The 2001 Washington State Legislature directed the Institute to “evaluate outcomes across state health and social service pilot projects and other national models involving women who have given birth to a drug-affected infant, comparing gains in positive birth outcomes for resources invested…” (Chapter 7, Section 608, Laws of 2001). This report addresses this legislation and examines five questions: (1) What is the risk of prenatal substance abuse? (2) How are key programs structured? (3) What positive birth outcomes are associated with specialized treatment programs? (4) What are the costs associated with achieving positive birth outcomes? and (5) What programs are most effective at achieving positive birth outcomes?