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

Definitions
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.

'Comprehensive assessment' or 'assessment' means the gathering of information for the evaluation of a child's and caregiver's physical, psychiatric, psychological, or mental health; developmental delays or challenges; and educational, vocational, and social condition and family environment as they relate to the child's and caregiver's need for rehabilitative and treatment services, including substance abuse treatment services, mental health services, developmental services, literacy services, medical services, family services, and other specialized services, as appropriate.

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.

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 be reported to the Office of Vital Statistics.

In policy: 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 as part of the family functioning assessment (FFA): 

• 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 or 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

When initiated as a component of judicial or nonjudicial case planning activities, the development of a plan of safe care (POSC) and initiation of service provision is the responsibility of the assigned case manager. The need for any or all components of a POSC should be identified and assessed in the FFA's ongoing progress updates and incorporated into case planning and treatment services.

A POSC must be discussed with the family by the child welfare professional. If the family agrees there is a need, a POSC should be developed, implemented, and monitored for infants under age 1 who have been affected by prenatal 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.

A POSC is to be developed through constructive, supportive, and nonadversarial relationships intruding as little as possible into the life of the family. Accordingly, a POSC is always voluntary.

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.

At any point a child welfare professional identifies that an infant under 1 year of age 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 must be discussed with the parent or caregiver and the referral completed if the family accepts.

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: Admin. Code § 65D-30.0142(d); DCF Oper. Proc. # 170-8

Pregnant individuals, regardless of age, who have had a documented addiction to opioid drugs in the past and who may be in direct jeopardy of returning to opioid drugs, may be placed in methadone medication-assisted treatment. For such individuals, evidence of current physiological addiction to opioid drugs is not needed if a physician or their qualified designee certifies the pregnancy and, in utilizing reasonable clinical judgment, finds treatment to be medically justified.

In policy: When initiated on a voluntary basis, the Healthy Start coalition will collaborate with other collaborators 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)

Monitoring Plans of Safe Care
Citation: DCF Oper. Proc. # 170-8

Monitoring is intended to assess whether families are being provided appropriate referrals and to what extent the delivery of services is meeting the identified needs of affected infants, mothers, and family members. Monitoring is intended to ensure child welfare professionals are initiating timely and appropriate referrals to service providers who have developed a culturally sensitive, multi-faceted, and multidisciplinary approach to working with mothers and infants prenatally exposed to substances.