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

Definitions
Citation: Ann. Code § 16-2301

The term 'neglected child' includes a child who is born addicted to or dependent on a controlled substance or has a significant presence of a controlled substance in their system at birth.

Notification/Reporting Requirements
Citation: Ann. Code § 4-1321.02

A licensed health professional who, in their own professional or official capacity, knows that a child under age 12 months is diagnosed as having a fetal alcohol spectrum disorder (FASD) shall immediately report or have a report made to the Child and Family Services Agency (CFSA).

Assessment of the Infant and Family
Citation: CFSA Investigation Proc. Oper. Man.

In policy: Substance-affected caregivers and their positive toxicology or FASD newborns will be screened in and assigned as child protective services (CPS) investigations. A positive drug test alone is insufficient for an automatic finding of child neglect. There would need to be other evidence of neglectful or abusive behavior.

The social worker must review the medical record to obtain a copy of the toxicology reports and review other demographic information that may be useful during the investigation, such as the parents' reported address, both parents' names, and any other information. In addition, the social worker should speak with hospital staff about the mother's current bonding with the child and any concerns they may have about the family.

The social worker must complete a substance abuse assessment referral for all investigations involving a positive toxicology screening for a newborn in an effort to help the parent or caregiver address their substance abuse needs. Their participation in a substance abuse assessment is voluntary, however, if the parent chooses not to participate in the assessment, the social worker must further assess any impact of substance use on the safety and well-being of the children and determine the next steps.

Responsibility for Development of the Plan of Safe Care
Citation: CFSA Investigation Proc. Oper. Man.

Social workers will visit the child and family to conduct a safety and risk assessment and work 
with the family to develop a plan of safe care (POSC). The POSC includes supportive information that addresses the needs of mothers and their infants who are identified as affected by substance abuse, experience withdrawal symptoms, or have been diagnosed with FASD. The POSC is designed to help the affected mother (or caregiver) with substance use issues and any other needs identified through the course of the investigation. The POSC must be developed jointly with the caregiver and family within 24 hours of initial contact.

Services for the Infant
Citation: CFSA Investigation Proc. Oper. Man.

All newborns with a positive toxicology screen must be referred to the Birth-to-Three Early Intervention Program. Completing this referral helps to ensure the infant is provided with proper care.

Services for the Parents or Other Caregivers
Citation: D.C. Code § 44-1202(b); CFSA Investigation Proc. Oper. Man.

Any minor; pregnant woman; or the parent, guardian, or other person who has legal custody of a minor and who meets the requirements of this section shall have priority for admission to the treatment facility over any single adult who does not have a minor child.

In policy: Early engagement with the Health Services Administration via a CPS nurse's referral will allow for a partnership with CPS to address the needs of the family. Once engaged, the CPS nurse assigned to these substance-affected families will make every effort to conduct two visits with the newborn and their caregiver (ideally, once in the hospital and once in the home). The CPS nurse will assess the medical and health needs of the impacted caregiver and infant, interface with the hospital medical staff prior to the infant and caregiver's discharge when possible, and offer recommendations for continued health 
care or support. The CPS nurses will also discuss safe sleep practices with the family.

The social worker must also refer the parent to Mary's Center's Maternal, Child Care, and Home Visiting program for visitation services to pregnant and postpartum women and their families.

Monitoring Plans of Safe Care

This issue is not addressed in the statutes and regulations reviewed.