Discretionary Child Protective Services Reporting for Infants With Prenatal Opioid Exposure

Abstract

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.