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 an illegal substance.

Notification/Reporting Requirements

Citation: Ann. Stat. § 38-2223

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.

Assessment of the Infant and Family

Citation: Pol. & Proc. Man. § 1650; Appx. 1A; Appx. 2L

When a report is received regarding an infant affected by substance abuse, withdrawal symptoms, or Fetal Alcohol Spectrum Disorder (FASD), Appendix 1A shall be used to guide the initial assessment decision. When criteria are met, the report shall be assigned for further assessment of abuse/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 with positive drug toxicology and criteria is 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.' 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.

FINA assignments are specific family conditions that do not meet criteria to assign for abuse/neglect but are assigned to assess to determine whether services to the child and family are indicated.

The following guide provides factors to guide the assessment for a plan of safe care (POSC):

• The nature and extent of the effects of the prenatal substance use
• The infant's medical condition and any current or ongoing health-care needs or need for frequent monitoring (e.g., medications or specialized equipment)
• The nature and extent of the mother or father's substance abuse
• The extent to which the mother and father are responsive to the infant's needs and bonding with the infant
• History of prenatal care and preparation for the care of the infant
• Extent or history of domestic violence, mental illness, or cognitive limitations
• Extent to which the mother and father are involved with and capable of providing for and meeting the needs of the infant
• The nature and extent of the impact of the substance use on the mother or father's abilities to provide for the safety and well-being of the infant
• The nature and extent of the parents' family and social support system
• History of previous treatment for the mother and father and the response to treatment
• Caregiver protective capacity
• The parents' level of cooperation with any referrals for services, such as substance abuse treatment (if indicated) or assistance or training in the care of a newborn

Responsibility for Development of the Plan of Safe Care

Citation: Pol. & Proc. Man. § 2050

Depending on the circumstances of the case, the POSC shall be completed by 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 and utilizes 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 CAPTA differs from a safety plan that addresses the 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 CPS specialist shall determine whether criteria is 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/is using opioids or other substances during pregnancy and/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

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 identifying the needs of the infant and 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: Pol. & Proc. Man. § 2050

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 Pregnant Woman Using Substances (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 make 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 and family:

• 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
• The physical/social/emotional health, substance use disorder treatment needs of the parent(s)/caregiver(s)
• Services and supports to strengthen the parent/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/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/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.