State agencies announce changes in policy and best practices for infants and parents affected by substance use at birth 

OLYMPIA – The Washington State Department of Children, Youth, and Families (DCYF), in conjunction with the Department of Health (DOH), the Health Care Authority, and the Washington State Hospital Association, have updated state requirements and best practices that aim to improve the health of infants and parents affected by substance use at birth.  

If there are no safety concerns, state policy now allows substance-exposed infants to receive voluntary wrap-around services without being reported to Child Protective Services. All hospitals should update policies to align with state policy and train staff no later than Jan. 1, 2025, to comply with federal requirements. 

 "While hospitals are still required to report cases where there is a safety concern for the child, not all families that have a child with prenatal substance exposure require child welfare intervention. We still want to connect these families with community-based services and resources that will support the family's needs, reduce risks, and increase protective factors," said DCYF Secretary Ross Hunter. 

Updated requirements also include best practices for the clinical care of mothers/birth parents who need withdrawal/stabilization care at birth, as well as for infants being monitored or treated for withdrawal. 

For years, the Finnegan Neonatal Abstinence Scoring Tool was the primary model of care for treating substance-exposed infants. However, a growing body of research shows infants treated using the Eat, Sleep, Console (ESC) model of care experience shorter hospital stays and are less likely to receive medication to treat neonatal opioid withdrawal symptoms. Eat, Sleep, Console prioritizes parental involvement and non-pharmacological care such as cuddling, swaddling, rooming-in with parents, chest/breastfeeding, and a quiet, dark room. The announced change formally recognizes Eat, Sleep, Console as the new best practice for birthing hospitals, and states medications and NICU admissions should no longer be the first line of treatment for infants exhibiting withdrawal symptoms.  

“The opioid and overdose epidemic is disrupting the lives of a growing number of families in our state,” said Tao Sheng Kwan-Gett, MD, MPH, Chief Science Officer at DOH. “These changes will help every baby born in Washington get the healthiest start possible.” 

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