Existing policies, strategies, and activities that compose the national response to the problem of prenatal substance exposure are considerably stronger than they were in the late 1980s and early 1990s. However, the substance-exposed infant (SEI) problem requires close ties across the boundaries of public and private systems serving children and their families, robust information systems and a willingness to use those systems to support accountability in achieving interagency missions, and greater attention to the gaps between policy as it is stated and policy as it is actually carried out at State and local levels. The 10 States reviewed in this report have shown that SEI policy can be made effective, and that it can be taken to scale. The report describes the findings from a review and analysis of States' policies regarding prenatal exposure to alcohol and other drugs, in order to help State, local, and tribal governments. The framework around which the report is organized asserts that there are five major timeframes when intervention in the life of the SEI can reduce potential harm of prenatal substance exposure: pre-pregnancy, prenatal, birth, neonatal, and throughout childhood and adolescence. This framework formed the basis for the review of State practices with SEIs. When the needs of substance-exposed children are addressed, it is apparent that the connections across these five points discussed are as important as the actual interventions. The handoffs from one point to the next and the linkages needed to coordinate services become a comprehensive services framework. Recommended action steps are outlined to provide the proper foundation for this framework resulting in better outcomes. Appendix, tables, references, and endnotes