Related Experiment Video
Updated: Aug 14, 2026
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
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.
Insights
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.
Objective:
Hospital guidelines implemented in May 2021 to end reflexive child protective services (CPS) reporting for infants with prenatal substance exposure nearly halved overall reporting rates among infants with prenatal opioid exposure (IPOE). Given concerns that discretionary reporting may exacerbate inequities, this study assessed whether the guideline's effects differed between subgroups of IPOEs.
Methods:
We used a difference-in-difference-in-differences (DDD) approach to assess the differential impact of guideline implementation on rates of CPS reporting and discharge in the custody of a biological parent by minoritized (vs nonminoritized) birthing parent race and ethnicity, prescribed (vs any nonprescribed) opioid exposure, and presence (vs absence) of additional nonopioid coexposures. Analyses included 3581 IPOEs born across 17 Massachusetts birthing hospitals from 2017 to 2024.
Results:
In DDD analyses, guideline implementation did not differentially affect rates of CPS reporting by race and ethnicity or coexposure to cannabis. Guideline implementation did lead to larger decreases in CPS reporting rates among IPOEs exposed to only prescribed opioids compared with those exposed to nonprescribed opioids (DDD, -61.3 percentage points [pp] [95% CI, -65.6 to -57.0]), as well as larger decreases among IPOEs without additional exposures to alcohol (-27.1 pp [-37.0 to -17.2]), amphetamines (-17.7 pp [-27.7 to -7.8]), benzodiazepines (-16.4 pp [-26.4 to -6.4]), and cocaine (-55.5 pp [-64.2 to -46.8]). Guideline implementation had no overall or differential impacts on rates of discharge in parental custody.
Conclusion:
Guideline-informed discretionary reporting for IPOEs did not lead to differential impacts by race or ethnicity. The largest decreases in reporting were among infants with only prescribed opioid exposure and without other substance coexposures.
