sECTION 10:

Hospital Holds

Quick Links to information below

Hospital Guidance For parents: advocating for yourself and your child?

Hospital Holds: what you need to know?

Hospital Policies that impact newborns and parents?

How to advocate for yourself and your newborn at the hospital?

What is a medically fragile child and how can i prove i can care for them?

Steps to take if CPS becomes involved: your rights as a parent?

Hospital Holds

Hospital Guidance for Parents: Advocating for Yourself and Your Child

When visiting a hospital for yourself or your child, understanding your rights, available resources, and potential concerns is essential.

This webpage is designed to provide you with in-depth information to help you work effectively with hospitals for your children’s well-being and to clarify when and under what circumstances DCYF or a hospital may become involved in decisions about your child’s care.

Under RCW 26.44.056, hospital administrators or licensed physicians may detain a child without parental consent if there is probable cause to believe the child is at risk of imminent physical harm due to abuse, neglect, or other severe circumstances. This detention is temporary and requires notification to law enforcement or child protective services, who may also take custody of the child under specific time limits.

By being informed, you can navigate the hospital experience confidently and protect your family’s well-being.

Hospital Holds: What You Need to Know

What Is a Hospital Hold?

As we have discussed above, under the RCW, a hospital hold is a legal measure allowing hospital administrators or physicians to delay a child’s discharge for up to 72 hours if there is probable cause to believe the child faces imminent physical harm upon release. During this time, the Department of Children, Youth, and Families (DCYF) assesses the situation to determine whether additional intervention is required. DCYF Policy 2559.

Keep in mind that while a physician’s decision to place a hospital hold on a child may be questioned, RCW 26.44.060(2) provides legal protection, stating that a hospital administrator or licensed physician who takes a child into custody pursuant to RCW 26.44.056 is not subject to criminal or civil liability solely for this action.

When Can a Hospital Hold Be Applied?

  1. Newborns: If an expectant mother’s or baby’s drug or alcohol exposure is detected and deemed to pose an immediate risk to the child’s safety.

  2. Older Children: If there is probable cause to believe the child faces imminent harm due to abuse, neglect, or severe safety concerns.

What Happens During a Hospital Hold?

If a hospital hold is initiated and DCYF is contacted.  DCYF will determine placement by conducting a safety assessment and holding a Family Team Decision Meeting (FTDM) to determine whether the child can return home or requires alternative placement. If a medically fragile child is involved, additional care plans and caregiver training may be necessary.

Hospital Policies that Impact Newborns and parents

Hospital Policy Updates: 

Previously, it was standard hospital policy to automatically notify DCYF if an infant was born with drugs in their system.

However, in June 2023, Washington State Department of Children, Youth, and Families (DCYF), in collaboration with the Department of Health (DOH), the Health Care Authority, and the Washington State Hospital Association, updated state requirements and best practices to improve the health of infants and parents affected by substance use at birth. This update incorporates the Eat, Sleep, Console model (check out this link for a pdf on what ESC is) of care for substance-exposed infants.  Washington State’s new policies prioritize supportive care over punitive measures for expectant mothers with substance use concerns. Hospitals are encouraged to adopt the Eat, Sleep, Console (ESC) (check out this link for the announcement from Department of Health program, which focuses on providing wraparound services for families rather than automatically referring cases to CPS.

What Is the Eat, Sleep, Console Program?

ESC monitors how well the baby eats, sleeps, and consoles. By collaborating with parents every few hours, hospitals develop tailored care plans that prioritize the baby’s health and family involvement.

  • Eating: Can the baby feed normally for their age?
  • Sleeping: Can the baby sleep for at least one undisturbed hour?
  • Consoling: Can the baby be soothed within 10 minutes?

Hospitals are encouraged to provide a Newborn Care Diary to assist parents in tracking progress.

What is the Plan of Safe Care (POSC)

While hospitals transition to these supportive measures, it’s essential to advocate for your care by requesting the ESC program and services offered under the Plan of Safe Care initiative. The plan of safe care (POSC) is a family-centered prevention plan designed to promote the safety and well-being of birthing parents and their infants with prenatal substance exposure.  It strengthens protective factors, promotes healthy development, and helps prevent child welfare involvement or out-of-home placements by connecting families to parenting education, safety guidance, early intervention, and wraparound services.

In August 2023, hospitals began using updated child welfare intake screening criteria to determine when a report to CPS is required. These updates ensure that families are only reported to Child Protective Services (CPS) when specific safety concerns are present.

