Prenatal Drug Exposure: CAPTA Reporting Requirements for Medical Professionals

Why use this fact sheet?

As medical professionals who work with pregnant patients, you face numerous medical, legal, and ethical decision points when treating a patient for substance use during pregnancy, and when providing care to a neonate with drug or alcohol exposure. Sometimes, the legal requirements for reporting substance use or exposure are unclear, or may be the opposite of medical best practice. Moreover, patient privacy dictates careful attention to the law to avoid unnecessary reports that may lead to HIPAA violations. This resource provides a brief summary of reporting requirements by state for prenatal drug use and substance-exposed newborns and provides explanations of the wording used in these requirements. This resource does not provide legal or medical advice but is intended to help you differentiate what is legally required from what is merely state agency guidance. Importantly, only two states require drug testing of pregnant and birthing patients in certain circumstances, and only four states mandate drug testing of newborns in certain circumstances.

Your hospital, clinic, or practice may have additional reporting requirements that you should be familiar with. Providers can help patients maintain their agency and confidentiality while navigating reporting obligations by:

  • Not reporting patients if not legally required Informing patients of what the provider may have to report prior to testing/treating the patient or neonate
  • Obtaining informed and documented consent around parental and neonatal drug testing
  • Carefully considering what information is necessary to document in a medical chart

Who wrote this guide and why?

If/When/How: Lawyering for Reproductive Justice is a legal advocacy organization. We created this fact sheet because one of the most common causes of the criminalization of pregnant and postpartum people is unnecessary reports to law enforcement or child protective services by medical providers. We often field questions from providers with concerns about if or when they are required to report substance exposure during pregnancy, especially as more providers see the harms of the child welfare system (“the family policing system”) firsthand.

Reporting a patient, even with the hope of connecting the family to resources, often leads to more harm. Reporting is not resourcing, and not all—or even most—families will get the resources they need as a result of a report to the family policing system. This guide helps you understand the reporting laws in your state.

What is CAPTA and what does it require?

The Child Abuse Prevention and Treatment Act (CAPTA) is federal legislation that requires states to create laws that mandate certain professionals to report child abuse or neglect (suspected or actual) to a child protective services agency. Subsequent additions to the legislation, from the Comprehensive Addiction and Recovery Act (CARA), also require medical professionals to notify child protective agencies when an infant is born substance-affected.

States implement their own reporting requirements to comply with CAPTA. Those requirements vary from state to state, including definitions for who is a mandated reporter, what constitutes reportable child abuse or neglect, and when medical professionals have to report suspected or actual prenatal drug exposure. State policies vary, but the general requirement is that all substance-affected newborns must be provided with a Plan of Safe Care (POSC), and all POSCs must be shared with the state child welfare agency. A POSC is different from a child protective services report, and is determined by medical professionals based on how best to address the health and development needs of the infant and birthing parent.

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