Tracy Markowitz is a 2015 graduate of the PsyD Program in Clinical Psychology at Antioch University, New England

Dissertation Committee

George Tremblay, PhD, Committee Chair
Martha Straus, PhD, Committee Member
Jean Twomey, PhD, Committee Member


infants, prenatal substance exposure, Child Welfare Service, attachment, policy

Document Type


Publication Date



Children with prenatal substance exposure are often born into families of low socio-economic status, low educational level, and with restricted access to health services. Pregnant substance-using mothers tend to reject, neglect, and generally misattune to their infant children. These environmental risk factors increase the likelihood of negative developmental outcomes such as poor academic performance, externalizing behaviors, and an insecure attachment style. In compliance with the Child Abuse Prevention and Treatment Act and the Adoption and Safe Families Act, Child Welfare Services often places at-risk infants into traditional or kinship foster care placements. This study looked at how placement type and frequency of foster care placements affected the development of secure attachment behaviors of 46 prenatally substance-exposed infants as measured by the Attachment Q-Sort (AQS). While findings are statistically nonsignificant, results indicate two interesting patterns: (a) There is a positive association between placement transitions and AQS and (b) Displaced children that were placed into kinship foster care have greater attachment security than their non-placed counterparts. I present these findings to three clinicians who work with children involved in Child Welfare Services. Study results and clinician reactions provide actionable suggestions for shifting child welfare policy.


ORCID Scholar ID #: 0000-0002-5698-506X