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

Definitions

Citation: Ann. Code § 15-11-2(56); DCFS Child Welf. Pol. Man., Pol. # 19.27

The term 'prenatal abuse' means exposure to chronic or severe use of alcohol or the unlawful use of any controlled substance, as such term is defined in § 16-13-21, that results in the following:

• Symptoms of withdrawal in a newborn or the presence of a controlled substance or a metabolite thereof in a newborn's body, blood, urine, or meconium that is not the result of medical treatment
• Medically diagnosed and harmful effects in a newborn's physical appearance or functioning

In policy: An infant 'affected by prenatal exposure to substance use' means the following:

• The infant is experiencing symptoms of withdrawal or exhibiting harmful effects in his or her physical appearance or functioning due to exposure to substances (legal or illegal).
• The infant has tested positive for the presence of a substance or a metabolite thereof in his or her body, blood, urine, or meconium.
• The infant has symptoms of a fetal alcohol spectrum disorder.
• The mother tested positive for illegal substances at the birth of the infant.
• The mother tested positive for prescription drugs due to misuse at the birth of the infant.
• The mother self-disclosed at the birth of the infant a substance or alcohol use problem and use during pregnancy.

'Fetal alcohol spectrum disorders' (FASD) are a set of conditions that can affect infants born to mothers who drank alcohol during pregnancy. Children with FASD may experience mild to severe physical, mental, behavioral, and/or learning disabilities, some of which may have lifelong implications (e.g., brain damage, physical defects, attention deficits). Symptoms of FASD can include facial abnormalities, growth deficiencies, skeletal deformities, organ deformities, central nervous system handicaps, and behavioral problems. FASD diagnostic conditions include the following:

• Type I: Fetal alcohol syndrome with confirmed maternal exposure
• Type II: FAS without confirmed maternal exposure
• Type III: Alcohol-related birth defects
• Type IV: Alcohol-related neurodevelopmental disorder

'Neonatal abstinence syndrome', formerly known as 'withdrawal symptoms,' may occur when a pregnant woman takes drugs such as heroin, codeine, oxycodone, methadone, or buprenorphine. Because the baby is no longer getting the drug after birth, the withdrawal may occur as the drug is slowly cleared from the baby's system. Symptoms may appear within a few hours of birth to 14 days after birth and depend on the type of substance used, length of time used, etc. Symptoms generally include blotchy skin coloring (mottling), diarrhea, excessive crying or high-pitched crying, excessive sucking, fever, hyperactive reflexes, increased muscle tone, irritability, poor feeding, rapid breathing, seizures, sleep problems, slow weight gain, stuffy nose, sneezing, sweating, trembling (tremors), and vomiting.

Notification/Reporting Requirements

Citation: DCFS Child Welf. Pol. Man., Pol. # 3.7; 19.27

The Division of Family and Children Services (DFCS) shall receive intake reports involving the following:

• Substance use or abuse, alleging child maltreatment involving the caregiver's substance/alcohol use or abuse and the caregiver's ability to meet the needs of his or her children
• Prenatal exposure, involving infants identified as being affected by substance abuse (illegal and/or legal), withdrawal symptoms resulting from prenatal drug exposure, or FASD, as follows:
  • Prenatal abuse, alleging child maltreatment involving infants who, while in the womb, are exposed to chronic or severe use of alcohol or the unlawful use of any controlled substance that results in symptoms of withdrawal in a newborn; or the presence of a controlled substance or a metabolite thereof in a newborn's body, blood, urine or meconium that is not the result of medical treatment; or medically diagnosed and harmful effects in a newborn's physical appearance or functioning
  • Prenatal exposure, with no allegation of child maltreatment

Note: All intakes involving prenatal exposure require the development of a plan of safe care (POSC).

While prenatal exposure may include cases with child maltreatment (prenatal abuse), not all cases requiring a POSC involve maltreatment. Some examples of cases involving prenatal exposure with no allegations of maltreatment are as follows:

• The infant is prenatally exposed resulting from the mother's use of prescribed medication for an illness. The mother is following her medication and treatment plan, as verified by her health-care provider.
• The infant is prenatally exposed resulting from the mother being given prescribed medication during the delivery process.
• The infant is prenatally exposed due to the mother's participation in a medication-assisted treatment (MAT) program for a substance use disorder. The mother is complying with her medication and treatment plan, as verified by the substance treatment provider and her health-care provider.

Assessment of the Infant and Family

Citation: DCFS Child Welf. Pol. Man., Pol. # 19.27

DFCS shall do the following:

• Assess the health and substance use needs of the infant, caregiver, and other family members
• Conduct a POSC meeting within 5 calendar days of receiving the substance abuse assessment from the substance use disorder treatment provider, when maltreatment is alleged or within 14 calendar days of the intake notification that contain no allegations of maltreatment
• Ensure that the POSC addresses the following:
  • The health and substance abuse treatment needs of the infant and parent or caregiver
  • The needs of the other family members affected by the substance use
• Identify the agency responsible for monitoring the POSC
• Monitor the POSC to determine whether referrals are made and delivery of appropriate services to the affected infant, family, or caregiver

The social services case manager will do the following:

