В Бостоне внедрение новых клинических рекомендаций сократило обращения в службу опеки над детьми на 50% без ущерба для их безопасности

BOSTON – August 13, 2026 | A new study conducted at Boston Medical Center (BMC), New England's largest essential hospital, found that a trauma-informed clinical guideline can help reduce reflexive Child Protective Services (CPS) reporting without compromising child safety. The study, published in Pediatrics, suggests that evaluating each family's circumstances before filing a report for an infant with prenatal substance exposure can reduce reporting by 50%, without affecting the proportion of infants safely discharged home with their families. The study, which examined CPS reporting and discharge outcomes from 2021 through the end of 2024, used data from the Perinatal-Neonatal Quality Improvement Network of Massachusetts (PNQIN). Researchers analyzed birth hospitalizations involving infants who had been exposed prenatally to prescribed or nonprescribed opioids at BMC, which implemented a trauma-informed guideline in 2021, and compared reporting rates to 17 other hospitals across Massachusetts. "A significant drop in reporting with no change in how many children go home with a biological parent suggests that it may be possible to reduce CPS reporting in certain situations without compromising child safety, though longer-term data on clinical and child welfare outcomes are still needed," said Rohan Khazanchi, MD, MPH, an adult and pediatric hospitalist at BMC and first author of the study. "For families, avoiding a CPS referral when one is not warranted can reduce additional stress during a vulnerable time when family bonding and maintenance of recovery should be the priority." BMC's approach, since adopted by other local institutions, directs clinical teams to identify specific protective concerns rather than reflexively filing CPS reports for all infants with prenatal substance exposure. This guideline is rooted in the recognition that reports filed automatically do not differentiate between families who need intervention and those who do not and that unnecessary CPS involvement, including the stigma it can create and its potential to deter people from seeking substance use treatment, can potentially cause real harm to children and families. The analysis found that the largest reductions in CPS reporting occurred among infants exposed only to prescribed opioids, including those born to mothers receiving medications for opioid use disorder (MOUD), as well as among infants without exposure to alcohol, amphetamines, benzodiazepines, cocaine, or non-prescribed opioids. The study found no differential impacts on reporting by race or ethnicity, suggesting that the guideline's benefits are being applied equitably. The authors estimate that, of the 956 infants with prenatal substance exposure born in the post-implementation period, about half would have avoided CPS reports had all hospitals in their dataset implemented a similar guideline with comparable efficacy. The publication follows Massachusetts legislation passed in December 2024 that ended automatic reporting requirements for infants with prenatal substance exposure. The policy changes reflect a growing body of research supporting individualized approaches to assessing infant safety and family needs. "As clinicians, we have long recognized that reflexive reporting feels punitive and rarely serves children's or families' best interests. This study helps establish that alternative, discretionary approaches are feasible and that clinical teams can appropriately identify infant safety concerns after birth," said Heather Hsu, MD, MPH, senior author of the study and a pediatric hospitalist at BMC. "We hope this research encourages hospitals and policymakers across the country to consider what a more compassionate, evidence-based standard of care could mean for families everywhere."