More than a year after Pennsylvania child welfare officials convened an expert group to address the growing problem of prenatal drug exposure, the state appears no closer to bringing itself into compliance with a federal law that requires health care providers and child welfare officials to take steps to protect narcotic-exposed newborns before hospitals discharge them.
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| Jim Greenwood |
The situation recently compelled a former Bucks County congressman to reach out to key state policy makers urging them to provide “immediate” guidance to counties to ensure drug-exposed newborns are put on the child protection radar regardless of the type of drug the mother used in pregnancy.
Those referrals between health care providers and child welfare authorities should be happening now under a 2016amendment to the federal Child Abuse Protection and Treatment Act, better known as CAPTA. But in Pennsylvania they aren’t always happening because of a conflict with state law that exempts babies born exposed to narcotics their mothers took under medical supervision, including heroin replacement drugs such as methadone, which are typically prescribed to pregnant heroin users as part of drug treatment.
In a letter sent last week, former U.S. Rep. James Greenwood urged state officials, including Attorney General Josh Shapiro and acting Department of Human Services Secretary Teresa Miller, to provide joint guidance to counties regarding the CAPTA requirement for appropriate referrals and plans of safe care. The letter also was sent to U.S. Sen. Bob Casey and the other Pennsylvania members of the U.S. House and Senate.
Greenwood wrote that while he supports efforts to develop comprehensive prevention and treatment strategies for prenatal narcotics exposure, the state needs to inform counties about the federal reporting requirement update.
“Pennsylvania infants born drug dependent today and in the upcoming months, urgently require two-generation plans of safe care focused on improving outcomes for the infant and his/her families,” he wrote.
Under a 2003 federal provision, which Greenwood wrote, states must have policies in place requiring health care providers to report newborns born prenatally exposed to narcotics or alcohol or that show signs of drug or alcohol withdrawal to child protection authorities; child welfare is required to assess the infant’s home environment and ensure a safe-care plan is in place, which may include services to drug-dependent parents and temporary supervision, before a child is sent home.
Greenwood, who now works for a biotechnology trade association, said in a phone interview the purpose of the federal law isn’t punishing pregnant substance abusers but providing an opportunity for child welfare and social services to intervene to make sure babies and their parents are in safe living environments.
“This is not about stigmatizing the mother at all. It’s about a yellow light that accompanies this baby into the world and society’s obligation to make sure this baby is safe,” he added.
The confusion over the reporting requirement is seen in state data, which shows a significant gap between the number of babies born drug-exposed versus the number reported to child welfare authorities, according to an analysis by this news organization. In 2016, the most recent year available, just under 2,100 Pennsylvania newborns whose births were covered under state-funded Medicaid health insurance were diagnosed with narcotic withdrawal symptoms, known as neonatal abstinence syndrome, but only 972 newborns with prenatal drug exposure were reported to county child welfare authorities, according to annual DHS data. Medicaid covered roughly 40 percent of births in Pennsylvania in 2015, the most recent year available, according to the Kaiser Family Foundation.
The birth numbers did not include substance-exposed newborns born to mothers with private health insurance, who account for the majority of births, because no public agencies collect that data.
The Wolf Administration declaration of a 90-day state of emergency in the fight against opioid and opiate addiction Wednesday has no impact on the exemption since it is an existing state law, meaning any change requires legislative action. In an emailed response, AG spokesman Joe Grace stated that the Office of Attorney General is prohibited by state law from offering legal advice directly to counties.
Greenwood isn’t alone in his concern about the foot-dragging with CAPTA compliance.
Last year, Bucks County Rep. Katharine Watson, R-144, of Warrington, introduced a bill — in response to a story in this news organization’s ongoing Born into Addiction series — that would reverse the 2015 amendment to the state’s Child Protective Services Act that creating a reporting exemption for substance-exposed newborns in cases where the mothers were legally prescribed addictive narcotics during pregnancy.
Watson, who chairs the Child and Youth Committee, said she has backed off pushing her bill through the House — for now — at the request of the state Department of Human Services, which convened a multi-disciplinary group of child health and welfare professionals about 18 months ago to create a comprehensive plan to bring the state into compliance.
Watson said the work group regularly updates her about its efforts to develop infrastructure and guidance needed to support compliance with the federal law, including universal screening narcotic protocols for pregnant women and determining who is responsible for the development and control plans of safe care.
Born Into Addiction
A continuing series about the youngest victims of narcotics abuse, newborns who were exposed in the womb and children being raised by parents who are addicted to opiates like heroin and their synthetic siblings, like oxycodone and methadone.
Pennsylvania has received an extension until June 30, 2018, to comply with the CAPTA law, but the work group has offered no assurances the recommendation will meet the deadline. That lack of a timetable concerns Watson.
“Do you realize how many babies will be born while they work all this out?” she said in a recent interview. “I need more of the doing — to keep talking about it makes me crazy.”
Among the outstanding issue for the work group is determining who is responsible for creating the plan of safe care. Federal guidance under CAPTA does not specify that it’s the child welfare system’s responsibility in all situations, according to a state DHS spokeswoman, Rachel Kostelac. She added the work group is gathering information to ensure that any plans developed appropriately address the needs of the infant and any caregivers.
Cathleen Palm is the founder and executive director of the Center for Children’s Justice in Berks County. She also sits on the state work group on prenatal substance exposure. She confirmed the committee has met monthly for more than a year and recently added health care representatives that work with pregnant drug users.
“I think the challenge is we’re trying to figure out what is really complicated stuff in both policy and practices with moms and babies and how to balance what both need at a time when there is an ongoing opiate crisis,” Palm said.
While Congress directed states to develop plans of safe care for drug-exposed newborns, it allocated no additional funding for it, Palm pointed out.
She added that many babies are getting properly referred to child welfare and the system is becoming overwhelmed. Many families need core safety components that are beyond the scope of child welfare, such as stable housing, drug treatment, transportation and child care.
Palm agreed with Greenwood that immediate state guidance about CAPTA referrals is missing, and that it almost seems like pregnant and postpartum women are disconnected from other strategies for addressing the opioid and heroin crisis.
“It’s almost like that part of the crisis — let’s put it over there on the table,” she said. “We needed guidance and best practice before, but now we need it even more. What they should be telling people is we don’t want there to be a barrier to connecting babies and mothers who have some substance exposure to these plans of safe care.”
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