• Assess the health and substance use disorder needs of the infant, caregiver, and other family members
• Review and analyze the information gathered from the assessment to determine the health and substance use needs of the infant, caregiver, and other family members, including, but not limited to, the following:
  • Substance use disorder assessment from the substance use disorder treatment provider
  • Other assessments conducted
  • Health information collected from the medical provider for the infant, other children, and mother; hospital discharge records, etc.
  • Interviews with the mother, other caregivers, and other family members
  • Observation of the infant, other children, and caregivers
  • Observation of the home
  • Other information, as appropriate
• Initiate a staffing with the social services supervisor to discuss the following:
  • The impact of the substance/alcohol use by the mother and any other caregivers in the home on the care and protection of the infant and other children in the home
  • The mother's compliance with MAT, if applicable
  • The mother and other caregiver's functioning, including physical health, mental health, life management, relationships, and parenting, etc.
  • The health care, developmental, or other needs of the infant and any other children in the home
  • Current formal or informal supports

Responsibility for Development of the Plan of Safe Care

Citation: DCFS Child Welf. Pol. Man., Pol. # 19.27

DFCS, in partnership with other agencies providing services to the family, shall develop and implement a POSC for families with infants identified as being affected by substance abuse (illegal or legal), or withdrawal symptoms resulting from prenatal drug exposure, or a fetal alcohol spectrum disorder (FASD).

The POSC incorporates into one document the plans from various agencies providing services to the family, such as the child welfare assessment, hospital discharge plan, substance use treatment case plan, and prenatal care plan to address the medical, behavioral, developmental, social, and emotional well-being of the family. Coordinated services to the family ensures timely access to a continuum of care, minimizes barriers to accessing care, improves infant and maternal outcomes, and facilitates identification of the family's overall needs and engagement into the appropriate services.

The POSC is required when a health-care provider has identified that an infant has been affected by substance abuse, withdrawal symptoms resulting from prenatal drug exposure, or FASD. This identification may occur during any stage of DFCS involvement, including at birth or later during the infant's development and/or as symptoms manifest. DFCS may develop the POSC prior to the birth of an infant, if child welfare is providing services due to other children in the home and the family agrees.

Services for the Infant

Citation: DCFS Child Welf. Pol. Man., Pol. # 19.27

A POSC should address the following:

• The following needs of the infant:
  • Health care, as follows:
    • Identification of a consistent pediatrician/health-care provider
    • Referral to specialty care, as indicated
    • High-risk follow-up care
  • Safety with the caregivers
  • Developmental screening and assessment
  • Linkage to early intervention services
  • Early care and education program
• The following needs of other children in the home:
  • Identification of a consistent pediatrician/health-care provider
  • Safety with the caregivers
  • Developmental screening and assessment
  • Linkage to early intervention services
  • Early care and education program

Services for the Parents or Other Caregivers

Citation: DCFS Child Welf. Pol. Man., Pol. # 19.27

A POSC should address the following:

• The following needs of the mother:
  • Health care, as follows:
    • Identification by the mother of a consistent and stable primary caregiver
    • Medication management
    • Pain management
    • Breast feeding, if recommended by the physician
  • Substance use and mental health care, including the following:
    • Timely access
    • Engagement, retention, and recovery supports
    • Appropriate treatment that is gender-specific, family focused, accessible, and trauma responsive and may include medication assisted treatment
    • Treatment for depression, anxiety, or domestic violence, as needed
    • Appropriate assessments and treatment services
  • Parenting/family support
  • Coordinated case management/home visits to assess infant care, parent/infant bonding, nurturing, mother's understanding of the special care needs of the infant(s) and ability to provide such care, parenting guidance and skill development, safe sleep practices, and maternal support
  • Child care
  • Benefits/eligibility determination for employment support, housing, and transportation
  • Supportive network (having relationships and social networks that provide support, friendship, love, and hope
• The following needs of other family members:
  • Substance use disorder assessment and treatment
  • Mental health assessment and treatment
  • Pain management
  • Medication management
  • Parenting skills (i.e. bonding, nurturing, understanding of the special care needs of the infant and the ability to provide it, safe sleep practices, etc.)
  • Their ability to meet the care and protection needs of the infant and any other children living in the home

Monitoring Plans of Safe Care

Citation: DCFS Child Welf. Pol. Man., Pol. # 19.27

DCFS will do the following:

• Follow up with other parties responsible for making referrals to determine if the referrals have been made and/or initiated, including, but not limited to, the following:
  • Substance use disorder treatment and/or any other recommendations from the substance use disorder assessment
  • Medical services for the infant, mother, and other household members
  • Referrals for developmental screening and any subsequent services for the infant and other children in the home
• Engage the parents or caregivers to determine if services have been initiated and are being provided in accordance with the plan

Ensuring the services identified in the POSC is implemented is critical to assuring the ongoing health and substance abuse needs of the infant and family. The POSC will address actions and services for the infant and family's needs that support the family achieving long-term recovery. Therefore, the needs must be incorporated into the case plan if the case is transferred to family preservation services or foster care to ensure ongoing monitoring. If the family does not continue child welfare services with DFCS, another individual or agency must be identified to monitor the POSC. This could be the medical provider or other providers already involved with the family and who can obtain information to monitor the plan.