Plans of Safe Care Infants With Prenatal Substance Exposure and Their Families - Arizona

Definitions
Citation: Rev. Stat. § 8-201(25)

The term 'neglect' means either of the following:

• A determination by a health professional that a newborn infant was exposed prenatally to a drug or substance listed in § 13-3401 and that this exposure was not the result of a medical treatment administered to the mother or the newborn infant by a health professional. The determination by the health professional shall be based on one or more of the following:
  • Clinical indicators in the prenatal period, including maternal and newborn presentation
  • History of substance use or abuse
  • Medical history
  • Results of a toxicology or other laboratory test on the mother or the newborn infant
• Diagnosis by a health professional of an infant under age 1 year with clinical findings consistent with fetal alcohol syndrome or fetal alcohol effects

Notification/Reporting Requirements
Citation: Rev. Stat. § 13-3620(E); Pol. & Proc. Man. Ch. 2, § 11.1

A health-care professional who, after a routine newborn physical assessment of a newborn infant's health status or following notification of positive toxicology screens of a newborn infant, reasonably believes that the newborn infant may be affected by the presence of alcohol or a drug listed in § 13-3401 shall immediately report this information, or cause a report to be made, to the Department of Child Safety. For the purposes of this subsection, 'newborn infant' means a newborn infant who is under 30 days of age.

In policy: The department shall investigate all reports alleging that a newborn infant has been prenatally exposed to alcohol or a controlled legal or illegal substance.

A newborn infant who has been prenatally exposed to alcohol or a controlled legal or illegal substance or is demonstrating withdrawal symptoms resulting from controlled substances is considered vulnerable to abuse or neglect. The overall substance use by the parent (including prenatal drug use, whether prescribed or not) and the parents' ability to perform essential parental responsibilities must be considered in the assessment of the newborn's safety.

Assessment of the Infant and Family
Citation: Pol. & Proc. Man. Ch. 2, § 11.1

For the family functioning assessment, the department shall complete the following:

• Gather information concerning the medical condition of the newborn, including any complications from the substance exposure, the discharge status and instructions (where applicable), and any recommendations for follow-up medical care
• If available, obtain documentation from the health-care professional(s) about the newborn infant's prenatal substance exposure, including the following:
  • Clinical indicators in the prenatal period, including maternal and newborn infant presentation
  • Information regarding history of substance abuse or use by the mother
  • Birth and medical records
  • Toxicology results or other laboratory test results on the mother and the newborn infant
• Obtain information from the health-care professional(s) regarding their observations of the parental responsiveness to the newborn, visitation, feeding, understanding of the newborn's special needs, or any other information to assist in the safety assessment and development of the infant care plan
• Obtain the hospital discharge plan and recommendations from the health-care professional about postdischarge infant care and medical follow-up
• If the newborn is hospitalized at the time of the report, do the following:
  • Visit the newborn's home environment prior to the newborn's discharge or, if it is not possible to visit prior to discharge, visit on the day of the infant's discharge
  • Advise the health-care professional that an assessment of the newborn's safety in the home is being completed and request that the department be notified prior to the infant's discharge
• Obtain the names and contact information of the health-care professionals who will provide routine health care for the newborn and any recommended special medical care
• Collect information to assess family functioning, threats of danger, and parent or caregiver protective capacities in a family, including the following regarding the parent or caregiver:
  • Any history of depression, anxiety, or other mental health concerns
  • Any history of substance use, including the types, frequency, and amount of drugs used
  • Any history of substance-exposed newborn births
  • Any history of participation in substance abuse treatment services and other prevention or intervention services
  • The perception of their caregiving role and responsibilities
  • The plan to meet the newborn's basic needs for shelter, clothing, medical care, etc.
  • Whether tobacco is smoked in the home and plans to discontinue use
  • Identification of the proposed caregivers of the newborn on a daily basis and when the mother is unavailable and whether that caregiver has the ability to provide safe care to the newborn
  • Sleeping arrangements, including assessment of whether the infant has a safe sleep environment
  • History of parenting, including parenting of siblings in the past or currently
  • Knowledge of child development, infant or toddler mental health, and behavior management, including information about relationships between parent and newborn and newborn and siblings
• If the parent is engaged in medically assisted treatment (MAT) to control an opioid addiction, obtain information about the parent's treatment progress
• For infants suspected of having fetal alcohol spectrum disorder (FASD), obtain the following as soon as possible or within 1 year:
  • Documentation of the diagnosis by a health professional indicating clinical findings consistent with FASD
  • The child's medical records
  • The health professional's recommendations for services for the child

