Plans of Safe Care Infants With Prenatal Substance Exposure and Their Families - Colorado
Definitions
Citation: Rev. Stat. § 19-1-103(1)(A)(VII); 19-3-102(1)(g); Code of Regs. Tit. 12, § 2509-1
Abuse' or 'child abuse or neglect' applies to any case in which a child is born affected by alcohol or substance exposure, except when taken as prescribed or recommended and monitored by a licensed health-care provider, and the newborn child's health or welfare is threatened by substance use.
A child is neglected or dependent if the child is born affected by alcohol or substance exposure, except when taken as prescribed or recommended and monitored by a licensed health-care provider, and the newborn child's health or welfare is threatened by substance use.
In regulation: 'Plan of safe care' (POSC) means a collaborative process to create a documented plan for the health, safety, and well-being of an infant reported with prenatal substance exposure following the infant's release from the care of a health-care provider, and address the health, support, and substance use treatment needs of the affected family or caregiver(s) according to the requirements outlined in 12 CCR 2509-2 section 7.107.5.
Notification/Reporting Requirements
Citation: Rev. Stat. § 19-3-304
Any mandated reporter who has reasonable cause to know or suspect that a child has been subjected to abuse or neglect or who has observed the child being subjected to circumstances or conditions that would reasonably result in abuse or neglect shall immediately, upon receiving such information, report or cause a report to be made to the county department, the local law enforcement agency, or through the child abuse reporting hotline system.
Assessment of the Infant and Family
Citation: Code of Regs. Tit. 12, § 2509-2 (7.103); Best Prac. Guide
When a substance-exposed newborn is a referral reason, the county department shall ask the Colorado POSC-enhanced questions.
From "Best Practice Recommendations for Collaboration and Integration of Plans of Safe Care Implementation in Colorado:" Health-care providers and the child welfare system should consider the following in the assessment of infants and families:
- The birthing parent's behavior and interaction or bonding with the newborn
- Parental protective capacities of the primary caregiver and any other adult caregivers both in and out of the home
- The family's support system
- The home environment
- Evidence of preparation and safe care for the infant, such as a crib, clothing, and formula
- Mental health concerns or the presence of domestic violence
- Assessment of all other adults and children living in the home
- The infant's current condition or special needs or disabilities
- The nature and extent of the birthing parent's alcohol and drug use and treatment history
- Information on the parents' mental health concerns, such as postpartum depression and any cooccurring disorder
- The presence of other children in the home and their current care and condition
- Family strengths and involvement of the infant's family members or support persons
- The birthing parent's level of cooperation and willingness to address concerns
- The extent and availability of the newborn's family or other individuals to assist with caregiving and the provision of other support
- The availability of stable housing with no apparent safety or health hazards
Responsibility for Development of the Plan of Safe Care
Citation: Code of Regs. Tit. 12, § 2509-2 (7.107.5)
The Colorado POSC shall be completed any time a referral is accepted for assessment, and the child meets the definition of a substance-exposed newborn as described in the statute. The plan shall be completed based on the information available and based on the interview or observation of the child alleged to be the victim and in collaboration with parents, caregivers, medical providers, and others who may be a part of the plan.
The action to complete a POSC shall be determined and based on an assessment that contains an allegation of substance-exposed newborn as follows:
- If a POSC has not been created by a medical, treatment, or community provider, the caseworker shall create a POSC.
- When a POSC has been developed by a medical, treatment, or community provider, the caseworker shall update the plan to reflect the current circumstances.
From the guide: Responsibility for development of POSC: Ideally, a POSC is initiated prenatally by the primary health-care provider caring for the family impacted by substance use disorder and is developed over time and in collaboration with the birthing parent and the birthing parent's support persons, other health-care providers involved in caring for the family (including prenatal providers, addiction medicine specialists, pediatricians, neonatologists, or family medicine providers), social workers, mental health specialists, and other professionals and agencies involved in serving the affected infant and family.
