High Risk Newborn: Exploring the lines around reporting a newborn to DCF

Maria was 19 years old when she gave birth to her first child, a daughter, in May of 2023, but she was very nervous.

Maria had been using marijuana during her pregnancy to help with nausea, she says, a fact that she shared with hospital staff before and after giving birth out of fear that perhaps breastfeeding could be problematic for her newborn baby. Regardless, she was encouraged to breastfeed.

“I was definitely aware that it could possibly get me in trouble with certain people, so I was very scared,” Maria said.

It was shortly after the birth, while she was still in the hospital, that she was visited by the hospital social worker, who expressed concerns over her marijuana usage and, more so, her financial situation. Maria had been in the Department of Children and Families (DCF) system as an adolescent; she was also receiving public benefits. She was the product of a broken household and poverty. In short, her life had been messy; far from an idealized notion of what family life should be.

Maria had been bounced around from group home to group home and forced to live with her grandmother, with whom she did not get along, for a long period of time. She’d had previous instances of suicidal thoughts as an adolescent that warranted hospitalization; she had a restraining order against the father, who had been abusive to her in the past, and a possible history of sex work. Maria knew her past stacked up against her, and the idea of a social worker evaluating her fitness as a mother immediately caused her to freeze up.

“Just knowing the possible outcomes of what could happen by them coming into my life I was very scared,” Maria said. “So, the guy comes and he’s asking all these questions about if I work, where I work, how I get my money, where my income is from, and how I’ll be taking care of my daughter. He just kept asking me questions like that, questions about my home life, but really what he was focusing on though was like my expenses and how I’m going to be paying for everything, how I was paying for my two-bedroom apartment.”

According to records, the doctor also had concerns over Maria’s discharge plan. Essentially, given Maria’s history, marijuana usage, and evasiveness, hospital staff were concerned and as mandated reporters, filed a report with DCF, noting her marijuana usage and the absence of the baby’s father. That set off several months of DCF intervention in her life, including multiple home visits.

Although DCF records indicate Maria was sometimes guarded and evasive in her interactions with the social worker, overall, the notes indicate that she was being a good mother. Her apartment was clean and well cared for and she had everything she needed for the baby, including family support.

The baby appeared to be fine based on medical assessments, and although DCF deemed Maria high risk due to her history and domestic abuse issues, reports indicate she was taking good care of the baby. DCF referred her to ongoing services with an outpatient provider.

Kate, on the other hand, is a working professional in Southwestern Connecticut, who experienced a precipitous birth in 2022 – a condition during which the woman’s body rapidly enters labor and essentially expels the baby.

No one realized what was happening at the time. Kate’s doula counseled her to remain at home and not go to the hospital yet. But as the pain rapidly intensified, and not knowing what to do, Kate took a painkiller that had been prescribed to her mother.

“It’s really terrifying, really painful, and sort of traumatic. I went into labor and had a baby in my arms pretty much two hours later,” Kate said. “It was worse pain than certainly my first birth was, and it came on very suddenly and very scary. I sort of panicked. I took an opioid pill that I had from when my mother had surgery. I took one and it didn’t help and that’s when I said we have to go the hospital.”

Like Maria, Kate immediately informed hospital staff that she had taken the pill, but there appeared to be little concern among the caregivers. She had no history of opioid abuse. The hospital social worker conducted his interview with her over the phone and expressed no concerns, Kate said.

Three weeks later, however, a DCF agent unexpectedly knocked on her door based on a report made to them that she had taken an opioid and a positive toxicology test on her newborn that was conducted without her knowledge.

“Obviously, it’s terrifying when they show up,” Kate said.

Over the course of the next two months, the social worker interviewed her five-year-old child, and Kate signed consent forms for the worker to speak with her personal therapist, her child’s school, and her doctor. She was also required to get drug abuse screening by an outside organization.

She eventually received clean drug screening and her case was closed, but it was a months-long ordeal that she says affected her deeply.

“It made things very stressful,” Kate said. “I thought he was a really good social worker, but there’s this threat hanging over you they can take your kid away. It affected my mental health.”