For infants with prenatal substance exposure but no child protective (safety) concerns, healthcare providers can initiate a Plan of Safe Care (POSC) through a referral to Help Me Grow, a community-based program that provides resources and support. However, when child protective (safety) concerns are identified, hospitals are required to contact Child Protective Services (CPS). Such concerns may include ongoing parental substance use that compromises the child’s care (e.g., falling asleep with the child in their arms), impaired decision-making, unsafe living conditions, a medically fragile child, or exposure to domestic violence.

The difference between POSC and ESC:

Plan of Safe Care (POSC)

  1. Focus:
    • A comprehensive, family-centered prevention plan designed to promote the safety and well-being of both the infant and the family.
    • Addresses broader issues, including parental substance use, early intervention needs, parenting education, and connections to wraparound services.
  2. Purpose:
    • Mitigates risks associated with prenatal substance exposure.
    • Prevents child welfare involvement or out-of-home placements when possible.
    • Links families to resources like home-visiting programs, parenting education, and health services.
  3. Scope:
    • Includes a wide range of services for the entire family, not just the infant.
    • Applies to any infant with prenatal exposure to substances (illegal, prescribed, or misused medications) and their families.
  4. Implementation:
    • Developed collaboratively with families and healthcare providers.
    • Often initiated by healthcare providers or child welfare agencies through referral programs like Help Me Grow.

Eat, Sleep, Console (ESC)

  1. Focus:
    • A care model for assessing and managing the immediate health and well-being of substance-exposed newborns.
    • Emphasizes observing the baby’s ability to eat, sleep, and be consoled as primary indicators of withdrawal severity.
  2. Purpose:
    • Supports the infant’s physical and emotional needs during withdrawal (neonatal abstinence syndrome or related conditions).
    • Reduces reliance on medication by prioritizing non-pharmacologic care and parental involvement.
  3. Scope:
    • Focused specifically on the infant’s immediate care in the hospital setting.
    • A short-term approach designed to ensure the baby’s well-being during the critical early days or weeks after birth.
  4. Implementation:
    • Carried out by hospital staff, often with active parental involvement.
    • Includes monitoring feeding, sleeping, and soothing abilities and providing a structured care plan.

Key Difference

  • The POSC is a long-term, family-centered plan designed to address the safety and support needs of both the infant and the family after discharge.
  • The ESC is a short-term, hospital-based care approach focused on the immediate well-being of the newborn during withdrawal.

How to advocate for yourself and your Newborn at the Hospital

Build a Support Network During Pregnancy

  • Consider a Doula or Birth Support Worker: If hiring a doula is not financially feasible, look for community-based programs that offer free or low-cost doula services, such as:
      • Community-Based Outreach Doula Programs (focus on underserved communities) See our resource page for links.
      • Nurse-Family Partnerships (for first-time, low-income mothers). See our resource page for links.
      • Parent-Child Assistance Programs (PCAP). See our resource page for links.

These folks can advocate for you while in the hospital when you are focused on being in labor. 

  • Engage with Home Visiting Services: Programs like First Steps or Help Me Grow provide education and support during and after pregnancy. Or you can seek public health nurses who can offer guidance and connect you to resources. The key to this is to demonstrate that you are taking proactive steps for you and your child.
  • Join Support Groups: Many community organizations and nonprofits offer free support groups for pregnant women, particularly those dealing with substance use or economic challenges. Additionally, online communities can also provide emotional support and practical advice. You are creating a network of people who can assist you through the times that are difficult to navigate while getting ready for and being in labor.  These folks, as well as the others discussed above can attest to the hospital, doctors, and nurses, that you are actively working on your sobriety and that you are aware of what issues your child may encounter being born with substances in their system.

Communicate Openly with Healthcare Providers

  • Share Your Plan of Care: Let your provider know about any proactive steps you are taking, such as enrolling in substance use treatment programs, attending parenting classes, or preparing a safe home environment.
  • Ask Questions: Understand what is expected of you and your baby during and after delivery. For example:
      • “What should I do to prepare for my baby’s care?”
      • “What are the hospital’s policies regarding substance-exposed newborns?”
  • Keep Records: Document any steps you’ve taken to improve your circumstances, such as attending appointments, participating in parenting classes, or completing substance use treatment.

