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

Date: August 2019

Definitions

Citation: Gen. Stat. § 17a-54b

For purposes of this section, the following definitions apply:

  • 'Drug abuse' means the ingestion of controlled substances without a prescription or other authorization required under State law.
  • 'Substance use' means the excessive use of drugs or alcohol in a manner that causes harm to oneself or others.
  • 'Fetal alcohol spectrum disorder' (FASD) means a range of health conditions that may affect an infant whose mother drank alcohol during pregnancy, including, but not limited to, fetal alcohol syndrome.

Notification/Reporting Requirements

Citation: Ann. Stat. § 17a-102a; DCF Substance Use Prac. Guide

A provider involved in the delivery or care of a newborn who, in the estimation of such provider, exhibits physical, neurological, or behavioral symptoms consistent with prenatal substance exposure, withdrawal symptoms from prenatal substance exposure, or FASD shall notify the Department of Children and Families (DCF) of such condition in such newborn. On and after January 15, 2019, such notice shall include a copy of the plan of safe care (POSC) created pursuant to the guidelines developed pursuant to § 17a-102a(c).

In policy: As required by Federal law, DCF is developing policies and procedures for the notification to child protective services of the birth of an infant affected by prenatal drug or alcohol exposure, to ensure the development of a POSC for infants who are prenatally exposed, and to ensure a referral for those infants to screening and early intervention services. These procedures include a requirement that health-care providers involved in the delivery or care of such infants notify DCF, but this notification shall not be construed as a mandated report of child abuse or neglect.

Assessment of the Infant and Family

Citation: DCF Substance Use Prac. Guide

Indicators that a newborn has special needs may include positive urine or meconium toxicology for substances and the condition of parental substance use. Born under such circumstances, a newborn shall be considered and addressed following the high-risk newborn policy standards. For this, the investigation shall include an assessment of the following:

  • The extent of the mother's prenatal care
  • The parents' willingness to participate in appropriate services
  • The support services within the family or community that are available to the parents
  • The safety and adequacy of the home
  • Potential postpartum depression and other mental health concerns
  • The parents' ability to provide appropriate care in the home

The DCF social worker shall visit with the child and family in the home within 3 days of discharge from the hospital and in-home visits shall occur at least twice a week for at least 4 weeks. One of the weekly visits may be made by an in-home service provider.

Responsibility for Development of the Plan of Safe Care

Citation: Gen. Stat. §§ 17a-54b; 17a-102a(c)

The Commissioner of Children and Families shall develop and implement policies and procedures in accordance with the Federal Child Abuse Prevention and Treatment Act to secure the health, safety, and well-being of infants identified as being affected at birth by drug abuse, withdrawal symptoms related to prenatal drug or alcohol exposure, or FASD. Such policies and procedures shall advance the best interests of such infants and shall include, but not be limited to, securing substance use treatment for such infants, their mothers, and other caregivers and ensuring the infants grow up in substance use-free homes.

No later than January 1, 2019, the Commissioner of Children and Families shall, in consultation with other departments, agencies, or entities concerned with the health and well-being of children, develop guidelines for the safe care of newborns who exhibit physical, neurological, or behavioral symptoms consistent with prenatal substance exposure, withdrawal symptoms from prenatal substance exposure, or FASD. Such guidelines shall include, but are not limited to, instructions to providers regarding such providers€™ participation in the discharge planning process, including the creation of written POSCs, that shall be developed between such providers and mothers of such newborns as part of such process.

Services for the Infant

Citation: Gen. Stat. § 17a-710(a); DCF Substance Use Prac. Guide

The treatment program for substance use disorders shall include pediatric care, including therapeutic care for neurologically, behaviorally, or developmentally impaired infants.

In policy: POSCs should include the provision of services and supports that address the needs of the infant and his or her caregivers' physical health, social-emotional health, and safety needs and is developed in an interdisciplinary and family-focused manner. It is based on the results of a comprehensive, multidisciplinary assessment that is coordinated across disciplines addressing the treatment needs of the infant and family or caregiver. Specifically, POSCs should address infant health and development.

Services for the Parents or Other Caregivers

Citation: Gen. Stat. § 17a-710(a); DCF Substance Use Prac. Guide

It shall be the policy of the Department of Mental Health and Addiction Services to develop and implement treatment programs for pregnant women of any age with substance use disorders and their children. The department shall seek private and public funds for such programs. Each program shall, to the extent possible and within available appropriations, offer comprehensive services, including the following:

  • Education and prevention programs in high schools and family-planning clinics
  • Outreach services to identify pregnant women with substance use disorders early and enroll them in prenatal care and substance abuse treatment programs
  • Case management services
  • Hospital care with substance abuse treatment available in coordination with obstetric services
  • Child care for other siblings
  • Classes on parenting skills
  • Home visitation for those who need additional support or who are reluctant to enter a treatment program
  • Access to Special Supplemental Nutrition Program for Women, Infants, and Children and other entitlement programs
  • Vocational training for mothers seeking entry to the job market
  • A housing component

To the extent possible, all services shall be coordinated to be delivered from a centralized location, utilizing medical vans where available and providing transportation assistance when needed.

In policy: POSCs should include the provision of services and supports that address the needs of the infant and his or her caregivers' physical health, social-emotional health, and safety needs and is developed in an interdisciplinary and family-focused manner. It is based on the results of a comprehensive, multidisciplinary assessment that is coordinated across disciplines addressing the treatment needs of the infant and family or caregiver. Specifically, POSCs should address the following:

  • Health
  • Substance use and mental health
  • Parenting and family support

Monitoring Plans of Safe Care

Citation: Gen. Stat. § 17a-54b

The commissioner shall submit a report, in accordance with the provisions of § 11-4a, no later than February 1, 2018, to the joint standing committees of the general assembly having cognizance of matters relating to children and public health on the following:

  • The number of cases involving such infants referred to the commissioner on and after the effective date of this section by health-care providers
  • The policies and procedures developed and implemented by the commissioner
  • Gaps in notification to the commissioner of such cases
  • Gaps in services provided to such infants, their mothers, and other caregivers
  • Recommendations for improvements in services

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