This final report summarizes the work of Delaware, New York, and Minnesota through the In-Depth Technical Assistance-Infants with Prenatal Substance Exposure (IDTA-IPSE) program. It presents findings, challenges, and barriers sites identified as they assessed changes made toward improving the safety, health, permanency, and well-being of infants affected by prenatal substance exposure, primarily opioids. This report also summarizes sites’ efforts toward improving recovery outcomes of pregnant and parenting women and their families.