The prospect of actually telling your healthcare provider may be scary but by doing it before the birth lets them know you understand your situation and are being proactive by seeking help prior to birth. It lets them know that you are working towards sobriety and are prepared for what ever issues may arise with birth or the care of your infant. By including them, you are actually turning them into an advocate for you because they are not making judgments or speculating about your situation, they have been included in on your situation and have been actively helping you.

Prepare for Your Hospital Visit

  • Know Your Rights: Familiarize yourself with hospital policies, like the Eat, Sleep, Console (ESC) program and the Plan of Safe Care (POSC) process. Understand the criteria for mandatory reporting to CPS, so you know what to expect if concerns are raised. If you feel like you are going to struggle with post birth and the emotions surrounding that situation it is so important to plan for that and have someone there for you.  As you have read above, the criteria for the hospital to report to CPS is if the hospital does not think you will be safe with your infant.  This is why it is important to listen to the nurses and follow their suggestions. Additionally, by having someone there that understands your situation shows that you have a network and shows that you have supports in place when you are not able to follow those suggestions. 
  • Bring an Advocate: If you are wondering who to have at the hospital with you consider a doula or support worker (any of the suggested people above).  If they are not available, consider asking a trusted friend, family member, or mentor to accompany you during delivery and hospital care.
  • Create a Birth Plan: Include details about how you would like to handle your baby’s care, any accommodations you need, and who to contact in case of questions
  • Utilize Community Resources: Community action agencies often provide case management, housing assistance, or other supports to help stabilize your situation.

Show Willingness to Collaborate

  • Participate in the Plan of Safe Care (POSC): If recommended, engage fully with the POSC to demonstrate your commitment to your baby’s well-being.
  • Take Action to Address Concerns:If safety concerns arise, work proactively to resolve them (e.g., addressing unsafe housing, following medical advice, or attending substance use counseling).
  • Stay Organized: Keep a file of important documents, such as medical records, proof of participation in support programs, and any communication with healthcare providers.

If You Feel Unfairly Judged

  • Request Clear Explanations: Ask for specific reasons if safety concerns are raised and clarify what steps you can take to address them. Despite their rude behavior (and that can sometimes happen) remain calm and continue to clarify.
  • File a Complaint if Necessary: If you feel you were treated unfairly, you can file a complaint with the hospital’s patient advocacy department or escalate it to a state agency like the Department of Health. But do this AFTER!! you have left the hospital.

During a Hospital Hold:

    1. Stay Calm: Your demeanor matters. Be respectful, cooperative, and proactive.

    2. Accept Services: Demonstrating willingness to engage in services shows your commitment to your child’s well-being.

    3. Suggest Family Caregivers: If a there are concerns for you or your child being medically fragile make sure to provide names of relatives or trusted individuals that you can share that will help you in your home to prevent out of home placement. 

What is a medically Fragile Child?

A medically fragile child is one who has significant health conditions requiring constant, specialized care. These conditions may include the need for 24-hour skilled medical attention from a healthcare professional or a specially trained caregiver. The child’s health may be at serious risk if essential medical technologies, supports, or services are interrupted or denied. In some cases, immediate medical intervention is necessary to prevent life-threatening outcomes. According to DCYF Policy 45171. 

Examples of medically fragile situations include:

  • Dependence on medical devices (e.g., ventilators or feeding tubes).
  • Frequent or severe episodes requiring emergency medical care.
  • Chronic conditions that necessitate consistent monitoring and intervention.

If the hospital or CPS believes that a parent cannot safely care for a medically fragile child, they will hold a meeting to talk about other placement options. DCYF has specific steps they follow to make sure medically fragile children get the care they need. These include figuring out what the child needs, like referring them to specialists for extra help and keeping track of their medical needs. DCYF also works with hospitals to make sure the child has a doctor and a good plan when leaving the hospital, including finding the right place for the child to stay (stable housing) and teaching caregivers how to meet the child’s unique needs (demanding education for the care of your child). They also create a Caregiver Support Plan (you can create a plan as well) that includes training for the caregiver (this can be training for you), help with Medicaid services, and plans for emergencies. Social workers check in regularly to make sure the plan is working and adjust it if needed. By following these steps and showing that you can meet your child’s needs, you can demonstrate your ability to care for your medically fragile child. Since these are the same steps DCYF takes when placing a child with someone else, proving you can do the same can strengthen your case

Steps to take If CPS Becomes Involved: Your Rights as a Parent

If CPS becomes involved, it is typically for one of two reasons: First, the hospital determined there were child protective concerns, such as safety issues or that your child was too medically fragile for you to care for them given your substance use—even if you are actively working on recovery or have a plan in place. Second, CPS may become involved if you brought your child to the hospital for injuries and the hospital believes that returning them to your care would place them in imminent harm.

