013) Canada	Research (quantitative)	Early screening, assessment and intervention	Use data from statistics Canada to assess prevalence of FASD diagnoses in Aboriginal children living on and off reserve	N/A
Williams et al. (2012) US	Research (quantitative)	Early screening, assessment and intervention	Evaluate effectiveness of a model program designed to screen young foster children and link them with infant mental health services	N = 151 in Phase 1 and 281 in Phase 2
Wotherspoon et al. (2009) Canada	Educational resource	Providing theoretically grounded care	Information sheet outlines the signs and appropriate responses to emotional trauma in infancy	N/A
Wotherspoon and Petrowski (2008) Canada	Educational resource	Providing theoretically grounded care	Information sheet offers information and advice on the social-emotional development of children under five for foster parents and case-workers	N/A
Wotherspoon and Gough (2008) Canada	Educational resource	Early screening, assessment and intervention	Information sheet outlines importance of assessing and responding to emotional neglect in infants and toddlers	N/A
Wotherspoon et al. (2008) Canada	Program description	Intersectoral collaboration	Describe partnership between an infant mental health consultation program and child welfare authorities	N/A
Wotherspoon and Petrowski (2008) Canada	Educational resource	Providing theoretically grounded care	Describe what young children need for healthy social and emotional development	N/A
Young et al. (2009) USA	Expert opinion – policy	Intersectoral collaboration	Assess state child welfare policies related to prevention, intervention, identification and treatment of prenatal substance exposure	N/A
Yumoto et al. (2008) USA	Research (quantitative)	Early screening, diagnosis and intervention	Test proposed models of risk for prenatally cocaine exposed children to developing difficulties	N = 337 children assessed at age 7
Zeanah et al. (2011) US	Expert opinion	Providing theoretically grounded care	Review research on attachment theory and describe interventions supporting child-parent attachment relationship	N/A
Zhou and Chivers (2010) Australia	Research (quantitative)	Early screening, diagnosis and intervention	Understand characteristics related to placement of infants in out-of-home care,	N = 5,738 infants less than one year entering care

Table 3 Comparison of themes from the three analyses

Infant review	Children and youth review	Integrated review: Infant to aged 19
Identification of infants and families at risk of requiring foster care	Challenges to stability and permanency	Supporting parents and foster care providers
Child welfare program elements	Challenges to FASD-informed service provision	Early screening, diagnosis and intervention
Outcomes for infants in care and their families	Overrepresentation of Indigenous children and youth in care	Providing theoretically grounded care
Mental health promotion	Presence of concurrent mental health concerns	Intersectoral collaboration

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