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

Definitions
Citation: Ann. Code § 12-18-103(14)(B); Code of Rules 016 15 CARR 004, Pol. II-F

The term 'neglect' includes either of the following:

• Causing a child to be born with an illegal substance present in the child's bodily fluids or bodily substances because the pregnant mother knowingly used an illegal substance before the birth of the child
• At the time of the birth of a child, the presence of an illegal substance in the mother's bodily fluids or bodily substances because the pregnant mother knowingly used an illegal substance before the birth of the child

The term 'illegal substance' means a drug that is prohibited to be used or possessed without a prescription under the Arkansas Criminal Code, § 5-1-101, et seq. A test of the child's or the mother's bodily fluids or bodily substances may be used as evidence to establish neglect.

In regulation: Fetal alcohol syndrome disorder (FASD) is an umbrella term used to describe the range of effects or disorders that can occur in an individual whose mother consumed alcohol during pregnancy.

The term 'affected by' means any of the following: 

• An infant exhibits a condition or conditions associated with the mother's use of alcohol during pregnancy, or a health-care provider has an articulated concern that the infant suffers from FASD.
• An infant exhibits an adverse effect or effects in physical appearance or functioning that are either diagnosed or otherwise observed and are a result of the mother's use of a legal or illegal substance during pregnancy.
• An infant exhibits withdrawal symptoms due to the mother's use of a legal or illegal substance during pregnancy. 

The term 'infant' means any child 30 days old or younger.  

Notification/Reporting Requirements
Citation: Ann. Code § 12-18-310; Code of Rules 016 15 CARR 004, Pol. II-F

All health-care providers involved in the delivery or care of infants shall do the following:

• Contact the Department of Human Services regarding an infant born with and affected by any of the following:
  • FASD
  • Maternal substance abuse resulting in prenatal drug exposure to an illegal or a legal substance
  • Withdrawal symptoms resulting from prenatal drug exposure to an illegal or a legal substance
• Share all pertinent information, including health information, with the department regarding an infant born with and affected by any of the following:
  • FASD
  • Maternal substance abuse resulting in prenatal drug exposure to an illegal or a legal substance
  • Withdrawal symptoms resulting from prenatal drug exposure to an illegal or a legal substance

The department shall accept referrals, calls, and other communications from health-care providers involved in the delivery or care of infants born with and affected by FASD, maternal substance abuse resulting in prenatal drug exposure to an illegal or a legal substance, or withdrawal symptoms resulting from prenatal drug exposure to an illegal or a legal substance.

In regulation: The Division of Children and Family Services (DCFS), in coordination with other State agencies and community partners, strives to address the needs of substance-exposed infants primarily through the following two approaches: 

• Addressing the needs of substance-exposed infants who are defined as neglected pursuant to statute and the needs of their families via an investigative response
• Implementing a referral process for health-care providers involved in the delivery and care of infants to report, for the purpose of an assessment not related to a child maltreatment investigation, infants who have not been neglected but who are born with and affected by any of the following:
  • FASD
  • Maternal substance abuse resulting in prenatal drug exposure to an illegal or legal substance
  • Withdrawal symptoms resulting from prenatal drug exposure to an illegal or a legal substance 

Health-care providers involved in the delivery or care of infants are required to make prenatal substance exposure referrals to the child abuse hotline. The hotline will accept prenatal substance-exposure referrals. Upon receipt of a prenatal substance exposure referral from a health-care provider, the hotline will assign the referral to DCFS for a referral and assessment. The request for an assessment screen accommodates instances where an individual is not reporting maltreatment but is requesting an assessment and appropriate services for the family based on an assessment of the family's strengths and needs.

Assessment of the Infant and Family
Citation: Code of Rules 016 15 CARR 004, Pol. II-F

Prenatal substance exposure referrals will be assigned to the appropriate county-level differential response (DR) staff (though prenatal substance exposure referrals are separate and apart from differential response allegations). For a prenatal substance exposure referral to be considered initiated, DR staff must make face-to-face contact with the infant or at least one parent of the infant within 72 hours of receipt of the referral from the hotline. If the infant and parent or caregiver are not seen together at the initiation, then DR staff must make face-to-face contact with the individual not seen at initiation within 5 calendar days of receipt of the referral as well as any other adult household members within the same 5 calendar day timeframe.

Responsibility for Development of the Plan of Safe Care
Citation: Ann. Code § 12-18-310; Code of Rules 016 15 CARR 004, Pol. II-F

A plan of safe care (POSC) shall be developed for infants affected by FASD, maternal substance abuse resulting in prenatal drug exposure to an illegal or a legal substance, or withdrawal symptoms resulting from prenatal drug exposure to an illegal or a legal substance. The POSC shall be designed to ensure the safety and well-being of an infant following the release of the infant from the care of a health-care provider. A POSC also shall include content that addresses the health and substance use disorder treatment needs of the infant and affected family or caregiver.

In regulation: During each contact with the parent(s) or caregiver(s), DR staff are responsible for engaging the family in an assessment of strengths and needs and developing a POSC for the family. The POSC will be designed to ensure the safety and well-being of an infant following the release of the infant from the care of a health-care provider and include content that addresses the health and substance use disorder treatment needs of the infant and affected family or caregiver.

DR staff will develop the POSC with the family within 14 calendar days of receipt of the referral and ask the family if they are interested in continuing services with DCFS through a supportive services case.

Services for the Infant
Citation: Ann. Code § 12-18-310; Code of Rules 016 15 CARR 004, Pol. II-J

The POSC shall be designed to ensure the safety and well-being of an infant following the release of the infant from the care of a health-care provider.

In regulation: A POSC must be developed for any infant born with and affected by FASD, maternal substance abuse resulting in prenatal drug exposure to an illegal or a legal substance, or withdrawal symptoms resulting from prenatal drug exposure to an illegal or a legal substance who is referred to DCFS by a health-care provider via the child abuse hotline.

DCFS will refer children who have known prenatal alcohol exposure or exhibit FASD symptoms or behaviors to the local resource unit. The resource unit will collaborate with the child's caseworkers to help determine if early intervention programs or other services specific to FASD are needed and connect the child and placement provider to such programs and services in an effort to better support the child and the placement provider.

Services for the Parents or Other Caregivers
Citation: Ann. Code § 12-18-310; Code of Rules 016 15 CARR 004, Pol. II-J

A POSC also shall include content that addresses the health and substance use disorder treatment needs of the infant and affected family or caregiver.

In regulation: If a child is diagnosed with FASD, the following services may be offered to the family:

• Referral to the Division of Developmental Disabilities Services, if applicable and available
• Referral to specialized day care, if applicable
• Referral to an FASD family support group (available to birth, foster, and adoptive families), if available
• FASD parenting classes (available to birth, foster, and adoptive families)

Monitoring Plans of Safe Care
Citation: Ann. Code § 12-8-509

The State agency or entity responsible for administering the child abuse hotline or investigating an incident of neglect shall develop and maintain statewide statistics of the incidents of neglect reported or investigated under § 12-18-103(14)(B) and provide an annual report to certain State house and senate legislative committees. The annual report shall include all findings and statistics regarding incidents of neglect reported or investigated under § 12-18-103(14)(B), including, but not limited to, the following information:

• The age of the mother
• The type of illegal substance to which the newborn child was exposed prenatally
• The estimated gestational age of the newborn child at the time of birth
• The newborn child's health problems