Kate says she is upset, less so with DCF, than with the hospital itself.

“I disclosed that I took this pill to like a gazillion different people at this hospital, any one of them could have told me, just so you know we’re required to report this to DCF, and I would have understood,” Kate said.

“I understand the need to be hyper-vigilant with newborns, I understand the need to err on the side of caution with reports or abuse or neglect,” Kate continued. “But if there is a policy where they have to report all positive drug tests to DCF without doing any social work assessment or intervention ahead of time, I think that’s ridiculous.”

Kate is both right and wrong about the policy in Connecticut. There is a policy that requires all newborns who were exposed to drugs or alcohol while in the womb to be notified to a central state system, but not necessarily reported for DCF investigation.

The distinction between what is “notified” and what is “reported” is nuanced and critical for understanding DCF investigations into high-risk newborns and allegations of neglect.

Maria is far from alone in having used marijuana during her pregnancy. According to both an internal presentation and figures from DCF , and a study conducted by University of Connecticut professor Margaret Siegler , and others, marijuana is by far the most reported single substance used by expectant mothers in Connecticut – and that information was based on numbers from 2021, before Connecticut legalized marijuana for recreational use.

Between March of 2019 and July of 2021, 4,763 babies were born “exposed” to some form of substance and in 69.2 percent of those cases, it was marijuana, equating to 5.6 percent of total births during that period. When accounting for births involving exposure to multiple substances, marijuana cases go up to 79 percent. In Kate’s case, the reports were smaller: roughly 20.6 percent of cases involved any opioid.

How do we know that? Because any prenatal exposure to substances like alcohol, methadone, marijuana, opiates, cocaine, methamphetamine, and MDM is notified by the hospital through an online state portal, part of the federal Child Abuse Prevention and Treatment Act (CAPTA).

DCF houses the CAPTA notification system, but it is a state system, and Connecticut does things differently from most other states: namely, the CAPTA notification contains no identifying information for the mother. Rather, it is a data-gathering tool for both state and federal agencies to assess the prevalence of drug use among expectant mothers.

All but one other state uses identifying information, which can result in increased child welfare investigations, potentially cause undue stress on new mothers, and suck up valuable staff resources chasing down cases that may or may not have merit. The State of Connecticut implemented a de-identified system in an effort to prevent that kind of waste.

The CAPTA program, in its current iteration, is part of a change implemented during President Barack Obama’s administration as a health monitoring system. Part of those changes were removing the word “illegal” from the drugs that required notification to incorporate alcohol and prescription drugs and providing funding for states to set up their systems.

“It’s a data gathering system incorporating principles of public health,” Professor Siegler said in an interview. “Typically, these surveillance systems are used for health conditions that are kind of riskier so there’s been HIV, COVID, and substance use in pregnancy is one of those situations considered high risk.”

Part of combatting those high-risk situations is that medical providers who make a CAPTA notification are required to implement a Family Care Plan (FCP) — also called a Plan of Safe Care (POSC) — with the mother before she leaves the hospital, which can include referrals to outside treatment services, education on safe sleeping for the baby, counseling, home visits, parenting groups, or financial assistance.

“Since 2016 there’s been a lot of public policy in this space nationally, some states have implemented new mandated reporting requirements where every infant with prenatal substance exposure is then reported to child welfare ostensibly for some type of child abuse assessment. Then other states have said you have to refer to child welfare but then we’re going to respond more therapeutically,” Siegler said. “Connecticut policy, I would situate it as the far end of the public health continuum.”

Siegler says that while most other states used their existing child welfare systems to gather the data, Connecticut implemented an entirely new and separate system: a CAPTA notification does not equal a report to DCF by a mandated reporter. Instead, that process is handled separately through a different online system.

If a mother either admits to using a substance during her pregnancy or substances are detected through either testing the mother or the child, a CAPTA notification is made with no identifying information. However, the CAPTA system also asks the medical provider if they have other safety concerns regarding abuse or neglect and, if they do, directs them to make a Careline report through a separate system. It is then up to DCF whether the report warrants intervention.

