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

Definitions

Citation: DSS All County Letter No. 17-92

Under California law, an 'infant born and identified as being affected by substance abuse or withdrawal symptoms resulting from prenatal drug exposure, or a fetal alcohol spectrum disorder (FASD)' is defined as an infant for whom substance exposure is indicated at birth, and subsequent assessment identifies indicators of risk that may affect the infant's health and safety.

Notification/Reporting Requirements

Citation: DSS All County Letter No. 17-92

A health practitioner or a medical social worker, prior to the infant's release from the hospital, must perform the assessment of needs. The purpose of the assessment is to identify needed services for the mother, child, or family and the level of risk to the newborn upon release to the home. The assessment will identify the level of services and intervention necessary and may include a referral to the county welfare department for child welfare services.

Upon receipt of a mandated report from a health-care provider, the county child welfare agency must then respond in accordance with the appropriate protocols and assessments required by State regulations set forth in Division 31-100 of the Child Welfare Manual of Policies and Procedures.

When investigating a referral, the county child welfare agency must assess and identify any safety threats to the child, including any safety threat posed by the parent's substance abuse. This includes completion of a risk assessment.

Assessment of the Infant and Family

Citation: Health & Safety Code § 123605; DSS All County Letter No. 17-92

Each county shall establish protocols between county health departments, county welfare departments, and all public and private hospitals in the county regarding the application and use of an assessment of the needs of, and a referral for, a substance-exposed infant to a county welfare department pursuant to § 11165.13 of the Penal Code.

The assessment of the needs shall be performed by a health practitioner or a medical social worker. The needs assessment shall be performed before the infant is released from the hospital.

The purpose of the needs assessment is to do all the following:

• Identify needed services for the mother, child, or family, including, where applicable, services to assist the mother caring for her child and services to assist maintaining children in their homes
• Determine the level of risk to the newborn upon release to the home and the corresponding level of services and intervention, if any, necessary to protect the newborn's health and safety, including a referral to the county welfare department for child welfare services
• Gather data for information and planning purposes

In regulation: Prenatal substance exposure may be demonstrated by a positive toxicology screen from the infant or mother at delivery, an infant showing signs of substance withdrawal, an FASD diagnosis, or other credible information that there was prenatal substance abuse by the mother (e.g., self-admission, witnessed drug or alcohol abuse while pregnant). An indication of substance exposure at birth includes exposure to either illegal and/or legal substances, such as prescription opioids or other drugs. Such indication will trigger an assessment of needs and indicators of risk to the child's health and safety.

A positive toxicology screen at the time of delivery is not in and of itself a sufficient basis for a mandated report. If, following the assessment, there are other factors present indicating risk to the child, a report shall be made by the health-care provider to the county child welfare agency. Other indicators of risk to the infant's health and safety that may be identified upon further assessment, include, but are not limited to, the following:

• Special medical and/or physical problems of the infant
• Special care needs of the infant
• Infant's experience of withdrawal symptoms
• Parent's lack of prenatal care
• Parent's history of drug/alcohol use
• Parent's history of drug/alcohol treatment
• Parent's awareness of impact of drug/alcohol use on the child
• Parent's emotional and mental functioning and stability
• Parent's responsiveness to the infant, bonding/attachment, and parenting skills
• Parent's preparedness to care for the infant (e.g., adequate baby supplies)
• Parent's history of abuse or neglect of other children
• Parent's history of family violence
• Parent's involvement in criminal activity or criminal activity in the household
• Lack of a family support system
• Unsafe home environment conditions

Responsibility for Development of the Plan of Safe Care

Citation: DSS All County Letter No. 17-92

When a safety plan and/or case plan is developed and implemented for an infant born and identified as being affected by substance abuse, that plan shall also act as the plan of safe care.

If the case worker determines the caregiver has the protective capacity to mitigate safety threats and/or risks with appropriate services while keeping the child in the home or placement, the case worker shall develop a safety plan to permit the child to remain in the home with specific, timely actions that mitigate the identified safety threats. If the safety threats are not mitigated during the investigation period, and the referral is promoted to a case, or if the child must be removed from the home, a case plan shall be developed in accordance with Welfare and Institutions Code § 16501.1.

Consistent with the existing requirements of safety plans and case plans, the case worker shall clearly identify and document the effect(s) of the substance abuse, withdrawal symptoms, and/or FASD in these plans as well as the specific action steps necessary to assist maintaining children in their homes or, if appropriate, to promote family reunification.

Services for the Infant

Citation: DSS All County Letter No. 17-92

These action steps must address the immediate safety needs of the affected infant and the ongoing treatment needs of the infant. The action steps shall include referrals to and delivery of services that are appropriate for the infant and the affected family member or caregiver.

Services for the Parents or Other Caregivers

Citation: DSS All County Letter No. 17-92

These action steps must address the health and substance abuse treatment needs of the affected family member or caregiver. The action steps shall include referrals to and delivery of services that are appropriate for the infant and the affected family member or caregiver.

Monitoring Plans of Safe Care

Citation: DSS All County Letter No. 17-92

The case worker also must monitor the safety plan or case plan to ensure appropriate implementation and that the specific action steps are completed. The monitoring should include all steps necessary to assure the safety of the infant. This includes ensuring that the family or caregiver is receiving the treatment and appropriate services required by the plan.