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

Definitions

Citation: Ann. Code Tit. 16, § 902B

'Infant with prenatal substance exposure' means a child no more than age 1 who is born with and identified as being affected by substance abuse or withdrawal symptoms or a fetal alcohol spectrum disorder (FASD). The health-care provider involved in the delivery or care of the infant shall determine whether the infant is affected by the substance exposure.

A 'plan of safe care' (POSC) is a written or electronic plan designed to ensure the safety and well-being of an infant with prenatal substance exposure following the release from the care of a health-care provider by addressing the health and substance use treatment needs of the infant and affected family or caregiver and monitoring these plans to ensure appropriate referrals are made and services are delivered to the infant and affected family or caregiver. The monitoring of these plans may be time limited based upon the circumstances of each case.

'Substance abuse' means the chronic, habitual, regular, or recurrent use of alcohol, inhalants, or controlled substances.

The term 'withdrawal symptoms' refers to a group of behavioral and physiological features in the infant that follow the abrupt discontinuation of a drug that has the capability of producing physical dependence. The definition does not include withdrawal symptoms that result exclusively from a prescription drug used by the mother or administered to the infant under the care of a prescribing medical professional, in compliance with the directions for the administration of the prescription as directed by the prescribing medical professional, its compliance and administration verified by the health-care provider involved in the delivery or care of the infant, and no other risk factors to the infant are present and does not warrant a notification to the Division of Family Services (DFS) under § 903B of this title.

Notification/Reporting Requirements

Citation: Ann. Code Tit. 16, § 903B; DFS Pol. Man., § F-4

The health-care provider who is involved in the delivery or care of an infant with prenatal substance exposure shall make a notification to the division by contacting the DFS report line, as identified in § 905 of this title. A notification made under this section is not to be construed to constitute a report of child abuse or neglect under § 903 of this title, unless risk factors are present that would jeopardize the safety and well-being of the infant.

In policy: DFS accepts for investigation all reports from medical facilities of infants exposed in utero to alcohol or drugs, as evidenced by either the mother or infant testing positive for drugs at birth. The response decision will be determined by careful consideration of the risk factors and danger-loaded elements. Any report alleging prenatal exposure in which the child is experiencing medical complications requires a response prior to the child's release from the hospital.

Assessment of the Infant and Family

Citation: DFS Pol. Man., § C-2; DFS User Man., D-15

For a report of a substance-exposed infant, the caseworker shall attend a predischarge meeting at the hospital with the involved agencies and conduct a safety assessment of the home prior to the discharge of the infant to the home. The caseworker also will be responsible for implementing, coordinating, and monitoring the POSC.

The POSC should ensure that a comprehensive assessment has been completed for infant, maternal, and paternal/secondary caregiver areas of risk and that referrals, information, and linkages to the community are completed prior to the discharge of the infant. The plan also must consider how the family's existing support network will support the POSC and discharge of the infant. The purpose of the POSC€”which is to identify the needs of the infant and family and to provide services with the goal of strengthening the family and maintaining the infant safely in the home€”shall be explained to the family.

Responsibility for Development of the Plan of Safe Care

Citation: Ann. Code Tit. 16, § 905B; DFS User Man., D-15

Upon receipt of a notification under § 903B of this title, DFS shall do the following:

• Determine if the case requires an investigation or family assessment
• Develop a POSC
• Provide copies of the POSC to all agencies and providers involved in the care or treatment of the infant with prenatal substance exposure and affected family or caregiver
• Implement and monitor the provisions of the POSC

In policy: The POSC coordinator will be responsible for developing and implementing a POSC with the family to ensure the safety and well-being of the infant upon discharge from the health-care provider. For those notifications screened in for an investigation, the POSC coordinator is DFS. For those notifications screened in for an assessment, the POSC coordinator is the contracted agency.

The POSC is prepared by the POSC coordinator who is responsible for gathering information from the multidisciplinary team and coordinating the referrals provided at the infant's discharge. In order to develop a coordinated and comprehensive assessment of the needs of the infant and family, the multidisciplinary team may include, but shall not be limited to, DFS; medical personnel; substance use disorder treatment, mental health, and early childhood intervention providers; home visitors; public health personnel; the investigation coordinator; and any other community supports, as appropriate.

Services for the Infant

Citation: DFS Pol. Man., § D-7

All infants born with and identified as being affected by substance abuse or withdrawal symptoms or FASD will have a POSC prior to discharge to ensure the safety and well-being of the infant and family. The health and substance abuse disorder treatment needs of the infant and affected family or caregiver will be addressed through referrals and delivery of appropriate services, and there will be a monitoring system to ensure that local entities are providing such referrals and delivery of services.

Services for the Parents or Other Caregivers

Citation: DFS Pol. Man., § D-7; DFS User Man., D-15

All infants born with and identified as being affected by substance abuse or withdrawal symptoms or FASD will have a POSC prior to discharge to ensure the safety and well-being of the infant and family. The health and substance abuse disorder treatment needs of the infant and affected family or caregiver will be addressed through referrals and delivery of appropriate services, and there will be a monitoring system to ensure that local entities are providing such referrals and delivery of services.

Prior to discharge, hospital education should be provided to the family as well as any referrals to appropriate home visiting programs. The infant's first pediatric appointment should be scheduled prior to discharge.

Monitoring Plans of Safe Care

Citation: Ann. Code Tit. 16, § 906B; DFS User Man., D-15

DFS shall document the following information in its internal information system for all notifications of infants with prenatal substance exposure under this chapter:

• The number of infants identified as being affected by substance abuse, withdrawal symptoms, or FASD
• The number of infants for whom a plan of safe care was developed, implemented, and monitored
• The number of infants for whom referrals were made for appropriate services, including services for the affected family or caregiver
• The implementation of such plans to determine whether and in what manner local entities are providing, in accordance with State requirements, referrals to and delivery of appropriate services for the infant and affected family or caregiver

In addition to any required Federal reporting requirements, the division, with assistance from the Department of Health and Social Services and the investigation coordinator, shall provide an annual report to the Child Protection Accountability Commission and Child Death Review Commission summarizing the aggregate data gathered on infants with prenatal substance exposure.

In policy: The POSC coordinator will be responsible for the ongoing review of the POSC and any referrals or community linkages completed throughout the life of the family's involvement with DFS after discharge. The POSC should be reviewed at a minimum bi-weekly within the first 30 days with a minimum contact schedule (frequency of contact) of bi-weekly within the first 30 days. In determining the contact schedule of the infant and family, a balanced assessment should take place considering the needs, strengths, risk level, support system (internal and external), and any postdischarge conditions of the infant that may arise.

The POSC coordinator will be responsible for determining how long the POSC remains in place and should include input and collateral information from the multidisciplinary POSC members as well as an ongoing assessment of the risks, needs, complicating factors, and supports and services in place. The POSC should be updated as needed to continuously monitor additional needs identified and referrals for service. The POSC is a fluid plan and the length of the POSC is dependent upon the infant and his or her family.

If the POSC coordinator determines that the family needs ongoing services, and the family is not already active in treatment, the case will be referred for ongoing services. If the POSC is still in place, the POSC coordinator will be the assigned caseworker. The assigned caseworker will then be responsible for the review of the POSC and any monitoring of referrals or services. The referrals and services may also be incorporated in the family's service plan.

Upon closure of the case by DFS, the most updated POSC shall be provided to the family who has the option to continue services and monitoring by community services and resources. When the case is closed, the POSC participants shall be notified that the POSC is being terminated by DFS but that the family may continue with their services and resources.