That intervention can come in the form of a Family Assessment Response (FAR) – which generally assesses the family situation and makes referrals for ongoing services – or more intensive investigations, known as a 136 Report, with the potential for removing the child and placement in the foster care system.

Using, for example, marijuana exposure, Dr. Siegler’s study shows that of 3,297 marijuana cases reported through CAPTA, 56 percent were “diverted,” meaning the mothers were referred for outside services and did not warrant DCF intervention, leaving 1,441 cases that did.

The numbers presented by DCF show an increase in newborn referrals to DCF in the year following CAPTA implementation. In the six months before CAPTA, DCF received 387 newborn referrals and accepted 382. In the six months following CAPTA, there were 443 referrals and 429 acceptances by DCF. Those numbers increase slightly again over the next six months, as well.

According to DCF data, 91 percent of hospital reports to child protective services for newborns were accepted, meaning that if a Careline report is made regarding a newborn there’s a high likelihood that DCF will accept the report and investigate. In other words: if a medical provider raises concerns, DCF officials tend to take the matter seriously. As mandated reporters and with concern for patients, the data shows that Connecticut hospital staff appear likely to play it safe.

“Connecticut laws are designed to ensure that a child’s safety is the number one priority, which necessitates a reporting structure that has a broad reach,” the Connecticut Hospital Association said in a brief statement. “Hospital providers are mandated to follow DCF reporting rules and guidance.”

Those reporting rules and what constitutes “neglect” or a “high risk newborn” can be confusing, however.

Up until April of 2023, the definition of neglect included, but was not limited to, “substance use by the mother of a newborn child and the newborn has a positive urine or meconium toxicology for drugs” — a definition that does use the terms “substance misuse” or “abuse.”

That was changed to the current definition that removes any mention of newborn testing at all, and includes, but is not limited to, “substance use by caregiver, which adversely impacts the child physically.”

Although it may seem contrary to common sense, the use of any drug, legal or illegal, by a pregnant woman alone cannot be the “sole or primary basis for any action or proceeding by the Department,” according to DCF’s guidelines. “Any action or proceeding by the Department must be based on harm or risk of harm to a child and the parent or guardian’s ability to provide appropriate care for the child.”

Some of those other reasons that warrant DCF intervention include exposure to family violence; a history of psychiatric problems; transience, and the ability to maintain a safe living environment. DCF also notes, that inadequate food, clothing, or shelter or transience cannot simply be due to poverty but must be an act “of omission or commission,” by the caregiver.

What constitutes the need for a DCF report for a newborn by hospital staff is a regulatory gray area based on best judgment by the medical provider. That means differing results based on the hospital’s interpretation of what constitutes neglect and when a DCF report should be made through their Careline rather than just a CAPTA notification. The decision can be tricky and turns on two key words: “notification,” and “report.”

For instance, the CAPTA Notification FAQ states that “A provider involved in the delivery or care of a newborn who, in the provider’s estimation, is exposed to substances in utero or exhibits physical, neurological, or behavioral symptoms consistent with prenatal substance exposure, associated withdrawal symptoms, or fetal alcohol spectrum disorder must notify DCF of these conditions in the newborn.”

The FAQ also states that. “Non-prescribed Marijuana is an illegal substance in Connecticut, so its use, by definition of this legislation and CT state statutes, makes it a substance of misuse.” While marijuana remain illegal at the federal level, the FAQ clearly hasn’t been updated to account for Connecticut’s legalized cannabis law.

The Provider Bulletin to hospitals informs them of federal and state legislation “requiring health care providers to notify the Department of Children and Families (DCF) at the time of the birthing event of infants born substance exposed… and/or those who experience withdrawal symptoms from the use of substances or the mother’s medications.”

“The notification process does not supplant the process when reporting cases that involve a suspicion of child abuse and neglect, which would include the use by the mother of illicit drugs or misuse of other substances,” the bulletin continues. “The Notification Process is NOT the same as mandated reporting. Whether or not the concerns of substance exposure meet the threshold for investigation of abuse and neglect will be determined by the questions answered in the online portal.”

