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

Date: August 2019


Citation: Ann. Stat. § 39.01

The term 'neglects the child' means that the parent or other person responsible for the child's welfare exposes a child to a controlled substance or alcohol. Exposure to a controlled substance or alcohol is established by a test administered at birth that indicates that the child's blood, urine, or meconium contains any amount of alcohol or a controlled substance or metabolites of such substances, the presence of which was not the result of medical treatment administered to the mother or the newborn infant.

Notification/Reporting Requirements

Citation: Ann. Stat. § 39.201; DCF Oper. Proc. # 170-8

Any person who knows, or has reasonable cause to suspect, that a child is neglected by a parent, legal custodian, caregiver, or other person responsible for the child's welfare, as defined in this chapter, shall report such knowledge or suspicion to the Department of Children and Families (DCF).

Each report of known or suspected child neglect by a parent, legal custodian, caregiver, or other person responsible for the child's welfare shall be made immediately to the department's central abuse hotline. Personnel at the department's central abuse hotline shall determine if the report received meets the statutory definition of child abuse, abandonment, or neglect. If it is determined by a child welfare professional that a need for community services exists, the department shall refer the parent or legal custodian for appropriate voluntary community services.

In policy: Attending health-care providers are required to identify and refer all infants prenatally exposed to controlled substances and alcohol for early intervention, remediation, and prevention services.

Assessment of the Infant and Family

Citation: Ann. Stat. § 383.14; DCF Oper. Proc. # 170-8

The Department of Health shall promote the identification and screening of all newborns in this State and their families for environmental risk factors such as low income, poor education, maternal and family stress, emotional instability, substance abuse, and other high-risk conditions associated with increased risk of infant mortality and morbidity to provide early intervention, remediation, and prevention services, including, but not limited to, parent support and training programs, home visitation, and case management. Identification, perinatal screening, and intervention efforts shall begin prior to and immediately following the birth of the child by the attending health-care provider. Such efforts shall be conducted in hospitals, perinatal centers, county health departments, school health programs that provide prenatal care, and birthing centers, and reported to the Office of Vital Statistics.

In policy: Identification of the use of alcohol and/or illegal substances shall be determined as follows:

  • The mother's admission of use
  • A positive drug screen (prenatal or at birth)
  • Medical staff assessment

To determine the appropriate intervention efforts needed to assist with maternal entry or retention in substance use treatment, enhancement of child well-being, and the development of family skills to facilitate healthier lifestyles, child welfare professionals shall obtain and assess the following information:

  • The mother's substance use needs:
    • Substance use history
    • Mental health history
    • Treatment history
    • Medication-assisted treatment history
    • Referrals for services
  • The infant's medical care:
    • Prenatal exposure history
    • Hospital care, length of stay, and diagnosis
    • Other medical or developmental concerns
    • Pediatric care and follow-up
    • Referral to early intervention and other services
  • The mother's medical care:
    • Prenatal care and pregnancy history
    • Other medical concerns
    • Screening and education
    • Follow-up obstetrics care
    • Referral to other health-care services
  • Family/caregiver history and needs:
    • Prior involvement with child welfare
    • Child safety or risk concerns
    • Parent-child relationship
    • Family history
    • Living arrangements
    • Current support network
    • Current services
    • Needed supports or services

Responsibility for Development of the Plan of Safe Care

Citation: DCF Oper. Proc. # 170-8

DCF must develop, implement, and monitor a plan of safe care (POSC) for infants under age 1 who have been affected by exposure to controlled substances or alcohol. Controlled substances include both prescription drugs not prescribed for the parent or not administered as prescribed.

A POSC is intended to facilitate a holistic, multidisciplinary approach to responding to the needs of the entire family. A POSC is intended to be developed at the earliest point the mother's use or infant's exposure has been identified.

At the point of the child welfare professional's contact with the family, a POSC may already have been developed by medical personnel, behavioral health specialists, or home visitor staff who regularly interact with the mother prior to, or soon after, the birth of the infant. It is the child welfare professional's responsibility to determine if a POSC had previously been offered to the mother and, if not, reassess the need for a plan to be implemented and monitored.

All infants and mothers affected by prenatal substance exposure shall be referred to a home visitor program (e.g., Healthy Start, Healthy Families, etc.) or family support program (e.g., high or very high-risk assessment score) for development of a POSC and care coordination.

At any point a child welfare professional identifies that an infant under age 1 has been affected by prenatal exposure to alcohol or controlled substances, a referral to a home visiting program for development and implementation of a POSC shall be discussed with the parent or caregiver.

Services for the Infant

Citation: DCF Oper. Proc. # 170-8

All attending health-care providers are required to refer infants identified as prenatally exposed to alcohol and controlled substances for early intervention, remediation, and prevention services. This process typically begins when Healthy Start staff offer universal risk screening for all pregnant women and infants to ensure that preventive care is directed as early as possible to prevent or minimize adverse outcomes. In some instances, child welfare professionals may determine a need for postbirth screening and services or hospitalization.

In addition to the services provided by home visitor programs, infants diagnosed with neonatal abstinence syndrome with evidence of clinical symptoms, such as tremors, excessive high-pitched crying, hyperactive reflexes, seizures, poor feeding, and sucking, shall be referred to Early Steps. Early Steps is Florida's early intervention system that offers services to eligible infants and toddlers (birth to 36 months) with significant delays or a condition likely to result in a developmental delay. Early intervention is provided to support families and caregivers in developing the competence and confidence to help their children learn and develop.

Services for the Parents or Other Caregivers

Citation: DCF Oper. Proc. # 170-8

When initiated on a voluntary basis, the Healthy Start coalition will collaborate with other stakeholders and partners to provide services for infants and families affected by prenatal exposure to alcohol and controlled substances, including but not limited to, the following:

  • Other home visitor programs
  • Healthy Families Florida
  • Providers of Healthy Start services
  • County health department(s)
  • Child Protection Team
  • Prenatal and pediatric care, hospitals and birthing centers
  • Children's Medical Services providers
  • Substance abuse treatment providers
  • DCF and their contracted providers (e.g., community-based care lead agencies, managing entities)

Healthy Start typically provides a range of services to identified women and infants including, but not limited to, the following:

  • Information, referral, and ongoing care coordination and support to assure access to needed services
  • Psychosocial, nutritional, and smoking cessation counseling
  • Childbirth, breastfeeding, and substance abuse education
  • Home visiting
  • Interconception education and counseling

Monitoring Plans of Safe Care

Citation: DCF Oper. Proc. # 170-8

To monitor the efficacy of referrals and voluntary service provision, Healthy Start coalitions typically enter into and maintain interagency agreements to ensure coordinated, multiagency assessment of and intervention for the health, safety, and service needs of women who abuse alcohol or other drugs during pregnancy and of substance-exposed children up to age 3.

In monitoring the efficacy of referral and service provision, contract management services will assess standards and criteria for transition of care and the development of interagency agreements, as provided in Healthy Start Standards & Guidelines 2007, Chapter 13, Transition and Interagency Agreements. Contract monitoring shall emphasize outcome data for infants receiving neonatal intensive care and infants and toddlers served by Early Steps in Children's Medical Services.

To monitor the efficacy of referrals and service provision on both a voluntary and nonvoluntary basis (i.e., judicial and nonjudicial department interventions), the Office of Contract Services, through the community-based Contract Oversight Team, will monitor service delivery related to POSCs in the following four specific areas of operation:

  • Quality management and performance improvement, including the following:
    • Data analysis
    • Performance improvement strategy (as needed)
  • Practice competency
  • Partner relationships
  • Community relationships