Presently, best practice would recommend the aforementioned POSC development process. However, presently, the responsibility of POSC development rests on the child welfare agency when a case meets the criteria for assessment.
Services for the Infant
Citation: Best Prac. Guide
The plan will address the safety, health, and substance use disorder treatment needs of the infant and affected family members or caregivers. Best practices indicate this should be done through the interdisciplinary coordination of services to enhance the overall well-being of the infant and their parents or caregivers.
Services for the infant include the following:
- Developmental screening and assessment
- Linkage to early intervention services
- Medical services needed to meet the ongoing health needs of the infant
- Home visiting programs
Services for the Parents or Other Caregivers
Citation: Rev. Stat. § 27-80-114; Code of Regs. Tit. 2, § 502-1 (21.220.4); Best Prac. Guide
The Department of Health Care Policy and Financing (DHCPF) shall cooperate with any organizations that wish to assist the DHCPF in providing services related to the treatment program for high-risk pregnant and parenting women. Organizations may provide services that are not provided to persons pursuant to the treatment program for high-risk pregnant and parenting women, which may include, but shall not be limited to, the following:
- Needs assessment services
- Preventive services
- Rehabilitative services
- Care coordination
- Nutrition assessment
- Psychosocial counseling
- Intensive health education
- Home visits
- Transportation
- Development of provider training
- Child care
- Other necessary components of residential or outpatient treatment or care
In regulation: Pregnant women shall be given priority admission to treatment for substance use disorders. Programs shall develop policies and procedures for service delivery to pregnant women, which shall include circumstances under which pregnant women may be discharged from treatment, as follows:
- Pregnant women may not be discharged from treatment solely for failure to maintain abstinence from substance use.
- Every effort shall be made to retain pregnant women in treatment for the duration of their pregnancies in an attempt to maintain an optimal period of abstinence from substance use.
Every attempt shall be made to admit pregnant women to treatment within 48 hours of first contact between the woman and the admitting program. If a pregnant woman is not admitted to treatment within 48 hours of first contact, the denial shall be clearly documented, the women's treatment coordinator shall be informed, and interim services shall be provided, consisting of, at minimum, the following:
- Referral for prenatal care
- Information on the effects of alcohol and drug use on the fetus
- Daily phone contact with the individual
- Education regarding the transmission and prevention of communicable diseases such as HIV and hepatitis
Pregnant women shall be linked to prenatal care immediately, and barriers to accessing prenatal care shall be addressed, including transportation to prenatal care. When a woman refuses to seek prenatal care or fails attempts to link her to care, this shall be documented in her record, and there shall be continuing efforts to link her to prenatal care until this is accomplished.
From the guide: Best practice indicates that a POSC should be designed to meet both the short- and long-term needs of the family, with the goal of strengthening the family and keeping the child safely in the home. A POSC could include the following components, depending on the needs of the family:
- Substance use assessment and services
- Medical services needed to meet the ongoing health needs of the parents and other caregivers
- Mental health services
- Assistance with obtaining safe housing
- Instruction on the special care needs of the infant
- Provision of infant safe sleep information and ensuring safe sleep arrangements in the home
- Child care or respite care
- Vocational training for parents seeking entry into the job market
- Comprehensive and coordinated social services, including family therapy groups, parent-child therapy, and residential support groups
Monitoring Plans of Safe Care
Citation: Rev. Stat. § 27-80-115; Best Prac. Guide
The DHCPF shall establish a data collection mechanism for persons receiving services under the treatment program for high-risk pregnant and parenting women, which must include the collection of data on cost-effectiveness, program success, and other relevant information that the DHCPF deems appropriate.
From the guide: The POSC should be frequently revisited and revised in collaboration with the birthing parent and the birthing parent's support persons, health-care providers (including prenatal providers, addiction medicine specialists, pediatricians, neonatologists, or family medicine providers), social workers, mental health specialists, and other professionals and agencies involved in serving the affected infant and family to meet their changing needs.