Furthermore, according to DCF’s flow chart for CAPTA notifications, DCF reports are to be made when the child tests positive for substances as a result of maternal substance misuse, there is a concern substance misuse will impact parenting, the family presents with suspicions of abuse or neglect, and if a Family Care Plan was not developed.

The language places much of the onus on medical providers to determine whether there is truly a safety issue at hand, and they must weigh the risks to the child looking forward before releasing a newborn and discharging the mother. For instance: does a mother who admits to using marijuana during her pregnancy constitute substance misuse, or neglect, even though that cannot be the sole reason for filing a report with DCF? What does this substance use mean for the child in the future?

Officially, the jury is still out on whether in-utero exposure to marijuana is harmful to the baby, but Siegler believes this is akin to when tobacco companies pushed a similar line decades ago when it came to smoking during pregnancy.

“I’m quite suspicious of that line being the answer. I do have robust literature on adverse effects of cannabis exposure in pregnancy, we can’t do randomized control trials, but we can’t do randomized control trials on any substance in pregnancy. And of course, common sense would tell us that it’s not good,” Siegler said. “I’m sure there are overreactions to cannabis use during pregnancy that are unwarranted and at the end of the day I think it’s much more important to understand what the mother is using it for. Is it sleep? Is it nausea? Is it trauma? What is going on?”

Hospital reporting is not always equally applied, particularly when there are multiple factors to be considered. In Maria’s case, she had a psychiatric history and domestic violence history which, even though she was upfront and honest about her marijuana use, added to the basis of the report when combined with her history. Kate, on the other hand, had only ingested one pill out of desperation, but nevertheless generated a DCF report.

So, it’s a judgment call, but in that judgment sometimes important cases can be missed when following the letter of the law, while other less serious cases get investigated.

When the Office of the Child Advocate released a 2024 report into the death of 10-month-old Marcello Meadows from an overdose of Fentanyl, Xylazine, and cocaine, it noted that during the birth of his older sibling in 2019 the hospital made a DCF report on the mother because she tested positive for methadone and her long history of substance use. DCF, however, did not investigate because she “was engaged in treatment” – namely, she was prescribed methadone as part of her addiction recovery.

When the baby’s toxicology came back twelve days later positive for nonprescribed opioids, however, the hospital did not send a second report. Three years and many of the mother’s addiction and criminal issues later, Marcello was born addicted to opioids and the tragedy unfurled from there: Marcello died, and DCF took custody of his sibling.

Likewise, over-reporting can also cause issues for both the new mother and potentially the hospital.

In 2023, a mother filed a lawsuit against her physician and Hartford Healthcare after the hospital reported her to DCF’s Careline for occasionally drinking wine during her pregnancy, even though both the mother and baby tested negative for all substances at birth. The medical personnel believed she was minimizing her alcohol use and could therefore potentially put the baby at risk. According to the complaint, even the DCF social worker was confused as to why she was assigned this case, but a 45-day investigation commenced anyway.

Although the DCF investigation was ultimately closed as unsubstantiated the family felt a “debilitating fear” that DCF could ultimately remove the baby and was seeking damages from the hospital for violating doctor-patient confidentiality and false imprisonment for not allowing the mother to leave the hospital before a report was made to DCF. The case was quickly dismissed by a judge who said the medical providers were acting in good faith by reporting her to DCF. An appeal was filed but ultimately not pursued by the mother.

Siegler, whose study noted a near absence of alcohol-related CAPTA notifications even though alcohol is likely the most common drug an unborn baby can be exposed to, believes some hospitals and healthcare systems can be more conservative in approaching these matters, which would make sense. DCF and other government agencies enjoy immunity when it comes to potential lawsuits; medical providers do not, potentially exposing them to liability.

It’s difficult to fault DCF for taking a report made by hospital personnel seriously, particularly considering the potentially devastating consequences, but one attorney believes that Connecticut is not doing enough to clearly define to medical providers what warrants DCF intervention, thus causing undue stress on mothers – the very thing DCF hoped to avoid when implementing its CAPTA notification system.

