{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:15:46Z","timestamp":1788221746873,"version":"build-2803163510"},"reference-count":94,"publisher":"American Academy of Pediatrics (AAP)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>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\u2019s effects differed between subgroups of IPOEs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>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, \u221261.3 percentage points [pp] [95% CI, \u221265.6 to \u221257.0]), as well as larger decreases among IPOEs without additional exposures to alcohol (\u221227.1 pp [\u221237.0 to \u221217.2]), amphetamines (\u221217.7 pp [\u221227.7 to \u22127.8]), benzodiazepines (\u221216.4 pp [\u221226.4 to \u22126.4]), and cocaine (\u221255.5 pp [\u221264.2 to \u221246.8]). Guideline implementation had no overall or differential impacts on rates of discharge in parental custody.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1542\/peds.2025-075126","type":"journal-article","created":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T00:03:11Z","timestamp":1786579391000},"source":"Crossref","is-referenced-by-count":0,"title":["Discretionary Child Protective Services Reporting for Infants With Prenatal Opioid Exposure"],"prefix":"10.1542","volume":"158","author":[{"given":"Rohan","family":"Khazanchi","sequence":"first","affiliation":[{"name":"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"},{"name":"2Department of Internal Medicine, Boston Medical Center, Boston, Massachusetts"},{"name":"3Department of Pediatrics, Boston Medical Center, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Davida M.","family":"Schiff","sequence":"additional","affiliation":[{"name":"4Division of General Academic Pediatrics, Mass General Brigham for Children, Boston, Massachusetts"},{"name":"5Division of Newborn Medicine, Mass General Brigham for Children, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Egan","sequence":"additional","affiliation":[{"name":"3Department of Pediatrics, Boston Medical Center, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Genevieve","family":"Preer","sequence":"additional","affiliation":[{"name":"3Department of Pediatrics, Boston Medical Center, Boston, Massachusetts"},{"name":"6Department of Pediatrics, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul R.","family":"Shafer","sequence":"additional","affiliation":[{"name":"7Department of Health, Law, Policy, and Management, School of Public Health, Boston University, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kirsten","family":"Austad","sequence":"additional","affiliation":[{"name":"8Department of Family Medicine, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, Massachusetts"},{"name":"9Evans Center for Implementation and Improvement Sciences, Boston University, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cecily M.","family":"Barber","sequence":"additional","affiliation":[{"name":"10Department of Obstetrics and Gynecology, Boston Medical Center, Boston, Massachusetts"},{"name":"11Department of Obstetrics & Gynecology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mei","family":"Elansary","sequence":"additional","affiliation":[{"name":"3Department of Pediatrics, Boston Medical Center, Boston, Massachusetts"},{"name":"6Department of Pediatrics, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts"},{"name":"9Evans Center for Implementation and Improvement Sciences, Boston University, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raquel","family":"Selcer","sequence":"additional","affiliation":[{"name":"3Department of Pediatrics, Boston Medical Center, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaye-Alese","family":"Green","sequence":"additional","affiliation":[{"name":"3Department of Pediatrics, Boston Medical Center, Boston, Massachusetts"},{"name":"12Boston Triple Board Residency Program in Pediatrics, Psychiatry, and Child & Adolescent Psychiatry at Boston Children\u2019s Hospital, Boston Medical Center, and Tufts Medical Center, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tobi","family":"Okopie","sequence":"additional","affiliation":[{"name":"3Department of Pediatrics, Boston Medical Center, Boston, Massachusetts"},{"name":"12Boston Triple Board Residency Program in Pediatrics, Psychiatry, and Child & Adolescent Psychiatry at Boston Children\u2019s Hospital, Boston Medical Center, and Tufts Medical Center, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna M.","family":"Modest","sequence":"additional","affiliation":[{"name":"13Department of Obstetrics & Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisha M.","family":"Wachman","sequence":"additional","affiliation":[{"name":"3Department of Pediatrics, Boston Medical Center, Boston, 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