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

Definitions
Citation: Admin. Regs. § 30-46-10

The term 'neglect' may include the birth of an infant who is identified as being affected by or having withdrawal symptoms resulting from prenatal exposure to a legal or illegal substance.

Notification/Reporting Requirements
Citation: Ann. Stat. §§ 38-2223; 65-1,163

When any mandated reporter has reason to suspect that a child has been harmed as a result of physical, mental, or emotional abuse or neglect or sexual abuse, the person shall report the matter promptly, as provided below. The report may be made orally and shall be followed by a written report if requested.

When reporting a suspicion that a child may be in need of care, the reporter shall disclose protected health information freely and cooperate fully with the Department for Children and Families (DCF) and law enforcement throughout the investigation and any subsequent legal process.

Any health-care provider who identifies a pregnant woman who is at risk for prenatal substance abuse may refer such woman, with her consent, to the local health department for service coordination by providing such woman's name to the local health department or the Kansas Department of Health and Environment within 5 working days.

There shall be no civil or criminal cause of action against a health-care provider related to the rendering or failure to render any service under this section. Referrals and associated documentation provided for in this section shall be confidential and shall not be used in any criminal prosecution. The woman's consent to make the referral shall be deemed a waiver of the physician-patient privilege solely for the purpose of making the report.

Assessment of the Infant and Family
Citation: Pol. & Proc. Man. § 1650

In policy: When a report is received regarding an infant affected by substance abuse, withdrawal symptoms, or fetal alcohol spectrum disorder (FASD), structured decision-making (SDM) shall be used to guide the initial assessment decision. When criteria are met, the report shall be assigned for further assessment of abuse or neglect with the sub-type 'substance-affected infant.' The report shall be assigned for a same-day response.

When a hospital makes a report regarding an infant born or the mother of an infant born with positive drug toxicology and criteria are not met to assign the report as a 'substance-affected infant,' the report should be assessed to assign as a 'family in need of assessment' (FINA) with the sub-type 'infant positive for substances.' SDM shall be used to guide the initial assessment decision. The assignment determination should focus on the situation of the child rather than solely on the substance abuse of the mother. If a determination is made to assign the report as 'infant positive for substances,' the report shall be assigned for a same-day response due to the high risk to the infant and to address any immediate needs of the family.

Responsibility for Development of the Plan of Safe Care
Citation: Pol. & Proc. Man. § 2050

Depending on the circumstances of the case, a plan of safe care (POSC) shall be completed by the DCF or service provider based on the needs of the family to support successful engagement in services. The POSC is a continuous plan that is updated and monitored as needed.  

The POSC is completed with the family, utilizing information gathered throughout the assessment from a multidisciplinary team. To develop a coordinated and comprehensive assessment of the needs of the infant and family, the multidisciplinary team may include, but not be limited to, personnel from the following:

• Child welfare
• Medical
• Substance use disorder treatment
• Mental health
• Early childhood intervention
• Home visitors
• Public health
• Other community supports, as appropriate

When identified early, the POSC ensures pregnant women using substances receive access to appropriate treatment, prenatal care, preparation for the birth of an infant who may experience neonatal abstinence syndrome, and follow-up after release from the hospital.

The POSC required by the Child Abuse Prevention and Treatment Act differs from a safety plan that addresses immediate safety. A POSC is a continuous and long-term plan for the family that focuses on the infant's ongoing health, development, safety, and well-being. 

When a report is assigned 'substance-affected infant,' FINA with the sub-type 'infant positive for substances,' or 'pregnant woman using substances' (PWS), the child protective services (CPS) specialist shall determine whether criteria are met for a POSC within the assigned response time. The CPS specialist shall consult with the health-care provider with knowledge of the effects of any prenatal substance abuse on the infant. A POSC shall be completed when one or more of the following criteria are met:

• The mother has used or is using opioids or other substances during pregnancy, or the pregnant woman is participating or has participated while pregnant in a medication-assisted treatment program.
• A medical professional confirms the infant is affected by substance abuse, withdrawal symptoms, or FASD. 

When criteria are unknown or not met for a POSC, the family-based assessment shall continue. If at any time during the life of the case additional information is available that meets criteria for a POSC, DCF or a service provider shall complete a POSC for the infant and family.

Services for the Infant
Citation: Pol. & Proc. Man. § 2050

The POSC addresses the physical health, substance use disorder treatment needs, general functioning, development, safety, and any special care needs of the infant who may be experiencing neurodevelopmental, physical effects, or withdrawal symptoms from prenatal exposure to substances.

A POSC is a continuous plan for the family that focuses on the infant's ongoing health, development, safety, and well-being. The family shall be informed that the purpose of the POSC is to identify the needs of the infant and the family to provide services with the goal of maintaining the infant and any other children safely in the home.

Services for the Parents or Other Caregivers
Citation: Ann. Stat. §§ 65-1,164; 65-1,1165; Pol. & Proc. Man. § 2050

Upon receiving a referral under § 65-1,163, the local health department shall offer service coordination to the pregnant woman and her family. The local health department shall coordinate social services, health care, mental health services, and needed education and rehabilitation services.

A pregnant woman referred for substance abuse treatment shall be a first-priority user of substance abuse treatment available through the Department of Aging and Disability Services (DADS). All records and reports regarding such pregnant woman shall be kept confidential. The secretary for DADS shall ensure that family-oriented substance abuse treatment is available. Substance abuse treatment facilities that receive public funds shall not refuse to treat women solely because they are pregnant.

In policy: Prior to the infant's release from the hospital, DCF shall list the needs of the infant and family members on the POSC. When DCF receives the report after the infant has been released from the hospital, or if the case is assigned for a PWS, the POSC shall be initiated as soon as possible, not to exceed 3 working days from the initial contact.

Once the needs are identified, a referral for services with community programs or family preservation services (FPS) shall be offered to the family to provide the services and/or assist the family in locating appropriate services to meet the needs identified in the POSC. Whenever possible, the service provider should be able to continue to monitor the POSC by identifying the services and making referrals for the services to meet the needs identified on the POSC care for the infant and family.

The POSC identifies the needs of the infant and family and the services to meet those needs. The POSC incorporates the following needs of the infant's family:

• The physical, social, and emotional health and substance use disorder treatment needs of the parent(s) or caregiver(s)
• Services and supports to strengthen the parent or caregiver's capacity to nurture and care for the infant

In addition, the POSC shall address the caregiver and other family member's physical, social, and emotional health; substance use disorder treatment; parenting capacity; and preparation to care for the infant.

Monitoring Plans of Safe Care
Citation: Pol. & Proc. Man. § 2050

The POSC requires monitoring of referrals to and delivery of appropriate services for the infant and family. POSCs may continue with service providers in addition to and after DCF involvement with the family.

If, following concerted efforts of engagement, the family selects not to participate in the POSC, the CPS specialist or the service provider shall document the family's decision not to participate. The POSC, containing the identified needs and recommended services, shall be provided to the family in the event the family seeks other community services on their own. The CPS specialist shall explain to the family that they may want to share the POSC with other community providers and resources to seek services on their own.

The POSC is updated as needed to monitor additional needs identified and referrals for services. The POSC shall be monitored to determine whether referrals are made to appropriate services and whether services are delivered to the infant and family or caregiver.

Upon closure of a family service or family preservation case, the POSC shall be provided to the family. The family has the option to continue services and monitoring by community services and resources.