A nurse tiptoes to one of the cribs and places a stethoscope against a tiny bundle of white blankets. The baby stirs, but doesn't open her eyes, then falls back into a peaceful sleep. She is one of four drug-exposed infants being cared for at the Pediatric Interim Care Center, located about 20 miles south of Seattle.
"The babies generally have anywhere from two to five drugs in their system, if not more," explained Barbara Drennen, who founded PICC in 1990. Since then, her staff have provided withdrawal care and a safe haven for more than 3,300 babies sent by the Washington Department of Children, Youth and Families.
Now, Drennen worries a new state policy that no longer requires hospitals to report all substance-exposed newborns to Child Protective Services will endanger infants like those she cares for. But the state says its goal is keeping children safe and avoiding breaking up families unnecessarily.
Washington's Department of Health (DOH) announced the new policy in June. Hospitals have until Jan. 1, 2025 to comply.
Clinicians at birthing hospitals were previously required to report newborns affected by prenatal drug or alcohol exposure to CPS. Now, families can receive what the state calls "voluntary wrap-around services" without being reported, as long as there are no safety concerns for the infant, according to DOH.
"There's not a lot of change in terms of the types of circumstances that they were previously reporting," said Alissa Copeland, early learning program manager for the state's Department of Children, Youth, and Families (DCYF). "The biggest change is that families that would not necessarily meet that threshold around safety concerns are now offered a voluntary community pathway that they didn't previously have available."
Substances can include alcohol, marijuana or hard drugs, as well as medications that a pregnant woman is using as prescribed, even if she's unaware that it could impact her baby, according to Copeland
But the new policy is swaddled in bureaucratic language. Hospitals can refer families to wrap-around services — such as housing, addiction treatment plans and infant supplies — without a CPS report as long as there are no safety concerns, according to the DOH. But while DCYF previously said the emphasis for reporting was on whether a baby is in "imminent risk of serious harm" rather than the substance involved, a Plan of Safe Care matrix from the agency suggests most cases in which an infant tests positive for an illegal drug will still require DCYF notification.
The changes aim to encourage mothers to pursue services without fear of CPS involvement, and destigmatize addiction, according to supporters of the new standards.
"There are many, many people who are high-functioning who are addicted to opiates," Dr. Sheela Sathyanarayana told the Washington State Standard. "Similarly, there’s many, many people who are in methadone programs. They know they have an addiction, they’re working on it, they’ve been consistently in a program that has been helping them."
Critics say the confusing policy will exacerbate underreporting problems.
"It's going to put [babies] in a very dangerous position," Drennen said. "Quite often people think mom just gave birth to this baby and she's going to be clean and she can take this baby home and take care of the baby. That's not always the case."
An optimistic social worker straight out of college, Denise Baker investigated gut-wrenching child abuse allegations and carried cases through the foster care placement process in Washington. She began her career in the 1980s, when crack and heroin were devastating communities across the country.
"Drug use was a factor in probably 80 to 90% of the families that I worked with," Baker told Fox News, adding that it was difficult to place substance-exposed babies with foster families. "They were very fussy, irritable babies, and they were at risk for ongoing developmental issues."
She stopped working with CPS when she became a mother, saying the cases hit "too close to home," and spent the end of her career working with aging adults.
Baker said she was appalled to hear of Washington's new reporting policy.
"The most vulnerable infants who are the most difficult to care for will be left with parents least able to care for them," she said.
The number of Washington infants reported to CPS as substance-exposed increased nearly 300% from 2012 to 2020, according to the most recent figures available.
But as addiction and overdoses skyrocketed even further in the Evergreen State following the start of the coronavirus pandemic, CPS intakes of all children plummeted. PICC experienced a 40% decrease in admissions, staff said, indicating that either fewer babies were being born with prenatal exposures or they just weren't getting referred to the center during the chaotic early months of the pandemic.
Baker emphasized that reporting a substance-exposed infant does not automatically mean a baby will be removed from his or her parents.
"It's a very long, difficult process to remove a child," she said. "There are a lot of legal protections for parents."
A tumultuous off-again-on-again relationship culminated with Larry Torres learning he might be a father one week before his daughter Madeline was born. Madeline was born exposed to drugs and spent several weeks at PICC recovering. With Madeline's mother out of the picture due to ongoing substance use, Torres spent every day at the center caring for his daughter.
"From what I could see, there wasn’t going to be anybody in her corner," Torres said.
Now Madeline is about to turn one year old. She's happy, healthy and loves when Torres reads to her or props her on his lap while he studies to become a drug and alcohol counselor. He said he finds the state's new policy for substance-exposed babies "a bit concerning."
"Now we're taking our eyes off of the child and we're focusing on the family and we're not really focusing on what the child needs," he said. "What my daughter went through and where she was placed, that was the best thing for her and I."
Washington is not the only state to change its approach to substance exposed newborns in recent years. DCYF spokesperson Nancy Gutierrez said the new policy is meant to align Washington with federal requirements under the Comprehensive Addiction and Recovery Act of 2016. The law stipulates that health care providers should notify CPS when infants are affected by substance abuse or withdrawal symptoms resulting from drug exposure. But reports should not automatically be construed as child abuse or neglect.
The act also leaves states the flexibility of defining phrases like "substance abuse" and "withdrawal symptoms."
States that have already changed their policies include Louisiana and New Mexico. Both states require health officials to notify child welfare officials if an infant exhibits signs of withdrawal or other drug effects, but specify that the notification should not be interpreted as a report of child abuse.
Baker had a grim outlook for Washington's change, predicting residents would see the effects of it "with the first death."
"There'll be some deaths," she said. "And then I do believe there would be public pressure and things could change."
Gutierrez disagreed that there was cause for concern.
"These changes do not prevent anyone from calling our intake lines, sharing any concerns of suspected abuse or neglect," Gutierrez said. "We're not preventing anyone from making those concerns known to our department."
Addiction has "hit every family in America," Drennen said. And while the drugs may have changed since she founded PICC 33 years ago, the importance of the center has not, she said.
The center gives caseworkers time to talk to families, conduct home checks and run background checks to make sure a substance-exposed baby will be safe, Drennen said. It's a buffer she fears will disappear as the state's new policies take effect.
"It has allowed the caseworker to go home at night and know the place she has put this baby in permanently has checked out fine," Drennen said. "This is what this program was designed for, and it has done its job."
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