Evaluators Can Leverage State Action to Align Policy with Clinical Best Practice: Updating Mandated Reporting Laws to Support Family-Centered Care 

Under the Child Abuse and Prevention Treatment Act (CAPTA), as amended by the Comprehensive Addiction and Recovery Act (CARA), states are required to have procedures for identifying and reporting to child protective services (CPS) any infants showing substance withdrawal symptoms, including alcohol and drugs. States must also establish a process for creating a Plan of Safe Care (POSC) that addresses the health needs of both the infant and the parent or caregiver. States often require mandatory reporters to contact CPS when prenatal substance exposure is identified.  

Unfortunately, mandatory reporting of prenatal drug exposure can discourage pregnant people from seeking treatment or disclosing substance use. Although the recommended standard of care for pregnant people with opioid use disorder (OUD) is treatment with medication for opioid use disorder (MOUD), pregnant people with OUD may be hesitant to engage with the health care system due to concerns about potential consequences involving CPS or the criminal legal system.

State Policy Action 

Some states are now updating their policies to better align with clinical best practice. In 2023, Massachusetts state legislators requested evidence of how reporting requirements at the time may have been detrimental to women and families. In response, a research team at Massachusetts General Hospital studied how state reporting requirements affect pregnant and postpartum individuals with OUD. The team interviewed people who had given birth within the past three years, and participants who received MOUD described feeling stigmatized and anxiety about being reported to CPS. One participant stopped MOUD during pregnancy to avoid being reported. The study has since been published in a peer-reviewed journal, allowing other states to rely on this data to advance similar policy change.   

The findings of this study likely informed legislative decision-making: In December, 2024, Massachusetts Governor Healey signed An Act Relative to Treatments and Coverage for Substance Use Disorder and Recovery Coach Licensure. This legislation ended the automatic requirement to file child protection reports for all detected cases of infant substance dependence.  

Based on the new law, mandated reporters must still report suspected physical or emotional abuse, neglect, sexual exploitation, and human trafficking, but can no longer make a report based solely on prenatal substance exposure. The updated law allows providers to assess parental capacity and use clinical judgment to assess risk, reporting cases to the Massachusetts Department of Children and Families (DCF) only when necessary to prevent maltreatment and ensure infant safety.  

While the law went into effect in March 2025, the Department of Public Health (DPH) is still in the process of promulgating regulations. The law requires DPH to involve various stakeholders in the rulemaking process, including clinicians who provide care to pregnant people and behavioral health providers, people with lived experience receiving treatment while pregnant, and advocacy organizations. Once finalized, the regulations will guide health care providers caring for infants and families affected by prenatal substance exposure, including how providers should assess prenatal substance exposure (including prescribed medications) and provider responsibilities under CAPTA.  

The new law also establishes mechanisms to track outcomes and measure impact. Under the law, DPH, in consultation with DCF and the Office of the Child Advocate, must submit an annual report by April 1, analyzing the prevalence of births identified as affected by prenatal substance exposure. It must also include: 

• • Identification of service gaps for perinatal patients and affected infants; 

• • A review of child abuse and neglect reports related to prenatal substance exposure, including reports that DCF ultimately screened out; 

• • An examination of reports specifically tied to an infant’s prenatal exposure to substances;  

• • Recommendations for any needed changes, including legislative or regulatory updates, to support the health, safety, and well-being of perinatal patients and infants; and 

• • To the extent disparities are identified in the safety or well-being of infants affected by prenatal substance exposure, recommendations on how to address those inequities.