Hospitals in Washington state no longer have to report all babies with prenatal drug exposure to Child Protective Services as long as there are no safety concerns. The policy change is intended to reduce stigma against parents with addiction and improve care at birthing hospitals.
“The opioid and overdose epidemic is disrupting the lives of a growing number of families in our state,” Dr. Tao Sheng Kwan-Gett, the chief science officer at the Washington Department of Health (DOH), said in a statement. “These changes will help every baby born in Washington get the healthiest start possible.”
Clinicians at birthing hospitals were previously mandatory reporters, required to contact CPS if newborns test positive for illicit substances or experience withdrawal. But now infants can receive “voluntary wrap-around services” without being reported, DOH wrote in a statement this week.
“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,” Ross Hunter, the state secretary of the Department of Child, Youth and Families (DCYF), said in a statement.
If hospital staff feel a child is at “imminent risk of serious harm” due to substance use, they are still required to report it to the state, a DCYF spokesperson told The Seattle Times. But the main concern is the safety of the child, not the substance being used.
Washington is leaning into the “Eat, Sleep, Console” model of care, which prioritizes a low-stimulation environment, breastfeeding and skin-to-skin contact. NICU admissions and medications should no longer be the first line of care for newborns showing withdrawal symptoms, according to the DOH.
“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,” Hunter said.
The new guidelines take effect immediately, but hospitals have until January 2025 to update their own policies and train staff.
Drug overdoses have skyrocketed nationwide over the past three years, and Washington is no exception. Nonfatal opioid overdoses in King County nearly doubled from 2019 to 2022 and are on the rise again this year, according to EMS data.
For half a century, hospitals have used a method called the Finnegan Neonatal Abstinence Scoring Tool to look for withdrawal symptoms in newborns. The tool looks at everything from sleeping and crying habits to sweating and how often newborns yawn.
Many infants who showed signs of opioid exposure were given pharmacological treatment for withdrawal. But there have been concerns that it overestimates the need for medication and uses subjective factors, according to the National Institutes for Health.
By contrast, the Eat, Sleep, Console model prioritizes nonmedical interventions and keeping mother and baby together.
“What do we really need babies to be able to do? We need babies to be able to eat, we need babies to be able to sleep and we need babies to be consolable,” one nurse practitioner told The Seattle Times. “Let’s look at those three things, instead of subjective symptoms, to assess how the baby’s doing and whether or not interventions are needed for withdrawal.”
The NIH reported this year that one clinical trial found the Eat, Sleep, Console model more effective than the Finnegan tool for assessing and managing opioid-exposed newborns.