Attorney Karolyn Ryan has been seeking out and meeting with mothers who feel they were unfairly targeted for DCF investigations after giving birth, and she is critical of how DCF has implemented state CAPTA regulations and how the agency has communicated with hospitals. In essence, she says, DCF is leaving medical providers on their own to figure out the definition of a high-risk newborn, or what meets their standards for investigation.

“The standard for investigation is there is no standard,” Ryan said in an interview. “DCF publicly states if you’re a hospital and you have a concern about a newborn, contact us and we will apply the statutory and regulatory criteria and it’s not true. There’s no statutory or regulatory criteria. The only criteria is that the person reporting it is a medical provider. We’re not telling them that they are the criteria.”

According to state statute, a high-risk newborn “means any newborn identified as such under any regulation or policy of the Department of Children and Families.” Ryan argues these definitions are vague, giving hospitals no clear guidance as to what merits a DCF report: parental substance use doesn’t say “misuse” and could be applied to either parent.

“What happens is that all of [the reports] are being accepted and the only criteria is that the person be a medical provider. When the medical provider starts with that online submission, one of the questions is: does the newborn present with suspicions of abuse or neglect? What’s wrong with that question is that it turns the tables back on the provider,” Ryan continued. “In an abundance of caution, they’re reporting, they’re all getting accepted and it’s really traumatizing for women.”

Although DCF has provided bulletins and training for hospitals in Connecticut regarding CAPTA and the Careline, she believes these bulletins, likewise, are unclear. Much of it comes down to language.

As indicated before, the CAPTA Provider Bulletin says a provider must “notify” child protective services if an infant is born exposed to substances. However, in DCF parlance, “notify” means a CAPTA notification, as opposed to filing a DCF report. But for a busy medical provider more apt to err on the side of caution, Ryan says, they sound similar.

Ryan also takes issue with the term “expo s ed to.” Under Connecticut’s CAPTA regulations, exposure can mean any exposure during the entire pregnancy. So, drinking alcohol when one is two months pregnant and possibly unaware of that pregnancy is still technically exposure. However, the federal language states that CAPTA notifications are to be made when a baby is born “affected by” substances.

This can be vastly different and Connecticut statute appears to contradict DCF’s policy that newborns exposed to substances during pregnancy receive a notification. Rather, the statute hinges on factors showing the newborn to be affected by substances.

“A provider involved in the delivery or care of a newborn who, in the estimation of such provider, exhibits physical, neurological or behavioral symptoms consistent with prenatal substance exposure, withdrawal symptoms from prenatal substance exposure or fetal alcohol spectrum disorder shall notify the Department of Children and Families of such condition in such newborn,” the statute reads.

So, the statutory definition relies on the effects of exposure after birth, as opposed to any exposure during pregnancy that may have no impact on the child at birth. “Congress ultimately said identified at birth,” Ryan says. “Substance exposure means everybody. This is not what [federal law] says, at all. DCF just changed it.”

Siegler, however, says there is a good reason for this. The federal CAPTA language was developed to combat the opioid crisis in the United States. Children born affected by some drugs, like opioids, can be spotted by medical professionals. Other types of substances, however, may be more difficult to spot until later in development.

“In my discussions with pediatricians, it’s actually really hard to tell if a baby is affected at the birth event, it’s based on how loud they cry and that can be really hard to disentangle. That contributed to the decision to have it be focused on any identified exposure,” Siegler said. “I’ve written about the need for the policy to be clearer on what they mean by ‘affected by’ because that’s a really sort of clinically meaningless term.”

Ryan points to New York’s as an example of how the policy could be better implemented and advised to medical providers. The New York Department of Health draws a clear distinction between a child being born “exposed to” and “affected by,” stating that notifications should only be made when the newborn displays “symptoms of substance withdrawal and have a positive toxicology screen,” along with any diagnosis of Neonatal Abstinence Syndrome or Fetal Alcohol Syndrome.

