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Discretionary Child Protective Services Reporting for Infants With Prenatal Opioid Exposure
Rohan Khazanchi1,2,3, Davida M Schiff4,5, Elizabeth Egan3
1Divisions of Health Policy & Insurance Research (HPI) and Child Health Research & Policy (CHeRP), Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Healthcare Institute, Boston, Massachusetts.
New hospital guidelines for infants with prenatal opioid exposure (IPOE) reduced child protective services (CPS) reporting. Discretionary reporting did not worsen racial inequities but decreased reporting most for infants with prescribed opioid exposure and no other coexposures.
Area of Science:
- Neonatal Abstinence Syndrome
- Public Health Policy
- Child Welfare
Background:
- Hospital guidelines changed in May 2021 to end reflexive child protective services (CPS) reporting for infants with prenatal substance exposure.
- These guidelines nearly halved overall reporting rates for infants with prenatal opioid exposure (IPOE).
- Concerns exist that discretionary reporting may exacerbate existing inequities.
Purpose of the Study:
- To assess whether the guideline's effects on CPS reporting differed between subgroups of IPOEs.
- To evaluate the impact of guideline implementation on reporting rates based on birthing parent race/ethnicity, opioid prescription status, and coexposures.
Main Methods:
- A difference-in-difference-in-differences (DDD) approach was used.
- The study analyzed data from 3581 IPOEs born between 2017 and 2024 across 17 Massachusetts hospitals.
- Key variables included birthing parent race/ethnicity, prescribed vs. nonprescribed opioid exposure, and presence of other substance coexposures.
Main Results:
- Guideline implementation did not differentially affect CPS reporting rates by race/ethnicity or cannabis coexposure.
- Larger decreases in CPS reporting were observed for infants exposed only to prescribed opioids compared to nonprescribed opioids.
- Significant decreases in reporting were also noted for infants without additional coexposures to alcohol, amphetamines, benzodiazepines, and cocaine.
Conclusions:
- Guideline-informed discretionary reporting for IPOEs did not result in differential impacts based on race or ethnicity.
- The most substantial reductions in CPS reporting were seen in infants with only prescribed opioid exposure and no other substance coexposures.