Responsibility for Development of the Plan of Safe Care
Citation: Pol. & Proc. Man. Ch. 2, § 11.1

The department shall develop an infant care plan (ICP) for newborn infants who were prenatally exposed to alcohol or substance use by the mother or the child up to age 1 who was diagnosed with FASD.

When developing the ICP, the department shall actively involve the following people:

• Parents or caregivers
• The infant's health care professionals
• The parent's or caregiver's substance abuse treatment service providers, to include MAT provider if applicable
• Out-of-home caregivers
• Supportive adults identified by the parents or caregivers (if applicable)

Services for the Infant
Citation: Pol. & Proc. Man. Ch. 2, § 11.1

The ICP describes the services and supports that will be provided to ensure the health and well-being of the infant and addresses the substance abuse treatment needs of the parent or caregiver. Each plan addresses the following areas:

• Medical care for the infant
• Safe sleep practices
• Living arrangements in the infant's home

Services for the Parents or Other Caregivers
Citation: Rev. Stat. § 36-141; Pol. & Proc. Man. Ch. 2, § 11.1

The Arizona health-care cost containment system for alcohol and substance abuse shall give priority to treatment services for pregnant abusers of alcohol and other drugs.

In policy: The infant care plan describes the services and supports that will be provided to ensure the health and well-being of the infant and addresses the substance abuse treatment needs of the parent or caregiver. Each plan addresses the following areas:

• Substance abuse treatment needs of the parents or caregivers
• Knowledge of parenting and infant development
• Living arrangements in the infant's home
• Child care
• Social connections

The department may also refer the parent, guardian, or custodian(s) to Arizona Families F.I.R.S.T. (AFF). The department will provide the parent with a copy of the AFF flyer and encourage the parent's participation in substance abuse awareness services and, if recommended, substance abuse treatment, in order to achieve behavioral changes and improve family functioning.

Monitoring Plans of Safe Care
Citation: Pol. & Proc. Man. Ch. 2, § 11.1

If a case involving a substance-exposed newborn is opened for ongoing services, the department will oversee the implementation of the ICP by observing, discussing, and assessing the child's status indicators and participation with health-care providers during monthly in-person contacts with the child and the child's caregiver.

If a parent has been referred to substance abuse treatment or other services, the department will oversee the sufficiency of the services by observing, discussing, and assessing the parent's progress and participation in services during monthly in-person contacts with the parent and through communication with the parent's service provider(s).

The department also must do the following: 

• Review and reassess the ICP during case plan staffings, child and family team meetings, and whenever there is an indication that the child's health or health-care needs resulting from prenatal substance exposure have changed
• Update the ICP if indicated and distribute it to the parent or caregiver and other team members

To determine when it is appropriate to close an ongoing services case involving a substance-exposed newborn, the department will consider the following:

• Whether the parent understands the care necessary to help the newborn overcome the effects of the substance use and reliably acts to provide necessary care
• Whether the parent has taken steps to change or control the behavior or conditions that placed the child in impending danger and whether these steps are sufficient to determine the child is safe from impending danger
• Whether the parent is involved with extended family members, community support networks, or service providers who will help the family maintain these changes over time
• Whether the parent understands the ICP and knows how and where to access help if additional needs for health care or substance abuse treatment arise in the future