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

Definitions
Citation: Ann. Code §§ 31-34-1-10; 31-34-1-11; 31-34-1-12; 31-34-1-13

Except as provided in §§ 31-34-1-12 and 31-34-1-13, a child is a child in need of services (CHINS) if the following apply:

• The child is born with any of the following:
  • Fetal alcohol syndrome
  • Neonatal abstinence syndrome
  • Any amount, including a trace amount, of a controlled substance, a legend drug, or a metabolite of a controlled substance or legend drug in the child's body, including the child's blood, urine, umbilical cord tissue, or meconium
• The child needs care, treatment, or rehabilitation that the child is not receiving or is unlikely to be provided or accepted without the coercive intervention of the court.

A child is a CHINS if the following apply:

• The child has an injury, has abnormal physical or psychological development, has symptoms of neonatal intoxication or withdrawal, or is at a substantial risk of a life-threatening condition that arises or is substantially aggravated because the child's mother used alcohol, a controlled substance, or a legend drug during pregnancy.
• The child needs care, treatment, or rehabilitation that the child is not receiving or is unlikely to be provided or accepted without the coercive intervention of the court.

A child is not a CHINS as defined in§ 31-34-1-10 or 31-34-1-11 of this chapter if the following are true:

• A drug detected in the body of the child as described in § 31-34-1-10 or the condition described in § 31-34-1-11 was caused by a legend drug.
• During pregnancy the child's mother possessed a valid prescription for the legend drug, was not in violation of the Indiana legend drug act, and made a good faith attempt to use the legend drug according to the prescription instructions.

A child is not a CHINS under § 31-34-1-10 or 31-34-1-11 if the following apply:

• A drug detected in the body of the child under § 31-34-1-10 or the condition described in § 31-34-1-11 was caused by a controlled substance.
• During pregnancy the child's mother possessed a valid prescription for the controlled substance and made a good-faith attempt to use the controlled substance according to the prescription instructions.

Notification/Reporting Requirements
Citation: Ann. Code § 31-33-5-1

In addition to any other duty to report arising under this article, an individual who has reason to believe that a child is a victim of child abuse or neglect shall make a report as required by this article.

Assessment of the Infant and Family
Citation: DCS CW Man., Ch. 4, § 40

In policy: The Department of Child Services (DCS) will consider using drug screening as a component of a comprehensive assessment of the family when there is an allegation of substance abuse or an indication that substance abuse may be a factor in the report of child abuse or neglect. 

A pregnant woman's drug abuse may constitute child abuse and neglect and may be legally sufficient for a finding of CHINS, which requires the coercive intervention of the court to ensure the family receives the necessary services. Factors that should be considered in the comprehensive assessment along with drug screen results include, but are not limited to, evidence of the following: 

• The child was born with fetal alcohol syndrome.
• The child was born with neonatal abstinence syndrome.
• The child was born with any amount of controlled substance, legend drug, or metabolite of a controlled substance or legend drug in their body, including blood, urine, umbilical cord tissue, or meconium, absent a prescription or medical supervision.
• The child has an injury, abnormal physical or psychological development, symptoms of neonatal intoxication or withdrawal that arises or is aggravated because of the child's mother using alcohol, a controlled substance, or a legend drug during pregnancy, absent a prescription or medical supervision.
• The child is at substantial risk of a life-threatening condition that arises or is substantially aggravated because their mother used alcohol, a controlled substance, or a legend drug during pregnancy, absent a prescription or medical supervision.

Responsibility for Development of the Plan of Safe Care
Citation: DCS CW Man., Ch. 4, § 42

In policy: A plan of safe care (POSC) will be completed regardless of the decision to substantiate or unsubstantiate the report. DCS will complete a POSC for each infant under age 1 who is identified as being born affected by or exposed in utero to substance use (either legal or illegal substances), experiencing symptoms of withdrawal, diagnosed with neonatal abstinence syndrome, or diagnosed with fetal alcohol spectrum disorder. The plan will address the mental and physical health and substance use treatment needs of the infant, parent(s), household members, and the infant's caregiver(s).

The family case manager will do the following: 

• Observe and assess the needs of each parent, household member, or caregiver
• Collaborate with each parent, household member, caregiver, child and family team member, and other professional partners and agencies involved in providing services for the infant, parent(s), household member(s), and caregiver(s) to develop a POSC
• Speak with the parents, guardians, and caregivers about safe sleep and document the discussion in the case management system
• Ensure the plan addresses the mental and physical health and substance use treatment needs of the infant and each parent, household member, or caregiver
• Create a safety plan, if needed, to address immediate safety needs of the child
• Have each participating parent, adult household member, and caregiver who is listed on the POSC sign the plan and provide them with a copy of the plan

Services for the Infant
Citation: DCS CW Man., Ch. 4, § 42

A POSC should address the needs of the mental and physical health or substance use treatment needs of the infant.

Safe sleep guidelines should be discussed with all parents, guardians, or custodians.

Services for the Parents or Other Caregivers
Citation: DCS CW Man., Ch. 4, § 42

A POSC should address the needs of the mental and physical health or substance use treatment needs of each parent, household member, or caregiver.

Protective factors are directly connected to the strengths of the family and may be used as a resource to learn new skills and solve problems. By using a protective factors approach, child welfare professionals and others can help parents find resources and supports that emphasize their strengths while also identifying areas where they need assistance, thereby mitigating the chances of child abuse and neglect.

Family, friends, and community members are often the most resourceful and effective support for the family, and their interventions are often the least disruptive for the child involved. Family support services may consist of childcare, transportation, home management assistance, teaching of skills, and financial assistance for housing, food, or clothing on a short-term basis.

Monitoring Plans of Safe Care
Citation: DCS CW Man., Ch. 4, § 42

The family case manager will review and adjust the POSC regularly throughout DCS involvement until the infant turns 1 year of age. Examples of when revisions should be made to the POSC include the following:

• Changes in the household
• Changes in the identified needs of the infant, parent, household member, or caregiver
• Changes in risk or protective factors