Washington State Hospitals Don’t Need to Report All Drug Exposed Newborns to CPS

Social and economic policies and norms that devalue mothers have had a profoundly negative impact on birth rates. (Peter Schulzek/Shutterstock)

Hospitals in Washington state are no longer required to report infants with prenatal drug exposure to Child Protective Services (CPS), provided there are no safety concerns.

The updated state policy allows voluntary “wrap-around” services to be provided to infants born exposed to drugs if health care providers have no safety concerns.

The move is a joint effort by the Washington State Department of Children, Youth, and Families (DCYF), the Department of Health (DOH), the Health Care Authority, and the Washington State Hospital Association.

DCYF framed the decision as a move to “enhance the well-being of infants and parents impacted by substance use at birth.”

“The opioid and overdose epidemic is disrupting the lives of a growing number of families in our state,” said Dr. Tao Sheng Kwan-Gett, chief science Officer at the Washington Department of Health (DOH). “These changes will help every baby born in Washington get the healthiest start possible.”

Hospitals are urged to align their policies with the new state requirements and ensure that their staff members are trained accordingly by the first day of 2025, in compliance with federal regulations, DOH said in a statement.

DCYF Secretary Ross Hunter emphasized the importance of connecting families with community-based services and resources, underscoring that not all families with children affected by prenatal substance exposure require child welfare intervention.

“While hospitals are still required to report cases where there is a safety concern for the child, not all families that have a child with prenatal substance exposure require child welfare intervention,” Hunter said in a statement. “We still want to connect these families with community-based services and resources that will support the family’s needs, reduce risks, and increase protective factors.”

New Model of Care

The updated requirements also include guidelines for the clinical care of mothers in need of withdrawal or stabilization care during childbirth. Similarly, best practices have been outlined for newborns who are being monitored or treated for withdrawal symptoms.

In the United States, at least one newborn with neonatal opioid withdrawal syndrome is diagnosed every 24 minutes, according to Rebecca G. Baker, director of the HEAL Initiative at the National Institutes of Health (NIH).

The state now formally recognizes the Eat, Sleep, Console (ESC) model of care for birthing hospitals as the best practice. This means that medications and NICU admissions “should no longer be the first line of treatment for infants exhibiting withdrawal symptoms.”

“Substance-exposed” infants, who often experience withdrawal opioid symptoms, were for years treated primarily according to the Finnegan Neonatal Abstinence Scoring Tool. But the Washington DOH states that a growing body of research shows that infants treated using the ESC model experience shorter hospital stays and are less likely to receive medication to treat neonatal opioid withdrawal symptoms.

The ESC model “prioritizes parental involvement and non-pharmacological care such as cuddling, swaddling, rooming-in with parents, chest/breastfeeding, and a quiet, dark room.”

The National Institutes of Health (NIH) reported in May that one clinical trial found the model to be more effective than the Finnegan tool for assessing and managing opioid-exposed newborns. However, it also cautioned that it has not been tested rigorously in a large population and noted concerns about “potentially undertreating infants or discharging them prematurely.”

How It Works

The DCYF policy states that “clinicians at birthing hospitals are mandatory reporters and must contact Child Protective Services when there are child protective concerns.”

They are mandated to report when there are child protection concerns, newborns test positive for illicit substances or misused medications, newborns experience withdrawal from substances, evidence of ongoing substance use by parents poses safety concerns, or when a newborn is diagnosed with Fetal Alcohol Spectrum Disorder (FASD) with safety concerns.

The new policy states that when infants with prenatal drug exposure do not meet these criteria, and if there are no safety concerns, clinicians can use an online portal to refer the parents to a service called Help Me Grow.

The portal uses an algorithm to help the clinician determine what action to take. The portal collected de-identified data which automatically get sent to DCYF in aggregate. In some cases, the portal will direct the clinician to call DCYF Intake.

“If a notification is required, the online portal’s algorithm will direct the provider to complete the POSC. The POSC is automatically sent to Help Me Grow,” the policy states.

“Help Me Grow will reach out to the family and refer them to services based on the POSC and other wrap-around supports. HMG-WA will collect de-identified data elements to report (in aggregate) to DCYF regularly.”