Ryan took her concerns before the Connecticut DCF Advisory Committee in October of 2023, arguing that DCF is not only leaving definitions of neglect and high-risk newborn to the providers, but also that the state’s implementation of CAPTA is harming minority mothers and those living in poverty.

DCF numbers indicate that Hartford Healthcare, St. Francis Hospital, and Yale New Haven Hospital had, by far, the most notifications. They are also massive healthcare systems, taking in a lot of patients, but Siegler’s study found that there are racial disparities in CAPTA notifications. She found that 22 percent of Black women received notifications, but only accounted for 13 percent of births.

“Non-Hispanic White and Hispanic mothers were proportionally underrepresented among notifications compared to state population data, and non-Hispanic Black mothers were overrepresented,” the study said.

Siegler believes this disparity may be related to the structure of the healthcare system a woman is engaged with – a hypothesis she is exploring. Namely, if a woman is receiving prenatal care at a clinic connected to a birthing hospital, it is more likely information on substance exposure will more easily be transferred to that hospital, while those receiving prenatal care at a private clinic may see that information lost in the medical records shuffle across systems.

But Karolyn sees implicit racial and class bias in those numbers, leading to minority women or women in poverty receiving more DCF investigations than their white or wealthier counterparts. Basically, she believes clinicians are more likely to report someone like Maria over her self-reported marijuana use because she was low-income and there was no father in the picture.

“We want women to feel comfortable going to hospitals,” Ryan said. “You have implicit biases in healthcare, CT has one of the highest black maternal death rates in the country, I believe we’re in the top ten.”

And while they may disagree over the use of “exposed to” in DCF’s language and the possible causes of racial disparities in CAPTA notifications, Siegler’s study did raise some of the issues that Ryan has raised, namely that medical providers aren’t given enough guidance and are left to their own opinions.

“CAPTA requires a series of informal hospitalist assessments: whether to verbally screen, order toxicology, interpret toxicology as an indication of substance misuse, and infer substance use and other factors as indications of child maltreatment risk. This leaves physicians to rely on their own opinions, training, or hospital policies,” Siegler wrote in the study.

“DCF has passed the buck to medical providers who are mandated reporters, who have real consequences, that is why this is so problematic,” Ryan said. “They should have guidelines. Those should be clearly communicated to hospitals.”

Officials from DCF and the Department of Mental Health and Addiction Services (DMHAS), however, say that not only were hospitals, including the Connecticut Hospital Association, involved in developing the CAPTA system, but the departments have been working collaboratively on education and training for medical providers through joint programs launched in conjunction with CAPTA.

The departments have been holding continuous training for mandated reporters about Connecticut’s statutes and regulations and what incidents require a CAPTA notification as opposed to a DCF report through the Substance Exposed Pregnancy Initiative of Connecticut (SEPI-CT) and the Women’s REACH Program .

DCF works jointly with DMHAS so that when medical providers highlight an issue with a new mother related to substance use, they have access to programs to help them in their recovery and work with providers to help craft a family care plan.

“This has been a long-standing partnership between DMHAS, DCF and other state entities, hospitals, persons with lived experience really to help ensure the rollout of CAPTA is interpreted as our state as intended and ensure that we are helping support families that meet the statute requirement and provide comprehensive services,” said Shelly Nolan, clinical behavioral health director for women’s services and problem gambling for DHMAS. “One of our other partners from the very beginning has been the Connecticut Hospital Association, and so they have also partnered to sponsor a variety of trainings through their infrastructure and their work groups which consists of medical providers, nurses, labor and delivery, and social workers.”

The main purpose in saying that parental substance use alone can’t be the sole reason for a DCF report is to encourage recovery, Nolan said, and to be sure that prescribed medications like methadone and suboxone for opioid use disorder are not used to spur a Careline report.

“We recognized here in Connecticut that pregnant persons who are using substances are often highly stigmatized, and we wanted to ensure that those folks felt safe asking for help and getting resources in the context of pregnancy because we know that it is a crucial period where change is really possible, and we want to support that recovery journey,” Nolan said.

