Neonatal Abstinence Syndrome: WCAAP Partners with ABC Law Group and F.I.R.S.T. Clinic

As opiate use disorder has increased nationwide, there has also been a rise in neonatal abstinence syndrome (NAS). NAS is seen in 60-80% of newborns with opiate exposure. The National Institutes of Health’s National Institute on Drug Abuse cites a recent national study that showed a fivefold increase in the incidence of NAS between 2004 and 2014, from 1.5 cases per 1,000 hospital births to 8.0 cases per 1,000 hospital births. That is one baby born with NAS every 15 minutes in the United States.

Here in Washington State, the most recent data on babies born with NAS is from 2013. At that time,  there were 7.9 cases of NAS per 1,000 hospital births—a more than sixfold increase from 2000 (CDC).  We suspect our numbers are even higher today. As a result, many children are being removed from their parent’s care by Child Protective Services (CPS) via a system that may vary from community to community and can be difficult to navigate.

We think there’s a better way to help mothers with opiate use disorder and babies experiencing NAS. The Washington Chapter of the American Academy of Pediatrics is partnering with ABC Law Group and the F.I.R.S.T. Clinic (Family Intervention Response to Stop Trauma) to promote family-centered care and decrease childhood trauma related to family separation when a new mother has an opiate addiction. We will work together to educate health care providers about the law, parental rights and legal resources in a collaborative effort to reach and support new mothers as early as possible. This initiative will begin in Snohomish County.

The F.I.R.S.T. clinic acts as a team in a first-responder style. The average response time from a parent or referring provider calling the F.I.R.S.T. clinic to direct contact with a lawyer is less than 20 minutes. Legal advocacy is paired with an entire suite of support and structure for a parent and child. The team includes a resource navigator who helps assist with a direct connection to clean, stable housing that can be used as a secure address to discharge to after successful completion of treatment. A veteran parent is also assigned to each case. This is a parent who has successfully navigated the CPS system and reunified with their child. The veteran parent accompanies the attorney and acts as a compassionate and emotional support for the new participant.

To keep children safe, CPS maintains the same channels for removal of infants and children if needed at any time, and mandatory reporting practices by hospitals and providers are unchanged. The F.I.R.S.T. Clinic aims to work with CPS and serve as a resource to ensure that families understand their rights and path to navigate the court system, rather than to sidestep existing CPS practices. In fact, an attorney involved earlier in the process often helps facilitate more parental cooperation and open communication with CPS.

WCAAP’s role in this initiative will be to educate and support providers and build bridges between the legal and medical systems. It is our intention that this partnership will result in better information for both parents and providers, support for the best evidence-based care for babies, and decreased trauma due to family separation. If you are interested in participating in WCAAP’s NAS workgroup in order to optimize care of opiate-exposed newborns, please contact Michelle Izumizaki at