Home > Protecting Children in Substance-Abusing Families > Protecting Children in Substance-Abusing Families : Appendix II : Sample Medical Center Protocol

	Rate this Publication Average Rating: 5.00 (out of 5), 8 Raters Printable Version PDF (142 pgs, 1590 KB) Email This

Protecting Children in Substance-Abusing Families
User Manual Series (1994)

Author(s):  U.S. Department of Health and Human Services Kropenske, Howard, Breitenbach, Dembo, et al.

Year Published:  1994

previous

You are in section: Table of Contents Preface Acknowledgments 1 - Introduction 2 - Identifying Alcohol and/or… 3 - Chemically Involved Parents:… 4 - Children of Chemically… 5 - Reporting Child Maltreatment… 6 - Comprehensive Family… 7 - Juvenile Court Involvement… 8 - Innovative Approaches to… Conclusion Appendix I - The Nature of… Appendix II - Sample Medical… Appendix III - Sample Interagency… Notes Glossary of Terms Selected Bibliography Other Resources Table 1 - Hospital Form For… Table 2 - Sample Interagency… Table 3 - Assessment/Intervention… Table 4 - Assessment/Intervention… Table 5 - Assessment/Intervention… Table 6 - Major Substances of…

next

Appendix II : Sample Medical Center Protocol

SUBJECT: SUSPECTED CHILD ABUSE AND/OR NEGLECT: DRUG/ALCOHOL RELATED SITUATIONS INVOLVING PERINATAL PATIENTS

PURPOSE

To specify the protocol for identifying potential child endangering drug/alcohol related situations involving perinatal patients. Efforts are directed at problem identification, counseling the parent(s), making appropriate referrals for treatment, and initiating protective service referrals when indicated.

POLICY

The capacity of the drug/alcohol dependent parent to provide a safe, nurturing environment necessary for a child to thrive must be assessed.

Infant drug/alcohol exposure evaluations are necessary to determine the need for services and referrals that promote a safe environment for the infant and appropriate help for the parents.

Information for evaluations is obtained by history, the observation of signs and symptoms in the mother and infant, and toxicologic examination. A multidisciplinary approach is used to respond to the medical, social, and legal needs of substance abusing parents and their infants.

RESPONSIBILITIES

1. The responsibility for evaluating infants exposed to potentially harmful substances rests with all mandated reporters which includes, but is not limited to physicians, nurses, and social workers. (See Attachment I.)
   
   
2. It shall be the responsibility of the health care team to evaluate each case and make the appropriate recommendations and referrals.
   
   
3. When a child-endangering situation is being evaluated:
   1. The health care team is responsible for providing a medical evaluation of mother and infant, a psychosocial assessment, support, and referrals to appropriate resources.
      
      
   2. If the assessment reveals factors that indicate risk to a child, the SCAN Team On-Call Consultant will be notified.
      
      
   3. When indicated, the physician, in collaboration with the clinical social worker (or, in the clinical social worker's absence, the head nurse or his/her designee) is responsible for:
      1. Reporting to Child Protective Services (CPS) in the county where the mother resides.
         
         
      2. Completing the State's Suspected Child Abuse Report.

   4. The attending physician is responsible for reviewing and cosigning the State's Medical Report-- Suspected Child Abuse.
      
      
   5. The SCAN Team will review each suspected child abuse case referred for consultation at the weekly SCAN Team meeting where recommendations are made for continued case management. Physicians and other hospital personnel are requested to present the cases in which they have been significantly involved.

PROCEDURES

1. During the Prenatal Period
   1. The objective of prenatal interventions with substance abusing patients is prevention, early problem identification, education, and treatment. Substance abuse may impair a patient's ability to obtain prenatal care. Extra effort should be made to facilitate prenatal care for patients whenever they come in contact with a health care provider.
      
      
   2. When a patient presents to the Medical Center with a current history of or signs or symptoms of drug/alcohol abuse: (See Attachment II.)
      1. The history of or signs or symptoms of drug/alcohol abuse shall be documented in the patient's medical record.
         