Take a deep breath—while this situation can feel overwhelming, there are steps you can take.

Seeking a Second Medical Opinion

Under RCW 26.44.030(8), you are entitled to request a second medical opinion if you disagree with a physician’s assessment. DCYF is obligated to cover this cost if CPS is involved.

  • Be proactive in requesting a second opinion.

  • Ensure the department consults you in choosing the healthcare professional. DCYF most likely WON’T OFFER IT, because the statute says “if the parents fail to designate a second physician, the department may make the selection!” So you need to let them know immediately who you choose. 

  • Make sure to request this AS SOON AS POSSIBLE because they usually do not let you know you have this option.  

Signing a Release of Information

When DCYF requests a release of information, you have the right to limit its scope:

  • Specify providers and timeframes relevant to your current services.

  • Avoid signing blanket releases that provide unnecessary access to historical records. See Section 5 time stamp 11:09 for details on how to fill out a Release of information. 

Family Team Decision Meeting

DCYF will hold a meeting to discuss the placement of your child. While they may talk about what is needed to make your home safe for your child to return, it’s important to recognize that this meeting can also be used to gather information to support their decision about your child’s placement. This is a critical time to stay calm and focused while advocating for your preferences.

If your child cannot return home immediately, express your desire for them to be placed with someone you trust. This could be a friend who knows your child, a family member, or a close friend if the child is an infant. It’s essential that this person lives in the same county or within a couple of hours, so reunification efforts can remain feasible.

For parents facing challenges related to substance use, the Rising Strong program is a valuable option to consider. This program offers housing, supervision, and substance use treatment while allowing you to remain with your child. If this program aligns with your needs, be clear and persistent in communicating to DCYF that you want to enroll in Rising Strong as part of your plan to work toward reunification.

Remember, this meeting is often a precursor to more formal decisions, so it’s essential to approach it thoughtfully and with a clear plan for advocating for your child’s placement and your reunification efforts

What Next?

If you receive a notice that your child is being removed, we are deeply sorry you’re going through this. Please know that when your case enters the court system, you will be appointed an attorney to help advocate for you and guide you through the process. Be sure to visit the Dependency tab and review the Shelter Care section, as this will outline your first steps and what to expect during your initial interactions with your attorney and the court system.

Links, Forms & Publications

DCYF Announcement to birthing hospitals and mandated reporters about POSC. 

DCYF POSC Birthing Hospital Brochure-This is a brochure describing the details of hte program

DCYF POSC Online referral flow chart– this is how the hospital is supposed to determine whether to make a referral to CPS. This way you know what hospitals are looking for. 

Online portal for Help Me Grow. 

Prenatal SUD Care Teams help prevent child welfare involvement by guiding gestational parents through Plan of Safe Care goals, connecting them to supportive services, and, if desired, navigating them to certified Centers of Excellence for Perinatal Substance Use.

First Steps Program: Medicaid-supported prenatal and infant care services. Learn more

Nurse-Family Partnership: Improving pregnancy outcomes and family self-sufficiency. Learn more

Help Me Grow Program: Connecting families to community resources. Learn more

Eat, Sleep, Console Program: Understanding newborn care. Learn more

Family Team Decision Meeting Guide -Longer to read

Family Team Decision Making Meeting Brochure

Meeting chart– so you can see where the FTDM falls with regards to other various meetings. This is especially important if DCYF is suggesting a Shared Planning Meeting. 

DCYF brochure– things to consider for mandatory reporters when reporting infant substance exposure. This way you can know what mandatory reporters are being told to look for. 

This is an older publication but it gives a description of all the programs that are available for prebirth, birth and postbirth.  Organizations who host these types of programs change frequently so type in the program and then spokane after it and it will reveal what organizations host that type of program. 

This is the plan of safe care form by DCYF that is filled out for services.  In order to ensure you get ESIT (Early Support of Infant and Toddlers) make sure the social worker checks the box on the form.  Right below that box it states “All newborns experiencing prenatal substance exposure are automatically eligible for ESIT services.” 

Consent for Release of information- This form is being provided for you so you can know in advance what you are signing and how to restrict it to only the information that is needed.  Again please go to Section 5 and watch the video at time marker 11:09 on how to ensure you safeguard your personal information.