Infants with prenatal substance exposure (PSE) are reported to Child Protective Services (CPS) at disproportionately high rates, leading to elevated risks of foster care placement and family separation. Despite the American College of Obstetricians and Gynecologists’ opposition to punitive reporting practices, many state and hospital policies continue to mandate reporting after prenatal substance use, raising critical concerns about equity, maternal mental health, and child development. This scoping review follows Arksey and O’Malley’s methodological framework to synthesize U.S. and Canadian evidence on CPS involvement (triggered specifically by clinician reporting) and its effects on birthing parents with substance use disorder and their children under age three. Preliminary screening of 7,385 records reveals limited high-quality evidence directly evaluating maternal mental health outcomes, recovery trajectories, and early child development after CPS intervention. Early findings from background literature indicate that mandatory reporting may discourage treatment engagement, erode trust in health systems, and exacerbate stress for families already facing systemic inequities. Anticipated outcomes include identifying substantial knowledge gaps, particularly regarding long-term child well-being and maternal recovery. The review aims to inform evidence-based policy approaches that prioritize family preservation, equitable care, and maternal-infant health rather than punitive surveillance.