Those trainings, along with support from both SEPI-CT and the Reach Program, have resulted in a downward trend in DCF reports for newborns. According to Kris Robles, clinical behavioral health manager for DCF who oversees the work on CAPTA legislation, Connecticut has seen a decrease in DCF reports coming from CAPTA from 48.4 percent in 2021 to 32.2 percent in 2023.

“We are seeing a significant trend downwards of CPS reports coming from or due to a CAPTA notification,” Robles said. “I think our efforts on education, prevention work, training, continues to demonstrate what requires a CPS report and what’s solely just a CAPTA notification.”

“Substance use alone doesn’t mean that they’re abusing a child,” Robles said. “It’s under the realm of mental health. It’s an unborn infant and so the hope is we’re addressing the substance use and giving them the resources on parenting, it doesn’t mean that they’re intentionally abusing any child and so that’s why it’s separated. It has to be in combination of: what else is happening? Are there other children present, things like that, that might pose additional concern?”

Lisa Daymonde, director of DCF’s Careline, says that past changes to mandated reporter laws may have contributed to hospitals and medical providers being extra cautious when it came to filing reports with DCF based on CAPTA notifications.

“Mandated reporter laws changed several years ago where there were fines involved around failure to report, and it did cause mandated reporters — in general, not just at the hospital, but in general — a fear of if I don’t report I’ll lose my job, I’ll be fined, I’ll be referred to the Chief States Attorney’s Office. That concern did exist,” Daymonde said. “I think that contributed and has contributed to our increase in numbers, and fear.”

However, Daymonde also says that it is ultimately on DCF to determine what is worthy of a FAR or investigation. When they receive a report, they use a “structured decision-making tool” to determine if the report meets the statutory and regulatory definition of abuse or neglect. Eighty-six percent of DCF reports come from mandated reporters, she says, and hospitals are the fourth largest group in the state contributing to those reports, behind schools, police, and mental health professionals.

Daymonde says that in addition to education, trainings, and conversations with hospitals and medical providers regarding Connecticut’s law and what to report or not report, they are also enhancing the CAPTA and Careline portals to give providers more information and answer any questions they may have when making either a notification or report.

“We’re working on some enhancements now right to sort of improve our questions, add additional drop downs in case we have questions about something to help guide them,” Daymonde said. “It’ll help answer their questions when they’re trying to decide if they should make a report, or it’s just a straight CAPTA.”

DCF and DMHAS also recognize the racial disparities in reporting and say they are actively working to address that.

“We know disproportionately Black and brown children are more likely to come to our attention so there is racial disparity,” Daymonde said. “If you’re Black or brown it’s more likely that you’re going to be reported to DCF at a disproportionate rate and those are things that we’ve been working on from a racial justice perspective.”

“One of the things that we’ve been focusing on as a state but in particular through SEPI-CT or infancy work with pregnant parents is around racial disparity and equity and providing education around stigma and bias,” Robles said. “That has been happening around both the DCF and DHMAS end. It’s not something that’s going to be ending, it’s an ongoing conversation that we need to continually have and having those courageous opportunities to have those exchanges, to be able share points of view. It is impacting in a negative way when there is bias in our decision making.”

The laws surrounding mandated reporters were updated during the 2024 legislative session under an omnibus education bill that was passed by the House and Senate on a bipartisan basis and signed by the governor. Under the terms of this new law, mandated reporters are granted “immunity from civil or criminal liability” if they make a report or fail to make a report “in good faith.” It also specifies that mandated reporters, including school boards, can make a “preliminary inquiry to determine if reasonable cause exists for a report.”

And while Daymonde says she believes these changes will “broaden” discretion among mandated reporters, she says it is still imperative for mandated reporter, if in doubt, to make a report and let DCF decide whether it merits further investigation.

“They’re mandated reporters and if they feel they’re not quite sure, they need to make it,” Daymonde said. “They’re mandated by law to make it, and if they have reasonable cause to suspect or believe that something has happened, or may happen, and they have concerns, they’re going to make that report, and they should make that report. It’s up to us to decide if it should be accepted or not.”