         
      2. The health care team is responsible for initiating a multidisciplinary assessment. (See Attachment III.)
         
         
      3. Refer the patient to the clinical social worker assigned to the service so that the assessment process can be coordinated and referrals to services can be made.
         
         
      4. Efforts to educate and counsel the patient regarding the risks of drug/alcohol abuse to self and fetus shall be documented in the medical record by the health care providers.
         
         
      5. Refer the patient back to their health care provider or to the High Risk OB Clinic for ongoing prenatal care, continuing assessment, and toxicology screening.

2. During the Labor and Delivery Period
   1. The following steps shall be taken for all patients presenting with a history of drug/alcohol abuse:
      1. The history shall be charted in the patient's medical record.
         
         
      2. Clinical Social Work shall be notified so that an assessment can be initiated.

   2. If the patient has signs or symptoms of drug/alcohol abuse (See Attachment II.) or other indicators of possible drug/alcohol abuse (See Attachment IV.), the following additional steps should be taken:
      1. The signs or symptoms or indicators shall be charted in the patient's medical record.
         
         
      2. The physician shall order a toxicology screen and shall discuss the results with the patient.
         
         
      3. The physician, in collaboration with the delivery room nurses and the clinical social worker, shall notify the SCAN Team consultant. (See Attachment I.)

3. During the Postnatal Period
   1. The health care team shall evaluate for all situations involving infants born with signs or symptoms suggestive of prenatal drug/alcohol exposure (See Attachment V.), or who are born to a mother with signs or symptoms or other indicators suggestive of drug/alcohol abuse. (See Attachments II. and IV.) In these situations:
      1. The signs or symptoms or other indicators of drug/alcohol abuse in the mother shall be documented in the mother's medical record.
         
         
      2. Signs or symptoms of drug/alcohol abuse in the infant shall be documented in the infant's medical record.
         
         
      3. The physician shall order a toxicology screen for the infant and discuss the result with the parent(s).
         
         

      4. The clinical social worker shall be notified in order to coordinate the multidisciplinary assessment prior to the discharge of the infant. (See Attachment III.)

         When appropriate, the assessment shall include consultation with psychiatry, child development, and agencies such as the parent's drug or alcohol treatment program, CPS, Regional Center, public health, siblings' schools, and siblings' pediatricians.

      5. The physician, in collaboration with nursing staff and the clinical social worker, shall notify the SCAN Team consultant. (See Attachment I.)

   2. CPS shall be notified when:
      1. The assessment of the multidisciplinary team leads to suspicion of endangerment due to the interaction of the particular infant, parent, and environmental variables present in the situation. (See Attachment VI.)
         
         
      2. The health care team is unable to adequately assess risk for the following reasons:
         1. A home visit is needed prior to discharge.
            
            
         2. The parent cannot be located.
            
            
         3. The parent withholds information crucial to the assessment or gives conflicting information.
            
            
         4. The parent refuses consent to contact involved community agencies for information pertinent to the assessment.

   3. The discharge plan developed by the health care team shall:
      1. Be developed in conjunction with CPS, when notified.
         
         
      2. Identify services needed by the infant/parent/family and specify referrals.
         
         
      3. Shall include a newborn follow-up visit at the Medical Center to take place within 10 days of discharge for infants who reside locally.

previous

You are in section: Table of Contents Preface Acknowledgments 1 - Introduction 2 - Identifying Alcohol and/or… 3 - Chemically Involved Parents:… 4 - Children of Chemically… 5 - Reporting Child Maltreatment… 6 - Comprehensive Family… 7 - Juvenile Court Involvement… 8 - Innovative Approaches to… Conclusion Appendix I - The Nature of… Appendix II - Sample Medical… Appendix III - Sample Interagency… Notes Glossary of Terms Selected Bibliography Other Resources Table 1 - Hospital Form For… Table 2 - Sample Interagency… Table 3 - Assessment/Intervention… Table 4 - Assessment/Intervention… Table 5 - Assessment/Intervention… Table 6 - Major Substances of…

next

This material may be freely reproduced and distributed. However, when doing so, please credit Child Welfare Information Gateway.

Updated on December 10, 2007