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

Date: August 2019

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 child in need of services 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 child in need of services 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 child in need of services 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

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. Substance use or abuse may be a factor in assessments involving 1) the use of drugs during pregnancy or 2) the use of drugs that results in a child's physical or mental condition being seriously impaired or seriously endangered. The child's safety as well as the family's strengths, needs, and protective capacities will be assessed. Any indication of substance use or misuse (as evidenced by self-disclosure or drug-screening results) will be assessed to determine if the use/misuse contributed to the maltreatment of the child. 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, the following:

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

DCS will complete a plan of safe care (POSC) or review and update an existing POSC for each infant under the 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, and/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 and/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 infant, including the following services:

  • Medical care (immediate, on-going, and emergency)
  • Medical coverage
  • Safe sleep
  • Developmental screening and interventions
  • Other supports, as needed

Services for the Parents or Other Caregivers

Citation: DCS CW Man., Ch. 4, § 42

A POSC should include the following:

  • The treatment needs of the parent(s), household member(s), caregiver(s), and infant
  • Other identified needs that are not determined to be immediate safety concerns
  • Utilization of community resources and extended family support systems
  • A plan for continued family support beyond DCS involvement

Specific services that may be provided to the parents include the following:

  • Substance use disorder assessment and treatment (including medication-assisted treatment)
  • Medical care
  • Mental health assessment and treatment
  • Parenting support
  • Safe housing
  • Food
  • Transportation
  • Appropriate child care
  • Referrals to community resources (including home visiting programs)

Extended family 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 child care; transportation; home management assistance and teaching of skills; and financial assistance for housing, food, or clothing on a short-term basis.

Monitoring Plans of Safe Care

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

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