Maria ultimately lost custody of her daughter following another domestic abuse incident when the father came back into her life. He was ultimately charged with violating a restraining order and is currently in prison, and while Maria admits DCF would be in her life regardless following that incident, she believes she’d still have her daughter had the hospital not alerted DCF in the first place.

Following the DCF family assessment, Maria was referred to “on-going services,” something Ryan – who is trying to help Maria get her baby back – says amounts to a “veiled threat” that is never-ending.

“It goes on forever, you did nothing wrong, but they’re still in your life,” Ryan said. “The parent may not be doing everything to DCF’s satisfaction, or an incident happens, and they file in court.”

Maria’s daughter was placed with her father and stepmother, but Maria is forced to see her child during supervised visits under DCF procedure to require supervised visits during temporary custody proceedings before the court, and because of reported “outbursts,” which Maria says is frustration at having to jump through so many hoops, including getting rides to the visits from friends and family and being kept from her daughter. After spending part of her childhood with DCF as a “victim,” she was now a “perpetrator.”

“I feel as if I’m being treated like the perpetrator in this situation,” Maria said. “So, I reasonably get frustrated with these people. I don’t cuss these people out, I’m not throwing chairs at them, flipping tables, I just get frustrated.”

Meanwhile, Kate has had no further contact with DCF but still carries a sense of shame around the investigation. “I had a lot of shame around it, I still do in some ways, and a lot of anger at the system particularly.”

Maria and Kate were not the only women Inside Investigator spoke with for this piece, but they offered two contrasting stories on how CAPTA notifications and Careline reports intersect with new mothers and DCF intervention.

One woman, Rosalie, received a visit from a hospital social worker when she asked the father of her pre-mature twins to be kept off the birth certificate. The social worker had a heavy accent and they had difficulty understanding each other, but it ultimately resulted in a DCF investigation.

The hospital and social worker also raised concerns about her living situation – she was living with her boyfriend’s family at the time – and said she didn’t visit the NICU often enough. Rosalie argues she’d just had a c-section, had no transportation, and had to walk to the hospital while recovering, making daily visits difficult.

Rosalie says the investigation ended when her father – who she says is financially well-off – helped her get an apartment in West Hartford and ultimately bought her a condo. “Because I was living with my boyfriend’s family, they assumed I must be low income, I must be this, I must be that. I’m not rich, but my family does have some amount of money.”

Another woman claims she was reported to DCF because she had little money and asked the hospital for diapers to bring home. She was investigated and referred to a community service program, a referral the hospital itself could have made.

Family situations can be messy and trying to ensure that every family and child is properly cared for can be messy, too. That’s why Ryan believes there should be clarity in policies and regulations, and less reliance on subjective interpretations and opinions by medical providers as to what constitutes a high-risk newborn. It’s a fine line between “exposed to” and “affected by” or “substance use,” and “substance misuse.”

“This is a big intrusion into people’s lives, being investigated for 45 days,” Ryan said, who is currently in court with DCF over a Freedom of Information request for more CAPTA data. “It’s the lack of clarity. I’d like them to issue clearer guidelines.”

“I think that pregnant women deserved to be treated better, because we don’t treat pregnant women that well in this country and we’re not much better here, even though we like to think we are,” said Ryan. “I think a lot of women, especially poor women, find out the hard way.”

But it’s also why DCF and DMHAS continue to offer education, training, and working groups with hospitals and mandated reporters. CAPTA helps inform what resources are necessary in particular areas of the state.

“There’s lots of different platforms where there’s education and support that is occurring when we’re talking about CAPTA and family care plans,” Robles said. “We have several hospitals that sit on our work group and present to us what their protocols are, what are they doing, what are some of the questions they have. It’s an exchange on both ends, and so I feel like it’s been very helpful.”

“That’s great they’re doing it,” Ryan said, “but it will always be broken until they go back to fix the high risk newborn policy to make sense, implemented properly in the Careline.”

The post High Risk Newborn: Exploring the lines around reporting a newborn to DCF appeared first on Connecticut Inside Investigator .